Fire Hydrant of Freedom
Politics, Religion, Science, Culture and Humanities => Politics & Religion => Topic started by: Crafty_Dog on September 18, 2007, 07:07:13 AM
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Woof All:
There are two health related threads already on the SC&H forum, so I pause before starting a third one here. That said, I do start this thread here because it is obvious that health care is going to be a major theme in the Presidential campaign.
We kick the thread off with Karl Rove :evil:
TAC,
Marc
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Republicans Can Win on Health Care
A market-based system can give us freedom, innovation and health security.
BY KARL ROVE
Tuesday, September 18, 2007 12:01 a.m. EDT
All around America, families are grappling with health-care concerns. They wonder if they'll have insurance at a price they can afford. They worry about how much out-of-pocket health costs take from the family budget. They question if they'll be able to pick their own doctor. Some feel trapped in jobs they don't like out of fear of losing their health insurance.
As the latest government-heavy plan announced by Hillary Clinton yesterday once again shows, the answers politicians offer on health care highlight the deep differences between liberals and conservatives. This is a debate Republicans cannot avoid. But it is one we can win--if we offer a bold plan. Conservatives must put forward reforms aimed at putting the patient in charge. Increasing competition will ensure greater access, lower costs and more innovation.
Liberals see the concerns of families as a failure of private insurance, and want the U.S. to move toward a government-run, single-payer model. This is a recipe for making problems worse. Socialized medicine inevitably leads to poor quality, inefficiency, rising taxes and rationing. The waiting lines and poor care that cause people from other countries to come here for treatment are not the answer.
Government can help poorer and older Americans get quality health care without sacrificing what everyone wants--the ability to choose their own doctor and health coverage that meets their family's particular needs. What reforms will do that?
• Level the tax playing field. People who work for companies get a tax break on the health insurance they get from their employer. Many small business employees, farmers and the self-employed are unable to benefit from the same tax advantage, because they or their employers can't afford health insurance. It's not fair or wise to penalize people who have to pay for health insurance out of their own pockets. They should benefit from the same tax advantage employees from bigger companies get.
The mortgage interest deduction made it easier for people to own a home and all America benefited. Similarly, every worker should get a deduction for health-insurance premiums. This would ease the burden on working families and make it possible for millions more Americans to own health insurance. Some Republicans in Congress support a tax credit rather than a deduction: that's reasonable, too. A deduction or a credit puts patients in charge by helping them get private coverage that meets their needs.
• Tax-free savings for health costs. We are encouraged to save tax-free for retirement and college; we should make it easier to save tax-free for out-of-pocket medical expenses, too. Tax-free savings accounts, paired with low-cost catastrophic health insurance, make coverage affordable for working families. For example, a youth minister told me his Health Savings Account (HSA) gave his family peace of mind because they now had insurance coverage for big emergencies and could save tax-free for everyday health expenses.
That's why, in less than three years, more than 4.5 million families have set up HSAs. Some Democrats want to rein in HSAs because they fear HSAs put the individual--not government--in charge and once someone gets to pick a plan that meets their needs, they won't like being dictated to by government.
And when people see they can save money by eating better, exercising and making healthy lifestyle choices, guess what? They do. I met with workers at Wendy's Headquarters in Ohio who were eagerly taking steps to lead healthier lives because it saved them money.
• Portability. When you change jobs, you don't have to change auto insurance, but you may have to change your health insurance and even your doctor. That's important in a world where young Americans are likely to have 10 jobs before they are age 36. Too many people are locked into jobs they don't like out of fear they'll lose health coverage. The solution is obvious: People should be able to take their health insurance with them when they change jobs.
• Arming consumers through more competition. Rep. John Shadegg (R., Ariz.) argues that people should be able to buy health insurance issued by a company based in another state. Lack of interstate competition helps to explain why the same health policy costs $8,334 in North Dakota but $10,312 in South Dakota. If consumers in South Dakota could buy that North Dakota policy, prices for health insurance would go down.
• Pool risk, lower costs. Large companies get purchasing power and savings because they share risk across large numbers of employees. Sen. Mike Enzi (R., Wyo.) and Rep. Sam Johnson (R., Texas) believe small businesses should be able to join together to pool risk, too. It would mean more competition and lower costs, and more people able to afford coverage.
• Greater transparency.Today, patients rarely know what a procedure will cost or how good a clinic or hospital is, except by reputation and word of mouth. For example, a study of metropolitan hospitals found prices for services varied widely--by as much as 259%--even after controlling for geographic variations in the cost of doing business. Putting information about cost and quality in the hands of patients would lower the cost and improve the quality of health care. Patients making informed choices would create market pressures for lower prices and better care.
• Stop junk lawsuits. I've heard sad stories from doctors and patients. The doctor who had to close her clinic in her hometown and move across the state to work at a hospital that would pay her rising liability insurance premiums. The head trauma specialist afraid that when he retired, his community in one of the poorest regions in the country couldn't attract a replacement. The pregnant woman who drove 80 miles from home in Las Vegas to get prenatal care.
Communities are losing talented health-care professionals who simply can't afford the bigger liability premiums caused by frivolous lawsuits. More than 48% of all counties in the U.S. have no ob-gyn physicians. Hospitals are finding it tougher to provide obstetrics, emergency room care or neurosurgery because of frivolous lawsuits. And doctors, afraid of lawsuits, practice "defensive medicine," ordering unnecessary tests and procedures which add to the cost of health care.
Whose interest does that really serve? If we want richer trial lawyers, let them keep filing junk lawsuits we all pay for. If we want better health care, curb frivolous lawsuits.
• Build on the progress already made by putting patients in charge and letting competition work. When Congress considered prescription drug coverage under Medicare, Democrats tried to have government set prices and deliver the drugs. When the Congressional Budget Office estimated the first year's monthly premium for seniors would be $35, Democrats tried to lock in that price.
Republicans disagreed, arguing competition would lower prices and provide more choices. They were right: Competition led to more options and an average monthly premium of around $23--an annual savings of $144 in the first year. Competition continues to save seniors (and taxpayers) money. When the bill passed, independent actuaries estimated the monthly premium for 2008 would be $41. Recently, Medicare officials announced that the 2008 average monthly premium will be around $25. Seniors would have paid over $4 billion more in prescription drug premiums the first two years of the program had Democrats mandated a $35 monthly premium. Taxpayers are saving also: This past January, the actuaries projected that the prescription drug benefit will cost $113 billion less over the next 10 years than estimated the previous year, primarily because of competition and low bids.
In short, the best health reform proposals will be those that recognize and build on the virtues of our market-based medical system. Sick people around the world come here because they can't get quality care in their home countries. Many health-care professionals come here to practice, leaving behind well-meaning health-care systems where government is in charge, bureaucrats make the decisions, and where the patient doesn't have the choice he or she does in the U.S.
Mrs. Clinton may think Americans want to trade freedom and innovation for the illusory security of government regulation and surrender control of their health decisions to government bureaucrats. My bet is 2008 will teach us something different if Republicans make health care a centerpiece issue.
Mr. Rove recently left the White House, where he was an adviser to President Bush.
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Chattels of the Nanny State
The Democratic battle of health plans has begun in earnest now that Hillary Clinton has promised "universal" coverage. Meeting with Iowans a few weeks ago, John Edwards probably told voters more than they wanted to hear about what it means when government controls your health care: Under his proposed scheme, Americans could be punished for not going to the doctor for preventive care.
Mr. Edwards made clear that a government big enough to give you health care is big enough to take it away. "You have to go in and be checked and make sure that you are OK," he said. For example, women would be required to have regular mammograms or presumably lose their right to coverage.
Mr. Edwards could almost be channeling David Cameron, leader of Britain's opposition Tory party, who recently came up with his own scheme to deny free National Health Service treatment to those who fail to follow a healthy lifestyle. "Heavy smokers, the obese and binge drinkers who were a drain on the NHS could be denied some routine treatments such as hip replacements until they cleaned up their act," reports the London Standard.
Small wonder that Michael Ancram, a former deputy leader of the Conservative Party, has taken Mr. Cameron to task in a manifesto calling for a return to the party's core principles of lower taxation, skepticism about the European Union and tough anti-crime measures. He urged the party leadership to stop "trashing" the legacy of Margaret Thatcher and downplay its trendy embrace of gay unions and draconian economic curbs on carbon emissions.
Would that some brave Democrat might step forward to criticize Mr. Edwards for going further than almost anyone has in the U.S. to link government's provision of health services with the direct policing of personal behavior. In a free health-care market, personal responsibility and healthy habits would be encouraged through lower insurance premiums and other incentives. It's when the government pays the bill and controls the entire system that you can expect the heavy hand of the state to directly control your lifestyle.
-- John Fund
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HillaryCare's New Clothes
Different means but the same political destination.
Wednesday, September 19, 2007 12:01 a.m. EDT
Hillary Clinton has been blasted for months by her Democratic Presidential rivals because, until Monday, she hadn't delivered her formal campaign promises for "universal" health care. But John Edwards and Barack Obama were unfair. She beat them to the punch by at least 13 years.
The former first lady's 1993-94 health-care overhaul ended disastrously. Still, it poured the philosophical and policy foundations of the current health-care debate. As she unveils HillaryCare II, Mrs. Clinton likes to joke that it's "deja vu all over again"--and it is, unfortunately. Her new plan is called "Health Choices" and mentions "choice" so many times that it sounds like a Freudian slip. And sure enough, "choice" for Mrs. Clinton means using different means that will arrive at the same end: an expensive, bureaucratic, government-run system that restricts choice.
Begin with the "individual mandate." The latest fad after Mitt Romney's Massachusetts miracle, it compels everyone to have insurance, either through their employers or the government. Not only would this element of HillaryCare require a huge new enforcement bureaucracy, it is twinned with a "pay or play" tax on businesses that don't, or can't afford to, provide health insurance to their employees.
The plan also creates a new public insurance option, modeled after Medicare, and open to everyone, regardless of income. To keep insurance "affordable," HillaryCare II offers a refundable tax credit that limits cost to a certain percentage of income. Yet the program works at cross-purposes, because coverage mandates always drive up the price of insurance. And if the "pay or play" tax is lower than a company's current health insurance costs, a company will have every incentive to dump its employee plan and pay the tax.
Meanwhile, the private insurance industry would be restructured with far more stringent regulations. Mrs. Clinton would require nationally "guaranteed issue," which means insurers have to offer policies to all applicants. She would also command "community rating," which prohibits premium differences based on health status.
Both of these have raised costs enormously in the states that require them (such as New York), but Mrs. Clinton says they are necessary nationwide to prevent "discrimination" that infringes "on the central purposes of insurance, which is to share risk." Not quite. The central purpose of insurance is to price, and hedge against, reasonably predictable risks. It does not require socializing every last expense and redistributing wealth.
No liberal reform would be complete without repealing the Bush tax cuts of 2001 and 2003; Mrs. Clinton would foot the bill for her plan with this tax increase. The rest of the estimated $110 billion per year in new government spending would be achieved by "modernizing" health-care delivery and "promoting wellness," though this $35 billion in savings is speculative, if not fanciful. Further tax hikes would be required: That $110 billion is a back-of-the-envelope calculation, and Team Hillary is keeping the specifics in its pocket.
Given how poorly "universal" policies fared the last time around, who can blame them? Mrs. Clinton and Ira Magaziner headed a health-care task force with more than 500 members that eventually produced 1,342 numbing pages of proposals. It's hardly surprising this boondoggle died without so much as a Congressional vote.
Yet Mrs. Clinton insisted that the public had been spooked by Rush Limbaugh, an article in a marginal political journal and advertising campaigns such as "Harry and Louise." In other words, the lessons she learned were political, not substantive. She thought she had overreached with too-sweeping changes. So she and her husband began to slice their universal health-care ambitions into smaller initiatives like the 1997 State Children's Health Insurance Program (Schip).
This is her strategy now. HillaryCare II is designed to cause minimal disruptions to current private insurance coverage in the short run, while dressing up the old agenda with slightly different mechanisms and rhetoric. Rather than fight small business, this time she is trying to seduce it with tax credits for small companies that provide insurance. Only later when costs rise will the credits shrink or other taxes rise. To court large manufacturers, like the auto and steel industries, she'll offer another, "temporary" tax credit to subsidize their health-care liabilities. Her plan, in short, is HillaryCare I in better clothes--a transitional platform to shift people to the default option, which is government insurance.
What's striking about all this is how little new thinking there is. Like the other Democratic proposals, HillaryCare II would mark another major government intrusion into health care. It would keep all of the system's current problems, most of them created by government policies, and entrench and expand them. The creativity is all in the political repackaging.
WSJ
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This article from today's NY Slimes could easily have gone in the Media thread as an example of liberal media bias-- witness the repeated efforts to blur the distinction between illegal and legal immigrants. It could also have gone in the immigration thread as an example of the consequences of illegal immigration. And it fits here-- this has all the makings of a political football.
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Immigrants’ Emergency Care Is Limited by U.S. Rule
By SARAH KERSHAW
Published: September 22, 2007
The federal government has told New York State health officials that chemotherapy, which had been covered for illegal immigrants under a government-financed program for emergency medical care, does not qualify for coverage. The decision sets the stage for a battle between the state and federal governments over how medical emergencies are defined.
The change comes amid a fierce national debate on providing medical care to immigrants, with New York State officials and critics saying this latest move is one more indication of the Bush administration’s efforts to exclude the uninsured from public health services.
State officials in New York and other states have found themselves caught in the middle. The New York dispute, focusing on illegal immigrants with cancer — a marginal group of unknown size among the more than 500,000 people living in New York illegally — has become a flash point for health officials and advocates for immigrants in recent weeks.
Under a limited provision of Medicaid, the national health program for the poor, the federal government permits emergency coverage for illegal immigrants and other noncitizens. But the Bush administration has been more closely scrutinizing and increasingly denying state claims for federal payment for some emergency services, Medicaid experts said.
Last month, federal officials, concluding an audit that began in 2004 and was not challenged by the state until now, told New York State that they would no longer provide matching funds for chemotherapy under the emergency program. Yesterday, state officials sent a letter to the federal Medicaid agency protesting the change, saying that doctors, not the federal government, should determine when chemotherapy is needed.
Federal health officials declined to discuss chemotherapy or the New York claims. But Dennis Smith, director of the Center for Medicaid and State Operations at the federal Centers for Medicare and Medicaid Services, said in a statement, “Longstanding interpretations by the agency have been that emergency Medicaid benefits are to cover emergencies.”
The federal statute that defines an emergency under Medicaid makes it clear that routine care for illegal immigrants and nonresidents, including foreign students and visitors, is not covered. But the only procedures it specifically excludes from reimbursement are organ transplants, leaving to the states the task of further defining an emergency. States and courts have grappled with the question for years, yielding no clear definition.
Some states have maintained that any time a patient is able to schedule an appointment — as opposed to showing up at an emergency room — the condition would not be considered an emergency. Others, including New York, have defined an emergency as any condition that could become an emergency or lead to death without treatment.
“There are clearly situations that we consider emergencies where we need to give people chemotherapy,” Richard F. Daines, the New York State health commissioner, said in an interview late yesterday. “To say they don’t qualify is self-defeating in that those situations will eventually become emergencies.”
Dr. Daines said that for every effort in the state to use Medicaid “creatively” to cover the uninsured, “the Bush administration, at every chance, is pushing it back.”
The state estimated that the federal government denied $60 million in matching funds for emergency Medicaid from 2001 to 2006, including $11.1 million for chemotherapy. Medicaid costs are typically split evenly between the state and the federal government.
It is unclear how many other states are providing chemotherapy to illegal immigrants, because all emergency services are generally lumped together in state Medicaid reports. But others have also been challenged on emergency Medicaid claims.
In Washington State, where illegal immigrants are entitled to Medicaid coverage for a month or more after treatment in an emergency, officials said a federal audit of their emergency Medicaid claims was under way, and the state has asked the federal government to provide a definition of emergency services.
“The awkward position state Medicaid programs are in is trying to figure out what kinds of medical care should be available for emergency conditions,” said Douglas Porter, assistant secretary for the Washington Health and Recovery Services Administration.
Washington and other states have also fought the federal government over Medicaid for infants born to illegal immigrants, an issue reflected in the ferocious debate over the national children’s health insurance program.
In the wake of stricter federal rules, New York, New Jersey, Connecticut and 20 other states have extended full Medicaid coverage, using only state money, to some immigrants who do not qualify for federal aid. Under federal law, proof of citizenship is required for full Medicaid coverage, but not for emergency coverage.
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(Page 2 of 2)
But some states with growing immigrant populations, like Georgia and Arizona, have themselves moved to limit coverage under emergency Medicaid, leading to intense opposition from immigrant health advocates.
Advocates for breast cancer patients said they were particularly concerned about the denial of coverage after lobbying the federal government for years to provide breast cancer screening to uninsured women. Under a program offered to underinsured and uninsured women, the Centers for Disease Control and Prevention provides free or low-cost screening.
“To allow women to be diagnosed with breast cancer and then create an obstacle for them to get treatment is a horrendous policy,” said Donna Lawrence, executive director of Susan G. Komen for the Cure in New York.
In New York City, cancer kills 15,000 residents a year. It is the second leading cause of death among both the native- and the foreign-born, according to a 2006 survey by the city’s health department, with lung, breast and colon cancer the top killers.
The state had initially accepted the federal finding that New York was not entitled to federal reimbursement for chemotherapy under the emergency Medicaid program. But until last month, state health officials had not informed medical providers that the treatment would no longer be covered by either state or federal funds.
That provoked a pitched outcry from immigrant health advocates over the last few weeks, and state health officials reversed their position this week, saying Medicaid should cover the treatment.
State officials said they were challenging the federal decision on the grounds that chemotherapy treatment qualifies as an emergency under the federal government’s own rules. Certain conditions, including diseases of the brain, spinal cord and bone marrow disease, could require immediate chemotherapy.
The state’s letter also said that chemotherapy can be used to “cure cancer, control cancer and/or ease cancer symptoms,” and that if that the measures typically used to treat cancer were not available to patients, their health could be in serious jeopardy — one of the federal criteria in determining an emergency.
The cost of emergency Medicaid is still a relatively small portion of state Medicaid budgets, experts said, and a majority of the money is spent on care for pregnant women, labor and delivery. But the demand for it rising quickly as the immigrant population balloons.
Health advocates say that many illegal immigrants who need and qualify for emergency care are afraid to seek help, and that emergency Medicaid is underused.
A recent study of emergency Medicaid services in North Carolina found that spending, largely devoted to pregnant women, increased by 28 percent from 2001 to 2004; still, the emergency costs accounted for less than 1 percent of total Medicaid expenditures.
New York City public hospitals, which serve 400,000 uninsured patients a year, among them illegal immigrants, would continue to provide the cancer treatment no matter what, said officials from the Health and Hospitals Corporation. But if there is no reimbursement from Medicaid, they said, they will have to look elsewhere for financial support.
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HillaryCare Flops in California
By JOHN FUND
September 22, 2007
SACRAMENTO, Calif. -- Hillary Clinton is patting herself on the back for proposing a health-care plan that is much more politically astute than her 1993 Rube Goldberg effort. She told an audience in New York this week: "I think I have successfully thought through all of the objections and pre-empted them."
She may want to think again. Last January, California Gov. Arnold Schwarzenegger proposed an eerily similar plan using the same rhetoric and even the same slogan adopted by Mrs. Clinton to describe hers: "Shared Responsibility."
That's no coincidence. Both ArnoldCare and HillaryCare 2.0 are the product of the same advisers. But despite all of its clever political compromises, ArnoldCare is bogged down in trench warfare in California's liberal Democratic legislature. If anything passes, it will likely be only a shell of a bill without any financing component. Legislators will hope voters approve a general tax increase to pay for it in November 2008.
The two plans have many features in common. ArnoldCare's $12 billion-a-year price tag represents about a 10th of Mrs. Clinton's estimate for the costs of her plan, roughly in line with California's share of the national economy. Both include mandates to buy health insurance, a ban on premium differences based on health status, Medicaid expansion, and a requirement that insurers have to offer policies to all applicants.
All of this is the brainchild of Laurie Rubiner, who directed health-care issues at the liberal New America Foundation until she left in 2005 to become Mrs. Clinton's Senate legislative director. She was replaced by Len Nichols, who in 1993 served as the liaison between President Bill Clinton's budget office and Mrs. Clinton's health-care task force. Ms. Rubiner isn't taking direct credit for selling Mr. Schwarzenegger on her plan, but aides to the governor confirm her role. Steve Clemons of the New America Foundation acknowledges that Ms. Rubiner "incubated and hatched" the ideas at the heart of the governor's plan. Ms. Rubiner declined to respond to a request for an interview.
Given the similarities, here are some political lessons that ArnoldCare might teach us about how Mrs. Clinton's plan might be received:
• The claim that no new bureaucracies are created will be challenged. Like Gov. Schwarzenegger, Mrs. Clinton envisions requiring everyone to prove they have health insurance. But she's vague on the details: "At this point, we don't have anything punitive that we have proposed." You can bet she will have some ideas.
Even so, making certain people have insurance is easier said than done. California has had a law mandating that drivers have car insurance since 1970 and has required physical proof of insurance to register a car for a decade. Even so, the Insurance Research Council says 25% of the state's drivers remain uninsured.
• Illegal aliens and their access to health insurance will be controversial. Mrs. Clinton promises health care for all, but is punting on the issue of whether the illegal aliens who often use emergency room services will be covered. Ms. Rubiner admits it's a "huge issue," but says "that's one we're going to have to think through a little bit."
Criticism of the governor's plans to cover illegal aliens forced him to drop the idea, but this week he fumed at those who raise such "Mickey Mouse"-type concerns. Mrs. Clinton's plan could be caught between populist forces opposing health care for illegal aliens and liberals who will insist on it.
• Hoping for bipartisan support isn't the same thing as getting it. Gov. Schwarzenegger sincerely believed he could convince Republicans to support his plan. In the end, he couldn't find anyone from either party to push his plan in the legislature. It was too tax-heavy for Republicans (his effort to call proposed tax hikes "loans" flopped) and not nearly interventionist enough for Democrats.
"The governor got significant parts of the business community to sign on, from Safeway to the Los Angeles Chamber of Commerce," one adviser to the governor told me. "But that didn't move the anti-tax Republican base."
• Nothing big passes Congress these days without bipartisan support. "The lesson from California is just how difficult it is to deal with so many players that have such disparate demands," says Dan Walters, a columnist for the Sacramento Bee. "The governor's original plan had the doctors opposing the fees it imposed on them and the nurses' union upset because it wasn't single-payer. Having all the first responders who dress in white opposing your plan isn't politically healthy."
Sen. Clinton claims she now realizes she'll need actual votes to pass something. But traces of the old Hillary remain. "I wish it were possible to just wave a magic wand and say from the White House, 'Here's what I want.' But that's not the way it works," she told the Associated Press.
The real test may be her willingness to accept some market-oriented GOP proposals such as tax-free savings accounts for health care and a curb on frivolous liability lawsuits as the price for the bipartisan support she now claims to want. Now that really would be a New Hillary.
Mr. Fund is a columnist for OpinionJournal.com.
WSJ
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September 23, 2007, 0:00 a.m.
Tough Days for Freedom
The heart of the matter.
By Mark Steyn
Our theme for today comes from George W Bush: “Freedom is the desire of every human heart.”
When the president uses the phrase, he’s invariably applying it to various benighted parts of the Muslim world. There would seem to be quite a bit of evidence to suggest that freedom is not the principal desire of every human heart in, say, Gaza or Waziristan. But why start there? If you look in, say, Brussels or London or New Orleans, do you come away with the overwhelming impression that “freedom is the desire of every human heart”? A year ago, I wrote that “the story of the western world since 1945 is that, invited to choose between freedom and government ‘security,' large numbers of people vote to dump freedom — the freedom to make your own decisions about health care, education, property rights, seat belts and a ton of other stuff.”
This week freedom took another hit. Hillary Rodham Clinton unveiled her new health-care plan. Unlike her old health-care plan, which took longer to read than most cancers do to kill you, this one’s instant and painless — just a spoonful of government sugar to help the medicine go down. From now on, everyone in America will have to have health insurance.
Hooray!
And, if you don’t, it will be illegal for you to hold a job.
Er, hang on, where’s that in the constitution? It’s perfectly fine to employ legions of the undocumented from Mexico, but if you employ a fit 26-year-old American with no health insurance either you or he or both of you will be breaking the law?
That’s a major surrender of freedom from the citizen to the state. “So what?” say the caring crowd. “We’ve got to do something about those 40 million uninsured! Whoops, I mean 45 million uninsured. Maybe 50 by now.” This figure is always spoken of as if it’s a club you can join but never leave: The very first Uninsured-American was ol’ Bud who came back from the Spanish-American War and found he was uninsured and so was first on the list, and then Mabel put her back out doing the Black Bottom at a tea dance in 1926 and she became the second, and so on and so forth, until things really began to snowball under the Bush junta. And, by the time you read this, the number of uninsured may be up to 75 million.
Nobody really knows how many “uninsured” there are: Two different Census Bureau surveys conducted in the same year identify the number of uninsured as (a) 45 million or (b) 19 million. The (a) figure is the one you hear about, the (b) figure apparently entered the Witness Protection Program. Of those 45 million “uninsured Americans”, the Census Bureau itself says over nine million aren’t Americans at all, but foreign nationals. They have various health-care back-ups: If you’re an uninsured Canadian in Detroit and you get an expensive chronic disease, you can go over the border to Windsor, Ontario, and re-embrace the delights of socialized health care; if you’re an uninsured Uzbek, it might be more complicated. Of the remaining 36 million, a 2005 Actuarial Research analysis for the Department of Health and Human Services says that another nine million did, in fact, have health coverage through Medicare.
Where are we now? 27 million? So who are they? Bud and Mabel and a vast mountain of emaciated husks of twisted limbs and shriveled skin covered in boils and pustules? No, it’s a rotating population: People who had health insurance but changed jobs, people who are between jobs, young guys who feel they’re fit and healthy and at this stage of their lives would rather put a monthly health tab towards buying a home or starting a business or blowing it on booze ‘n’ chicks.
That last category is the one to watch: Americans between the ages of 18 and 34 account for 18 million of the army of the “uninsured.” Look, there’s a 22-year old and he doesn’t have health insurance! Oh, the horror and the shame! What an indictment of America!
Well, he doesn’t have life insurance, either, or homeowner’s insurance. He lives a life blessedly free of the tedious bet-hedging paperwork of middle-age. He’s 22 and he thinks he’s immortal — and any day now Hillary will propose garnisheeing his wages for her new affordable mandatory life-insurance plan.
So, out of 45 million uninsured Americans, nine million aren’t American, nine million are insured, 18 million are young and healthy. And the rest of these poor helpless waifs trapped in Uninsured Hell waiting for Hillary to rescue them are, in fact, wealthier than the general population. According to the Census Bureau’s August 2006 report on “Income, Poverty and Health Insurance Coverage,” 37 percent of those without health insurance — that’s 17 million people — come from households earning more than $50,000. Nineteen percent — 8.7 million people — of those downtrodden paupers crushed by the brutal inequities of capitalism come from households earning more than $75,000.
In other words, if they fall off the roof, they can write a check. Indeed, the so-called “explosion” of the uninsured has been driven almost entirely by wealthy households opting out of health insurance. In the decade after 1995 — i.e., since the last round of coercive health reform — the proportion of the uninsured earning less than 25,000 has fallen by 20% and the proportion earning more than 75 grand has increased by 155%. The story of the last decade is that the poor are getting sucked into the maw of “coverage” and the rich are fleeing it. And, given that the cost of health “insurance” bears increasingly little relationship to either the cost of treatment or the actuarial reality of you ever getting any particular illness, it’s entirely rational to say: “You know what? I’ll worry about that when it happens. In the meantime, I want to start a business and send my kid to school.” Freedom is the desire of my human heart even if my arteries get all clogged and hardened.
I was glad, at the end of Hillary Health Week, to see that my radio pal Laura Ingraham’s excellent new book Power To The People has shot into the New York Times Bestseller List at Number One. It takes a fraudulent leftist catchphrase (the only thing you can guarantee about a “people’s republic” is that the people are the least of it) and returns it to those who mean it - to those who believe in a nation of free citizens exercising individual liberty to make responsible choices.
Do you remember the so-called “government surplus” of a few years ago? Bill Clinton gave a speech in which he said, yes, sure, he could return the money to taxpayers but that we “might not spend it the right way”. The American political class has decided that they know better than you the “right way” to make health-care decisions. Oh, don’t worry, you’re still fully competent to make decisions on what car you drive and what movie you want to rent at Blockbusters. For the moment. But when it comes to the grown-up stuff best to leave that to Nurse Hillary.
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“[T]he so-called ‘explosion’ of the uninsured has been driven entirely by wealthy households opting out of health insurance. In the decade after 1995—i.e., since the last round of coercive health reform—the proportion of the uninsured earning less than $25,000 has fallen by 20 percent, and the proportion earning more than 75 grand has increased by 155 percent. The story of the past decade is that the poor are getting sucked into the maw of ‘coverage,’ and the rich are fleeing it. And, given that the cost of health ‘insurance’ bears increasingly little relationship to either the cost of treatment or the actuarial reality of you ever getting any particular illness, it’s entirely rational to say: ‘You know what? I’ll worry about that when it happens. In the meantime, I want to start a business and send my kid to school.’ Freedom is the desire of my human heart even if my arteries get all clogged and hardened.” —Mark Steyn
GOVERNMENT
“Governments are not empowered to grant rights; governments can only limit, or extinguish rights. Governments can, however, bestow gifts upon its citizens. But in order to do so, governments must first take resources from those who have earned them, and redistribute those resources to others. Hillary-care, Obama-care, Edwards-care, and every other form of socialized medicine, is inherently fraught with fraud, abuse, and corruption... If the federal government is to be involved in health care, it should be looking toward encouraging, and providing incentives for private medical care that is determined between the patient and provider. The problem is complex, and cannot be solved by any government program. Health care is certainly one of the primary areas where the principles of freedom should be observed and advanced. Any candidate, or politician, who thinks government can solve the problem better than a free market, should be rejected.” —Henry Lamb
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Here is a nice one from Mister Bush :roll:
Bush vetoes child health insurance plan
President, Congress battle over $30 billion coverage difference
WASHINGTON - President Bush, in a sharp confrontation with Congress, on Wednesday vetoed a bipartisan bill that would have dramatically expanded children's health insurance.
It was only the fourth veto of Bush's presidency, and one that some Republicans feared could carry steep risks for their party in next year's elections. The Senate approved the bill with enough votes to override the veto, but the margin in the House fell short of the required number.
Senate Majority Leader Harry Reid, D-Nev., decried Bush's action as a "heartless veto."
"Never has it been clearer how detached President Bush is from the priorities of the American people," Reid said in a statement. "By vetoing a bipartisan bill to renew the successful Children's Health Insurance Program, President Bush is denying health care to millions of low-income kids in America. "
The White House sought little attention, with Bush casting his veto behind closed doors without any fanfare or news coverage. He was discussing it later Wednesday during a budget speech in Lancaster, Pa.
Socialized medicine?
The State Children's Health Insurance Program is a joint state-federal effort that subsidizes health coverage for 6.6 million people, mostly children, from families that earn too much to qualify for Medicaid but not enough to afford their own private coverage.
The Democrats who control Congress, with significant support from Republicans, passed the legislation to add $35 billion over five years to allow an additional 4 million children into the program. It would be funded by raising the federal cigarette tax by 61 cents to $1 per pack.
The president had promised to veto it, saying the Democratic bill was too costly, took the program too far from its original intent of helping the poor, and would entice people now covered in the private sector to switch to government coverage. He wants only a $5 billion increase in funding.
Bush argued that the congressional plan would be a move toward socialized medicine by expanding the program to higher-income families.
Democrats deny that, saying their goal is to cover more of the millions of uninsured children and noting that the bill provides financial incentives for states to cover their lowest-income children first. Of the over 43 million people nationwide who lack health insurance, over 6 million are under 18 years old. That's over 9 percent of all children.
Veto override considerations
Eighteen Republicans joined Democrats in the Senate, enough to override Bush's veto. But this was not the case in the House, where despite sizable Republican support, supporters of the bill are about two dozen votes short of a successful override.
House Majority Leader Steny Hoyer, D-Md., said Democrats were imploring 15 House Republicans to switch positions but had received no agreements so far.
House Minority Whip Roy Blunt, R-Mo., said he was "absolutely confident" that the House would be able to sustain Bush's expected veto.
Senate Minority Whip Trent Lott, R-Miss., said Congress should be able to reach a compromise with Bush once he vetoes the bill. "We should not allow it to be expanded to higher and higher income levels, and to adults. This is about poor children," he said. "But we can work it out."
It took Bush six years to veto his first bill, when he blocked expanded federal research using embryonic stem cells last summer. In May, he vetoed a spending bill that would have required troop withdrawals from Iraq. In June, he vetoed another bill to ease restraints on federally funded stem cell research.
Bush's letter to Congress on insurance bill veto
War between the states over health insurance
In veto math, the magic number is 146
Bush veto: A blessing or curse for Republicans?
New York Times Politics
In the case of the health insurance program, the veto is a bit of a high-stakes gambit for Bush, pitting him against both the Democrats who have controlled both houses of Congress since January, but also many members of his own party and the public.
The Democratic Congressional Campaign Committee launched radio ads Monday attacking eight GOP House members who voted against the bill and face potentially tough re-election campaigns next year.
And Gerald McEntee, president of the American Federation of State, County and Municipal Employees union, said a coalition of liberal groups planned more than 200 events throughout the nation to highlight the issue.
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I support President Bush's veto.
We need to read beyond the title of the bill. It was not about "supporting poor children"-- it expanded coverage FAR beyond that. This bill was simply another shot fired in the Democrats attack on the remaining vestiges of the private sector in our health care.
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The problem is that as far as I am aware P. Bush veto's anything that comes to Poor children or Poor folk's in general. I don't think in the past 8 year's he has shown that much Concern for the well being of the poor. Maybe I am wrong here in the fact that he has gone out of his way to better the lives of poor Americans and if he has then I must be reading the wrong report's and watching the wrong poll's
Either way a Pres. must be aware that his first duty is the duty to his people..Health, Education and Protection and none of these seem to be on any Politicans mind lol!
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"Bush veto's (sic) anything that comes to Poor children or Poor folk's (sic) in general."
This simply is factually wrong. This is only the second veto of Bush's presidency. Please forgive my bluntness, but the rest of your post is mostly at variance with the facts as well. Spending under Bush has gone up massively across the board-- including to "the poor". This is not to say he doesn't have especially soft places in his heart for certain corporate interests, but the mob has been feeding at the public trough with little restraint during his presidency.
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Like I said, I could be wrong but I just go off of what I read and why his rating's are at record low's and even how he is not very popular in his own Party because of the choices he makes. Be it War choices, Public choices or whatever choices the man makes they don't always seem to be the best ideas on where to put money.
I am neither a Republican nor a Democrate..I have never voted the party and only the issue , so my views are never based off I am a democrate and I must hate republican's or the other way around.
And what about Bush Housing Plan did that ever go though?
And ya..I voted for CONAN errr Arnold. :mrgreen:
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As noted in the Media thread, much of what we are given to read is not honest-- due diligence is a must! Bush's popularity and lack thereof has much to do with Iraq-- and worth noting is that Congress's ratings are distinctly worse than his!!!
Here's this:
Schip Hits the Fan
The crocodile outrage flowed fast and deep yesterday after President Bush's promised veto of the Schip bill that would have vastly expanded a federal subsidy for children's health care.
Ted Kennedy called it "the most inexplicable veto in the history of the country." Barack Obama decried a "callousness of priorities." Nancy Pelosi flirted with the edges of self-parody, saying: "President Bush used his cruel veto pen to say 'I forbid 10 million children from getting the health benefits they deserve.'"
Of course, the veto will not actually deprive any current enrollees (10% of whom are adults) of medical care. President Bush made sure of that when he signed a continuing resolution funding the program until an accommodation is reached. Count on this fact remaining little noticed amid the current political circus.
Democrats believe they have a strong shot at overriding the veto, but will wait a week or two to continue milking the controversy and to solidify a campaign issue for 2008. Of the eight House Democrats who opposed the expansion and three others who didn't vote, the leadership has already rolled five of them. That means at least 14 Republicans need to turn over as well, out of 151 in the opposition.
To that end, lobbying groups including Families USA, MoveOn.org, AARP, SEIU and AFSCME, as well as the Democratic Party, are mounting an advertising campaign targeting vulnerable Republicans, mainly in swing districts. No doubt we'll see more of the same end-of-days hysteria.
Harry Reid in particular has been trying to shame Republicans by name, singling out Rep. Roscoe Bartlett of Maryland, the only member of his delegation to vote nay. In response, Mr. Bartlett thanked Mr. Reid "for recognizing that I cast the only correct vote about Schip in the state of Maryland.... Democrats are demanding that Schip be expanded to have government-controlled, taxpayer-paid health care for millions of children who already have private health coverage."
In a soundbite, Mr. Bartlett has exactly described what the battle is all about.
Political Journal WSJ
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Health Care Needs an Internet Revolution
By BILL GATES
October 5, 2007; Page A17
We live in an era that has seen our knowledge of medical science and treatment expand at a speed that is without precedent in human history. Today we can cure illnesses that used to be untreatable and prevent diseases that once seemed inevitable. We expect to live longer and remain active and productive as we get older. Ongoing progress in genetics and our understanding of the human genome puts us on the cusp of even more dramatic advances in the years ahead.
But for all the progress we've made, our system for delivering medical care is clearly in crisis. According to a groundbreaking 1999 report on health-care quality published by the Institute of Medicine (the medical arm of the National Academy of Sciences) as many as 98,000 Americans die every year as a result of preventable medical errors. That number makes the health-care system itself the fifth-leading cause of death in this country.
Beyond the high cost in human life, we pay a steep financial price for the inability of our health-care system to deliver consistent, high-quality care. Study after study has documented the billions of dollars spent each year on redundant tests, and the prolonged illnesses and avoidable injuries that result from medical errors. The impact ripples through our society, limiting our ability to provide health care to everyone who needs it and threatening the competitiveness of U.S. businesses, which now spend an average of $8,000 annually on health care for employees.
At the heart of the problem is the fragmented nature of the way health information is created and collected. Few industries are as information-dependent and data-rich as health care. Every visit to a doctor, every test, measurement, and procedure generates more information. But every clinic, hospital department, and doctor's office has its own systems for storing it. Today, most of those systems don't talk to each other.
Isolated, disconnected systems make it impossible for your doctor to assemble a complete picture of your health and make fully informed treatment decisions. It also means that the mountain of potentially lifesaving medical information that our health-care system generates is significantly underutilized. Because providers and researchers can't share information easily, our ability to ensure that care is based on the best available scientific knowledge is sharply limited.
There is widespread awareness that we need to address the information problem. In 2001, the Institute of Medicine issued a follow-up report on health-care quality that urged swifter adoption of information technology and greater reliance on evidence-based medicine. In his 2006 State of the Union address, President Bush called on the medical system to "make wider use of electronic records and other health information technology."
But increased digitization of health-care information alone will not solve the problems we face. Already, nearly all procedures, test results and prescriptions are recorded in digital form -- that's how health-care providers transmit information to health insurers so they can be paid for their work. But patients never see this data, and doctors are unable to share it. Instead, individuals do their best to piece together the information that they think their caregivers might need about their medical history, the medications they take and the tests they've undergone.
What we need is to place people at the very center of the health-care system and put them in control of all of their health information. Developing the solutions to help make this possible is an important priority for Microsoft. We envision a comprehensive, Internet-based system that enables health-care providers to automatically deliver personal health data to each patient in a form they can understand and use. We also believe that people should have control over who they share this information with. This will help ensure that their privacy is protected and their care providers have everything they need to make fully-informed diagnoses and treatment decisions.
I believe that an Internet-based health-care network like this will have a dramatic impact. It will undoubtedly improve the quality of medical care and lower costs by encouraging the use of evidence-based medicine, reducing medical errors and eliminating redundant medical tests. But it will also pave the way toward a more important transformation.
Today, our health-care system encourages medical professionals to focus on treating conditions after they occur -- on curing illness and managing disease. By giving us comprehensive access to our personal medical information, digital technology can make us all agents for change, capable of pushing for the one thing that we all really care about: a medical system that focuses on our lifelong health and prioritizes prevention as much as it does treatment. Putting people at the center of health care means we will have the information we need to make intelligent choices that will allow us to lead healthy lives -- and to search out providers who offer care that does as much to help us stay well as it does to help us get better.
The technology exists today to make this system a reality. For the last 30 years, computers and software have helped industry after industry eliminate errors and inefficiencies and achieve new levels of productivity and success. Many of the same concepts and approaches that have transformed the world of business -- the digitization of information, the creation of systems and processes that streamline and automate the flow of data, the widespread adoption of tools that enable individuals to access information and take action -- can be adapted to the particular requirements of health care.
No one company can -- or should -- hope to provide the single solution to make all of this possible. That's why Microsoft is working with a wide range of software and hardware companies, as well as with physicians, hospitals, government organizations, patient advocacy groups and consumers to ensure that, together, we can address critical issues like privacy, security and integration with existing applications.
Technology is not a cure-all for the issues that plague the health-care system. But it can be a powerful catalyst for change, here in the U.S. and in countries around the globe where access to medical professionals is limited and where better availability of health-care information could help improve the lives of millions of people.
Mr. Gates is chairman of the Microsoft Corporation.
WSJ
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John Stossel: 20/20 Sick In America
part1 http://www.youtube.com/watch?v=aEXFUbSbg1I&mode=related&search=
part2 http://www.youtube.com/watch?v=BpsEAVbCkMM&mode=related&search=
part3 http://www.youtube.com/watch?v=refrYKq9tZQ&mode=related&search=
part4 http://www.youtube.com/watch?v=QzhiG0dcwN8&mode=related&search=
part5 http://www.youtube.com/watch?v=Xsp_Jh5EIT0&mode=related&search=
part6 http://www.youtube.com/watch?v=E_KCLm9cekU&mode=related&search=
profits drive accountability. accountability improves service. Improving service increases customer satisfaction.
when a government apparatus is put in place without viable free market alternatives, there is no incentive to improve services and satisfy customers. Case in point: America's public schools:
http://www.youtube.com/watch?v=pfRUMmTs0ZA
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The NHS wins when its patients die
By Charles Moore
Last Updated: 12:01am BST 13/10/2007
Have your say Read comments
Florence Nightingale's famous Notes on Nursing, published in 1859, state that "the greater part of nursing consists in cleanliness". In my edition, the foreword points out that much of Miss Nightingale's writing, excellent though it is, is now out of date. In particular, the need for cleanliness is well understood. That foreword was written in 1946.
Now it is 2007, and we learn that nurses in the hospitals run by the Maidstone and Tunbridge Wells NHS Trust told patients suffering from diarrhoea to "go in their beds". Between 2004 and 2006, 90 patients treated in those hospitals died from Clostridium difficile, and the disease was a factor in the death of a further 241.
Were it not for bad nursing, bad medical attention and bad administration, none of these patients need have died. Indeed, they would not have contracted C. difficile at all unless they had gone into hospital. So, after 150 years' advance of education, technology, prosperity and science, we have lost what Florence Nightingale taught.
It was the distressing subject of diarrhoea, indeed, that provoked Miss Nightingale to one of her most trenchant footnotes. She gave the example of how, if a bedpan with a lid were changed only once a day ("As well might you have a sewer under the room"), by a maid rather than a nurse, the problem might go undetected. he bedpan must be changed frequently, inspected, and all of it, including its lid, properly cleaned.
I notice that the Healthcare Commission's report on Maidstone says that stool charts, i.e. recorded inspections of the diarrhoea, were made in fewer than 15 per cent of cases.
Florence Nightingale adds: "If a nurse declines to do these kinds of things for her patient, 'because it is not her business', I should say that nursing is not her calling." It is a "waste of power", she says, for nurses to do things such as scouring floors, but if it needs doing, they must do it: "the true nurse-calling" puts "the good of their sick first, and second only the consideration what is their 'place'?".
The testimony of the families from the Maidstone area is that their relations who died were often humiliated, left in filth, and ignored. The weakest — the old — were treated the worst. It was a failure of systems, yes, but also of individual professionals and of common humanity.
Every year, as a journalist, I go to party conferences and hear politicians of all parties make speeches about how wonderful the National Health Service is. Gordon Brown got all weepy this year about how it saved one of his eyes.
Last year, David Cameron said that where Tony Blair had spoken of three words — "Education, education, education" — he would emphasise three letters — "N-H-S".
The point our leaders are constantly making is not medical, but moral. It is that the NHS embodies organised altruism. It proves that we, as a nation, care for one another. It makes us "the envy of the world", and it makes us good.
One naturally wants to agree. We all like to think that matters of life and death are well looked after. And most of us will have direct experience of NHS nurses and doctors who have treated us with great kindness, care and skill.
Nevertheless, the basic proposition is not true. The National Health Service is not, morally, or in any other way, the best system of healthcare in the world. Indeed, it is morally defective at its very root, because it does not — cannot — put the sick first. Until this is recognised, it cannot be reformed.
The NHS is, with our state school system, the last major survival in this country of the idea of the 1940s that government can decide what is best for us and make sure that it is done. Aneurin Bevan, who invented the thing, once said that not a bed-pan (that object again) should fall to the ground without the minister knowing about it.
A colleague of mine, who investigated alternative healthcare systems when the extreme dirtiness of many British hospitals first became an issue, went to France to compare. In hospital after hospital, he found floors so clean that you could have eaten your lunch off them. Did the Health Minister order them to clean them, he asked an administrator.
He was met with a look of incredulity. "Of course not. We run ourselves. Patients have a choice of hospital. If they do not choose us, we get no money. No hospital can survive if it is not clean."
Two weeks ago in Bournemouth, Gordon Brown was on to the subject of C. difficile, babbling about ordering "deep clean" and more than doubling the number of hospital matrons to 5,000.
"Bring back matron" has become a party conference cry, like "Bring back the rope" used to be. But matron will be only a name so long as Mr Brown (or whoever is Prime Minister) ultimately decides who should have what where.
We all know that a Minister for Industry could not possibly decide how many computers we produce or how many investment banks we should have. We all know that a Minister for Food could not wisely decree what vegetables should be sold in which shops.
But we cling to the idea that a single organisation employing 1.4 million people, with the GDP of an entire Scandinavian country, run by politicians, can meet our health needs.
Suppose Sainsbury's cold meat counter was found to have helped kill more than 300 people, would the company survive? Yet the NHS sails on, dealing death. According to a report four years ago by Professor Karol Sikora, we could save 10,000 deaths a year from cancer, just by hitting the European average; but we don't, and nobody takes the blame.
The boyfriend of the chief executive of the death-dealing Maidstone trust tells the press: "No way is she going to talk to you. Why should she?" The trust has arranged her severance pay of £250,000.
We all complain about the "target culture" that made administrators in Maidstone ignore actual human suffering before their eyes. But if you have a top-down system of healthcare, targets are the inevitable response to whatever is the latest disaster.
In this case, one of the targets was to cut waiting times in Accident and Emergency to four hours (four hours! You wouldn't put up with that to buy a cinema ticket, yet we have been brainwashed into thinking that it's not too bad for your child with a broken arm). In this world without choice, each claim of need jostles against another: either faster A&E, or cleaner bed-pans, but not both.
This is all, morally, wrong. It turns the patient from being the entity for which the service exists into a nuisance. Each new patient is just an added cost and each dead patient is an administrative convenience.
Under systems of social insurance, such as exist in Germany, Belgium or France, many problems remain, but this most basic one disappears. Money goes with each patient, who can choose who treats him. Therefore every doctor, hospital and nurse wants patients.
Our system also turns the nurse and doctor away from their duty, and therefore attacks their moral sense. It tells them to ignore "the habit of observation", which, said Florence Nightingale, was the key skill of nursing, in favour of through-put or targets or — for human nature reasserts its worse side when badly led — sneaking off home exhausted and disillusioned.
The NHS is run from top to bottom, and therefore, from top to bottom, it is bad.
http://www.telegraph.co.uk/opinion/main.jhtml;jsessionid=5BRUDBCNSKWZ5QFIQMGCFFOAVCBQUIV0?xml=/opinion/2007/10/13/do1302.xml
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The Health Cost Myth
By JOHN R. GRAHAM
November 13, 2007; Page A25
'As major employers, we are engaging in one of the most crucial domestic policy debates of our time -- fixing our nation's health-care crisis, reducing out of control costs, and ensuring every American has affordable health care," said CEO Steve Burd of Safeway, a supermarket chain, earlier this year.
He's not alone. Several American business leaders have come to believe that the American health-care system is not only bad for our health but also for national competitiveness. In the automotive industry, General Motors claims that it spends about $1,600 per car on health care. In Japan, according to GM, Toyota's per automobile healthcare expenditure is just $110.
Some politicians and executives have concluded that the "solution" to this problem is universal, government-run health care. They must be onto something, right?
Health coverage is indeed becoming more expensive for businesses. Over the past eight years, the percentage of firms offering health benefits to employees has dropped significantly, to 60% from 69%.
This decline, however, is almost completely accounted for by businesses with fewer than 10 employees.
These firms find health benefits unaffordable because states have laid a massive burden of over-regulation on small-group health insurance since the early 1990s, making it increasingly expensive. In the face of this, the freedom to contract employment without health benefits provides a valuable option for American entrepreneurs and workers. Only in the U.S. can they opt out of the government-regulated health "system," if it allows them to be more competitive.
But what about the share of Gross Domestic Product (GDP) spent on health care, a metric of health system performance and value that some consider definitive? The United States leads the pack in this regard, spending far more on health than other countries. Surely this puts the U.S. at a competitive disadvantage, doesn't it?
No: It's the other way around. America's high productivity gives us the ability to spend more on health care, especially the latest treatments and technologies, than other developed nations that labor under forms of socialized health care.
Robert L. Ohsfeldt and John R. Schneider of the American Enterprise Institute have determined that health spending increases at a constant rate of about 8% for every $1,000 increase in GDP per capita. For example, if GDP rises from $30,000 per capita to $31,000, health spending increases by $232. But if GDP per capita rises from $40,000 to $41,000, health spending increases by $500.
Thus, because Americans earn so much more than people in other countries, it naturally follows that we spend more on health care.
Consider four countries whose health-care systems are often held up as admirable alternatives: Canada, Germany, France and Great Britain. Certainly, the U.S. spends significantly more on health care than those countries do, but these nations also earn significantly less income per person.
Look at it this way: Even after paying for our health care, Americans have far more money left over than their neighbors to spend on other goods and services. It works out to about $8,000 more than the average German or Frenchman, and about $4,000 more than the average Canadian or Briton.
Of course, averages obscure many harsh realities and hide the fact that many Americans are unable to afford health care.
To improve the state of American health care and lighten the burden on business and workers, policy leaders should push for portability of health benefits, transparent pricing for health services, tort reform and more competition among both insurers and providers.
Crusaders for "universal" health care allege that America's unique lack of government-mandated coverage is a handicap to the nation's competitiveness. Given America's superior economic performance, however, it is a uniqueness we should not rush to abandon.
Mr. Graham is the director of health care studies at the Pacific Research Institute.
WSJ
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WSJ
E-Prescriptions
By JOHN KERRY AND NEWT GINGRICH
November 16, 2007; Page A20
In 1799, doctors likely hastened the death of George Washington by draining a third of his blood to treat a bacterial infection. Bleeding was a common practice in those days, it dates back to the Greeks and Romans.
But nowadays, if a doctor used bloodletting he would be barred from practicing medicine. In the age of the Internet, is it any less inexcusable that we have yet to modernize and transform our health-care system?
We have talked long enough about using technology to cut costs and improve the quality of care. Now is the time to act -- and the place to start is preventable medication errors.
According to the Institute of Medicine, Americans average one medication mistake for every day spent in a hospital, accounting for more than 1.5 million injuries each year. Medication errors will kill at least 7,000 Americans this year. Of the more than three billion prescriptions written each year, doctors report nearly one billion require a follow-up between providers and pharmacies for clarification. The cost to our health-care system is in the billions.
One reason for this mess is that 95% of prescriptions are transmitted using 5,000-year-old technology: pen and paper.
That is unacceptable. The deaths and inefficiencies of paper prescriptions can be nearly entirely eliminated if we use the same technology we that use in other aspects of our lives. Electronic prescriptions can replace handwritten, misread and mismatched prescriptions with online, automated and expert technology.
The benefits are clear and compelling. When a doctor "writes" an electronic prescription, a computer can warn of potentially dangerous interactions with other medications or allergies and thereby prevent thousands of unnecessary hospitalizations each year. E-prescribing can also let a physician know whether a drug is covered by a patient's insurance or whether an alternative generic is available at a fraction of the cost. One initiative led by Chrysler, General Motors and Ford to encourage doctors to write e-prescriptions in the Detroit region has generated more than one million prescription alerts that have saved lives and money.
The benefits of e-prescribing are so important that the Institute of Medicine has called for every doctor and nurse to prescribe electronically by the year 2010. Business and labor leaders, health insurers and consumer advocates are unanimous in their support of this common-sense initiative.
Doctors also know that e-prescribing is vital for our health-care system. One recent study of 400 physicians found that 85% of physicians think e-prescribing is a good idea; 81% say it would reduce medication errors; and 65% say it would save time. They like a system that reduces their liability and allows them to focus on providing care, not filling out paperwork.
The problem is that very few doctors use the technology. Of those 400 physicians polled, only 7% actually transmit prescriptions electronically. And 63% say implementing the technology is not a priority. Why? It's not always in their immediate financial interest to do so.
That must change.
The federal government can lead by requiring that doctors who do business with Medicare convert to e-prescribing. This can be done by using market forces and the federal government's purchasing power to align financial incentives.
First, offer bonus payments to Medicare doctors who already prescribe electronically or who adopt the technology. Such payments will help doctors, especially those with small practices without many patients, to pay for startup costs. Private insurers, like WellPoint, are already using this strategy to drive adoption of e-prescribing.
If a majority of doctors don't e-prescribe a few years down the road, the government should require all doctors to adopt e-prescribing or face financial penalties. E-prescribing should become a condition of doing business with Medicare. This is no different than the requirements other suppliers expect to see when they negotiate with customers.
A new study by the Department of Health and Human Services estimates that if 18% of doctors in Medicare adopt e-prescribing, the government will save $4 billion and nearly three million adverse drug events can be prevented over five years.
This is something Republicans and Democrats can agree on. While we continue to debate how to cover the uninsured, improve quality, and lower costs, there is too little being done to modernize health care. E-prescribing for Medicare is just the beginning of the modernization and digitization our ailing health-care system urgently needs. A high-tech, healthier future is within our grasp. We just need creative leadership bold enough to reach for it.
Mr. Kerry, a Democrat, is a senator from Massachusetts. Mr. Gingrich, a Republican, is former speaker of the House and founder of the Center for Health Transformation. Chrysler, GM, Ford and WellPoint are members of the center.
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Foreign Health Affairs
By REGINA E. HERZLINGER
November 19, 2007; Page A18
America, a nation prone to love at first sight with seductive health-care fixes, is now falling for the systems of the Netherlands and Switzerland. Their representatives recently displayed their dowry in D.C., and U.S. Health and Human Services Secretary Michael Leavitt personally checked out the potential brides earlier this month.
Beware: The last time we fell in love, it was with managed care, as exemplified by California's Kaiser Permanente. But the Kaiser model proved difficult to replicate outside of California, even for Kaiser itself. The version of managed care we got was of the "Just Say No" variety: "No" to enrollee requests and provider referrals. It has made a mess of our health-care system.
Though media accounts lump the systems of Switzerland and the Netherlands together, they are profoundly different. There are things to be learned from each, though neither presents a complete model the U.S. should emulate.
The Swiss and Dutch systems share one terrific feature -- universal coverage. Americans increasingly want this. Both achieve universal coverage using private sector insurers, at far lower cost than the U.S. -- 12% of GDP for Switzerland and 10% for the Dutch, versus a staggering 15% for the U.S. in 2003. They also have far better health outcomes than the U.S., even when Switzerland is compared to socio-demographically similar U.S. states such as Connecticut and Massachusetts. The sick in both countries can afford to buy health insurance, and also pay the same price. Yet private insurers compete in the market because they are paid more for sick enrollees through various risk-adjustment systems.
But the devil is in the details.
The Swiss are required to buy health insurance themselves, using their own money -- they account for 65% of health care expenditures. If individuals cannot afford it, most Cantons transfer funds to them. There are neither employer nor government health-insurance programs for the poor or elderly. The Swiss government accounts for only a quarter of the health-care spending versus nearly 50% for the U.S.
The Swiss system is consumer-driven because consumers themselves pay for their purchases. The Dutch government, in contrast, funds consumers to purchase their own health insurance to a much greater extent -- five million people in the country are on some sort of government dole. Thus, when the Dutch buy their insurance, they may think they are using other people's money.
The results? The Swiss have lower health-care inflation -- 2.8% versus 4.1% for the Dutch and the U.S. from 1996-2003 -- and substantially more in the way of health-care resources. And Switzerland tops the world in most measures of user satisfaction.
The 93 private insurance companies that compete in Switzerland dwarf the 41 in the Netherlands. Swiss providers also compete because, in addition to paying for their health insurance, the Swiss pay for nearly 32% of their health-care services out of their own pockets, as compared with only 8% for the Dutch. Yet even with its limitations, Dutch health-care inflation fell from the time when Dutch employers bought health care, and waiting lists have reportedly tumbled.
Nevertheless, the Swiss system is hardly perfect. On the demand side, the government limits insurance competition with requirements for extensive minimum benefit packages and considerable micromanagement of prices. Imagine a car market in which the government designs the vehicles and stringently oversees distributors' prices. Pretty soon all the cars would come with features we do not necessarily want -- heated seats -- at a price we do not want to pay.
Even worse is the Swiss government's micromanagement of medical care suppliers. Unwisely adopting the U.S. government's Medicare payment system, it not only dictates medical care prices but also specifies the bundles of care for which it will pay. This kind of micromanagement discourages innovation. For example, when Duke Medical Center lowered the costs of treating congestive heart patients by 40% in only one year with innovations that improved health status, it lost nearly all the savings it created. The U.S. government pays only for activities like hospital stays and doctor visits. Perversely, medical innovators who improve health and reduce hospital visits, lose money.
So before we latch on to the Dutch or Swiss models, let's be careful. Yes, the consumer-driven health care of these two nations is clearly the better model for implementing universal coverage. But their governments' micromanagement of the prices of insurers and providers should be avoided, not emulated. Instead, government should help lower-income people, enforce transparency, prosecute fraud and abuse -- but otherwise get out of the way.
Ms. Herzlinger is professor of business administration at Harvard Business School and a senior fellow at the Manhattan Institute. She is the author of "Who Killed Health Care?" (New York: McGraw-Hill, 2007).
WSJ
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I am left wondering if PC cowardice accounts for this article's failure to mention the role of illegal aliens in overwhelming emergency departments. Notice how most/all of the examples given are from places like Tucscon AZ.
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Seriously ill suffer as relationship between physician and hospital unravels
By Christopher Lee
The Washington Post
updated 12:39 a.m. MT, Fri., Dec. 21, 2007
Hospital emergency departments across the United States, already struggling with overcrowding and growing patient loads, are increasingly unable to find specialists to help treat seriously injured and ill patients, according to medical experts.
Crucial minutes, hours and even days can go by as patients suffering from trauma, strokes, broken bones and other maladies await evaluations by neurologists, orthopedic surgeons and other specialists because hospitals are having difficulty getting them to serve 24-hour emergency "on-call" shifts.
"It can mean death," said Linda Lawrence, president of the American College of Emergency Physicians and a practicing emergency department doctor in California. "Patients have died in transport, or waiting to find a neurosurgeon, or getting to a heart center for a cardiologist."
A nationwide survey by the American College of Emergency Physicians in 2005, the most recent available, found that of the 1,328 emergency department directors who responded, 73 percent said they had a problem with inadequate on-call coverage by specialists, including neurosurgeons, orthopedic surgeons and obstetrician/gynecologists. That was up from 67 percent in 2004.
Stretched to breaking point
The shortage comes at a time when emergency rooms at many hospitals are routinely stretched to the breaking point. The annual number of visits to emergency departments rose 18 percent, to 110 million, from 1994 to 2004, according to the Centers for Disease Control and Prevention. At the same time, the number of hospitals operating 24-hour emergency departments fell by 12 percent.
The shortage of specialists is the result of a fear of malpractice lawsuits, a reluctance to go without pay when seeing uninsured patients, and a growing intolerance for the disruption in their personal lives and private practices, the experts say. Many specialists are also decreasing their work for general hospitals.
Retiree Mary Jo McClure, 74, experienced the problem firsthand one Friday afternoon in January when she fell down some concrete steps, tearing large chunks of flesh from one leg. The plastic surgeon on call for Tucson Medical Center refused to leave her private-practice patients to come to the emergency department to treat McClure, who has health insurance. The doctor said instead she would see the injured woman in her office the next Monday.
But over the weekend, the specialist telephoned the family to say that she could not treat McClure after all because she performs only cosmetic procedures and is not trained to handle severe wounds, McClure said.
"What was she doing on the roster?" asked McClure, who searched for six days before finding a plastic surgeon at another hospital who would see her. "Do they expect you to walk in for a face-lift? . . . That was a very bad day, because you are hurt and you're in pain, and you always feel like the hospital will help you."
'A constant issue'
Judy Rich, the hospital's executive vice president and administrator, said the plastic surgeon later acknowledged that she should have seen McClure.
"It's a constant issue, our emergency room coverage," Rich said. "We count on the medical staff to come in when they are called. . . . There's too many patients and not enough specialists many times in communities, and Tucson, I think, is pretty typical of the kind of dilemma that we have."
In the Washington area, specialists are generally available, but emergency room patients sometimes must be transferred to get the expert care they need, said Eric Glasser, assistant chief of the emergency department at Georgetown University Hospital.
"At Georgetown, we take referrals from the whole region, because some hospitals can't find a neurosurgeon," said Glasser, president of the D.C. chapter of the emergency physicians' group. "They have to be transported long distances when minutes count. And that, in turn, impacts overcrowding in our hospitals."
For the most part, the dearth of specialists nationally arises not from a numerical shortage but from the growing unwillingness of many specialists to take on-call duty, said Ann S. O'Malley, a physician and senior researcher who co-authored a new study of the issue for the District-based Center for Studying Health System Change.
'Unraveling'
Traditionally, many specialists agreed to pull on-call duty in exchange for admitting privileges and use of a general hospital's facilities to perform operations and other procedures as part of their regular practice, O'Malley said. But the rise of physician-owned specialty hospitals and outpatient surgical centers over the past 15 years has reduced doctors' reliance on the general hospital.
"The historic relationship between physicians and hospitals is unraveling," O'Malley said.
Another factor is the rising number of the uninsured, with specialists complaining that they often do not get paid for treating patients they see in the emergency room. Moreover, rising malpractice insurance costs and the threat of lawsuits have made more physicians reluctant to see such patients, with whom they have no established professional relationship. Because taking on-call duty can require trips to the emergency department at any hour, it can disrupt doctors' personal lives and force them to reschedule appointments or elective surgeries for their regular, paying patients.
"It's our responsibility to take care of these patients, because that's what we do. That's part of our inherent fiber of being an orthopedic surgeon," said Leon S. Benson, a hand surgeon near Chicago who is active in the American Academy of Orthopaedic Surgeons, a professional association. "But there's no question that as the inconvenience and fatigue and poor compensation and difficulty in having appropriate resources to take care of patients build up, you get this perfect-storm effect where more and more people are thinking, 'Gee, I don't know if I want to do that anymore.' "
Benson, 47, an associate professor of clinical orthopedic surgery at Northwestern University, takes emergency department on-call duty every other day, but he acknowledged that he is the exception these days.
'System is being pressured'
"I can understand nationally why this is becoming a bigger issue, because the system is being pressured," he said. "More volume is getting through a pipe that's getting smaller in diameter. And then what you actually do while you're on call gets to be more and more painful."
Some hospitals have taken steps such as hiring specialists full time or on contract, covering professional fees for doctors who see uninsured patients, and paying physicians daily or monthly stipends for on-call duty, said O'Malley, the analyst. That helps, Benson said, but hospitals might impress physicians more by setting aside trauma rooms and teams of people to assist the on-call specialist in a timely, efficient way when an emergency arises.
The shortage of on-call specialists is so dire at Covenant Medical Center in Lubbock, Tex., that the hospital sometimes has to haul out telemedicine equipment that enables neurologists in faraway cities such as San Antonio to evaluate possible stroke victims through a video link, said Juan Fitz, associate director of the emergency department.
Sarah Thompson, 29, an emergency medical technician at Covenant, said she had to be admitted to the hospital for six days in September before doctors could find an oral surgeon to evaluate a swelling in her jaw and neck. It turned out to be cat-scratch fever that caused swollen lymph nodes and a secondary infection, not an abscessed tooth, as doctors first suspected, she said.
"They had an oral surgeon on call, but he wouldn't come to see me," said Thompson, who was pregnant. "He was supposed to be taking call. And then they called him, and they said he was out of town. It was a big mess-up. . . . All of our doctors were very frustrated with the situation. They tried their best."
Lawrence, the president of the emergency physicians' group, said that legislation introduced this year on Capitol Hill -- but not yet considered in committee -- would create a bipartisan national commission to study challenges related to the provision of emergency medical services, including the on-call specialist problem.
"Something people don't understand is that even if you have insurance, if I don't have an on-call orthopedic surgeon, I can't help you," Lawrence said. "It's an issue that affects everybody, insured and uninsured. If there's no bed available, there's no bed available."
URL: http://www.msnbc.msn.com/id/22335941/
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Equity and Health Care
February 4, 2008; Page A14
Democrats, and even a few Republicans, are in a populist mood, and fair enough. But if they really want the tax code to be more "progressive" -- i.e., from each according to his means -- they ought to forget the Bush tax cuts and address the way the government subsidizes health insurance. On the advice of our doctors, we're not holding our breath.
According to the Democratic consensus, too many people lack health insurance, and the liberal remedy is to protect the status quo while expanding public programs for the uninsured. That's the opposite of a rational health policy: Not only does the current system cause unnecessary problems for the insured, but many of the gaps in coverage owe to the way tax subsidies shortchange the uninsured, particularly working-class and middle-income families.
If such inequality and unfairness existed anywhere other than health care, the Democrats would be raising hell. Instead, they're silent -- which is politically telling.
The core problem is that people who get insurance through their employers pay no income or payroll taxes on the value of the benefit. The Treasury defines this as a "tax expenditure," meaning it's revenue the government forgoes to encourage certain behavior. If these losses were converted to the equivalent of direct spending, the tax exemption would have cost more than $208 billion in 2006. The only federal programs that cost more are Social Security, Medicare and national defense. But all that money props up only employer-provided insurance. Individuals who buy policies don't get any tax breaks and pay with after-tax dollars.
If the purpose of health-care reform is to decrease the ranks of the uninsured, these job-related tax breaks are poorly targeted, even regressive. The more generous the employer health plan, the more the subsidies increase. On average, lower-wage workers have more limited coverage as part of their compensation, usually from small- or medium-sized businesses. Estimates show that the subsidy is worth more than $3,000 for upper-income families (with higher marginal tax rates), and less than $1,000 for those on the lower income rungs.
These aren't new insights, and economists have recommended changing these incentives for decades. What's hard to believe are the convenient blind spots of the Democratic Presidential candidates. Hillary Clinton, queen of the wonks, includes in her health-care proposal an undefined cap on the deduction for "high-income Americans," but all of her emphasis is on larger spending subsidies. Barack Obama doesn't even mention it. Neither did John Edwards.
They're uncharacteristically missing a chance to effectively raise taxes on "the rich." Curbing these subsidies could generate billions for their elaborate "universal" health programs. More to the point, this is a simple matter of equity, usually Democratic terrain. If the government is going to support health insurance, then those subsidies ought to apply regardless of a person's income, where they work, or how they purchase their insurance.
So why the Democratic silence? Perhaps it's because they think such a change would interfere with their main policy goal, which is slow but steady progress toward government control of the health-care market. Or possibly it's because many of the most generous tax-subsidized health plans come from union-negotiated contracts. Or maybe Democrats simply don't want to concede that President Bush has a point.
In his 2007 State of the Union address, Mr. Bush suggested redistributing the government's health subsidies. His proposal would sever the link between insurance and employment, shifting the deduction to individuals and capping it at $15,000 a year for a typical family. About four-fifths of the country would do better than they do now, while the rest currently have the most gold-plated employer coverage and would still have plenty of options.
Not only would this be a relatively cost-effective way to increase coverage. It would also address the major market distortions that the employer-exclusive deduction causes, with individuals essentially prepaying for routine costs through third-party insurance companies. If Republican candidates came to their senses, they'd recognize an opportunity to poach a traditionally Democratic issue -- as well as an opening to address middle-class anxiety without demagoguing business or "the rich." Individual policies would also be portable when workers are between jobs, reducing risk and uncertainty.
But the big questions are for the Democrats, who claim to believe that health-care reform is as much a moral as an economic issue. Whatever their other ambitions, how can they stand by a system that offers the least assistance to the working class and nothing at all to the uninsured?
WSJ
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The Wages of HillaryCare
February 7, 2008
Hillary Clinton and Barack Obama agree on most policy issues, but that makes their rare differences all the more revealing. To wit, their running scrap over Mrs. Clinton's "individual mandate" for health care, which Mr. Obama has now had the nerve to expose for its inevitable government coercion.
Mrs. Clinton's proposal requires everyone to buy health insurance, along with more insurance regulation, a government insurance option for everyone and tax hikes. Mr. Obama likes all that but his mandate would only apply to children. He argues that the reason many people aren't insured is because it's too expensive, not because they don't want it. Mrs. Clinton counters that coverage can't be "universal" without a mandate.
But then Mr. Obama had the impudence to defend his views. His campaign distributed a mailer in key primary states that claimed the Clinton plan "forces everyone to buy insurance, even if you can't afford it." It also featured an image of an anxious couple at a kitchen table. The Clinton apparat went apoplectic, claiming the flyer evokes the famous "Harry and Louise" commercials. A common article of liberal faith is that this "smear campaign" doomed HillaryCare in 1994 -- as opposed to, say, its huge cost and complexities. But never mind.
Yet if Mrs. Clinton's plan is better because it has a mandate, how does it work in the real world, where some people still won't be able to afford insurance, or would decline to acquire it? At a recent debate, the Illinois Senator drove the point home, asking Mrs. Clinton, "You can mandate it but there will still be people who can't afford it. And if they can't afford it, what are you going to fine them? Are you going to garnish their wages?" And in an interview with ABC's George Stephanopoulos on Sunday, Mrs. Clinton conceded that "we will have an enforcement mechanism" that might include "you know, going after people's wages."
Well, well. In other words, HillaryCare II isn't all about "choice," but would require financial penalties for people to pay attention, including garnishing wages. To put it more accurately, the individual mandate is really a government mandate that requires brute force plus huge subsidies to get anywhere near its goal of universal coverage.
Mitt Romney's mandate program in Massachusetts is already expected to reach $1.35 billion in annual costs by 2011, up from $158 million today. And that's with only half of the previously uninsured currently enrolled; no less than 20% didn't qualify for subsidies and were granted exemptions because the costs were too much of a hardship.
Most experts calculate that a national mandate with subsidies like Mrs. Clinton's would enroll about half to two-thirds of the uninsured, less for a voluntary plan and subsidies alone. But such guesswork is pointless without the basic enforcement assumptions, which Mrs. Clinton refuses to provide. She's more interested in wielding what she calls "a core Democratic principle" against Mr. Obama. "My opponent will not commit to universal health care," she said Saturday.
The logic of Mr. Obama's approach is that policy makers should target those who are priced out of coverage. The Census Bureau says 38% of the uninsured earned more than $50,000 in 2006, 19% above $75,000. They aren't a major public policy problem -- except that a big reason they lack coverage is because it is more expensive than it needs to be thanks to government market interference. And 29% earn under $25,000, which means they probably qualify for existing subsidy programs like Medicaid or Schip but haven't enrolled.
The news here is that all of this is being exposed now, and by a fellow Democrat. Many Americans are uncomfortable with the coercion of the mandate -- and not all of them are Republicans. The California health-care overhaul was recently done in by liberals concerned about its consequences for the working poor.
The political lesson that Mrs. Clinton learned in 1994 wasn't about compromise or market forces. It was that a government health-care takeover can only be achieved gradually and by stealth. Her individual mandate is an attempt to force everyone to buy into a highly regulated and price-controlled system where government redistributes income and dictates coverage. We assume the McCain campaign is paying attention.
wsj
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WSJ
Health Questions for the Candidates
By BETSY MCCAUGHEY
February 20, 2008; Page A15
On March 4, voters in the Texas Democratic primary will choose between Hillary Clinton and Barack Obama. The battle is shaping up to be a health-care Alamo. Twenty five percent of people living in the Lone Star state are uninsured, according to the U.S. Census. That's the highest rate of any state.
Sen. Clinton has issued the challenge, telling Sen. Obama "I'll see you in Texas." She promises to provide health coverage for "every single one of the nation's 47 million uninsured," and she accuses Sen. Obama of offering a "band aid" solution that would leave about a third of those 47 million uncovered.
In preparation for the Texas showdown, Sen. Clinton and Sen. Obama will debate this Thursday night in Austin -- and both candidates have called for less oratory and more specifics. With that in mind, here are some of the questions they should be asked:
- Sen. Clinton: When you pledge to cover every one of the 47 million uninsured, do you include recent and future newcomers to the United States, legal and illegal?
The recent rise in the uninsured is due primarily to new arrivals and their U.S.-born children, and it is happening mostly in the five border states, according to the Center for Immigration Studies and U.S. Census data. In Texas, the cost of caring for these newcomers and children has been paid by local and state taxes, with little help from the federal government. For example, 39% of babies born in Parkland Hospital in Dallas are children of illegal immigrants. County taxpayers foot the bill.
At the University of Texas Medical Branch at Galveston, doctors are thrust into an ethical crisis. The hospital provides charity care to all. Its budget is at breaking point, and the hospital has had to lay off workers. In December, the hospital proposed that doctors triage cancer patients based on immigration status rather than medical need. But Galveston doctors say they are bound by their oath to heal, and that border control is Washington, D.C.'s problem.
Texas, as a border state, has specific problems, but also some typical ones. Of the nine million children in the U.S. considered "uninsured," six million are already eligible for government programs such as Medicaid or Schip, but their parents have not signed them up.
- Sen. Obama: You have said that you will require all parents to have health insurance for their children. What will you do to enforce this law?
In Texas, 850,000 children are eligible but not enrolled. The available programs provide check-ups, prescription drugs, hospital care, and dental care. The state runs radio ads, hands out brochures in several languages, and partners with community organizations to inform parents about these programs, but parents still fail to act.
- Sen. Clinton: a question about young adults. They think of themselves as invincible and are not apt to buy insurance. Your "mandate" would force them to do so, and more than that, to pay the same premium as middle aged people whose health care needs generally are much greater. You defend the one-price rule as "shared responsibility," but isn't it an unjust, hidden tax on the younger generation?
Today in Austin, Texas a 25-year-old man can buy a $1,000 deductible policy for $70, according to e-healthinsurance.com. A 55-year-old man pays $270 for the same policy. In nearly all states, young adults currently get price breaks, and for good reason. They need, on average, about $1,500 a year in health care. Your health plan bars insurers from giving these price breaks to the young.
- Sen. Obama: You have pledged to make health insurance "affordable." Texas lawmakers have made insurance less affordable by requiring that every plan include in vitro fertilization, acupuncture, marriage counseling and some 50 other features. This is like passing a law saying that the only car you're permitted to buy is a fully loaded luxury sedan.
Would you allow Texans (and all of us who live in states with similarly costly insurance requirements) to shop for cheaper insurance outside our own state?
- Sen. Clinton: You promise that "everyone who is already insured will be able to keep the coverage they have today." Yet your proposal says all health plans must cover services "experts deem necessary."
About 4.5 million people have high-deductible insurance, because it costs less and allows them to make their own decisions about where and when to get medical care. But when Massachusetts passed mandatory health insurance, people with high-deductible plans were forced to switch to more expensive medical policies to meet that state's definition of insurance.
Will that also happen under your proposal?
- Sens. Obama and Clinton: Some doctors and hospitals are worried about your plans to make electronic record-keeping compulsory. What will be the penalty for a doctor who doesn't get computerized?
In the California primary debate, Sen. Clinton claimed a Rand study shows that savings due to information technology could pay for half of her $110-billion-a-year universal health coverage plan. What the Rand study actually says is that information technology will produce savings, estimated at $77 billion a year, but not until year 15 -- and not necessarily for the thousands of doctors and hospitals who are forced to spend $125 billion (Rand's estimate) up front for the equipment.
- Sens. Obama and Clinton: Both your proposals call for limits on the profit margins of insurance companies. Attacking the most unpopular industry in America may sound politically attractive, but if profit margins are legally capped, investors will flee to other industries and private insurance could become a thing of the past. That would leave only a government-run health-care system.
Do you believe the nation should take that risk?
Ms. McCaughey, a former lieutenant governor of New York, is an adjunct senior fellow at the Hudson Institute.
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***- Sens. Obama and Clinton: Some doctors and hospitals are worried about your plans to make electronic record-keeping compulsory. What will be the penalty for a doctor who doesn't get computerized?
In the California primary debate, Sen. Clinton claimed a Rand study shows that savings due to information technology could pay for half of her $110-billion-a-year universal health coverage plan. What the Rand study actually says is that information technology will produce savings, estimated at $77 billion a year, but not until year 15 -- and not necessarily for the thousands of doctors and hospitals who are forced to spend $125 billion (Rand's estimate) up front for the equipment.***
I can tell you now that the cost of going electronic is a lot for many physicians including myself. It is not even feasable.
Additionally, I have yet to see anywhere wherein it produces any savings, cost efficiencies, extra income, or much of any other benefit to providers who will soon be forced to do it.
It is obviously too much to ask before an election why we can't just stop illegals from coming here and having babies at the expense of citizens. It ain't just in Texas. I see it all the time here in Jersey. I would not be surprised to find out that a large percentage of the 47 million number we hear about is simply this. That said I have people born here who can't afford care because of pre-existing conditions, or they earn too little. Yet instead of helping them we have people waltzing into the country and getting free hospital care.
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LONDON — Created 60 years ago as a cornerstone of the British welfare state, the National Health Service is devoted to the principle of free medical care for everyone. But recently it has been wrestling with a problem its founders never anticipated: how to handle patients with complex illnesses who want to pay for parts of their treatment while receiving the rest free from the health service.
Although the government is reluctant to discuss the issue, hopscotching back and forth between private and public care has long been standard here for those who can afford it. But a few recent cases have exposed fundamental contradictions between policy and practice in the system, and tested its founding philosophy to its very limits.
One such case was Debbie Hirst’s. Her breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist’s support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment.
By December, she had raised $20,000 and was preparing to sell her house to raise more. But then the government, which had tacitly allowed such arrangements before, put its foot down. Mrs. Hirst heard the news from her doctor.
“He looked at me and said: ‘I’m so sorry, Debbie. I’ve had my wrists slapped from the people upstairs, and I can no longer offer you that service,’ ” Mrs. Hirst said in an interview.
“I said, ‘Where does that leave me?’ He said, ‘If you pay for Avastin, you’ll have to pay for everything’ ” — in other words, for all her cancer treatment, far more than she could afford.
Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.
Patients “cannot, in one episode of treatment, be treated on the N.H.S. and then allowed, as part of the same episode and the same treatment, to pay money for more drugs,” the health secretary, Alan Johnson, told Parliament.
“That way lies the end of the founding principles of the N.H.S.,” Mr. Johnson said.
But Mrs. Hirst, 57, whose cancer was diagnosed in 1999, went to the news media, and so did other patients in similar situations. And it became clear that theirs were not isolated cases.
In fact, patients, doctors and officials across the health care system widely acknowledge that patients suffering from every imaginable complaint regularly pay for some parts of their treatment while receiving the rest free.
“Of course it’s going on in the N.H.S. all the time, but a lot of it is hidden — it’s not explicit,” said Dr. Paul Charlson, a general practitioner in Yorkshire and a member of Doctors for Reform, a group that is highly critical of the health service. Last year, he was a co-author of a paper laying out examples of how patients with the initiative and the money dip in and out of the system, in effect buying upgrades to their basic free medical care.
“People swap from public to private sector all the time, and they’re topping up for virtually everything,” Dr. Charlson said in an interview. For instance, he said, a patient put on a five-month waiting list to see an orthopedic surgeon may pay $250 for a private consultation, and then switch back to the health service for the actual operation from the same doctor.
“Or they’ll buy an M.R.I. scan because the wait is so long, and then take the results back to the N.H.S.,” Dr. Charlson said.
In his paper, he also wrote about a 46-year-old woman with breast cancer who paid $250 for a second opinion when the health service refused to provide her with one; an elderly man who spent thousands of dollars on a new hearing aid instead of enduring a yearlong wait on the health service; and a 29-year-old woman who, with her doctor’s blessing, bought a three-month supply of Tarceva, a drug to treat pancreatic cancer, for more than $6,000 on the Internet because she could not get it through the N.H.S.
Asked why these were different from cases like Mrs. Hirst’s, a spokeswoman for the health service said no officials were available to comment.
In any case, the rules about private co-payments, as they are called, in cancer care are contradictory and hard to understand, said Nigel Edwards, the director of policy for the N.H.S. Confederation, which represents hospitals and other health care providers. “I’ve had conflicting advice from different lawyers,” he said, “but it does seem like a violation of natural justice to say that either you don’t get the drug you want, or you have to pay for all your treatment.”
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Karol Sikora, a professor of cancer medicine at the Imperial College School of Medicine and one of Dr. Charlson’s co-authors, said that co-payments were particularly prevalent in cancer care. Armed with information from the Internet and patients’ networks, cancer patients are increasingly likely to demand, and pay for, cutting-edge drugs that the health service considers too expensive to be cost-effective.
“You have a population that is informed and consumerist about how it behaves about health care information, and an N.H.S. that can no longer afford to pay for everything for everybody,” he said.
Professor Sikora said oncologists were adept at circumventing the system by, for example, referring patients to other doctors who can provide the private medication separately. As wrenching as it can be to administer more sophisticated drugs to some patients than to others, he said, “if you’re a doctor working in the system, you should let your patients have the treatment they want, if they can afford to pay for it.”
In any case, he said, the health service is riddled with inequities. Some drugs are available in some parts of the country but not in others. Waiting lists for treatment vary wildly from place to place. Some regions spend $280 per capita on cancer care, Professor Sikora said, while others spend just $90.
In Mrs. Hirst’s case, the confusion was compounded by the fact that three other patients at her hospital were already doing what she had been forbidden to do — buying extra drugs to supplement their cancer care. The arrangements had “evolved without anyone questioning whether it was right or wrong,” said Laura Mason, a hospital spokeswoman. Because their treatment began before the Health Department explicitly condemned the practice, they have been allowed to continue.
The rules are confusing. “It’s quite a fine line,” Ms. Mason said. “You can’t have a course of N.H.S. and private treatment at the same time on the same appointment — for instance, if a particular drug has to be administered alongside another drug which is N.H.S.-funded.” But, she said, the health service rules seem to allow patients to receive the drugs during separate hospital visits — the N.H.S. drugs during an N.H.S. appointment, the extra drugs during a private appointment.
One of Mrs. Hirst’s troubles came, it seems, because the Avastin she proposed to pay for would have had to be administered at the same time as the drug Taxol, which she was receiving free on the health service. Because of that, she could not schedule separate appointments.
But in a final irony, Mrs. Hirst was told early this month that her cancer had spread and that her condition had deteriorated so much that she could have the Avastin after all — paid for by the health service. In other words, a system that forbade her to buy the medicine earlier was now saying that she was so sick she could have it at public expense.
Mrs. Hirst is pleased, but up to a point. Avastin is not a cure, but a way to extend her life, perhaps only by several months, and she has missed valuable time. “It may be too bloody late,” she said.
“I’m a person who left school at 15 and I’ve worked all my life and I’ve paid into the system, and I’m not going to live long enough to get my old-age pension from this government,” she added.
She also knows that the drug can have grave side effects. “I have campaigned for this drug, and if it goes wrong and kills me, c’est la vie,” she said. But, she said, speaking of the government, “If the drug doesn’t have a fair chance because the cancer has advanced so much, then they should be raked over the coals for it.”
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Obama's Health Care Record
By SCOTT GOTTLIEB
May 5, 2008; Page A15
Laughing gas can be useful during complicated dental procedures, but should every health plan be required to cover it and should health insurance cost more because of it?
Barack Obama thinks so. As a state senator in Illinois, he voted to require that dental anesthesia be covered by every health plan for difficult medical cases. Today, the requirement is one of 43 mandates imposed by Illinois on health insurance, according to the Illinois Division of Insurance. Other mandates require coverage of infertility treatments, drug rehab, "personal injuries" incurred while intoxicated, and other forms of care.
By my count, during Mr. Obama's tenure in the state Senate, 18 different laws came up for a vote and passed that imposed new mandates on private health insurance. Mr. Obama voted for all of them.
As a presidential candidate, Mr. Obama says people lack health insurance because "they can't afford it." He's right. But he is also partly responsible for why health insurance is too expensive. A long list of studies show that mandates like the ones Mr. Obama has championed drive up the cost of insurance for the very people priced out of coverage.
A 2008 study by an insurance-industry supported research organization, the Council for Affordable Health Insurance (CAHI), estimates that mandates increase the cost of basic health coverage by 20% to 50%, depending on the state. Average policies in high-mandate New Jersey cost about $4,000 according to a 2004 insurance survey, much more than the $1,200 charged in low-mandate Wyoming.
CAHI estimates that there are 1,961 state-mandated benefits across the country. It's not just specific products and services that get mandated, but also whole categories of providers like chiropractors and psychologists. By one count, states have enacted about 500 laws mandating coverage for 25 different types of providers.
States also mandate new categories of eligibility that force small businesses to cover additional dependents. One popular measure is the "slacker mandate," which extends coverage to unmarried dependents under the age of 30.
Not all mandates are equally expensive. Drug rehab, for example, increases a plan's premiums by 9% on average, according to America's Health Insurance Plans (AHIP). Coverage for psychologists adds 12% to premiums. But in total, in some states mandates increase the cost of insurance from 10% to 20%, according to AHIP.
These increased costs aren't shared equally among all who have health insurance. People who are covered through self-insured employers (usually large corporations) are shielded from state mandates because of the federal Employee Retirement Income Security Act (ERISA), which prevents states from enacting controls on plans that cross state lines.
The burden of paying for state mandates is usually borne by individuals who buy their own insurance, small employers and others not covered by ERISA. In total, about half of the people who have insurance bear the brunt of the cost of state mandates. And, as it turns out, individuals who do not work for large corporations are much more likely to be uninsured. AHIP calculates that between 20%-25% of uninsured Americans can't afford coverage because of the increased cost of providing mandated care.
It doesn't have to be that way. If insurers were allowed to offer "bare-bones" plans – which would be cheaper because they would cover just essential care – many consumers who are priced out of health insurance now would likely buy these plans instead of living without insurance.
State mandates even hurt those who have insurance because they prompt insurers to cut back on coverage for catastrophic illnesses. This undermines the purpose of insurance by turning policies into prepaid health care rather than security from the economic consequences of serious medical problems. And because many mandates define the duration and scope of specific benefits, they lock in treatment standards that grow outdated as knowledge advances. That can diminish incentives to find more effective ways of delivering medical care.
Why, then, do we have mandates?
For the simple reason that each mandate has a powerful constituency – be it chiropractors, dentists or other groups – who benefit when their services are included on the list of mandated care. These groups pressure lawmakers to expand the list of mandates and, over time, the list grows to be very long and expensive. Often the care that is being mandated is for minor medical problems because small, routine ailments are suffered by more people and therefore have broader political constituencies.
One way to make insurance more affordable is to extend the benefits of the ERISA exemption to people who buy insurance on their own, putting them on a level playing field with those who get coverage through large employers by freeing them from expensive state insurance laws.
Most insurance plans would still cover important health-care items such as prenatal HIV testing or routine colon cancer screening or bone density tests – three additional mandates Mr. Obama helped enact in Illinois. But without government mandates, plans would also have the flexibility to offer lower-priced insurance options.
Better still, Congress could pass legislation that has long languished in the House allowing people to purchase health plans across state lines. People could choose which state regulations to buy into, creating a market for the insurance mandates. This would give states more incentives to fix local problems that have helped make health insurance expensive in the first place. It's a fair bet that there would be an exodus of policyholders from higher-cost, higher-mandate states like New Jersey and even Illinois (which has more expensive mandates than about half of the other states).
Mr. Obama says people need more options to purchase insurance outside the workplace. He also says he can draw on his experience as a state legislator to lead a reform of the kinds of special interests that pursue these mandated benefits. Right now Mr. Obama's health-care proposal, like Hillary Clinton's plan, does the opposite by adding federal regulations on top of state laws.
"My plan emphasizes lowering costs," Mr. Obama says. If that is really what he wants to do, he can start by freeing consumers from forced subsidization of the pricey state mandates. Given a choice between the lower costs he promises and subsidized dental anesthesia he has delivered, some would opt for the affordable health insurance and make do with some extra Novocain.
Dr. Gottlieb is a resident fellow at the American Enterprise Institute.
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Medicaid Money Laundering
May 19, 2008; Page A14
Every politician moans that entitlement spending is out of control, so it ought to be easy at least to stop blatant fraud and abuse. Evidently not: Congress is currently resisting an attempt to rein in even a Big Con that everyone acknowledges.
The scene of this crime is Medicaid, the open-ended program that provides health coverage for about 59 million low-income people, with the rolls expanding every year. States determine eligibility and what services to cover, and the feds pick up at least half the tab, though the effective "matching rate" is as high as 83%. Now it turns out that states have been goosing their financing arrangements to maximize their federal payouts and dump more of their costs onto taxpayers nationwide.
The swindle works like this: A state overpays state-run health-care providers, such as county hospitals or nursing homes, for Medicaid benefits far in excess of its typical rates. Then the federal government reimburses the state for "half" of the inflated bills. Once the state bags the extra matching funds, the hospital is required to rebate the extra money it received at the scam's outset. Cash thus makes a round trip from states to providers and back to the states – all to dupe Washington.
The Government Accountability Office and other federal inspectors have copiously documented these "creative financing schemes" going back to the Clinton Administration. New York deposited its proceeds in a Medicaid account, recycling federal dollars to decrease its overall contribution. So did Michigan. States like Wisconsin and Pennsylvania fattened their political priorities. Oregon funded K-12 education during a budget shortfall.
The right word for this is fraud. A corporation caught in this kind of self-dealing – faking payments to extract billions, then laundering the money – would be indicted. In fact, a new industry of contingency-fee consultants has sprung up to help states find and exploit the "ambiguities" in Medicaid's regulatory wasteland. All the feds can do is notice loopholes when they get too expensive and close them, whereupon the cycle starts over.
The Bush Administration did just that. In 2003, it began audits that resulted in 29 states dialing back the practice. In 2007, officials tried to make the reforms permanent through formal rules changes, saying federal Medicaid dollars would only pay for Medicaid services received by Medicaid beneficiaries.
Naturally, the states were furious. All 50 Governors were (and are) opposed, while pressure groups like AARP and their media collaborators chime in with horror stories about "cuts" to the social safety net. Congress promptly forbade enforcement of the new regulations. That moratorium, which was slipped into last year's Iraq war funding bill, expires at the end of this month.
Now Congress wants to extend it until President Bush leaves office. The House passed a bill – 349-62 – but Harry Reid was unable to whisk it through the Senate unnoticed. Wavering GOP Senators are trying to strike a deal with the Bush Administration, which is threatening a veto, mostly with offers to beef up the $25 million allocated to "combat" Medicaid fraud and abuse. Of course, these antifraud troops only fight after state schemes have paid out. And should the moratorium stick around, states will merely revert to their con artistry, knowing they are no longer being watched.
A reform alternative would be for the government to distribute block grants, rather than a set fee for every Medicaid service. That would amputate Washington from state accounting and insulate taxpayers from these shakedowns. States would have an incentive to spend more responsibly, and also craft innovative policies without Beltway micromanagement. But we can dream.
In the short term, Congress could – but probably won't – allow the Administration to close this case. No one really knows how much the state grifters have already grabbed, though the Congressional Budget Office estimates that the Administration remedies would save $17.8 billion over five years and $42.2 billion over 10.
We realize this is considered a mere gratuity in Washington, but Medicaid's money laundering is further evidence that Congress isn't serious about spending discipline.
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The New Big Dig
May 21, 2008
Mitt Romney's presidential run is history, but it looks as if the taxpayers of Massachusetts will be paying for it for years to come. The former Governor had hoped to ride his grand state "universal" health-care reform of 2006 to the White House, but his state's residents are now having to live with what he and the state's Democratic Legislature passed. As the Boston press likes to say, it's "the new Big Dig."
The showpiece of RomneyCare was its individual mandate, a requirement that all Massachusetts residents obtain health insurance by July of last year or else pay penalties. The idea was that getting everyone into the insurance system would eliminate the "free-rider" problem of those who refuse to buy insurance but then go to emergency rooms when they're sick; thus costs would fall. "Will it work? I'm optimistic, but time will tell," Mr. Romney wrote in these pages in 2006.
Well, the returns are rolling in, and the critics look prescient. First, the plan isn't "universal" at all: About 350,000 more people are now insured in Massachusetts since the reform passed. Federal estimates put the prior number of uninsured at more than 657,000, so there was a reduction. But it was not secured through the market reforms that Governor Romney promised. Instead, Massachusetts also created a new state entitlement that is already trembling on the verge of bankruptcy inside of a year.
Some two-thirds of the growth in coverage owes to a low- or no-cost public insurance option. Called Commonwealth Care, it uses a sliding income scale to subsidize coverage for everyone under 300% of the federal poverty level, or about $63,000 for a family of four. Commonwealth Care also accounts for 60% of statewide growth in individual insurance over the last year, and the trend is expected to accelerate, perhaps double.
One lesson here is that while pledging "universal" coverage is easy, the harder problem is paying for it. This year's appropriation for Commonwealth Care was $472 million, but officials have asked for an add-on that will bring it to $625 million. For 2009, Governor Deval Patrick requested $869 million but has already conceded that even that huge figure is too low. Over the coming decade, the expected overruns float in as much as $4 billion over budget. It's too early to tell how much is new coverage or if state programs are displacing private insurance.
The "new Big Dig" moniker refers to the legendary cost overruns when Boston rebuilt its traffic system. Now state legislators are pushing new schemes to offset RomneyCare's runaway expenses, including reductions in state payments to doctors and hospitals, enlarged business penalties, an increase in the state tobacco tax, and more restrictions on drug companies and insurers.
Mr. Romney's fundamental mistake was focusing on making health insurance "universal" without first reforming the private insurance market. The "connector" that was supposed to link individuals to private insurance options has barely been used, as lower-income workers flood to the public option. Meanwhile, low-cost private insurers continue to avoid the state because it imposes multiple and costly mandates on all policies.
Hailed at first as a new national model, the Massachusetts nonmiracle ought to be a warning to Washington. Barack Obama and Hillary Clinton are both proposing versions of RomneyCare on a national scale, with similar promises that covering everyone under a government plan will reduce costs. Mr. Obama at least argues that more people would be covered were insurance more affordable. But his solution is Massachusetts on steroids – make insurance less expensive for policyholders by transferring the extra costs onto the government. Mrs. Clinton likes that but also wants the individual mandate, despite the mediocre results so far.
The real problem in health care is the way the tax code and third-party payment system distort incentives. That's where John McCain has been focusing his reform efforts – because that really does have the potential to reduce costs while covering more of the uninsured – and Republicans ought to follow his lead.
In this respect paradoxically, we can be thankful that Massachusetts ignored the cost problems that doomed other recent liberal health insurance overhauls in California, Pennsylvania, Wisconsin and Illinois. The Bay State is showing everyone how not to reform health care.
See all of today's editorials and op-eds, plus video commentary, on Opinion Journal.
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The Florida Revelation . . .
May 29, 2008; Page A16
Republicans in Congress may be out of gas, but that doesn't mean conservative ideas aren't percolating elsewhere, and even on the supposedly Democratic stronghold of health care. Take the news from Florida, where GOP Governor Charlie Crist succeeded last week in moving an innovative reform through the state legislature.
The Sunshine State has about 3.8 million people without insurance, or about 21% of the population, the fourth-highest rate in the country. The "Cover Florida" plan hopes to improve those numbers by offering access to more affordable policies. As even Barack Obama says, the main reason people are uninsured isn't because they don't want to be; it's because coverage is too expensive.
But the Florida reform, which both houses of the legislature approved unanimously, renounces Mr. Obama's favored remedy: It nudges the government out of the health-care marketplace. Insurance companies will be permitted to sell stripped-down, no-frills policies exempted from the more than 50 mandates that Florida otherwise imposes, including for acupuncture and chiropractics. The new plans will be designed to cost as little as $150 a month, or less.
Mr. Crist observed that state regulations increase the cost of health coverage, and thus rightly decided to do away with at least some of them. It's hard to believe, but this qualifies as a revelation in the policy world of health insurance. The new benefit packages will be introduced sometime next year and include minimum coverage for primary care and catastrophic expenses for major illness.
Critics are already saying that, without mandates, the plan won't guarantee quality of care. That's purportedly why the states have imposed more than 1,900 specific-coverage obligations. But invariably mandates are the product of special-interest lobbying. Health-care providers – not consumers – are always asking for tighter regulation, because they profit from making everyone subsidize generous plans that cover, say, podiatry or infertility treatment. Given the choice, consumers might choose policies that cover some services but not others.
These government rules are imposed without regard for how much they will cost and who will bear the burden. In practice, the costs are disproportionately carried by lower- and middle-income workers, who already on average have more limited insurance coverage as part of their compensation, or none at all. When prices rise because of mandates, the less affluent are often forced to make an all-or-nothing choice between "Cadillac coverage," which involves just about everything, or going uninsured. In other words, they're prohibited from buying the lower-cost options that might be better suited to their needs.
Governor Crist is to be credited for removing this artificial, regressive floor on plans. It's a simple matter of equity. And though the plan will only enroll those who have gone without coverage for six months, it also creates a clearinghouse that will let small businesses that can't afford coverage offer their employees a variety of similar policies.
Despite his often populist brand of politics (such as on hurricane insurance), Mr. Crist also avoided the typical liberal health-care response of expanding public programs. Mitt Romney should have taken this route in Massachusetts, but fell instead for the siren song of "universal coverage," even if provided by the government. Florida is already having a tough fiscal year, but such state-level expansions are often pushed anyway.
Some 13 states currently offer bare-bones policies on a full or trial-run basis. While not a cure-all, they're movement in the right direction – especially as the states can't do anything about the continuing tax bias for employer-provided health insurance. That kind of much-needed change can only come from Washington, as John McCain is proposing.
The Florida success also shows the political benefits when Republicans talk seriously about health care. Mr. Crist has made increasing consumer choice a signature issue. When Mr. McCain talked up his health-care reforms earlier this spring, he did so in Tampa. He chose the right state.
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"including for acupuncture and chiropractics"
Insurers will pay for these but they won't pay for treatment of people who are overweight or obese. Those are considered "cosmetic".
I don't have answers on how to fix health care but I am really not thrilled at more government intrusion into our lives. It is out of control already.
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I have mixed feelings about *universal* health care. Of course the idea of world class health care for everyone that is paid for by x is a wonderful thought. Who isn't for that? But we all know it isn't that simple.
As one who pays for health care for myself and an employee I have many different thoughts and conerns from different directions but I don't have the answers. The only thing I can say is that for any universal coverage to not bankrupt the system there would *have* to be some form of rationing. Most Americans don't understand this and on an individual basis refuse to except this. And as a doctor I don't want to be the one in the middle who is the person who tells the patient they cannot have that MRI on day #1 for a shoulder or back sprain. Yet the business guys with the HMOs have put us in that spot. There better be strict guidelines set up in a way so I can refer this to the patient. "No, you can't have this test because you don't qualify by national guidelines until these steps are followed".
Everyone cannot scour the country like Ed Kennedy shopping for all sorts of experimental care and expect others to pay for it.
BTW I wonder about his care. Why is it he couldn't get the care in Massachussetts where there is world class health care? Ever here of Mass General? What is that guy at Duke and their University trying to sell? There is to me an *obvious* self promotional aspect to their offering experimental stuff to a famous wealthy guy. It is a sales decision - no more and no less.
Anyway here is some thoughts on universal care:
***Senators Clinton’s and Obama’s split over mandating coverage distinguishes them from one another, but does that difference matter?
From the June ACP Internist, copyright © 2008 by the American College of Physicians.
Stacey ButterfieldBy Stacey Butterfield
In the seemingly endless Democratic primary, Sens. Hillary Clinton and Barack Obama have expended a lot of effort trying to distinguish themselves from one other. She stands for experience, he stands for change, and so on.
They both stand for health care reform and have acknowledged that they propose very similar plans for covering the uninsured. But their plans do have one difference—mandates for coverage—and there doesn’t seem to be any consensus on whether that is a big, important difference or a small, insignificant one.
Both plans require insurers to offer coverage to everyone, and use federal funds to make the coverage affordable for consumers. However, Mrs. Clinton’s plan will require all Americans to purchase coverage or face as-yet-unspecified penalties. Mr. Obama’s plan requires mandatory insurance only for children; for adults, coverage will be optional.
Proxies explained their candidates’ proposals at the 2008 World Health Care Congress (WHCC) in Washington, D.C., where one of the keynote addresses featured representatives of the three major presidential campaigns. Since my last column focused on Mr. McCain’s proposals, I’ll stick to the discussion between Mrs. Clinton’s and Mr. Obama’s campaigns.
Democrats’ health plans not much help to undecided votersU.S. Representative Jim Cooper of Tennessee, who represented Mr. Obama, said the mandate issue has been overplayed. “I think that’s much ado about a technical subject,” he told the audience of health care leaders in April. “The health care plans of Hillary Clinton and Barack Obama are almost identical. We are for universal coverage.”
He also offered an explanation for Mr. Obama’s policy decision. “An upfront, individual mandate will probably get zero Republican co-sponsors in Congress,” Mr. Cooper said.
That’s not true, argued Chris Jennings, the political strategist who represented Mrs. Clinton at the WHCC. “There already is [bipartisan support],” he said. He noted that mandatory coverage legislation has been proposed by Sen. Ron Wyden (D-OR) and Sen. Robert Bennett (R-UT), and two Republican governors, Mitt Romney and Arnold Schwarzenegger, have been the driving forces behind state efforts to mandate insurance.
“The reason why we want everyone to be in the system is to make it work rationally,” Mr. Jennings said. If consumers can wait until they are sick to purchase health insurance, it would raise the premiums of those who buy insurance as well as drawing intense protest from health insurers, he explained.
Obviously, the most likely to opt out under the non-mandatory plan would be the young and healthy whose premiums would typically subsidize the cost of covering the less healthy, more expensive patients. Mr. Obama’s advocates argue that if health insurance is made affordable, almost everyone would choose to buy it, but there’s no way to prove that without enacting a plan.
The Obama plan does have the advantage of being less expensive. Analysts have calculated that his plan would cost taxpayers 50%-80% of what the Clinton plan would. Since either plan would cost the government tens of billions of dollars a year, it’s somewhat difficult for laypeople to really grasp the price difference.
So what is the priority in creating a new health care coverage system? Gaining bipartisan support? Ensuring that everyone is within the system? Limiting cost?
Attendees at the WHCC, who were mostly health care industry executives, seemed to be thoroughly divided about the answers to these questions. After the representatives from the two Democratic campaigns and a spokesperson for Mr. McCain had presented their candidates’ proposals for health reform, the audience voted on their perceptions of feasibility and cost.
The votes were just about even. Mrs. Clinton’s plan got slightly positive ratings, with about 54% of the group finding it feasible and 51% saying it would help with costs. The voters were exactly split on the feasibility of Mr. Obama’s plan and slightly favorable (54%) on cost. The evaluation of Mr. McCain’s plan was slightly negative, with 45% voting yes on feasibility and 46% on cost.
With that mixed evaluation from the health care experts, it’s no wonder that the American voters are still undecided about who they want to lead health care reform.***
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"If you think health care is expensive now, wait until the government makes it free." PJ O" Rourke.
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One might think because I am a doctor I would have some strong opinions one way or the other regarding what is *best* for health care, but I don't. I'm just trying to pay my bills like everyone else. I don't endorse McCain or the others based on their health care opinions except to the extent that I don't want even more regulation, strangulation, and an even more gigantic government in any shape or form.
I thought those who read this board might find this helpful.
John McCain touts his plan for the U.S. health care system
From the May ACP Internist, copyright © 2008 by the American College of Physicians.
Jessica Berthold By Stacey Butterfield
Despite the importance of health care in the 2008 presidential campaign, relatively little attention has been paid to the plans that the Republican nominee Sen. John McCain has proposed for the U.S. health care system.
Part of that is because Sen. McCain himself has spent less time talking about the issue than his Democratic opponents. His reticence makes sense, given that Republican voters rank health care as a less important issue (fourth) than do Democrats (second), a Kaiser Foundation poll found. But Sen. McCain has released some proposals to reform health care, and although his plans are not fully fleshed out, they represent a dramatic change from both the current status quo and Democratic proposals.
Unlike the Democrats, cost, rather than access, is the focus. “The problem is not that most Americans lack adequate health insurance,” Sen. McCain told an audience in Des Moines, Iowa. “The biggest problem with the American health care system is that it costs too much.”
John McCain touts his plan for the U.S. health care systemThe centerpiece of his plan to tackle cost is to change the tax code, which would eliminate the incentives for employer-sponsored health coverage and offer individuals a $2,500 tax credit ($5,000 per family) for purchasing their own insurance. Under his plan, which also encourages health savings accounts and cost transparency, patients will have substantially more responsibility for making their own health care and coverage determinations, and would be less likely to choose the most expensive and often unnecessary options, he said in the same speech.
To foster nationwide competition and thereby reduce cost, Sen. McCain also proposes eliminating state-by-state divisions of insurance marketing and physician practice.
Although states would lose some control over insurance regulation and medical licensing, they would take on the new responsibility of finding coverage for high-risk, high-cost patients. States should develop methods for providing additional assistance to families who face unusually high premiums, Sen. McCain said. “The federal government can help fund this effort, but in exchange states should allow Medicaid and SCHIP funds to be used for private insurance,” he explained.
Sen. McCain envisions substantial changes to private insurance as a result of his encouragement of competition. “Insurance should be innovative, moving from job to home, job to job, and providing multi-year coverage. Allow individuals to get insurance through any organization or association that they choose,” his Web site states.
Of concern to internists, he favors eliminating lawsuits against physicians who follow clinical guidelines and adhere to protocols, payments for coordinated care and nonpayment for preventable errors.
Although he hasn’t provided details, Sen. McCain has also expressed opinions on some other hot-button health care issues. He supports walk-in clinics as an alternative/addition to physician offices and emergency rooms. He opposed Medicare Part D because of the cost of providing drug benefits to senior citizens who could afford to pay for their medications, but he favors re-importation of drugs and faster introduction of generics to lower drug expenditures.
Some responsibility for lowering the expense of the U.S. health care system also will fall onto the general public under the McCain plan. He mentions obesity, diabetes and high blood pressure specifically as areas where individual efforts could reduce disease incidence.
A discussion of autism recently caused some controversy for Sen. McCain. According to the New York Times, he recently told a Texas audience that “strong evidence” indicates that vaccine preservatives are causing rising autism rates. His comment drew heat from host of experts who cited strong evidence to the contrary.
Sen. McCain is the underdog in convincing voters to support his plan for reform. A March Wall Street Journal poll conducted by Harris Interactive after the Ohio and Texas primaries found that 45% of voters would trust Democrats to lead health reform while only 25% said they would trust Republicans. Among the three remaining candidates, 44% of those polled said they would trust Sen. Hillary Clinton with overhauling health care, compared with 40% for Sen. Barack Obama and 30% for Sen. McCain.
Presumably, as the campaign moves forward, Sen. McCain will release more details. For information on his opponents’ plans, check back next month, when the Campaign Trail will conduct a similar analysis of the Democratic candidates’ health care platforms.
© Copyright 2008 American College of Physicians. All Rights Reserved.
190 North Independence Mall West, Philadelphia, PA 19106-1572
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There is a reason patients are not paid a lot of money to participate in pharmaceutical studies. Ethics experts and institutional review boards composed of religious, business, legal medical and other lay people decide that offering too much money clouds the judgement of people into participate in these studies. In fact I had conducted some of these myself and it would have been *a lot easier* to offer a lot more money and have more participants then we would need rather than be able to offer a pittence and take forever to find subjects. Additionally IRB approve the informed consent, advertising, and to suggest that these veterans or anyone else is just thrown into these studies without their complete and explicit consent is bogus publicity. These are not Nazi experiments. The patient know full well they are in experimental studies and know full well there are risks.
Again as I said before a one in a million reaction to chantix is hardly some sort of scandal. I think Obama dumba should have to spend a month taking care of the millions of patients dying of cancer, and emphysema because they couldn't stop smoking - that SOB.
***VA testing drugs on war veterans
Experiments raise ethical questions
Audrey Hudson (Contact)
Tuesday, June 17, 2008
UPDATE: Obama's office sent a letter Tuesday to James Peake, secretary of the Department of Veterans Affairs, on the issue. You can read the full text of the letter here.
UPDATE II: Sen. John Cornyn, Texas Republican, issued his own letter to Peake as well. You can read it here.
The government is testing drugs with severe side effects like psychosis and suicidal behavior on hundreds of military veterans, using small cash payments to attract patients into medical experiments that often target distressed soldiers returning from Iraq and Afghanistan, a Washington Times/ABC News investigation has found.
In one such experiment involving the controversial anti-smoking drug Chantix, the Department of Veterans Affairs (VA) took three months to alert its patients about severe mental side effects. The warning did not arrive until after one of the veterans taking the drug had suffered a psychotic episode that ended in a near lethal confrontation with police.
ROD LAMKEY JR./THE WASHINGTON TIMES Veteran James Elliott arrives at the Veterans Affairs Medical Center in Washington for his scheduled substance-abuse class in April. Mr. Elliott, a chain smoker, served 15 months in Iraq as an Army sharpshooter and suffers post-traumatic stress disorder.
ROD LAMKEY JR./THE WASHINGTON TIMES Iraq war veteran James Elliott opted for a government clinical trial for a smoking-cessation drug for $30 a month, starting in November. Two weeks later, the FDA informed the VA of serious side effects.
ROD LAMKEY JR./THE WASHINGTON TIMES STILL SMOKING: Iraq war veteran James Elliott smokes on his porch in Silver Spring as he talks about his experiences in war and dealing with post-traumatic stress disorder. Mr. Elliott suffered a psychotic episode while taking the anti-smoking drug Chantix.
James Elliott, a decorated Army sharpshooter who suffers from post-traumatic stress disorder (PTSD) after serving 15 months in Iraq, was confused and psychotic when he was Tasered by police in February as he reached for a concealed handgun when officers responded to a 911 call at his Maryland home.
For photos, video of James Elliott, official FDA documents and more, visit the interactive site for the Disposable Heroes report.
Mr. Elliott, a chain smoker, began taking Chantix last fall as part of a VA experiment that specifically targeted veterans with PTSD, opting to collect $30 a month for enrolling in the clinical trial because he needed cash as he returned to school. He soon began suffering hallucinations and suicidal thoughts, unaware that the new drug he was taking could have caused them.
Just two weeks after Mr. Elliott began taking Chantix in November, the VA learned from the Food and Drug Administration (FDA) that the drug was linked to a large number of hallucinations, suicide attempts and psychotic behavior. But the VA did not alert Mr. Elliott before his own episode in February.
In failing to do so, Mr. Elliott said, the VA treated him like a "disposable hero."
"You're a lab rat for $30 a month," Mr. Elliott said.***
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From the New England Journal of Medicine which does carry of leftist flavor when it comes to politics and health care. (Well they do reside in Massachussetts. :wink:)
I don't know why Hollywood shouldn't pay for our health care needs with a windfall profits tax. Maybe athletes and sports team owners should pay a windfall tax too (who still weasel public money for their stadiums.). And my well known favorite industry - the music industry.
This is what we will see from Bo on a national scale. It is a very complicated situation so I have no real opinion one way or another and am just sitting helplessly on the sidelines anyway so what ever will be - will be....
****The New England Journal of Medicine
Volume 358:2757-2760 June 26, 2008 Number 26
Health Care Reform in Massachusetts — Expanding Coverage, Escalating Costs
Robert Steinbrook, M.D.
The far-reaching health care reforms that Massachusetts enacted in April 2006 are often cited as a model for other states.1 After 2 years, the good news is that the new programs have ramped up rapidly, the number of people without health insurance has been substantially reduced, and overall public and political support remains broad. Early data suggest that access to care has improved, especially among low-income adults; there have also been "reductions in out-of-pocket health care spending, problems paying medical bills, and medical debt."2 As of May 2008, about 350,000 residents — 5.5% of the state's population — were newly insured (see figure). About half of them are enrolled in Commonwealth Care, a subsidized insurance program for adults who have no access to employer-sponsored insurance, Medicare, Medicaid, or veterans' or student insurance programs and who earn no more than 300% of the federal poverty guidelines. About a third have purchased private insurance or gained employer-sponsored coverage, and the rest have enrolled in Medicaid. About 72% of the approximately 25,000 people with new individual policies have purchased them through Commonwealth Choice, an unsubsidized offering of private health plans approved by the Commonwealth Health Insurance Connector Authority, which administers many aspects of the reforms. In addition, the individual and small-group insurance markets have been merged, markedly reducing the cost of individual premiums.
Figure 1
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Growth in Health Insurance Coverage in Massachusetts after Health Care Reform.
Panel A shows the health insurance coverage among the 352,170 Massachusetts residents (5.5% of the 2007 state population of 6.4 million) who are newly insured. An estimated 550,000 to 715,000 residents (8.6 to 11.2%)1 were without health insurance before reform. Data for Commonwealth Care enrollees are from the Commonwealth Connector as of May 1, 2008. Medicaid data are from MassHealth as of February 29, 2008. Data for private insurance are from the Massachusetts Association of Health Plans, representing the increase in the number of people enrolled in commercial insurance between January 1, 2007, and January 1, 2008. New private-insurance enrollment includes coverage through Commonwealth Choice, an unsubsidized offering of approved private health plans that has been available through the Commonwealth Connector since July 2007; as of May 1, 2008, a total of 18,122 people had purchased insurance through Commonwealth Choice. Panels B and C show the numbers of residents enrolled in Commonwealth Care and Commonwealth Choice, respectively.
Not all the news is good, however. Perhaps 5% of the state's population — the exact figure is a matter of conjecture and may be higher — is still uninsured, the financial burden of the reforms is increasing, and the challenges of sustaining the subsidized program have been exacerbated by the economic downturn. The features of plans that decrease the cost of premiums also increase out-of-pocket costs for those who obtain care. Although adults reported lower levels of health care needs that remained unmet because of cost in the fall of 2007 than in the previous year, those with low incomes reported increased difficulty in getting appointments or in finding a doctor or other provider who would see them.2 And the state ultimately decided that not all residents must actually carry health insurance, as the legislation originally intended: exemptions are available for adults who make too much money to enroll in the subsidized insurance program but are deemed unable to afford policies in the private market; others can be exempted on religious grounds or when unusual financial circumstances arise. If more residents were eligible for subsidized insurance, fewer would qualify for hardship exemptions, but such an approach would further increase the cost of the new programs. Already, enrollment in Commonwealth Care is growing faster than was projected. Annual state spending would be $1.08 billion for fiscal year 2009 if 255,000 residents are enrolled, an increase of about 80,000 enrollees from the current number.3 If 225,000 residents enroll, as an earlier estimate suggested, spending would be $869.4 million. By comparison, spending for Commonwealth Care was $132.9 million in fiscal year 2007 and is projected to be $647.4 million in fiscal year 2008. Moreover, as compared with the national average, the per-capita cost of medical care in Massachusetts is high.
"To maintain public and financial commitment to the new programs, controlling costs is 110% of the challenge for the next several years," according to Jon Kingsdale, executive director of the Commonwealth Connector. The monthly cost per member in the subsidized insurance program is $352.43, which is about what was budgeted and considerably less than the median cost of employer-sponsored coverage in the state. There are no monthly premiums for adults earning less than 150% of the federal poverty guidelines (in 2008, $15,612 for an individual and $31,812 for a family of four); premiums for those who earn 150 to 300% of the federal poverty guidelines are set according to a sliding scale, with a maximum premium for an individual of $105 a month. About 70% of those who have signed up pay no premiums. People who are eligible for Commonwealth Care are deemed to have access to affordable coverage; Medicaid covers the children of adults enrolled in Commonwealth Care.
The requirement to carry insurance is enforced through the state income-tax return. In general, the Massachusetts Department of Revenue uses the affordability schedule adopted by the Commonwealth Connector and other financial and insurance information to verify the self-reported information on tax returns and to determine eligibility for hardship exemptions. In 2008, the maximum penalty for not having insurance is $912. In 2007, it was $219. Revenue from this penalty is expected to be $8.5 million for fiscal year 2008.3
In June 2008, the Department of Revenue released preliminary data about the health insurance information reported on 2007 tax returns, covering 86% of the tax filings that are eventually expected. Of the taxpayers required to file insurance information, only 1.4% failed to comply. About 168,000 of 3.34 million adults (5.0%) reported that they did not have health insurance coverage at the end of the year. On the basis of the affordability schedule, about 97,000 were deemed "able to afford" insurance — 86,000 who paid the penalty and 11,000 who have appealed it. About 62,000 were deemed "unable to afford insurance" and are thus eligible for an exemption. In addition, about 9,000 taxpayers claimed a religious exemption, and about 200 had already obtained a "certificate of exemption," for financial reasons, from the Commonwealth Connector. About 10% of residents either do not file tax returns or are not accounted for as dependents on the returns of others, so the actual number without health insurance is probably higher.
As of January 1, 2009, people with health insurance must have plans that provide "minimum creditable coverage." Among other requirements, such plans must cover at least three doctor visits for an individual or six for a family before charging any deductible, and they must offer prescription-drug coverage (with a limit on any separate deductible of $250 for an individual and $500 for a family). However, annual deductibles (capped at $2,000 for an individual and $4,000 for a family) and out-of-pocket spending (capped at $5,000 for an individual and $10,000 for a family) can be very high.
In 2008, health insurance in Massachusetts is considered affordable — regardless of the premium — for individuals with incomes above $52,501, for couples with incomes above $82,501, and for families of any size with incomes above $110,001, according to the Commonwealth Connector. For people with lower incomes, the affordability schedule, which is revised annually, is used to determine whether residents can pay for health insurance, regardless of whether it is obtained through the Commonwealth Connector or directly from an insurer. According to the 2008 schedule, affordable policies typically require no more than 7.5% to 10.6% of income to be paid for premiums; the percentages vary according to income and type of household. People with preexisting medical conditions are not charged more for individual policies. However, because premiums increase with age, people with incomes below the affordability thresholds are considered to have no affordable private insurance options after a certain age — currently, 55 years for individual coverage, 50 years for couple coverage, and 30 years for family coverage. Income-based categorical exemptions apply mostly to adults who are not offered employer-sponsored insurance. Until a more detailed analysis of tax returns is completed, state officials will not know how many of the people deemed unable to afford health insurance fall into these categories. And, of course, people who use medical care have additional expenses for copayments, deductibles, prescription charges, and other out-of-pocket costs.
Premiums for the unsubsidized Commonwealth Choice program will increase by an average of 5% for fiscal 2009, which begins on July 1. Government payments for premiums in Commonwealth Care will increase by an average of 9.4%. The state's cost for Commonwealth Care is partially offset by federal reimbursement — projected to be at $268.3 million in fiscal year 2008 and for $360.6 million in fiscal year 20093 — and a decrease in payments to community health centers and hospitals that treat the uninsured, which has caused difficulties for some centers and hospitals. Other revenues are limited. Revenue from the "fair share contribution," an annual per-employee charge of $295 paid by businesses that have 11 or more full-time–equivalent employees but do not provide or contribute to health insurance, is projected to be $6.7 million in fiscal 2008, as compared with the $50 million per year that was estimated when the reform was enacted.1,3 The difference could reflect inaccurate or incomplete reporting or an inaccurate initial estimate of the number of employers that would be subject to the assessment. More people, including low-income adults, have employer-sponsored insurance than did before the reform.
Massachusetts has thus far avoided legal challenges to its reforms that might have been brought under the federal Employee Retirement Income Security Act, which prohibits states from setting plan standards for self-insured employers. Possible explanations are that the requirement for maintaining a minimum standard of coverage is placed on individuals rather than employers, that businesses largely support the reform,4 and that their obligations are modest. An employer's requirements are met if at least 25% of its workers enroll in the company health plan or if it offers to pay at least one third of the premium for individual coverage. Employers are not required to provide health insurance to part-time employees. So far, employers have blocked efforts to make them pay more of the costs of the reform.
Health care reform in Massachusetts is not a panacea for the many shortcomings of the health care system.5 It is worth remembering that California, for example, has more people without health insurance (6.7 million) than Massachusetts has residents (6.4 million) and that the financing and delivery of medical care have not changed.1 Having health insurance is not having health care.5 There are still many difficulties with access to primary care and other services. However, Massachusetts has made some strides, and given sufficient resources, more can be done. This includes identifying and reaching people who are still uninsured and helping them gain coverage, expanding employer-sponsored insurance, and improving the options for part-time employees, for low-paid workers who are offered insurance by their employers but who earn less than 300% of the federal poverty guideline and cannot afford it, and for others with hardship exemptions. The state legislature is considering new cost-control measures, and there is interest in a plan from Blue Cross–Blue Shield of Massachusetts, the largest carrier in the state, which pays doctors and hospitals according to a combination of capitation and pay-for-performance approaches. As a practical matter, the improvements in health insurance coverage can continue indefinitely as long as public and political support remain strong and the state is willing — with the substantial help of the federal government through the renewal of a Medicaid waiver agreement — to keep paying the ever-increasing bill.
Dr. Steinbrook (rsteinbrook@attglobal.net) is a national correspondent for the Journal.
References
1. Steinbrook R. Health care reform in Massachusetts -- a work in progress. N Engl J Med 2006;354:2095-2098. [Free Full Text]
2. Long SK. On the road to universal coverage: impact of reform in Massachusetts at one year. Health Aff (Millwood) 2008;27:W270-W284.
3. The Commonwealth of Massachusetts. Information statement. April 16, 2008. (Accessed June 6, 2008, at http://www.dacbond.com/GetContent?dctm_r_object_id=0900bbc7800c82b4.)
4. Gabel JR, Whitmore H, Pickreign J. Report from Massachusetts: employers largely support health care reform, and few signs of crowd-out appear. Health Aff (Millwood) 2008;27:w13-w23. [Free Full Text]
5. Angell M. Health reform you shouldn't believe in. The American Prospect. April 21, 2008.
The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved.****
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American Cancer Care Beats the Rest
By DAVID GRATZER
July 22, 2008; Page A19
"Your accomplishment of [universal access] is the envy of every U.S. citizen who understands what you've done," Sen. Edward Kennedy (D., Mass.) told a Canadian audience in 1996. This week, a major international study confirms that Mr. Kennedy is right to stay at home for his own cancer care: U.S. medicine bests the cancer treatment available to people in 30 other countries.
The Concord study compares five-year cancer survival rates for several malignancies: breast cancer in women; prostate cancer; colon and rectal cancer in women and men. Combining the efforts of some 100 researchers, drawing data from almost two million cancer patients in 31 countries, the study, to be published in the August issue of The Lancet, is groundbreaking.
Who's on top? Arguably Cuba, which records the best overall outcomes for breast cancer and colorectal cancer (in women), and seems to beat U.S. health care in three out of the four categories. The study's authors -- who apparently hold higher standards than filmmaker Michael Moore -- disregard these results owing to data quality issues.
The study finds that the U.S. leads in the field of breast and prostate cancer. France excelled in women's colorectal cancer and Japan in men's colorectal cancer. The news isn't all good here: great discrepancies exist between white and African-Americans. That said, the United States clearly leads other nations in overall survival.
These results aren't completely surprising. Though international comparisons are hard to make, Lancet Oncology published last August a comparison of American and European care, and the U.S. fared better in 13 of the 16 cancers studied.
Americans don't usually hear good news stories about health care. Mr. Moore favorably reviewed British, French and even Cuban health care in the movie "Sicko," showing satisfied patients and happy, chic docs. Paul Krugman wrote last year in the New York Times that: "there's very little evidence that Americans get better health care than the British."
Cancer care there is different than here. Take for instance the country whose health-care system Mr. Krugman likes so much. The Lancet Oncology study finds that five-year survival rates for cancer in men, for example, are 45% in England (slightly higher in Wales, lower in Scotland) but 66% in the U.S.
Why do the British lag behind American survival rates? Screening standards are different. In the United States, internists recommend that men 50 and older get screened for colon cancer; in the National Health Service in the United Kingdom, screening begins at 75. And British patients wait much longer to see specialists. A Clinical Oncology study of British lung cancer treatment found in 2000 that 20% "of potentially curable patients became incurable on the waiting list." Novel drugs offered here often aren't available there; for instance, Avastin, a drug for advanced colon cancer, is prescribed more often in the U.S. than in the UK, by some estimates as much as ten-fold more.
A drug called Temodal is the U.S. standard of care for Sen. Kennedy's type of brain cancer. In Britain, a government body charged with funding decisions -- the euphemistically named NICE, or National Institute for Health and Clinical Excellence -- ruled in 2001 that Temodal wasn't worth the money as a first-line treatment; in 2007, they partially lifted the prohibition. Patients can still get the drug, they just need to pay out of pocket -- for all their cancer care. The National Health Service recently ruled that if patients opt out of one type of care (say by getting Temodal), they opt out of all publicly funded care.
Two cheers, then, for American health care and better cancer outcomes. Rising costs, however, threaten to undermine the economy. Not surprisingly, our debate is shifting to a discussion of getting better value from our health dollars. Just last week, the U.S. House of Representatives held hearings on this topic (full disclosure, I was a witness). Former Sen. Tom Daschle and his co-authors speak at length about "value" in their new book, "Critical: What We Can Do About the Health-Care Crisis." Given his potential role in a future Democratic administration, the book may lay out the first outline of ObamaCare.
What's to be done? Mr. Daschle talks up the idea of a federal health-care board charged with "recommending coverage of those drugs and procedures backed by solid evidence. It would exert influence by ranking services and therapies by their health and cost impacts." The inspiration? Mr. Daschle cites Britain's NICE. The Congressional Budget Office is slated to release a paper on this topic later this year.
Given the Concord results, the CBO may want to hold off on that effort. Value -- like in the other five-sixths of the economy -- will come from competition and choice, not a government committee. But the federal government can take a leadership role in promoting competition. How? By creating greater transparency of prices, releasing more Medicare information on complications and outcomes, encouraging hospitals and clinics to standardize their health records, and slashing regulations that discourage competition. Together, these efforts would make it easier for American patients to seek out excellence. And that seems as American as apple pie and good cancer care.
Dr. Gratzer, a physician, is a senior fellow at the Manhattan Institute. His most recent book, "The Cure: How Capitalism Can Save American Health Care" (Encounter Books, 2006), is now out in paperback.
See all of today's editorials and op-eds, plus video commentary, on Opinion Journal.
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I have been leaning towards favoring Romney as Veep for McC, in great part because, unlike McC, he can articulate free market economics pretty well-- but then there is the coming clusterfcuk of Romeny Care-- which will make it hard for McC to challenge BO's promised socialization.
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The Price of RomneyCare
July 29, 2008; Page A16
Gearing up for 2009, liberals are eager to claim Massachusetts as a Valhalla of health reform. Their enthusiasm is apparently evidence-proof.
Even Mitt Romney, who should know better, took to these pages recently to proclaim, "Health-care reform is working in Massachusetts." Shortly after Mr. Romney's self-tribute, Governor Deval Patrick wheeled out a new $129 million tax plan to make up for this year's health spending shortfalls. Yet partisans are cheering the cost overruns as a sign of success.
Supporters are exultant because 350,000 people are newly covered since former Governor Romney's parley with Beacon Hill Democrats in 2006; this cuts the state's uninsured rate by about half. That's not the promised "universal" system, but never mind. The ominous news is that only about 18,000 people -- or 5% of the newly insured -- have taken advantage of the "connector," which was supposed to be the plan's free-market innovation linking individuals to private insurers.
Most of this growth in coverage has instead come via a new state entitlement called Commonwealth Care. This provides subsidized insurance to those under 300% of the poverty level, or about $63,000 for a family of four. About 174,000 have joined this low- or no-cost program, a trend that is likely to speed up.
As this public option gets overwhelmed, budget gaskets are blowing everywhere. Mr. Patrick had already bumped up this year's spending to $869 million, $144 million over its original estimate. Liberals duly noted that these tax hikes are necessary because enrollment in Commonwealth Care is much higher than anticipated. But of course more people will have coverage if government gives it to them for free. The problem is that someone has to pay for it.
Thus the extra tab of $129 million, which may need to go higher because it relies on uncertain federal funds from Medicaid. For now, Mr. Patrick wants one-time (yeah, right) charges of $33 million on insurers and $28 million on providers, plus some shuffling of state funds. The balance comes from an estimated $33 million boost in the state's "pay or play" tax: If businesses don't offer "fair and reasonable" insurance to their employees, they get hit.
This is a textbook example of how business taxes evolve into "pay or pay," the first recourse of state-funded health systems. Politicians love levies on business because they disguise the overall bill from voters. But such taxes are merely passed along to workers in the form of reduced take-home pay, since all health costs are part of compensation.
The main reason people are uninsured is because coverage is too expensive. Massachusetts didn't have many options for reforming the way health dollars are laundered in the third-party payment system created by the federal tax code. But it could have helped make insurance cheaper by reforming its private market before defaulting to public programs.
The Bay State has long served up coverage-specific insurance mandates, such as for fertility treatments, which raise costs. Yet in a just-deserts twist, Massachusetts health planners are now reviewing ways to trim mandates because the state is footing more of the bill, even if they didn't care when imposing them on individuals and small business. A state-sponsored study shows that total spending on mandates was $1.32 billion in 2005, or 12% of premiums. The study is devastating despite its pro-mandate slant.
Not that such practical lessons have stopped liberals from joining the Massachusetts parade. They have to gussy up the state's model because the extravagant claim that led to its creation -- that health care will be less expensive if everyone is covered -- is being relentlessly discredited. It's the same claim they want to make when they try to pass a similar plan for the whole country in next year's Congress.
See all of today's editorials and op-eds, plus video commentary, on Opinion Journal.
And add your comments to the Opinion Journal
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Pulling the Trigger
August 2, 2008; Page A10
Let's hope Capitol Hill never catches fire. Congress would switch off the alarm and pretend there were no flames. That, at least, was the policy message sent by Speaker Nancy Pelosi and her health-care enforcers when the House voted last week to deactivate a warning that entitlement spending is running amok.
Everybody has known forever that Medicare's spending trend is untenable. The program soaked up 3.2% of GDP and 16% of all federal spending in 2007, and it is expected to grow by 7.4% or more a year over the next decade. The Tom DeLay Republicans made the problem worse with their 2003 prescription drug benefit, but in doing so they felt a twinge, a flicker, a memory flash of fiscal conscience. So as a token gesture Republicans added a "trigger" that was supposed to force some future Congress to address the program's long-term insolvency.
The trigger kicks in if Medicare's Trustees project, for two years in a row, that the program will draw more than 45% of its funding from general government revenue -- instead of from payroll taxes, or premiums and co-pays from beneficiaries. That has happened for the last two years, and probably will every year for the foreseeable future. And when it does, the White House is required to write up "corrective" legislation. Under special procedures, the White House proposal is guaranteed an up-or-down vote in the House, though not the Senate.
The trigger doesn't actually require any cost-saving, much less real discipline. All it does is oblige the political class to nod at Medicare's deteriorating finances. But even that minor annoyance is too much for Democrats, so the House voted 231-184 last Thursday to change the rules to avoid considering President Bush's proposal.
Not that the Administration's proposal is ambitious. It would merely slow the rate of spending growth enough to shut off the 45% trigger. Provisions include moving toward electronic health records and a microincrease in prescription drug premiums for 1.5 million wealthy seniors. The horror!
Congress was free to reject any of this. But a vote might draw attention from the otherwise sleepy Capitol Hill press corps, and Democrats objected even to having the discussion. Liberal health-care maharishi Pete Stark wailed about "a political ploy to foster an unfounded panic," while Majority Leader Steny Hoyer called the trigger "completely arbitrary."
Democrats have tried repeatedly since 2006 to abolish the trigger because it gets in the way of their health-care agenda, even if only a little bit. Barack Obama has plans for a slow-motion roll toward "Medicare for all," the ultimate goal of Democratic health policy. The trigger reminds people of how spendthrift and taxing the budget for Medicare already is -- even when it's reserved only for seniors.
The House vote stalls action until the next Administration, when Democrats will almost certainly dump the trigger entirely.
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For those of us who have had quite enough of lipsticked pigs and the politics of personality, here is an effort at discussing the issues from BO's team posting at the WSJ
Why Obama's Health Plan Is Better
By DAVID M. CUTLER, J. BRADFORD DELONG and ANN MARIE MARCIARILLEArticle
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The big threat to growth in the next decade is not oil or food prices, but the rising cost of health care. The doubling of health insurance premiums since 2000 makes employers choose between cutting benefits and hiring fewer workers.
Rising health costs push total employment costs up and wages and benefits down. The result is lost profits and lost wages, in addition to pointless risk, insecurity and a flood of personal bankruptcies.
APSustained growth thus requires successful health-care reform. Barack Obama and John McCain propose to lead us in opposite directions -- and the Obama direction is far superior.
Sen. Obama's proposal will modernize our current system of employer- and government-provided health care, keeping what works well, and making the investments now that will lead to a more efficient medical system. He does this in five ways:
- Learning. One-third of medical costs go for services at best ineffective and at worst harmful. Fifty billion dollars will jump-start the long-overdue information revolution in health care to identify the best providers, treatments and patient management strategies.
- Rewarding. Doctors and hospitals today are paid for performing procedures, not for helping patients. Insurers make money by dumping sick patients, not by keeping people healthy. Mr. Obama proposes to base Medicare and Medicaid reimbursements to hospitals and doctors on patient outcomes (lower cholesterol readings, made and kept follow-up appointments) in a coordinated effort to focus the entire payment system around better health, not just more care.
- Pooling. The Obama plan would give individuals and small firms the option of joining large insurance pools. With large patient pools, a few people incurring high medical costs will not topple the entire system, so insurers would no longer need to waste time, money and resources weeding out the healthy from the sick, and businesses and individuals would no longer have to subject themselves to that costly and stressful process.
- Preventing. In today's health-care market, less than one dollar in 25 goes for prevention, even though preventive services -- regular screenings and healthy lifestyle information -- are among the most cost-effective medical services around. Guaranteeing access to preventive services will improve health and in many cases save money.
- Covering. Controlling long-run health-care costs requires removing the hidden expenses of the uninsured. The reforms described above will lower premiums by $2,500 for the typical family, allowing millions previously priced out of the market to afford insurance.
In addition, tax credits for those still unable to afford private coverage, and the option to buy in to the federal government's benefits system, will ensure that all individuals have access to an affordable, portable alternative at a price they can afford.
Given the current inefficiencies in our system, the impact of the Obama plan will be profound. Besides the $2,500 savings in medical costs for the typical family, according to our research annual business-sector costs will fall by about $140 billion. Our figures suggest that decreasing employer costs by this amount will result in the expansion of employer-provided health insurance to 10 million previously uninsured people.
We know these savings are attainable: other countries have them today. We spend 40% more than other countries such as Canada and Switzeraland on health care -- nearly $1 trillion -- but our health outcomes are no better.
The lower cost of benefits will allow employers to hire some 90,000 low-wage workers currently without jobs because they are currently priced out of the market. It also would pull one and a half million more workers out of low-wage low-benefit and into high-wage high-benefit jobs. Workers currently locked into jobs because they fear losing their health benefits would be able to move to entrepreneurial jobs, or simply work part time.
In contrast, Sen. McCain, who constantly repeats his no-new-taxes promise on the campaign trail, proposes a big tax hike as the solution to our health-care crisis. His plan would raise taxes on workers who receive health benefits, with the idea of encouraging their employers to drop coverage. A study conducted by University of Michigan economist Tom Buchmueller and colleagues published in the journal Health Affairs suggests that the McCain tax hike will lead employers to drop coverage for over 20 million Americans.
What would happen to these people? Mr. McCain will give them a small tax credit, $5,000 for a family and $2,500 for an individual, and tell them to navigate the individual insurance market on their own.
For middle- and lower-income people, the credits are way too small. They are less than half the cost of policies today ($12,000 on average for a family), and are far below the 75% that most employers offering coverage contribute. Further, their value would erode over time, as the credit increases less rapidly than average premiums.
Those already sick are completely out of luck, as individual insurers are free to deny coverage due to pre-existing conditions. Mr. McCain has proposed a high-risk pool for the very sick, but has not put forward the money to make it work.
Even for those healthy enough to gain coverage in the individual insurance market, the screening, marketing and individual underwriting that insurers do to separate healthy from sick boosts premiums by 17% relative to employer-provided insurance, well beyond the help offered by the McCain tax credit.
The immediate consequences of the McCain plan are even worse. The McCain plan is a big tax increase on employers and workers. With the economy in recession, that's the last thing America's businesses need.
Finally, Mr. McCain does nothing to bend the curve of rising health-care costs downward. He does not fund investments in learning, rewarding and preventing. Eliminating state coverage requirements will slash preventive service availability.
The high cost-sharing plans he envisions will similarly discourage preventive care. And as he does nothing about the hidden costs of the uncovered -- expensive ER visits, recurring conditions resulting from inadequate follow-up care.
Everyone agrees our health-care financing system must change. But only one candidate, Barack Obama, has real change we can believe in.
Mr. Cutler is professor of economics at Harvard and an adviser to Barack Obama's presidential campaign. Mr. DeLong is professor of economics at University of California, Berkeley. Ms. Marciarille is adjunct law professor at McGeorge School of Law.
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Well here is that Cutler guy again. Does one find it interesting he is a 'Harvard economist' advising how health care should be distributed? I am sure he is a die hard political neutral (sarcasm emphasized). From New England Journal on Cutler and the rest of the "experts". BTW, remember "prevention" is not always synonomous with lower costs.
***Volume 359:1085-1087 September 11, 2008 Number 11
Next
Speaking Truth to Power — The Need for, and Perils of, Health Policy Expertise in the White House
Jacob S. Hacker, Ph.D.
President Harry Truman once famously wished for a one-handed economist, because the ones advising him were forever saying, "On the one hand . . . but on the other hand. . . ." President George W. Bush went one appendage further: "If [these economists] had three hands they'd say, on the one hand, on the other hand, and then on the third hand."1 Yet presidents keep coming back to economists and other policy experts, especially in the fiendishly complex field of health care. Democratic presidential candidate Barack Obama leans on Harvard economist David Cutler; his larger stable of health advisers includes Austin Goolsbee and Jason Furman, both economists. Republican John McCain relies on economics Ph.D. Gail Wilensky, as well as on the former director of the Congressional Budget Office, Douglas Holtz-Eakin, another economist.
Economists are not, of course, the only experts to which presidents and presidential aspirants turn. On health care, Obama and McCain are advised by lawyers, doctors, holders of public-policy degrees, and the occasional noneconomist social scientist. What remains constant is the role these advisers occupy, a role awash in ambiguity, opportunity, and risk. The adviser is the president's ally — in the lingo of organizational economics, an "agent" serving the interests of a "principal." Yet as a bearer of specialized knowledge, the adviser is also responsible to a larger profession, to its values and commitments, and ultimately to the ideal of expertise itself.
The adviser, in short, must both "speak truth to power" and aid in the exercise of power, both offering unbiased intelligence and acting as a very biased assistant. It is fashionable to pretend these two roles are the same, but they are not. An expert adviser has special knowledge, training, and skills — all of which are needed more than ever in the White House. The question is whether these talents can really be used, or be useful, in the bare-knuckles world of American politics — and, more important, whether the values they embody can be upheld when science, advocacy, and democracy collide.
Consider the travails of noted health policy expert Len Nichols. As Hillary Clinton battled for the Democratic nomination, Nichols joined a conference call for reporters set up by her campaign. The topic was an Obama advertisement charging that Clinton would force people to buy insurance "even if they can't afford it." On the call, Nichols likened the ad to "having Nazis march through Skokie" — a depiction the Clinton campaign immediately disavowed. Shortly thereafter, Nichols apologized for letting his "passions" overwhelm him. The head of the New America Foundation, where Nichols works, declared his comments "regrettable," not least because the foundation "does not endorse or advise any campaign in an official capacity."2
Nichols's sin — besides the obvious rhetorical offense — was to cross the line between expert and partisan. Politics is about power more than truth, about winning more than being right. But expertise is about truth more than power, and being right is the whole point. The authority of the expert cannot survive long when expert judgment is seen to hinge on grudges or biases. The abiding concern of the expert adviser is how to maintain independence while acting as a faithful ally and advocate — how to make power serve truth while still serving the principal.
Yet the greater, and more vexing, problem is far less recognized: the limits of expertise itself. When the Clinton administration's health plan died in 1994, many dismissed its health policy advisers as naive. And yet the closest of these advisers were not just highly regarded health policy experts, they were some of the most knowledgeable the White House has ever seen. Paul Starr, who had masterfully dissected the past failure of national health insurance, left Princeton to help write the plan. Scores of other experienced policy gurus — including Len Nichols — lent their wisdom. Even Ira Magaziner, the much-maligned policy wonk who oversaw the president's gargantuan health care task force, had more than a passing familiarity with health and economic policy. All of them had studied the lessons of history — and ended up repeating them anyway.
The modern presidency demands expertise. The rise of a massive, interconnected executive branch, the ever-increasing complexity of public policy, the "permanent campaigns" of contemporary elections, with their endless issues, talking points, and proposals — all make the president's job as much about fostering and managing competing information streams and creating communities of allied expertise as about fulfilling the authoritative role President Bush evocatively termed "the decider." Contemplating Dwight Eisenhower's arrival, Harry Truman foresaw the challenge for the former general as presidential impotence: "He'll sit here, and he'll say, `Do this! Do that!' And nothing will happen."3 But the more basic challenge may be to decide what to do on issues as varied and complex as global warming and stem-cell research, health care financing and financial-market regulation. Here expertise is invaluable, unavoidable — and sometimes, as the failure of the Clinton plan reminds us, perilous.
Health policy experts can do more sophisticated analyses than ever, and there are more of them than ever, too — in policy schools, departments of economics, schools of public health, think tanks, private foundations, and government. But the progress in quality of expertise has not been matched by progress in thinking about the role of the expert or about how policy advice can and should be adapted to the political realities that those receiving advice inevitably confront. Policy experts are brilliant when it comes to designing proposals but often horrible at thinking through the ways in which their proposals will be refracted through the political prism. Subtle visions of policy are wedded to crude caricatures of politics, and, not surprisingly, those visions all too often either fail to become reality or fail to work.
Worse, the expert's claim to authority can undercut the more important wellspring of democratic leadership: the demands and wishes of the people. Experts are habitually disdainful of what ordinary citizens believe. People have opinions; experts have facts. When a well-regarded economist complains that democratic policy choice should be restricted because "irrational" voters endorse all sorts of harmful nostrums — whether trade protection or farm price supports (he might have added health insurance with low deductibles, drug price controls, and free choice of doctors) — he may be out on a limb.4 But the tree is one that many policy experts climb.
Ironically, then, the failure of the Clinton administration's plan was made more, not less, likely by the amount of policy expertise poured into its design. The Clinton advisers sought the ideal policy synthesis. Though aware of political realities, they treated them as problems of policy design, to be managed within the confines of the president's blueprint rather than incorporated into a political strategy that would make the president's goals and ideals, not a 1342-page bill, the guiding light of congressional debate. And the advisers designed the proposal knowing full well that many of its elements, such as greater emphasis on tightly managed health plans, were at odds with what most of the public professed to want. That was a problem for the political consultants, who would try to figure out how to "sell" Americans on what was good for them. The result was a fiasco — and a cautionary tale about the limits of expert presidential advice in an age that demands it.
This time around, health policy advisers — whatever their formal background, and whether two-handed or more Vishnu-like — would do well to take a different tack. We badly need health care experts in the White House who offer advice based on evidence and analysis, not prejudice. But even the best experts need to know when to defer to the political process, to see the purpose of their craft as facilitating democratic debate rather than providing final answers once Americans have decided on the questions.
Winston Churchill once said that "scientists should be on tap, not on top."5 That is a good starting point. But sometimes presidential policy experts should also have the good sense to get out of the way.
Dr. Hacker reports receiving advisory board fees from Pfizer and speaking fees from America's Health Insurance Plans, both of which he reports donating to charity. No other potential conflict of interest relevant to this article was reported.
Source Information
Dr. Hacker is a professor of political science at the University of California at Berkeley, codirector of Berkeley Law School's Center on Health, Economic, and Family Security, Berkeley, CA, and a fellow at the New America Foundation, Washington, DC.
References
President Bush discusses economy, trade. Washington, DC: The White House, May 2, 2008. (Accessed August 22, 2008, at http://www.whitehouse.gov/news/releases/2008/05/20080502-8.html.)
Melber A. Clinton surrogate compares Obama ad to Nazi march [updated]. The Nation. February 1, 2008. (Available at http://www.thenation.com/blogs/campaignmatters?bid=45&pid=278988.)
Neustadt RE. Presidential power: the politics of leadership. New York: Wiley, 1960.
Caplan B. The myth of the rational voter: why democracies choose bad policies. New Haven, CT: Yale University Press, 2007.
Rose N. Churchill: an unruly life. New York: Simon & Schuster, 1994.
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Studies Detail Contrasts in Rivals' Health-Care Plans
Obama's Proposal Would Insure More but at Higher Cost
By LAURA MECKLERArticle
WASHINGTON -- Republican presidential candidate John McCain's health-care plan would make only a small dent in the ranks of the uninsured, at best covering about five million more people, two new reports conclude.
Democratic nominee Barack Obama would cover more people -- eventually adding about 34 million, according to one of those reports, by the nonpartisan Tax Policy Center.
Barack Obama
Sen. Obama's plan would be costly, the center concluded: $1.6 trillion over 10 years. Sen. McCain's would cost nearly as much: $1.3 trillion over the same span. The center doesn't give either campaign credit for initiatives to reduce the cost of health care.
The advantages of the McCain plan, according to the reports, are less government regulation, a more generous tax break and, for many, more flexibility and choice in where to buy coverage.
The Tax Policy Center called its estimates for both plans preliminary because neither campaign has put out enough information to provide a full evaluation. Similarly, a pair of studies analyzing the candidates' plans, being published Tuesday in Health Affairs, a peer-reviewed policy journal, found many details lacking. But the campaigns have made clear what direction they would take the health-care system. The differences provide a sharp contrast for voters.
Neither plan would offer universal coverage, though Sen. Obama regularly says his would. Critics of each plan suggest the other would erode the employer-based system that currently covers some 170 million people.
The reports shed new light on the potential and the problems of each plan.
THE OBAMA PLAN:
Sen. Obama would give consumers more options, but he would increase federal regulations.
He would create a new government-run plan as well as an "exchange" in which private companies would offer insurance to compete with the government plan. New rules would require that insurance companies provide coverage to everyone, at consistent prices, even those with existing ailments. Parents would be required to cover their children, and large employers would be required to cover their workers or pay a fine.
It amounts to a significant amount of new regulation, health experts Joseph Antos, Gail Wilensky and Hanns Kuttner write in Health Affairs.
"Each of these [new rules] extends the control of government over health insurance, imposing new requirements that will drive up the cost of insurance," they write.
The government-run plan would set a minimum standard for benefits that private plans would have to meet, they explain. Politically, there will be pressure to include generous benefits, they say, and that will lead to high premiums, leaving few options for those who want cheaper, more basic coverage.
It is likely that companies would be required to offer the same generous benefits to their workers, they say -- another increase in government regulation. Still, the impact on the uninsured is significant. Overall, the Tax Policy Center predicts that the Obama plan would reduce the number of uninsured by 18 million people in the first year and by 34 million in 10 years.
THE McCAIN PLAN:
Sen. McCain would reduce both state and federal regulations and give consumers more choices about where to buy health insurance.
Current law offers a tax break only to those who get insurance through their jobs. The McCain plan would give a refundable tax credit to all who find coverage: $2,500 per person or $5,000 per family. In trade, workers would pay income taxes on the value of health insurance as part of their compensation.
But, unlike a similar plan put forth by President George W. Bush last year, health benefits still would be exempt from the payroll tax paid by workers and employers, and that is why the McCain plan is more expensive than Mr. Bush's, said Len Burman, director of the Tax Policy Center. Because people could buy insurance on their own, some would leave the employer-sponsored system, especially young and healthy people who can get a better deal on their own. Older, sicker people are likely to face problems buying coverage.
Overall, the Tax Policy Center and the four academics writing in Health Affairs project that about 20 million would leave employer-sponsored coverage, while about 21 million people would be newly covered on the open market. That is a net increase of about one million insured people.
"Many employers would be quick to drop health benefits in response to a major policy change, such as the McCain plan, that greatly altered the business case for offering benefits," the article concludes. The Tax Policy Center projects that the number of newly insured Americans could climb in future years and perhaps reach five million people before dropping again.
The Health Affairs article, whose lead author is Thomas Buchmueller of the University of Michigan, finds other problems with the McCain plan. Because administrative costs are higher on the open market, where insurers evaluate customers individually, he predicts that coverage would be more expensive but less generous.
The McCain plan would allow consumers to buy insurance across state lines. That would give people more choices, but it also would undermine state laws that mandate certain benefits and provide various consumer protections.
Write to Laura Meckler at laura.meckler@wsj.com
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"According to an August 2008 study published in Lancet Oncology, the renowned British medical journal, Americans have a better than five-year survival rate for 13 of the 16 most prominent cancers when compared with their European and Canadian counterparts.
With breast cancer, for instance, the survival rate among American women is 83.9 percent. For women in Britain, it’s just 69.7 percent. For men with prostate cancer, the survival rate is 91.9 percent here but just 73.7 percent in France and 51.1 percent in Britain.
American men and women are more than 35 percent more likely to survive colon cancer than their British counterparts."
http://www.dcexaminer.com/opinion/columns/guestcolumnists/Is_the_grass_greener_with_socialized_medicine.html
Is the grass greener with socialized medicine?
By Sally C. Pipes
Special to the Examiner | 8/23/08 7:35 PM With Democrats convinced 2008 is their year, the campaign trail is awash with promises to make universal health care a reality by the end of the next president’s first term.
The basic argument of those who support a government takeover of the health care system is familiar. As New York Times columnist Paul Krugman once put it, “America’s health care system spends more, for worse results, than that of any other advanced country.”
Krugman’s line has been repeated so often it’s considered gospel truth in most public debates — people rarely check to see if it matches the facts. As the American humorist Josh Billings quipped, “the problem with the world ain’t ignorance, it’s the things people know that just ain’t so.”
If they did, they’d probably be surprised. Socialized health care isn’t all it’s cracked up to be.
Take the much-vaunted Canadian system. More than 825,000 Canadian citizens are currently on waiting lists for surgery and other necessary treatments. Fifteen years ago, the average wait between a referral from a primary-care doctor to treatment by a specialist was around nine weeks. Today, that wait is over 16 weeks.
That’s almost double what doctors consider clinically reasonable. As Canadian physician Brian Day explained to The New York Times, Canada “is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years.”
In part, these waits are due to a doctor shortage. According to the Organization for Economic Cooperation and Development, Canada ranks 24th out of 28 countries in doctors per thousand people.
Why so few doctors? Over the past decade, about 11 percent of physicians trained in Canadian medical schools have moved to the United States. That’s because doctors’ salaries in Canada are negotiated, set and paid for by provincial governments and held down by cost-conscious budget analysts. Today, in fact, the average Canadian doctor earns only 42 percent of what a doctor earns in the United States.
Canada also limits access to common medical technologies. When compared with other OECD countries, Canada is 13th out of 24 in access to magnetic resonance imagings, 18th of 24 in access to computed tomography scanners, and seventh of 17 in access to mammograms.
The problems plaguing Canada are characteristic of all universal health care systems.
In Britain, more than 1 million sick citizens are currently waiting for hospital admission. Another 200,000 are waiting just to get on a waiting list. Each year, Britain’s National Health Service cancels around 100,000 operations.
Britain even has a government agency explicitly tasked with limiting people’s access to prescription drugs. Euphemistically called the National Institute for Health and Clinical Effectiveness, the agency determines which treatments the British health care system covers. More often than not, saving money takes priority over saving lives.
In 2008, for instance, NICE refused to approve the lung cancer drug Tarceva. Despite numerous studies showing that the drug significantly prolongs the life of cancer patients — and the unanimous endorsement of lung cancer specialists throughout the United Kingdom — NICE determined that the drug was too expensive to cover relative to its effectiveness. As of August 2008, England is one of only three countries in Western Europe that denies citizens access to Tarceva.
Britain’s behavior is typical — every European government rations drugs to save money. Eighty-five new drugs hit the U.S. market between 1998 and 2002. During that same time period, only 44 of those drugs became available in Europe.
The evidence clearly indicates that patients under socialized medicine are suffering. Why, then, do countries with government-run health care consistently outrank the United States on international quality surveys?
It’s not because the American health care system is inferior. It’s because these surveys use deeply flawed metrics that don’t reflect health care quality.
Case in point: The World Health Organization rankings of overall health system performance placed the United States 37th out of 191 countries. That’s behind not only Canada, Britain and France, but even countries like Costa Rica, Morocco and Cyprus.
Life expectancy accounted for 25 percent of a nation’s WHO ranking. But life expectancy is the function of a variety of factors. Medical care is just one of them. Just as important are a nation’s homicide rate, the number of accidents, diet trends, ethnic diversity and much more.
Another factor accounting for 25 percent of a nation’s ranking was “distribution of health,” or fairness. By this logic, treating everyone exactly the same is more important than treating people well. So long as everyone is equal — even if they’re equally miserable — a nation will do quite well in the WHO rankings.
In measuring the quality of a health care system, what really matters is how well it serves those who are sick. And it’s here that America really excels.
According to an August 2008 study published in Lancet Oncology, the renowned British medical journal, Americans have a better than five-year survival rate for 13 of the 16 most prominent cancers when compared with their European and Canadian counterparts.
With breast cancer, for instance, the survival rate among American women is 83.9 percent. For women in Britain, it’s just 69.7 percent. For men with prostate cancer, the survival rate is 91.9 percent here but just 73.7 percent in France and 51.1 percent in Britain.
American men and women are more than 35 percent more likely to survive colon cancer than their British counterparts.
It’s no wonder then that foreign dignitaries living in countries with socialized health care systems routinely come to this country when they need top-flight medical treatment.
When Italian Prime Minister Silvio Berlusconi needed heart surgery in 2006, he traveled to the Cleveland Clinic — often considered America’s best hospital for cardiac care. When Canadian Member of Parliament Belinda Stronach, who had denounced a two-tier health care system for Canadians, needed breast cancer surgery herself in 2007, she headed to a California hospital and paid out of pocket.
So much for the “free” health care they could have received at home.
As for the supposed cost advantages of socialized medicine? Those are illusory, too. True, other developed nations may spend less on health care as a percentage of gross domestic product than the United States does — but so does Sudan. Without considering value, such statistical evaluations are worthless.
And one of the primary reasons health care costs more in America is that we are a wealthy country that demands the best. And, we’re investing a lot more in medical research.
The United States produces over half of the $175 billion in health care technology products purchased globally. In 2004, the federal government funded medical research to the tune of $18.4 billion. By contrast, the European Union — which has a significantly larger population than the United States — allocated funds equal to just $3.7 billion for medical research.
Between 1999 and 2005, the United States was responsible for 71 percent of the sales of new pharmaceutical drugs. The next two largest pharmaceutical markets — Japan and Germany — account for just 4 percent each.
While no one can deny that there are significant problems in the American health care system, overall it provides exceptional value. The ideologues who claim we’d be better off under socialized medicine are massively wrong. Government-run health care has proven to be heartless and uncaring — and the inferior treatments it provides come with a very steep price tag.
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Crafty I suppose you are self employed, do you have any health insurance tips for someone looking to buy their own health insurance. The policy I have through work sucks, so I am looking around, to see if I can do better on my own.
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About all I can offer is that by being a corporation, I can deduct the cost of my health insurance, rather than pay for it with after tax dollars.
Also, I would give a VERY serious look at Health Savings Accounts. HSAs have a lot to recommend them.
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I have a question:
Lets say I don't have health care because I can't afford it. Would socialized health care be better or worse for me?
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"Lets say I don't have health care because I can't afford it. Would socialized health care be better or worse for me?"
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Free lunch may taste good, but in the long view, I think you are worse off. Just my opinion. It really depends on how you feel about mandating someone else to pay your basic living expenses.
'Can't afford it' has two components, income and the (artificially) high cost of health care. Poor people in America already have free health care. It's amazing to see how they use the money they save on other things.
Why are health care expenses artificially high? Third party pay. There is a disconnect between the user of the service and the payer of the service that removes market spending discipline. Price is the most efficient way of allocating a scarce resource. Unfortunately, the more important the resource the more we turn to less efficient methods.
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In the long run you are right Doug... but I don't think many people consider that.
I am a single guy, with no dependents... and I bring in a good wage... I am already paying for plenty of other peoples basic living expenses so I feel you there as well. I am not sure that poor people are really capable of saving money. If they could they would not really be poor would they? I guess that is a little off topic...
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Crafty I suppose you are self employed, do you have any health insurance tips for someone looking to buy their own health insurance. The policy I have through work sucks, so I am looking around, to see if I can do better on my own.
In a previous life, I was an Employee Benefit Consultant for a very large Employee Benefit Consulting Firm. Mostly large to very large clients, but for buying health insurance, the concept is the same. I guess Tankerdriver the question is, "Are you healthy?" No one can predict the future, but today, are you healthy? And, given your genes, are you healthy? And finally, it depends on age. But let's assume you are healthy and reasonably young (under 40) then Crafty is right, an HSA is the way to go. Why? You can save a lot of money tax deferred (don't forget to put away the money for a rainy day), you can buy a "quality" medical plan" and it's portable. Portable is important. The plan you belong to, your employer's plan, you must remember it isn't yours. Yes, if you quit or a laid off, you have COBRA for 18 maybe 36 months, but after that you have zero; not good if you have a heart attack, cancer, etc. After COBRA runs out, if you are healthy, fine, but if not, you can't buy health insurance at any price when you really need it. The counter argument is that your employer's plan usually offers pretty good low deductible benefits (maybe you have a choice of plans?) and it is free (employer paid) or minimal cost to you. If you truly have job security, i.e. police, fire, government employee, etc. maybe that is the way to go, but...
I have an excellent quality, albeit expensive HSA. I must pay the first $2400.00 out of my own pocket (an incentive to stay healthy) but that is ok because overall I have been blessed with good health. I rarely need to go to the doctor. And I am self employed. And if something happens I want to go to the "best" doctors and hospitals, not the ones on a limited list. But if I were you and had an ongoing or chronic problem, then I might consider joining a group plan if I had that choice. Also, note, as you get older, you HSA premium will rise becoming much more expensive than a group plan. I pay a small fortune for a plan I (almost) never use yet I don't consider being without it. You never know and while I can afford $2400.00 I can't afford $500,000+ for a serious illness. It happens.
As for "poor people in America already have free health care" that is true, albeit a very poor substitute for quality care. Many/most doctors, especially your top tier will not treat non pay patients. And many top hospitals will reject that patient. And you might get the CT Scan, but they will say you really don't need the MRI (too expensive is what they mean) and you want the new cancer drug, well forget it, it's too expensive. The quality of care is second class, no third class or worse. it's not only my opinion, although from personal experience I have been treated different when they thought I didn't have but later found out I did have good coverage, but numerous studies and books show the disparity of quality care. Is that right? Is that fair? I don't know, I guess it's a different subject.
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Does everyone deserve the same level of healthcare?
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My inclination is that No, not every deserves the same level of healthcare... but I say that with caution. Although some people are no doubt in the situation they are in by choice, you can't choose who your parents are, and your parents more or less determine what type of healthcare you get as a child.
That waitress that works 60 hours a week to raise her kids might not be able to afford the best healthcare... but does that mean she deserves it less than a wealthy banker? What about a convicted felon?
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"Does everyone deserve the same level of healthcare?"
Of course that could mean does everyone deserve mediocre care or does everyone deserve the health care of royalty, free back massages, tummy tucks, costly experimental meds, you name it. And do they deserve it to be free or paid by someone else.
To make the answer - yes - I would ask it differently, does everyone in this country deserve the right to choose and purchase health care from the same menu of choices and costs?
Does everyone deserve to live in the largest mansion? Does everyone deserve oceanfront property? Does everyone deserve to dine in the same restaurant? Every night of the week? No, you have to earn, save and choose the best. Or you can make other choices. Some would rather live a block from the ocean and put the rest of the money toward something else. Does everyone deserve admittance to the best college? Does every golfer deserve Tiger's winnings? Does every man deserve to sleep with the planet's most beautiful woman?
We guarantee 'same' level of health care only by banning above average care. How does that make us better off?
Health Care is more equal in Europe but survival rates for the most likely ailments you could face are far worse:
http://www.medscape.com/viewarticle/561737
"Survival was significantly higher in the United States (than Europe) for all solid tumors, except testicular, stomach, and soft-tissue cancer, the authors report. The greatest differences were seen in the major cancer sites: colon and rectum (56.2% in Europe vs 65.5% in the United States), breast (79.0% vs 90.1%), and prostate cancer (77.5% vs 99.3%),
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I suppose it depends upon the definition of "same level of healthcare".
Are you entitled to the same rich (low deductible, little out of pocket, PPO choice) benefit plan? I don't think so; that is what I think DougMacG was alluding to. Are you entitled to a short wait, fast service, and the very best doctors; probably not. But are you entitled to an MRI when your knee looks like a pretzel? Are you entitled to stay one more day in the hospital if you can't even stand up? Are you entitled to that expensive drug that may save you life or at least take away the pain? Are you entitled to a plastic surgeon after a car accident? A respected Orthopedic surgeon versus a resident? I don't know the answer, but if you don't have insurance in this country, too bad, you lose.
As for survival rates, DougMacG was a bit disingenuous. America, as it concerns very high cost treatment items like cancer is superb where star war technology rules. However, if you look at overall rankings of America's Health Care we are rarely in the top 10 and often are not even in the top 20 among industrialized nations. Plus on any chart our morbidity and mortality rankings are quite low. Yet we spend, by far, the greatest amount per capita on heath care. Still, the survival rates for the most likely ailments you could face are far worse in America.
Yes, if you are very rich, America is the place to be. Unfortunately, we are not all rich. And God help the person who had a good corporate medical plan, but was laid off and now cannot buy insurance. He'll soon be joining the poor after he sells his house and all his belongings.
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Healthy Line of Attack
By the Editors
In recent days, Barack Obama’s campaign has intensified its attacks on John McCain’s proposal for reform of our health-insurance system. Based on a spate of recent radio and television ads, and on the line Joe Biden took in last week’s vice-presidential debate, McCain should expect some sharp attacks against his bold proposal in this tonight’s debate. He should be ready to respond, because the attacks are either false or grossly distorted, and his plan deserves to be defended and touted.
The McCain plan begins by addressing the fundamental health-care concern of the middle class: that insurance is too expensive, too rigid, and too insecure. Rising premiums are pushing down take-home wages, the choice of insurance plans is made by the company and not by the family, and leaving a job means losing coverage in uncertain times. The solution, McCain argues, is to put more control in the hands of families rather than holding them hostage to their employers’ plans.
Today, most Americans have only as many insurance options as their employer provides — which is usually one, take it or leave it. This is largely a function of bad government policy. Federal law says that if your employer buys your insurance, the money he spends (which is taken out of your wages) is not counted as part of your income, and so is not taxed. But if you buy your insurance yourself, you do pay taxes on the money you use. For six decades, this has provided an enormous incentive to opt for employer-provided health insurance and has kept a real market for individually purchased coverage from developing. This is an enormous disadvantage for those who don’t have the option of employer-based coverage or who have needs that aren’t met by their employer-based plans.
The McCain plan begins by erasing the distinction between employer-provided and individually purchased health insurance. It replaces the existing tax deduction with a tax credit of $2,500 per person (or $5,000 per family) offered to everyone, regardless of whether their employer offers health coverage.
If you now get insurance from work and want to continue to do so, what your employer pays for your coverage will now count as income, but the credit will more than cover your additional taxes — you keep your coverage, and even end up with a little more money in your pocket at tax time. If you now get insurance from work but would rather choose a different plan — or if are dropped from your current coverage — the wages your employer now takes out for insurance would become regular cash wages, and together with the new tax credit will let you buy the insurance you want independently. Again, you end up with more options and more money at the end of the day. If you don’t have insurance today, or are getting it on your own, the tax credit will help you better afford it. In every case, you end up with more money, more options, and more control over your own health insurance.
Meanwhile, the McCain plan also seeks to vastly increase options and reduce costs by allowing competition in the insurance industry across state lines, which would allow many who are now uninsured to get private coverage. It would help protect vulnerable patients with preexisting conditions by expanding risk pools and by providing subsidies for private coverage for those with low incomes.
The Obama campaign’s attacks on the plan have been astoundingly dishonest. In last week’s debate, Sen. Biden claimed McCain’s plan would raise taxes on middle-class families, when every independent assessment has shown it would lower their tax burden. He argued it was tantamount to what has sent Wall Street into a tailspin — but the more accurate analogy to the mess in our housing market is the Obama health-care plan, which would have the government compete with private insurers and distort the market by confusing politics with economics just as Fannie Mae and Freddie Mac have done.
Indeed, the Obama campaign’s increasingly fervent attacks serve mostly to take attention away from the details of their own health-care proposals, which would price private insurers out of business, subsidize a government-run alternative, levy a heavy new tax on employment, and misspend many hundreds of billions of dollars just as we are entering difficult economic times.
Long-term, Obama’s plan amounts to putting the whole country on Medicare, which would reduce the quality of care, empower bureaucrats over doctors and patients, and, quite possibly, bankrupt the federal government. McCain’s plan envisions instead a competitive market for health insurance, which would give patients more options and more control, leave taxpayers with more money in their pockets, and ensure our thriving biomedical research industry an opportunity to keep developing new treatments and technology.
The McCain plan deserves a defender and champion this week, and John McCain should finally step up and become one in tonight’s debate.
National Review Online - http://article.nationalreview.com/?q=NmU4MmE4ODZjNGU1MmQ5NThiN2M2YTIzNjUxZjhiNWY=
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For someone running as the tribune of "change," Barack Obama showed again in last night's debate that he sure is comfortable with the status quo on health care. He continued his recent assaults on John McCain's health reform even though it is precisely the kind of plan that someone of Mr. Obama's professed convictions ought to support.
APThe attacks include swing-state TV spots and Joe Biden's multiple distortions, though the most over-the-top come from the candidate himself. Over the weekend, Mr. Obama called the McCain plan "radical," "out of line with our basic values" and, in case he wasn't clear, "catastrophic for your health care." Since Mr. McCain offered only a once-over-lightly defense of his plan, allow us to give it a try.
Perhaps Mr. Obama is so agitated because Mr. McCain's proposal is highly progressive. The Republican wants to readjust the subsidies that Congress channels into health coverage for business so that lower- and middle-wage workers aren't shortchanged, as they are now. Currently, people who get insurance through their employers pay no income or payroll taxes on the value of the benefit. This is revenue the government forgoes to encourage certain behavior. If those losses were direct spending, the tax exemption would have cost more than $246 billion in 2007.
But all that money props up only employer-provided insurance. For reasons of historical accident and lobbying clout, individuals who buy policies get no tax benefits and pay with after-tax dollars. Mr. McCain is proposing to make the tax benefits available to everyone, regardless of how they purchase their insurance.
He would offer a refundable tax credit of $5,000 for families, $2,500 for individuals, and the benefit isn't dependent on where people work or what they earn. Some would stick with their current job-based coverage. Given the option, others -- especially the uninsured, armed with new health dollars -- would decide to buy coverage on their own. That in turn would stimulate a market for more affordable insurance.
Mr. Obama doesn't want to let people make this choice. He even claims it would amount to "taxing your health-care benefits for the first time in history," which is a wild distortion. His point seems to be that because companies wouldn't have to pay for health care, they could raise wages and thus taxes would also increase for workers on those higher incomes. But doesn't Mr. Obama want higher wages?
All in all, workers would come out ahead with the McCain plan. According to the left-leaning Tax Policy Center, the average taxpayer would see his tax bill drop by $1,241 in 2009. On average, lower-wage workers have more limited coverage as part of their compensation, mostly from small- or medium-size businesses. But the more generous the employer health plan, the more the tax subsidies increase. According to the Joint Committee on Taxation, the current employer benefit is only worth between $600 and $3,000 for people making under $100,000. The upper-income brackets save between $4,000 and $5,000.
The most affluent -- i.e., the top quintile of earners -- would be slightly worse off after 2013 under the McCain plan, though they'd still have plenty of options. Even as he routinely promises to raise taxes on "the rich," Mr. Obama is leaping to their unlikely defense here only to frighten everyone else. The McCain plan is fairer than the status quo, which subsidizes the most expensive employer (and union) insurance plans.
But don't take our word for it. Mr. Obama's chief economic adviser agrees with the McCain critique of the current system, or at least he once did. "This massive program of tax breaks is ineffective and regressive, wasting money on those who have health insurance while doing little for those who can barely afford it and nothing at all for those without it," wrote Jason Furman in 2006 in the journal Democracy. Before he joined the Obama campaign, Mr. Furman championed a health reform that relied on many of the same tax tools as Mr. McCain's.
In contrast to Mr. McCain, the Obama plan is all about expanding government health care. Mr. Obama is proposing a "public option" that is similar to Medicare but open to everyone of any age. With this new taxpayer-funded entitlement, private insurers would be crowded out as the government gradually paid all of the country's health-care costs.
Yet according to the Congressional Budget Office, federal spending on Medicare and Medicaid already takes up 4% of GDP today and will rise to an unsustainable 9% over the next two decades. Mr. Obama wants to add even more costs to this taxpayer balance sheet. The inevitable result as spending explodes would be price controls and rationing.
On choice, portability, quality and especially equity, the McCain health plan is far superior to Mr. Obama's. The Democrat is merely offering Canada on the installment plan.
Please add your comments to the Opinion Journal forum.
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http://hotair.com/archives/2008/10/17/shock-people-take-advantage-of-free-government-health-care/
"If you think healthcare is expensive now, just wait until it's free."
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Something needs to be done...
A good article in this morning's paper.
http://www.latimes.com/business/la-fi-insure21-2008oct21,0,6869686.story
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Its the NY Times so caveat lector:
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Businesses Wary of Details in Obama Health Plan
By KEVIN SACK
Published: October 26, 2008
AGAWAM, Mass. — Dave Ratner, owner of Dave’s Soda and Pet City, is pretty sure he is about to get “whacked” by the new state law that requires employers to contribute to health care benefits for their workers or pay a $295-per-employee penalty. In order to avoid thousands of dollars in fines, Mr. Ratner is considering not adding part-time workers at his four pet supply stores in Western Massachusetts.
But the penalty in Massachusetts is picayune compared with what some health experts believe Senator Barack Obama, the Democratic presidential nominee, might impose as part of his plan to provide affordable coverage for the uninsured. Though Mr. Obama has not released details, economists believe he might require large and medium companies to contribute as much as 6 percent of their payrolls.
That, Mr. Ratner said, would be catastrophic to a low-margin business like his, which has 90 employees, 29 of them full-time workers who are offered health benefits.
“To all of a sudden whack 6 to 7 percent of payroll costs, forget it,” he said. “If they do that, prices go up and employment goes down because nobody can absorb that.”
Writ large, that is one of the significant concerns about Mr. Obama’s health plan, which like this state’s landmark 2006 law would subsidize coverage for the uninsured by taxing employers who do not cover their workers. And it is a primary reason that so-called play-or-pay proposals have had an unsteady history for nearly two decades.
With Mr. Obama’s plan, business leaders say, the devil will be in the unknown details.
Mr. Obama would prohibit insurers from rejecting applicants because of medical conditions, require health insurance for children and create a new federal health plan to provide comprehensive coverage to the uninsured. Those beneath certain income levels would be granted tax credits to make premiums affordable, and small businesses would be offered tax credits to provide benefits.
The tax credits are projected to cost at least $110 billion. Mr. Obama has said he would pay for it primarily by raising income taxes on those making more than $250,000 and by reducing health spending. But when he announced the plan in May 2007, he emphasized that employers would share in the cost.
“We will ask all but the smallest businesses who don’t make a meaningful contribution today to the health coverage of their employees to do so by supporting this new plan,” he said.
Left undefined has been what size firms would be exempted, what constitutes a “meaningful contribution,” and how much noncompliant businesses would be required to pay. Senator John McCain, the Republican nominee, badgered Mr. Obama in two of their debates to define the penalty, but Mr. Obama did not rise to the bait.
“We made a decision even before the plan was rolled out not to decide,” said David M. Cutler, a Harvard economist who speaks for the campaign on health care. “It’s not that there’s a decision out there that we’re not telling. It’s literally that we’ve decided not to decide.”
That may be smart politics. But it makes business groups nervous that Mr. Obama might impose an unmanageable burden. They also worry that any time his health plan faces a shortfall, businesses will be asked to up their ante, as has happened in Massachusetts.
“Play-or-pay can become a blank check to an already overcapitalized health care system,” said Helen B. Darling, president of the National Business Group on Health, which represents 300 companies.
Business groups also have concerns that Mr. McCain’s plan to change the tax treatment of health benefits would erode employer-sponsored insurance.
Mr. Cutler said the Obama campaign regarded play-or-pay less “as a revenue raiser” than as a way of “leveling the playing field.” It would hold accountable those employers whose uninsured workers might seek treatment in emergency rooms or enroll in government insurance plans, with costs subsidized by others through higher premiums and taxes. Mr. Cutler said the expense to businesses would be offset by savings from Mr. Obama’s proposals to reduce health spending, though that is an uncertain prospect.
Several econometric models have assumed that Mr. Obama would have to set his penalty near 6 percent of payroll (Mercer, a benefits consulting firm says that large employers typically pay 15 percent). Recent play-or-pay proposals in California and Pennsylvania put the figure at 3 or 4 percent, and both failed in part because of business opposition.
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Hawaii is the only state that requires employers to provide health benefits, while Vermont, like Massachusetts, gently fines those who do not. Several other states have enacted similar laws over the last two decades, but they have been repealed, rejected by voters or challenged in court.
Economists believe the cost of health benefits is ultimately shifted to employees through lower wages. When wages cannot be lowered, layoffs may result. Katherine Baicker of Harvard and Helen G. Levy of the University of Michigan have projected that play-or-pay might push 224,000 workers into that category.
When negotiating their health plan, Massachusetts lawmakers rejected a payroll tax and instead set a “fair share contribution” that was low enough to appease businesses. The amount also was kept low to steer clear of the 1974 federal law prohibiting states from regulating multistate group insurance plans. Companies with 10 or fewer full-time equivalent employees were exempted.
State officials hoped the penalty would generate a little revenue, but recognized it was not likely to prompt employers to start offering coverage. It raised only $7.7 million in its first year, well under projections. So when a substantial budget gap opened in the $869 million health plan this year, Gov. Deval Patrick asked businesses to help fill the hole.
He compromised on a revised formula that is projected to bring in $30 million by increasing the number and average size of firms that will be penalized. The state expects 1,100 businesses to be fined, up from 855, or about 3 percent of eligible companies.
The deal left business leaders satisfied for the moment. They recognize that the $295 penalty is a fraction of the $4,000 that Massachusetts employers spend to insure an individual worker.
But businesses worry the state will raise their obligation each year. They argue they have already absorbed costs of insuring 159,000 workers with group coverage since the state began mandating insurance (a total of 439,000 have enrolled, giving the state the country’s highest insurance rate).
“You want the system to work,” said Jon Hurst, president of the Retailers Association of Massachusetts. “You just want to make sure there isn’t more cost-shifting to businesses because they are paying their fair share.”
State officials are gratified that — contrary to national trends — the share of employers offering health benefits has increased slightly. One fear about play-or-pay is that if the penalty is too low employers will stop offering coverage and pay the fines instead, shifting workers to government insurance programs.
But leaders here also are sensitive to the possibility that further increases in the penalty might stymie wage and job growth.
“In this day and age,” said Dr. JudyAnn Bigby, the state secretary of health and human services, “it wouldn’t take much of a change in policy to push some entities over the brink.”
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"offset by savings from Mr. Obama’s proposals to reduce health spending"
Cutler and there is another Massachussetts liberal type - his name eludes me now - are getting everyone covered first and figuring about how to pay for it later. Right or wrong I don't know but they are not being honest with all the ramifications of what they advocate. But what else is new with liberals?
Health spending will not be reduced by expanding coverage to all without increasing people's personal responsibility for the costs as well. I don't hear them say anything about this. Not one iota. Amazing isn't it?
The fastest way to reduce the costs of health care is to transfer costs to patients. You would be surprised how quickly people will refuse tests not absolutely necessary or opt for generics as soon as they learn they will have to pay more.
But there is some blame for all. The insurers, the providers (doctors and hospitals), administrators, politicians, pharmaceuticals, device makers, acadamia, lawyers, cottage industries and more.
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CCP: "The fastest way to reduce the costs of health care is to transfer costs to patients."
VERY well put, yet the more we see a cost problem the more we move in the opposite direction.
Same goes for college tuition.
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yet the more we see a cost problem the more we move in the opposite direction.
Yes your so right. The "government" fix will exponentially increase costs not reduce them IMO.
The "fix" is in.
You think we have illegals crossing the border now?
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Crafty just curious as man with children
I am a bit baffled by your contempt for universal health care
I think Americans call these entitlements . I'm canadian so the concept of being turned away at a hospital for monetary reasons
is completely foreign to me. Over crowding yes but not for lack of cash
Do you think your personal wealth should dictate whether your child should live or die?
I find this odd in that The Dog Brother culture is based on the community of the tribe or is it a pack
As a tribe you work together to become stronger you protect the little ones so that they have a chance to grow up to become productive members of the pack
You protect the elderly and infirm because they are your source of knowledge
Even in a pack wolves they protect the young and an older less able pack member is left at the den to guard the pubs or so I' told
Universal health care is not an "entitlement" it is a community decision to look after one another
The US is the only G8 country that does not provide some form of universal health care
I make a good wage and pay a boat load of taxes much more than it would cost for my once yearly trip to the doctor
but when accidents happen like when i tore the cartilage in my knee competing in Bjj in Brazil.
The system was there for me. I saw my GP took a weeks to get in. He refered me to a specialist
took 3 months to see him . Sent me for a MRI 6 weeks, another consultation with the specialist and he booked me for surgery in 6 weeks
got fixed, got some physio, went back to brazil the following july and won.
Total cost to me 0 becuse my employer pays for more health care insurance.
Other wise a couple of 100 for meds, physio and a chiropractor.
Now if that would have happened in the US in lets say the 1980 during the recession when i was an unemployed student
and both my parents had lost there jobs. I would be still limping today.
I can tell you similar stories about the various broken finger, concussions and nasty infections
that were dealt with before they become serious because as an unemployed student all I had to do was go to the local medical clinic and wait my turn
I was told in the US I could have had done in two weeks for 5000. If you are rich no need to wait your turn?
I consider myself a libertarian not interested in being surveilled, counted or have the government telling what to read or who to associate with,
who i can marry or what substance in can put in my body.
I don't want the government listen to my phone calls, reading my mail or seeing what crazy things i look up on the interweb or seeing how i spend my money
But what about my community.
Do my taxes benefit the community?
I say yes because if i had to make a choice between my daughter getting medical attention that would save her life and committing a crime
I think i would be a criminal and crime is an act against the community.
I see universal health care as a decision to strengthen your community
is Canada's system perfect hell no its rationed health care but if you are rich you can always go to the US
I think with Mr Obama you are about to find your community
Best Regards
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Woof TE:
I am about to OD on forum matters so I will be a bit briefer than your question deserves:
No one is talking about letting someone without money die from car accidents etc.
I would draw attention to your apparent notion that it is morally superior to turn people away for overcrowding as versus turning people away for insufficient money. What is your reasoning here?
Denial of service due to overcrowding--due to virtually unlimited demand and diminished supply-- is precisely what happens when a good such as health is made "free"-- which in part is what is meant when we say "If you think health care is expensive now, just wait until the government makes it free." (PJ O'Rourke) At the moment, in Canada you do not suffer the full consequences of your course of action precisely because you live next door to us.
Let me tell you a story of an experience of mine:
In 1992 I had a freak BJJ accident wherein the ACL, PCL, and Lateral Collateral Ligaments of my left knee were snapped in half. Thanks to the wonders of modern medicine, what 5 to 10 years previous to that would have left me seriously gimp for life was fixed during the course of three surgeries which replaced the snapped ligaments with tendons from cadavers. INCREDIBLE! The cost was nearly $50,000 (remember this was 1992-93 dollars) Because I bought health insurance, I was out of pocket $5,000 and the insurance company paid the other $45,000.
THE SYSTEM WORKED - BECAUSE I WORKED AND TOOK RESPONSIBILITY FOR MYSELF.
OTOH, if Hillary Clinton and her health care program had been in charge, they probably would have decreed that there were too many specialists making too much money (this was a favorite point of hers) and there probably would not have been the specialists and the technology capable of saving my knee--- and my life in martial arts.
THAT IS WHAT UNIVERSAL HEALTH CARE MEANS TO ME.
Furthermore, I used to be a lawyer in Washington DC, so I have a very visceral sense of the human beings who would be the bureaucrats deciding whether I was allowed to get a particular treatment are. They are slow, vapid, and basically don't give a fcuk. As a free man in a free country, giving such people control over how I pursue my health is a bitter anathema.
IMHO it is important to understand that the clusterfcuk we have now is NOT the free market and most of its undesirable features can be traced rather directly to government intervention.
That's all I have time for right now. I hope it helps explain my perspective.
TAC,
Marc
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Growing up, my health/dental care came courtesy of the IHS (Indian Health Service). It operated with the efficiency of the post office and the compassion of the IRS. :-D
A running joke on the reservation goes "What's the leading cause of death on the rez? IHS."
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Shocking News! State Mandates Increase the Cost of Health Insurance!
Ronald Bailey | November 18, 2008, 11:36am
Researchers at Brigham Young University, the National Bureau of Economic Research and the Brookings Institution have found that health insurance mandates raise the price for everybody. As the press release describing the study explains:
New research shows that the cost of health insurance for a typical family increases about $100 per month when state governments limit price adjustments based on factors like age, health or risky behaviors such as smoking.
The finding by Brigham Young University economist Mark Showalter is one of several examples of how one state's set of rules can result in widely different prices than what's found in the state next door. Perhaps the most eye-opening contrast exists in Trenton, New Jersey, where premiums cost about twice as much as those sold across the Delaware River in Pennsylvania...
Seven states prevent insurers from adjusting prices based on one or more factors like age, health status or risky behavior. The researchers found such rules - known as community ratings - increased family premiums between 21 and 33 percent.
The rule is intended to promote equity but may consequently make insurance too expensive for healthy people. The study found New Jersey's strict form of community ratings responsible for premiums set two to three times higher than if the requirement were not in place.
Who knew that 1800 federal and state mandates would boost the price of health insurance? Well, actually, lots of analysts do. For example, Harvard business school professor Regina Herzlinger told reason:
"It's like I'm shopping for a car and my state mandates that all cars have heated seats," says Herzlinger. Car buyers would not long stand for a heated car seat mandate that raises the price of a car by $1,000, and similarly individual health insurance shoppers would object to unnecessarily expensive insurance mandates.
It is very likely that legislators rarely consider the costs of such mandates to consumers, so the good news is that the study now quantifies them so that these trade-offs can be made explicitly. Whole press release for the study is available here.
http://www.reason.com/blog/show/130140.html
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The piece referred to above.
Health Insurance Premiums Rise Up To 33 Percent With State Pricing Rule, USA
18 Nov 2008
New research shows that the cost of health insurance for a typical family increases about $100 per month when state governments limit price adjustments based on factors like age, health or risky behaviors such as smoking.
The finding by Brigham Young University economist Mark Showalter is one of several examples of how one state's set of rules can result in widely different prices than what's found in the state next door. Perhaps the most eye-opening contrast exists in Trenton, New Jersey, where premiums cost about twice as much as those sold across the Delaware River in Pennsylvania.
"Establishing the actual costs of specific state regulations informs discussion of how to make health insurance more affordable," Showalter said. "It helps present a picture of what would happen if consumers were allowed to buy insurance from other states."
Showalter began the research during an appointment as a senior economist for the U.S. Council of Economic Advisers. He co-authored the new study with Amanda Kowalski of the National Bureau of Economic Research and William Congdon of The Brookings Institution. Their report will appear later this month in the academic journal Forum for Health Economics & Policy.
The researchers analyzed prices offered state-by-state for the estimated 26.5 million Americans who purchase directly from insurers rather than through an employer.
Seven states prevent insurers from adjusting prices based on one or more factors like age, health status or risky behavior. The researchers found such rules - known as community ratings - increased family premiums between 21 and 33 percent.
The rule is intended to promote equity but may consequently make insurance too expensive for healthy people. The study found New Jersey's strict form of community ratings responsible for premiums set two to three times higher than if the requirement were not in place.
University of Minnesota health economist Roger Feldman, who was not involved with the study, is funded by the U.S. Department of Health and Human Services to figure out how an interstate market might reduce the number of uninsured Americans.
"This study enables us to predict the effect of allowing consumers to shop for insurance across state lines," said Feldman. "Those kinds of simulations would not be possible without this study."
The researchers also found that health insurance premiums rise 10 percent or more when a state government makes insurers accept all doctors, hospitals or pharmacies instead of steering customers to an exclusive network of providers.
Twenty-one states have laws that require insurers to allow a patient to buy prescription drugs from any pharmacy they choose. Seven of those states force insurers to offer the same flexibility with choosing a doctor or hospital. According to the study, these laws result in a typical family paying about $30 more per month for health insurance.
Data for Showalter's study came from two major health insurers that do business nationwide. The analysis took into account factors that vary by location, such as the cost of health care, state taxes and consumer demographics.
"All of the regulations we studied have presumed benefits," Showalter said. "Our goal was to quantify the costs so that policymakers can better weigh the two."
A BYU alumnus, Showalter received a Ph.D. from the Sloan School of Management at the Massachusetts Institute of Technology. In 1991 he joined the BYU Economics Department faculty and has since published many journal articles on health and education.
Birgham Young University
Article URL: http://www.medicalnewstoday.com/articles/129802.php
http://www.medicalnewstoday.com/articles/129802.php
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The Obama Health Plan Emerges Article
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"Universal" government-run health care proved too ambitious even for FDR, who stripped it out of the Social Security Act of 1935. Lyndon Johnson settled for Medicare and Medicaid. Now liberals think the political moment has finally arrived to achieve what has eluded every other Democratic President from Harry Truman to Bill Clinton.
APOne signal is yesterday's news that Barack Obama has selected Tom Daschle, the very liberal former Senate warhorse, to head the Health and Human Services Department. But a even clearer sign was last week's release by Montana Senator Max Baucus of a policy blueprint that closely resembles the one Mr. Obama campaigned on for 17 months. The plan is significant not only because its author is Chairman of the powerful Finance Committee, which oversees taxes and about half of all government spending. Mr. Baucus is also one of the more moderate, and cautious, senior Democrats.
If the Obama White House decides that reorganizing the 17.1% of the economy that the U.S. is likely to spend on health care in 2010 is a first-year priority, then Mr. Baucus's bill will be the place they start. Americans need to learn what they'd be paying for.
First, Democrats want the government to create a national insurance exchange, or marketplace, in which all comers could buy into a range of heavily regulated private policies at group rates. These private plans would then "compete" with a new public insurance option, i.e., a program managed by the government and modeled after Medicare. Lower-income earners would get subsidies to make coverage "affordable." Businesses that didn't cover their employees would pay a tax on some portion of their payroll.
The last cog is the "individual mandate." This requirement that everyone buy coverage has grabbed most media scrutiny of the Baucus plan, because Mr. Obama opposed it during the campaign. But the many moving parts don't work together unless the young and healthy foot the bill for care of the older and sicker -- one reason Hillary Clinton kept nagging Mr. Obama about the individual mandate during the primaries.
The irony is that the public option -- not the mandate -- is far and away the most radical part of the plan. Green eyeshade objections are obviously out of favor in modern Washington, but the reality is that the Baucus-Obama plan would be extraordinarily expensive as it slowly but relentlessly grew the government's share of health spending. The draft doesn't include an exact cost, though casually notes the ballpark "investment" could run as high as $150 billion a year.
Even those huge outlays are likely conservative, considering that subsidies would go to families earning up to 400% of the federal poverty level. According to the Census Bureau, that would apply to 61.5% of the American population, or about 184 million people -- less those already on Medicare and Medicaid.
Some financing will come from the "pay or play" tax on businesses, but because Mr. Baucus is no more omniscient than anyone else, the tax rate is left undefined. If it is too low, companies will have every incentive to "cash out" their employee liabilities and pay the tax instead. Then workers will flood the public option.
The Baucus plan expects to make up more of the money with nips like better health technology and tucks such as "a national focus on wellness." But those don't come close to adding up to $150 billion -- or the health system would have made them already. As for the claim that centralizing health spending will lead to more "efficiency" . . . well, that is the triumph of hope over evidence.
Over the past 40 years, per capita health spending has grown an average of 2.1 percentage points faster than the economy. The dominant U.S. insurer -- Medicare -- has had no success in mitigating this climb, despite valiant attempts. Since the 1980s, Medicare has actually controlled the prices that physicians and hospitals are paid for thousands of billable services. In 2007, the program spent some $425 billion according to these arbitrary guesses. Because of its huge purchasing power, and because many private plans adopt its reimbursement rates, Medicare significantly shapes all health-care financing and delivery.
Now the Democrats want to double down with the public option, apparently on the theory that the bureaucracies fail only when they're too small. Even without the new program, Medicare and Medicaid costs are rising substantially both as a share of the economy and the federal budget. The nearby chart tracks the historical behavior of government health spending and the Congressional Budget Office's post-2007 fiscal scenario in the absence of reform. Today, health entitlements account for 4% of GDP but will rise to 7% in 2025 and about 15% in 2062.
Not that the current level of benefits will ever be paid. According to the Medicare trustees, the program's excess costs over the next 75 years -- that is, the difference between expected outlays and revenues -- is more than $36 trillion, which even they acknowledge is several trillion too low given current trends. Even if Congress doubled all individual and corporate tax rates, it still wouldn't raise enough revenue to pay for Medicare and Medicaid.
The Obama-Baucus solution to this slow-motion catastrophe is to add tens of millions more people to the federal balance sheet. Because the public option will enjoy taxpayer sponsorship, it will offer generous packages to consumers that no private company could ever afford or justify. And because federal officials will run not only the new plan but also the "market" in which it "competes" with private programs -- like playing both umpire and one of the teams on the field -- they will crowd out private alternatives and gradually assume a health-care monopoly.
Many proponents of plans similar to Mr. Baucus's openly cite this as one of their goals. Eventually, the public option will import Medicare's price controls into the private sector as it tries to manage the inevitable cost overruns. When that doesn't work, Congress will deal with the problem by capping overall spending and rationing care through politics (instead of prices) -- like Canada does today.
Either Senator Baucus and President-elect Obama are making promises that can't possibly be kept. Or they're not being honest about their plans for U.S. health care.
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Unfortunately, the grim picture this article paints is all too true.
***the public option will import Medicare's price controls into the private sector as it tries to manage the inevitable cost overruns. When that doesn't work, Congress will deal with the problem by capping overall spending and rationing care through politics (instead of prices) -- like Canada does today***
Medicare's price controls? Is some cases Medicare is preferred by providers as opposed to some of the commercial carriers.
***The Baucus plan expects to make up more of the money with nips like better health technology and tucks such as "a national focus on wellness." But those don't come close to adding up to $150 billion -- or the health system would have made them already. As for the claim that centralizing health spending will lead to more "efficiency" . . . well, that is the triumph of hope over evidence.***
The idea that converting to electronic recods will cut the necessary inefficiencies out to the extent we are saved is a fantasy.
I got to laugh when Newt and others sit in front of the camera and say all we need to do is centralize the information and costs will stop increasing. While I agree it is a good idea and must be done in some way I beg to differ that it will save the future of medical care.
As for "wellness" - there are some preventative things that are done that save long term costs and there are others that actually drive up long term costs.
Without rationing health care costs will continue to skyrocket. Specialists who do procedures are whing because they can't charge the exorbitant fees they were bilking form the system for years. and those specialists who don't preform procedures have trouble paying bills. As for primary care folks like me - well the whole field is collapsing. You all may very well be seeing nurses instead of primary doctors from now on.
I spoke to one physician recently who was praying for total nationalization of health care. He feels anything is better than dealing with multiple insurances, patients without coverage etc. One national medical organization I know was ecstatic that Tom Daschle is picked for Sec of HHS. They feel he is on their side with regards to saving primary care which may soon be as obsolete as GM,Ford,Chrysler.
I am still not for nationalization. But the public I am afraid is not facing the truth about rationing. They still want everything possible especially as long as someone else covers it.
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10,000 Britons die needlessly every year as GPs with out-of-date training miss vital cancer symptoms
By Daniel Martin
Last updated at 1:32 AM on 21st November 2008
GPs often do not send enough patients for tests
More than 10,000 people die needlessly each year because their cancers are not diagnosed in time, a study says.
The charity Cancer Research UK found GPs too often miss symptoms or do not send enough patients for tests.
In some cases their training is simply out of date. The report says some people are deterred from seeking treatment by the difficulty of getting an appointment.
And there is too little public awareness about cancer symptoms, meaning many victims do not see their GP until it is too late to save their lives. The result is that Britain's survival rates for cancer are still the worst in Western Europe, despite the billions poured into the Health Service by Labour.
Only 53 per cent of women and 42 per cent of men with cancer survive for more than five years.
Of 14 major countries compared by the charity, Britain came 11th for women and 12th for men, alongside Poland and Slovenia. If our rates were as good as the best in Europe, the report says, there would be 10,744 fewer deaths a year.
Lead researcher Professor Michael Coleman said: 'We know many cases are being diagnosed too late and this is a major reason for our poor survival rates.'
He said many GPs were not up to date on cancer treatment, and family doctors with an average practice size saw only around eight new cancer cases a year.
'Some GPs would benefit from guidance on identifying patients more successfully,' he said.
Another problem was access, said Professor Coleman. 'Patients find it difficult to make appointments or park their cars, and many are worried about taking time off work and losing money.'
Only a half of GP practices see patients outside working hours - and even these open for an average of only three more hours a week.
Survival rates
The failure of GPs comes despite their pay soaring by more than 50 per cent - to over £100,000 - since a new contract was agreed in 2004.
They are also working fewer hours a week.
Better survival rates in Europe are partly due to the fact that patients in many countries can have direct access to a specialist, while in Britain they must go through their GP.
The Government's cancer 'czar', Professor Mike Richards, said: 'We want to work with GPs to find out which patients and which symptoms they are most likely to miss. They need to be more alert and send people for tests much earlier.'
Britain's poor record has also been blamed on drug rationing by NICE - which can take up to 18 months to decides whether the NHS should fund new treatments - and low spending on cancer drugs, £76 a head a year, compared to £143 in Germany and £121 in France.
Professor Karol Sikora, professor of cancer medicine at London's Imperial College, said last night the low survival rates were a failure of the whole NHS, not just GPs. He said: 'People have to wait too long for scans and biopsies. There is undercapacity in radiography and chemotherapy.
'We don't get access to the drugs they get in Europe. Huge amounts of money have been thrown at cancer over the past decade so it is surprising to see these problems are still here.
'The main culprit is the NHS itself - it's a bureaucratic monolith.'
http://www.dailymail.co.uk/health/article-1088022/Our-cancer-shame-10-000-Britons-die-needlessly-year-GPs-miss-vital-symptoms.html#
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The article points out that cancer is being diagnosed too late in Britain but it is not at all clear why.
Are patients getting their screening tests? Are they being offered? Is it the delay in confirmatory testing and eventual referral to specialist?
Many studies also show that more screening does not equate to better care or longer survival. In fact many studies show that more screening makes for more problems. There are relatively few screening test that are clearly supported by evidence of having net benefit. For every total body scan one might want to do to look for a lurking cancer we will find two dozen other things that will warrant more tests, biopsies, anxiety and money that would never have been a problem.
We could also do screening up the wazoo till the nation goes bankrupt. There is a balance.
Access to specialists is important and should be easy. Yet patients who run to different speicalists do wind up getting more tests (especially if the specialist has the test in their office and can bill for it - usually reasonable but clearly overdone at times) get fragmented care.
In this country nurses are replacing primary care doctors so one could argue there will be more opportunity for diagnoses to be missed. But some simple care they probably could do. I notice patients of mine who go to local walk in clinics for colds are invariably getting antibiotics though invariably it is uncommon they really need them. I try to talk my patients out of it. In these clinics that are more concerned for generating customer satisfaction they are all getting antibiotics because the patients think they need it. They are now contributing to further use of antibiotics and the problem of resistance.
But I digress.
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Bobby Jindal, Louisiana's prodigy Governor, has been arguing lately that only policy innovators will break a path out of the GOP's political wilderness -- and he is leading by example. Mr. Jindal recently announced a major renovation of the way his state provides health coverage to the poor and uninsured, thus taking up a topic for which most Republicans require a shot of epinephrine just to pay attention.
AP
Gov. Bobby Jindal
Name any health criteria, and Louisiana is probably scraping bottom. According to one national ranking, the state was 49th in health outcomes in 2007 and worst overall in 2006. Even though about a quarter of the population is enrolled in Medicaid, another quarter is uninsured. Even though the federal government's "matching rate" pays out 71% of state Medicaid costs, state spending has doubled to 16% of the general budget over just the last two years. That share is projected to rise to 22% by 2011, swallowing funding for schools, police and other priorities.
Governor Jindal plans to steer working-poor Medicaid recipients out of the current "fee for service" program, where the state pays a set rate for all health-care charges (some 54 million this year). Instead, they'd choose among private managed-care plans, with Louisiana paying a fixed per-patient amount, adjusted for health risks. Essentially, Mr. Jindal wants to use Medicaid dollars to fund something like private insurance. That way, physicians and hospitals will be compensated for outcomes -- rather than volume of visits and procedures -- and get incentive payments for good performance.
Such a "defined contribution" plan is one way to wrestle run-amok health costs back under control and spend more responsibly. It isn't a new idea, but it is a good one. Congressional Republicans passed a similar reform in 1995 for Medicare, which Bill Clinton vetoed -- only to have his own bipartisan commission endorse it in 1999.
In today's Opinion Journal
REVIEW & OUTLOOK
Secretary of BailoutsJindal's MedicineThe Sidwell Choice
TODAY'S COLUMNISTS
The Americas: Election Fraud in Nicaragua
– Mary Anastasia O'GradyInformation Age: When Even Good News Worsens a Panic
– L. Gordon Crovitz
COMMENTARY
The Fed Is Out of Ammunition
– Christopher WoodWhat a Single Nuclear Warhead Could Do
– Brian T. KennedyChange Our Public Schools Need
– Terry M. MoeBush Does the Right Thing for Darfur
– Kenneth RothSince Louisiana will increase the value of its Medicaid dollars and free up other funding, it will also be able to expand eligibility. The initiative will start with about 380,000 people in New Orleans, Baton Rouge and two other regions, with the rest of the state integrated over the next five years. The hope is that by integrating fee for service's separate silos and realigning incentives, the quality of the delivery system will also improve.
Medicaid allows states the flexibility to experiment like Mr. Jindal, but it requires a federal waiver. Currently, Louisiana's negotiations are hung up on $771 million that the feds claim the state owes, much of it in alleged "overpayments." States often game the system to filch federal money they don't deserve, courtesy of national taxpayers. But in this case, Louisiana ought to get credit for good behavior, especially considering that Mr. Jindal inherited the problem. In any event, the state only wants to pay back Medicaid over a longer term while producing savings compared to the status quo.
The Bush Administration's go-ahead is also a matter of urgency. If the talks aren't wrapped up soon, Mr. Jindal will be forced to start over with Barack Obama's team, which will be hostile to reforms that bank on the private sector. Either way, just the transition itself could delay things for six months or a year or more.
Congress is currently considering a state Medicaid "bailout" as part of its second stimulus package, in which Washington would pay for an even greater share of state health spending. That would reward the most spendthrift states. Mr. Jindal's proposal is a far better idea.
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Agree with Jindal about innovation. We need more like him. Romney sounded good over the weekend talking about Detroit.
We don't need more pundits like Laura Ingram - *my way or the highway*.
***physicians and hospitals will be compensated for outcomes -- rather than volume of visits and procedures -- and get incentive payments for good performance***
There is ongoing research on this model now by many groups. Many different interests from providers, insurers, government, vendors, pharma, pharmacies, patients, cottege industries.
Its premature to say how this is going to work. In theory there are pros and cons, but I like the idea and hope it will have value to all. Early results suggest it will.
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"physicians and hospitals will be compensated for outcomes -- rather than volume of visits and procedures"..."There is ongoing research on this model now by many groups. Many different interests from providers, insurers, government, vendors, pharma, pharmacies, patients, cottege industries. Its premature to say how this is going to work. In theory there are pros and cons, but I like the idea..."
My daughter's orthodontia (braces) is set up this way. One lump sum / payment plan all specified up front, includes the full program. Excludes certain things especially any service needed from others such as the dentist or oral surgeon. No additional charge for minor follow up visits scheduled or unscheduled. Somehow they cover it out of the first six grand. You don't ever have to second guess motives on how often to come in. And they don't get started in a service that isn't financed to completion - like a house.
For all my whining about the cost I have my (14yo)daughter considering orthodontics as a profession.
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Hi Doug,
Bundling the service for a health problem into one overall cost irregardless of number of visits, phone calls, etc is part of it.
I am just going by experience and my study of the situation but am not an expert:
There are different ways of bundling. Surgeons are usually bundled by procedure - say they get a lump sum that includes visits and procedure for hernia repair. Others are capitated - that is they get a lump sum from the insurer to provide all care to a patient. I am not in favor of this because the financial incentive is for providers to do as little as possible since they earn the same either way.
Another would be boutique medicine wherein a doctor provides all care (availability, visits, hospital, etc) to a patient for a specified monthly or yearly fee billed directly to a patient.
The main concept of *outcomes*, is bonus pay in getting patient to their target goals based on national standards. Say more pay for physicians if there patients blood pressures are where they should be and not over the goal for example. Other outcomes I guess could be patient satisfaction, screening tests recommended as per national guidlines, preventative care etc.
The idea is to base reimbursement partly on measured performance rather than just on how many patients or procedures one does.
Reimbursement for quality and not just quantity I guess would be another way to put it.
As of right now those doctors who do procedures are compensated far more than doctors who do cognitive types of care whether specialist or primary.
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A charismatic Democratic President takes office promising to extend health insurance to all Americans. His party enjoys majorities in Congress, and the GOP is at sea. The press corps finds policy a bore and instead files stories that draw facile analogies to the heyday of FDR.
APYes, all that will be true next year -- but it was also true in January 1993. Fewer than two years later, the grand health-care ambitions of Bill and Hillary Clinton were reduced to tatters. No one is more attuned to this memory than today's Democrats, who aren't about to let history repeat itself. And since the lessons they learned from the HillaryCare fiasco are political, and not substantive, they are already moving full-speed ahead.
This mentality is nicely captured by Tom Daschle, the former Senate Majority Leader who Barack Obama has tapped to run Health and Human Services. "I think that ideological differences and disputes over policy weren't really to blame," he writes of 1994 in his book "Critical," published earlier this year. Despite "a general agreement on basic reform principles," the Clintons botched the political timing by focusing on the budget, trade and other priorities before HillaryCare.
President-elect Obama will not make the same mistake. Congressional Democrats are already deep into the legislative weeds, while Mr. Daschle is organizing the interest groups and a grassroots lobbying effort. Mr. Obama may be gesturing at a more centrist direction in economics and national security, but health care is where he seems bent on pleasing the political left.
According to Mr. Daschle, because of the Clintons' hesitation, "reform opponents succeeded in confusing and even frightening Americans about what change might mean," and this time the Democrats mean to define the debate. Consider the December 2 letter to us from Senator Max Baucus, who is upset that a recent editorial on his health-care plan did not use his favorite terms of art (his style being surrealism). "It will require affordability, but premiums will not be set," he writes. So the government will merely determine "affordability" -- which might as well be the same thing.
Much as Mrs. Clinton insisted that her health bureaucracies were "alliances," Mr. Baucus says his new entitlement "will not be 'managed by the government,' but by an independent council of Presidentially appointed health-care experts." The Senate Finance Chairman wants us to believe that a government commission to determine benefits and subsidies will somehow be above politics.
Shrewder moves are being made to co-opt should-be opponents. The Clintons decided to go to war with "proponents of the status quo," as Mrs. Clinton put it in a bare-knuckled speech in May 1993. This meant vilifying business, especially insurance companies guilty of "unconscionable profiteering" and even drug makers like Merck, which Mr. Clinton had courted during his campaign. This time, Democrats are trying to seduce business with subsidies and other bribes.
They may succeed, which is no surprise given that many corporations would be only too happy to dump their health liabilities on the government. The "Divided We Fail" coalition, which advocates "universal" coverage, includes not only usual suspects like unions and AARP but also the Business Roundtable and the National Federation of Independent Business, the small-business lobby that led the charge against HillaryCare.
America's Health Insurance Plans, the industry trade group, recently said its members would accept all comers regardless of health status or previous illness -- i.e., guaranteed issue -- but only if the government requires everyone to buy insurance. The individual mandate will expand their business in the short term, but it won't be long before Congress is also regulating premiums, cost-sharing and administrative expenses. Dr. Faustus, call your internist.
In today's Opinion Journal
REVIEW & OUTLOOK
The Obama Health-Care ExpressFight Racism, U.N.-StyleLet Ford Save Ford
TODAY'S COLUMNISTS
Main Street: Now for an Honest Debate on Gitmo
– William McGurnGlobal View: Obama's Team of Conformists
– Bret Stephens
COMMENTARY
Getting Out of the Credit Mess
– Harvey GolubRestore the Uptick Rule, Restore Confidence
– Charles R. SchwabHolding CEOs Accountable
– Jonathan MaceyAnother opening for Democrats is the new director of the Congressional Budget Office, a post vacated when Peter Orszag joined the Obama Administration. CBO totes up the official cost of legislation and thus is one of those obscure Beltway outfits that frames the political argument. A "score" that is too costly make a bill harder to pass.
In the 1990s, CBO director Robert Reischauer knee-capped HillaryCare by pointing out its true costs and giving little credit to claims it would generate savings. With good reason: Putative cost "offsets" never seem to materialize when Congress tries to plan the insurance markets. Now Democrats will try to install a CBO director who can be more easily rolled.
Most disturbingly, Democrats are talking up "budget reconciliation" to pass a health overhaul. This process was created in 1974 and allows legislation dealing with government finances to be whisked through Congress on a simple majority after 20 hours of debate. In other words, it cuts out the minority by precluding a filibuster. Mr. Daschle writes that reform "is too important to be stalled by Senate protocol," and Mr. Baucus has said he's open to the option.
Any taxpayer commitment this large ought to require a social consensus reflected in large majorities, but Democrats are determined to plow ahead anyway. They know that a health-care entitlement for the middle class will never be removed once it is in place; and that government will then dominate American health-care choices for decades to come. That's all the more reason for the recumbent GOP to get its act together.
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The soda tax does not make much sense. There is ZERO evidence that people who stop drinking soda alone will lose weight. There is even some evidence (in animals) that the calorie free sodas with the artificial sweeteners actually cause weight gain.
Leave it to a crat to lay awake at night to dream up ways to rip us off. As for the health care cuts it wouldn't hurt if we get rid of the illegals who contribute to putting hospitals out of business by usuing ER services. No mention of that of course.
How about taxes on political contributions? How about windfall profits taxes on the incomes of any politician above whatever it was before they took office?
How about a tax on all white men? That would be fair. How about taxes from government employees unions?
How about a luxury tax on all cosmetic procdures?
New taxes, cuts in budget plan
Paterson sees $404M tax on non-diet soda; higher levies on health care
By JAMES M. ODATO, Capitol bureau
Click byline for more stories by writer.
First published: Sunday, December 14, 2008
New taxes, deep cuts to education and health care, and a restructuring of the state's economic development programs will be hallmarks of Gov. David Paterson's first budget plan to be released in two days, according to interviews of people briefed on components.
The plan will come with a host of revenue raisers — increased taxes on hospitals and insurance policies, for instance — and at least one new assessment, a so-called obesity tax on non-diet soda to raise $404 million. The governor also is contemplating requiring new license plates to raise cash, reviving sales tax on clothing purchases, removing the tax cap on gasoline and threatening to require Indian retailers to collect taxes on sales to non-Indians by signing into law a bill passed earlier this year by the Legislature.
Paterson will unveil the spending plan, aimed at closing a $12.5 billion deficit for next year, on Tuesday. The total size of the Paterson budget is unknown.
There is no word on Paterson's plans for the state work force, although he has said he will adhere to a strict hiring freeze while looking to consolidate some components of government.
The cuts will be across the board and will build upon a deficit reduction plan Paterson proposed in November as he attempted to close the $1.5 billion shortfall in the $120 billion budget negotiated for this year. The plan was inherited from the executive budget introduced last January by Gov. Eliot Spitzer.
The health industry will be particularly upset, although Paterson's cuts will raise blood pressure throughout. He will call for about $3.53 billion in health care cuts, not including federal share of matching Medicaid dollars, which could be another $2 billion in cuts.
The biggest hits will be to insurance companies, which will be asked to come up with about $855 million in extra assessments. Those amount to more taxes on health insurance plans, increased sales tax on hospital discharges and more shifting of general fund costs to the Insurance Department so that insurance companies pay for programs such as Timothy's Law, the mandated coverage of mental health treatments.
Further, the governor also will propose a new tax on some physician services to raise $50 million.
The bottom line will be a net increase in costs that ultimately get paid by subscribers, thereby increasing the cost of coverage at a time that most upstate insurers are struggling.
Hospital cost saving initiatives will amount to $700 million next year and $50 million this year. Some of that will come from a 0.7 percent tax on gross receipts and Medicaid rate reductions. Graduate medical education funds will be redirected to save $141 million and another $23 million will be cut through reforming reimbursement.
Nursing homes will be cut by $4.2 million this year and $420 million next year. Home care will be cut $190 million next year.
A number of other public health programs will come with savings by, for instance, taxing non-diet sodas under an "obesity tax" that will raise $404 million. Prescription drug costs, a hit on pharmacies and drug makers, will cut by $111 million.
Among the reductions in education spending, public colleges will be directed to raise tuitions. But despite the cuts, Paterson will try to make it easier for SUNY schools to partner with private developers who want to build on campus property. The public/private initiative is seen as a way to stimulate construction of private housing for campus residents.
The Empire Zone program will be cut by at least 50 percent, saving the state tens of millions by not extending benefits as liberally.
The budget will come a day after Senate Republicans vote on a bill to stimulate the economy by phasing out the Empire Zone program through 2011 and using the savings as tax breaks for companies.
The governor has contemplated instituting a different pension system for new employees, but the so-called Tier 5 program may not make it to the budget. He is also expected to reiterate a call for greater health care payments from retirees and the closure of some juvenile detention facilities.
James M. Odato can be reached at 454-5083 or by e-mail at jodato@timesunion.com.
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"The soda tax does not make much sense. There is ZERO evidence that people who stop drinking soda alone will lose weight. There is even some evidence (in animals) that the calorie free sodas with the artificial sweeteners actually cause weight gain."
- And if there was a study proving the soda/weight connection, how about we publicize the information instead of changing the tax code. My understanding is that there is a reverse correlation in that skinny people tend to drink the real soda and heavier people more likely tend to choose the diet version.
"How about taxes on political contributions? How about windfall profits taxes on the incomes of any politician above whatever it was before they took office?...
How about a tax on all white men? ...How about a luxury tax on all cosmetic procedures?"
Very funny. It's all tempting. Tax everything we don't like when it's our turn to be in power. They tried the most obvious one - luxury tax on new yachts. It lasted about a minute. Turned out that most rich yachters already had a perfectly good boat and the Democrat leader of the Senate (Mitchell D-Maine) was from a yacht building state...
Call me old fashioned but how about we tax each dollar of income the same no matter the source and each dollar of consumption the same no matter the destination, i.e. equal treatment under the law. People might have a different view of demanding or tolerating free services if they didn't believe someone else was paying for it.
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By SALLY C. PIPES
People are policy. And now that President-elect Barack Obama has fielded his team of Tom Daschle as secretary of Health and Human Services and Melody Barnes as director of the White House Domestic Policy Council, we can predict both the strategy and substance of the new administration's health-care reform.
The prognosis is not good for patients, physicians or taxpayers. If Mr. Daschle meant what he wrote in his book "Critical: What We Can Do About the Health-Care Crisis," Americans can expect a quick, hard push to build more federal bureaucracy, impose price controls, restrict medicines and technology, boost taxes, mandate the purchase of health insurance, and expand government health care.
In his book, Mr. Daschle proposes a National Health Board to regulate the way health care is provided. This board would have vast powers in regulating the massive federal health-care system -- a system that includes Medicare, Medicaid, and other programs. Under Mr. Obama, it is likely that that system will be expanded and that new government insurance for the nonelderly, nonpoor will be created.
Given the opportunity, Mr. Daschle would likely charge the board with determining which treatments and drugs are cost effective and therefore permissible to use for patients covered by the government. And because the government is such a big player in the health-care market (46% of health-care spending comes from the government), the board would effectively set parameters for private insurers.
It is nearly certain that the process of determining which drugs and which treatments would be approved for use would be quickly politicized. The details of health-care policy may not be kitchen table conversation, but the fact that a Washington committee can deny grandma a hip replacement due to her age, or your sister a new and expensive drug, is. Health care is personal and voters will pressure lawmakers on access to care.
Liberal experts, Mr. Daschle included, believe that America needs to ration new technology and drugs. In his book, Mr. Daschle complains about overuse of new technology and praises the United Kingdom's National Institute for Health and Clinical Excellence (NICE), a rationing system that controls government costs. NICE's denial of care is legendary -- from the arthritis drug Abatacept to the lung cancer drug Tarceva. These drugs are effective. It's just that the bureaucrats don't consider them cost effective.
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Americans will not put up with such limits, nor will our elected representatives. Mr. Daschle himself proves this. He punts the hard decisions about rationing to an unelected board. Yet his main proposals are not only about expanding subsidized programs to cover more people but about adding the massively expensive benefit categories of mental health, which has a strong lobby behind it, and long-term care, which is important to the broad middle class.
One of the great myths in health care is that the uninsured are responsible for driving up private premiums by shifting costs. Uncompensated care certainly shifts some costs to private payers. Yet these costs are actually quite manageable in the aggregate, akin to what retailers lose due to shoplifting. The major cost shift is from government programs -- Medicare and Medicaid -- to private plans. The government pays doctors to treat Medicare and Medicaid patients. But the rates it pays, on average, are less than the cost for providing care to these patients. This is why Medicaid patients, and increasingly Medicare patients, struggle to find doctors. Putting more people on these programs will destabilize the remaining private system and create a coalition for price and wage controls.
Americans will never tolerate this. Remember our managed-care experiment in the 1990s. It succeeded in its main goal of controlling costs without an aggregate reduction in health quality. But in asking Americans to limit their choices, it prompted a bipartisan act of Congress to provide patients with a Bill of Rights. Now Mr. Daschle proposes nothing less than a giant HMO with a federal bureaucracy setting the benefit plan.
Mr. Daschle's model is Massachusetts. But Massachusetts's plan is an unfolding disaster and demonstrates how Mr. Daschle's private/public model is merely a stalking horse for government-dominated health care.
In Today's Opinion Journal
REVIEW & OUTLOOK
The Wizards of OilThe Philanthropy ShakedownYou Are Your Record
TODAY'S COLUMNISTS
Global View: Hamas Know One Big Thing
– Bret StephensMain Street: New Jersey Is the Perfect Bad Example
– William McGurn
COMMENTARY
Samuel Huntington's Warning
– Fouad AjamiWhy Detroit Has an Especially Bad Union Problem
– Logan RobinsonObama Will Ration Your Health Care
– Sally C. PipesThe FDA Is Killing Crohn's Patients
– Gideon J. Sofer
The headline claim is that the program has signed up 442,000 more people for health insurance. The reality is that 80,000 of these were simply put on Medicaid and 176,000 more on the taxpayer-subsidized plans. Costs have exploded, requiring additional tax hikes and the entire system is only possible due to sizable transfers from the federal government. The plans are so unaffordable that in 2007, 62,000 people were exempted from the individual mandate. So much for universal coverage.
The only way the Massachusetts plan will survive is with continued and increasing federal subsidies -- that is, tax revenue from the residents of other states. The only way Mr. Daschle's proposed plan would survive is with massive deficit spending -- that is, with taxpayer money from future Americans, many of whom are not yet born.
Mr. Daschle and the Democrats have spent years developing both the policy and political strategy to make the final push for taxpayer-financed universal health insurance. They have the players on the field, a crisis providing a sense of urgency, and a playbook filled with lessons learned from years of health policy reform disasters -- most recently that of HillaryCare in 1994.
The big questions for believers in private medicine are at this point political and strategic. With employers and most insurers reportedly on board with the new administration's desire for radical overhaul, who will step in to ask the tough questions? Will these issues get raised in time to provoke a meaningful, fact-based debate? Americans could easily find that Mr. Obama's 100-day honeymoon ends with a whole new health-care regime they hadn't quite bargained for.
Ms. Pipes, president and CEO of the Pacific Research Institute, is the author of "The Top Ten Myths of American Health Care: A Citizen's Guide" (Pacific Research Institute, 2008).
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Interesting he is introduced by Bob Dole.
This statement is humorous:
***I want to take politics out of it as much as possible and allow scientists to do their job."***
You can't take politics out of health care. How will scientists do their job with the government regulating every inch of our system?
***Daschle Makes Case for Appointment to HHS Post
By Emily P. Walker, Washington Correspondent, MedPage Today
Published: January 08, 2009
WASHINGTON, Jan. 8 -- Tom Daschle, picked by President-elect Barack Obama to be Health and Human Services secretary, said medical trainees should have school loans forgiven and receive other incentives to choose careers in primary care.
Daschle told senators at his confirmation hearing today he wants to send a message to medical students: "If you take this route, we're going to find ways to ensure that you have the financial wherewithal to become that front-line provider that we need."
Daschle testified before the Senate Health, Education, Labor, and Pensions (HELP) Committee, chaired by Edward Kennedy (D-Mass.).
Senate approval is expected for the well-liked ex-senator from South Dakota. Republicans on the committee gave him a friendly reception at the hearing, and Orrin Hatch (R-Utah) announced he would support Daschle's nomination.
Daschle told the committee he has been laying the groundwork for a healthcare reform plan, which he said cannot be dictated from the White House and Congress.
He advocated a more grassroots approach and said he's taken ideas from Obama's transition Web site, which has received tens of thousands of comments, and from local community health forums in the last several months.
Daschle said the Centers for Medicare and Medicaid Services should save money by moving to a medical-home care model and steering its focus toward prevention and wellness rather than paying for disease treatment.
The CDC should better utilize community-based prevention efforts, like smoking cessation and weight loss programs, Daschle said. He said he would "revitalize" CDC's ability to detect and investigate health threats and focus on better coordination between public and private entities.
Daschle promised to restore trust in the FDA, citing a survey that found nearly two-thirds of Americans don't believe that the agency can ensure drug safety and effectiveness.
"Ensuring the food we eat and the medications we take are safe is a core protection that American people deserve and a core responsibility of government," Daschle said.
Daschle said all the agencies he would oversee need to operate with fewer political motivations.
"I want to reinstate a science-driven environment," he said. "I want to take politics out of it as much as possible and allow scientists to do their job."
Daschle said the National Institutes of Health budget is so limited that only 10% of grant applications are funded.
"I will work to strengthen NIH, with leadership that focuses on the dual objectives of addressing the healthcare challenges of our people and maintaining America's economic edge through innovation," he said.
Although the HELP committee traditionally holds confirmation hearings for the HHS post, the Finance Committee will hold its own hearing and have final say on whether to advance Daschle's nomination to the Senate floor. That hearing has not been scheduled yet.
The HELP committee's senior Republican Michael Enzi (R-Wyo.) said the last two HHS secretaries were confirmed within two weeks of their appearances before the HELP committee.
Daschle served three terms in the Senate and was minority leader from 2001 to 2004, when he lost a re-election bid. He joined the Center for American Progress, a Democratic think tank, as a senior fellow and has advised the lobbying firm Alston & Bird.
He published a book on health care in 2008, Critical: What We Can Do About the Health-Care System. Enzi said he had recommended it to all his staff.
Today's hearing was also notable for the appearances of Kennedy, who appeared healthy and fit despite his recent bout with malignant glioma, and Robert Dole, the former GOP senator from Kansas.
Dole introduced Daschle, saying Congress and the public appear ready to address healthcare reform.
Dole, as leader of Senate Republicans in the early 1990s, had engineered the defeat of the Clinton administration's reform proposal.
He now works with Daschle at Alston & Bird.***
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CCP: Thank you for your opposition to government run health care!
One note on the Daschle appointment with Bob Dole introducing, I thought Obama was promising a lobbyist-free administration:
"Daschle ... advised the lobbying firm Alston & Bird...Dole introduced Daschle...He now works with Daschle at Alston & Bird."
Daschle's wife was/is also a HUGE lobbyist so maybe 99% of the family income comes from lobbying? Makes Obama look a lot like Bill Clinton - say anything you want to any audience at any time and have enough charm to pull it off. It's not the lobbying; it's the obvious deception that disgusts me.
Not mentioned, Daschle was the ringleader of the blocking of appointments to the judiciary by the minority in the senate, so he went from winning re-election by 30 points to losing in his own state.
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Not mentioned, Daschle was the ringleader of the blocking of appointments to the judiciary by the minority in the senate, so he went from winning re-election by 30 points to losing in his own state.
He was voted out so BO who is just another party hack turns around and rewards him with this.
And the pols in DC are all getting rich anyway with their lobbying and such.
Even the supposedly honorable Dole is on the dole - and from Daschle no less. Gives a new meaning to bipartisanship doesn't it.
I guess his viagra plug makes him an expert in health care. :x :-(
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For those of us who want to see what's in store for US health care we should probably read Daschle's book. We are going down the road of gigantic federal control, expansion, redistribution, and subtle (politically covered) rationing. There will be a board which will oversee and control one seventh of our economy:
Visions for Change in U.S. Health Care — The Players and the Possibilities
John K. Iglehart
Under the incoming presidential administration, U.S. Democratic leaders are determined to achieve a long-elusive goal: securing "affordable, accessible health care for every single American," as President-elect Barack Obama put it recently. Recognizing the blunders that doomed the reform effort of President Bill Clinton 16 years ago, the new administration is working closely with Congress to craft a bill that will attract sufficient support to ensure enactment.
Although some critics argue that we can ill afford the costs of expanded coverage and other reforms with the economy in recession and an ever-growing federal deficit, Obama counters that these are pocketbook issues, integral to recovery efforts. At a December news conference, when he introduced Tom Daschle as his choice for secretary of Health and Human Services, Obama said a major health care initiative "has to be intimately woven into our overall economic recovery plan. It's not something that we can put off because we are in an emergency. This is part of the emergency."
The new administration's proposal for health care reform will not be part of the large stimulus package that Democratic legislators plan to enact in early January. Though the proposal is a work in progress, its central tenets are well known and, in some key respects, resemble the plan enacted in Massachusetts — which, in 2 years, has reduced the state's uninsured to 2.4% of its population (the lowest in the country), according to a 2008 report by the Urban Institute.
Obama's proposal would enable people with employer-sponsored health insurance coverage to retain it, if they prefer, and would require large employers either to offer their workers "meaningful coverage" or to contribute a certain percentage of their payroll to support a new public plan. The proposal would also create an insurance exchange through which people without employer coverage could select private coverage or the public plan at rates similar to those offered through large employers. Obama has pledged to "lower costs by taking on anticompetitive actions in the drug and insurance companies," to support disease prevention and health promotion efforts, and to invest $50 billion over the next 5 years to accelerate adoption of health information technology.1
A number of health-related items are being considered as elements of the early stimulus package, largely to prevent people who lose their jobs from losing their coverage and to begin investing in the infrastructure for a more efficient delivery system. These items include increased federal support to states to maintain or expand their Medicaid enrollment, reauthorization of and increased funding for the State Children's Health Insurance Program, grants to states to speed adoption of health information technology, and expansion of the Consolidated Omnibus Budget Reconciliation Act (COBRA) to give certain laid-off workers the right to temporarily continue insurance coverage at group rates.
Democrats' fortunes improved dramatically in November when Obama swept to a historic victory over Republican Senator John McCain. Thanks to the unpopularity of President George W. Bush and Obama's coattails, Democrats also increased their majorities in both houses of Congress — to margins of 257 to 178 in the House and 58 to 42 in the Senate (if Democrat Al Franken of Minnesota wins the seat), including two independents who caucus with the Democrats. (The retirement of Obama and Democrats Hillary Clinton and Ken Salazar from the Senate leaves open seats in Illinois, New York, and Colorado, and the race in Minnesota is undecided.) Republicans — if their caucus can maintain tight discipline — will still wield considerable influence in the Senate, where it takes 60 votes to overcome a filibuster.
Determined to avoid the mistakes that brought down the Clinton reform plan, Obama demonstrated in his early appointments the importance he attaches to maintaining close ties between Congress and the White House. He selected Rahm Emanuel, a powerful congressman from Illinois, as chief of staff, and former Senate Majority Leader Daschle as secretary of Health and Human Services and director of a new White House Office of Health Reform. Daschle has set out his own ideas for reform in a recent book, calling for all Americans to purchase coverage and for the creation of a federal health board (modeled after the Federal Reserve Board) that would have sweeping powers to mandate policies for all federal health programs.2 Peter Orszag was named Obama's director of the Office of Management and Budget, a powerful agency that prepares the government's annual budget. Since 2007, Orszag has been the director of the Congressional Budget Office, where he has placed a heavy emphasis on health-related issues.
Democratic congressional leaders will also play influential roles in promoting the administration's health reform agenda and urging Republican legislators to join as cosponsors. House Speaker Nancy Pelosi (D-CA) is a dominant figure who ranks health care reform among her highest priorities. Senate Majority Leader Harry Reid (D-NV) may have more difficulty maintaining discipline within his ranks because in the Senate there is disagreement on the shape reform should take. For example, Senators Ron Wyden (D-OR) and Robert Bennett (R-UT) have persuaded 15 other senators to cosponsor a bill that the authors assert reflects an "ideological truce" between the parties: "Democrats are correct in saying that universal coverage is necessary to fix health care," they write. "Republicans are correct in saying that market forces play an important role in health care by promoting competition and innovation. The Healthy Americans Act strikes a balance between these ideals."3
Five congressional committees will be instrumental in refining any reform plan. Three of Pelosi's California colleagues, all liberal Democrats, hold leadership positions on the three key House panels: Henry Waxman is the new chair of the House Energy and Commerce Committee, George Miller chairs the House Education and Labor Committee, and Pete Stark chairs the House Ways and Means Subcommittee on Health. The relevant Senate committees are the Finance Committee, chaired by Max Baucus (D-MT), and the Health, Education, Labor, and Pensions Committee, chaired by Edward Kennedy (D-MA).
The House Ways and Means Committee is generally considered the most influential panel in Congress because of a constitutional requirement stipulating that all tax legislation must originate there. It also oversees Medicare Part A (which covers hospitals), public welfare, Social Security, trade, and unemployment compensation. Although Representative Charles Rangel (D-NY) chairs the committee, he often defers to Stark on health issues, and his standing has been weakened by ethics problems currently under investigation. Stark recently told reporters that once reform legislation is introduced, consideration of it would probably consume most of 2009, with enactment possible in early 2010. Stark has long supported "Medicare for all" as his preferred approach to expanding coverage; he opposes privatizing the program. He was a lead sponsor of the Children's Health and Medicare Protection Act (CHAMP), a measure the House approved in August 2007 on a vote of 225 to 204 that would have replaced the formula on which Medicare's physician fees are set. The bill, which died in the Senate, would also have placed greater emphasis on primary care and preventive services covered by Medicare by allowing physician payments in these areas to grow at a rate 2.5% faster than that of the gross domestic product (GDP), whereas payments for all other physician services would be limited to the GDP's growth rate.
Waxman established a reputation as an adroit legislator during the 15 years he chaired the House Energy and Commerce Subcommittee on Health (1979 to 1994). His most significant legislative accomplishment during a period that included the presidency of the conservative Ronald Reagan was pressing Congress to vastly expand Medicaid.4 In recent weeks, Waxman demonstrated his political acumen by securing enough votes in the House Democratic caucus to wrest the chairmanship of the Energy and Commerce Committee from John Dingell (D-MI), who in February will become the longest-serving House member in history, with 53 years of service. The practical Waxman recently noted that the "best approach to reform is what we can pass . . . that secures the goal of universal coverage, sensible controls on cost, and assurance of quality care." But he also said he would work to bring generic versions of biologic products to the market and to restore the effectiveness of the Centers for Disease Control and Prevention and the Food and Drug Administration.
Baucus's Senate Finance Committee oversees Medicare, Medicaid, public welfare, Social Security, taxes, trade, and unemployment insurance. Baucus is a moderate who occasionally upsets his liberal colleagues by casting votes more reflective of Montana conservatism than his party's activism. In mid-2008, however, he came out strongly in favor of ambitious health care reform and has since released an 89-page "call to action" that embraces a commitment to strengthening the employer-based insurance system, bolstering the role of primary care, and reexamining Medicare's graduate medical education policies.5 Baucus also outlined an approach to reforming Medicare's physician payment system that resembles the model in CHAMP.
Senator Kennedy, for his part, is determined to top his many health policy accomplishments by winning enactment of universal coverage. In September, Kennedy, who is undergoing treatment for brain cancer, directed his staff to organize roundtable discussions among representatives of disparate interests (large and small businesses, community health organizations, consumers, health plans, hospitals, labor, physicians, and others) to identify issues on which there is broad agreement or conflicting opinion and strive to build support for reform. One purpose of these ongoing discussions is to neutralize opposition to the ambitious reform designs that Democrats hope to enact. One participant, Karen Ignagni, chief executive officer of America's Health Insurance Plans (the new incarnation of an organization that helped to bring down Clinton's reform plan with its devastating "Harry and Louise" ads), said of the roundtable: "You see a range of diverse stakeholders trying to work together to achieve health care reform."
Congressional Republicans have been slow to engage Democrats on health care issues. They have developed no alternative proposals, and no armies of grassroots supporters or well-financed private organizations seem poised to do battle against reform. This situation could change rapidly once proposals are introduced, hearings commence, and winners and losers are clearly identified. Republicans' greatest concerns seem to be the creation of a new public plan, which many fear is a backdoor approach to a single-payer system; the possible creation of a federal health board with sweeping new powers over benefit packages, which might stifle innovation; and the long-term financial implications of providing near-universal coverage.
President-elect Obama faces a daunting set of challenges as his grand vision for change comes into closer contact with the realities of U.S. politics. Obama has acknowledged that hundreds of billions of dollars will be added to the federal deficit as he pursues economic recovery, but he has also vowed to scour the budget in search of wasteful spending to offset these new costs. This exercise, in which Congress will undoubtedly participate, will provoke many a pitched battle and is certain to affect Americans' reaction to the new president's definition of "change."****
Source Information
Mr. Iglehart is a national correspondent for the Journal.
An interactive graphic on key players in health care reform is available at NEJM.org.
References
Obama B, Biden J. Barack Obama and Joe Biden's plan to lower health care costs and ensure affordable, accessible health coverage for all. (Accessed December 22, 2008, at http://www.barackobama.com/issues/healthcare.)
Daschle T, Greenberger SS, Lambrew JM. Critical: what we can do about the health-care crisis. New York: Thomas Dunne Books, 2008.
Wyden R, Bennett B. Finally, fixing health care: what's different now? Health Aff (Millwood) 2008;27:689-692. [Free Full Text]
Iglehart JK. Medicaid revisited -- skirmishes over a vast public enterprise. N Engl J Med 2007;356:734-740. [Free Full Text]
Baucus M. Call to action: health reform 2009. Washington, DC: Committee on Finance, 2008. (Accessed December 22, 2008, at http://www.finance.senate.gov.)
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The House made its first down payment on President Obama's health-care plans last week, passing 289-139 a major expansion of the State Children's Health Insurance Program. The Senate is scheduled to take it up soon and pass it easily as well. These days tens of billions in new spending is a mere pittance, but Schip is also the Democratic model for a quantum jump in government health care down the line.
The bill became a liberal Pequot after President Bush repeatedly vetoed it in 2007 (while supporting a modest expansion). The GOP has no hope of stopping it now, so Schip will more than double in size with $73.3 billion in new spending over the next decade -- not counting a budget gimmick that hides the true cost. The program is supposed to help children from working-poor families who earn too much to qualify for Medicaid, but since it was created in 1997 Democrats have used it as a ratchet to grow the federal taxpayer share of health-care coverage.
With the new bill, Schip will be open to everyone up to 300% of the federal poverty level, or $63,081 for a family of four. In other words, a program supposedly targeted at low-income families has an eligibility ceiling higher than the U.S. median household income, which according to the Census Bureau is $50,233. Even the 300% figure isn't really a ceiling, given that states can get a government waiver to go even higher. Tom Daschle's folks at Health and Human Services will barely read the state paperwork before rubberstamping these expansions.
The political purpose behind Schip has always been to capture the middle class. Every time the program grows, it displaces private insurance. Even before Democrats struck down rules limiting crowd out, research indicated that for every 100 children signed up -- now more than 7.1 million -- there is a reduction in private coverage for 25 to 50 kids. Exactly the same thing will happen if Messrs. Obama and Daschle end up introducing a "public option," a government insurance program modeled after Medicare but open to anyone of any income. As with Schip, any net increase in insurance coverage will come by having taxpayers gradually supplant the private system.
Schip money is delivered as a block grant, which states are supposed to match, though national taxpayers end up paying 65% to 83% of the total cost. When states make health-care promises they can't afford -- such as New York, which expanded the program to 400% of poverty -- the feds always step in with, yes, a bailout. The House bill creates a "contingency fund" precisely for that purpose, and also allots bonus payments to states that boost Schip enrollment, so Governors will be further rewarded for overspending. All this is propped up by a permanent increase in the tobacco tax, which will rise to $1 a pack from the current 39 cents -- thus financing a permanent and growing entitlement with a declining corps of smokers.
Lately Mr. Obama has been making noises about the necessity of entitlement reform. This is no way to start.
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The more we dig into the pile of spending and tax favors known as the "stimulus bill," the more amazing discoveries we make. Namely, Democrats have apparently decided that the way to gun the economy is to spend even more on health care.
This is notable because if there has been one truly bipartisan idea in Washington, it's that the U.S. as a whole spends too much on health care. President Obama has been talking up entitlement reform as a way to free up the money for his other social priorities. But it turns out that Congress is using the stimulus as cover for a massive expansion of federal entitlements.
Only the bill's $20 billion or so devoted to electronic health records can be reasonably called an investment. More typical is the $87 billion that will go to Medicaid, which -- silly us -- we underestimated by about $6 billion in our stimulus editorial yesterday. This pot of money will be used to blow out the federal matching rate by 4.9 percentage points across the board. Medicaid is nominally a joint state-federal program, but the feds pick up 57% of the Medicaid bill on average and are willing to go as high as 82% in some states. In other words, Democrats want to bail out the states that make unaffordable health-care promises and haven't tried to control costs. This latest rescue will give Governors more incentive to do so, given that the more they spend, the more Congress pays.
National taxpayers will also fund a new program allowing some laid-off workers receiving unemployment checks to enroll in Medicaid. For the first time ever on a large scale, the federal government will pay 100% of the costs they incur, and states are explicitly prohibited from means-testing this benefit. Supposedly the $11 billion plan will expire in 2010, but the word "temporary" does not exist in the entitlement world -- and Democrats will fight furiously to extend these benefits before they sunset.
Another damaging inspiration is the plan to throw $30.3 billion at Cobra insurance plans. The unemployed are currently allowed to keep their work health benefits for 18 or 36 months since 1986. While they search for a new job, they must pay 102% of the full insurance premium, including the employer's share. But Democrats now plan to subsidize these plans to the tune of 65%.
Are they making Cobra a new entitlement? Cobra was never intended as an option to assist the long-term unemployed -- considering that adverse selection means Cobra enrollees cost businesses about 145% as much as covered employees. Since Democrats want to boost participation by propping up Cobra use, that will result in less capital to invest in new jobs in the middle of a recession. It will also mean adding another disincentive (in addition to unemployment insurance) to get a new job. When you subsidize people not to work, you get more nonworkers.
Not for nothing did Democratic heath-care commissar Pete Stark tell the New York Times that "We accomplished more today than in the last eight years" after his committee approved the Medicaid and Cobra pieces of the stimulus. In one swoop Democrats will make employer-sponsored health care even more expensive and expand opportunities for an anxious public to join, or remain on, the welfare rolls. The pretext of "stimulus" is being leveraged to capture ever more of the private health-care market and transfer those costs onto government.
But don't forget that everyone agrees that health spending is already too high. So the stimulus also devotes $1.1 billion to create a new bureaucracy called the Federal Coordinating Council for Comparative Effectiveness Research. A billion dollars isn't nearly enough to conduct the rigorous clinical studies needed to provide more information on what medical treatments result in the best outcomes. But Democrats want to get this "health-care Fed" on the books now so it's around when they pass the next entitlement expansion -- for the entire middle class.
When government finances start to buckle under that subsidy, the comparative effectiveness outfit will start to ration care to control costs, much like the United Kingdom's National Institute for Clinical Excellence (NICE). The draft report accompanying the House portion of the bill notes that procedures and drugs "that are found to be less effective and in some cases, more expensive, will no longer be prescribed."
In sum, what we are really getting in this stimulus bill are several more steps in the gradual government takeover of the health-care market.
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By NADEEM ESMAIL
President Obama and Congressional Democrats are inching the U.S. toward government-run health insurance. Last week's expansion of Schip -- the State Children's Health Insurance Program -- is a first step. Before proceeding further, here's a suggestion: Look at Canada's experience.
Martin KozlowskiHealth-care resources are not unlimited in any country, even rich ones like Canada and the U.S., and must be rationed either by price or time. When individuals bear no direct responsibility for paying for their care, as in Canada, that care is rationed by waiting.
Canadians often wait months or even years for necessary care. For some, the status quo has become so dire that they have turned to the courts for recourse. Several cases currently before provincial courts provide studies in what Americans could expect from government-run health insurance.
In Ontario, Lindsay McCreith was suffering from headaches and seizures yet faced a four and a half month wait for an MRI scan in January of 2006. Deciding that the wait was untenable, Mr. McCreith did what a lot of Canadians do: He went south, and paid for an MRI scan across the border in Buffalo. The MRI revealed a malignant brain tumor.
Ontario's government system still refused to provide timely treatment, offering instead a months-long wait for surgery. In the end, Mr. McCreith returned to Buffalo and paid for surgery that may have saved his life. He's challenging Ontario's government-run monopoly health-insurance system, claiming it violates the right to life and security of the person guaranteed by the Canadian Charter of Rights and Freedoms.
Shona Holmes, another Ontario court challenger, endured a similarly harrowing struggle. In March of 2005, Ms. Holmes began losing her vision and experienced headaches, anxiety attacks, extreme fatigue and weight gain. Despite an MRI scan showing a brain tumor, Ms. Holmes was told she would have to wait months to see a specialist. In June, her vision deteriorating rapidly, Ms. Holmes went to the Mayo Clinic in Arizona, where she found that immediate surgery was required to prevent permanent vision loss and potentially death. Again, the government system in Ontario required more appointments and more tests along with more wait times. Ms. Holmes returned to the Mayo Clinic and paid for her surgery.
On the other side of the country in Alberta, Bill Murray waited in pain for more than a year to see a specialist for his arthritic hip. The specialist recommended a "Birmingham" hip resurfacing surgery (a state-of-the-art procedure that gives better results than basic hip replacement) as the best medical option. But government bureaucrats determined that Mr. Murray, who was 57, was "too old" to enjoy the benefits of this procedure and said no. In the end, he was also denied the opportunity to pay for the procedure himself in Alberta. He's heading to court claiming a violation of Charter rights as well.
These constitutional challenges, along with one launched in British Columbia last month, share a common goal: to win Canadians the freedom to spend their own money to protect themselves from the inadequacies of the government health-insurance system.
The cases find their footing in a landmark ruling on Quebec health insurance in 2005. The Supreme Court of Canada found that Canadians suffer physically and psychologically while waiting for treatment in the public health-care system, and that the government monopoly on essential health services imposes a risk of death and irreparable harm. The Supreme Court ruled that Quebec's prohibition on private health insurance violates citizen rights as guaranteed by that province's Charter of Human Rights and Freedoms.
The experiences of these Canadians -- along with the untold stories of the 750,794 citizens waiting a median of 17.3 weeks from mandatory general-practitioner referrals to treatment in 2008 -- show how miserable things can get when government is put in charge of managing health insurance.
In the wake of the 2005 ruling, Canada's federal and provincial governments have tried unsuccessfully to fix the long wait times by introducing selective benchmarks and guarantees along with large increases in funding. The benchmarks and the guarantees aren't ambitious: four to eight weeks for radiation therapy; 16 to 26 weeks for cataract surgery; 26 weeks for hip and knee replacements and lower-urgency cardiac bypass surgery.
Canada's system comes at the cost of pain and suffering for patients who find themselves stuck on waiting lists with nowhere to go. Americans can only hope that Barack Obama heeds the lessons that can be learned from Canadian hardships.
Mr. Esmail, based in Calgary, is the director of Health System Performance Studies at The Fraser Institute.
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Dashcle was felt to be in position with his influence peddling contacts and experience to be able to push through heatlh reform. Whether or not we would like his reforms is open to debate. For those who have no insurance they would likely be pleased. For those with existing medicare, they would likely get rationed care. And for those who pay for commercial insurance they would get screwed most likely. That said the system is broken and something has to change but what I don't know:
Losing Daschle Hurts, but Won't Kill Health Plans
Posted Feb 3, 09 4:13 PM CST in Science & Health, Opinion, Politics
(Newser) – The loss of Tom Daschle is a blow to President Obama’s plans for health-care reform, but the administration still has the resources to get the job done, Jonathan Cohn writes in the New Republic. Daschle was not only to head the Department of Health and Human Services, but also a White House office on health reform—which is where his political know-how would’ve come in handy.
“Daschle had a combination of talents not easy to find in one person,” Cohn writes. “But that doesn’t mean you can’t replace those skills, particularly if you’re willing to find several people instead of one.” While number of current or former governors could take over the cabinet position, Cohn pushes scholar Jeanne Lambrew for the reform office: “In fact, based on things I’ve heard, she’s been doing much of it for a while.”
Source: New Republic
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Ruin Your Health With the Obama Stimulus Plan: Betsy McCaughey
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Commentary by Betsy McCaughey
Feb. 9 (Bloomberg) -- Republican Senators are questioning whether President Barack Obama’s stimulus bill contains the right mix of tax breaks and cash infusions to jump-start the economy.
Tragically, no one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department.
Senators should read these provisions and vote against them because they are dangerous to your health. (Page numbers refer to H.R. 1 EH, pdf version).
The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.
But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.”
Keeping doctors informed of the newest medical findings is important, but enforcing uniformity goes too far.
New Penalties
Hospitals and doctors that are not “meaningful users” of the new system will face penalties. “Meaningful user” isn’t defined in the bill. That will be left to the HHS secretary, who will be empowered to impose “more stringent measures of meaningful use over time” (511, 518, 540-541)
What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment? The vagueness is intentional. In his book, Daschle proposed an appointed body with vast powers to make the “tough” decisions elected politicians won’t make.
The stimulus bill does that, and calls it the Federal Coordinating Council for Comparative Effectiveness Research (190-192). The goal, Daschle’s book explained, is to slow the development and use of new medications and technologies because they are driving up costs. He praises Europeans for being more willing to accept “hopeless diagnoses” and “forgo experimental treatments,” and he chastises Americans for expecting too much from the health-care system.
Elderly Hardest Hit
Daschle says health-care reform “will not be pain free.” Seniors should be more accepting of the conditions that come with age instead of treating them. That means the elderly will bear the brunt.
Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council (464).
The Federal Council is modeled after a U.K. board discussed in Daschle’s book. This board approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit. Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis.
In 2006, a U.K. health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye. It took almost three years of public protests before the board reversed its decision.
Hidden Provisions
If the Obama administration’s economic stimulus bill passes the Senate in its current form, seniors in the U.S. will face similar rationing. Defenders of the system say that individuals benefit in younger years and sacrifice later.
The stimulus bill will affect every part of health care, from medical and nursing education, to how patients are treated and how much hospitals get paid. The bill allocates more funding for this bureaucracy than for the Army, Navy, Marines, and Air Force combined (90-92, 174-177, 181).
Hiding health legislation in a stimulus bill is intentional. Daschle supported the Clinton administration’s health-care overhaul in 1994, and attributed its failure to debate and delay. A year ago, Daschle wrote that the next president should act quickly before critics mount an opposition. “If that means attaching a health-care plan to the federal budget, so be it,” he said. “The issue is too important to be stalled by Senate protocol.”
More Scrutiny Needed
On Friday, President Obama called it “inexcusable and irresponsible” for senators to delay passing the stimulus bill. In truth, this bill needs more scrutiny.
The health-care industry is the largest employer in the U.S. It produces almost 17 percent of the nation’s gross domestic product. Yet the bill treats health care the way European governments do: as a cost problem instead of a growth industry. Imagine limiting growth and innovation in the electronics or auto industry during this downturn. This stimulus is dangerous to your health and the economy.
(Betsy McCaughey is former lieutenant governor of New York and is an adjunct senior fellow at the Hudson Institute. The opinions expressed are her own.)
To contact the writer of this column: Betsy McCaughey at Betsymross@aol.com
Last Updated: February 9, 2009 00:01 EST
http://www.bloomberg.com/apps/news?pid=newsarchive&sid=aLzfDxfbwhzs
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What If ‘Comparative Effectiveness’ were applied to cheeseburgers?
D.C. Examiner Op-Ed
By: Sally C. Pipes
2.6.2009
The Examiner (Washington, D.C.), February 6, 2009
A shocking new provision was discovered today in the $825 billion stimulus package recently passed by the House of Representatives. Hidden half-way down page 538 is a clause that would provide $1.1 billion to help government bureaucrats compare the effectiveness of various cheeseburgers.
The provision was discovered by a congressional aide, who is also accusing his boss of torture for making him read the 647-page bill in its entirety.
As it turns out, the language of the “cheeseburger effectiveness” clause is virtually identical to a better-known provision in the bill that applies to medicine. The only apparent difference between the two clauses is that one uses the word “cheeseburgers” throughout, whereas the other uses terms like “medical treatments.”
Congressional watchdogs quickly linked the cheeseburger clause to Rep. Norman Busybody, whose family owns Planet Taco, the third-largest fast-food chain in Texas.
“Many restaurants routinely pressure consumers into ordering a more expensive newfangled burger, even when it doesn’t represent a clear improvement in flavor over previous burgers."
Rep. Busybody insists that his cheeseburger effectiveness provision will solve this crisis – just as the comparative effectiveness provision will help solve the healthcare crisis.
“There are too many burgers on the market. Patrons are confused by all the choices out there,” he says. “They anguish over whether they should order a Big Mac or a Whopper. Soon after my law is passed, there will be only one burger on all fast-food menus. It will be made from tofu and taste horrible, so people will probably just eat tacos instead.”
Under the new program, government researchers will be charged with testing new sandwiches in three classes – chicken, fish, and beef – before they hit the marketplace. They'll check for such features as flavor, texture, general aesthetic appeal, possible side-effects, and nutritional value. Tacos will be exempt from all testing.
Fast-food restaurants worry the government-funded research will put billions of dollars from the sales of their newest and most lucrative sandwiches in jeopardy. They fear the research will be followed by regulation that would ban most cheeseburgers from the market as part of a congressional effort to lower overall food costs.
Rep. Busybody says their fears are warranted. His staff is currently working on follow-up legislation that would ban the three most problematic types of burgers:
1) ‘Me-too’ burgers, which have fancy names, but are no better tasting than other cheeseburgers already on the market;
2) Marginally-improved burgers, like the Triple-Decker, which costs a dollar more than the Double Quarter Pounder, but is only slightly more satisfying;
3) Frequently ineffective burgers, like the Fish-and-Pickles, which some people love, but many find disgusting.
Many in Congress have already come out in support of the cheeseburger measure within just hours of its discovery.
“If comparative effectiveness research can save the country money for medicine, then why not apply it to cheeseburgers, as well?” says Rep. Stanley Toetheline, who last week paid $200,000 in backtaxes upon his nomination to the House Ethics Committee.
Some consumers disagree. “Most days I order a Chicken Cheddar. But sometimes I want a Biggie Bacon,” says Joe Hartattak, a fork-lift operator from Kansas who eats fast food five times a week. “Some of my friends prefer the Double Trouble. We’re all different – so choice is important to us.”
Rep. Busybody disagrees. “People like Hartattak are just country bumpkins – the kind of fools who actually pay their taxes. They need smart government bureaucrats – people like me – to micromanage their lives.”
Other supporters say the research will help protect consumers like Hartattak from buying cheeseburgers that may not be worth the extra money.
Federal officials are already exploring a scheme to make findings from the studies binding by prohibiting “Travel & Entertainment” tax deductions for the purchase of unapproved burgers.
"If we're to get profiteering burger-companies under control, this comparative-effectiveness research effort has to have some teeth," says the administration’s newly appointed Burger Czar Ron Machater. "The tax penalty will ensure that restaurants can't rip off consumers with overpriced products.”
Backers of the research provision say restaurants don't have the incentive to compare their burgers with those of competitors. "Consumers are in the dark when it comes to figuring out which burger tastes best. Clearly, only the government has the resources and objectivity necessary to make an effective selection between the Big Mac and the Whopper,” says Machater, who admits to being a vegetarian.
In fact, Machater believes that fast-food television commercials – also known as “direct-to-burger-eater advertising” – should be banned altogether. “These ads hypnotize unsuspecting couch-potatoes into making late-night trips to White Castle.”
The burger effectiveness legislation is modeled after Britain’s National Institute for Health and Clinical Effectiveness (NICE) – an agency that evaluates medical treatments and then decides which ones the British health care system will cover.
Critics argue that in its zeal to save money, NICE often denies patients access to life-saving medicines. Last year, for example, NICE was widely criticized after it announced that four breakthrough drugs would not be covered for people with kidney cancer. As of today, only one of those drugs has been approved and it was just recently. Not surprisingly, Britain dramatically trails the United States in cancer survival rates.
Rep. Busybody says that Britain’s nightmare experience with “comparative effectiveness” doesn’t worry him. “Just because this model has been an abject failure in Britain doesn’t mean it won’t work here,” he says. “We’re on untrodden territory here – no one has ever tried this with cheeseburgers before.”
Sally C. Pipes is president and ceo of the Pacific Research Institute. She is the author of The Top Ten Myths of American Health Care: A Citizen’s Guide.
This information was found online at:
http://liberty.pacificresearch.org/press/what-if-comparative-effectiveness-were-applied-to-cheeseburgers
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***One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446).***
Well yes. Of course.
Electronic medical records will also be used to store, centralize data, and have all this at the government's fingertips to so they can find ways to reduce costs by rationing care.
Nurses will replace doctors by simply following algorithms, cheaper and sometimes less effective drugs will be preferred, more services will not be paid as deemed inappropiate, patients will be forced to do preventative care (with financial incentives) and maybe even their habits, such as cigarettes, diets, exercise patterns will be tracked and their rates adjusted "accordingly".
I don't like it. But the system is totally out of control. Without some form of rationed care we will go bankrupt.
I believe the best hope is actually the pharmaceutical industry to find drugs that actually work to combat obesity and cancer and arthiritis that keeps as healthier and only in that way can we get what we want. Otherwise its rationed care or we all go bankrupt.
Offering health care to illegals doesn't help but that is probably only a small part of the problem.
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Well, tragically it certainly looks to be going that way. The present system slandered as being free market, is actually bureaucratic madness. We of free minds and free markets need to make the case.
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Scott Grannis
Stealth Healthcare in the stimulus bill
Tom Daschle didn't make it to the HHS post, thanks to being a tax cheat, but he has left us his legacy in the form of significant legislation buried in the new stimulus bill. Read all about it here if you haven't already. It boils down to creating a new national medical database that will keep track of everyone's medical records, so that eventually a National Coordinator of Health Information Technology can ration healthcare.
Any effort by the government to implement something like single-payer or universal healthcare will inevitably result in rationing and shortages. That's just simple economics: if people don't have to pay for their own health care, costs will rise, health care services will be in short supply, and the whole system will become inefficient. To wish it would happen otherwise is fanciful.
The urge to move us to universal healthcare is based on the belief that a modern, advanced society has an obligation to ensure that everyone receives healthcare treatment; it would be unconscionable to deny anyone treatment. Well, consider what would happen if we felt the same way about food: surely no one should be allowed to starve in this age of abundance ...
If the government paid for everyone's food, imagine the consequences. Filet mignon would fly off the shelves; home refrigerators would be stocked to capacity, spoiled food routinely chucked in the trash can; competition to produce better and cheaper products would become a quaint vestige of the past; hamburger meat would pile up; food quality would decline; complaints would skyrocket. It wouldn't take long before the government created an entire bureacracy to monitor and "regulate" prices. Any mistakes in setting prices would resort in shortages or abundancies. Sound familiar?
Call your Senator now and tell him to vote against this bill!
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Call your Senator now and tell him to vote against this bill!
I doubt Klobuchar would change her mind (she's co-sponsor of S1). Both Franken and Coleman would be on board, so pretty much don't count on MN. :oops:
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***Well, consider what would happen if we felt the same way about food:***
Well the Dems have already decided that owning a home is an entitlement. Thanks to them and the Republicans that were afraid to stand up to them because essentially they are the minority party in the US today and were afraid of upsetting those who would benefit from the give aways, we are going broke.
It is happening with health care. It is the most massive social engineering we have ever seen. And the Dems keep increasing their constituent base that would benefit from this and would love to have the minority who pay for it continue to do so and to an even larger extant.
Michelle BO is ashamed of our country. So I guess now she can be proud that we are turning to socialism.
That's what she and BO wanted all along. Even with all their constituancies they are only getting it because of the impending collapse of the economy. That is remarkable to me. That most Americans still would not support them if it were not for the crash of banks.
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The "stimulus" is the bill that keeps on giving, not least for journalists. Health-care providers and patients may have a different reaction, however, when they learn that Democrats are using the bill to create a health information monopoly that will help centralize government control of the health-care market.
In theory, electronic medical records are among the few stimulus ideas that might do some actual good. Democrats and Republicans agree that exchanging the paper files we mostly use now for digital versions will lower costs, cut down on medical errors, and maybe cure the common cold.
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Both the House and Senate stimulus bills include about $20 billion in incentive payments (mainly through Medicare and Medicaid) to encourage the digitization of medical records. Fair enough. But one of the reasons only an estimated 17% to 29% of doctors use health IT is because there are still many technical issues to work out. Different systems must be compatible so doctors can communicate with each other, coordinate care and share information -- and they don't want to invest in a platform that could become as obsolete as HD-DVD.
Democrats have decided that the way to jump this gap is for government simply to pick the next Blu-Ray. Instead of building on a voluntary public-private standard-setting body created by the Bush Administration, the stimulus bill codifies it as a federal office and gives it broad new powers if private companies are not "substantially and adequately" meeting the needs of doctors and hospitals. The health IT outfit will soon be deciding which platforms are up to code and shutting down competitors.
This will certainly muffle innovation, given that high-school dropouts have been known to scam U.S. health bureaucrats out of millions of dollars that should be preventable with off-the-shelf auditing software. Anyway, what's the rush? Democrats give the game away by mandating that most medical providers who aren't linked into the government-approved health information network after 2016 will start to be penalized. Their real political goal is to make a down payment on national health care.
The stimulus actually makes it harder for doctors, hospitals and pharmacies to use health IT, under the guise of "privacy." This is especially dishonest. Insurers already know the health condition of millions of Americans from claims information, which list diagnoses, prescriptions, procedures, etc. The government does too, because it pays so many medical bills through the entitlement programs.
In its pure form, the primary purpose of health IT is to organize all this data in a useful way, so we can get a better sense of health trends and outcomes. Large insurers like Kaiser Permanente and others are starting to do just that on their own, as well as creating the data-based tools that could give consumers a better value for their health dollars. The plug could get pulled from such efforts because the faux privacy provisions are so onerous.
The true political goal is cost control. For the Pete Stark Democrats whose ambition is Medicare for all -- no exceptions -- giving government exclusive control over electronic health information and reporting is a step toward "comparative effectiveness" research. That in turn will be used to impose price controls and deny some types of medical treatment and drugs. And because government is able to skew the whole health system through Medicare and Medicaid, comparative effectiveness could end up micromanaging the practice of medicine.
If three Republican Senators are going to help pass this stimulus, the least they can do is demand that this stalking horse for government-run health care is out. We need to debate this in the open, not slip it into legislation under false cover.
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This piece can be read on several levels. With the specter of comparative effectiveness buried in the "stimulus" package looming, the politicization of health care standards is bound to follow, as demonstrated below. Combined with the pathological science trail blazed by global warming zealots, there are a lot of avenues open for politics guised as science to be inserted into all our lives.
Science, Politics, and Values
The Politicization of Professional Practice Guidelines
John D. Kraemer, JD, MPH; Lawrence O. Gostin, JD
JAMA. 2009;301(6):665-667.
The Infectious Diseases Society of America (IDSA) issued updated clinical practice guidelines in 2006 for the diagnosis and treatment of Lyme disease.1 Within days, the Connecticut attorney general launched an investigation, alleging IDSA had violated state antitrust law by recommending against the use of long-term antibiotics to treat "chronic Lyme disease (CLD)," a label applied by advocates to a variety of nonspecific symptoms for which frequently no evidence suggests the etiologic agent of Lyme disease is responsible. The IDSA was forced to settle the claim to avoid exorbitant litigation costs, even though the society's guidelines were based on sound science. The case exemplifies the politicization of health policy, with elected officials advocating for health policies against the weight of scientific evidence.
The Antitrust Investigation of IDSA
Although untreated or inadequately treated Lyme disease can progress to cause neurological complications and arthritis, there is no evidence the disease has a chronic form (except perhaps as sequelae) in the absence of objective clinical or serological evidence of active infection.2 Nevertheless, some patient groups and a small minority of physicians contend Borrelia burgdorferi, the causative agent of Lyme disease, commonly persists in patients after standard antibiotic treatments. They maintain that a constellation of nonspecific symptoms such as fatigue, myalgia, headaches, and chest pain are evidence of chronic infection, and that standard diagnostics are inaccurate.3 Furthermore, some recommend using long-term, high-dose antibiotics—frequently administered intravenously—to treat patients with nonspecific symptoms and no objective evidence of infection.3
The IDSA treatment guidelines strongly disagreed and instead labeled the constellation of symptoms "post-Lyme syndrome"—either sequelae without ongoing infection or unrelated to B burgdorferi. The guidelines state, "There is no convincing biologic evidence for the existence of symptomatic chronic B burgdorferi infection among patients after receipt of recommended treatment regimens for Lyme disease. Antibiotic therapy has not proven to be useful and is not recommended for patients with chronic (6 months) subjective symptoms after recommended treatment regimens for Lyme disease."1 The IDSA guidelines also rejected the use of a variety of alternative diagnostic tests deemed unvalidated by the Centers for Disease Control and Prevention (CDC) and US Food and Drug Administration.
IDSA's guidelines were based on the biological implausibility of B burgdorferi persistence after proper treatment in the absence of objective indications of treatment failure; the high background rates of the subjective symptoms often attributed to chronic Lyme infection; and the absence of benefit from, and the serious adverse effects of, long-term treatment. The CDC4 and National Institutes of Health5 concurred in the judgment that long-term antibiotic use is not justified: "despite extensive study, no clear evidence has emerged to support the contention that CLD results from a past or persistent Lyme disease infection."5 American Academy of Neurology treatment guidelines for Lyme disease affecting the nervous system reached the same conclusion.6
The International Lyme and Associated Diseases Society (ILADS), a CLD advocacy group, immediately protested and asserted the superiority of its alternative guidelines,3 which others have suggested were based on substandard review methods.7 Shortly after, Connecticut Attorney General Richard Blumenthal launched an investigation of IDSA's guideline writing process, alleging it violated state antitrust laws by excluding differing viewpoints from its guideline creation process and including members who had financial interests in, or ties to, Lyme diagnostic and treatment makers.8 IDSA did disclose its panel members' potential conflicts of interest in its published guidelines, even though there is no evidence that any conflicts altered the guidelines' content. Meanwhile, the committee that created the ILADS guidelines included the president of a company that manufactures an alternative Lyme disease diagnostic test9 and multiple physicians whose practices are listed with a CLD advocacy group's patient referral service10—but ILADS did not disclose the conflicts in its guideline document.3
Antitrust laws are designed to ensure legitimate commercial competition and protect against predatory corporate practices due to inappropriate restraints on trade. Professional organizations, such as IDSA, can violate antitrust laws if their standard-setting is an unreasonable attempt to advance their members' economic interests by suppressing competition.11 Applying the antitrust "rule of reason," a challenger must show that the professional organization both possesses substantial market power and that the anticompetitive effects of its standards outweigh patient benefits.12 Even assuming IDSA wielded sufficient market power through its nonbinding guidelines to meet the first part (which is questionable considering that insurers and clinicians can independently choose which treatments to cover and prescribe), the second part of the rule of reason cannot be met because IDSA guidelines substantially advanced patients' interests.
The courts should defer to professional medical associations when standards are set on the basis of valid science aimed at protecting patient health or safety. A precisely on-point federal case (though one that does not bind Connecticut courts interpreting the state antitrust law) upheld the American Academy of Ophthalmology guidelines attaching the label "experimental" to radial keratotomy, a surgical procedure for correcting nearsightedness.13 "Antitrust law is about consumers' welfare," said the court, so ultimately professional guidelines are a "medical not a legal question."13 That truism should decide antitrust cases, so that when a professional organization bases its work on the weight of science there can be no improper restraint of trade.
After spending more than a quarter of a million dollars on legal expenses, IDSA agreed to settle with the attorney general (without admitting any fault), assenting to an ombudsmen-reviewed panel to assess the 2006 guidelines.14 While it is unlikely IDSA's guidelines will change due to the investigation, the daunting potential for litigation by those unhappy with the outcomes of treatment guidelines may well chill the willingness of medical associations to make appropriate scientific evaluations of controversial topics—a development that would significantly threaten patient care and increase medical costs.
Science, Values, and Politics
At the heart of this controversy is the conflict between the positive nature of science and the normative function of value systems and political thought. Science is, and can only be, descriptive and explanatory. Whether a scientific finding is judged to be accurate is dependent on the quality and rigor of the methods used and whether that finding is replicable. The scientific process is not democratic—no amount of desire for different results can establish them—and inconsistent findings create true controversy only when their methods are of comparable validity.
At the same time, the sciences cannot be normative. They can establish context and a factual base for normative discourse, but scientific findings cannot entail any particular normative conclusion without reference to outside systems of thought. Science, for example, cannot resolve the never-ending debate over abortion in the United States. Medical science can describe the maternal health risks of pregnancy, elucidate fetal development, and establish risks of birth defects and complications. Nothing, however, inherently follows from any of these; rather, policy makers must look outside science, to moral, religious, ethical, and legal norms—eg, when aggregated cells become human life or what the relationship between citizens and their government should be. Medical science can, and should, inform these discussions, and in a vibrant and healthy society, such value questions will be vigorously debated.
However, all too often, the normative and positive blend into one another. Positive assertions are presented in a normative light—for example, that the cost of treating a condition surpasses a benchmark of cost-effectiveness, hence it should not be used. This really consists of 3 separate assertions: the cost of treatment equals a particular amount (a positive claim); treatments costing more than a certain amount are not cost-effective; and cost-effectiveness should guide the allocation of health care resources. All these claims may be justifiable, but only the first can be established through scientific methods.
The converse—when normative views are passed off as positive assertions—is even more problematic, such as the well-documented issue of abortion and breast cancer in the Bush administration. Multiple adequately powered and well-designed and analyzed studies investigated the putative association between abortion and breast cancer and found no evidence of its existence. However, from 2002 to 2003, information was placed on the National Cancer Institute Web site suggesting a link between abortion and breast cancer, based largely on older epidemiologic studies that failed to sufficiently control for recall bias.15
The Connecticut attorney general's action against IDSA falls into this latter category. The CLD advocacy community understandably seeks answers for the symptoms attributed to Lyme disease. But when high-quality research repeatedly was inconsistent with the group's hypotheses, the community should have sought other answers. Instead, many advocacy organizations—and the attorney general—insisted (against the weight of evidence) on a link between the symptoms and chronic infection and continued to call for long-term antibiotic treatments. Even this was perhaps defensible—after all, medical studies cannot prove the nonexistence of a phenomenon—although physicians in the CLD community should treat their patients based on the best-available evidence. But when political leaders using the force of law sued IDSA for its appropriate scientific conclusions that differed with the results they desired, they abused the public good.
A wall of separation is needed between science, norms, and politics. Science should inform normative discussions and provide the evidentiary base for political choices. Likewise, values will always be important in deciding how science is applied for human benefit. But neither should be permitted to distort the other—limits on the outer boundaries of what questions each can answer must be respected when making public policy. Medical science, and the health of patients who depend on it, are too important to be subjected to political ideologies.
AUTHOR INFORMATION
Corresponding Author: Lawrence O. Gostin, JD, O’Neill Institute for National and Global Health Law, Georgetown University, 600 New Jersey Ave NW, Washington, DC 20001 (gostin@law.georgetown.edu).
Financial Disclosures: None reported.
Author Affiliations: O’Neill Institute for National and Global Health Law, Georgetown University, Washington, DC.
REFERENCES
1. Wormser GP, Dattwyler RJ, Shapiro ED; et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Disease Society of America. Clin Infect Dis. 2006;43(9):1089-1134. FULL TEXT | ISI | PUBMED
2. Feder HM Jr, Johnson BJ, O'Connell S; et al, Ad Hoc International Lyme Disease Group. A critical appraisal of "chronic Lyme disease" [correction published in N Engl J Med. 2008;358(10):1084]. N Engl J Med. 2007;357(14):1422-1430. FREE FULL TEXT
3. Cameron D, Gaito A, Harris N; et al, ILADS Working Group. Evidence-based guidelines for the management of Lyme disease. Expert Rev Anti Infect Ther. 2004;2(1)(suppl):S1-S13. FULL TEXT | PUBMED
4. Lyme disease treatment and prognosis. CDC Web site. http://www.cdc.gov/ncidod/dvbid/lyme/ld_humandisease_treatment.htm. Updated October 8, 2008. Accessed January 16, 2009.
5. Chronic Lyme disease. National Institute of Allergy and Infectious Diseases Web site. http://www3.niaid.nih.gov/topics/lymeDisease/understanding/chronic.htm. Updated October 23, 2008. Accessed January 16, 2009.
6. Halperin JJ, Shapiro ED, Logigian E; et al, Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007;69(1):91-102. FREE FULL TEXT
7. Bowie WR. Guidelines for the management of Lyme disease: the controversy and the quandrary. Drugs. 2007;67(18):2661-2666. ISI | PUBMED
8. Connecticut Attorney General's Office. Attorney General's investigation reveals flawed Lyme disease guideline process, IDSA agrees to reassess guidelines, install independent arbiter. http://www.ct.gov/AG/cwp/view.asp?A=2795&Q=414284. Updated May 14, 2008. Accessed January 16, 2009.
9. IGeniX Inc Web site. http://igenex.com/Website. Accessed January 16, 2009.
10. LDA automated doctor referral system. Lyme Disease Association. http://www.lymediseaseassociation.org/referral/index.php. Accessed January 16, 2009.
11. Wilk v American Medical Association, 895 F2d 352 (7th Cir 1990).
12. Harris JL. Connecticut attorney general investigating possible anticompetitive impact of practice guidelines. ReedSmith Health Law Monitor. 2007;11(1):2-4. http://www.reedsmith.com/_db/_documents/0704hlm.pdf. Accessed January 16, 2009.
13. Schachar v American Academy of Ophthalmology, Inc, 870 F2d 397 (7th Cir 1989).
14. Klein JO. Danger ahead: politics intrude in Infectious Diseases Society of America guideline for Lyme disease. Clin Infect Dis. 2008;47(9):1197-1199. FULL TEXT | ISI | PUBMED
15. United States House of Representatives Committee on Government Reform—Minority Staff. Politics and Science in the Bush Administration. 2003.
http://oversight.house.gov/features/politics_and_science/pdfs/pdf_politics_and_science_rep.pdf. Posted November 13, 2003. Accessed January 16, 2009.
http://jama.ama-assn.org/cgi/content/full/301/6/665
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There is simply no way to provide health care to 48 million more people without taking money or benefits from those who already do have paid coverage
How is the 634 billion health care proposal going to be funded?
Much of the money is to be generated from squeezing private insurers who are in the Medicare Advantage program. They now get more than Medicare alone pays but will soon get no more than 100% thus to make money they will have to cut costs more than Medicare. This will no doubt result in less benefits, more costs to patients, and much more controlled care. If yo think your HMO is controlling you now this will be child's play to what we will see.
The smaller players will fail. There will be consolidation and the around 15 big players who provide around 70% of it now may stop providing this service to Medicare recipients altogether. More Hospitals will go out of business. Most are in the red now anyway.
Most physicians will already get further squeezed more than they already are. As a primary care physician I am one of the few that may get a pitance more (5% is tossed about). But the big BO gov. will simply find another way to get it back somewhere else so this essentially meaningless raise is just that.
*****Obama health plan opens tough negotiation
President Barack Obama's prescription for the nation's ailing health care system comes with Medicare cuts and tax hikes — usually poison pills that doom any overhaul effort in Congress.
But the budget Obama proposed Thursday is not a finished blueprint for overhauling health care. Rather it's the opening bid in a tough negotiation. Anybody who's been in a bargaining session knows you never end up with your opening bid.
Obama is asking Congress: If you're going to cover an estimated 48 million uninsured Americans in the world's costliest medical system, how do you pay for it?
Obama's plan would set aside $634 billion over 10 years in a major effort to cover all Americans — a goal that could cost more than $1 trillion. Half the money would come from tax increases on upper-income earners; the other half from cuts to Medicare and Medicaid. Private insurance plans serving Medicare seniors would take the biggest hit, but hospitals, drug companies and home health agencies also face cuts.
Republicans and fiscally conservative Democrats are sure to disagree with Obama's specifics, but they may quietly applaud his determination to pay for health care reform, instead of adding to the deficit.
"This is a serious effort to get the process moving," said Mark McClellan, a doctor and health economist who ran Medicare for former President George W. Bush. "The specific financing proposals are going to have a very tough time."
Obama's approach is a conscious departure from the path former President Bill Clinton took in the 1990s. Clinton's 1,300-page health care bill tried to answer every question and ultimately went nowhere. Obama is asking Congress to fill in the blanks.
"He's outlining these cuts as examples of places where savings can be accrued," said Christine Ferguson, a health policy professor at George Washington University. "You put those on the table, and if people want to have this discussion, they have to propose alternatives."
Whether that dialogue succeeds depends not just on Obama, but on Congress and interest groups representing insurers and doctors, hospitals and drug companies, consumers and small business.
Clinton's top priority was to get everybody covered quickly. Obama has framed the problem differently, focusing on how to slow rising costs, so that everybody can eventually be covered.
"What the president is doing is bold, but it's not overreaching," said economist Robert Reischauer, president of the Urban Institute research center. "The administration is coming to grips with the reality that this will cost a lot of money, and it's committed to paying for it."
The tricky part is in the details.
For example, more than half of Obama's spending cuts would come from Medicare managed care plans. The private plans cost the government 14 percent more on average than care for seniors in traditional Medicare. That translates into lower out-of-pocket costs for seniors, who in a bad economy have been flocking to the plans, increasing enrollment to about 10 million.
"People are flooding into the program," said Dan Mendelson, president of Avalere Health, an information company serving government and the health care industry. "I don't think cuts of this magnitude ultimately are going to be palatable to Congress."
Obama would replace the current payments with a competitive bidding system estimated to save $177 billion over 10 years. That sent insurance company shares skidding Thursday on Wall Street. But some market analysts said there may be a silver lining: While competitive bidding could decrease profit margins, it might generate higher revenues for insurers if seniors keep signing up.
America's Health Insurance Plans, the insurance industry trade group, wasn't ready to leave the bargaining table.
While warning that Obama's cuts would "jeopardize the health security" of seniors, the group's president, Karen Ignagni, said insurers "are committed to doing our share" to expand coverage.****
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[the Obama plan] "will no doubt result in less benefits, more costs to patients, and much more controlled care."
Costs paid directly by the consumer and prices yielded directly to the producer comprise the mechanism that allocates resources the most efficiently. But the more crucial the market, the more we try to use inferior mechanisms to allocate the resources. In the 1990's the WSJ published an unbelievably complicated flow diagram of how healthcare decisions would be made, almost cartoon-like, taken from the literal text of the Hillary-care proposal. Congressional staffers and mid-level bureaucrats will be making very important decisions for people they never met.
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Scott G wrote this week: "we could probably solve 80-90% of the healthcare problem by simply changing the tax code so that anyone, not just employers, could deduct the cost of healthcare insurance. This would reintroduce basic market dynamics to the healthcare market, and that is the only thing that can make healthcare cost-effective and widely available."
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***Congressional staffers and mid-level bureaucrats will be making very important decisions for people they never met.***
They will be getting their advice from ivory tower New England liberal health care policy types a few are MDs and most are phDs who write the flow charts and policies with the idea of providing as much universal coverage in a cost effective way. They are looking at populations, and budgets, not individuals. These people are from Harvard Yale the usual know it all suspects.
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Perhaps I should have posted under "Cognitive Dissonance" this piece that records Michelle Obama's role in, ah, redirecting, poor patients from the hospital where she was an administrator:
March 02, 2009
Michelle Obama's Patient-Dumping Scheme
By David Catron
The First Lady helped create a notorious program that dumped poor patients on community hospitals, yet the national media ignore the story. Imagine if her husband were a Republican.
The University of Chicago Medical Center has received a good deal of justly opprobrious press over its policy of "redirecting" low-income patients to community hospitals while reserving its own beds for well-heeled patients requiring highly profitable procedures. Substantial coverage was given to a recent indictment of the program by the American College of Emergency Physicians. ACEP's president, Dr. Nick Jouriles, released a statement suggesting that the initiative comes "dangerously close to ‘patient dumping,' a practice made illegal by the Emergency Medical Labor and Treatment Act, and reflected an effort to ‘cherry pick' wealthy patients over poor."
Oddly absent from most of the unflattering press coverage of UCMC's patient-dumping scheme is any mention of the role our new First Lady played in devising the program. A laudable exception has been the Chicago Sun-Times, which reported last August that "Michelle Obama -- currently on unpaid leave from her $317,000-a-year job as a vice president of the prestigious hospital -- helped create the program."
On the rare occasions when other "news" media have bothered to connect the Urban Health Initiative to its glamorous creator, they have attempted to whitewash this tawdry program. Typical of such disingenuous coverage was a story in the Washington Post, which described it as "an innovative program to steer the patients to existing neighborhood clinics."
But no amount of journalistic lipstick can hide the reality that Mrs. Obama's initiative is a patient-dumping scheme. Such "cherry-picking," as Dr. Jouriles accurately describes it, was, at one time, fairly common. Prestigious institutions like the University of Chicago Medical Center routinely "dumped" Medicaid, uninsured and other unprofitable patients on less mercenary community hospitals. Many patients suffered needlessly, and more than a few actually died, as the result of this practice. So, in 1986, President Reagan signed the Emergency Medical Labor and Treatment Act (EMTALA) into law. EMTALA made such "redirection" illegal, but many high profile hospitals still chafed at being forced to treat poor patients. Enter Michelle Obama, UCMC's "Vice President for Community and External Affairs."
Mrs. Obama first hatched the UCMC program as the "South Side Health Collaborative," which featured a gang of "counselors" whose job it was to "advise" low-income patients that they would be better off at other hospitals and clinics. The program was so successful in getting rid of unwanted patients that she expanded it, gave it a new name, and hired none other than David Axelrod to sell the program to the public. According to the Sun-Times, "Obama's wife and Valerie Jarrett, an Obama friend and adviser who chairs the medical center's board, backed the Axelrod firm's hiring." Axelrod helped the future First Lady formulate a public relations campaign in which the "Urban Health Initiative" was represented as a boon to the community actuated by the purest of altruistic motives.
The resultant PR campaign was a study in Orwellian audacity. Chicago's inner city residents soon began hearing that UCMC's patient dumping program would "dramatically improve health care for thousands of South Side residents" and that the medical center was generously willing to provide "a ride on a shuttle bus to other centers." Likewise, the people who ran the community hospitals to which these unwanted patients were being shuttled began to read claims in local media to the effect that the Urban Health Initiative was good for them as well. Dr. Eric Whitaker, the Blagojevich crony who succeeded Mrs. Obama as Director of the program, repeatedly assured gullible reporters that the financial impact on these hospitals would be positive: "The initiative actually is improving their bottom lines." The CFOs of those hospitals were no doubt relieved to learn that treating Medicaid and uninsured patients is profitable.
But you just can't please some people. In one of the few frank passages of the Post article, we discover that many members of UCMC's medical staff believe the program is nothing more than an "attempt to ensure that the hospital retains only affluent patients with insurance." And another association of emergency physicians has joined ACEP in denouncing the Urban Health Initiative. The Chicago Tribune reports that Dr. Larry Weiss, president of the American Academy of Emergency Medicine is unhappy about UCMC's failure to consult its own ER physicians before initiating the program: "Not including emergency-room physicians ... would be analogous to changing the way surgery is performed in an operating room without involving any surgeons." Dr. Whitaker assures us, however, that such critics are merely "opposed to change."
Presumably, he would be similarly dismissive of Angela Adams, who brought her son to the medical center's ER after his lip had been partially torn off by a pit bull. As the Tribune puts it, "Instead of rushing Dontae into surgery ... the hospital's staff began pressing her about insurance." Unfortunately for Dontae, he was covered by Medicaid. So, all he got from the UCMC emergency department was a shot, some antibiotics, and instructions to "follow up with Cook County." Angela had to take her son across town to John Stroger Hospital, where he was immediately admitted for reconstructive surgery. Like doctors Jouriles and Weiss, Angela is having trouble seeing the community benefit of the Urban Health Initiative.
Meanwhile, the program's parents, Michelle Obama and David Axelrod, have moved to Washington. As the First Lady and the President's closest advisor, they wield enormous power. Indeed, they may be the most powerful people in the Obama Administration, aside from the President himself. If these two characters were willing to betray their Chicago neighbors -- the South Side's most vulnerable citizens -- with a disgraceful program like the Urban Health Initiative, what sort of mischief will they devise for the hapless denizens of flyover country?
Come to think of it, isn't Obamacare being sold to us in pretty much the same way the Urban Health Initiative was sold to Chicago?
David Catron is a health care finance professional who has spent more than twenty years working for and advising hospitals and medical practices. He blogs at Health Care BS.
Page Printed from: http://www.americanthinker.com/2009/03/michelle_obamas_patientdumping_1.html at March 02, 2009 - 02:51:26 PM EST
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March 04, 2009
Two Forms of ID and Your Colonoscopy Report, Please
By Carol Peracchio
For the past two years I have been employed in nursing as a medical record reviewer. I've reviewed hundreds of records, the old fashioned handwritten kind, and also the electronic medical record (EMR).
I am not ideologically opposed to EMRs. When done well, they are much more efficient and easier to read and use. However, it can take months to train an office in EMRs. And if the computers are down, everything stops. But overall, EMRs are a net plus. No, what I'm opposed to is Obama's plan to set up a Ministry of Health Information. In Obama's stimulus bill recently signed into law are provisions that will allow Washington unfettered access to every American's health history through the magic known as the EMR.
When I hear Obama and his spokesmen giving us the hard sell about EMRs I am reminded of the Sham-Wow® pitchman. EMRs will cure everything wrong with our health care! Watch as EMRs tackle that long wait to see your doctor! Now you're whisked into the exam room in ten seconds or less! High deductibles your problem? Not with EMRs! Our computerized records will cut overhead by 50%! Are you getting this, Camera Guy?
The problem with their sales pitch is it isn't convincing. After all, no one in the Obama administration has any experience with EMRs or in taking care of sick people. Like many non-medical people, Obama apparently envisions American health care like the television program Gray's Anatomy: chock full of gorgeous physicians who push the gurneys themselves and come up with exotic diagnoses based on high tech data. Every patient is teetering on the edge of calamity. Thank God the EMR has Mr. Patient's every burp recorded and at Dr. McDreamy's fingertips. Otherwise he'll never be able to make the life-saving diagnosis of Mrs. Jane Doe by commercial!
In reality, the vast majority of patients have dull ailments like bursitis and pneumonia. They see the doctor for their diabetes and the surgeon to get their gall bladder out. Most of us see the same doctor for years. If we move, Dr. New's office gets our records from Dr. Old's office. Most people would be stunned to find out how quickly an experienced physician can get "up to speed" on a new patient. We like to think we're complicated, fascinating cases. Most of the time, we're pretty boring.
"But what if the patient is unconscious or otherwise unable to communicate? Won't having everyone's health records in a central location help in that instance?" the Obama team will ask.
This situation does occur. People who take daily medications should carry a list with them. Those who have chronic illnesses or allergies should have medic-alert bracelets. There are solutions to this rare occurrence besides placing 300 million people's medical records in the hands of ACORN Health Information Management.
I recently heard an expert on television claim that gathering everyone's EMRs on one big government server will solve that sterotypical problem -- the doctor with indecipherable handwriting. I have to agree that some of these doctors must be writing with their feet. However, I employed a much simpler remedy than taking steps toward socialized medicine. I called the doctor and asked him what he wrote. True, there are practitioners out there who should not be allowed anywhere near a pen. But if my records are going to be sent to Barack Obama, I'd prefer they remain illegible!
How about the sharing of medical information between institutions? The new administration insists this is another reason they need all your private health records in Washington. Dr A at General Hospital needs a consult from Dr B at Memorial Hospital. In days of yore they would phone, fax or email. If I remember my geometry correctly, the shortest distance between two hospitals would not include a trip through Nancy Pelosi's office. Ask the mortgage industry how much "help" it is to have Washington in the middle.
In 2003, the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule took effect. Across America millions of health care workers attended numerous inservices to learn how the law "establishes regulations for the use and disclosure of Protected Health Information (PHI)." There would be no more indiscriminate sharing of a patient's status with anyone who called the hospital unit. Nurses were told that all PHI was on a "need to know" basis: if a health care worker didn't have an excellent reason to be in a patient's chart or EMR, that worker could be fired. Patients are now asked to list exactly who can be given information, including their spouse; in other words, the patient should control the dissemination of his PHI. I've heard the complaints that at times we've gone overboard with confidentiality. However, I really don't think we want to go back to the days when Mrs. Jones checked in to the hospital and the news hit the beauty parlor on Main Street before she was in her room.
So why are we now so anxious to hand Obama and the Democrats our most personal health details? Don't tell me my information is safe; I'm sure Jack Ryan felt the same way about his sealed divorce records. Once your records are cyberwinging their way to Harry Reid, et. al., it's out of your and your doctor's hands. That little STD you had? The results of an HIV test? The fact that your sister carries the breast cancer gene? Who wants to know? That's the 780 billion dollar question.
What has happened to the American liberal? Where are the protestors who felt the Declaration of Independence should be edited to include the right to privacy along with life, liberty and the pursuit of happiness? Suddenly, because a Democrat president and Congress are asking, the Left is lining up at Kinko's to copy and mail their health records to Washington, DC. Wake up! Remember, it is entirely possible that in two years the Republicans may be back in power. Have you thought out that a Republican Congress would then have access to your EMR? And if you think that you'll ever get the EMR genie back in the bottle, well, you probably also order products from late-night TV.
So since the liberals (and the mainstream media) have swallowed the EMR sales pitch hook line and sinker, I've been wondering if there's anything the rest of us can do to protect our private health information. And here is where I'd appreciate some expertise from the lawyers who frequent this site:
Do we as individuals have any right to keep private our own Protected Health Information?
If my doctor has to get my permission before leaving lab results on an answering machine, shouldn't he have to get my permission before sending my PHI to Washington DC? We need another Schechter Poultry, someone who will stand between Obama's New Deal and our medical records and cry "Halt!" Or has the right to privacy gone the way of the house call?
Carol Peracchio is a registered nurse.
Page Printed from: http://www.americanthinker.com/2009/03/two_forms_of_id_and_your_colon.html at March 04, 2009 - 12:11:36 PM EST
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A friend of mine is an Oncologist. He has recently converted over to only keeping electronic medical records (EMR). It's a pain, he had to buy computers for each examining room,
train his staff, etc. BUT the final result is superior and efficient; he is very happy he made the switch. More and more doctors are switching voluntarily.
I don't get the privacy issue here. The doctor's office will still keep EMR records local; another copy goes to Washington. For example, my parents are covered under Medicare; a government
single pay plan. It seems to work pretty well; the doctors are happy overall as are my parents. As for records, of course the doctor retains his copy, but Medicare (Washington) may
at any time ask for a copy as can the secondary insurance company ask for a copy. And unless we pay cash at the doctor's office, we all sign a release authorizing the physician to bill and
release medical records to third parties. HIPPA does not apply if a release has been obtained.
Although implementation would take time; a national EMR plan could/would be more efficient. That being said, it is not a panacea like the plan being sold to the public. In the end,
costs will not significantly reduce unless people are willing to make difficult choices. We want our cake and to eat it too; it doesn't work that way.
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You don't get a privacy issue with all records being on a central database accessible by sundry federal factotums? You don't recall the unauthorized perusal of BHO's travel records from within the State Department? You don't recall Nixon, Clinton, J. Edgar Hoover, et al using federal resources and records to get leverage over people and bring down foes? You don't remember, as was cited in the piece above, how BHO's senatorial foes had sealed records leaked, thus dooming their candidacy? Do you recall how Joe the Plumber's financial info got released?
If these and doubtless numerous other examples of confidential government information being mishandled don't lead to obvious conclusions than I doubt a productive conversation can ensue.
BTW, your side of the aisle is all about privacy when it comes time to tap a potential terrorist's phone or get someone to an abortion clinic, but those considerations don't apply to medical records? How's that bit of cognitive dissonance reconcile itself?
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If you go see a doctor tomorrow, pay attention the paperwork you sign. One form in the stack will be an authorization to release medical records.
Only if you pay cash and refuse to sign the form will you be exempt.
Ergo the government/industry already has access to your medical records, insurance companies have access to your medical records, hospitals do,
other doctors do, etc. Theoretically, this information cannot be disseminated or "abused"; yet as you pointed out records are often improperly accessed
and abused. Another data bank will not significantly change that.
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Horsepuckey. Currently the feds would have to do some pretty serious work to get a hold of my records and leave questionable fingerprints all over the place in doing so. I just transferred my files from one Dr. to another and am not particularly worried some clown in DC can get his hands on all those photocopies. That changes when there is a central repository for reasons I've already stated and that you failed to address.
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Stealth Care
By INVESTOR'S BUSINESS DAILY | Posted Wednesday, March 04, 2009 4:20 PM PT
Spending: The stimulus provides for the creation of a federal health care bureaucracy not unlike Hillarycare. Decisions that should be made by doctors and patients will belong to bureaucrats deciding cost-effectiveness.
IBD Exclusive Series: Inside The Stimulus
The stimulus bill commits $19 billion to accelerate adoption of Health Information Technology (HIT) systems by doctors and hospitals. It involves the creation of electronic medical records to be stored in a central database. This is said to be for reducing treatment errors and increasing efficiency in the delivery of medical care.
It also authorizes the creation of the Office of the National Coordinator for Health Information Technology — and the appointment of a 15-member board of officials from federal agencies and others — charged with developing this nationwide health information database
It further creates an entity called the Federal Coordinating Council for Comparative Effectiveness Research, which will decide which treatments you should get, whether you should get them, and whether they should even be available. It is modeled after a British board which helps run the notoriously inefficient and bureaucratic National Health Service.
These agencies will monitor treatments to make sure your doctor is caring for you in a way the federal government deems appropriate and cost-effective. Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost-effectiveness standard that would lead to health care rationing. It would determine what medical care should be provided and who should get it.
The U.K. board approves or rejects treatments after dividing the cost of the treatment by the number of years the patient is expected to benefit. Such a formula is found on page 464 of the stimulus bill.
Under these formulas, younger patients likely get treatment for whatever ails them before granny can get her hip replacement. In 2005, the Orwellian-named British National Institute for Health and Clinical Excellence proposed that the National Health Service use age as a measurement of a patient's worthiness for treatment.
In 2006, for example, a U.K board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other. After all, how many years would they be needing two good eyes?
The system that will store everyone's medical records electronically, which was supposed to make health care delivery more efficient, will make it more subservient to government whim by providing a system to monitor doctors' treatment.
Medical treatments should be determined by doctors and patients and not by a bureaucracy that will ration your health care, deciding whether you really need it and are really worth it.
http://www.ibdeditorials.com/IBDArticles.aspx?id=321064867290632
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The them is us. it is America as we knew it. The you is BO and his true agenda. America just voted the most liberal guy in the Senate to be our leader. Why people now are so surprised by his leftist leanings I guess comes from the humanistic natural defense mechanism of denial.
Personally I have seen enough. Lets not be taken by his deception. This guy will go on to "being open to all ideas and options", and "everything is on the table" etc etc.
This guy's game is now obvious. "Pretend you are one of them, then can change them." Thanks to Mark Levin for opening my eyes pre election about what BO is really about and what he is up to. As he says "it is pay back time". This is reparations time. Problem is we will all suffer far more because of this.
Folks, the *plan* for health care reform is already done. Just like it is for Wall Street, Gas and coal companies, businesses, those at the higher end of the pay scale, Israel, and all the rest. This is just a dog and pony show to snooker the gullible:
****Obama open to compromise on health care overhaul
AP – President Barack Obama delivers remarks to the White House Forum on Health Reform, Thursday, March 5, … WASHINGTON – President Barack Obama said the consensus from the White House health care summit is that there is an immediate need for health care reform, and signaled that he's open to compromise on Thursday.
Obama told participants at the end of a health summit that although he offered a plan during last year's campaign, he isn't wedded to that proposal. He told Republicans and Democrats, doctors and insurers — "I just want to figure out what works."
The president said there are some elements that all sides can agree on such as electronic health records that will save lives and money. Other issues — such as his $634 billion down payment for expanded coverage — are certain to create deep divisions.
He said: "We have to keep an open mind."
Obama invited more than 120 people who hold a wide range of views on how to fix the system.
Obama entered the room with Sen. Edward Kennedy of Massachusetts, who is battling a brain tumor. After brief remarks summarizing the participants' observations, Obama called on Kennedy. The veteran Democratic senator said he looked forward to being a foot soldier in the push for health care reform and said: "this time we will not fail."
Kennedy, who recently turned 77, is battling brain cancer and has been in Florida continuing his treatment and physical rehabilitation. He chairs the Health, Education, Labor and Pensions Committee and was a strong Obama backer during the 2008 campaign.****
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Some links that'll give you an idea what waitlists for surgery look like north of the border.
Waiting Lists For Surgery In Canada
British Columbia:
http://www.health.gov.bc.ca/waitlist/
Here's one for Cardiac surgery:
http://www.health.gov.bc.ca/waitlist/cardiac.html
Here's Ontario:
http://www.health.gov.on.ca/transformation/wait_times/wait_mn.html
Click in here, and click on "Wait Times In your Area". Then click on "Find By Map Location", and pick out an area at random. See how much time one has to wait for cancer surgery
http://www.health.gov.on.ca/transformation/wait_times/public/wt_public_mn.html
Here's a site that gives you the average wait times for whatever ails you in Alberta:
http://www.ahw.gov.ab.ca/waitlist/AccessGoalCharts.jsp
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Interesting exchange about universal health care can be found here:
http://www.cato-at-liberty.org/2009/03/06/this-is-why-universal-coverage-is-a-religion-and-not-about-compassion-or-saving-lives/
Contains more formatting than I'd care to replicate and a lot of links.
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Why wait, let's get rid of free market supermarkets and have government run food centers instead! I'm sure that'll work just as well as Obamacare.
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WTF?!
On CNN's Political Tracker: http://politicalticker.blogs.cnn.com/2009/03/10/senator-warns-white-house-on-possible-vet-proposal/#more-43270
WASHINGTON (CNN) - Veterans Affairs Secretary Eric Shinseki confirmed Tuesday that the Obama administration is considering a controversial plan to make veterans pay for treatment of service-related injuries with private insurance, but was told by lawmakers that it would be "dead on arrival" if sent to Congress...
But it's still under consideration after several lawmakers tried to get ahead of the change:
...No official proposal to create such a program has been announced publicly, but veterans groups wrote a pre-emptive letter last week to President Obama opposing the idea after hearing the plan was under consideration. The groups also noticed an increase in “third-party collections” estimated in the 2010 budget proposal—something they said could only be achieved if the VA started billing for service-related injuries.
Asked about the proposal, Shinseki said it was under "consideration."
"A final decision hasn't been made yet," he said...
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Riot/protest video edited out of this topic per moderator directive. I stand by my observation that this unrest is now in Sweden because these people moved there, not for the weather, not for the jobs with 70% unemployed, but for the world's most lavish welfare benefits including universal healthcare. - Doug
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Interesting footage, but the connection to the subject of this thread is ephemeral at best. Please repost it in the Isalm in Europe thread.
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http://www.americanthinker.com/2009/03/extinguishing_physician_consci.html
Extinguishing Physician Conscience
By Mary L. Davenport, MD
The largest generational cohort in American history, the Baby Boomers, will be the first Americans to be denied available effective life-saving treatments for reasons of cost. The seeds for this mass liquidation have already been planted.
Imagine that it is 2016, and you are a 65 year old boomer. You have been admitted to your local community hospital with malaise, fatigue, vomiting and cloudy mental status. You have had blood pressure problems and diabetes for a few years, and have just been diagnosed with renal failure. As you drift in and out of consciousness, you are vaguely aware your old family practice physician, who had taken care of you for 20 years, is not around. A religious man, he quietly retired from medical practice in 2014, after the full force of the Obama administration‘s removal of conscience protection for physicians in February, 2009, came into effect.
You feel vaguely uncomfortable as you are placed in a darkened room in the Comfort Care wing of the hospital. In moments of lucidity, you wonder if you shouldn't have some oxygen, an IV or SOMETHING! But the appropriate therapy, kidney dialysis, is not on the approved list of treatments for patients over 65, having been deemed too expensive. The new regulations from the Department of Health and Human Services were presented just last month to your hospital's Futile Care Committee. It was decided at the highest levels that for those over 65 years of age, renal dialysis would not be a beneficial treatment, that the alternatives of a kidney transplant were too expensive, and that your quality of life on chronic dialysis would be too diminished.
Your children wonder why you are not in an ICU. They are told that you will be placed on a morphine drip to make you more comfortable as you pass away, and that this is the highest standard of care for your diagnosis and age. It is called terminal sedation. You signed an advanced directive indicating that you did not want extraordinary care for a terminal condition, and under the new protocols renal failure, although treatable, qualifies as a terminal condition.
Your children frantically try to find their old family doctor. But your health plan replaced him with a large group of younger physicians, the hospital's Consortium for Health, a private-public foundation that was created to promote efficiency and reduce wasteful spending in medical care. By 2014 when he left, your family doctor was a dinosaur, having been trained in an earlier era. His medical school was one of the last to retain the original Hippocratic Oath. It affirmed the covenantal relationship between the physician and patient, overseen by God, and that whatever the physician did would be for the patient's benefit. You had felt safe entrusting your health to Dr. O'Brien's professional judgment.
Not only did the Hippocratic Oath your doctor took decades ago took specifically forbid physician assisted suicide and abortion, it also established patient confidentiality so that your secrets would never be disclosed. That is, until 2012, when physicians participating in the national healthcare system, which included ALL licensed physicians, were mandated to submit your visits to the unified electronic medical record system. This data base was created in 2003 to coordinate medical care, detect emerging health threats, and exchange clinical information. Your doctor was very uncomfortable with this policy despite reassurances that HIPAA regulations would maintain your privacy.
But forces beyond any individual's control began to erode your relationship with your doctor long before he left the practice of medicine. The insurance companies stopped paying him in the late 1990's for hospital care, preferring to hire "hospitalists" or "intensivists" for greater efficiency in reducing hospital stays. Since office visits were reimbursed at lower and lower rates, your doctor had to see more and more patients in the office to just stay even. So although O'Brien knew you well and was trained to treat conditions such as renal failure or pneumonia, he stopped treating patients in the hospital.
Around 2007 both the hospital and office physicians began to be paid by a formula that rewarded them for saving money on medical care. When your family doctor was forced to join the Consortium in 2012 because the health plans stopped contracting with individual physicians, a powerful new computer system tracked each doctor's prescribing habits, referrals to specialists, and utilization of expensive lab tests. But your doctor was an "outlier" in this new system, having been brought up in Hippocratic tradition of doing what was necessary for the individual patient, rather than the Greater Good, the newer communitarian ethic followed by the younger doctors. He was financially penalized for doing too much for his patients, since the formulas based 30% of physician income on "efficiency."
Your old doctor could tolerate the erosion of his income, but had trouble with the new regulations that insisted that he discuss and refer for "all legal procedures." Since by 2013 physician assisted suicide was legal in 21 of 50 states, the Consortium enumerated the conditions that mandated the "euthanasia talk", including multiple sclerosis, metastatic breast cancer, and many others. He could never actually bring himself to violate his original Hippocratic Oath that not only forbade assisting his patients in committing suicide but also prohibited even mentioning it. It was impossible to rid himself of the idea that a physician's role was to assist in healing and that medical killing was antithetical to his professional integrity.
Back in 2007, ACOG, the ob/gyn's professional organization, issued Ethics Committee Opinion 385, contending that ob/gyn doctors had the duty to either do abortions or have offices in close proximity to abortion doctors to whom they would refer patients. There was an outcry from professional organizations of pro-life ob/gyns, Catholic physicians, and other Christian doctors. Especially troubling to many was the assertion in Committee Opinion 385 that defined conscience as a sentiment, and measured its "authenticity" by the degree to which a provider would suffer "guilt, shame or loss of self esteem" if it were violated. Your doctor and many of his colleagues regarded medical killing as anathema, and were incensed by describing their integrity as a physicians as a "feeling". But by 2013 the protests had died down, and the ethics committee recommendation for ob/gyn's had evolved into a mandate for family practice doctors under new rules enforced by the Department of Health and Human Services.
The final blow came in early 2014. Back in 2008, in Benitez v North Coast Women's Care Medical Group, the California Supreme Court ruled against ob/gyn doctors who did not want to provide intrauterine insemination to a lesbian couple because of their religious beliefs. Although most European nations did not allow the buying or selling of eggs or sperm, and restricted fertility therapies to heterosexual married couples, the California courts not only permitted but required health care providers to cooperate in any reproductive therapies for any patient regardless of sexual orientation or marital status.
Although the birth of octuplets in 2009 with assisted reproductive technology to a single woman with six other children initially created a brief public uproar, ultimately no legislation was passed protecting physicians who did not want to participate in a patient's procreative endeavor. Your physician had a 68 year old bipolar single male patient who wanted to have an heir. The patient requested that your doctor appeal to the Consortium to provide him with a donated egg and surrogate mother for his desired offspring. Since your doctor did not want to be used as a tool in his patient's peculiar agenda and was legitimately afraid of an expensive lawsuit that would decimate his dwindling retirement funds if he refused, he decided at this point to quit medicine altogether and move to a sunny warm state.
Your family doctor had been inspired as a young man by study of the U.S. Constitution and other foundational documents that he thought would forever ensure his liberty. He had studied the same "Rules of Civility" that the young George Washington had encountered in 1747. One of the most memorable of these maxims was "Labor to keep alive in your breast that little spark of celestial fire called conscience." It was clear to him that conscience here referred to man's innate understanding of moral right and wrong. When the American Founders would later declare independence from Great Britain in 1776, it was by virtue of this "spark of celestial fire" that they would establish the principles of human equality, unalienable rights, and government by consent as the foundations of American constitutional government.
Just before he left for his retirement home, your doctor was deeply disturbed to see the concept of conscience mocked in the New England Journal of Medicine by University of Wisconsin law professor R. Alta Charo in her article "The Celestial Fire of Conscience - Refusing to Provide Medical Care." Charo's presentation did not acknowledge that many Americans do not believe that abortion, assisted suicide, and embryonic stem cell therapies are legitimate medical care in the first place. Her article also did not distinguish between emergency and elective care, and merely regards the health care provider as a tool for whatever ends the patient wants to achieve. Attorneys such as Ms. Charo claimed the right to take whatever cases they want, but seem deny the same basic right to physicians. Patients can always seek the care of other providers.
Your doctor (and many other Americans) believed that failure to protect physician conscience will destroy the trust and accountability that is essential to the physician patient relationship. If the physician and patient cannot freely collaborate, ultimately another agenda -- that of the health plan or state -- will replace it, to everyone's detriment.
Dr. Davenport is an obstetrician/gynecologist in private practice in El Sobrante, California.
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Proposal problematic for Obama as he denounced similar one in campaign
By Jackie Calmes and Robert Pear
The New York Times
updated 9:31 a.m. CT, Sun., March. 15, 2009
WASHINGTON - The Obama administration is signaling to Congress that the president could support taxing some employee health benefits, as several influential lawmakers and many economists favor, to help pay for overhauling the health care system.
The proposal is politically problematic for President Obama, however, since it is similar to one he denounced in the presidential campaign as “the largest middle-class tax increase in history.” Most Americans with insurance get it from their employers, and taxing workers for the benefit is opposed by union leaders and some businesses.
In television advertisements last fall, Mr. Obama criticized his Republican rival for the presidency, Senator John McCain of Arizona, for proposing to tax all employer-provided health benefits. The benefits have long been tax-free, regardless of how generous they are or how much an employee earns. The advertisements did not point out that Mr. McCain, in exchange, wanted to give all families a tax credit to subsidize the purchase of coverage.
At the time, even some Obama supporters said privately that he might come to regret his position if he won the election; in effect, they said, he was potentially giving up an important option to help finance his ambitious health care agenda to reduce medical costs and to expand coverage to the 46 million uninsured Americans. Now that Mr. Obama has begun the health debate, several advisers say that while he will not propose changing the tax-free status of employee health benefits, neither will he oppose it if Congress does so.
At a recent Congressional hearing, Senator Ron Wyden, an Oregon Democrat whose own health plan would make benefits taxable, asked Peter R. Orszag, the president’s budget director, about the issue. Mr. Orszag replied that it “most firmly should remain on the table.”
Mr. Orszag, an economist who has served as director of the Congressional Budget Office, has written favorably of taxing some employer-provided health benefits and using the revenue savings for other health-related incentives. So has another Obama adviser, Jason Furman, the deputy director of the White House National Economic Council.
They, like other proponents, cite evidence that tax-free benefits encourage what Mr. McCain called “gold-plated” policies, resulting in inefficient and costly demands for health care and pressure on employers to hold down workers’ pay as insurance expenses rise. And, they say, the policy discriminates against those — many of whom are low-income workers — who do not have employer-provided coverage.
When Senator Max Baucus, Democrat of Montana, advocated taxing benefits at a recent hearing of the Finance Committee, which he leads, Treasury Secretary Timothy F. Geithner assured him that the administration was open to all ideas from Congress. Mr. Geithner did, however, allude to the position that Mr. Obama had taken as a candidate.
The administration’s receptivity to the idea is owed partly to the advocacy of Mr. Baucus, whose committee has jurisdiction over tax policy and health programs, and to support from Republicans. There is less enthusiasm among Democrats in the House, though the health debate is at an early stage and no comprehensive plans are on the table.
Also, Mr. Obama’s own idea for raising revenues for health care — limiting the income tax deductions that the most affluent taxpayers claim — has run into opposition not only from Mr. Baucus but also from his counterpart in the House, Representative Charles B. Rangel, Democrat of New York, who is chairman of the Ways and Means Committee.
Mr. Obama’s proposed limit on deductions would raise an estimated $318 billion over 10 years, or half of his proposed “health care reserve fund.” That is a fraction of the revenues that could be raised from taxing employer-provided health benefits.
In the campaign, Mr. McCain estimated that taxing all health benefits would raise $3.6 trillion over a decade — “a multitrillion-dollar tax hike,” one Obama advertisement said.
The Congressional Budget Office says that including health benefits in taxable income could mean $246 billion in additional revenue for a single year. Stopping short of full taxation, as Mr. Baucus and others suggest, would mean less new revenue.
The latest government figures, for 2007, show that 70 percent of the 253 million people with health insurance received at least some of their coverage through employers. Employment-based insurance covers three-fifths of the population under 65.
Those who want to tax benefits in whole or in part make two main arguments. They say the tax exclusion is a generous subsidy that insulates employees from the true costs of health care, leading them to demand more of it and driving up overall costs. Critics also say the policy is unfair because it favors higher-income people. “It’s too regressive,” Mr. Baucus said. “It just skews the system.”
But in a blueprint for health legislation that he issued last November, Mr. Baucus said taking the exclusion on health benefits out of the tax code would go “too far” and “cause widespread disruption in employer-based health benefits.” Mr. Obama has also said he wants to preserve employer-provided coverage. Mr. Baucus, in his paper, cited other options, like taxing benefits above some value, taxing only wealthy employees or both.
However the proposal is devised, advocates will not have an easy time selling it.
Republicans, like Mr. McCain and former President George W. Bush before him, tend to favor taxing the benefits to finance other incentives for people to buy their own insurance. But given Mr. Obama’s use of the issue in his campaign, Republicans are unlikely to support a change unless the president himself proposes it, a senior adviser to Senate Republicans said.
Many Democrats, especially House liberals, are opposed. “It’s a dumb idea,” said Representative Pete Stark of California, chairman of the Ways and Means Subcommittee on Health. “We have to maintain as much as we can of the employer payments.”
Administration officials often say they will not repeat the mistakes of former President Bill Clinton, whose plan for universal health insurance collapsed in 1994. But Frank B. McArdle, a health policy expert at Hewitt Associates, a benefits consulting firm, said, “If President Obama agrees to cut back the tax break for employee health benefits, he will risk repeating one of Mr. Clinton’s errors by disrupting health insurance for people who have it and like it.”
Some big businesses consider nontaxable employment benefits a tool for recruiting and retaining workers. The United States Chamber of Commerce opposes eliminating the exclusion on health benefits, but James P. Gelfand, senior manager of health policy, said the group had not taken a position on limiting it.
Organized labor, a pillar of the Democratic Party base, considers the benefits among the union movement’s historic achievements for the middle class. But a split could be developing between the manufacturing unions, which have negotiated rich benefit packages, and the growing service employees unions, which include many low-wage workers without generous benefits.
Alan V. Reuther, legislative director of the United Automobile Workers, said: “These proposals would represent a tax increase on working families. They would undermine good health care coverage.”
But at the Service Employees International Union, which was an early supporter of Mr. Obama, Dennis Rivera, the coordinator of the union’s health care campaign, said that while his organization was “predisposed not to agree to the taxing of health benefits,” he would wait to pass judgment. The union, Mr. Rivera said, wants to see how any tax changes fit into the overall effort to revamp the health care system. “We need to see the total picture,” he said.
This story, Administration Is Open to Taxing Health Benefits, originally appeared in the New York Times.
Copyright © 2009 The New York Times
URL: http://www.msnbc.msn.com/id/29703278/
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© 2009 MSNBC.com
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More Reasons Not to Nationalize Health Care
Posted by Doug Bandow
Advocates of a government takeover of the health care system routinely offer up horror stories of American medicine, and no system yet has found a way around the problem of human imperfection, especially when operating in a system with such distorted incentives–most from ill-considered government policies. Yet the horror stories in nationalized health care systems are manifold and tend to be more intractable since they result from government policy.
For instance, consider the quality of care delivered by hospitals in one region in Great Britain (with a hat-tip to Philip Klein of the American Spectator for finding this story). According to the Daily Telegraph:
Sir Ian Kennedy, chairman of the Healthcare Commission, said the report is a ’shocking story’ and that there were failures at almost every stage of care of emergency patients. “There is no doubt that patients will have suffered and some of them will have died as a result,” he said.
The investigation of the trust now called the Mid-Staffordshire NHS Foundation Trust, found overstretched and poorly trained nurses who turned off equipment because they did not know how to work it, newly qualified doctors left to care for patients recovering from surgery at night, patients left for hours in soiled bedclothes, reception staff expected to judge how seriousness of patients arriving at A&E, patients left without food or drink, others who received the wrong medication or none at all, blood and faeces left on lavatories and floors, and doctors diverted away from seriously ill patients in order to treat minor ones who were in danger of breaching the four hour waiting time target.
When high mortality rates triggered questions, the trust board of directors ‘fobbed off’ investigators by saying the rates were a result of statistical errors but the Healthcare Commission found this was not that case.
The report said there was a ‘reluctance to acknowledge or even consider that the care of patients was poor’.
The trust was more concerned with hitting targets, gaining Foundation Trust status and marketing and had ‘lost sight’ of its responsibilities for patient care, the report said.
Sir Ian said: “The resulting report is a shocking story. Our report tells a story of appalling standards of care and chaotic systems for looking after patients.”
While Britain tends to be near the bottom in terms of health care system in industrialized states, there are plenty of horror stories elsewhere. Socialism doesn’t work, whether in health care or elsewhere. As Investor’s Business Daily reminds us:
The Swedish government system is no better. It also refuses to provide some expensive medication and, inhumanely, refuses to let patients buy the drugs themselves. Why? According to a Journal of American Physicians and Surgeons article, bureaucrats believe doing so “would set a bad precedent and lead to unequal access to medicine.”
Like Canadians, Swedes are subjected to long waits. They also have denial-of-care problems that sometimes lead to death.
A reasonable person would see the record of repeated failures in government-run medicine as evidence that such a system is not sustainable. Yet every central planner thinks he or she — or his or her immediate group — is smart enough to correct the flaws of socialist programs and therefore has the moral authority to force others to participate in his experiments. It is the same thinking that will move a person to say we are the ones we’ve been waiting for.
The Obama administration seems determined to waste a lot of money “stimulating” the economy. We can replace money lost. But if the administration succeeds in nationalizing the medical system directly or indirectly, the damage may prove irreversible–and deadly.
http://www.cato-at-liberty.org/2009/03/18/more-reasons-not-to-nationalize-health-care/
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Praise Mitt Romney. Three years ago, the former Massachusetts Governor had the inadvertent good sense to create the "universal" health-care program that the White House and Congress now want to inflict on the entire country. It is proving to be instructive, as Mr. Romney's foresight previews what President Obama, Max Baucus, Ted Kennedy and Pete Stark are cooking up for everyone else.
AP
Mitt Romney.
In Massachusetts's latest crisis, Governor Deval Patrick and his Democratic colleagues are starting to move down the path that government health plans always follow when spending collides with reality -- i.e., price controls. As costs continue to rise, the inevitable results are coverage restrictions and waiting periods. It was only a matter of time.
They're trying to manage the huge costs of the subsidized middle-class insurance program that is gradually swallowing the state budget. The program provides low- or no-cost coverage to about 165,000 residents, or three-fifths of the newly insured, and is budgeted at $880 million for 2010, a 7.3% single-year increase that is likely to be optimistic. The state's overall costs on health programs have increased by 42% (!) since 2006.
Like gamblers doubling down on their losses, Democrats have already hiked the fines for people who don't obtain insurance under the "individual mandate," already increased business penalties, taxed insurers and hospitals, raised premiums, and pumped up the state tobacco levy. That's still not enough money.
So earlier this year, Mr. Patrick appointed a state commission to figure out how to control costs and preserve "this grand experiment." One objective is to change the incentives for preventative care and treatments for chronic disease, but everyone says that. It sometimes results in better health but always more spending. So-called "pay for performance" financing models, on the other hand, would do away with fee for service -- but they also tend to reward process, not the better results implied.
What are the alternatives? If health planners won't accept the prices set by the marketplace -- thus putting themselves out of work -- the only other choice is limiting care via politics, much as Canada and most of Europe do today. The Patrick panel is considering one option to "exclude coverage of services of low priority/low value." Another would "limit coverage to services that produce the highest value when considering both clinical effectiveness and cost." (Guess who would determine what is high or low value? Not patients or doctors.) Yet another is "a limitation on the total amount of money available for health care services," i.e., an overall spending cap.
The Institute for America's Future -- which is providing the intellectual horsepower (we use the term loosely) for reforms like those in Massachusetts -- argues that the cost overruns prove the state must cap how much insurers are allowed to charge consumers and regulate their profits. If Mr. Patrick doesn't get there first, that is. He reportedly told insurers and hospitals at a closed meeting this month that if they didn't take steps to hold down the rate of medical inflation, he would.
Even the single-payer cheerleaders at the New York Times have caught on to this rolling catastrophe. In a page-one story this month, the paper reported on the "expedient choice" that Mr. Romney and Democrats made to defer "until another day any serious effort to control the state's runaway health costs. . . . Those who led the 2006 effort said it would not have been feasible to enact universal coverage if the legislation had required heavy cost controls. The very stakeholders who were coaxed into the tent -- doctors, hospitals, insurers and consumer groups -- would probably have been driven into opposition by efforts to reduce their revenues and constrain their medical practices, they said."
Now they tell us. What really whipped along RomneyCare were claims that health care would be less expensive if everyone were covered. But reducing costs while increasing access are irreconcilable issues. Mr. Romney should have known better before signing on to this not-so-grand experiment, especially since the state's "free market" reforms that he boasts about have proven to be irrelevant when not fictional. Only 21,000 people have used the "connector" that was supposed to link individuals to private insurers.
Which brings us to Washington, where Mr. Obama and Congressional Democrats are about to try their own Bay State bait and switch: First create vast new entitlements that can never be repealed, then later take the less popular step of rationing care when it's their last hope to save the federal fisc.
The consequences of that deception will be far worse than those in Massachusetts, however, given that prior to 2006 the state already had a far smaller percentage of its population uninsured than the national average. The real lesson of Massachusetts is that reform proponents won't tell Americans the truth about what "universal" coverage really means: Runaway costs followed by price controls and bureaucratic rationing.
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Well for those people who for whatever reason have no health coverage now, rationed care is better than no care. They will be quite pleased to have someone else pay for their health care - rationed or not.
For the rest of us who will have to foot the bill - we are screwed.
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Ummm , , , has "no care" actually been the case?
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second post
How U.S. Health Care Really Stacks Up
By INVESTOR'S BUSINESS DAILY | Posted Thursday, March 26, 2009 4:20 PM PT
Facts: A movie has been made solely to criticize it. The left treats it as if it's an invader that must be repelled. Most Americans, however, are satisfied with this object of so much hate — America's health care industry.
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Read More: Health Care
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Manipulative filmmaker Michael Moore says "we have the worst health care in the Western world" and has offered up Cuba as a paradigm for the U.S. to follow.
Former South Dakota Sen. Tom Daschle, who was nearly named the administration's health and human services secretary, says the "flaws in our health care system are pervasive and corrosive."
Rep. Dennis Kucinich, a former Democratic presidential candidate, called the current health care market "predatory capitalism." Some Democrats go so far as to say the system is racist.
The kindest thing most Democrats will say about health care in the U.S. is that it's broken. Their talking points to back up the claim revolve around costs, America's low position (37th) in World Health Organization rankings and the number of uninsured.
The last is a useless measure, since only a small portion of the uninsured are chronically without coverage. So are the WHO rankings, which can't be trusted because of disparities in how countries compile statistics, demographic and cultural differences, and the WHO's leftist bias.
Which leaves us with the issue of costs.
Yes, with $2.5 trillion expected to be spent this year, health care in the U.S. is more expensive than in any other country, including Great Britain and Canada, whose nationalized, universal care systems are held up as models .
But what we spend isn't thrown down a rathole. The National Center for Policy Analysis has published a study, "10 Surprising Facts About American Health Care," that shows how Americans get something for the extra dollars they lay out. To wit:
• "Americans have better survival rates than Europeans for common cancers." Breast cancer mortality: 52% higher in Germany and 88% higher in the United Kingdom than in the U.S. Prostate cancer mortality: 604% higher in the U.K., 457% higher in Norway. Colo-rectal cancer mortality: 40% higher among Britons.
• "Americans have lower cancer mortality rates than Canadians." Rates for breast cancer (9%), prostate cancer (184%) and colon cancer among men (10%) are higher than in the U.S.
• "Americans have better access to treatment of chronic diseases than patients in other developed countries." Roughly 56% of Americans who could benefit are taking statin drugs. Only 36% of the Dutch, 29% of the Swiss, 26% of Germans, 23% of Britons and 17% of Italians who could benefit receive them.
• "Americans have better access to preventive cancer screenings than Canadians." Nine of 10 middle-aged American women have had a mammogram; 72% of Canadian women have. Almost every American woman (96%) has had a pap smear; fewer than 90% of Canadian women have. Roughly 54% of American men have had a prostate cancer test; fewer than one in six Canadian men have. Almost a third of Americans (30%) have had a colonoscopy; only 5% of Canadians have had the procedure.
• "Lower-income Americans are in better health than comparable Canadians." Nearly 12% of U.S. seniors with below-median incomes self-report being in "excellent" health, while 5.8% of Canadian seniors say the same thing.
• "Americans spend less time waiting for care than patients in Canada and the United Kingdom." Canadians and Britons wait about twice as long, sometimes more than a year, to see a specialist, have elective surgery or get radiation treatment.
• "People in countries with more government control of health care are highly dissatisfied and believe reform is needed." More than seven in 10 Germans, Canadians, Australians, New Zealanders and Britons say their health systems need either "fundamental change" or "complete rebuilding."
• "Americans are more satisfied with the care they receive than Canadians." More than half (51.3%) of Americans are very satisfied with their health care services, while 41.5% of Canadians hold the same view of their system.
• "Americans have much better access to important new technologies like medical imaging than patients in Canada or the U.K." There are 34 CT scanners per million Americans. There are 12 per million in Canada and eight per million in Britain. The U.S. has nearly 27 MRI machines per million. Britain and Canada have 6 per million.
• "Americans are responsible for the vast majority of all health care innovations." The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other single developed nation; the most important recent medical innovations were developed here.
Can the nationalized, universal systems in Britain, Canada or anywhere else improve on this? No, but we can ruin our health care by following the policies of countries where medical treatment is far below the American standard.
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I agree with the post but,
I am afraid that one can find statistics that buttresses both sides of the argument. For or against national or single payer care.
I am not for big government care. But at this point the free market's answer appears unsustainable with regards to costs.
The electronic medical records may or may not decrease costs - the jury is out - as is the concept that preventative care reduces costs (evidence suggests it increases costs in many cases).
There is simply no way to insure another 40 mill people and not ration care.
That said we will need to ration care anyway at some point.
People are living longer and the result is more health care needs. As well of course the baby boom thing.
The best hope in my opinion still comes ironically from the pharmaceutical industry.
For example it is becoming apparent that diabetes 2 is possibly an intestinal disease and bariatric surgery which was used for weight loss results in reversal of diabetes far more than expected for any degree of weight loss. This seems to have been discovered by accident. It is also clear that some people who are NOT overweight still will have diabetes reversed by this surgery.
Thus a treatment with goal of cure for this is surgery. At this time it costs several thousand dollars. Yet in the long run thses procedures may reduce costs.
If the drug industry can find a real cure or better treaments for obesity and other conditions than costs may actually decrease.
It is all too complicated. I could work towards a Phd thesis and still not know the answers though I would have a better handle on the problems.
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"That said we will need to ration care anyway at some point."
The proper mechanism is called "price". :-D
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The proper mechanism is called "price".
I don't follow you. :?
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Sorry for my failed effort at laconic wit :-)
In a free market, who gets something is determined by price.
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Well now you are getting to the question: is health care a right or a privilege that is earned?
I just tried to look up if there are any polls conducted on the opinions of people on this issue. I do not find much.
Clearly BO feels it is a right and in conjuction, a responsibility for those who can and do pay to do so for those who can't or won't.
I don't know where the majority of Americans are on this issue. I suspect most feel it is a right but I could be wrong.
What do I feel? Well of course as a doctor I am expected to be kind, thoughtful, and a true humanitarian and philanthropist, and alive and working only for the public good.
All the while my wife and I are getting stalked and robbed.
And everyone and their sister has an opinion about how much doctors should or shoudn't make.
So is it a right or a privilege? Personally I am tired of philosophy and I frankly don't even give a darn.
My thoughts don't mean anything anyway.
I suspect one reason BO is so popular is because most agree with him.
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When it comes to healthcare, the U.S., Britain and Canada are hurting
Healthcare in all three countries has the same problem. They just feel it in different places.
By Ezra Klein
April 7, 2009
When asked by the New England Journal of Medicine to detail his healthcare vision during the campaign, John McCain concluded with a rousing denunciation of "new government bureaucracies that will translate into higher taxes, reduced provider payments and long waiting lines."
Long lines come up frequently in the American healthcare discussion, the symbol of all that is to be feared about a government-run system. And it's true that in Canada and Britain, the two countries most often cited in discussions of what nationalized healthcare might mean, some patients report having to wait months for some elective treatments. Sometimes.
But we've got waiting lines too -- along with 50 million uninsured and a system that costs more than twice as much per person as that of any other country. We've just managed to hide our lines through clever statistical gimmickry.
Britain and Canada control costs in a very specific fashion: The government sets a budget for how much will be spent on healthcare that year, and the system figures out how to spend that much and no more. One of the ways the British and Canadians save money is to punt elective surgeries to a lower priority level. A 2001 survey by the policy journal "Health Affairs" found that 38% of Britons and 27% of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5%. Score one of us!
Well, sort of. American healthcare controls costs in another way. Rather than deciding as a society how much will be spent in the coming year and then figuring out how best to spend it, we abdicate collective responsibility and let individuals fend for themselves. So although Britain and Canada have decided that no one will go without, even if some must occasionally wait, the U.S. has decided that most of those who can't afford care simply won't get it.
When that very same survey also looked at cost problems among residents of different countries, 24% of Americans reported that they did not get medical care because of cost. Twenty-six percent said they didn't fill a prescription. And 22% said they didn't get a test or treatment. Those latter numbers are probably artificially small: If you can't afford to see a doctor, you never know that you can't afford the treatment she would recommend. In Britain and Canada, only about 6% of respondents reported that costs had limited their access to care.
Moreover, surveys conducted by the Organization for Economic Cooperation and Development have found that most countries don't have waiting lines or the uninsured. Not Germany or France or Japan or Sweden, all of which have more of a mix of public and private options. But Canada is next door, and Britain speaks our language, so we tend to spend a lot of time comparing our system with these systems and not a lot of time thinking through the full range of options.
In light of the "Health Affairs" data, smugness about our speedy access to care seems a bit peculiar. If someone can't afford care, we record their waiting time as zero. You don't wait for what you can't have. But a more accurate accounting would record that wait as infinite, or it would record when the patient eventually ends up in the emergency room because the original ailment went untreated. Research like this raises a simple question: Would you rather wait four months for a surgery or be unable to get it altogether?
Just last week, House Republicans expressed their preference for the latter. Their long-awaited budget document was admirably specific about changes to Medicare. They call for "a new Medicare program" in which enrollees are given a check "equal to 100% of the Medicare benefit," which they can then take to the private market to purchase their own care.
This proposal has a purpose beyond dismantling a popular government entitlement program. Currently, Medicare does not abide by a budget. It is not run like the Canadian or British healthcare systems. Instead, it pays whatever is deemed "reasonable and necessary." Because of that, costs are shooting through the roof: The Congressional Budget Office estimates that Medicare spending will more than triple by 2050.
The Republican plan gives Medicare a budget. Costs grow only as fast as the check grows. And because the check grows more slowly than health spending does, the program saves money. But this is, in effect, almost precisely the strategy of Britain and Canada: It is the government imposing an arbitrary budget on its healthcare spending.
The difference is that the British and Canadian governments try to apportion that health spending so that the whole population gets care. That can mean, alongside other cost-saving measures, longer waits for services. The Republican budget simply would give individuals a fixed check. That will mean that patients who exceed that sum and don't have money of their own go without needed care.
So Americans will continue to brag that no one waits, and Canadians and Britons will continue to brag that no one goes without. And somewhere, the French and the Germans and the Japanese and the Swiss and many others will wonder why we insist on choosing between such awful extremes.
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"Rather than deciding as a society how much will be spent in the coming year and then figuring out how best to spend it, we abdicate collective responsibility and let individuals fend for themselves."
Wow , , , :roll:
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Who thinks that this should be done with food? It's only "fair".....
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The coming clusterfcuk gathers momentum:
By JEROME GROOPMAN and PAMELA HARTZBAND
The Obama administration is working with Congress to mandate that all Medicare payments be tied to "quality metrics." But an analysis of this drive for better health care reveals a fundamental flaw in how quality is defined and metrics applied. In too many cases, the quality measures have been hastily adopted, only to be proven wrong and even potentially dangerous to patients.
Martin KozlowskiHealth-policy planners define quality as clinical practice that conforms to consensus guidelines written by experts. The guidelines present specific metrics for physicians to meet, thus "quality metrics." Since 2003, the federal government has piloted Medicare projects at more than 260 hospitals to reward physicians and institutions that meet quality metrics. The program is called "pay-for-performance." Many private insurers are following suit with similar incentive programs.
In Massachusetts, there are not only carrots but also sticks; physicians who fail to comply with quality guidelines from certain state-based insurers are publicly discredited and their patients required to pay up to three times as much out of pocket to see them. Unfortunately, many states are considering the Massachusetts model for their local insurance.
How did we get here? Initially, the quality improvement initiatives focused on patient safety and public-health measures. The hospital was seen as a large factory where systems needed to be standardized to prevent avoidable errors. A shocking degree of sloppiness existed with respect to hand washing, for example, and this largely has been remedied with implementation of standardized protocols. Similarly, the risk of infection when inserting an intravenous catheter has fallen sharply since doctors and nurses now abide by guidelines. Buoyed by these successes, governmental and private insurance regulators now have overreached. They've turned clinical guidelines for complex diseases into iron-clad rules, to deleterious effect.
One key quality measure in the ICU became the level of blood sugar in critically ill patients. Expert panels reviewed data on whether ICU patients should have insulin therapy adjusted to tightly control their blood sugar, keeping it within the normal range, or whether a more flexible approach, allowing some elevation of sugar, was permissible. Expert consensus endorsed tight control, and this approach was embedded in guidelines from the American Diabetes Association. The Joint Commission on Accreditation of Healthcare Organizations, which generates report cards on hospitals, and governmental and private insurers that pay for care, adopted as a suggested quality metric this tight control of blood sugar.
A colleague who works in an ICU in a medical center in our state told us how his care of the critically ill is closely monitored. If his patients have blood sugars that rise above the metric, he must attend what he calls "re-education sessions" where he is pointedly lectured on the need to adhere to the rule. If he does not strictly comply, his hospital will be downgraded on its quality rating and risks financial loss. His status on the faculty is also at risk should he be seen as delivering low-quality care.
But this coercive approach was turned on its head last month when the New England Journal of Medicine published a randomized study, by the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Canadian Critical Care Trials Group, of more than 6,000 critically ill patients in the ICU. Half of the patients received insulin to tightly maintain their sugar in the normal range, and the other half were on a more flexible protocol, allowing higher sugar levels. More patients died in the tightly regulated group than those cared for with the flexible protocol.
Similarly, maintaining normal blood sugar in ambulatory diabetics with vascular problems has been a key quality metric in assessing physician performance. Yet largely due to two extensive studies published in the June 2008 issue of the New England Journal of Medicine, this is now in serious doubt. Indeed, in one study of more than 10,000 ambulatory diabetics with cardiovascular diseases conducted by a group of Canadian and American researchers (the "ACCORD" study) so many diabetics died in the group where sugar was tightly regulated that the researchers discontinued the trial 17 months before its scheduled end.
And just last month, another clinical trial contradicted the expert consensus guidelines that patients with kidney failure on dialysis should be given statin drugs to prevent heart attack and stroke.
These and other recent examples show why rigid and punitive rules to broadly standardize care for all patients often break down. Human beings are not uniform in their biology. A disease with many effects on multiple organs, like diabetes, acts differently in different people. Medicine is an imperfect science, and its study is also imperfect. Information evolves and changes. Rather than rigidity, flexibility is appropriate in applying evidence from clinical trials. To that end, a good doctor exercises sound clinical judgment by consulting expert guidelines and assessing ongoing research, but then decides what is quality care for the individual patient. And what is best sometimes deviates from the norms.
Yet too often quality metrics coerce doctors into rigid and ill-advised procedures. Orwell could have written about how the word "quality" became zealously defined by regulators, and then redefined with each change in consensus guidelines. And Kafka could detail the recent experience of a pediatrician featured in Vital Signs, the member publication of the Massachusetts Medical Society. Out of the blue, according to the article, Dr. Ann T. Nutt received a letter in February from the Massachusetts Group Insurance Commission on Clinical Performance Improvement informing her that she was no longer ranked as Tier 1 but had fallen to Tier 3. (Massachusetts and some private insurers use a three-tier ranking system to incentivize high-quality care.) She contacted the regulators and insisted that she be given details to explain her fall in rating.
After much effort, she discovered that in 127 opportunities to comply with quality metrics, she had met the standards 115 times. But the regulators refused to provide the names of patients who allegedly had received low quality care, so she had no way to assess their judgment for herself. The pediatrician fought back and ultimately learned which guidelines she had failed to follow. Despite her cogent rebuttal, the regulator denied the appeal and the doctor is still ranked as Tier 3. She continues to battle the state.
Doubts about the relevance of quality metrics to clinical reality are even emerging from the federal pilot programs launched in 2003. An analysis of Medicare pay-for-performance for hip and knee replacement by orthopedic surgeons at 260 hospitals in 38 states published in the most recent March/April issue of Health Affairs showed that conforming to or deviating from expert quality metrics had no relationship to the actual complications or clinical outcomes of the patients. Similarly, a study led by UCLA researchers of over 5,000 patients at 91 hospitals published in 2007 in the Journal of the American Medical Association found that the application of most federal quality process measures did not change mortality from heart failure.
State pay-for-performance programs also provide disturbing data on the unintended consequences of coercive regulation. Another report in the most recent Health Affairs evaluating some 35,000 physicians caring for 6.2 million patients in California revealed that doctors dropped noncompliant patients, or refused to treat people with complicated illnesses involving many organs, since their outcomes would make their statistics look bad. And research by the Brigham and Women's Hospital published last month in the Journal of the American College of Cardiology indicates that report cards may be pushing Massachusetts cardiologists to deny lifesaving procedures on very sick heart patients out of fear of receiving a low grade if the outcome is poor.
Dr. David Sackett, a pioneer of "evidence-based medicine," where results from clinical trials rather than anecdotes are used to guide physician practice, famously said, "Half of what you'll learn in medical school will be shown to be either dead wrong or out of date within five years of your graduation; the trouble is that nobody can tell you which half -- so the most important thing to learn is how to learn on your own." Science depends upon such a sentiment, and honors the doubter and iconoclast who overturns false paradigms.
Before a surgeon begins an operation, he must stop and call a "time-out" to verify that he has all the correct information and instruments to safely proceed. We need a national time-out in the rush to mandate what policy makers term quality care to prevent doing more harm than good.
Dr. Groopman, a staff writer for the New Yorker, and Dr. Hartzband are on the staff of Beth Israel Deaconess Medical Center in Boston and on the faculty of Harvard Medical School.
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If one doesn't think the NEJM is a liberal rag this is from the same issue:
Conscientious Objection Gone Awry — Restoring Selfless Professionalism in Medicine
Julie D. Cantor, M.D., J.D.
A new rule from the Department of Health and Human Services (DHHS) has emerged as the latest battleground in the health care conscience wars. Promulgated during the waning months of the Bush administration, the rule became effective in January. Heralded as a "provider conscience regulation" by its supporters and derided as a "midnight regulation" by its detractors, the rule could alter the landscape of federal conscience law.
The regulation, as explained in its text (see the Supplementary Appendix, available with the full text of this article at NEJM.org), aims to raise awareness of and ensure compliance with federal health care conscience protection statutes. Existing laws, which are tied to the receipt of federal funds, address moral or religious objections to sterilization and abortion. They protect physicians, other health care personnel, hospitals, and insurance plans from discrimination for failing to provide, offer training for, fund, participate in, or refer patients for abortions. Among other things, the laws ensure that these persons cannot be required to participate in sterilizations or abortions and that entities cannot be required to make facilities or personnel available for them. And they note that decisions on admissions and accreditation must be divorced from beliefs and behaviors related to abortion. On their face, these laws are quite broad.
But the Bush administration's rule is broader still. It restates existing laws and exploits ambiguities in them. For example, one statute says, "No individual shall be required to perform or assist in the performance of any part of a health service program or research activity funded" by DHHS if it "would be contrary to his religious beliefs or moral convictions."1 Here the rule sidesteps courts, which interpret statutory ambiguities and discern congressional intent, and offers sweeping definitions. It defines "individual" as physicians, other health care providers, hospitals, laboratories, and insurance companies, as well as "employees, volunteers, trainees, contractors, and other persons" who work for an entity that receives DHHS funds. It defines "assist in the performance" as "any activity with a reasonable connection" to a procedure or health service, including counseling and making "other arrangements" for the activity. Although the rule states that patients' ability to obtain health care services is unchanged, its expansive definitions suggest otherwise. Now everyone connected to health care may opt out of a wide range of activities, from discussions about birth control to referrals for vaccinations. As the rule explains, "an employee whose task it is to clean the instruments used in a particular procedure would also be considered to assist in the performance of the particular procedure" and would therefore be protected. Taken to its logical extreme, the rule could cause health care to grind to a halt.
It also raises other concerns. In terms of employment law, Title VII of the Civil Rights Act, which applies to organizations with 15 or more employees, requires balancing reasonable accommodations for employees who have religious, ethical, or moral objections to certain aspects of their jobs with undue hardship for employers. But the new rule suggests that if an employee objects, for example, to being a scrub nurse during operative treatment for an ectopic pregnancy, subsequently reassigning that employee to a different department may constitute unlawful discrimination — a characterization that may be at odds with Title VII jurisprudence.2 As officials of the Equal Employment Opportunity Commission remarked when it was proposed, the rule could "throw this entire body of law into question."3
Furthermore, although the rule purports to address intolerance toward "individual objections to abortion or other individual religious beliefs or moral convictions," it cites no evidence of such intolerance — nor would it directly address such intolerance if it existed. Constitutional concerns about the rule, including violations of state autonomy and rights to contraception, also lurk. And the stated goals of the rule — to foster a "more inclusive, tolerant environment" and promote DHHS's "mission of expanding patient access to necessary health services" — conflict with the reality of extensive objection rights. Protection for the silence of providers who object to care is at odds with the rule's call for "open communication" between patients and physicians. Moreover, there is no emergency exception for patient care. In states that require health care workers to provide rape victims with information about emergency contraception, the rule may allow them to refuse to do so.
Recently, the DHHS, now answering to President Barack Obama, took steps to rescind the rule (see the Supplementary Appendix). March 10 marked the beginning of a 30-day period for public comment on the need for the rule and its potential effects. Analysis of the comments (www.regulations.gov) and subsequent action could take some months. If remnants of the rule remain, litigation will follow. Lawsuits have already been filed in federal court, and Connecticut Attorney General Richard Blumenthal, who led one of the cases, has vowed to continue the fight until the regulation is "finally and safely stopped."4
This state of flux presents an opportunity to reconsider the scope of conscience in health care. When broadly defined, conscience is a poor touchstone; it can result in a rule that knows no bounds. Indeed, it seems that our problem is not insufficient tolerance, but too much. We have created a state of "conscience creep" in which all behavior becomes acceptable — like that of judges who, despite having promised to uphold all laws, recuse themselves from cases in which minors seek a judicial bypass for an abortion in states requiring parental consent.5
The debate is not really about moral or religious freedom writ large. If it were, then the medical profession would allow a broad range of beliefs to hinder patient care. Would we tolerate a surgeon who holds moral objections to transfusions and refuses to order them? An internist who refuses to discuss treatment for diabetes in overweight patients because of moral opposition to gluttony? If the overriding consideration were individual conscience, then these objections should be valid. They are not (although they might well be permitted under the new rule). We allow the current conscience-based exceptions because abortion remains controversial in the United States. As is often the case with laws touching on reproductive freedom, the debate is polarized and shrill. But there comes a point at which tolerance breaches the standard of care.
Medicine needs to embrace a brand of professionalism that demands less self-interest, not more. Conscientious objection makes sense with conscription, but it is worrisome when professionals who freely chose their field parse care and withhold information that patients need. As the gatekeepers to medicine, physicians and other health care providers have an obligation to choose specialties that are not moral minefields for them. Qualms about abortion, sterilization, and birth control? Do not practice women's health. Believe that the human body should be buried intact? Do not become a transplant surgeon. Morally opposed to pain medication because your religious beliefs demand suffering at the end of life? Do not train to be an intensivist. Conscience is a burden that belongs to the individual professional; patients should not have to shoulder it.
Patients need information, referrals, and treatment. They need all legal choices presented to them in a way that is true to the evidence, not the randomness of individual morality. They need predictability. Conscientious objections may vary from person to person, place to place, and procedure to procedure. Patients need assurance that the standard of care is unwavering. They need to know that the decision to consent to care is theirs and that they will not be presented with half-truths and shades of gray when life and health are in the balance.
Patients rely on health care professionals for their expertise; they should be able expect those professionals to be neutral arbiters of medical care. Although some scholars advocate discussing conflicting values before problems arise, realistically, the power dynamics between patients and providers are so skewed, and the time pressure often so great, that there is little opportunity to negotiate. And there is little recourse when care is obstructed — patients have no notice, no process, and no advocate to whom they can turn.
Health care providers already enjoy broad rights — perhaps too broad — to follow their guiding moral or religious tenets when it comes to sterilization and abortion. An expansion of those rights is unwarranted. Instead, patients deserve a law that limits objections and puts their interests first. Physicians should support an ethic that allows for all legal options, even those they would not choose. Federal laws may make room for the rights of conscience, but health care providers — and all those whose jobs affect patient care — should cast off the cloak of conscience when patients' needs demand it. Because the Bush administration's rule moves us in the opposite direction, it should be rescinded.
Dr. Cantor reports representing an affiliate of Planned Parenthood in a legal matter unrelated to conscientious objection. No other potential conflict of interest relevant to this article was reported.
Dr. Cantor is an adjunct professor at the UCLA School of Law, Los Angeles.
This article (10.1056/NEJMp0902019) was published at NEJM.org on March 25, 2009.
References
42 U.S.C.A. 300a-7(d).
Shelton v. Univ. of Medicine & Dentistry of New Jersey, 223 F.3d 220 (3d Cir. 2000).
Pear R. Protests over a rule to protect health providers. New York Times. November 17, 2008:A14.
Press release of the State of Connecticut Attorney General's Office, Hartford, February 27, 2009. (Accessed March 20, 2009, at http://www.ct.gov/ag/cwp/view.asp?A=3673&Q=434882.)
Liptak A. On moral grounds, some judges are opting out of abortion cases. New York Times. September 4, 2005.
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Dear Mr. Ricardo Alonso-zaldivar,
They may not be a "lobbying" group but they certainly do have and use a voice - its called voting. The same for those who pay no income taxes. They express their "voice" with their votes! And I don't need a poll to tell me which party they overwhelmingly vote for:
****Associated Press Writer Ricardo Alonso-zaldivar, Associated Press Writer – 1 hr 19 mins ago
WASHINGTON – If the uninsured were a political lobbying group, they'd have more members than AARP. The National Mall couldn't hold them if they decided to march on Washington.
But going without health insurance is still seen as a personal issue, a misfortune for many and a choice for some. People who lose coverage often struggle alone instead of turning their frustration into political action.
Illegal immigrants rallied in Washington during past immigration debates, but the uninsured linger in the background as Congress struggles with a health care overhaul that seems to have the best odds in years of passing.
That isolation could have profound repercussions.
Lawmakers already face tough choices to come up with the hundreds of billions it would cost to guarantee coverage for all. The lack of a vocal constituency won't help. Congress might decide to cover the uninsured slowly, in stages.
The uninsured "do not provide political benefit for the aid you give them," said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. "That's one of the dilemmas in getting all this money. If I'm in Congress, and I help out farmers, they'll help me out politically. But if I help out the uninsured, they are not likely to help members of Congress get re-elected."
The number of uninsured has grown to an estimated 50 million people because of the recession. Even so, advocates in the halls of Congress are rarely the uninsured themselves. The most visible are groups that represent people who have insurance, usually union members and older people. In the last election, only 10 percent of registered voters said they were uninsured.
The grass-roots group Health Care for America Now plans to bring as many as 15,000 people to Washington this year to lobby Congress for guaranteed coverage. Campaign director Richard Kirsch expects most to have health insurance.
"We would never want to organize the uninsured by themselves because Americans see the problem as affordability, and that is the key thing," he said.
Besides, added Kirsch, the uninsured are too busy scrambling to make ends meet. Many are self-employed; others are holding two or three part-time jobs. "They may not have a lot of time to be activists," he said.
Vicki and Lyle White of Summerfield, Fla., know about such predicaments. They lost their health insurance because Lyle had to retire early after a heart attack left him unable to do his job as a custodian at Disney World. Vicki, 60, sells real estate. Her income has plunged due to the housing collapse.
"We didn't realize that after he had the heart attack no one would want to insure him," said Vicki. The one bright spot is that Lyle, 64, has qualified for Medicare disability benefits and expects to be getting his card in July.
But for now, the Whites have to pay out of pocket for Lyle's visits to the cardiologist and his medications. The bills came to about $5,000 last year. That put a strain on their limited budget because they are still making payments on their house and car.
"I never thought when we got to this age that we would be in such a mess," said Vicki, who has been married to Lyle for 43 years. "We didn't think we would have a heart attack and it would change our life forever."
While her own health is "pretty good," Vicki said she suffers chronic sinus infections and hasn't had a checkup since 2007. "I have just learned to live with it," she said.
The Whites' example shows how the lack of guaranteed health care access undermines middle-class families and puts them at risk, but that many of the uninsured eventually do find coverage. Lyle White has qualified for Medicare, even if the couple must still find a plan for Vicki.
Research shows that nearly half of those who lose coverage find other health insurance in four months or less. That may be another reason the uninsured have not organized an advocacy group. At least until this recession, many have been able to fix the situation themselves.
"The uninsured are a moving target," said Cathy Schoen, a vice president of the Commonwealth Fund, a research group that studies the problems of health care costs and coverage.
But even if gaps in coverage are only temporary, they can be dangerous. "Whenever you are uninsured, you are at risk," said Schoen. "People don't plan very well when they are going to get sick or injured."
Indeed, the Institute of Medicine, which provides scientific advice to the government, has found that a lack of health insurance increases the chances of bad outcomes for people with a range of common ailments, from diabetes and high blood pressure to cancer and stroke. Uninsured patients don't get needed follow-up care, skip taking prescription medicines and put off seeking help when they develop new symptoms.
Such evidence strengthens the case for getting everybody covered right away, Schoen said. But she acknowledges the politics may get tough. "It certainly has been a concern out of our history that unorganized voices aren't heard," she said.****
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Above every other health-care goal, Democrats this year want to institute a "public option" -- an insurance program financed by taxpayers, managed by government and open to everyone, much like Medicare. This new middle-class entitlement is the most important debate in Congress this year, because it really is the last stand for anything resembling private health insurance.
This public option will supposedly "compete" with private alternatives. As President Obama likes to put it, those who are happy with the insurance they have now can keep it -- and if they happen to prefer the government offering, well, gee whiz, that's the free market at work. The reality is far different. Not only will the new program become the default coverage for the uninsured, but Democrats intend to game the system to precipitate -- or if need be, coerce -- an exodus to government from private insurance. Soon enough, that will be the only "option" left.
A public program won't compete in a way that any normal business would recognize. As an entitlement, Congress's creation will enjoy potentially unlimited access to the Treasury, without incurring the risks or hedging against losses that private carriers do. As people gravitate to "free" or heavily subsidized care, the inevitably explosive costs will be covered in part with increased outlays to keep premiums artificially low or even offer extra benefits. Lacking such taxpayer cash, private insurance rates will escalate.
Much like Medicare, overall spending in the public option will be controlled over time by paying less for medical services, drugs and technology. With its monopsony purchasing power, below-market fees will be dictated on a take-it-or-leave-it basis -- an offer hospitals and physicians won't be able to refuse. Medicare's current reimbursement policies pay hospitals only 71% of private rates, and doctors 81%, according to the Lewin Group.
In a recent analysis, Lewin estimates that enrollment in the public option will reach 131 million people if it is open to everyone and pays Medicare rates. Fully 119 million people will shift out of -- or lose -- private coverage. Everything depends on the payment levels that Congress adopts, as well as the size of the eligible pool. But even if a public option available to all takes the highly improbable step of paying at some midpoint between private and Medicare rates, nearly 68 million people will still be crowded out of private insurance. The nearby table summarizes Lewin's eye-popping findings.
This public option would be the most radical change in the way American health care is financed -- and thus provided -- in at least 44 years, and maybe ever. About 170 million people currently have private insurance, which is already pressured by the price controls of Medicare and Medicaid. A significant share of government underpayments are simply transferred to the private sector, adding tens of billions of dollars every year to consumer health bills.
A 2006 study in the journal Health Affairs concludes that around 17 cents of every dollar in relative reductions in Medicare payments to private hospitals are shifted onto private patients -- and that such cost-shifting accounts for fully 12.3% of the total increase in private payer prices between 1997 and 2001.
This share would be far higher were government payment rates not limited to the elderly and the poor but imposed over the entire system. This will only hasten the flight to government. Meanwhile, employers small and large will have every incentive to dump their plans and transfer their workers to the public rolls. The result will inevitably be a cascade of failures or withdrawals from the market by commercial insurers, with the public option as the only option for the diaspora.
Congress will finish the job with regulatory changes. Under the aegis of a level playing field, all private plans will be forced to offer benefit packages similar to those in the public option. They will also be required to accept all comers, regardless of pre-existing conditions, and also be forced to offer similar rates to all enrollees, ending the ability to manage risk through underwriting. Any private plan will essentially become a public utility where government decides what products it must offer and how much it can charge.
Democrats couldn't be clearer on this point. House baron Pete Stark -- who thought HillaryCare was too moderate and has long favored Medicare for all -- said at a recent hearing that currently "We have no mechanism to directly push the private sector to do delivery system reform and address rising costs." But the public option, he added, would force private insurers to "modernize," which seems to be his term for industrial policy.
Under this model, the annual political warfare over Medicare payment policies would be imported to what is left of the private sector. Once government takes over the majority of U.S. health-care liabilities, it can either provide every service at huge and growing cost, or it can ration services. People who need an MRI or hip replacement or whatever will face waiting lines. Medical innovation will be at the mercy of the price controls hashed out in Washington.
Proponents of a public option point to the Federal Employees Health Benefits Program to dismiss such criticism, but that program is offered only to a discrete population. Mr. Obama's proposal would be open to everyone and necessitate a huge permanent increase in government spending as a share of the economy. Medicare and Medicaid alone account for 4% of GDP today and will rise to 9% by 2035, according to the Congressional Budget Office. CBO estimates that individual and corporate income tax rates would have to rise by about 90% to finance the projected increase in spending through 2050 -- without the new middle-class entitlement.
Proponents will say we are exaggerating, but the consequences we describe are inevitable when government bulldozes into a market. Democrats want to sell their "public option" as a modest and affordable reform that won't affect anyone's private insurance. It isn't true. Republicans, especially those in the Senate who want to cut a deal on health care, should understand that a public option is the beginning of the end of private health insurance.
Please add your comments to the Opinion Journal forum.
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WSJ
by MARC SIEGEL
Here's something that has gotten lost in the drive to institute universal health insurance: Health insurance doesn't automatically lead to health care. And with more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have.
Consider that the Medicare Payment Advisory Commission reported in 2008 that 28% of Medicare beneficiaries looking for a primary care physician had trouble finding one, up from 24% the year before. The reasons are clear: A 2008 survey by the Texas Medical Association, for example, found that only 38% of primary-care doctors in Texas took new Medicare patients. The statistics are similar in New York state, where I practice medicine.
More and more of my fellow doctors are turning away Medicare patients because of the diminished reimbursements and the growing delay in payments. I've had several new Medicare patients come to my office in the last few months with multiple diseases and long lists of medications simply because their longtime provider -- who they liked -- abruptly stopped taking Medicare. One of the top mammographers in New York City works in my office building, but she no longer accepts Medicare and charges patients more than $300 cash for each procedure. I continue to send my elderly women patients downstairs for the test because she is so good, but no one is happy about paying.
The problem is even worse with Medicaid. A 2005 Community Tracking Physician survey showed that only 50% of physicians accept this insurance. I am now one of the ones who doesn't take it. I realized a few years ago that it wasn't worth the money to file the paperwork for the $25 or less that I received for an office visit. HMOs are problematic as well. Recent surveys from New York show a 10% yearly dropout rate from the state's largest HMO, the Health Insurance Plan of New York (HIP), and a 14% drop-out rate from Health Net of New York, another big HMO.
The dropout rate is less at major medical centers such as New York University's Langone Medical Center where I work, or Mount Sinai Medical Center, because larger physician networks have more leverage when choosing health plans. Still, I am frequently hamstrung as I try to find a good surgeon or specialist to refer one of my patients to.
Overall, 11% of the doctors at NYU Langone don't participate in at least two insurance plans -- Aetna or Blue Cross, for instance -- so I end up not being able to refer my patients to some of our top specialists. This problem, in addition to the mass of paperwork and diminishing reimbursements, is enough of a reason for me to consider dropping out as well.
Bottom line: None of the current plans, government or private, provide my patients with the care they need. And the care that is provided is increasingly expensive and requires a big battle for approvals. Of course, we're promised by the Obama administration that universal health insurance will avoid all these problems. But how is that possible when you consider that the medical turnstiles will be the same as they are now, only they will be clogged with more and more patients? The doctors that remain in this expanded system will be even more overwhelmed than we are now.
I wouldn't want to be a patient when that happens.
Dr. Siegel, an internist and associate professor of medicine at the NYU Langone Medical Center, is a Fox News medical contributor.
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ama Tactic Shields Health Care Bill From a Filibuster
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LinkedinDiggFacebookMixxMySpaceYahoo! BuzzPermalinkBy CARL HULSE
Published: April 24, 2009
WASHINGTON — At the prodding of the White House, Democratic Congressional leaders have agreed to pursue a plan that would protect major health care legislation from Republican opposition by shielding it from last-minute Senate filibusters.
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The aggressive approach reflects the big political claim that President Obama is staking on health care, and with it his willingness to face Republican wrath in order to guarantee that the Democrats, with their substantial majority in the Senate, could not be thwarted by minority tactics.
While some Democratic senators were reluctant to embrace the arrangement, Mr. Obama made clear at a White House session on Thursday afternoon that he favored it, people with knowledge of the session said.
Mr. Obama has given way in some battles with Congress, but the new stance suggests he may be much less willing to compromise when it comes to health care, his top legislative priority, even if it means a bitter partisan fight.
The no-filibuster arrangement is fiercely opposed by Republican leaders, who say health care is too important to be exempted from the Senate rules that usually mean major bills must win support from 60 senators.
At the White House meeting this week, Mr. Obama told senators from both parties that he did not want a health care overhaul to fail if it came up a vote shy of the 60 needed to break filibusters, the people with knowledge of the session said. Republicans have used the procedure themselves in the past, but Senator Mitch McConnell of Kentucky, the Republican leader, told Mr. Obama in the meeting that that approach was likely to heighten partisan tensions in Congress.
The arrangement is spelled out in a tentative budget agreement reached Thursday night between Congressional leaders and the White House, allowing health legislation that meets budget targets to be approved by a simple Senate majority, under a process known as reconciliation.
Democrats say they intend to use the process as a last resort, and will include a provision in the budget that would not trigger the Senate shortcut until Oct. 15. That would leave the door open for months of negotiations over health care legislation, which the Democrats hope to deliver by the end of the year.
“Virtually everyone who has been part of these discussions recognizes that reconciliation is not the preferred way to write this legislation,” said Senator Kent Conrad, Democrat of North Dakota and chairman of the Senate Budget Committee. “But the administration wants to have a reconciliation instruction as an insurance policy.”
Mr. Conrad said the decision not to invoke the no-filibuster rule until mid-October was intended “as a signal that people are very serious and want this to work through the normal give-and-take.”
But that might not mollify Republicans, who say that once Democrats have the ability to fast-track the measure they will have no incentive to negotiate seriously with Republicans.
Republicans have threatened to use their own procedural weapons to bog down the Senate if Democrats adopt a budget that restricts filibusters on an issue as important as health care.
“The floor of the Senate will become a very untidy place if they start using reconciliation for major policy,” warned Senator Judd Gregg of New Hampshire, senior Republican on the budget panel.
Mr. Conrad and Representative John M. Spratt Jr. of South Carolina, the House Budget Committee chairman, were hammering out final details of the $3.5 trillion budget in talks with the administration that were expected to head into the weekend.
“Most issues have been resolved,” Senator Harry Reid of Nevada, the majority leader, said Friday, “but there are some that have not.”
The Democrats can rely on 58 votes in the Senate, and expected to add a 59th once the courts finish their review of the disputed election in Minnesota. But Mr. McConnell said that using the no-filibuster approach on health care “without the benefit of a full and transparent debate, does a disservice to the American people.”
“It would make it absolutely clear they intend to carry out their plans on a purely partisan basis,” he said.
Mr. Conrad had advised against using reconciliation, saying it did not lend itself to such a complex issue as health care.
But Mr. Conrad came under intense pressure from the White House, his own Senate leadership and the House to include it, to guard against Republicans’ using the filibuster to kill a health care bill. Proponents of reconciliation note that House and Senate Republicans have so far stood almost united against the new administration’s major initiatives.
Besides the agreement to use reconciliation, negotiators were coming to terms on lingering tax issues and the overall level of domestic spending, with the amount originally requested by Mr. Obama expected to be reduced by about $10 billion for 2010. The White House was pushing for final approval of a budget by Wednesday to put a successful coda on the Obama administration’s first 100 days.
The tentative agreement would also apply reconciliation rules to a less-partisan fight over student lending, but does not include filibuster protection for energy or climate-change legislation.
Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee, said Friday that he would prefer not to pursue health legislation through the reconciliation process.
“I think it gets in the way,” Mr. Baucus said, explaining that his goal was to produce a health care bill that could “get significantly more than 60 votes.”
“If we jam something down somebody’s throat, it’s not sustainable,” he said.
But other leading Democrats say they need the ability to circumvent filibusters if Republicans refuse to negotiate. They noted that Republicans often relied on reconciliation when they held power, notably using it to enact President George W. Bush’s tax cuts in 2001 and 2003.
Senate rules give the minority party, in this case the Republicans, ample ability to snarl the legislative process in a chamber where much activity is conducted under agreements between majority and minority leadership.
Republicans could force multiple votes on mundane matters, slow walk administration nominations, force Democrats to spend days teeing up bills for debate and require lengthy bills to be read in full. In 2005, Democrats threatened to bring the Senate to a halt using similar tactics when Republicans said they would strip them of the ability to filibuster judicial nominations. That showdown was averted.
Now, Republicans would run some political risk of being portrayed as obstructing health care and other initiatives sought by a popular new president if they were seen as shutting down the Senate out of pique.
Robert Pear contributed reporting.
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It is not so much that there is a shortage of doctors as much as shortage in some areas. In my area there is too many doctors.
But anyway:
Obama administration concerned about growing shortage of primary-care doctors
by Robert Pear/New York Times Sunday April 26, 2009, 9:59 PM
Washington -- Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the number of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.
The officials said they were particularly concerned about shortages of primary-care providers who are the main source of health care for most Americans.
One proposal -- to increase Medicare payments to general practitioners, at the expense of high-paid specialists -- has touched off a lobbying fight.
Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors -- a difficult argument at a time of huge budget deficits.
Some of the proposed solutions, while advancing one of President Barack Obama's goals, could frustrate others. Increasing the supply of doctors, for example, would increase access to care, but could make it more difficult to rein in costs.
The need for more doctors comes up at almost every congressional hearing and White House forum on health care. "We're not producing enough primary-care physicians," Obama said at one forum. "The costs of medical education are so high that people feel that they've got to specialize." New doctors typically owe more than $140,000 in loans when they graduate.
Lawmakers from both parties say the shortage of health-care professionals is already having serious consequences. "We don't have enough doctors in primary care or in any specialty," said Rep. Shelley Berkley, Democrat of Nevada.
Sen. Orrin G. Hatch, Republican of Utah, said, "The work force shortage is reaching crisis proportions."
Even people with insurance are having problems finding doctors.
Miriam Harmatz, a lawyer in Miami, said: "My longtime primary-care doctor left the practice of medicine five years ago because she could not make ends meet. The same thing happened a year later. Since then, many of the doctors I tried to see would not take my insurance because the payments were so low."
To cope with the growing shortage, federal officials are considering several proposals. One would increase enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants. A third would expand the National Health Service Corps, which deploys doctors and nurses in rural areas and poor neighborhoods.
Sen. Max Baucus, Democrat of Montana, chairman of the Finance Committee, said Medicare payments were skewed against primary-care doctors -- the very ones needed for the care of older people with chronic conditions like congestive heart failure, diabetes and Alzheimer's disease.
"Primary-care physicians are grossly underpaid compared with many specialists," said Baucus, who vowed to increase primary-care payments as part of legislation to overhaul the health-care system.
The Medicare Payment Advisory Commission, an independent federal panel, has recommended an increase of up to 10 percent in the payment for many primary-care services, including office visits. To offset the cost, it said, Congress should reduce payments for other services -- an idea that riles many specialists.
Dr. Peter J. Mandell, a spokesman for the American Association of Orthopaedic Surgeons, said: "We have no problem with financial incentives for primary care. We do have a problem with doing it in a budget-neutral way. If there's less money for hip and knee replacements, fewer of them will be done for people who need them."
The Association of American Medical Colleges is advocating a 30 percent increase in medical school enrollment, which would produce 5,000 additional new doctors each year.
"If we expand coverage, we need to make sure we have physicians to take care of a population that is growing and becoming older," said Dr. Atul Grover, the chief lobbyist for the association. "Let's say we insure everyone. What next? We won't be able to take care of all those people overnight."
The experience of Massachusetts is instructive. Under a far-reaching 2006 law, the state succeeded in reducing the number of uninsured. But many who gained coverage have been struggling to find primary-care doctors, and the average waiting time for routine office visits has increased.
"Some of the newly insured patients still rely on hospital emergency rooms for nonemergency care," said Erica L. Drazen, a health policy analyst at Computer Sciences Corp.
The ratio of primary-care doctors to population is higher in Massachusetts than in other states.
Increasing the supply of doctors could have major implications for health costs.
"It's completely reasonable to say that adding more physicians to the work force is likely to increase health spending," Grover said.
But he said: "We have to increase spending to save money. If you give people better access to preventive and routine care for chronic illnesses, some acute treatments will be less necessary."
In many parts of the country, specialists are also in short supply.
Linde A. Schuster, 55, of Raton, N.M., said she, her daughter and her mother had all had medical problems that required them to visit doctors in Albuquerque.
"It's a long, exhausting drive, three hours down and three hours back," Schuster said.
The situation is even worse in some rural areas. Dr. Richard F. Paris, a family doctor in Hailey, Idaho, said that Custer County, Idaho, had no doctors, even though it is larger than the state of Rhode Island. So he flies in three times a month, over the Sawtooth Mountains, to see patients.
The Obama administration is pouring hundreds of millions of dollars into community health centers.
But Mary K. Wakefield, the new administrator of the Health Resources and Services Administration, said many clinics were having difficulty finding doctors and nurses to fill vacancies.
Doctors trained in internal medicine have historically been seen as a major source of frontline primary care. But many of them are now going into subspecialties of internal medicine, like cardiology and oncology.
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The folks who ran Katrina now look to takeover the people's remaining medical freedoms. A giant clusterfcuk comes , , , :cry:
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Crafty: "The folks who ran Katrina..." or as we say in Mpls, the folks who brought us the bridge... How come the same liberals demanding government-run healthcare aren't clamoring to move into public housing?
Steve Forbes makes many good points in this piece, also some very specific improvements to the current system that could easily be done now at no cost: "Allow mandate-free insurance policies... Permit people to buy health insurance across state lines... Make it easier for small businesses to buy insurance in a pool... Equalize the tax treatment of premiums... Raise limits on contributions to HSAs and on deductibles.
http://www.forbes.com/forbes/2009/0511/017-opinions-steve-forbes-the-fight.html
The Fight
The biggest domestic battle since the Clintons tried to nationalize health care in the early 1990s is about to unfold. Sometime in June the Obama Administration will formally introduce its plan to deal with the problem of the 46 million Americans who don't have health insurance. But the proposal will have far larger--and more ominous--implications for the country than the number of uninsured. This will be President Obama's attempt to do what the Clintons couldn't: truly socialize American health care. Make no mistake: Obama's plan will be the Administration's absolute top priority, trumping new energy taxes and the forced unionization of private-sector workers. Irrevocably sinking Washington's claws deep into an area constituting 17% of the economy is too great an opportunity for this Administration to pass up.
The President will propose that the government set up its own health insurance company, a Medicare-for-everyone system. The purpose, as he puts it, will be to provide competition with the private carriers. But this won't be competition; it will be a de facto government takeover.
The Administration will portray opponents as heartless for not wanting to do something about the uninsured. It will proclaim that private carriers make too much money and spend too much on overhead and marketing and that a nonprofit government insurer can make insurance affordable for those who currently don't get it through their employer or are out of a job.
Health care socialists will declare, "Look at Medicare. Despite its flaws and incomplete coverage it still provides a fantastic, affordable safety net for tens of millions of the elderly. Why can't we do that for everyone?"
Such a scheme would be a disaster. It would destroy innovation and lead to shortages and rationing. All the frustrations we experience with our current higgledy-piggledy system will pale beside the replacement's increasingly subpar care, ever lengthening lines for basic services and ever longer waits for "elective" surgeries.
Let's clear up some of the myths. Both Medicare and Medi-caid are heavily subsidized by privately insured patients, to the tune of $90 billion a year. Federal reimbursement in these two programs is far below cost, which is why an increasing number of doctors are refusing to treat or are substantially cutting back on the number of Medicare and Medicaid patients they see.
Medicare and Medicaid are rife with fraud. Unlike private insurers, the government refuses to spend real resources on routing out the wrongdoing: overbilling, overtesting and charging for visits not made or tests not given.
Obama beat them at presidential politics in 2008. Now he hopes to achieve what they conspicuously didn't do in health care.
The quality of care will decline. Health care "outcomes" for Medicaid patients are substantially below those of similar private-insurance patients. Fees are so low that patients are often treated more like ill, undesirable cattle.
Socialized systems are anathema to innovation. Breakthroughs in medications, diagnostic tools and medical devices require substantial capital investment and entail high risk. In the pharmaceutical industry, barely one in 250 promising compounds ever makes it to the marketplace. In the 1960s western Europe was a font of new medicines. But nationalized medicine put a stop to that. Today most of the breakthroughs come from the U.S. Even when another country invents something, it is in the U.S. that the product is fully developed. For example, the MRI breakthrough was achieved by a Brit, but MRIs are much more widely used in the U.S.
Medicare is no exception to this anti-innovation bias. As health care expert John C. Goodman, CEO of the National Center for Policy Analysis, has noted:
"Almost no one talks to his or her doctor on the phone. Why? Because Medicare doesn't pay a doctor to talk to you on the phone. And private insurers, who tend to follow Medicare's lead, don't pay for phone consultations, either. The same goes for e-mail: Only about 2% of patients and doctors e-mail each other--something that is normal in every other profession.
"What about digitizing medical records? Doctors typically do not do this, which means that they can't make use of software that allows electronic prescriptions and makes it easier to detect dangerous drug interactions or mistaken dosages. Again, this is something that Medicare doesn't pay for. Likewise patient education: A great deal of medical care can be handled in the home without ever seeing a doctor or a nurse--e.g., the treatment of diabetes. But someone has to give patients the initial instruction, and Medicare doesn't pay for that."
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A federal government insurance company, with its subsidies, will attract more and more people from private plans. Instead of overtly running providers such as Aetna ( AET - news - people ) and UnitedHealthcare out of business, the federal government will take them over through mandating what they can and cannot do, as well as "reinsuring" private carriers for costs above certain levels. In other words, nongovernment insurance companies will become vassals and virtual subsidiaries of the Washington-run system.
What are the alternatives to this health care nightmare? There are many positive, nongovernment things that could instead be done.
--Allow mandate-free insurance policies. True catastrophic health insurance--not the current dollar-for-dollar coverage--is very affordable.
--Permit people to buy health insurance across state lines. Removing such barriers would sharply increase competition.
--Make it easier for small businesses to buy insurance in a pool, whether through trade associations or other kinds of affiliations.
--Equalize the tax treatment of premiums. Companies get a tax deduction for health insurance premiums, as do the self-employed. Why not give that break to employees who choose to buy their own individual policies? They would get a deduction or a refundable tax credit (meaning if they don't have a tax liability they'd get an actual check from Uncle Sam). Many small businesses offer no insurance, or those that do may offer policies some workers find unsatisfactory. These folks should have the ability to easily get their own alternatives.
--Raise limits on contributions to HSAs and on permissible deductibles.
All of these ideas would substantially cut the number of un-insured. For those truly uninsurable, why not give them the medical equivalent of food stamps and subsidize their catastrophic health insurance premiums through private companies?
President Obama says he wants to make health care affordable for all. Applying free-market principles to health care would do just that. Even with private-sector insurance there isn't a true free market--not when most expenses are covered by third parties. The key is to give consumers, not businesses and government bureaucracies, control of their health care dollars. Having businesses put money into workers' HSAs would be preferable to today's system. Once consumers actually control the money, they will apply pressure to get more value for it. After all, it's theirs.
Free-market dynamics have worked in virtually every other part of the economy, spurring production and innovation and helping us get more for less. Food is even more basic than health care. We don't have a third-party-payer system for food (except for food stamps). Result: Today people spend a smaller portion of their income for food than they did decades ago. And the variety of foods is greater than ever. Free markets can do the same with regard to health care; governments manifestly cannot.
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Some good ideas Doug,
But, you said..... and I basically agree.....
Free-market dynamics have worked in virtually every other part of the economy, spurring production and innovation and helping us get more for less. Food is even more basic than health care. We don't have a third-party-payer system for food (except for food stamps). Result: Today people spend a smaller portion of their income for food than they did decades ago. And the variety of foods is greater than ever. Free markets can do the same with regard to health care; governments manifestly cannot."
Except for Medicare, the medical system is basically free market, yet it doesn't work, i.e. people are paying more for medical care than ever before. Why?
My 2 cents.
People expect the "best". Yet using food (as you did) for example, some people eat steak and some people eat hamburger. And the system works. In medical care everyone wants the newest and the best, but doesn't want to pay for it. Tough choices need to be made.
Also, ease of entry. Now, all doctors get paid the same whether they went to Harvard Medical School or Montana Tech. Lawyers in contrast usually earn more if they went to Harvard versus the joke of a college; why not Medical? And why not allow easy entry for foreign medical MD's if they pass the medical exam here? Again, it works for lawyers. Yet doctors keep a closed community limiting the number of doctors in America to
artificially raise incomes. Is that right? Some doctors as you pointed out are declining Medicare patients. What about the Doctor's oath?
Bottom line, people expect the best, but will not pay for it out of their own pocket. Tough choices, who gets what procedures, what technologies, what drugs, etc must be made otherwise a competitive system will never work. America pays more than nearly any other country for their health care, and yes, for the high tech issues like cancer etc it is the best, but for the everyday Joe, our morbidity is not superior to most industrialized countries.
And then we get back to the issue of whether Medical care is a right, like a Fire Department, Police Department, roads, etc available and equal for all, or is only the best available to the affluent. Is that right??? Maybe yes, maybe no.
But something needs to be done, that is a given...
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Except for Medicare, the medical system is basically free market, yet it doesn't work, i.e. people are paying more for medical care than ever before. Why?
Whoa! Not sure an informed discussion can follow a statement as inaccurate as that. The current US system is a heavily regulated, oddly constructed hodgepodge that spins off perverse incentive with great frequency. Most health insurance is provided through a person's employer, for instance, rather through any free market vehicle hence driving a wedge between the market and the health insurance decision making process. Until recently many health insurance policies did very little to reward good decision making and punish bad decision making on the part of the insured, again divorcing tangible consequences from market forces. Then a given employer's policy wasn't transferable to a new job, which prevents some from making market oriented vocational decisions as they are tied via pre-existing conditions or other situations to their current employer. Then there are the uninsured who receive basic medical services via the ER with those costs passed on to the insured, rules and regs that prevent an insurer in one state from competing in another, duchies and principalities such as Massachusetts passing all manner of regulations meant to insure all that instead drives doctors out of the system, FDA regs, EPA regs, regs that keep the pain ridden and terminally ill from easily accessing narcotic analgesics and so on. And all these examples of non-market oriented mechanism are what leap to mind with a few minutes thought. A little research would doubtless reveal considerably more.
It galls me when the housing crash is called a failure of the free market when massive government intervention, political favor granting, and ill-considered tinkering had much to do with it. Similarly it strikes me that any discussion of the current health care system is doomed to failure if its initial premise is that we are currently operating under a free market system where health care is concerned. Indeed, when attempts at market based reforms are demagogued as they were last election cycle and when nanny state supporters struggle ceaselessly to impose a single payer system I'm surprised the term "free-market" is even raised in this debate as it's clearly not part of the current health care paradigm.
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A piece written just prior to the election that speaks to the points made above:
www.heritage.org
Candidates' competing prescriptions for health care
by Robert E. Moffit, Ph.D.
October 24, 2008 |
[back to web version]
Approximately 47 million Americans lack health coverage. It's a huge problem.
To their credit, both major presidential candidates have both ponied up ambitious plans to deal with it. Their approaches are expansive and expensive. And that's where the similarities end.
When it comes to the future of America's health system, John McCain and Barack Obama hold two very different visions.
The Obama health plan would centralize power in Washington.
Increasingly, federal officials would hold the purse strings and make the decisions on health care delivery.
The McCain plan would decentralize control over health care financing and decision-making, empowering individuals and families. In the public health arena, states would retain authority rather than cede power to the feds.
In the case of both plans, some crucial details are sparse. But it's easy to spot the major differences in approaches taken by the candidates.
To expand coverage, Sen. Obama would take four major steps:
Create a new national health plan. The new government health plan would enroll those without job-sponsored coverage and those not eligible for coverage under existing government health programs, such as Medicaid and SCHIP.
Create a national health insurance exchange. The exchange would be the ultimate regulatory "watchdog," making sure that private health plans competing with the government plan met the same regulatory standards as those applied to the new federal health plan.
Impose a "play or pay" employer mandate. Employers would be expected to offer their workers a level of health coverage set by the government. Those who didn't would have to pay a new federal tax - of an unspecified amount - which would be used to help finance the new government plan.
Embrace new regulatory initiatives governing health care delivery by physicians and other medical professionals, and expand existing government health programs - particularly Medicaid and SCHIP.
Just how much that would entail government control over medical practice is, again, unclear.
No doubt, Obama's approach would take a big bite out of the uninsured problem. But not as much as you might think.
His approach adds millions to the public health rolls by skimming millions from private health plans - especially employer-based plans.
The Lewin Group, the country's most authoritative health econometrics firm, estimates the plan would extend government health coverage to 48.3 million Americans. But nearly half of those (47 percent) are currently insured through their employers. They and their families would "gain" government coverage because the Obama approach makes it economically advantageous for their companies to discontinue their health benefits and dump them into the government-run plan.
The McCain plan calls for three major steps:
Replace federal tax breaks exclusively for employment-based coverage with a universal health care tax credit ($5,000 for a family, $2,500 for an individual). The new health care tax credit would replace the current employees' tax exclusion, not the employer's deduction.
Create a national market for health insurance. Individuals and families could buy state-regulated health insurance plans anywhere in the country, not just in the state where they happen to live.
Implement a "guaranteed assistance program." The feds would give states financial assistance to provide affordable coverage for the 2 million to 5 million Americans considered "uninsurable" due to serious medical conditions. This would be accomplished through state-based high-risk pools or similar mechanisms
Like Obama, McCain would also promote changes in care delivery with an eye toward securing greater value for health care dollars.
Independent analysts generally see McCain's proposal, powered by the universal health care tax credit, as producing a rapid expansion in private health coverage and a reduction in dependency on government programs. The Lewin Group estimates it would extend private insurance coverage to an additional 26.5 million Americans. Millions of Americans on Medicaid, a welfare program, would transition over to private health insurance. The net reduction in the ranks of the uninsured, according to Lewin: 21.1 million.
The most common concern about the McCain plan focuses on its financing.
Some critics imply his proposal to pay for the tax credit by taxing health benefits amounts to a tax increase. In truth, however, this approach would yield a major tax cut to the vast majority of Americans, particularly for the middle class. Analysts at the Urban Institute estimate the change in tax treatment would leave the typical family roughly $1,200 ahead annually.
The financial question pales in comparison to the far larger issue at hand: the direction this country will take in crafting a 21st century health system. Sen. Obama's plan would take us on the path to a government-controlled system. Sen. McCain's approach would shift the reins of health care financing and selection into the hands of individuals and families.
Robert Moffit, is director of the Center for Health Policy Studies at The Heritage Foundation.
http://www.heritage.org/Press/Commentary/ed102408a.cfm
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"Except for Medicare, the medical system is basically free market"
Guinness answered this better, but I was going to say that sure - it's a free market - about like OPEC, lol. Government based healthcare and government rules and mandates I think are a huge part of the market and as Forbes demonstrates, set the tone for how things are done in the rest of the market. I would not favor a totally unregulated market in medicine, but if we want control on costs we have to find a way for competition and consumer choices to flourish.
Healthcare was compared with the market for food but high-tech might be a more insightful comparison. I can buy a computer model that has been proven for a few years and widely available for a few hundred bucks. Or I can buy the very latest experimental high tech device barely out of the lab for maybe hundreds of thousands. In every other area we balance those choices with our budget and our circumstances. Not with other people's money available and life and health choices on the line. In health care we keep wanting the newest and latest treatment no matter the price or whether or not the performance is proven and we demand that someone else pay for it.
Do you want government to ration these decisions or prices and individual choices to do that? Neither is perfect, but I prefer leaning toward the price mechanism and free choices over the bureaucracy as much as possible.
Studies show that a lion's share of health care costs, especially the more recent increases, go toward our treatments during our last 6 months of life. Basically we are denying our own mortality, and then dying anyway. If you made those treatment choices out of your own saving, and imagine if you had the right to pass your earned, accumulated wealth on to your family, would you still want to pay any price and fight every fight even the ones not winnable while knowing that you are spending the last of your family's inheritance?
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Except for Medicare, the medical system is basically free market, yet it doesn't work, i.e. people are paying more for medical care than ever before. Why?
Whoa! Not sure an informed discussion can follow a statement as inaccurate as that. The current US system is a heavily regulated, oddly constructed hodgepodge that spins off perverse incentive with great frequency. Most health insurance is provided through a person's employer, for instance, rather through any free market vehicle hence driving a wedge between the market and the health insurance decision making process. Until recently many health insurance policies did very little to reward good decision making and punish bad decision making on the part of the insured, again divorcing tangible consequences from market forces. Then a given employer's policy wasn't transferable to a new job, which prevents some from making market oriented vocational decisions as they are tied via pre-existing conditions or other situations to their current employer. Then there are the uninsured who receive basic medical services via the ER with those costs passed on to the insured, rules and regs that prevent an insurer in one state from competing in another, duchies and principalities such as Massachusetts passing all manner of regulations meant to insure all that instead drives doctors out of the system, FDA regs, EPA regs, regs that keep the pain ridden and terminally ill from easily accessing narcotic analgesics and so on. And all these examples of non-market oriented mechanism are what leap to mind with a few minutes thought. A little research would doubtless reveal considerably more.
It galls me when the housing crash is called a failure of the free market when massive government intervention, political favor granting, and ill-considered tinkering had much to do with it. Similarly it strikes me that any discussion of the current health care system is doomed to failure if its initial premise is that we are currently operating under a free market system where health care is concerned. Indeed, when attempts at market based reforms are demagogued as they were last election cycle and when nanny state supporters struggle ceaselessly to impose a single payer system I'm surprised the term "free-market" is even raised in this debate as it's clearly not part of the current health care paradigm.
Let me try...
Albeit some years ago, having worked for William Mercer (Benefit Consultants) for a number of years, representing large 50,000+ee employers, I assure that these employers (the buyers) are interested in reducing costs. HMO's have become prevalent; deductibles have been raised, higher co-pays were instigated, networks established, etc all with the express purpose of lowering costs. For a number of years, group plans have rewarded good decision making and punished bad decision making. As for the market, well the market (competing insurance companies) are the ones who fought for pre-existing clauses. And large groups, basically self insured likes pre existing clauses as well. Do you want to hire and employee, pay him 30K but absorb a 500K medical expense? Market forces have denied these people coverage. Again, market forces denied the transferability of coverage; who wants a new sick employee? Better to have a short form medical questionnaire and deny coverage to the uninsured or ill. It was only the government intervention that COBRA came about. Better than nothing a lifeline to some.
I agree, the uninsured bog down the ER room. But again, market forces deny coverage to these people. It will take the government to intervene to provide coverage.
As for state regulation, why on other posts is "state's powers " lauded and encouraged? Yes, a few states implement silly rules, but I doubt if many doctors leave the state because of it. Nor many employers for that matter; they just suck it up. And oddly, market force again usually will dictate which rules and regs are passed; employers don't sit on the butt; but rather offer stiff opposition to almost any law increasing costs. I remember when pregnancy wasn't covered and a few states started to mandate the coverage. There was a huge fight, market forces wanted to deny coverage, but in the end government intervened. And I think we are better off.
As for keeping the pain ridden and terminally ill from easily accessing narcotics, well in our litigious society, it is not easy. You may want your loved one to have these medications, and if they die from the medication and/or become addicted logic your logic (and mine) says you eased their pain. But someone else may not agree. And who is to decide? And think about the possible abuse. Those drugs are cheap; it is not a cost issue, but a safety issue.
Free market? There are lots of insurance companies competing here in California. And a doctor is free to choose how to run his practice. My doctor for example will not take any HMO and only a very few (high paying) PPO's. He prefers cash. A new doctor just out of school to increase their business often will sign up for any HMO that will take him. Ask at UCLA if the top oncologists will take HMO. The answer is a resounding "NO". I know from a friend's personal experience. That is the free market at work.
In review the issues of transferability, pre-existing conditions, uninsured, etc are essentially denied coverage because of "free market" not in spite of; frankly it's not profitable business; that's easy. It takes the government to intervene to demand coverage and make a level playing field otherwise why should a business enter a non profitable market?
The issue is choices, hard choices. As I said before, we want our cake and eat it too. Frankly, I like and agree with most of Doug's immediately preceding posted comments. Choices; but America wants the newest and best medical care for everyone and if it isn't offered America is indignant. Some choices need to be made. Maybe an insurance company is best, or the government, but individuals? It's tough to say "no, don't use an MRI (even though it's better) a CT Scan is good enough". I can choose my computer based upon my financial situation and need, but I want the "best" medical care for my family whether I can pay for it or not. And I will let you (not personal Doug) decide not to spend the family's inheritance not to keep your wife alive later in life; it's tough... albeit logical. We are too emotionally attached.
I'm not saying an all government plan is the answer. I am saying that something needs to be done. And yes, there is waste. But the government needs to mandate that somehow everyone will be insured. That pre-existing condition clauses don't exist, etc. Medical care is not buying a new computer, it is a life at stake.
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Re transferability:
Doesn't this issue have its roots in the wage and price controls of WW2? IIRC the govt did allow health insurance to become part of the payments to workers without taxing it-- but if an individual wants to buy insurance on his own, he must do so with after tax dollars. Yes?
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"And I will let you (not personal Doug) decide not to spend the family's inheritance not to keep your wife alive later in life; it's tough... albeit logical. We are too emotionally attached."
Don't worry JDN, nothing personal taken, but you read me wrong. I am saying that it IS a valid choice to spend your own money on heroic health measures, or mansions yachts and trips around the world instead of leaving a nest egg. But it doesn't work for ALL of us to choose the highest cost solutions on everything and then demand that someone else pay for it - and keep costs down.
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"Doesn't this issue have its roots in the wage and price controls of WW2? IIRC the govt did allow health insurance to become part of the payments to workers without taxing it-- but if an individual wants to buy insurance on his own, he must do so with after tax dollars. Yes?"
Yes, though you can make limited pre-tax HSA contributions (health savings account).
Sure enough, health care was federalized though the tax code. JDN makes a good point about states rights. I will indulge him on that and agree with any move that takes the feds completely out of the health care business, and auto manufacturing, and housing/mortgages, and ...
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"And I will let you (not personal Doug) decide not to spend the family's inheritance not to keep your wife alive later in life; it's tough... albeit logical. We are too emotionally attached."
Don't worry JDN, nothing personal taken, but you read me wrong. I am saying that it IS a valid choice to spend your own money on heroic health measures, or mansions yachts and trips around the world instead of leaving a nest egg. But it doesn't work for ALL of us to choose the highest cost solutions on everything and then demand that someone else pay for it - and keep costs down.
Glad nothing personal taken.
Yes, It is a valid choice how to spend your own money, however I think people can logically find it rather easy not to buy the mansion, yacht(s) :-) or trip around the world in their late years. Yet difficult to deny their wife the best care (i.e. most expensive). I'm not sure you can equate the two. It's a tough choice, although I concede your logic, such decisions are often made with emotion; logic doesn't enter into it. "Because it's expensive, "Let them die" or don't do another round of the latest Chemo ($5000 for 10 pills+++) cocktail" is hard to say... Will/Do people consciously accept a lower level of medical care for lower quality of care in exchange for lower cost? Especially on the life threatening issues? I'm not sure... And is that even right?
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Albeit some years ago, having worked for William Mercer (Benefit Consultants) for a number of years, representing large 50,000+ee employers, I assure that these employers (the buyers) are interested in reducing costs.
I certainly assume they are. But they are not the end user of the health product and hence have little impact on the decision making occurring at the time a health service is provided. A system where consumers are insulated from market forces is not a "free-market," and hence should not be indicted as a free market failure.
HMO's have become prevalent; deductibles have been raised, higher co-pays were instigated, networks established, etc all with the express purpose of lowering costs. For a number of years, group plans have rewarded good decision making and punished bad decision making.
Which is why I said "until recently." Still, in my market and most others there are non-HMO choices that many opt for, as I did recently having grown annoyed with the HMO habit of rationing care via long waits and bureaucratic hoop navigation when seeking anything other than preventative care.
As for the market, well the market (competing insurance companies) are the ones who fought for pre-existing clauses. And large groups, basically self insured likes pre existing clauses as well. Do you want to hire and employee, pay him 30K but absorb a 500K medical expense? Market forces have denied these people coverage. Again, market forces denied the transferability of coverage; who wants a new sick employee? Better to have a short form medical questionnaire and deny coverage to the uninsured or ill. It was only the government intervention that COBRA came about. Better than nothing a lifeline to some.
As mentioned, non-free market forces such as limiting plans to a given state prevent innovation that might allow folks with ongoing illness to band together and seek specific treatments. My mother had multiple sclerosis and died due to its complications, but was limited throughout her life by the insurance available through my father's employer. There is a very active MS community out there, as there is for many illnesses, and it doesn't take a lot of imagination to envision an entrepreneur who caters to a targeted market creating a plan focussed on a specific set of needs. Throw portable health insurance into the mix and I'm confident innovation would occur. Alas, non-market based interventions prevent this from occurring, necessitating government intervention such as COBRA.
I agree, the uninsured bog down the ER room. But again, market forces deny coverage to these people. It will take the government to intervene to provide coverage.
Hmm, I'm having some trouble wrapping my head around this statement. Isn't it market forces that deny this same group yachts? Need we demand government intervention to address this inequity too? I was going to use the example of higher end housing, but in fact the government did intervene on that front, I remember reading somewhere. Remind us how that turned out.
Again, the debate as you framed it is that the free market has failed to provide health care, though as hopefully has been established, the market isn't free so indicting it for failures such as these puzzles me. Moreover, attempts to introduce free market devices such as tax free medical savings accounts that would provide the uninsured with an incentive to save money and participate in something like a High Deductible Low Premium insurance plan are routinely nixed by the very same government officials who favor single payer schemes. Just a coincidence, no doubt. Markets are stifled, then blamed by the political types. Good work if you can get it, I guess.
As for state regulation, why on other posts is "state's powers " lauded and encouraged?
MA is welcome to make all doctors wear pink mohawks and walk around flapping their arms like birds if they'd like, just don't call it an expression of the free market, yes?
Yes, a few states implement silly rules, but I doubt if many doctors leave the state because of it. Nor many employers for that matter; they just suck it up. And oddly, market force again usually will dictate which rules and regs are passed; employers don't sit on the butt; but rather offer stiff opposition to almost any law increasing costs.
"Taxachusetts" as some of its residents less than fondly call it is in fact is experiencing contractions in employment and population that predate the recession, is trying to come up with schemes to tax people who live in neighboring states because of the high cost of living those folks live elsewhere but work in MA, is looking at ways to recover sales tax when residents make purchases outside the state to avoid high rates, etc. My very liberal sister the Boston lawyer has even gotten to the point where she is connecting the dots; I'd be very surprised if these same circumstances don't impact medical care.
I remember when pregnancy wasn't covered and a few states started to mandate the coverage. There was a huge fight, market forces wanted to deny coverage, but in the end government intervened. And I think we are better off.
Back when I started riding BMW motorcycles we use to say "you can get a Beemer in any color you want as long as it is black." Similarly, you can get any sort of insurance you want, as long as it's offered by your employer. Wish there was a way to lay a wager over what would have happened if portable insurance had been around back then; I'd be willing to bet pregnancy insurance would have come along quicker if it was something people could have easily opted for, but that choice, ie the free market, was disallowed by employers. Indeed, a lot of what you cite in fact refutes the premise that the markets are free. Is this being noted or am I gonna start wondering why I'm participating in a counterproductive loop?
As for keeping the pain ridden and terminally ill from easily accessing narcotics, well in our litigious society, it is not easy. You may want your loved one to have these medications, and if they die from the medication and/or become addicted logic your logic (and mine) says you eased their pain. But someone else may not agree. And who is to decide? And think about the possible abuse. Those drugs are cheap; it is not a cost issue, but a safety issue.
And so the free market is invoked and trumped in the same paragraph. If we are talking about markets let's talk about markets. If we are talking about morality or whatever let's stick to that. The drug example, however, is a very straightforward one illustrating just how far the medical market is tainted by non-market forces, which again gives lie to your premise.
Free market? There are lots of insurance companies competing here in California. And a doctor is free to choose how to run his practice. My doctor for example will not take any HMO and only a very few (high paying) PPO's. He prefers cash. A new doctor just out of school to increase their business often will sign up for any HMO that will take him. Ask at UCLA if the top oncologists will take HMO. The answer is a resounding "NO". I know from a friend's personal experience. That is the free market at work.
Wow, I can't find the energy to start unraveling that. Here's a question you can pose to your doctor: does he think he'd see more patients or fewer if everyone had portable insurance unburdened by government regulation? I think the answer is obvious, and if it is what does it say about the rest of your arguments?
In review the issues of transferability, pre-existing conditions, uninsured, etc are essentially denied coverage because of "free market" not in spite of; frankly it's not profitable business; that's easy. It takes the government to intervene to demand coverage and make a level playing field otherwise why should a business enter a non profitable market?
I trust my responses to this point make it clear that I disagree with your summary, and similar sorts of government interventions like the recent one in the housing market speak for themselves.
I feel an attack of the snarkies coming on so I'm gonna leave it there. I'm not hardwired in a manner that allows me to calmly discuss a premise as its antithesis is cited as evidence. If you are going to persist in identifying the free market while citing examples that are not part of free markets as I understand them, then perhaps it's time to define the term so discussion can proceed sans the cognitive dissonance that starts my acid tongue waggin'.
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BbyG said, "Here's a question you can pose to your doctor: does he think he'd see more patients or fewer if everyone had portable insurance unburdened by government regulation? I think the answer is obvious, and if it is what does it say about the rest of your arguments?"
I don't think my doctor worries too much about government regulation slowing down the number of patients visited; he is pretty full 5-6 days a week right now. His income might be affected by the paperwork, but then free enterprise insurance company's paperwork is much if not more to blame as well. As for portability, yes, it's a great idea. Never happened until the government stepped in and demanded COBRA. Free enterprise is driven by profit; nothing wrong with that. But actuarially there is little or no profit in portability, or covering people who banded together with MS or Cancer, etc. Imagine going to an underwriter and say, "Hey, I've got a group of 5000 people diagnosed with cancer or MS or... would you like to cover them?" Again, it will never happen. Only the government can intercede.
And don't forget, if you feel so strongly you can always opt out of your employer's plan and chose an individual plan. It will cost you, but if you can get covered it's portable. I like that and that's why I have an individual high medical savings account for many years. I don't want to ever be left high and dry with a pre-existing condition if my employer decides to close the office.
And it IS a discussion on morality as well; it cannot be avoided. No one would say buy the biggest and best yacht versus a dinghy if you are are a tight budget; it is a luxury. But is medical care a "luxury"?
Or a necessity? And if I never could afford my yacht, one would say "oh well" but if I died because I couldn't afford or obtain insurance, well... something is very wrong... It's different. And morality IS an issue.
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As long as "free-market" and "morality" aren't conflated within a discussion I don't have an issue. Just don't argue one while introducing the other and behaving as though they are one in the same.
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So last night I had a wan notion: how 'bout if we start a movement to make any health insurance scheme produced by congress and signed by the president be beta tested for an election cycle--4 years--by congress and all federal employees and then have the efficacy of that plan reviewed by the GAO? If it's something they want to foist on the nation then they can prove that it works first.
A pipe dream, I realize, and even if it were to occur congress itself would insert little clauses in line 10,583 that would give them access to the sort of backdoor care patrician a$$holes demand, but they exempt themselves from so much of what they drop on others it'd be nice to see it turned around, for once.
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From 'Rest in Peace' , Sen. Specter blamed the Republican party for the death of Jack Kemp. My first reaction is just bad manners; sounds like Specter is getting angry and bitter along with growing old. I saw Specter on the shows - he is not senile but getting a little slower and sadly desperate in his cling to power. For his new party, though, this type of thinking is an accepted pattern. They said the same things about cures they say should have happened for Christopher Reeves and Michael J. Fox.
Besides bad manners, one issue with Reeves and Fox is the stem cell issue and the other with Specter, Kemp and cancer is about public spending. (Let's leave stem cell controversy for another day.)
Public spending on medical research is Specter's beef (or maybe he's just rambling because he saw a camera and microphone on - like Biden does). My view is out of the mainstream, but I think the federal government should be a whole lot smaller, the cost should be a whole lot lower, privately we would be a whole lot wealthier and then our favorite form of charity might be to give money directly to medical research for the ailments that are most likely to strike our families. Cancer research is certainly at or near the top of anyone's list.
Ironically, prostate cancer might be one of the most likely types many people here might face and the survival rate here is the U.S. under our current, 'failed' system with underfunded research is far higher than in the countries with the national healthcare systems that we strive to emulate.
If we were to slash all the programs out of the budget that aren't called for in the constitution I would hopefully cut medical research last, but I would prefer to see it off of coercion-based funding. That's just me, but I wouldn't put a man on the moon at taxpayer expense either.
One objection I always have is that we measure compassion (and results) in dollars spent. As some watching the global warming fiasco have noticed, science at major institutions sometimes seems to be more about the funding than about the cure or the truth. Published results always seem to call for more study needed and more funding. CCP, you have more real world exposure to the medical research side than most of us so let us know what you see...
Another related point is that in health care we spend a huge portion of the money on the last 6 months of life. In the federal budget other than medical research we spend zillions on programs that are either counter productive or lower in benefit to cost ratio than crucial medical research. Setting priorities means putting something AHEAD of something else for funding, not just sending more and more to every feel-good bill that ever passed a previous congress. Did Specter make clear what we should spend LESS on in order to fund eternal life?
Two ideas for government involvement in research: a) offer rewards for results instead of funding for study, or b) consider buying up the best patents and then making 'the cures' available everywhere for free, a public good.
MD's here may see it differently but I doubt that there is 'a cure' or elimination for cancer. I think that we just trudge forward with better preventions, better treatments, better results and longer life expectancies just like we are doing and seeing now.
[If Specter really wanted to save lives and protect the weakest among us, he could change his position on the first issue he mentioned having in common with his new party, pro-choice support for abortion rights.]
CCP and others, your thoughts?
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As some watching the global warming fiasco have noticed, science at major institutions sometimes seems to be more about the funding than about the cure or the truth. Published results always seem to call for more study needed and more funding.
I subscribe to an RSS feed from Eureka Alert, a journal of breaking scientific research, but find myself marking all the items as read when in fact I haven't seen them because most the headlines try to work in some wan relationship to AGW in. It's freaking embarrassing to read piece after piece where some author/committee is so starved for funding/attentions that they come up with crap like "Global Warming Responsible for Lower Rate of Circumcision in Sub-Saharan Africa." The whole AGW boondoggle has turned into a warped funding talisman, a talisman that is diametrically opposed to the values of science. It is downright scary to think that we are raising a generation of scientists who think that cargo cult funding schemes have to be incorporated into every scientific effort; I've little doubt this regimen of perverse incentive will bite us on the fanny down the road.
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Doug,
I am not an expert on cancer research but from what I have read about ongoing research over the years suggests that Specker's remarks are no less ridiculous, absurd, and downright stupid.
There has been more money spent on cancer research than anything as far as I know.
Treating much less curing cancer is simply *that complex* and *that challenging*. More dollars he implies? What/who do you throw more dollars to? There are only so many researchers. There are only so many avenues that are discovered to explore at any given time. There is only so much we can learn at a time. It takes *years* if not decades of study to prove anything one way or the other. Why we haven't even been able to prove if doing a prostate screening blood tes (PSA) is beneficial or harmful after many years of trying to figure it out!
I am not clear how much of the confusion is based on *misunderstanding* by the media, politicians, public, etc. I am not sure how much of it is grandstanding by scientists themselves who are no less interested in money, politics, power, fame, other agendas than the rest of humanity. don't let the fact that they research cancer fool you into thinking they are all so noble and pure. Quite the contrary. Some of stories I have heard from researchers are not pretty with regards to pettiness.
I am really not sure. But taken on the face of it, Spector's comments seem totally irresponsible.
As for your two ideas:
***Two ideas for government involvement in research: a) offer rewards for results instead of funding for study, or b) consider buying up the best patents and then making 'the cures' available everywhere for free, a public good.****
I think the first is a bad idea because most research ends in failure. *At least* to the tune of 90%. So I think that will stiffle a lot of research. Who wants to pay for something that has unusually high risk?
As to the second, I think it is an *excellent* idea.
Just my two cents.
"
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http://www.reason.com/blog/show/133357.html
Tenth Circuit to Hear Arguments Today on the Science Behind Painkiller Prosecutions
Radley Balko | May 6, 2009, 4:12pm
A couple of weeks ago, Jacob Sullum blogged about a case in Kansas where the government seems to be targeting not only Stephen Schneider, a physician specializing in pain treatment and his wife Linda, but also Siobhan Reynolds, who heads up the pain patient advocacy group the Pain Relief Network.
Reynolds has become a sort of shoestring-budgeted PR machine for doctors under investigation whom she believes are getting railroaded. She educates local media on pain treatment, including the sometimes very high doses of medication needed to treat patients who have built up a tolerance to opiods. Her efforts in the Schneider case have resulted in some refreshingly balanced coverage. And that apparently has Assistant U.S. Attorney Tanya Treadway steaming.
As Sullum noted, last year Treadway tried to impose a gag order on Reynolds. She was denied. Several of Schneider's patients who had spoken out on his behalf say shortly after, federal agents forced their way into their homes, in one case confiscating a letter Schneider had written from prison.
So Treadway is now calling Reynolds the "subject" of a grand jury investigation into possible obstruction of justice. Treadway has asked Reynolds to turn over all of her correspondence with pain patients, attorneys, the Schneiders, and just about everyone else in any way associated with the case. Reynolds is fighting the subpoena, and is now represented by the ACLU.
Last year, Treadway also attempted to bar the Schneiders from obtaining court-appointed counsel, citing their considerable wealth. The problem is that everything the Schneiders own is subject to forfeiture, meaning any attorney who agreed to take their case would do so knowing there would be a pretty good chance he'd never get paid. The government essentially argued that the accused couple should have no counsel in court (unless they could find someone to take the case pro bono), and be barred by law from having anyone defend them in public. When all of that failed, they asked for a change in venue, claiming that patients and Reynolds speaking out for the Schneiders had tainted the jury pool.
Treadway's efforts are particularly egregious given that it has become pretty standard practice for U.S. attorneys to issue press releases and sometimes even call press conferences to announce when a physician has been indicted for over-prescribing painkillers—as they did in the Schneider case. The government can work the media and jury pool all it likes. But when a suspect gets an advocate who knows how to work the media, they first try to shut her up with a gag order, then intimidate her with a grand jury investigation.
But Treadway's aggressiveness may well come back to bite her. Her office originally tried to link the Schneiders' practice to 56 alleged patient overdose deaths. U.S. District Judge Monti Belot balked, and threw out all of the deaths but four. He then sternly warned Treadway not to appeal his decision. Belot also instructed the government not to use inflammatory descriptions like "pill mill" in front of the jury, another common tactic in these cases.
Treadway appealed anyway, delaying the Schneiders' trial by months. The interesting thing is that her appeal allowed the defense to file a cross-appeal that will challenge not only Treadway's attempt to link the Schneiders to the four remaining deaths, but also the government's entire methodology of using "red flags" and questionable links to patient deaths to prosecute pain doctors. Reynolds, who has seen a lot of these cases, says it's the first case she can recall where a federal appeals court will hear arguments on whether the government's system of identifying what it says are drug diverting physicians is scientifically sound enough to be admitted into evidence.
One red flag the government uses, for example, is to look for physicians who simply prescribe a raw number of pills that investigators say is too high, a practice pain advocates say has made doctors afraid of engaging in the high-dose opiate therapy course of chronic pain treatment that's been so effective. Other red flags include doctors who spend what investigators say is too little time with patients to make an accurate diagnosis, a problem pain advocates say has become increasingly common not because more doctors are selling scripts to addicts and drug dealers, but because the few doctors who do still treat chronic pain are overwhelmed with patients whose former doctors have been arrested, stripped of their licenses, or run out of business by investigations.
The Schneiders' brief also argues that the government's practice of linking deaths to opioids is problematic because such deaths often include patients who merely had high concentrations of opiates in their systems and died unexpectedly. Several of the patients who died of heart attacks, for example, weren't checked for signs of heart disease. The heart attack plus a high concentration of opiods in their system was enough for the government to link the opiods to the heart attack.
The government's argument that the Schneiders were causing a disproportionately high number of deaths also rests on comparing the number of clinic patients who died to the population at large, instead of to the number of patients undergoing treatment at a clinic not suspected of any wrongdoing. It isn't all that difficult to see how patients undergoing treatment for chronic pain might have a higher mortality rate than the general population.
The federal government has been using these arguments to prosecute doctors for years, but to this point, there has never been a formal hearing to determine if there's any actual science behind them. Pain specialists are skeptical. The general consensus is that red flags are fine for identifying potentially problematic doctors by, say, a medical board, but they're simply not enough to find a doctor guilty of criminal wrongdoing. Pain specialist and pain organizations have also long decried the arbitrariness with which the red flags and ambiguous links to patient deaths are applied. Today, the U.S. Tenth Circuit Court of Appeals will hear their complaints.
There would be some poetic justice here if Treadway's aggressive tactics in the Schneider case were to result not only in a fatal blow to her own cause, but in the Tenth Circuit becoming the first federal appeals court to call into question the very foundation of how the government builds its case against pain physicians.
Prior Reason coverage of the pain issue here.
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Listen. That sound of silence? That's what's known as the united Republican response to President Barack Obama's drive to socialize health care.
The president has a plan, and he's laid it on the table. The industry groups that once helped Republicans beat HillaryCare are today sitting at that table. Unions are mobilized. A liberal umbrella group, Health Care for American Now, is spending $40 million to get a "public option," a new federal entitlement that would kill off private insurance. Democrats passed a budget blueprint that will allow them to cram through that "public option" with just 51 votes.
Republicans? They're trying to figure out what they think.
Well, not all of them. Earlier this week I ended up in the office of Oklahoma Sen. Tom Coburn, where the doctor was hosting North Carolina Sen. Richard Burr. The duo is, for the second time, crafting a comprehensive reform that would lower costs, cover the uninsured, and put Americans in control of their health care. And while the senators decline to talk GOP politics, their bill raises the multitrillion-dollar question: Will the party have the nerve or sense to coalesce behind some such conservative alternative to the Democratic product?
They'd better, because the days of Republicans winning these battles solely by spooking Americans are over. Phil Gramm, Harry and Louise might have scored with that approach in the 1990s, but the intervening years have brought spiraling costs and public unrest. Americans want a fix. Democrats promise one. The GOP can't tank the public option simply by complaining it will kill private insurance. The party has to finally elucidate how it plans to allow the private market to work.
Not that the senators don't think Republicans need to make clear to the country that the public option is, in Mr. Burr's words, "a fast track to a single-payer system." But they are also operating on the belief that Republicans must go beyond Band-Aid solutions to embrace, as Mr. Coburn puts it, a "complete transformation" of a system that is "structurally" flawed.
Their own bill overhauls the tax code, currently stacked in favor of corporate employees, to provide a tax credit to every American to purchase insurance. It expands health-savings accounts. It creates state health-insurance exchanges, where private insurers compete to cover Americans, including the uninsured. (This is partly modeled on the Medicare drug program, which has provided seniors with choice and held down costs.)
More broadly, it seeks to reorient financial incentives so that the system is no longer focused, as Mr. Coburn puts it, on "sick care," but on preventing the chronic diseases that eat 75% of health expenditures. These incentives would be used to lower costs and discourage insurers from cherry-picking patients. The bill also dives into Medicare and Medicaid reform.
Yet no small number of Senate Republicans are biding their time in Max Baucus land, waiting to see what the Democratic finance chairman produces as a "bipartisan" product. (Read: A bill the president wants.) This crowd has taken to heart Mr. Obama's accusation that they are the party of "no," and think it might be easier to be the party of Baucus, or the party of Baucus-lite, or the party of nothing whatsoever.
The White House is targeting folks like Chuck Grassley, Orrin Hatch and other Senate Republicans who back in 1997 voted for the State Children's Health Insurance Program, which was pitched by Democrats at the time as a modest program to help poor kids. It has, of course, become exactly what Democrats always intended it to be: a ballooning federal entitlement that is today transferring middle-class children from private insurance onto the federal rolls. This might be thought of as a teachable moment. But now Republican "moderates" are all ears for the administration's soothing suggestions that perhaps the "public option" can be "structured" so as to protect private insurance. Uh-huh.
Another group of Republicans are still going 50 rounds over taxes -- namely, whether a deduction isn't a more principled and cleaner way than credits to equalize the tax treatment of insurance. This is a legitimate debate, but one that should've been had 10 years ago when Republicans were in the majority. While the GOP fiddled, Democrats focused the argument on "uninsureds," which has made a tax deduction (which would only cover those who pay taxes) even less politically palatable.
Over in the House time runs on, as the Republican leadership and a health-care working group continue to noodle over platforms, policies, egos and timing. Democrats intend to be debating their bill by June.
As for Messrs. Coburn and Burr, they spent a good half hour with me enthusiastically explaining why a competitive market would improve health, provide control and choice, lower costs, and tackle entitlements. It's a good pitch. If only the rest of America could hear the party make it.
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So Democrats have declared their willingness to use a parliamentary tactic to force a far-reaching restructuring of U.S. health care through Congress on a partisan vote. Imagine if Tom DeLay had tried to do that on, say, Social Security. Would Democrats have rolled over?
On the one hand, President Obama and his party say they're hoping to strike a good-faith compromise on health care. On the other, they're threatening this "budget reconciliation" maneuver to coerce Republicans into rubber-stamping liberal policy. And if the GOP won't oblige, Democrats say they'll add a new multitrillion-dollar liability to the federal fisc anyway, using a process that was designed to cut spending and reduce the deficit.
The political game here is that Democrats want to use this threat to peel off a handful of GOP Senators before the bill comes to the floor in June. That would short-circuit this year's health-care debate before it begins. Their targets include the likes of Chuck Grassley, Orrin Hatch, Susan Collins and Olympia Snowe, all of whom bowed to the Democrats in 2007 on expanding the state children's insurance program (Schip). But those were minor stakes compared to this year's battle, especially over the so-called public option for health insurance.
This new entitlement -- like Medicare but open to all ages and all incomes -- would quickly crowd out private insurance as people gravitated to heavily subsidized policies, eventually leading to a single-payer system. So Democrats are trying to seduce diffident Republicans with a Potemkin compromise. A "soft" public option would limit enrollment only to the uninsured or those employed by small businesses, or include promises that the plan will pay market rates. As recently proposed by Chuck Schumer, it would pay claims entirely with premiums and co-pays. But if the plan can't force down reimbursement rates through brute force, and doesn't get taxpayer dollars, why bother to "compete" with private plans?
The truth is Democrats know that any policy guardrails built this year can be dismantled once the basic public option architecture is in place. The White House strategy is to dilute it just enough to win over credulous Republicans. That is what has always happened with government health programs:
When Medicare was created in 1965, benefits were relatively limited and retirees paid a substantial percentage of the costs of their own care. But the clout of retirees has always led to expanding benefits for seniors while raising taxes on younger workers.
In 1965, Congressional actuaries expected Medicare to cost $3.1 billion by 1970. In 1969, that estimate was revised to $5 billion, and it actually came in at $6.8 billion. That same year, the Senate Finance Committee declared a Medicare cost emergency. In 1979, Jimmy Carter proposed limiting benefits, only to have the bill killed by fellow Democrats. Things have gotten worse since, and Medicare today costs $455 billion and rising.
Medicaid was intended as a last resort for the poor but now covers one-third of all long-term care expenses in the U.S. -- that is, it has become a middle-class subsidy for aging parents of the Baby Boomers. Its annual bill is $227 billion, and so far this fiscal year is rising by 17%.
Schip was pitched a decade ago as a safety net for poor kids, and some Republicans helped sell it as a free-market reform. But Schip is now open to families that earn up to 300% of the poverty level, or $63,081 for a family of four. In New York, you can qualify at 400% of poverty.
Any new federal health plan will inevitably follow the same trajectory, no matter how much Republican Senators might claim they've guaranteed otherwise. The Lewin Group consultants estimate that 119 million people who now have private insurance could potentially be captured by the government under the Obama public option. This is on top of the 90 million already in Medicare or Medicaid. This would guarantee a spending explosion that would over time lift federal outlays as a share of GDP into the upper 20% range or higher. Republicans would spend the rest of their days deciding whether to vote for tax increases to finance this, or stand accused of denying health care to the middle class.
This doesn't mean the die is cast. Democrats also know that durable reforms in America have typically passed with bipartisan majorities. They understand that a national health plan that passes on partisan lines could be pared back as unaffordable or unfair, the way the "catastrophic" health plan for seniors was repealed in 1989.
As New Hampshire Republican Judd Gregg recently told us, Democrats also don't want their swing-state Senators to have to defend such a partisan process in the 2010 election. That's why they're eager for even the veneer of bipartisanship that three or four GOP Senators would provide. And that's why they're willing to threaten a procedural bludgeon to intimidate Republicans to provide that veneer.
This health-care debate isn't like the "stimulus" bill, which was largely about short-term spending and deficits. This one is about whether to turn 17% of the U.S. economy entirely and permanently into the arms of the government. For Republicans, this is about whether they still stand for anything at all.
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Oh really? How?
It sounds like special interest group panic at the thought of BO in charge.
All weird to me:
Obama lauds industry offer to contain health costs
WASHINGTON – President Barack Obama has praised health industry groups for coming forward with an offer to reduce the growth of spending by $2 trillion a year to overhaul the system.
Obama appeared at the White House with an array of industry figures, including union representatives, and called it the occasion "historic."
Industry figures pledged that they would voluntarily slow their rate increases over the next 10 years.
Obama said the step the industry took Monday must be carried out as part of "a broader effort" to change the health care system, keep costs under control and provide health insurance for the some 46 million Americans who do not now have it.
He said, "I will not rest until the dream of health care reform is achieved in the United States of America."
THIS IS A BREAKING NEWS UPDATE. Check back soon for further information. AP's earlier story is below.
WASHINGTON (AP) — Health industry groups are promising to reduce the growth of spending by $2 trillion over 10 years by improving coordination, focusing on efficiency and embracing better technology and regulatory reform.
Hospitals, insurance companies, drug makers and doctors have told President Barack Obama in a letter that they'll voluntarily slow their rate increases in coming years. It's a move that government economists say would create breathing room to help provide health insurance to an estimated 50 million Americans who now do not have it.
The industry letter released Monday said "these and other reforms will make our health care system stronger and more sustainable."
It's a change from the time in the early 1990s when then-President Bill Clinton took on health care reform and industry leaders fought back.
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By SCOTT GOTTLIEB
At the heart of President Barack Obama's health-care plan is an insurance program funded by taxpayers, administered by Washington, and open to everyone. Modeled on Medicare, this "public option" will soon become the single dominant health plan, which is its political purpose. It will restructure the practice of medicine in the process.
Chad Crowe
Republicans and Democrats agree that the government's Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama's plan for a centrally managed government insurance program exacerbates Medicare's problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors' financial incentives.
Like Medicare, the "public option" will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. (Medicare pays doctors 20% to 30% less than private plans, on average.) While the public option is meant for the uninsured, employers will realize it's easier -- and cheaper -- to move employees into the government plan than continue workplace coverage.
The Lewin Group, a health-care policy research and consulting firm, estimates that enrollment in the public option will reach 131 million people if it's open to everyone and pays Medicare rates, as many expect. Fully two-thirds of the privately insured will move out of or lose coverage. As patients shift to a lower-paying government plan, doctors' incomes will decline by as much as 15% to 20% depending on their specialty.
Physician income declines will be accompanied by regulations that will make practicing medicine more costly, creating a double whammy of lower revenue and higher practice costs, especially for primary-care doctors who generally operate busy practices and work on thinner margins. For example, doctors will face expenses to deploy pricey electronic prescribing tools and computerized health records that are mandated under the Obama plan. For most doctors these capital costs won't be fully covered by the subsidies provided by the plan.
Government insurance programs also shift compliance costs directly onto doctors by encumbering them with rules requiring expensive staffing and documentation. It's a way for government health programs like Medicare to control charges. The rules are backed up with threats of arbitrary probes targeting documentation infractions. There will also be disproportionate fines, giving doctors and hospitals reason to overspend on their back offices to avoid reprisals.
The 60% of doctors who are self-employed will be hardest hit. That includes specialists, such as dermatologists and surgeons, who see a lot of private patients. But it also includes tens of thousands of primary-care doctors, the very physicians the Obama administration says need the most help.
Doctors will consolidate into larger practices to spread overhead costs, and they'll cram more patients into tight schedules to make up in volume what's lost in margin. Visits will be shortened and new appointments harder to secure. It already takes on average 18 days to get an initial appointment with an internist, according to the American Medical Association, and as many as 30 days for specialists like obstetricians and neurologists.
Right or wrong, more doctors will close their practices to new patients, especially patients carrying lower paying insurance such as Medicaid. Some doctors will opt out of the system entirely, going "cash only." If too many doctors take this route the government could step in -- as in Canada, for example -- to effectively outlaw private-only medical practice.
These changes are superimposed on a payment system where compensation often bears no connection to clinical outcomes. Medicare provides all the wrong incentives. Its charge-based system pays doctors more for delivering more care, meaning incomes rise as medical problems persist and decline when illness resolves.
So how should we reform our broken health-care system? Rather than redistribute physician income as a way to subsidize an expansion of government control, Mr. Obama should fix the payment system to align incentives with improved care. After years of working on this problem, Medicare has only a few token demonstration programs to show for its efforts. Medicare's failure underscores why an inherently local undertaking like a medical practice is badly managed by a remote and political bureaucracy.
But while Medicare has stumbled with these efforts, private health plans have made notable progress on similar payment reforms. Private plans are more likely to lead payment reform efforts because they have more motivation than Medicare to use pay as a way to achieve better outcomes.
Private plans already pay doctors more than Medicare because they compete to attract higher quality providers into their networks. This gives them every incentive, as well as added leverage, to reward good clinicians while penalizing or excluding bad ones. A recent report by PriceWaterhouse Coopers that examined 10 of the nation's largest commercial health plans found that eight had implemented performance-based pay measures for doctors. All 10 plans are expanding efforts to monitor quality improvement at the provider level.
Among the promising examples of private innovation in health-care delivery: In Pennsylvania, the Geisinger Clinic's "warranty" program, where providers take financial responsibility for the entire episode of care; or the experience of the Blue Cross Blue Shield plans in Pennsylvania, Michigan and Virginia, where doctors are paid more for delivering better outcomes.
There are plenty of alternatives to Mr. Obama's plan that expand coverage to the uninsured, give them the chance to buy private coverage like Congress enjoys, and limit government management over what are inherently personal transactions between doctors and patients.
Rep. Nydia Velazquez (D., N.Y.) has introduced a bipartisan measure, the Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (Choice) Act of 2009, that would make it cheaper and easier for small employers to offer health insurance. Mr. Obama would also get bipartisan compromise on premium support for people priced out of insurance to give them a wider range of choices. This could be modeled after the Medicare drug benefit, which relies on competition between private plans to increase choices and hold down costs. It could be funded, in part, through tax credits targeted to lower-income Americans.
There are also measures available that could fix structural flaws in our delivery system and make coverage more affordable without top-down controls set in Washington. The surest way to intensify flaws in the delivery of health care is to extend a Medicare-like "public option" into more corners of the private market. More government control of doctors and their reimbursement schemes will only create more problems.
Dr. Gottlieb, a former official at the Centers for Medicare and Medicaid Services, is a fellow at the American Enterprise Institute and a practicing internist. He's partner to a firm that invests in health-care companies
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Isn't this the same Gottleib who wrote a biotech newsletter for Gilder?
"Among the promising examples of private innovation in health-care delivery: In Pennsylvania, the Geisinger Clinic's "warranty" program, where providers take financial responsibility for the entire episode of care;"
This I want nothing to do with. Do you want your doctor deciding between ordering more care or saving him/herself money at every turn? This "option" is something that I am reading more and more about and its not a good idea.
"or the experience of the Blue Cross Blue Shield plans in Pennsylvania, Michigan and Virginia, where doctors are paid more for delivering better outcomes." This is too general a statement. If he means better BP control, better diabetes control - mabye.
"There are plenty of alternatives to Mr. Obama's plan that expand coverage to the uninsured, give them the chance to buy private coverage like Congress enjoys, and limit government management over what are inherently personal transactions between doctors and patients."
Why in the part above he points to ways that increase insurance carriers management between doctors and patients. So it winds up being wealthier people can afford to pay off the carriers to not intrude into that relationship.
"Rep. Nydia Velazquez (D., N.Y.) has introduced a bipartisan measure, the Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (Choice) Act of 2009, that would make it cheaper and easier for small employers to offer health insurance. Mr. Obama would also get bipartisan compromise on premium support for people priced out of insurance to give them a wider range of choices. This could be modeled after the Medicare drug benefit, which relies on competition between private plans to increase choices and hold down costs. It could be funded, in part, through tax credits targeted to lower-income Americans."
I don't know. Lower income Americans already pay little in taxes. Gottleib actually thinks this will make it easier and cheaper for Small Business to pay for employee health care? Tax credits to these people? Isn't the tax code already too complicated?
Folks, Gottlieb makes it sound like its so simple and the answers are staring us in the face.
There really is only one answer that is staring me in the face. You want to hold down costs, you want to add tens of millions of people to the roles. Than we have to ration care. There is no other answer. Paying providers based on "outcomes" is often a code word for this folks. It is based on large populations, not an individuals unique medical situation. You will have liberals in DC and Boston, and New Haven deciding what is best and that will become the dictum.
Yes waste can be squeezed out of the system but it will never do enough of what the politians are saying it will without significant rationing of care.
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"and limit government management over what are inherently personal transactions between doctors and patients"
One other thought.
Ther real question is thus should private insurance carriers limit care or government?
That is the "to be or not to be question" at the bottom line.
So who would one rather have limiting or controlling care? Private insurance administrators or government bureaucrats?
Personally I don't have a fondness for either.
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http://www.reason.com/news/show/133439.html
Health Care Corporatism Arrives
Consumers will pay the price if government partners with the health care industry
Ronald Bailey | May 12, 2009
In the past few months, Americans have seen their government essentially seize control of one sector of the economy after another. Federal authorities now tell the automobile, banking, credit card, and insurance industries what products and services to offer, all while hiring and firing industry executives in order to implement government orders.
Health care represents the latest frontier in this drive to centrally manage the American economy. Yesterday, the country's major health care producers, including insurance companies, hospital and physician organizations, pharmaceutical companies, and health care labor unions, promised President Barack Obama they would reduce the growth rate of their future incomes by 1.5 percent over the next ten years. If those cuts actually happened, it would mean that in 2019 health care costs (both government and patient) would be $700 billion lower than current projections, reducing health care spending by $2 trillion over the next ten years.
Why would the industry agree to this preemptive surrender? Because it means the end of competition. Under the proposed agreement, the government would guarantee a certain level of profit for each health care producer. From the industry's point of view, the goal is to get a seat at the table as politicians and government technocrats "reform" health care—which means it will decide who the winners and losers will be.
There's a word for when the government directs the production of goods and services and divides the economic pie: corporatism. The Concise Oxford Dictionary of Politics succinctly defines coporatism as "a system of interest intermediation linking producer interests and the state, in which explicitly recognized interest organizations are incorporated into the policy-making process, both in terms of the negotiation of policy and of securing compliance from their members with the agreed policy."
If the coporativist bargain works out as they plan, both insurers and hospitals expect to profit from the government mandating health insurance coverage for all Americans. Insurers look forward to millions of new customers who will have to buy insurance either individually, through their employers, or through government vouchers. In addition, since the government will set rates and benefits, health insurers won't have to bother with the vexing problem of competition. Of course, state and federal mandates and regulations have already taken us a ways down this road, but corporativist "health care reform" should eliminate any lingering vestiges of consumer choice. For their part, hospitals will have plenty of newly-insured patients to fill their wards and will no longer need to offer uncompensated care to the health care indigent.
As for the pharmaceutical companies, they have experienced rapidly increasing price controls over the years. For example, the Obama administration's 2010 budget lowers what Medicare will pay for drugs from 15 percent below average price to 22 percent below average. In agreeing to the corporativist bargain, those companies hope to get a better deal and to prevent the adoption of cost-benefit tests for the approval of new drugs.
Along similar lines, Medicare and Medicaid price controls have been squeezing doctors' fees for decades. As the federal government either converts private insurance companies into minutely regulated public utilities, creates a rival government health care payment system, or simply adopts a national single-payer (government entitlement) system, doctors rightfully worry that their fees will drop even further as government bureaucrats attempt to slash costs. But with a seat at the health care negotiating table, doctors hope to make the best out of a very bad situation. Interestingly, health care labor unions will probably emerge as the biggest winners in this corporatist arrangement, because they'll be able to extract higher than market wages from politicians dependent on union votes.
In his remarks welcoming the "historic" concessions by the health care industry, President Barack Obama noted that health care "costs are out of control." The goal of corporatist health care reform is to cut those costs. It's a noble aim. The only problem is that the one surefire way to cut costs is completely off the bargaining table: competition. Producers certainly won't reduce costs unless competitors force them to do so. And why would they? Reducing costs means reducing incomes.
Indeed, costs in our current health care system rise faster than the rate of inflation precisely because there is so little competition. The third party payment system, where employers or government agencies pay for insurance, gives consumers few incentives to shop around and bid down prices. On top of that, the federal and state governments have piled so many mandates on insurers that consumers are offered little more than one-size-fits-all policies with similar rates.
It's no secret the current health care system is rife with inefficiencies. But without effective competition, there will be no effective way to discover them and root them out. Competition incentivizes consumers and competitors to eliminate inefficiencies. The notion that wise government regulators can wring them out is beyond laughable.
Consider the recent announcement that a line-by-line review of the federal budget by the Obama administration found just $17 billion in savings from $3.6 trillion budget. That's far less than one half of 1 percent of the total budget. And the constituencies who benefit from that $17 billion are now mobilizing to oppose even those absurdly modest cuts. Just like producers who have no competition, federal agencies have no incentive to improve or to cut their budgets. History shows that the government agencies cut health care "costs" chiefly by imposing price controls on the private sector.
Corporatism represents an ugly deal between governments and producers. The hospitals, doctors, pharmaceutical companies, and health care labor unions hope that the corporativist bargain will guarantee future profits while eliminating competition. Perhaps it will, perhaps it won't. But there's absolutely no question that corporativist health care will increase inefficiencies, stifle innovation, and reduce consumer choice. That's a disastrous deal for the rest of us.
Ronald Bailey is Reason magazine's science correspondent. His book Liberation Biology: The Scientific and Moral Case for the Biotech Revolution is now available from Prometheus Books.
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http://hotair.com/archives/2009/05/12/video-are-the-elderly-cost-effective/
Logan's Run, anyone?
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How ObamaCare Will Affect Your Doctor
Expect longer waits for appointments as physicians get pinched on reimbursements.
By SCOTT GOTTLIEB
At the heart of President Barack Obama's health-care plan is an insurance program funded by taxpayers, administered by Washington, and open to everyone. Modeled on Medicare, this "public option" will soon become the single dominant health plan, which is its political purpose. It will restructure the practice of medicine in the process.
Republicans and Democrats agree that the government's Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama's plan for a centrally managed government insurance program exacerbates Medicare's problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors' financial incentives.
Like Medicare, the "public option" will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. (Medicare pays doctors 20% to 30% less than private plans, on average.) While the public option is meant for the uninsured, employers will realize it's easier -- and cheaper -- to move employees into the government plan than continue workplace coverage.
The Lewin Group, a health-care policy research and consulting firm, estimates that enrollment in the public option will reach 131 million people if it's open to everyone and pays Medicare rates, as many expect. Fully two-thirds of the privately insured will move out of or lose coverage. As patients shift to a lower-paying government plan, doctors' incomes will decline by as much as 15% to 20% depending on their specialty.
Physician income declines will be accompanied by regulations that will make practicing medicine more costly, creating a double whammy of lower revenue and higher practice costs, especially for primary-care doctors who generally operate busy practices and work on thinner margins. For example, doctors will face expenses to deploy pricey electronic prescribing tools and computerized health records that are mandated under the Obama plan. For most doctors these capital costs won't be fully covered by the subsidies provided by the plan.
Government insurance programs also shift compliance costs directly onto doctors by encumbering them with rules requiring expensive staffing and documentation. It's a way for government health programs like Medicare to control charges. The rules are backed up with threats of arbitrary probes targeting documentation infractions. There will also be disproportionate fines, giving doctors and hospitals reason to overspend on their back offices to avoid reprisals.
The 60% of doctors who are self-employed will be hardest hit. That includes specialists, such as dermatologists and surgeons, who see a lot of private patients. But it also includes tens of thousands of primary-care doctors, the very physicians the Obama administration says need the most help.
Doctors will consolidate into larger practices to spread overhead costs, and they'll cram more patients into tight schedules to make up in volume what's lost in margin. Visits will be shortened and new appointments harder to secure. It already takes on average 18 days to get an initial appointment with an internist, according to the American Medical Association, and as many as 30 days for specialists like obstetricians and neurologists.
Right or wrong, more doctors will close their practices to new patients, especially patients carrying lower paying insurance such as Medicaid. Some doctors will opt out of the system entirely, going "cash only." If too many doctors take this route the government could step in -- as in Canada, for example -- to effectively outlaw private-only medical practice.
These changes are superimposed on a payment system where compensation often bears no connection to clinical outcomes. Medicare provides all the wrong incentives. Its charge-based system pays doctors more for delivering more care, meaning incomes rise as medical problems persist and decline when illness resolves.
So how should we reform our broken health-care system? Rather than redistribute physician income as a way to subsidize an expansion of government control, Mr. Obama should fix the payment system to align incentives with improved care. After years of working on this problem, Medicare has only a few token demonstration programs to show for its efforts. Medicare's failure underscores why an inherently local undertaking like a medical practice is badly managed by a remote and political bureaucracy.
But while Medicare has stumbled with these efforts, private health plans have made notable progress on similar payment reforms. Private plans are more likely to lead payment reform efforts because they have more motivation than Medicare to use pay as a way to achieve better outcomes.
Private plans already pay doctors more than Medicare because they compete to attract higher quality providers into their networks. This gives them every incentive, as well as added leverage, to reward good clinicians while penalizing or excluding bad ones. A recent report by PriceWaterhouse Coopers that examined 10 of the nation's largest commercial health plans found that eight had implemented performance-based pay measures for doctors. All 10 plans are expanding efforts to monitor quality improvement at the provider level.
Among the promising examples of private innovation in health-care delivery: In Pennsylvania, the Geisinger Clinic's "warranty" program, where providers take financial responsibility for the entire episode of care; or the experience of the Blue Cross Blue Shield plans in Pennsylvania, Michigan and Virginia, where doctors are paid more for delivering better outcomes.
There are plenty of alternatives to Mr. Obama's plan that expand coverage to the uninsured, give them the chance to buy private coverage like Congress enjoys, and limit government management over what are inherently personal transactions between doctors and patients.
Rep. Nydia Velazquez (D., N.Y.) has introduced a bipartisan measure, the Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (Choice) Act of 2009, that would make it cheaper and easier for small employers to offer health insurance. Mr. Obama would also get bipartisan compromise on premium support for people priced out of insurance to give them a wider range of choices. This could be modeled after the Medicare drug benefit, which relies on competition between private plans to increase choices and hold down costs. It could be funded, in part, through tax credits targeted to lower-income Americans.
There are also measures available that could fix structural flaws in our delivery system and make coverage more affordable without top-down controls set in Washington. The surest way to intensify flaws in the delivery of health care is to extend a Medicare-like "public option" into more corners of the private market. More government control of doctors and their reimbursement schemes will only create more problems.
Dr. Gottlieb, a former official at the Centers for Medicare and Medicaid Services, is a fellow at the American Enterprise Institute and a practicing internist. He's partner to a firm that invests in health-care companies .
http://online.wsj.com/article/SB124208383695408513.html
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I disagree with most of this.
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Ok, I'll beg-- please tell us why :lol:
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May 18, 2009, 4:00 a.m.
Alternative to Obamacare
A new plan, courtesy of Richard Burr and Tom Coburn.
By Duncan Currie
Without much fanfare, Sens. Richard Burr (R., N.C.) and Tom Coburn (R., Okla.) have become leading advocates of market-based health reform. This week they will introduce their alternative to Obamacare. It has no chance of passing in the current Congress.
But it does signify progress for GOP health-care reformers, who recognize that if Republicans are to improve their credibility on this issue, they must offer their own proposals for reducing costs and expanding coverage. Among other things, the Burr-Coburn bill would establish an advanceable, refundable tax credit for health insurance, worth nearly $2,300 for individuals and just over $5,700 for families. This would make coverage more affordable for the self-employed, the unemployed, and those whose employers don’t provide health benefits — all of whom lose out under the current employer-based system. It would also help workers who are between jobs or are dissatisfied with their employer-provided insurance.
Meanwhile, the legislation would make Health Savings Accounts (HSAs) more attractive by removing the tax penalty on health-insurance premium payments made with HSA money, and by raising the ceiling on annual HSA contributions. In addition, the bill would let High Deductible Health Plans — which are paired with HSAs — cover preventative services.
HSAs were first introduced as part of the 2003 Medicare Modernization Act. In January, Diamond Management & Technology Consultants reported that, while the recent expansion of the HSA market had been “slower than expected,” HSAs “have become an integral element of the consumer-directed health-care trend.” According to Diamond, HSAs grew at an average annual rate of almost 70 percent between 2005 and 2008. Diamond reckons that the number of HSA accounts will swell to at least 11 million and perhaps as high as 13 million by 2012, at which point those accounts will have $35 billion–$45 billion in total assets.
Burr and Coburn also want to create State Health Insurance Exchanges that would function as marketplaces for consumers. These exchanges would have safeguards to protect patients with preexisting conditions. States would also have the opportunity to form new health-insurance pools.
The bill does not shy away from entitlement reform. It would subsidize the transfer of certain low-income families from Medicaid to private insurance plans, an important step in ensuring that these Americans have ready access to health care. It would also restructure how federal and state governments share the burdens of Medicaid and Medicare; revamp the Medicare Advantage program; establish Medicare Accountable Care Organizations; and force wealthy Medicare recipients to pay more for the services they receive under Medicare Part B.
Nancy Pelosi has declared that the goal of health-care reform is to achieve “quality, affordable, accessible health care for all Americans.” The Burr-Coburn legislation would not guarantee “universal” insurance coverage, but it would make quality health insurance and care more affordable and accessible. Conservative policy wonks will doubtless find nits to pick in the bill, and it’s unclear how many Republicans will embrace the Burr-Coburn approach. In recent years, says former GOP whip Rep. Roy Blunt, “no more than two dozen” Republican House members have been deeply engaged in the health-care issue. That is now changing, thanks in large part to the challenge of defeating Obamacare.
As the debate unfolds, Americans will be swamped with data and projections. Analysts at McKinsey and Co., the consulting giant, have compiled some especially striking numbers. According to Diana Farrell, Eric Jensen, and Bob Kocher, “the United States spends $650 billion more on health care than might be expected given the country’s wealth and the experience of comparable members of the Organization for Economic Cooperation and Development (OECD).” Outpatient care — which now constitutes 65 percent of all American health care, compared with 43 percent in 1980 — accounts for roughly two-thirds ($436 billion) of that $650 billion. Today, U.S. health-care spending represents about 17 percent of GDP. Based on present trends and historic growth rates, Jean Drouin, Viktor Hediger, and Nicolaus Henke estimate that this figure could rise to 30 percent by 2040 and to more than 50 percent by 2080.
As Farrell, Jensen, and Kocher observe, most Americans do not have “any real value consciousness” when it comes to health-care costs, partly because they are heavily insulated from those costs: “In the United States, the ‘average’ consumer of health care pays for only 12 percent of its total cost directly out of pocket (down from 47 percent in 1960), as well as for 25 percent of health-care insurance premiums, a share that has stayed relatively constant for the last decade.” Meanwhile, much of the information about health-care pricing remains inaccessible. The Burr-Coburn bill would set up a new commission designed to make this information more transparent.
Politicians from both parties have warned that soaring health-care spending is unsustainable and could lead to a fiscal and economic disaster. Just last week, a new report from the Medicare trustees announced that the Medicare Part A trust fund will be “exhausted” by 2017. Total Medicare expenditures are projected to reach of 11.4 percent of GDP in 2083, compared with 3.2 percent of GDP today. “Growth of this magnitude, if realized, would substantially increase the strain on the nation’s workers, Medicare beneficiaries, and the Federal Budget,” the report states.
Of course, Democrats and Republicans disagree sharply about how to rein in health-care spending. But Americans could do their part by making certain lifestyle and dietary changes. Farrell, Jensen, and Kocher reckon that the overall decline in the health of the U.S. population from 2003 to 2005 raised medical costs by between $20 billion and $40 billion. A new study published in the peer-reviewed journal PLoS Medicine calculates that in 2005, smoking was responsible for one-third of all deaths from cancer and high blood pressure was responsible for 45 percent of all deaths from cardiovascular diseases.
The Burr-Coburn legislation notes that roughly 75 percent of American health-care expenditures go toward the treatment of five chronic but “largely preventable” diseases, and it would give states new incentives to lower the rates of these diseases. The bill would boost health-education efforts. It would also allocate $50 million a year to make vaccines more widely available and reward states that meet a vaccine coverage target.
The health-care showdown is bound to be fiercely contentious, given its sweeping implications. As countless pundits have remarked, the political terrain looks much different today than it did in 1993 and 1994, when President Clinton took his ill-fated stab at transforming the U.S. health system. Republicans are fighting an uphill battle. But the Burr-Coburn bill indicates that at least some of them are serious about developing their own version of comprehensive reform.
— Duncan Currie is deputy managing editor of National Review Online.
National Review Online - http://article.nationalreview.com/?q=MjBjYjBmMGVjYzE5MGJiZmM4YjExNTUxZDVhNDk3ODU=
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I really don't have answers and was not playing coy. It is that complicated. Gottlieb it seems to me makes a lot of assumptions.
Some of his solutions are experimental.
Some doctors would do better if more people were covered, not worse.
I guess it depends on the saturation of doctors in the area.
Not many doctors could survive on cash only practices. No one would show up.
Or this one, Medicare's incentives are wrong. Payments increase for those who stay sick.
Well of course. The more one's legal problems persist the more one pays lawyers. The more one's house falls apart the more we spend fixing it.
Were talking chronic progressives diseases. Not problems that can be fixed forever in most instances.
Or pay based on outcomes? Every human being and every situation is unique.
What about this one:
"The Burr-Coburn legislation notes that roughly 75 percent of American health-care expenditures go toward the treatment of five chronic but “largely preventable” diseases, and it would give states new incentives to lower the rates of these diseases. The bill would boost health-education efforts."
So is this implying if we live healthier 75% of health care costs could go away?
What kind of a statement is this?
Has this guy ever heard of aging?
I don't know. The more I read about opinions on what should be done the more I think no one has a clue.
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So is this implying if we live healthier 75% of health care costs could go away?
What kind of a statement is this?
Has this guy ever heard of aging?
I don't know. The more I read about opinions on what should be done the more I think no one has a clue.
You guys sure do have a lot of fat people in the U.S. Im always disturbed by the amount of fat people riding around on scooters when i go to American walmarts. I'll bet that if you got rid of obesity your health care costs would go down dramatically.
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My opinion on this topic causes me to be flamed quite a bit here in Canada, but here it goes. Universal health care should not exist period. taxes should be lowered and people should be forced to buget. But that is not going to happen. The next best thing would see people who are fat, smoke or drink pay a massive sur charge for access to health care. and before you say it, i have an older brother who is a drunk and one 6pak away from needing a liver transplant. My thoughts are, if he cant afford to pay for his selfish life style why should i. Have fun in the next life bro, hope the bar is closed on the other side. Maybe im cold, but i have grown tierd of seeing selfish people cause others to suffer.
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Huss,
Um, every time i've gone to Canada, the population looks pretty.....American.
Aside from Looneys and liters, it's hard to tell i'm in a different country.
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http://www.forbes.com/2007/02/07/worlds-fattest-countries-forbeslife-cx_ls_0208worldfat_2.html
Rank Country %
1. Nauru 94.5
2. Micronesia, Federated States of 91.1
3. Cook Islands 90.9
4. Tonga 90.8
5. Niue 81.7
6. Samoa 80.4
7. Palau 78.4
8. Kuwait 74.2
9. United States 74.1
10. Kiribati 73.6
11. Dominica 71.0
12. Barbados 69.7
13. Argentina 69.4
14. Egypt 69.4
15. Malta 68.7
16. Greece 68.5
17. New Zealand 68.4
18. United Arab Emirates 68.3
19. Mexico 68.1
20. Trinidad and Tobago 67.9
21. Australia 67.4
22. Belarus 66.8
23. Chile 65.3
24. Venezuela (Bolivarian Republic of) 65.2
25. Seychelles 64.6
26. Bahrain 64.1
27. Andorra 63.8
28. United Kingdom 63.8
29. Saudi Arabia 63.5
30. Monaco 62.4
31. Bolivia 62.2
32. San Marino 62.1
33. Guatemala 61.2
34. Mongolia 61.2
35. Canada 61.1
36. Qatar 61.0
37. Uruguay 60.9
38. Jordan 60.5
39. Bahamas 60.4
40. Iceland 60.4
41. Nicaragua 60.4
42. Cuba 60.1
43. Germany 60.1
44. Brunei Darussalam 59.8
45. Slovenia 59.8
46. Peru 59.6
47. Vanuatu 59.6
48. Finland 58.7
49. Jamaica 57.4
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"You guys sure do have a lot of fat people in the U.S."
Reminds me of a very international after dinner conversation in Bern, Switzerland. We were riffing on national stereotypes. I asked what the stereotype was of Americans. "Fat people in shorts with white socks" came the answer. Ouch!!!
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How Washington Rations
ObamaCare omen: a case study in 'cost-control.'
Try to follow this logic: Last week the Medicare trustees reported that the program has an "unfunded liability" of nearly $38 trillion -- which is the amount of benefits promised but not covered by taxes over the next 75 years. So Democrats have decided that the way to close this gap is to create a new "universal" health insurance entitlement for the middle class.
Such thinking may be a non sequitur, but it will have drastic effects on the health care of all Americans -- and as it happens, this future is playing out in miniature in Medicare right now. Desperate to prevent medical costs from engulfing the federal budget, the program's central planners decided last week to deny payment for a new version of one of life's most unpleasant routine procedures, the colonoscopy. This is a preview of how health care will be rationed when Democrats get their way.
At issue are "virtual colonoscopies," or CT scans of the abdomen. Colon cancer is the second leading cause of U.S. cancer death but one of the most preventable. Found early, the cure rate is 93%, but only 8% at later stages. Virtual colonoscopies are likely to boost screenings because they are quicker, more comfortable and significantly cheaper than the standard "optical" procedure, which involves anesthesia and threading an endoscope through the lower intestine.
Virtual colonoscopies are endorsed by the American Cancer Society and covered by a growing number of private insurers including Cigna and UnitedHealthcare. The problem for Medicare is that if cancerous lesions are found using a scan, then patients must follow up with a traditional colonoscopy anyway. Costs would be lower if everyone simply took the invasive route, where doctors can remove polyps on the spot. As Medicare noted in its ruling, "If there is a relatively high referral rate [for traditional colonoscopy], the utility of an intermediate test such as CT colonography is limited." In other words, duplication would be too pricey.
This is precisely the sort of complexity that the Democrats would prefer to ignore as they try to restructure health care. Led by budget chief Peter Orszag, the White House believes that comparative effectiveness research, which examines clinical evidence to determine what "works best," will let them cut wasteful or ineffective treatments and thus contain health spending.
The problem is that what "works best" isn't the same for everyone. While not painless or risk free, virtual colonoscopy might be better for some patients -- especially among seniors who are infirm or because the presence of other diseases puts them at risk for complications. Ideally doctors would decide with their patients. But Medicare instead made the hard-and-fast choice that it was cheaper to cut it off for all beneficiaries. If some patients are worse off, well, too bad.
Medicare is already the country's largest purchaser of health care. Private carriers generally adopt its rates and policies, and the virtual colonoscopy decision may run this technology out of the marketplace. Now multiply that by the new "public option" that Democrats favor, which would transfer millions of patients to a new insurance program managed by the federal government. Washington's utilitarian judgments about costs would reshape the practice of medicine.
Initially, the open-ended style of American care will barely be touched, if only for political self-preservation. Health planners will adjust at the margins, as with virtual colonoscopy. But scarcity forces choices. As the Medicare trustees note in their report, the tax increases necessary to fund merely the current benefit schedule for the elderly would cripple the economy. The far more expensive public option will not turn into a pumpkin when cost savings do not materialize. At that point, government will clamp down with price controls in the form of lines and rock-bottom reimbursement rates.
Mr. Orszag says that a federal health board will make these Solomonic decisions, which is only true until the lobbies get to Congress and the White House. With virtual colonoscopy, radiologists and gastroenterologists are feuding over which group should get paid for colon cancer screening. Companies like General Electric and Seimens that make CT technology are pressuring Medicare administrators too. More than 50 Congressmen are demanding that the decision be overturned.
All this is merely a preview of the life-and-death decisions that will be determined by politics once government finances substantially more health care than the 46% it already does. Anyone who buys Democratic claims about "choice" and "affordability" will be in for a very rude awakening.
http://online.wsj.com/article/SB124268737705832167.html
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"Nearly everyone wants to limit the costs of rising medical care."
"Nearly everyone wants the newest and best technology"
Unfortunately, these two statements are not congruous. Choices, difficult choices must be made.
Of course, "Companies like General Electric and Seimens that make CT technology are pressuring Medicare administrators too."
Whether needed or not, that's how GE makes it profits and why it pays it's lobbyists.
Yet the National Cancer Institute says;
"While there is always room for technological improvements, we need to do a better job of using the current screening technologies. Because, despite their limitations, they have been proven effective in reducing the burden of disease."
Where do you draw the line at costs?
Is a virtual colonoscopy more patient friendly? Sure. In most cases does it produce any better results? No. Does it cost more? A lot more...
So someone needs to make the tough choices. Individuals seem to want the newest and best, regardless if the results are the same and regardless of the cost
since they don't individually pay for it. The "insurance company pays" or "Medicare pays" yet in reality we all pay.
And new technology will continue to be pushed by corporations. Do you really think they have our best interest at heart?
IF we go to a National Health Care Plan maybe it should offer basic care WITHOUT all the bells and whistles? Sure you have to wait. And maybe you don't get
the latest technology. Or the newest wonder/experimental drugs. But as a nation, at least everyone would have basic coverage.
And perhaps there is room for supplemental coverage? My father has Medicare, but he pays a fortune (money well spent) for his excellent supplemental care. But it is
a choice on the table.
My point is that we cannot have our cake (newest technology) and eat it (affordability) too. One/We must choose.
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JDN - that's it in a nutshell. Speaking of vitual colonoscopy the imaging lobbyists who were set to make a bundle doing this test were of course outraged it was not approved for reimbursement by Medicare. Of course it is all in the goal of better patient care.
And of course the gastroenterologist who may (or may not) lose out were delighted in the name of patient care that it was not approved. Who does one believe?
Bottom line your right. We either ration care, or we don't provide care to all, or/and we go broke.
And who does Gottlieb work for now?
"Medicare Shoots Down Virtual Colonoscopy Reimbursement (GE, SI)
Posted: May 12, 2009 at 4:26 pm
Today was a big day for the world of colonoscopies and the battle in detecting colon cancer and polyps. The Center for Medicare and Medicaid Services issued a final decision that Medicare would not cover the reimbursement for virtual colonoscopies. This is a blow for the medical imaging sector, particularly for leaders such as General Electric Co. (NYSE: GE) and Siemens AG (NYSE: SI). This is also a blow in the battle for detecting of polyps or early stages of colon cancer.
The CMS noted in its memo, “The evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test…. CT colonography for colorectal cancer screening remains noncovered.”
Whether you have to get a colonoscopy done the old fashioned way or virtually it still requires the material you have to consume to clear out the bowels. The difference of a virtual or traditional method is rather simple. The CT machine scan is a relatively non-invasive procedure besides an ingestion of a chemical marker and requires no real sedation followed by a CT/MRI scan. For the traditional exam, sedation is required and a fiber optic camera on a flexible tube is inserted through the anus and snaked up all the way through your intestine. Guess which one is more desirable if you are the patient.
Detecting colon cancer while it is a mere polyp or in the very early stages is far better from a cost-basis, a quality of life basis, and on the basis of what is a better use of the medical system. The belief is that there would be many more colonoscopies conducted if this was approved in a virtual manner, and in theory much fewer colon cancer cases. The downside to the virtual colonoscopy is that if polyps (or worse are detected, then a traditional colonoscopy and then whatever procedure would be required anyhow.
This is perhaps one of the first tests of what may or may not be coming down the pipe with the new healthcare system, yet this decision may be independent of any of the comparisons between the healthcare system of today versus the system of tomorrow. Some form of universal healthcare is much more likely than ever. That will be a welcome wagon for the army of uninsured or underinsured Americans. For the rest of us we all really want to know what the new system will really be, and what sort of service we can expect.
When it comes to old fashioned colonoscopies versus the virtual colonoscopies, the CMS just said “Up Yours!”… Quite literally in this case."
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Don't have an issue with any of the economic realities being mentioned, though I do have one with some of the pronouns being bandied. Who is this "we" that's gonna determine how health care is rationed? The current debate employs so much smoke and so many mirrors that informed constituencies are hard to find in the first place, and then many of the mechanisms being discussed for use in "solving" health care finance issues are regulatory in nature and hence make it hard to identify lawmakers who can be held accountable when a program fails. There is so much obfuscation employed on all sides of the issue and so many of the mechanisms lay so far beyond the control of most voters that I have a hard time accepting that "we" are much of an actor in this passion play.
My read on the current single payer effort is that it will paint the sunniest face on they type of care it seeks to shill, make all sorts of promises, suck folks into it's system, and then at some point declare "golly gee willikers, we have unfunded mandates that dwarf the $35 trillion deficit projected for Medicare and hence have to ration care." Never heard of a system that adopted single payer going back to a more market based solution--once you get folks suckling at the teat there are too many "wheet wheets" to move 'em off--so a one size fits all single payer system becomes what you're stuck with.
Make all the legiscreatures and their staffs adopt the system they seek to peddle for four years first. If it works then they can try to make the sale.
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CCP and all , thanks for health care info. One piece said the virtual was cheaper (assuming no follow up invasion is needed) and I think another said virtual costs more (maybe because of the follow up). I will be getting quotes soon. I have only major medical coverage so I will be the ever so rare, cost-conscious patient. We have family history of colon cancer - I should have done this starting at age 45. The photo sounds a lot better to me than the snake. Besides the cost, I think I have snake through anus phobia. Now at 52 and change I should be a fine candidate for a free one at a medical university (wiulling to travel) - any suggestions?
As a polical matter, liberals contend that health care is much better in western Europe than the US but then they measure it in percentage insured. I would measure heath care systems by survival rates of the worst ailments we are most likely to face. For men here that include prostate and colon cancer (women - breast concer etc.)and I think survival rates are much higher in the US.(?) http://coloncancer.about.com/od/stagesandsurvivalrate1/a/CCSurvivalCount.htm
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Doug, on the medical side (CCP) can do a much better job, but it is my understanding that IF (God forbid) there is a problem or question, and a biopsy is needed,
the regular (up your....) colonoscopy will still need to be done; you pay double.
As for health care being better or worse, I think one needs to look at overall mortality, not just mortality from a select few diseases. And in doing so you will find that
we lag many industrialized countries. By the way, I too have a High Deductible Major Medical policy.
Regarding your colon cancer example, yes, our High Technology (think high cost) can often assure a higher mortality rate after cancer has been discovered, BUT as your own article
points out, "Colon cancer survival rates vary throughout the world. Quality of care is one reason, but another is colon cancer screening programs. In general, the earlier colon
cancer is detected, the easier it is to treat." Japan (national health care) at much less cost than the USA has an equal or better colon cancer survival rate
than we do. (again see your posted article). And they definitely do not have any better technology or talent.
So if people simply get a basic colonoscopy, catch it early, the easier it is to treat. Yet, as you pointed out, cost is a very real issue. Given you family history, no doubt whatever the cost
you should proceed with the test, but would you pay the money without the family history to wake you up? I question that... Yet, if a basic colonoscopy was "free" (no out of pocket)
I bet you might consider doing so and therefore hopefully catch the disease in the early stages.
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Please keep in mind that the comparative survival rate data can lead to a lot of apple and oranges conflation. Many industrial nations have far more stringent immigration/citizenry requirements that skew things. If you do your comparisons across similar demographics all of a sudden many of the gaps shorten significantly. Compare immigrant communities, or blacks living at the poverty line across countries and you'll find those numbers similar, though the US has a greater percentage of the population that fits those categories and hence its overall survival rate data skews that direction.
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Gee, and I thought France and England were going to $%^& due to their liberal immigration policy and
growing ghetto areas? :-)
As for Japan (little immigration) they have an aging population which translates into higher morbidity yet
they still have a better mortality rate.
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Gee back at you, how 'bout Sweden, Norway, Holland, Switzerland, Finland, and so on? I'm sure there are many others, but I don't follow this issue as part any health debate, but I do as part of the firearm rights debate where, what do you know, rates of firearms crime stays pretty consistent across ethnic groups in various contiguous countries, which suggest a strong cultural component is involved.
But hey, since you asked the question how 'bout you do some follow up research? The UK already cooks its books where its crime figures are concerned, do they do the same with health outcomes? Are non-citizen immigrants counted among the data? Much of the recent car torching and rioting in France was caused by non-citizen immigrants annoyed about economic opportunities, or the lack thereof, in France; are they counted as citizens in health stats? If not, what would that do to the curve?
BTW, I deal all day with folks who think facile deconstruction of a point is the acme of argumentation, and regularly then hand them their fannies. Doubt you're aware you consistently employ the same tactic and so would like to suggest you add a couple more tools to your rhetorical tool box.
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What does firearm rights have to do with health care? :?
By the way, since you brought it up, I am in favor of firearm rights for all adult individuals.
And I didn't ask any health care question... So no interest in doing additional research.
As for my tool box, it's fine thank you, as is my fanny. You might check yours though.
It might be kind of sore lately...
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Now, now, gentlemen, lets stick to the merits of the subject matter at hand , , ,
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Whoa, parallel universe alert. . . .
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:?
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Sorry for the confusion, it's just on a regular basis when I read one of JDN's responses I feel like I've encountered some sort of rift in space and time.
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Not that I ever read them, but a HS friend who read the Cliff Notes version told me that in Plato's writings of the conversations with Socrates that there was a member of the group who asked questions seen by most of the rest of the group as foolish. I wonder how Socrates dealt with his questions?
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According to Plato's Apology, Socrates' life was that of being the "gadfly" of Athens.
Sometimes I too feel like I am the Gadfly of this forum. :-)
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Would suggesting "hemlock" be too coarse a response?
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Socrates is seen as a wise and benevolent father figure, martyred for his intellectual beliefs.
After Socrates' death opinion in Athens turned against his accusers.
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Ummm , , , JDN , , , I was thinking of you less in the role of Socrates and more in the role of "a member of the group who asked questions seen by most of the rest of the group as foolish" :lol:
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Ummmm Marc, I somehow got that... I just chose to ignore it :-)
My final post was to BbyG "Hemlock" comment. "martyred for his intellectual beliefs". and, after his death,
the Forum turned against his accusers. :-)
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Now all we gotta see is an intellectual belief, and, with 3 pairs of socks, the shoe might fit. :evil:
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You're like a dog with an old bone; you just can't quit.
BbyG, I'm sorry if your fanny is STILL sore....
But really, you really should take Crafty's advice and "move on"...
And maybe move back to topic...
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Pot calls kettle black, film at 11.
Get a million JDNs banging on a million keyboards and not so much as a zit would be raised on my butt.
Feel free to move on when the mood strikes you. Until then, if an inanity hammer is all you got, I guess that's all you'll swing.
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:-o :-D
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GENTLEMEN:
Let us return to the merits of the subject at hand please!!!
THANK YOU!
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Summary of new CATO report examining likely aspects of BHO's health care. Entire report, a very long read, available here:
http://www.cato.org/pubs/pas/pa638.pdf
May 21, 2009
Policy Analysis no. 638
Obamacare to Come: Seven Bad Ideas for Health Care Reform
by Michael D. Tanner
President Obama has made it clear that reforming the American health care system will be one of his top priorities. In response, congressional leaders have promised to introduce legislation by this summer, and they hope for an initial vote in the Senate before the Labor Day recess.
While the Obama administration has not, and does not seem likely to, put forward a specific reform plan, it is possible to discern the key components of any plan likely to emerge from Congress:
At a time of rising unemployment, the government would raise the cost of hiring workers by requiring employers to provide health insurance to their workers or pay a fee (tax) to subsidize government coverage.
Every American would be required to buy an insurance policy that meets certain government requirements. Even individuals who are currently insured — and happy with their insurance — will have to switch to insurance that meets the government's definition of "acceptable insurance."
A government-run plan similar to Medicare would be set up in competition with private insurance, with people able to choose either private insurance or the taxpayer-subsidized public plan. Subsidies and cost-shifting would encourage Americans to shift to the government plan.
The government would undertake comparative-effectiveness research and cost-effectiveness research, and use the results of that research to impose practice guidelines on providers — initially, in government programs such as Medicare and Medicaid, but possibly eventually extending such rationing to private insurance plans.
Michael D. Tanner is a senior fellow with the Cato Institute and coauthor of Healthy Competition: What's Holding Back Health Care and How to Free It (2007).
Private insurance would face a host of new regulations, including a requirement to insure all applicants and a prohibition on pricing premiums on the basis of risk.
Subsidies would be available to help middle-income people purchase insurance, while government programs such as Medicare and Medicaid would be expanded.
Finally, the government would subsidize and manage the development of a national system of electronic medical records.
Taken individually, each of these proposals would be a bad idea. Taken collectively, they would dramatically transform the American health care system in a way that would harm taxpayers, health care providers, and — most importantly — the quality and range of care given to patients.
http://www.cato.org/pub_display.php?pub_id=10218
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"Private insurance would face a host of new regulations, including a requirement to insure all applicants and a prohibition on pricing premiums on the basis of risk."
Personally I think it is necessary that insurance be available to all regardless of pre-existing conditions. In reality many of these people go onto disability because that is the only way they can get medical care. Or those who don't qualify wind up using more care down the road.
I do think that providing insurance to some should also come with the requirement that are partners in keeing costs down. They follow doctors suggestions, at least make efforts to quit smoking, lose weight, take their medicines. So I am not as sure that I agree with prohibition of pricing based on risk though - perhaps based on patient contribution to their own health and well being perhaps.
"Subsidies would be available to help middle-income people purchase insurance, while government programs such as Medicare and Medicaid would be expanded."
I dont know enough to commment on the merits of this. But we all know that some of us will be bearing the extra burden of paying for these things. Why is that fair?
"Finally, the government would subsidize and manage the development of a national system of electronic medical records."
There are so many vendors with so many products not all of which are compatible. One size or style or brand is best for all medical practice types or goals.
I am not even sure how cost/benefit ratios work out for these. But it is as inevitable as the internet is in general.
I am not electronic in my office. I don't mind the government helping us subsidize this if it must be done.
But like anything the gov grants us it comes with strings attached. Not least of which has been mentioned - gathering, monitoring, surveillancing health records for multiple imaginable purposes including but limited to control over delivery of care, outcomes data, rationing, delivery and following the adherence to "guidelines" ( to be developed by the big liberals in medical care at Yale and Harvard - many who are PhDs - not MDs), controlling and redirecting payments to providers based on their behavior as deemed appropriate not by them or their patients but by the bamas of the world.
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One size or style or brand is best for all medical practice types or goals.
Correction: "is NOT best"
"Not least of which has been mentioned - gathering, monitoring, surveillancing health records for multiple imaginable purposes including but limited to control over
Correction: "but NOT limited to"
Sorry. Sometimes I post without re reading and checking the language like I should.
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The newest WHO report was just issued.
L.A. Times
Japan tops world life expectancies with 83 years
Girls born in Japan today are likely to live until 2095, some with a good chance of seeing the dawn of the next century thanks to having the world's longest life expectancy, the World Health Organization reported from Geneva on Thursday.
The tiny nation of San Marino boasts the longest average life span for men,
at 81 years. The United States lags behind the top nations, with an average life expectancy of 78 for the two sexes combined.
Men in Sierra Leone fare the worst worldwide, living on average just 39 years.
Here are the nations at the top of life expectancies for the two sexes combined as of 2007, according to WHO:
Longest life expectancies
Japan: 83
Australia: 82
Iceland: 82
Italy: 82
San Marino: 82
Switzerland: 82
Andorra: 81
Canada: 81
France: 81
Israel: 81
Monaco: 81
New Zealand: 81
Norway: 81
Singapore: 81
Spain: 81
Sweden: 81
__________
Embarrassingly; the list is too long to show the order where America finally ranks.
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Hey to answer CCp's qustion from the other day
So who would one rather have limiting or controlling care? Private insurance administrators or government bureaucrats?
I would rather have private insurance . Do to the fact that a if a private provider is awful the negative effects are limited and eventually the provider goes out of buisness.While in the govt version the negative effects are wide spread and never goes out of buisness or improves it just costs more.
Boyo
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Not sure where the WHO data JDN cites came from as the CDC, that collects mortality data in the US, only had 2004-05 data available. As that may be, and as mentioned previously, there is a strong cultural component to these sorts of stats, a component that culturally homogenous countries with restrictive immigration policies (such as Japan) don't have to contend with.
Life Expectancy at Birth by Race and Sex, 1930–2005
Learn the life expectancy (measured at birth) of American men and women, differentiated by race. For the 2005, the latest data available, the life expectancy for men of all races is 75.2 years and 80.4 years for women.
All races White Black
Year Both sexes Male Female Both sexes Male Female Both sexes Male Female
2005 77.8 75.2 80.4 78.3 75.7 80.8 73.2 69.5 76.5
20041 77.8 75.2 80.4 78.3 75.7 80.8 73.1 69.8 76.3
2003 77.5 74.8 80.1 78.0 75.3 80.5 72.7 69.0 76.1
2002 77.3 74.5 79.9 77.7 75.1 80.3 72.3 68.8 75.6
2001 77.2 74.4 79.8 77.7 75.0 80.2 72.2 68.6 75.5
2000 77.0 74.3 79.7 77.6 74.9 80.1 71.9 68.3 75.2
1999 76.7 73.9 79.4 77.3 74.6 79.9 71.4 67.8 74.7
1998 76.7 73.8 79.5 77.3 74.5 80.0 71.3 67.6 74.8
1997 76.5 73.6 79.4 77.2 74.3 79.9 71.1 67.2 74.7
1996 76.1 73.1 79.1 76.8 73.9 79.7 70.2 66.1 74.2
1995 75.8 72.5 78.9 76.5 73.4 79.6 69.6 65.2 73.9
1994 75.7 72.4 79.0 76.5 73.3 79.6 69.5 64.9 73.9
1993 75.5 72.2 78.8 76.3 73.1 79.5 69.2 64.6 73.7
1992 75.8 72.3 79.1 76.5 73.2 79.8 69.6 65.0 73.9
1991 75.5 72.0 78.9 76.3 72.9 79.6 69.3 64.6 73.8
1990 75.4 71.8 78.8 76.1 72.7 79.4 69.1 64.5 73.6
1989 75.1 71.7 78.5 75.9 72.5 79.2 68.8 64.3 73.3
1988 74.9 71.4 78.3 75.6 72.2 78.9 68.9 64.4 73.2
1987 74.9 71.4 78.3 75.6 72.1 78.9 69.1 64.7 73.4
1986 74.7 71.2 78.2 75.4 71.9 78.8 69.1 64.8 73.4
1985 74.7 71.1 78.2 75.3 71.8 78.7 69.3 65.0 73.4
1984 74.7 71.1 78.2 75.3 71.8 78.7 69.5 65.3 73.6
1983 74.6 71.0 78.1 75.2 71.6 78.7 69.4 65.2 73.5
1982 74.5 70.8 78.1 75.1 71.5 78.7 69.4 65.1 73.6
1981 74.1 70.4 77.8 74.8 71.1 78.4 68.9 64.5 73.2
1980 73.7 70.0 77.4 74.4 70.7 78.1 68.1 63.8 72.5
1979 73.9 70.0 77.8 74.6 70.8 78.4 68.5 64.0 72.9
1978 73.5 69.6 77.3 74.1 70.4 78.0 68.1 63.7 72.4
1977 73.3 69.5 77.2 74.0 70.2 77.9 67.7 63.4 72.0
1976 72.9 69.1 76.8 73.6 69.9 77.5 67.2 62.9 71.6
1975 72.6 68.8 76.6 73.4 69.5 77.3 66.8 62.4 71.3
1974 72.0 68.2 75.9 72.8 69.0 76.7 66.0 61.7 70.3
1973 71.4 67.6 75.3 72.2 68.5 76.1 65.0 60.9 69.3
19722 71.2 67.4 75.1 72.0 68.3 75.9 64.7 60.4 69.1
1971 71.1 67.4 75.0 72.0 68.3 75.8 64.6 60.5 68.9
1970 70.8 67.1 74.7 71.7 68.0 75.6 64.1 60.0 68.3
1960 69.7 66.6 73.1 70.6 67.4 74.1 — — —
1950 68.2 65.6 71.1 69.1 66.5 72.2 — — —
1940 62.9 60.8 65.2 64.2 62.1 66.6 — — —
1935 61.7 59.9 63.9 62.9 61.0 65.0 53.1 51.1 55.2
1930 59.7 58.1 61.6 61.4 59.7 63.5 48.1 47.3 49.2
(—) Data not available.
1. Preliminary data.
2. Deaths based on a 50% sample.
Source: National Center for Health Statistics, National Vital Statistics Reports, vol. 54, no. 19, June 28, 2006. Web:www.cdc.gov/nchs.
http://www.infoplease.com/ipa/A0005148.html
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Not surprising that blacks do not live as long as whites. Being poor, uneducated, lack of adequate social welfare programs,
availability of top physicians and care, ability to pay, etc. all have a negative influence on longevity.
Japan is homogenous. Welfare systems are in place to protect the poor and in general Japan's National Health System seems
to offer good quality care from cradle to grave to all individuals.
__________
Social factors have bigger effect on longevity than genes
Posted in Longevity and Age Management, Demographics, Longevity on Tue September 02, 2008
A three-year-long analysis of the “social determinants†of health by the World Health Organization (WHO) has led them to the conclusion that social factors - not genetics - are to blame for the huge variations in ill health and life expectancy seen around the world, a report concludes.
The report, which was complied by a panel of experts forming the WHO’s Commission on the Social Determinants of Health, found that a girl born in Japan is, on average, likely to live for 42 years longer than a girl born in the African country of Lesotho. Inequities in life expectancy and morbidity between countries have been reported for many years, however this report is the first to highlight the large variations in life expectancy that also occur within different regions of countries and suburbs of cities throught the world. For example, a boy living in Calton, a deprived suburb of the Scottish city of Glasgow will, on average, live for 28 years less than a boy born in Lenzie, an affluent suburb a couple of miles away.
Â
In short, the report showed that poor socioeconomic circumstances equated to poor health. Furthermore, the differences in morbidity and longevity were so significant that genetics were deemed insignificant in comparison. It also revealed that wealth alone does not determine the health of a nation. Several countries, including: Cuba, Costa Rica, China, and Sri Lanka, have managed to achieve good levels of health despite their relatively low national incomes. Â
The authors wrote: “[The] toxic combination of bad policies, economics, and politics is, in large measure responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible." To combat the problem of health inequity, they recommend that governments follow the shining example of Nordic countries that have introduced policies which encourage equality of benefits and service, full employment, gender equity, and low levels of social exclusion.
Closing the gap in a generation: Health equity through action on the social determinants of health. Commission on Social Determinants of Health. World Health Organization. Full report from WHO website.
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Precisely, which is why single data point comparative studies are pretty useless when it comes time to address a nuanced issue. Presented as a single item the question appears to be "what do Americans need to do to live as long as the Japanese, et al?" The more nuanced data makes the question become: "how do we inspire cultural changes that will increase longevity in these national subset?" In view of the well documented failure of government to address these sorts of issues in these same subsets where, say, education, is concerned, one would hope suggestions are forwarded that don't rely on more of the same.
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As the article pointed out and I am glad you agree;
"To combat the problem of health inequity, they recommend that governments follow the shining example of Nordic countries that have introduced policies which encourage equality of benefits and service, full employment, gender equity, and low levels of social exclusion.
As a method of encouraging equality of benefits, it should be noted that most the the industrialized highly rated countries have some form of a national health insurance plan.
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Well, didn't Sweden just let Saab go under? :lol:
Also, see the Islam in Europe thread, it appears there is an argument to be made that Sweden, perhaps in part due to the burdens of its nanny state, seems to lack the will to defend itself from Lebanonization.
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I actually do not agree with WHO's socialist agenda and think that so many other throw money at the problem solutions have failed so spectacularly that I'm baffled when recapitulation is suggested. I note further there are black American sub-cultures like the Gulla and the Geechee that embrace a different set of cultural ethics which appear to be related to a lower incidence of social pathologies found in other black populations. Alas, when members of those sub-cultures like Clarence Thomas ascend, one side of the aisle demonizes him and hangs "Uncle Tom" appellations while tapping their foot along to rap, hip hop, and gangster culture.
Egalitarian solutions failed in the Soviet Union, failed in Mao's China, fail in school districts throughout this nation, to name a few. How 'bout if before we start throwing money we don't have at solutions like the ones that haven't worked before we instead reward responsible behavior and chastise irresponsible? Or does that suggestion make me too culturally insensitive to be suffered further?
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Well, didn't Sweden just let Saab go under? :lol:
That is bad?
I wish we had let Chrysler and GM as well as a lot more banks go under.
At least Sweden showed some common sense.
And... at least Sweden has a health system, a social support system, and test scores among high school students far superior to the US
that enables the workers to get back on their feet faster.
However, the subject at hand is mortality; they simply live longer...
Maybe (?) because they, like most of the countries high on the list have a national health care plan?
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Well, didn't Sweden just let Saab go under? :lol:
However, the subject at hand is mortality; they simply live longer...
Maybe (?) because they, like most of the countries high on the list have a national health care plan?
**Yeah, generations of government healthcare has done wonders for American Indians. Let's give everyone this level of care!**
http://info.ihs.gov/Disparities.asp
INDIAN HEALTH DISPARITIES
Members of 562 federally recognized American Indian and Alaska Native Tribes and their descendants are eligible for services provided by the Indian Health Service (IHS). The IHS is an agency within the Department of Health and Human Services that provides a comprehensive health service delivery system for approximately 1.9 million of the nation’s estimated 3.3 million American Indians and Alaska Natives (American Indian and Alaska Native alone; bridged 2000 census ) . Its annual appropriation is approximately $3.35 billion. The IHS strives for maximum Tribal involvement in meeting the health needs of its service population, who live mainly on or near reservations and in rural communities in 35 states, mostly in the western United States and Alaska.
Approximately 57% of American Indians and Alaska Natives living in the United States rely on the IHS to provide access to health care services in 46 hospitals and over 600 other facilities operated by the IHS, Tribes, and Alaska Native corporations, or purchased from private providers.
The American Indian and Alaska Native people have long experienced lower health status when compared with other Americans. Lower life expectancy and the disproportionate disease burden exist perhaps because of inadequate education, disproportionate poverty, discrimination in the delivery of health services, and cultural differences. These are broad quality of life issues rooted in economic adversity and poor social conditions.
American Indians and Alaska Natives born today have a life expectancy that is 4.6 years less than the U.S. all races population (72.3 years to 76.9 years, respectively; 1999-2001 rates), and American Indian and Alaska Native infants die at a rate of nearly 12 per every 1,000 live births, as compared to 7 per 1,000 for the U.S. all races population (2002-2004 rates).
American Indians and Alaska Natives die at higher rates than other Americans from tuberculosis (750% higher), alcoholism (550% higher), diabetes (190% higher), unintentional injuries (150% higher), homicide (100% higher) and suicide (70% higher). (Rates adjusted for misreporting of Indian race on state death certificates; 2002-2004 rates. )
Given the higher health status enjoyed by most Americans, the lingering health disparities of American Indians and Alaska Natives are troubling. In trying to account for the disparities, health care experts, policymakers, and Tribal Leaders are looking at many factors that impact upon the health of Indian people, including the adequacy of funding for the Indian health care delivery system.
The American Indian and Alaska Native population has several characteristics different from the U.S. all races population that would impact upon assessing the cost for providing similar health services enjoyed by most Americans. The Indian population is younger, because of higher mortality, than the U.S. all races. The IHS service population is predominately rural, which should suggest lower costs; however, the disproportionate incidence of disease and medical conditions experienced by the Indian population raises the costs, which almost obliterates the lower cost offsets.
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Don't know about American Indians (no disrespect meant). But ask BbyG; he seems to be the self appointed expert on statistical subsets and sub cultures.
Perhaps a better and much broader example of a government sponsored plan covering tens of millions of Americans is Medicare; most older people I know including my parents are quite happy with the
system.
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**Yeah, we can't afford medicare now. This program is already a looming disaster. So let's spend more?**
Unsustainable Medicare
Fixes for the program's funding will be needed soon.
Saturday, May 5, 2007; Page A16
THE RELEASE last week of the annual report of the Medicare trustees underscores an unavoidable fact that too many politicians have nonetheless been avoiding for too long: Of all the entitlement programs, Medicare is on the most dangerously unsustainable financial course, squeezed simultaneously by rising health-care costs and an aging population.
When Congress passed the Medicare prescription drug bill four years ago, it included a mechanism designed to call attention to runaway spending in the health care program for seniors and the disabled. Medicare is funded by a combination of payroll taxes (hospital costs) and general revenue (doctor's visits and prescription drug costs). Bureaucratic alarms sound if the Medicare trustees project that the share of funds to be drawn from the general Treasury is set to exceed 45 percent in the near future. That alarm sounded for the first time last year and was repeated again last week. The second warning requires that the president -- in the budget he will submit early next year -- propose changes to reduce Medicare's drain on the Treasury. Under the law, Congress must quickly consider those remedies, though it doesn't have to act.
This is an especially blunt instrument to deal with an especially large problem, and the Bush administration's proposed solution, to require automatic cuts, is too crude. The challenge facing Medicare isn't how it's funded, it's how much it costs. Indeed, the program was designed to be financed in a hybrid fashion, and the very prescription drug bill that included the arbitrary 45 percent trigger tilted the mix more toward general revenue.
President Bush, to his credit, has proposed some ways of taming the Medicare monster. In this year's budget, he calls for $66 billion in Medicare cuts over the next five years. Of this, $10 billion would come from requiring higher-income beneficiaries -- $80,000 in annual income, $160,000 for a couple -- to pay higher premiums for prescription drug coverage, as they do now for their basic coverage, and by ending the indexing of this income test. The income ceiling may require adjustment, but for now this is a sensible proposal; in any event, higher premiums for the better-off should have been part of the plan from the start. Also worth discussing are the administration's proposals to cut payments to hospitals, nursing homes and other providers. But Democrats have greeted the proposals with more hostility than interest.
The administration can be faulted for insisting on retaining an expensive, lopsided payment scheme by which private insurance plans "competing" with traditional Medicare receive a government subsidy for doing so. These private plans have been growing rapidly, and they now cover one in five beneficiaries. That would be fine if such "Medicare Advantage" plans were competing on a level playing field, but they're not: The government is paying them on average 12 percent more than traditional fee-for-service providers. The Medicare policy board that advises Congress has endorsed leveling this playing field. The higher payments, according to the Congressional Budget Office, amount to $65 billion over five years, and $160 billion over 10. No wonder the companies that market these plans are lobbying so furiously to keep their undue Medicare advantage.
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But ask BbyG; he seems to be the self appointed expert on statistical subsets and sub cultures.
No just speaking to data sets already mentioned that you then ignore while petulantly positing another stupid argument. At what point do you note how poorly your technique works?
Hey, didn't see the UK on the single axis mortality stats you're attempting to weave an argument from. Seeing how they already have the health care system and other social programs you're pining for in the US, what does that say about the point you're already doing a poor job making?
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Odd, most of the world's general public accepts the World Health Organization statistics except you BbyG.
And nearly every health organization in the world utilizes their statistics and findings.
But then I forgot you are an MD and a world famous Epidemiologist. :roll:
You find some obscure Black American subcultures and therefore conclude the WHO statistics invalid...
Or you try to find an anomaly...
And that's your brilliant argument to disregard the entire WHO findings?
:?
Do you ever read your own manure? You should; it's good for a laugh.
:-D
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Helluva afterdinner conversation here gentlemen , , , :x
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Odd, most of the world's general public accepts the World Health Organization statistics except you BbyG.
And nearly every health organization in the world utilizes their statistics and findings.
But then I forgot you are an MD and a world famous Epidemiologist. :roll:
**I guess BBG should follow your example and only comment on things he has expertise in, right?**
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Here is something interesting from the WSJ .I wasn't sure where to post in the science thread or here but since it deals with the WHO and in a back door way healthcare here it is. :evil:
Malaria, Politics and DDT
The U.N. bows to the anti-insecticide lobby
In 2006, after 25 years and 50 million preventable deaths, the World Health Organization reversed course and endorsed widespread use of the insecticide DDT to combat malaria. So much for that. Earlier this month, the U.N. agency quietly reverted to promoting less effective methods for attacking the disease. The result is a victory for politics over public health, and millions of the world's poor will suffer as a result.
The U.N. now plans to advocate for drastic reductions in the use of DDT, which kills or repels the mosquitoes that spread malaria. The aim "is to achieve a 30% cut in the application of DDT worldwide by 2014 and its total phase-out by the early 2020s, if not sooner," said WHO and the U.N. Environment Program in a statement on May 6.
Citing a five-year pilot program that reduced malaria cases in Mexico and South America by distributing antimalaria chloroquine pills to uninfected people, U.N. officials are ready to push for a "zero DDT world." Sounds nice, except for the facts. It's true that chloroquine has proven effective when used therapeutically, as in Brazil. But it's also true that scientists have questioned the safety of the drug as an oral prophylactic because it is toxic and has been shown to cause heart problems.
Most malarial deaths occur in sub-Saharan Africa, where chloroquine once worked but started failing in the 1970s as the parasite developed resistance. Even if the drugs were still effective in Africa, they're expensive and thus impractical for one of the world's poorest regions. That's not an argument against chloroquine, bed nets or other interventions. But it is an argument for continuing to make DDT spraying a key part of any effort to eradicate malaria, which kills about a million people -- mainly children -- every year. Nearly all of this spraying is done indoors, by the way, to block mosquito nesting at night. It is not sprayed willy-nilly in jungle habitat.
WHO is not saying that DDT shouldn't be used. But by revoking its stamp of approval, it sends a clear message to donors and afflicted countries that it prefers more politically correct interventions, even if they don't work as well. In recent years, countries like Uganda, Tanzania and Zambia have started or expanded DDT spraying, often with the help of outside aid groups. But these governments are also eager to remain in the U.N.'s good graces, and donors typically are less interested in funding interventions that WHO discourages.
"Sadly, WHO's about-face has nothing to do with science or health and everything to do with bending to the will of well-placed environmentalists," says Roger Bate of Africa Fighting Malaria. "Bed net manufacturers and sellers of less-effective insecticides also don't benefit when DDT is employed and therefore oppose it, often behind the scenes."
It's no coincidence that WHO officials were joined by the head of the U.N. Environment Program to announce the new policy. There's no evidence that spraying DDT in the amounts necessary to kill dangerous mosquitoes imperils crops, animals or human health. But that didn't stop green groups like the Pesticide Action Network from urging the public to celebrate World Malaria Day last month by telling "the U.S. to protect children and families from malaria without spraying pesticides like DDT inside people's homes."
"We must take a position based on the science and the data," said WHO's malaria chief, Arata Kochi, in 2006. "One of the best tools we have against malaria is indoor residual spraying. Of the dozen or so insecticides WHO has approved as safe for house spraying, the most effective is DDT." Mr. Kochi was right then, even if other WHO officials are now bowing to pressure to pretend otherwise.
Boyo
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GM; the American Medical Association, et al seem to to accept and use WHO's findings.
Basically everyone does.....
Not perfect, but normal practice...
And oddly enough, since this particular forum is "The Politics of Health Care" except perhaps
for CCP's greater personal knowledge I am an "expert" using the term loosely having spend over ten years advising large (10,000+ employees) corporations
on their medical plans and having been married to a Board Certified Neurologist (I took care of the business aspects for her) for a number of years.
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Do you ever read your own manure? You should; it's good for a laugh.
I expect more hip waders are donned reading your inanities.
Again you dodge a larger point by thrumming your chest about a single data point and copping snotty attitudes about a UN agency cited as an authority. As the post about DDT should show, UN sponsored agencies are not paragons of scientific virtue so quoting their findings as the final word on the subject demonstrate your failings, not mine.
Time for another "nonny nonny boo boo," I suppose, as it appears to be your strongest argument.
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Do you ever read your own manure? You should; it's good for a laugh.
I expect more hip waders are donned reading your inanities.
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OK folks, taking a poll here: Any suggestions for the tone the conversation seems to be establishing?
a) Its the internet, what else do you expect
b) continue to call to their better nature
c) or?
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water boarding :-D
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Suits me. Bet I'd hold out longer.
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water boarding :-D
But please don't tell me CCP that you would be the attending physician?
:-)
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Humor is good.
Now take a dozen deep breaths and start FRESH with NO backward looking cracks please!!!
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Politicians wouldn't be politicians if they didn't trim their sails to the prevailing winds. Even so, the emerging 180-degree turn by Democrats on taxes and health insurance is one for the record books.
AP
Democrats have spent years arguing that proposals to equalize the tax treatment of health insurance are an outrage against the American people. Workers pay no income or payroll taxes on the value of job-based plans, but the same hand isn't extended to individuals who must buy coverage on their own. Last year liberals mauled John McCain for daring to touch the employer-based exclusion to finance more coverage for the individually uninsured. He was proposing "a multitrillion-dollar tax hike -- the largest middle-class tax hike in history," said Barack Obama, whose TV ads were brutal.
But now Democrats need the money to finance $1.2 trillion or more for their new health insurance entitlement. Last week Senate Finance Chairman Max Baucus released his revenue "policy options" and high on the list is . . . taxing health benefits. Or listen to White House budget director Peter Orszag, who recently told CNN's John King that the exclusion "was not in the President's campaign plan, it wasn't in our budget. Clearly, some Members of Congress are putting it on the table and we are going to have to let this play out."
Mr. King tried again. "Let this play out. But would the President sign a bill that includes a pretty significant tax increase? That would be a tax increase." Mr. Orszag: "We're not going to be -- I think it's premature to be commenting on individual items . . . There are lots of ideas that are being put on the table." Translation: You betcha he'd sign it.
The tax exclusion is such a big revenue prize because Mr. Baucus is scrubbing every other tax nook and cranny and only coming up with rounding errors. A sampler:
- Impose an excise tax on hard alcohol, beer and some kinds of wine. That would be in addition to a sin tax on beverages sweetened with sugar or high-fructose corn syrup, such as soda. Mr. Baucus doesn't offer revenue estimates, though the Congressional Budget Office says a $16 per proof gallon alcohol tax might raise $60 billion over 10 years, and another $50.4 billion at three cents per 12 ounces of sugary drink.
- End or limit the tax-exempt status of charitable hospitals, which only costs currently a mere $6 billion a year.
- Make college students in work-study programs subject to the payroll tax. Also targeted are medical residents, perhaps on the principle that they'll one day be "rich" doctors. CBO has no score on these.
- Reducing Medicare reimbursement rates for supposedly "over valued physician services," such as diagnostic imaging. CBO says that requiring doctors to get prior clearance could save $1 billion in 10 years.
- For individuals with high-deductible insurance plans, contributions to health savings accounts would no longer be tax deductible. That would penalize patients who choose plans that encourage them to be informed consumers. CBO says that banning HSA payments entirely would yield all of $10 billion.
By contrast, the employer-based exclusion offers a huge money pot -- an estimated $226 billion in 2008. Yet as liberal MIT economist Jonathan Gruber recently told Mr. Baucus's committee, "no health expert today would ever set up a health system with such an enormous tax subsidy to a particular form of insurance" (his emphasis). It creates a coverage gap between workers who receive it from their employers and those who pay -- or can't afford to pay -- with after-tax money.
The tax exclusion is also one reason health costs continue to rise. It encourages workers to take an extra dollar of compensation in fringe benefits instead of cash while also routing low-deductible health spending through third parties. Some 84 cents of every medical dollar is spent by someone other than the patient. The insured have no incentives to make cost-conscious decisions about care.
So reforming the exclusion would inject a dose of discipline into American medicine. But for most Democrats the goal isn't to create a more rational health-insurance market. They simply want the revenue for another government program. Mr. Baucus won't target gold-plated employer insurance plans in general, because union-negotiated benefits are usually gold-plated. Rather, he may cap or phase out the exclusion by income, starting with workers earning more than $200,000. Insurance options that don't conform to government diktats (health savings accounts) would also lose any tax advantage. This would do nothing for market efficiency, but it would be one more stealth tax increase.
Democrats owe an apology to Mr. McCain, and it'll be fascinating to see if they will now suffer a political backlash of their own making. Having told the country that this tax reform is really a tax increase, Democrats are opening themselves to the same attacks they leveled against Republicans.
They could avoid that fate if they used the tax exclusion money to finance, say, a tax credit for the uninsured. That would be a genuinely bipartisan reform. But liberals won't accept that because they want to take one giant step toward government-run health care. And the only way they can pay for it is by taxing everything in sight, including your current health insurance.
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Ah the joys of government run health care. Government mandates that patients be treated within four hours of admittance. Strapped for resources, hospitals don't have the beds to admit, so the meet the mandate by leaving patients languishing in ambulances etc:
Patients forced to wait hours in ambulances parked outside A&E departments
Ambulance chiefs have warned that lives are being put at risk "on a daily basis" by long delays allowing patients into Accident and Emergency units.
By Laura Donnelly, Health Correspondent
Last Updated: 10:04PM BST 30 May 2009
An investigation by The Sunday Telegraph has found that thousands of 999 patients are being left to wait in ambulances in car parks and holding bays, or in hospital corridors – in some cases for more than five hours – before they can even join the queue for urgent treatment.
Experts warn that hospitals are deliberately delaying when they accept patients – or are diverting them to different sites – in order to meet Government targets to treat people within fours hours of admitting them.
The extent of the problems have been revealed in correspondence between senior health officials, obtained under the Freedom of Information Act, which also show their serious concerns about the dangers the delays pose to patients.
A letter by Sir Graham Meldrum, chairman of West Midlands Ambulance Service, sent to hospital chief executives last November warns that patients are "being put at risk on a daily basis", with 7,600 patients a month facing delays of more than 30 minutes – a situation which has since deteriorated, with more than 8,000 such delays in March.
The documents also reveal an investigation into the death of a patient who waited three hours to be seen by A&E staff after being taken by ambulance to The Royal Wolverhampton Hospitals Trust.
On two occasions in January, ambulances took more than five hours to unload patients at Queen's Hospital in Romford, Essex.
In the same month, journeys to Weston-super-Mare hospital in Somerset were repeatedly held up, with more than a dozen waits of two hours, including delays of four and five hours.
Dozens of A&E units refused all 999 arrivals for periods of several hours, on hundreds of occasions, forcing crews to take desperately sick patients on lengthy journeys, and shifting pressures to other hospitals, the documents show.
In the course of six months, hospitals in the West Midlands ordered a "divert" on more than 450 occasions, closing A&E units to all 999 arrivals for hours at a time.
During a six-week period last autumn, hospital chiefs in the north east of England closed casualty units to 999 arrivals on 34 occasions, for up to 19 hours at a time.
Internal documents from the London Ambulance Service reports of extensive delays throughout December: "Ambulances have queued in large numbers for up to five hours to unload, and two hour delays were relatively common," it says.
The briefing note, written in January, says hospitals were so short-staffed that ambulance staff were regularly forced to look after multiple patients simultaneously, so that colleagues could respond to 999 calls.
Delays to patients arriving to A&E by ambulance are increasing in many parts of the country as hospitals struggle to cope with a massive increase in the number of emergency hospital admissions since family doctors stopped providing routine out-of-hours care.
Since the changes were made five years ago, the number of emergency hospital admissions has risen by 30 per cent, while the number of beds fell by more than 20,000.
More than 100,000 ambulance journeys were delayed at casualty units by more than 30 minutes in the month of March alone – an increase of 18 per cent in 12 months.
Mike Penning, the shadow health minister, said: "Labour's tick box culture is forcing staff to prioritise the four hour target ahead of ensuring patient get the treatment they need.
"It is madness that all of this has happened at a time when the number of people being admitted to A&E units is soaring."
Ambulance staff and patients groups said hospitals were routinely ignoring NHS guidance which says the "clock" for the A&E four hour wait should start 15 minutes after an ambulance arrives on site.
Katherine Murphy, from the Patients Association, said: "We are hearing increasing numbers of stories of seriously-ill patients lying in pain in ambulances, worried out of their mind, while others are taken on long journeys because casualty units have been closed.
"The guidance may say they should not be delayed, but the A&E target is the one that comes with financial penalties attached, and it is the one hospitals care about."
Most ambulance trusts measure delays by "turnaround time" – the time between the ambulance's arrival at A&E and its availability for the next call.
It includes any time cleaning or restocking the vehicle, which should take no more than a few minutes.
Research by one ambulance trust found three quarters of delays occurred before the patient was handed over to staff, and that 84 per cent of those cases were connected to bed shortages.
Sam Oestricher, ambulance representative for trade union Unison, said ambulances were being treated "as mobile waiting rooms".
He said: "Our members are spending hours effectively babysitting patients, who have been rushed to A&E departments because they need to be seen urgently.
"It leaves patients and crews in a terribly anxious, frustrating situation, and it greatly increases the risks."
Jim Wardrope, A&E consultant at Sheffield Northern Hospital and past president of the College of Emergency Medicine said: "The whole system is running hot, so that when the pressure comes, it backs up quickly and we end up desperately searching for trolleys."
Health Minister Ben Bradshaw said "severe action" would be taken against any hospitals found to be keeping patients in ambulances in an attempt to cheat on the A&E targets.
He added: "The vast majority of hospitals up and down the country are meeting the four hour target without keeping people waiting in ambulances."
More than 4,800 people have backed The Sunday Telegraph's Heal Our Hospitals campaign, which is calling for a review of hospital targets to make sure they work to improve quality of care.
http://www.telegraph.co.uk/health/healthnews/5412191/Patients-forced-to-wait-hours-in-ambulances-parked-outside-AandE-departments.html
http://www.telegraph.co.uk/health/healthnews/5412191/Patients-forced-to-wait-hours-in-ambulances-parked-outside-AandE-departments.html
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Where I am patients are triaged. Waits for the true emergencies are low but when the ED is busy some could wait for hours.
I don't see any other way.
All our lives are going to be nothing more than following mandates.
For doctors it already is that way, but it will get worse.
You should only use so much electricity, water, sugar, gas, oil, than the government hopes you do use more because then they can tax you/us.
Flush more than once per day per person per household then more can be confiscated.
Pelosi wants to inventory "everything".
I assume there will be a tax for too much TV, sitting, blogging, message boards. Hey if your not walking your fat. We tax for cigarettes alcohol why not for each pound you are over a certain BMI?
A National sales tax is coming.
On and on. Crafty you are so right. We are totally screwed.
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There Is No Such Thing As a Free Health Care. But There Are Lots of Things Called Free-er Health Care That Get Really, Really Expensive In Ways That Range Far Beyond Dollars and Cents.
Nick Gillespie | June 2, 2009, 8:09am
Get ready for the Summer of Glove, as in rubber-examination gloves used for digital exams. This time the patient is the entire U.S. economy, which we're being told suffers from bloating and sluggishness due to way too much spending on health care.
Legislation to revamp the health-care system likely would cut the rate of annual growth in costs by 1.5 percentage points, increasing the gross domestic product by more than 2 percent in 2020 above what it would be if no changes were made, according to projections by President Barack Obama's Council of Economic Advisers.
"Health care reform is incredibly important not just for the American people but for the American economy," Christina Romer, who chairs the council, said in a briefing for reporters on the CEA report released this morning.
Those are the types of bold, long-term predictions that hold as much water as an 88-year-old man on a full-liquid diet. I mean, really, if you're going to make predictions that are completely pulled out of your ass, why not follow what Treasury did with the TARP bailout and just choose a "really big number" picked out of thin air?
More to the point, the Wile E. Coyote Super Geniuses in D.C. have been working overtime since their junior-high theses on proposals to finally fix health care (despite it not being totally clear what the term even means, or how it means very different things to very similar people).
They have seen the past and it didn't work. But that doesn't mean it can't not work this time:
Democrats, who control both the House and Senate, are considering proposals that would require employers to cover all full-time workers or pay a penalty to the government; create a "health exchange" to allow consumers to buy insurance at lower, group rates; set up a new government-run plan to cover some of the uninsured; and levy new taxes to pay for universal coverage.
Employer mandates. Insurance pools. Government programs. New taxes. Hope and change, and even without Tom Daschle in the cabinet! I don't know they do it, but goddamn, it's beautiful.
Exactly how any of the above differs from what we're already doing escapes me. Our health care system is the ugly accretion of decades of stupid government policies (starting with the decision not to tax employer-based health care costs as compensation, thus pushing the idea of tying coverage to the workplace) that have gotten gnarlier and more twisted with each additional, incremental add-on.
So, if you're actually legislatin' in the 21st century on the promise of hope and change, why not actually start thinking about doing some things that are genuinely different and have at least a snowball's chance in hell of working?
Start with injecting actual market forces into health care by disrupting professional cartels that raise the cost of buying any prescription drug by $100 or whatever you get charged for a perfunctory doctor's visit (and by the way, start questioning the prescription drug regime too)?
Inject some actual price signals into the system by getting rid of the tax-code hocus-pocus that creates third-party payer systems and gets employers, most of whom can't turn a goddamn dollar at their chosen field of expertise, into the business of providing health care?
Take an example from fields such as dentistry and eyecare, where fewer services are covered by insurance and hence more open to the sorts of competition and discovery process that routinely drives prices down and the level of services up in every area of exchange from airline tickets to hamburgers to high-tech computer gear. And recognize that health insurance is not the same as health; indeed, it's not quite clear just exactly how the two are linked.
And also take a deep breath and recognize that spending more money on health care is not necessarily a bad thing, if it's the free choice of people (which currently it isn't). Like eating more prepared meals, it can be a glorious sign of increasing wealth.
But most of all, stop acting like characters from Tennessee Williams or William Faulkner. Learn from the past already, don't just mindlessly repeat it.
http://www.reason.com/blog/show/133880.html
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hahahahahahaha, i hope this hurts everyone who voted for him. I would love to witness the facial expressions of every single moron for voted for obama when they realize that not only did he lie to them but he is violating them 10X worse the then evil GWB did.
Obama said to be open to taxing health benefits
By ERICA WERNER, Associated Press Writer Erica Werner, Associated Press Writer – Tue Jun 2, 7:43 pm ET
WASHINGTON – President Barack Obama is leaving the door open to taxing health care benefits, something he campaigned hard against while running for president. Senate Finance Committee Chairman Max Baucus, D-Mont., raised the issue with Obama during a private meeting Tuesday with the president and other Democratic senators and later reported the president's response: "It's on the table. It's an option."
The federal government would reap about $250 billion a year if it treated health care benefits given to employees like wages and taxed them.
Baucus and others are eyeing that money as they search for ways to pay for a costly health care overhaul that would extend coverage to 50 million Americans who are now uninsured. That could cost some $1.5 trillion over 10 years.
The president adamantly opposed health benefit taxes during the campaign, arguing they would undermine job-based coverage. But he's now indicating openness to that suggestion from Congress, even if he criticized Republican presidential rival John McCain for proposing a sweeping version of the same basic idea.
Obama has made some suggestions of his own for paying for a health care overhaul, including cuts to Medicare and limiting tax deductions wealthy people can take, but they've run into opposition from Congress. And, they only add up to about $630 billion over 10 years.
"The president made it clear during the campaign that he has serious concerns about taxing health care benefits," White House spokesman Reid Cherlin said in a statement about Tuesday's meeting.
"He stated again his belief that health reform can't wait another year, and that while all options should be considered, those options should include the revenue proposals that he included in his budget," Cherlin said. "He made it very clear that he prefers the approach he has already outlined."
Some experts think limiting the tax exclusion for health benefits is the only way to get the necessary money to pay for a sweeping health care overhaul. But there's opposition from organized labor and from many Democrats, including House Ways and Means Chairman Charles Rangel, D-N.Y., who said recently there was "no way" he would support the approach.
Baucus wants to look at limiting — but not entirely eliminating — the tax-free status of employer-provided health benefits. Obama is leaving the details of crafting a health care bill to Congress and used Tuesday's meeting to urge senators to swift action.
"This window between now and the August recess I think is going to be the make-or-break period," Obama said before the meeting was closed to reporters. "This is the time where we've got to get this running."
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Associated Press writers Philip Elliott and Ricardo Alonso-Zaldivar contributed to this report.
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Huss notes the meaninglessness of Obama's positions in the campaign to his own positions now. Unbelievable how many times on so many topics that has already happened, starting with when he joked (?) about things said in a campaign when he appointed Hillary to be Sec. of State.
I was most struck by a phrase tucked at the end of the AP story:
"... Obama said before the meeting was closed to reporters" !!!
When it was the old Hillary task force or when it is the new leftist machine, they do that to get things done for the American people. When it was Cheney trying to develop a proposal for energy production so that the economy would not collapse in 8 years (whoops), it was black helicopters and evil conspiracies.
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GOP Health Plan Contrasts With Obamacare
While Democrats fret about how to find another $1.5 trillion to pay for their scheme to expand government health care to include all Americans, congressional Republicans have introduced their alternative Patients' Choice Act. The Act, which has no chance of passage by a Democrat-controlled Congress committed to expanding federal bureaucracy and power, is an attempt to redirect $300 billion in federal tax deductions from the employer-based health system that was created after World War II.
Under the proposal, families would qualify for tax credits of $5,700 a year and individuals $2,300 to buy insurance and invest in health savings accounts. Up to one-fourth of any unspent money in the accounts could be rolled over to the next year. The bill would allow lower-income Americans a way out of the Medicaid trap rapidly careening toward its inevitable bankruptcy less than eight years hence because it is $34 trillion in debt. In fact, Medicare is so deep in debt that devoting 100 percent of GDP to it still won't make this single government program solvent.
Despite admitting the insolvency of our national finances when he said last week, "[W]e are out of money," Barack Obama is trying to sell the notion that the proposed federal takeover of 18 percent of the nation's economy via his new health care plans somehow helps the nation economically. Obama also suggested myopically that $200 billion could be shaved from Medicare over the next 10 years (the program is bankrupt about three years earlier) even though a majority of physicians now refuse to see Medicare patients because of artificially low reimbursement rates. Instead of squandering the nation's future health care with legions of expensive bureaucrats, the GOP alternative deserves serious consideration because it doesn't cost the taxpayers anything and doesn't require the creation of a massive government bureaucracy to operate.
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"Under the proposal, families would qualify for tax credits of $5,700 a year and individuals $2,300 to buy insurance and invest in health savings accounts. Up to one-fourth of any unspent money in the accounts could be rolled over to the next year. The bill would allow lower-income Americans a way out of the Medicaid trap"
How much do people on medicaid pay in taxes that this deduction is even going to apply to them?
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Dunno, but does not the term "tax credit" mean a one-to-one relationship with taxes paid? In contrast, a deduction is worth only the % paid on the income/gain-- yes?
Thus, if I am correct, most any taxes paid by these people (no doubt there will be some exceptions) will be applicable here.
Of course, the devil is in the details.
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Kennedy’s Health Bill: A First Look
Posted by Michael D. Tanner
A draft of Sen. Ted Kennedy’s health care reform bill is finally available, and it is difficult to overstate how far he would move us to a government-run health care system. An initial read-through reveals among the key provisions:
An individual mandate, requiring that every American purchase a “qualified” insurance plan. (Sec. 161(a)) The mandate will be enforced through the tax code with Americans required to pay a penalty if they fail to comply. In an extraordinary delegation of congressional authority, the Kennedy bill would give the Secretaries of Treasury and Health and Human Services the power to determine what this penalty should be. Individuals would be required to submit information on their insurance status over the previous year to the Secretary of HHS, along with “any such other information as the Secretary may require.” (Sec. 6055(b)(2) and (3)). Individuals who already have insurance could keep it. However, if they changed plans (or presumably changed jobs), their new insurance would have to meet the definition of “qualified.”
A “pay or play” employer mandate requiring employers to provide all workers with health insurance and pay a minimum amount of the premium, or pay a tax (Sec 162). Again, the amount of the new tax is left to the discretion of the Secretaries of HHS and Treasury. Some small employers would be exempt from the mandate, but the size of those firms remains TBA. (Sec. 3113(g)) Companies with fewer than 250 workers would be forbidden to self-ensure. (Sec. 2720)
A new federal bureaucracy, the Medical Advisory Council, which would determine what benefits will be required to be part of your “qualified” insurance plan. (Sec. 3103(h) and (i)). Lest anyone think Congress won’t get involved. The Council’s decisions can be disapproved by Congress if, say, they don’t mandate inclusion by a favored provider group or disease constituency. (Sec 3103(g)).
Massive new federal subsidies. Medicaid would be expanded to individuals earning 150 percent of the poverty level, and the federal government would pay all incremental costs of the increased enrollment. (Sec 152.) Single, childless adults would become eligible for Medicaid. Even more egregious, individuals and families with incomes between 150-500 percent of the poverty level ($110,250 for a family of four) would be eligible for subsidies on a sliding scale-basis.(Sec. 3111(b)(1)(A-G)).
Insurers would be required to accept all applicants regardless of their health (guaranteed issue) and forbid insurers from basing insurance premiums on risk factors (Community rating). There does not appear to be any exception for lifestyle factors, such as smoking, alcohol or drug use, diet, exercise, etc. Thus, not only will the young and healthy be forced to pay higher premiums to subsidize the old and unhealthy, but the responsible will be forced to pay more to subsidize the irresponsible.
A “public option” operating in competition with private insurance (Section 31__). How this plan would be funded, the level of premiums, etc. is left mostly TBA. In response to criticism, the Kennedy bill does require that the public plan pay providers 10 percent above Medicare reimbursement rates. (Sec 31__(B)). That would still allow for a considerable degree of cost-shifting to private insurance. And, we should recall that such promises are ephemeral. When Medicare began, proponents promised it would reimburse at the same rate as insurance. That promise didn’t last long.
States would be prodded to set up “gateways,” similar to Massachusetts’ “connector.” (Sec 3104(a)) If a state fails to do so, the federal government will set one up for them. (Sec. 3104(d)) The federal government would provide grants to states to help them set up these gateways. The amount of the grants is, you guessed it, left to the discretion of the Secretary of HHS. Gateways may also fund their operations by assessing a surcharge on insurers. Sec. 3101(b)(5)(A)/
A new federal long-term care program (Sec 171).
Kennedy does not include any estimate of how much his plan would cost, nor any proposal for how to pay for it.
More details will undoubtedly emerge, but it is very clear that the Kennedy plan would put one-sixth of the US economy and some of our most important, personal, and private decisions firmly under the thumb of the federal government.
Michael D. Tanner • June 8, 2009 @ 2:40 pm
http://www.cato-at-liberty.org/2009/06/08/kennedys-health-bill-a-first-look/
Primary source:
http://keithhennessey.com/wp-content/uploads/2009/06/kennedy_health_bill_draft.txt
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June 09, 2009, 4:00 a.m.
How Not to Reform Health Care
Massachusetts is widely touted as a model for health-care reform. It isn’t.
By Michael Tanner
As the national debate over health-care reform begins, many in Congress are looking to Massachusetts as a model for what that reform might look like. Indeed, from mandates and subsidies to some form of exchange or “connector,” many of the key components of the Massachusetts reforms are likely to end up in the bill to be voted on this year.
But three years after it was voted in, experience suggests the “Massachusetts model” actually provides an object lesson in how not to reform health care. The program has failed in its main goal of achieving universal coverage. It has failed to restrain the growth in health-care costs. And it has greatly exceeded its initial budget, placing new burdens on the state’s taxpayers.
There is no doubt that the Massachusetts program has reduced the number of people without health insurance in the state — but by how much is a matter of considerable dispute. According to official statistics, the state’s uninsured rate has declined from 10.4 percent in 2006 to just 2.6 percent today. However, there are several reasons for doubting the accuracy of this number. For example, a door-to-door survey by the Census Bureau in March 2008 estimated that 5.4 percent of state residents were uninsured. And an examination of state income-tax returns indicates that roughly 5 percent of residents were uninsured as of Jan. 1, 2008. The best estimates suggest that more than 200,000 Massachusetts residents remain uninsured, out of the 670,000 uninsured in 2006. That’s a far cry from the “universal coverage” that was promised when the bill was passed.
Health-care costs continue to rise much faster in Massachusetts than in the nation as a whole. Proponents of the reform promised that it would reduce costs. Gov. Mitt Romney said “the cost of health care would be reduced” and the plan would make health insurance “affordable” for every Massachusetts citizen. Supporters went so far as to suggest that the reforms would reduce the price of individual insurance policies by 25 to 40 percent. In reality, since the program became law, insurance premiums have been increasing by 10 to 12 percent per year, nearly double the national average. On average, health insurance costs $16,897 a year for a family of four in Massachusetts, compared to $12,700 nationally. Meanwhile, total health-care spending in the state has increased by 28 percent.
New regulation and bureaucracy are limiting consumer choice and adding to costs. A new mandate for prescription-drug coverage was added, and high-deductible policies were restricted. Some Massachusetts residents who were happy with their old insurance policies have had to change their coverage in order to comply with the mandates.
Although much of the burden falls on individual policy-holders, the costs to the taxpayers have also skyrocketed. Despite one tax increase already, the program faces huge deficits in the future. As a result, the state is considering caps on insurance premiums, cuts in reimbursements to providers, and even the possibility of a “global budget” on health-care spending — with its attendant rationing.
The reforms have added a new burden on companies, especially smaller ones, wanting to do business in the state. The Small Business and Entrepreneurship Council cites the Massachusetts health-care regulations and the mandate on companies as its reasons for ranking Massachusetts dead last among the 50 states for business-friendly health-care policies.
A shortage of providers, combined with higher demand, is increasing waiting times to see a physician, especially primary-care providers. The wait for seeing an internist, for example, has nearly doubled since the reforms were implemented.
Supreme Court Justice Louis Brandeis rightly called America’s state governments “the laboratories of democracy.” States are able to experiment with policies on a small scale before these policies are adopted by the whole nation.
Let us hope that Congress learns from the failure of the Massachusetts experiment.
— Michael Tanner is a senior fellow at the Cato Institute and the co-author of Healthy Competition: What’s Holding Back Health Care and How to Free It.
National Review Online - http://article.nationalreview.com/?q=NDNiY2ZiNTZkYzgyNWViYzU3ZDBkYmYwZTc4ZmUxNmI=
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By KARL ROVE
It was a sobering breakfast with one of the smartest Republicans on Capitol Hill. We can fix a lot of bad stuff President Barack Obama might do, he told me. But if Mr. Obama signs into law a "public option," government-run insurance program as part of health-care reform we won't be able to undo the damage.
I'd go the Republican member of Congress one further: If Democrats enact a public-option health-insurance program, America is on the way to becoming a European-style welfare state. To prevent this from happening, there are five arguments Republicans must make.
The first is it's unnecessary. Advocates say a government-run insurance program is needed to provide competition for private health insurance. But 1,300 companies sell health insurance plans. That's competition enough. The results of robust private competition to provide the Medicare drug benefit underscore this. When it was approved, the Congressional Budget Office estimated it would cost $74 billion a year by 2008. Nearly 100 providers deliver the drug benefit, competing on better benefits, more choices, and lower prices. So the actual cost was $44 billion in 2008 -- nearly 41% less than predicted. No government plan was needed to guarantee competition's benefits.
Second, a public option will undercut private insurers and pass the tab to taxpayers and health providers just as it does in existing government-run programs. For example, Medicare pays hospitals 71% and doctors 81% of what private insurers pay.
Who covers the rest? Government passes the bill for the outstanding balance to providers and families not covered by government programs. This cost-shifting amounts to a forced subsidy. Families pay about $1,800 more a year for someone else's health care as a result, according to a recent study by Milliman Inc. It's also why many doctors limit how many Medicare patients they take: They can afford only so much charity care.
Fixing prices at less than market rates will continue under any public option. Sen. Edward Kennedy's proposal, for example, has Washington paying providers what Medicare does plus 10%. That will lead to health providers offering less care.
Third, government-run health insurance would crater the private insurance market, forcing most Americans onto the government plan. The Lewin Group estimates 70% of people with private insurance -- 120 million Americans -- will quickly lose what they now get from private companies and be forced onto the government-run rolls as businesses decide it is more cost-effective for them to drop coverage. They'd be happy to shift some of the expense -- and all of the administration headaches -- to Washington. And once the private insurance market has been dismantled it will be gone.
Fourth, the public option is far too expensive. The cost of Medicare -- the purest form of a government-run "public choice" for seniors -- will start exceeding its payroll-tax "trust fund" in 2017. The Obama administration estimates its health reforms will cost as much as $1.5 trillion over the next 10 years. It is no coincidence the Obama budget nearly triples the national debt over that same period.
Medicare and Medicaid cost much more than estimated when they were adopted. One reason is there's no competition for these government-run insurance programs. In the same way, Americans can expect a public option to cost far more than the Obama administration's rosy estimates.
Fifth, the public option puts government firmly in the middle of the relationship between patients and their doctors. If you think insurance companies are bad, imagine what happens when government is the insurance carrier, with little or no competition and no concern you'll change to another company.
In other words, the public option is just phony. It's a bait-and-switch tactic meant to reassure people that the president's goals are less radical than they are. Mr. Obama's real aim, as some candid Democrats admit, is a single-payer, government-run health-care system.
Health care desperately needs far-reaching reforms that put patients and their doctors in charge, bring the benefits of competition and market forces to bear, and ensure access to affordable and portable health care for every American. Republicans have plans to achieve this, and they must make their case for reform in every available forum.
Defeating the public option should be a top priority for the GOP this year. Otherwise, our nation will be changed in damaging ways almost impossible to reverse.
Mr. Rove is the former senior adviser and deputy chief of staff to President George W. Bush.
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Notice that other than prescription savings he doesn't tell us the truth about where the savings are coming from.
It is going to come from limiting access to specialists, tests, and other services the "experts" will deem are "inappropriate". It will be based on population based studies and essentially be like HMO medicine. Care will be monitored (medicare already is anyway), and restricted in ways akin to Millman and Robinson flow charts that private risk managers use to determine what they will and what they won't pay for.
My understanding of this (though I am by no means an expert) is that outcomes data is used to determine if doing things more cheaply or restricting care increases hospitalization, rehospitalization, death or morbidity rates. I am not clear that the data is proof the care is as safe or as good. It depends what one is measuring when determining the "outcomes". On the other hand I am not clear there is any data that suggests health care is worse though it is certainly less convenient. For harder to measure outcomes itmay be worse.
As for the prescription savings I do agree that many patients are on more expensive non generic drugs that are no better of more effective than cheaper generic older drugs.
This is what the EMR is for. To collect all the data and then come out with dictates that will instruct providers on how we must deliver care. It will be mandated. Whether private insurers can survive I am not sure. I don't necessarily jump to the conclusion that some from the right are trying to scare us all into believing that "there is absolutely no way private health insurance will be doomed but that could very well be the case. Certainly BO despite whatever he says he is certainly working with the goal in mind of a national health care system. There is really no other rational conclusion. BO's people have been looking at these things for years. It ain't new. It ain't BOs ideas though he obviously embraces them wholeheartedly.
In any case, there is no question BO isn't leveling with us about his real intentions:
Obama calls for new health care spending cuts AP Reuters – President Barack Obama speaks about reforming America's health care system at a Wisconsin Town Hall … Josh Gerstein Josh Gerstein – Sat Jun 13, 7:06 am ET
President Barack Obama says he's now found savings that will pay almost all the costs of a massive overhaul of America's health care system.
Obama on Saturday is announcing an additional $313 billion in new proposed savings that he says would bring the total funding available for his top-priority health insurance reform to nearly $950 billion over 10 years.
White House officials insisted the new savings were rock-solid, but also acknowledged they had yet to settle on a specific mechanism to achieve lower prescription drug costs that make up nearly one-quarter of the new savings.
“Any honest accounting must prepare for the fact that health care reform will require additional costs in the short term in order to reduce spending in the long term,” Obama says in his weekly radio and Internet address. “Today, I am announcing an additional $313 billion in savings that will rein in unnecessary spending, and increase efficiency and the quality of care.”
The new proposals from Obama came as the drive for health care reform reaches a pivotal juncture in Congress. On Monday, the Senate Finance Committee is scheduled to receive Congressional Budget Office estimates on a slew of health-care options. On Wednesday, the committee is expected to unveil proposed legislation.
In advance of those milestones, the White House was moving aggressively to counter public criticism that funding plans for the health reform effort are unrealistic, particularly in the face of an expected 10-year pricetag of $1 trillion or more. Some analysts have faulted the White House for being overly optimistic about savings and tone-deaf to which tax-raising proposals are likely to fly in Congress.
In his address Saturday, Obama refers to a 10-year total of more than $600 billion in “savings” for health care. However, he does not explain in his latest comments that, under his revised budget released last month, $326 billion of that amount would come from tax hikes on Americans making over $250,000 a year, “loophole closers,” and higher fees for some government services.
In a conference call with reporters Friday, Office of Management and Budget Director Peter Orszag said the latest announcement signaled that the White House had met its obligation to identify funding sources for a broad-based effort to make health insurance more affordable and more widely available.
“We are making good on this promise to fully finance health care reform over the next decade,” Orszag declared.
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The bulk of the new $313 billion in savings would come from cutting or reducing the growth of payments to hospitals, medical equipment manufacturers and laboratories — though the major cuts don't target doctors, Orszag said.
Over the next decade, $110 billion is slated to come from reducing reimbursements to take account of what Orszag described as the ability of providers to improve their efficiency. “Health care services should be able to achieve and do achieve productivity improvements over time,” he said. According to a fact sheet released by the White House, future increases in such Medicare payments would be reduced based on an assumption that health care providers achieve half the productivity increases seen elsewhere in the economy. The budget official said the reductions would take place even if providers failed to garner the projected efficiencies.
Another $106 billion would come from cuts in so-called disproportionate share payments the federal government makes to hospitals with large numbers of uninsured patients. “As the ranks of uninsured decline under health reform, those payments become less necessary,” Orszag said.
About $75 billion is slated to come from lower payments for prescription drugs. However, Orszag said the White House was “in discussions with stakeholders over the best way of achieving that $75 billion.”
Notwithstanding that ambiguity, Orszag asserted that the White House had put forward $950 billion in budgetary offsets that could be use to fund health reform. He called the proposals "hard" and "scoreable," meaning that they were sufficiently certain and specific to pass muster with CBO officials who formally tally the cost of budget items.
Asked about the discrepancy, Orszag said, “There’s been continuous skepticism that we will come forward with detail….The detail on the $75 billion for prescription drugs will be forthcoming in the very near future and I will rest my reputation as a former CBO director on the fact that there are multiple ways in which those savings can be achieved and we are committed to achieving that level of savings in this package.”
There were signs that the announcement of the additional $313 billion of savings may have been rushed. In addition to the vagueness about the $75 billion in lower drug costs, the White House’s health care reform coordinator, Nancy-Ann DeParle, did not join a conference call with reporters to announce the new proposals. Her presence had been advertised in advance, but a spokesman said she was in another meeting and could not participate.
The cuts and savings are likely to engender warnings from providers that de-facto rationing will occur as patients in some areas find themselves unable to find providers willing to perform lab tests, X-rays and the like, due to the lower reimbursement rates.
Hospitals are also likely to protest that the disproportionate share payments, which are targeted for cuts of 75 percent, are vital to maintaining hospitals in costly urban centers, and to keeping teaching hospitals viable.
“It is unlikely to be an exact match on a hospital-by-hospital basis but what we believe will occur is that the remaining DSH payments that will still exist can be better targeted to the hospitals most in need,” Orszag said.
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June 12, 2009
A New Public Health Plan: How Congressional Details Will Impact Doctors and Patients
by Greg D’Angelo
WebMemo #2482
President Obama and congressional leaders are proposing the creation of a new public health insurance plan to compete with private insurance plans. The President first proposed a public insurance option during the 2008 presidential campaign, but now the details and design of this new option--like most other aspects of the health reform legislation currently under development--have been left almost entirely to Congress.
Many in Congress are looking to Medicare as a model for a new public health plan, yet they fail to realize the consequences for patients and providers alike, as millions of Americans would lose the private coverage that they have today.
Crucial Details
According to the Lewin Group, a nationally prominent econometrics firm, the two most crucial design details of this new option are the size of employers eligible to buy into the new plan and the provider payment levels used for reimbursement under the plan.[1]
These key issues are bound to be contentious in the upcoming debate over health care reform.[2] The Obama campaign proposal would have made individuals without employer coverage, the self-employed, and small employers (defined as fewer than 25 employees) eligible for the public plan. But the President never specified provider payment levels or the method for determining reimbursement rates for doctors, hospitals, and other medical professionals for the thousands of medical services that would be delivered.[3]
Members of Congress and their staffs will thus have to hammer out these crucial details in legislation if a public plan is to be introduced.
Unlevel Playing Field
If Congress creates a public plan modeled on Medicare--as some have previously proposed--the result, of course, would be to undercut any pretense of a promised "level playing field" for competition with private health insurance.[4] Public plan premiums would be 25-40 percent lower than private insurance premiums as the public plan would reimburse providers less than private payers would--and often less than the cost of care delivered.
Payment rates for doctors and hospitals under public programs are set administratively, not by the market. They are, on average, lower than private payment rates for similar care.[5] Medicare provider payments for hospital care are only 71 percent of private rates, while Medicare provider payments for physician care are only 81 percent of private rates.[6] In other words, Medicare payment levels are roughly 19-29 percent lower than private levels.
Congress's ability to impose low provider payments and artificially reduce the cost of the public option compared to private insurance will increase enrollment in the public plan while crowding out, or displacing, existing private coverage.
Loss of Private Coverage
When considering a public plan modeled after Medicare, Lewin finds that the estimated reduction in the number of uninsured does not vary greatly (observing a change of only 800,000 individuals) as eligibility for the plan is extended beyond small employers to employers of all sizes.[7] Instead, there is a substantial increase in enrollment in the public plan and in the loss of private coverage.
If the public plan were opened to only small employers, enrollment in the public plan would reach 42.9 million, and 32 million Americans would lose their private coverage.[8] However, if the public plan is opened to all employers, enrollment in the public plan increases dramatically to 131.2 million, and 119.1 million Americans would lose their private coverage.[9] In this particular case, of the 171.6 million people who currently have private coverage, about 70 percent of them would lose the coverage that they have today.[10]
More specifically, of the estimated 157.4 million Americans who have private employer coverage, up to 107.6 million people could lose their private employer coverage, even if they like it and would prefer to keep it.[11]
Imposing Higher Costs on Individuals and Families
Increased enrollment in a new public plan would likely result in higher premiums for those with private insurance.
Historically, public programs--specifically Medicare and Medicaid--have reimbursed providers at levels below the costs of their services. For example, in 2003, on average, Medicare paid hospitals only 95 percent of the cost of providing services, while Medicaid paid hospitals only 89 percent of the cost of providing services.[12] These below-cost payments in public programs are at least in part offset by above-cost reimbursements to providers by private payers--as evidenced by hospital reimbursements to the tune of 122 percent of costs in 2003.[13] This cost-shift, in turn, inflates private health insurance premiums for individuals and families.[14]
The cost-shift dynamic plays a prominent role in the health care sector. A study by the actuarial firm Milliman calculated that public programs currently shift $88.8 billion in costs onto private payers per year, increasing the typical American family's annual private health insurance premium by $1,512, or 10.6 percent.[15] Moreover, Lewin speculates that a new public plan could increase the annual cost-shift per privately insured by as much as $526, which will only serve to further perpetuate the crowd-out of private insurance.[16]
Lower Incomes for Physician and Hospitals
A new public plan could also significantly reduce provider incomes. As more people gain insurance, physicians and hospitals would benefit from decreased levels of uncompensated care. However, the increase in public coverage along with new demands to provide services to the newly insured could outweigh any increased revenues from reductions in uncompensated care.
If all employers become eligible for the public plan, the annual net income of hospitals could fall by $36 billion while the annual net income of physicians could drop by $33.1 billion. Increasing demands on health care providers coupled with decreasing provider incomes could compromise patients' access to high-quality care. Faced with low reimbursement, doctors are already reportedly opting out of Medicare--a problem that is likely to be exacerbated with the creation of a new public plan.[17]
Consider the Consequences
Discussions surrounding the creation of a new public plan, based on Medicare and intended to compete with private health plans, have not adequately considered the potential consequences for patients and providers.
Creating a new public health plan option is likely in direct conflict with the many promises Congress and the Obama Administration have made regarding health reform.
While many claim that a public plan would merely represent an alternative choice to private health plans operating on "a level playing field," the reality is that Congress will use the government's power to artificially deflate the cost of the public plan by lowering provider reimbursement rates.
It has been suggested repeatedly that if Americans like their health plan they can keep it and that nothing would change except that they would pay less. But the creation of a new public plan modeled on Medicare could result in the loss of the private coverage that millions have today by undermining the current system of employer-sponsored insurance. Those who are actually able to keeping their private insurance will likely be forced to pay more--not less--to cross-subsidize the public plan.
While patients have been ensured their choice of doctor and care without government interference, great uncertainties remain regarding what the future holds for the doctor-patient relationship as millions of Americans are pushed into a new public plan.
The Devil Is in the Details
It is unlikely that Congress and the President will be able enact a major overhaul of the health care system that both includes a new public health insurance option and meets their many oft-stated promises.
When it comes to health care policy, what politicians promise is less important than the details of their policy prescriptions. Watch carefully.
Greg D'Angelo is Policy Analyst in the Center for Health Policy Studies at The Heritage Foundation.
[1]The Lewin Group, "Opening a Buy-In to a Public Plan: Implications for Premiums, Coverage and Provider Reimbursement," February 11, 2009, at http://www.lewin.com/content/publications/OpeningBuyInPublicPlan.pdf (June 11, 2009); see alsothe Lewin Group, "The Cost and Coverage Impacts of a Public Plan: Alternative Design Options," April 6, 2009, at http://www.lewin.com/content
/publications/LewinCostandCoverageImpactsofPublicPlan-Alternative%
20DesignOptions.pdf (June 11, 2009).
[2]President Barack Obama, letter to Senators Edward M. Kennedy and Max Baucus, June 3, 2009, at http://www.whitehouse.gov/the_press_office/Letter-f
rom-President-Obama-to-Chairmen-Edward-M-Kennedy-and-Max-Baucus/ (June 11, 2009). See also Robert Pear, "2 Democrats Spearheading Health Bill Are Split,"The New York Times, May 30, 2009, at http://www.nytimes.com/2009/
05/30/health/policy/30health.html (June 11, 2009); Robert Pear, "Kennedy and Baucus ‘Seek Common Ground' on Health Care Legislation," The Caucus, May 30, 2009, at http://thecaucus.blogs.nytimes.com/
2009/05/30/kennedy-and-baucus-seek-common-ground-on-health-care-
legislation/?hp (June 11, 2009); "Text of a letter from Republicans on the Senate Finance Committee to the President," U.S. Senate, June 5, 2009, at http://www.heritage.org/Research/HealthCare/upload/
6509No_Public_Plan_SFCLetter.pdf (June 11, 2009).
[3]See Obama for America, "Barack Obama and Joe Biden's Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage for All," at http://www.barackobama.com/pdf/issues/Health careFullPlan.pdf (June 11, 2009); The Lewin Group, "McCain and Obama Health Care Policies: Cost and Coverage Compared," October 15, 2008, pp. ES1-ES4, 5, 21, and Appendix B (B20-B27), at http://www.lewin.com/content/publications/TheLewinGroupMcCain-
ObamaHealthReformAnalysisRev10-15-08.pdf (June 11, 2009).
[4]Cathy Schoen, Karen Davis, and Sara R. Collins, "Building Blocks for Reform: Achieving Universal Coverage with Private and Public Group Health Insurance," Health Affairs, Vol. 27, No. 3 (May 2008), at http://content.healthaffai
rs.org/cgi/content/abstract/27/3/646 (June 11, 2009); Cathy Schoen, Karen Davis, and Sara R. Collins, "The Building Blocks of Health Reform: Achieving Universal Coverage and Health System Savings," Commonwealth Fund, May 2008, at http://www.commonwealthfund.org/~/media/Files/Publications/Issue
%20Brief/2008/May/The%20Building%20Blocks%20of%20Health%20Reform%20%
20Achieving%20Universal%20Coverage%20and%20Health%20System%
20Savings/Davis_buildingblocks_1135_ib%20pdf.pdf (June 11, 2009); Commonwealth Commission on a High Performance Health System, "The Path to a High Performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way," February 2009, at http://www.commonwealthfund.org/Cont
ent/Publications/Fund-Reports/2009/Feb/The-Path-to-a-High-Performance-U
S-Health-System.aspx (June 11, 2009); "A Path to a High Performance U.S. Health System: Technical Documentation," prepared by The Lewin Group for the Commonwealth Fund, February 19, 2009, at http://www.lewin.com/content/publications/LewinPATHTechnical
Documentation.pdf (June 11, 2009).
[5]Congressional Budget Office, "Key Issues in Analyzing Major Health Insurance Proposals," December 2008, pp. XIX, 91-97, at http://www.cbo.
gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf(June 11, 2009).
[6]Ingenix Consulting in partnership with the Lewin Group, "The Obama Health Reform Proposal: Impact on Payers," December 8, 2008, p. 7. See also two other studies by the same authors: "The Obama Health Reform Proposal: Impact on Providers," December 9, 2008, p. 4;"The Obama Health Reform Proposal: Impact on Employers," December 16, 2008, p. 3, 5-6.
[7]John Sheils, the Lewin Group, "The Cost and Coverage Impacts of a Public Plan," testimony before the Committee on Ways and Means, U.S. House of Representatives, April 29, 2009, at http://www.lewin.com/content/publications/
Testimony_April_29,_2009.pdf (June 11, 2009).
[8]Ibid.
[9]Ibid.
[10]Ibid.
[11]Ibid.
[12]The Lewin Group, "Opening a Buy-In to a Public Plan"; see also Allen Dobson, Joan DaVanzo, and Namrata Sen, "The Foundation, History and Implications of the Cost-Shift Hydraulic," the Lewin Group, July 15, 2005, at http://www.fah.org/fahCMS/Documents/Future%20of%20Hospital%20Care/Dobson%
20slides%207.7.05%20History%20and%20Foundation%20of%20the%20Cost-Shift.pdf (June 11, 2009); Allen Dobson, Joan DaVanzo, and Namrata Sen, "The Cost-Shift Payment ‘Hydraulic': Foundation, History, and Implications," Health Affairs, Vol. 25, No. 1 (January 2006), at http://content.healthaffairs.org/cgi/conten
t/abstract/25/1/22 (June 11, 2009).
[13]Ibid. Lewin suggests MedPAC data indicate that this cost-shifting hydraulic may have accelerated in recent years. As hospital payments declined to 91 percent of costs by 2007, over the same time private payer rates increased to 132 percent of costs.
[14]The Lewin Group, based on its analysis of the available cost-shift literature, concludes that about 40 percent of the costs of low public payments and uncompensated care are passed on to the privately insured in the form of higher prices.
[15]Will Fox and John Pickering, "Hospital and Physician Cost Shift: Payment Level Comparison of Medicare, Medicaid, and Commercial Payers," Milliman, December 2008, pp. 2-4, at http://www.milliman.com/expertise/healthcare/p
ublications/rr/pdfs/hospital-physician-cost-shift-RR12-01-08.pdf (June 11, 2009).
[16]Figure assumes Medicare payment rates and all employers eligible for the public plan. See Sheils, "The Cost and Coverage Impacts of a Public Plan."
[17]Julie Connelly, "Doctors Are Opting out of Medicare," The New York Times, April 1, 2009, at http://www.nytimes.com/2009/04/02/business/
retirementspecial/02health.html?_r=1 (June 11, 2009).
http://www.heritage.org/Research/HealthCare/wm2482.cfm
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*The cost-shift dynamic plays a prominent role in the health care sector. A study by the actuarial firm Milliman calculated that public programs currently shift $88.8 billion in costs onto private payers per year, increasing the typical American family's annual private health insurance premium by $1,512, or 10.6 percent.[15] Moreover, Lewin speculates that a new public plan could increase the annual cost-shift per privately insured by as much as $526, which will only serve to further perpetuate the crowd-out of private insurance.[16]*
Milliman again (see my previous post).
This makes sense. Someone has to pay for all the medicaid that doesn't cover a providers costs. I doubt doctors lose money on medicare. I am not sure about whether or not hospitals do.
One can only imagine the cost shifts to the rest of the country when we start subsidizing another 40 million.
How many of those are illegals I wonder?
I wonder how many of these are people with pre existing conditions who want insurance but cannot get?
I assume the rest simply can't afford it.
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This piece makes me nervous in that it intimates a behavior modification heavy hand is in order, but it's nice to see this debate framed in empiric rather than idealistic terms.
OPINIONJUNE 12, 2009
How Safeway Is Cutting Health-Care Costs
Market-based solutions can reduce the national health-care bill by 40%.
By STEVEN A. BURD
Effective health-care reform must meet two objectives: 1) It must secure coverage for all Americans, and 2) it must dramatically lower the cost of health care. Health-care spending has outpaced the rise in all other consumer spending by nearly a factor of three since 1980, increasing to 18% of GDP in 2009 from 9% of GDP. This disturbing trend will not change regardless of who pays these costs -- government or the private sector -- unless we can find a way to improve the health of our citizens. Failure to do so will make American companies less competitive in the global marketplace, increase taxes, and undermine our economy.
At Safeway we believe that well-designed health-care reform, utilizing market-based solutions, can ultimately reduce our nation's health-care bill by 40%. The key to achieving these savings is health-care plans that reward healthy behavior. As a self-insured employer, Safeway designed just such a plan in 2005 and has made continuous improvements each year. The results have been remarkable. During this four-year period, we have kept our per capita health-care costs flat (that includes both the employee and the employer portion), while most American companies' costs have increased 38% over the same four years.
Martin Kozlowski
Safeway's plan capitalizes on two key insights gained in 2005. The first is that 70% of all health-care costs are the direct result of behavior. The second insight, which is well understood by the providers of health care, is that 74% of all costs are confined to four chronic conditions (cardiovascular disease, cancer, diabetes and obesity). Furthermore, 80% of cardiovascular disease and diabetes is preventable, 60% of cancers are preventable, and more than 90% of obesity is preventable.
As much as we would like to take credit for being a health-care innovator, Safeway has done nothing more than borrow from the well-tested automobile insurance model. For decades, driving behavior has been correlated with accident risk and has therefore translated into premium differences among drivers. Stated somewhat differently, the auto-insurance industry has long recognized the role of personal responsibility. As a result, bad behaviors (like speeding, tickets for failure to follow the rules of the road, and frequency of accidents) are considered when establishing insurance premiums. Bad driver premiums are not subsidized by the good driver premiums.
As with most employers, Safeway's employees pay a portion of their own health care through premiums, co-pays and deductibles. The big difference between Safeway and most employers is that we have pronounced differences in premiums that reflect each covered member's behaviors. Our plan utilizes a provision in the 1996 Health Insurance Portability and Accountability Act that permits employers to differentiate premiums based on behaviors. Currently we are focused on tobacco usage, healthy weight, blood pressure and cholesterol levels.
Safeway's Healthy Measures program is completely voluntary and currently covers 74% of the insured nonunion work force. Employees are tested for the four measures cited above and receive premium discounts off a "base level" premium for each test they pass. Data is collected by outside parties and not shared with company management. If they pass all four tests, annual premiums are reduced $780 for individuals and $1,560 for families. Should they fail any or all tests, they can be tested again in 12 months. If they pass or have made appropriate progress on something like obesity, the company provides a refund equal to the premium differences established at the beginning of the plan year.
At Safeway, we are building a culture of health and fitness. The numbers speak for themselves. Our obesity and smoking rates are roughly 70% of the national average and our health-care costs for four years have been held constant. When surveyed, 78% of our employees rated our plan good, very good or excellent. In addition, 76% asked for more financial incentives to reward healthy behaviors. We have heard from dozens of employees who lost weight, lowered their blood-pressure and cholesterol levels, and are enjoying better health because of this program. Many discovered for the first time that they have high blood pressure, and others have been told by their doctor that they have added years to their life.
Today, we are constrained by current laws from increasing these incentives. We reward plan members $312 per year for not using tobacco, yet the annual cost of insuring a tobacco user is $1,400. Reform legislation needs to raise the federal legal limits so that incentives can better match the true incremental benefit of not engaging in these unhealthy behaviors. If these limits are appropriately increased, I am confident Safeway's per capita health-care costs will decline for at least another five years as our work force becomes healthier.
The Healthy Measures program currently applies only to our nonunion work force. While we have numerous health and wellness provisions in our union contracts, we are working with union leaders like Joe Hansen of the United Food and Commercial Workers to incorporate healthy measures provisions in our union work force as well.
While comprehensive health-care reform needs to address a number of other key issues, we believe that personal responsibility and financial incentives are the path to a healthier America. By our calculation, if the nation had adopted our approach in 2005, the nation's direct health-care bill would be $550 billion less than it is today. This is almost four times the $150 billion that most experts estimate to be the cost of covering today's 47 million uninsured. The implication is that we can achieve health-care reform with universal coverage and declining per capita health-care costs.
There is a very real possibility that we will see positive transformational health-care reform in the near future. I am encouraged by the effort I see on Capitol Hill, particularly the bipartisan effort in the Senate. While some tough issues remain, if we continue to work in a bipartisan manner I believe we will resolve these issues successfully and find agreement on meaningful reform.
Mr. Burd is CEO of Safeway Inc., and the founder of the Coalition to Advance Healthcare Reform.
http://online.wsj.com/article/SB124476804026308603.html#
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June 15, 2009
Naive, Hypocritical and Dishonest
By Robert Samuelson
WASHINGTON -- It's hard to know whether President Obama's health care "reform" is naive, hypocritical or simply dishonest. Probably all three. The president keeps saying it's imperative to control runaway health spending. He's right. The trouble is that what's being promoted as health care "reform" almost certainly won't suppress spending and, quite probably, will do the opposite.
A new report from Obama's own Council of Economic Advisers shows why controlling health costs is so important. Since 1975, annual health spending per person, adjusted for inflation, has grown 2.1 percentage points faster than overall economic growth per person. Should this trend continue, the CEA projects that:
-- Health spending, which was 5 percent of the economy (gross domestic product, GDP) in 1960 and is reckoned at almost 18 percent today, would grow to 34 percent of GDP by 2040 -- a third of the economy.
-- Medicare and Medicaid, the government insurance programs for the elderly and poor, would increase from 6 percent of GDP now to 15 percent in 2040 -- roughly equal to three-quarters of present federal spending.
-- Employer-paid insurance premiums for family coverage, which grew 85 percent in inflation-adjusted terms from 1996 to $11,941 in 2006, would increase to $25,200 by 2025 and $45,000 in 2040 (all figures in "constant 2008 dollars"). The huge costs would force employers to reduce take-home pay.
The message in these dismal figures is that uncontrolled health spending is almost single-handedly determining national priorities. It's reducing discretionary income, raising taxes, widening budget deficits and squeezing other government programs. Worse, much medical spending is wasted, the CEA report says. It doesn't improve Americans' health; some care is unneeded or ineffective.
The Obama administration's response is to talk endlessly about restraining health spending -- "bending the curve'' is the buzz -- as if talk would suffice. The president summoned the heads of major health care trade groups representing doctors, hospitals, drug companies and medical device firms to the White House. All pledged to bend the curve. This is mostly public relations. Does anyone believe that the American Medical Association can control the nation's 800,000 doctors or that the American Hospital Association can command the 5,700 hospitals?
The central cause of runaway health spending is clear. Hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, either private or governmental. The open-ended payment system encourages doctors and hospitals to provide more services -- and patients to expect them. It also favors new medical technologies, which are made profitable by heavy use. Unfortunately, what pleases providers and patients individually hurts the nation as a whole.
That's the crux of the health care dilemma, and Obama hasn't confronted it. His emphasis on controlling costs is cosmetic. The main aim of health care "reform" now being fashioned in Congress is to provide insurance to most of the 46 million uncovered Americans. This is popular and seems the moral thing to do. After all, hardly anyone wants to be without insurance. But the extra coverage might actually worsen the spending problem.
How much healthier today's uninsured would be with that coverage is unclear. They already receive health care -- $116 billion worth in 2008, estimates Families USA, an advocacy group. Some is paid by the uninsured themselves (37 percent), some by government and charities (26 percent). The remaining "uncompensated care" is either absorbed by doctors and hospitals or shifted to higher private insurance premiums. Some uninsured would benefit from coverage, but others wouldn't. Either they're healthy (40 percent are between ages 18 and 34) or would receive ineffective care.
The one certain consequence of expanding insurance coverage is that it would raise spending. When people have insurance, they use more health services. That's one reason why Obama's campaign proposal was estimated to cost $1.2 trillion over a decade (the other reason is that the federal government would pick up some costs now paid by others). Indeed, the higher demand for health care might raise costs across the board, increasing both government spending and private premiums.
No doubt the health program that Congress fashions will counter this reality by including some provisions intended to cut costs ("bundled payments" to hospitals, "evidence-based guidelines," electronic record keeping). In the past, scattershot measures have barely affected health spending. What's needed is a fundamental remaking of the health care sector -- a sweeping "restructuring"-- that would overhaul fee-for-service payment and reduce the fragmentation of care.
The place to start would be costly Medicare, the nation's largest insurance program serving 45 million elderly and disabled. Of course, this would be unpopular, because it would disrupt delivery patterns and reimbursement practices. It's easier to pretend to be curbing health spending while expanding coverage and spending. Presidents have done that for decades, and it's why most health industries see "reform" as a good deal.
Copyright 2009, Washington Post Writers Group
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Price controls worked so well for Nixon, Ford, Carter, and the Soviet Union for that matter that it appears its time has come once again.
Price Controls "Pay" for President Obama's Health Care Reforms
Ronald Bailey | June 15, 2009, 3:12pm
Today in a speech before the American Medical Association, President Barack Obama outlined how he plans to raise the $1 trillion necessary to pay for his proposed health care reform agenda over the next decade. First, the president cited his $635 billion health reserve fund as the famous "down payment" for his reform agenda. About half - $300 billion - of this aspirational reserve fund is "paid for" by capping the tax breaks on charitable deductions of rich Americans to 28 percent. Never mind that this proposed tax hike has yet to pass Congress and that many key Democratic leaders on Capitol Hill oppose it.
Another chunk of the notional Health Reserve Fund will come from reducing payments - $177 billion - to private Medicare Advantage companies that provide insurance coverage for about 10 million Medicare beneficiaries. The president also plans to reduce hospital Medicare reimbursements by $25 billion over the next ten years. Another $30 billion is accounted for by charging wealthier Medicare beneficiaries more for their drugs.
In his weekly radio address and his speech today, President Obama claimed to have found an additional $313 billion in Medicare and Medicaid savings over the next ten years which will help pay for his $1 trillion health care reform agenda. These savings include a cut of $109 billion in payments to physicians based on recalculating the federal government's productivity payment formula.
Another $106 billion will come from cuts in payments to hospitals for treating uninsured people. The argument here is that once the reforms are enacted there won't be many uninsured people seeking uncompensated services at hospitals. This gambit may "save" money for Medicare and Medicaid, but some other agency or enterprise will be paying for the hospital services that the newly insured receive. Isn't this shifting the pots from which $106 billion will come rather than reducing overall spending on hospital care? Isn't it likely that a good part of the $106 billion will have to come from the president's proposed government insurance scheme?
More "savings" of $75 billion that could used to "pay for" President Obama's health care reforms would come from "more efficient purchasing" of prescription drugs. The Medicare Part D prescription drug plan was adopted in 2003 with a non-interference clause that promised that the federal government would not impose price controls on pharmaceuticals. Of course, when Medicare was established in 1965, the government made the same promise to physicians and hospital then. I suspect that "more efficient purchasing" is just a nicer way of saying "price controls." And it should be noted that according to the president, "we can save about one billion more by rooting out waste, abuse, and fraud throughout our health care system." Just a billion?
After parsing the numbers, it looks as though most the "savings" that President Obama wants to use to finance his health care reforms are achieved by imposing price controls.
It must be asked: can federal government "savings" projected over a decade really be credible in any case? Recall that in December 2000, the Clinton administration declared that "the United States can be debt-free this decade. By dedicating the entire budget surplus to debt reduction, the United States can eliminate its publicly held debt by FY 2009."
It is undeniable that health care in America needs massive reform. But the best step toward health care reform would be to begin unwinding our dysfunctional system of third party insurance payments and shifting toward consumer driven health care. But President Obama has made it clear that it not the direction he intends to go.
http://www.reason.com/blog/show/134126.html
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June 16, 2009, 3:38 PM
Democrats Defend Health Care Plans, Despite Cost Estimate
By DAVID M. HERSZENHORN AND ROBERT PEAR
Senate Democrats and the White House struggled on Tuesday to respond to an initial financial analysis by the Congressional Budget Office showing that a main proposal for overhauling health care would cost $1 trillion over 10 years but would leave 36 million Americans uninsured.
The preliminary analysis by the budget office, a nonpartisan number-crunching agency, showed Democrats falling far short of their goal, which is to provide insurance to all Americans and offset the expense of doing so with new taxes or cost savings. And Republicans quickly seized on the figures to charge that the Democrats’ efforts would fail.
In trying to answer both the Republican criticism and basic questions about the cost analysis, the Democrats exposed deep internal disagreements over how to pay for revamping the health care system, with some pushing to tax employer-provided health benefits above a pre-set limit, and others preferring tax increases outside the health arena.
Despite the challenges presented by the cost estimates for its sweeping bill, the Senate health committee said it would proceed on Wednesday with its first public work on the legislation.
“Obviously, we thought we’d get better numbers based on earlier work that was done, but this can’t stop you,” said Senator Christopher J. Dodd, Democrat of Connecticut, who is leading the efforts on the committee. “You have to move ahead and dealing with it accordingly and getting additional numbers where you can.”
The Senate Finance Committee, which is developing its own bill, said it would delay releasing a detailed description of its proposal for several days, partly out of concern over cost estimates from the budget office.
The cost study provided ready ammunition to critics, including the Republican Senate leader, Mitch McConnell of Kentucky.
“Preliminary estimates for this flawed legislative proposal are staggering,” Mr. McConnell said in a speech on the Senate floor. “The health care proposal being put together is not only extremely defective, it will cost a fortune. And that cost will come straight out of the taxpayer’s pocketbook.”
Mr. Dodd and other leaders of the Senate health committee argued at a news conference that the spending analysis did not factor in major components of the legislation that have yet to be made public, including a proposal for a new government-run insurance program that they said would save billions of dollars.
The Democrats, however, had no answers for several other concerns raised by the analysis, including the projection that the plan would leave 36 million people uninsured. The analysis also cast doubt on the Democrats’ claim that no one will lose coverage they now enjoy, concluding that 11 million people would change plans, for better or worse.
The cost-analysis also revealed some other potential consequences of the Health committee bill, including the possibility that some children could end up shifted off of Medicaid and the Children’s Health Insurance Program, which provide comprehensive health coverage, and instead be required to obtain new insurance with less extensive benefits. Advocates for children were already gearing up to fight that change.
The White House press secretary, Robert Gibbs, said on Tuesday afternoon: “One incomplete older proposal I don’t think is indicative of where we are now.”
But expanding coverage without adding to the deficit is looking like a steeper challenge than even many of the leading proponents of a health care overhaul had imagined.
Mr. Dodd and other Democrats complained that the budget office analysis did not reflect hundreds of billions of dollars in anticipated savings as broad structural changes in the system yield more efficient and cost-effective services. As a practical matter, however, Congress must abide by the budget office figures.
But Democrats are deeply divided over how to pay for their plan.
Mr. Dodd said he was opposed to taxing employer-provided benefits and would prefer other proposals, including limits on tax deductions for the highest wage-earners proposed by President Obama earlier this year, including some limits on the deduction of charitable donations.
Members of the Senate Finance Committee, including its chairman, Senator Max Baucus, Democrat of Montana, are developing a proposal that would tax employer-provided benefits. And Mr. Baucus said he believes that Mr. Obama would be open to the proposal, even though the president opposed the idea while campaigning for office.
Senator Tom Harkin, Democrat of Iowa, and a member of the health committee, said he was not necessarily opposed to taxing health benefits but that new taxes on unhealthy foods, including perhaps sodas and other high-sugar foods, might be appropriate.
http://thecaucus.blogs.nytimes.com/2009/06/16/democrats-defend-health-care-plans-despite-cost-estimate/
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The following is a draft of a speech titled "The Obama Years: A Reappraisal" that mysteriously was never delivered at the 2070 national meeting of the Institute of Advanced Obamalogy:
So it came to pass in the waning days of the health-care wars that Democrats learned the American people really didn't want a nationalized health-care industry.
The Obama administration's "public option," which all knew to be a vote for a government takeover, proved a drink too stiff for four or five Democratic senators whose re-election was not in the bag.
President Obama applauded himself for achieving "85% of what we set out to accomplish." But pundits and wonks were in despair. They retreated to their watering holes and cried into their Stoli martinis. The cause of their lives was over. A once-in-a-generation opportunity had been muffed. Without a massive bill in Congress, with many titles and subtitles and subchapters, they moaned, there was no hope for fixing all that ailed the American health-care system.
But politics went on, and while the armies of wonkdom mourned, three little-known congressmen (Eric Paul, Ryan Cantor and Kemp Newtley) discovered an unexpected public enthusiasm for a flat tax.
Through incessant Twittering over the heads of the media, they persuaded millions of voters they'd be better off with lower rates even if it meant giving up tax-free employer provided health insurance. It didn't hurt, either, that the wailing of insurance and medical lobbyists was over-the-top -- convincing voters that the tax benefit really was just a form of corporate welfare disguised as a mostly illusory benefit for individuals.
Though the realization was slow in dawning, policy experts would eventually rediscover what they had known all along (but had conveniently forgotten in order to lend their voices to "solutions" that required ever more government spending) -- that tax reform, in the American context, is health-care reform.
And, lo, it proved true, as 100 million intelligent, well-educated employees of Corporate America were allowed to see for the first time what "tax free" health insurance was really costing them. They saw how it distorted their behavior and caused them to allocate far more of their incomes to the medical-industrial complex than they would have chosen for themselves.
Eyes newly opened, they demanded cheaper insurance options, covering fewer services (cancer wigs, family counseling, in-vitro fertilization), and opted for plans with higher deductibles and co-pays in return for much lower monthly rates.
Because consumers were now spending their "own" money on health care, doctors and hospitals found it necessary to publish and even advertise their prices. A hospital that specialized in heart surgery, performing thousands of procedures a year, found it had both the highest quality and lowest cost -- and now marketed itself as such. Ditto specialists in cancer, diabetes and other conditions.
For the first time, Americans spent less and got more. Spending fell overnight by 13%, which happened to be exactly what economists had predicted if the price tags were restored to health care and consumers were allowed to see clearly what they were getting (or not getting) for their money. As predicted, too, spending thereafter rose only in line with incomes.
What's more, many fewer people remained voluntarily uninsured now that health insurance was no longer a gold-plated extravagance affordable only by those in the top brackets who could slough off 40% of the cost on other taxpayers. Existing programs for the needy, in turn, could be downsized and revamped into voucher programs. The federal budget benefited twice over -- from fewer claimants and from medical care that was less costly. Fiscal wreck was avoided.
In truth, President Obama had been little involved to this point. Following his early domestic "successes," he was spending more and more time abroad sharing his matchless eloquence with previously unblessed audiences from Ulan Bator to Ouagadougou.
A highly symbolic moment, however, came when Mr. Obama, who had put on weight in office and now tipped the scales at nearly 300 pounds, returned from a speaking tour on the virtues of nonproliferation to audiences in the Islamic Republic of Palau. Having overindulged in local delicacies, he was surprised when the White House medical office handed him a Wal-Mart debit card and sent him to a nearby Wal-Mart supercenter boasting "Everyday Low Prices on Gastric Bypass Surgery."
Emerging afterward to the usual crowd of ululating network reporters and bloggers, Mr. Obama pronounced himself entirely pleased and satisfied with the "success of my health-care reforms."
And so it came to pass that historians and Obamalogists would count health-care reform among the incomparable triumphs of the Obama administration, and lost to history would be the names of Eric Paul, Ryan Cantor and Kemp Newtley.
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Sen. Kennedy’s Budget-Breaking “Reform” Bill
Posted by Doug Bandow
It appears that the Obama administration has decided to disown the venerable Senator. No wonder. The Congressional Budget Office estimated the ten-year cost of Sen. Kennedy’s bill at $1 trillion, but admitted that its analysis was incomplete.
Now the consulting group HSI Network, LLC comes foward with an estimate of $4 trillion:
The Senate Committee on Health, Education, Labor and Pensions (HELP) have proposed a health reform bill called the Affordable Health Choice Act (AHC) that seeks to reduce the number of uninsured and increase health system efficiency and quality. The draft legislation was introduced on June 9th, 2009. The proposal provided adequate information to suggest what the impact would be of AHC using the ARCOLA™ simulation model. AHC would include an individual mandate as well as a pay or plan provision. In addition, it would include a means-tested subsidy with premium supports available for those up to 500% of the federal poverty level. Public plan options in three tiers: Gold, Silver and Bronze are proposed in a structure similar to that of the Massachusetts Connector, except that it is called The Gateway. These public plan options would contain costs by reimbursing providers up to 10% above current reimbursement rates. There is no mention of removing the tax exclusion associated with employer sponsored health insurance. There is also no mention of changes to Medicare and Medicaid, other than fraud prevention, that could provide cost-savings for the coverage expansion proposed. Below, we summarize the impact of the proposed plan in terms of the reduction on uninsured, the 2010 cost, as well as the ten year cost of the plan in 2010 dollars.
HELP Affordable Health Choices Act
Uninsurance is reduced by 99% to cover approximately 47,700,000 people
Subsidy - Tax Recovery = Net cost:
$279,000,000,000 subsidy to the individual market
$180,000,000,000 subsidy to the ESI market with
Net cost: $460,500,000,000 (annual)
Net cost: $4,098,000,000,000 (10 year)
Private sector crowd out: ~79,300,000 lives
HSI figures that a lot more people will take advantage of federal health insurance subsidies, driving costs up far more than indicated by the CBO figure. (H/t to Phil Klein at the American Spectator online.)
Of course, no one knows what the bill would really cost in operation. But the history of social insurance and welfare programs is sky-rocketing expense well beyond original projections. Go back and look at the initial cost estimates for Medicare and Social Security, and you will run from the room simultaneously laughing and crying.
Health care reform would be serious business at any moment of time, but especially when the country faces $10 trillion in new debt over the next decade on top of the existing $11 trillion national debt. And with the $100 trillion Medicare/Social Security financial bomb lurking in the background, rushing to leap off the financial cliff with this sort of health care legislation would be utterly irresponsible.
http://www.cato-at-liberty.org/2009/06/18/sen-kennedys-budget-breaking-reform-bill/
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Wow, when CNBC starts questioning the numbers being bandied by those foisting Obamacare the terms of the debate are surely changing.
http://www.cnbc.com/id/15840232?video=1158405259&play=1
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Second post:
Medical Analysis By Milton Friedman
Peter Robinson, 06.19.09, 12:01 AM ET
President Obama, the press, all the Democrats and a fair number of the Republicans in Congress share the same assumption about health care. Whatever you believe should be done about the problem, it sure is complicated.
Yet one man figured it out.
In 2001 the economist Milton Friedman read up on health care, discovered that the inefficiencies in our system trace back to a single policy mistake, worked out a policy test that would help us correct it and then described his findings in a few thousand words of plain English.
Since the end of the Second World War, Friedman explained, medical care in the U.S. has displayed three features: technological advances, increases in spending and rising dissatisfaction.
The first of the three was common to one sector of the economy after another. Agriculture, manufacturing, electronics, communications--all had experienced technological progress. Yet the two final features proved unique to health care. While we were paying less and getting more when buying food or computers, in health care the opposite was happening.
Why?
Because, Friedman saw, most payments for medical care are made not by the patients who receive the care but by third parties, typically employers. Since, in Friedman's phrase, "nobody spends somebody else's money as wisely as he spends his own," this third-payer system by its very nature introduces inefficiencies throughout the health care system.
The reason for this wasteful third-party system? The tax code. Money spent on health care is exempt from the income tax only if the health care is provided through an employer. "We have become so accustomed to employer-provided medical care," Friedman wrote, "that we regard it as part of the natural order. Yet it is thoroughly illogical."
The policy mistake that produced this illogical mess took place during World War II, when the government imposed wage controls. Unable to compete for workers by paying them more, employers began providing medical care, and the new benefit spread rapidly.
When the Internal Revenue Service caught on, requiring employers to include the value of medical benefits as part of the wages they reported, workers, who had grown accustomed to the benefits, protested. Congress responded with legislation that made employer-provided medical benefits tax-exempt.
By the time the 1960s arrived, Americans were used to having third parties pay their medical bills. Thus the enactment of Medicare and Medicaid--under which the government, rather than employers, acted as the third party--seemed perfectly reasonable.
Friedman wrote: "Third-party payment has required the bureaucratization of medical care. ... A medical transaction is not simply between a caregiver and a patient; it has to be approved as 'covered' by a bureaucrat. ... The patient has little ... incentive to be concerned about the cost since it's somebody else's money. The caregiver has become, in effect, an employee of the insurance company or, in the case of Medicare and Medicaid, of the government. ... An inescapable result is that the interest of the patient is often in direct conflict with the interest of the caregiver's ultimate employer."
In that one paragraph of under 100 words, a diagnosis of our ailment.
What should we do about it? Ideally, Friedman argued, we should reverse the mistake that started all the trouble, repealing the tax exemption of employer-provided medical care. Yet Friedman was a realist. Vested interests, he recognized, would make such a radical reform impossible. Instead he believed we should seek incremental changes, asking of each proposal simply whether it would move health care "in the right direction."
Expanding savings accounts that allow individuals control over relevant spending, Friedman argued, would move health care in the right direction. So would extending the tax exemption to all medical expenses, whether they are paid by employers or individuals. A "sweeping socialization of medicine [such as that] proposed by Hilary Clinton"--and, now, by Barack Obama--would not.
Wherever possible, reduce the role of third parties. Increase the autonomy of individuals. Get the government and vast, bureaucratic insurance companies out of the way, permitting the free market to work its effects in health care, just as it does in virtually every other sector of the economy.
That's not too complicated, now, is it?
Peter Robinson, a research fellow at the Hoover Institution at Stanford University and contributor to RobinsonandLong.com, writes a weekly column for Forbes.
http://www.forbes.com/2009/06/18/milton-friedman-medical-insurance-opinions-columnists-health-care.html
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By DAVID B. RIVKIN JR. and LEE A. CASEY
Is a government-dominated health-care system unconstitutional? A strong case can be made for that proposition, based on the same "right to privacy" that underlies such landmark Supreme Court decisions as Roe v. Wade.
The details of this year's health-care reform bill are still being hammered out. But the end result is sure to be byzantine in complexity. Washington will have immense say over how, when and through whom Americans are treated. Moreover, despite the administration's public pronouncements about painless cuts in wasteful spending, only the most credulous believe that some form of government-directed health-care rationing can be avoided as a means of controlling costs.
The Supreme Court created the right to privacy in the 1960s and used it to strike down a series of state and federal regulations of personal (mostly sexual) conduct. This line of cases began with Griswold v. Connecticut in 1965 (involving marital birth control), and includes the 1973 Roe v. Wade decision legalizing abortion.
The court's underlying rationale was not abortion-specific. Rather, the justices posited a constitutionally mandated zone of personal privacy that must remain free of government regulation, except in the most exceptional circumstances. As the court explained in Planned Parenthood v. Casey (1992), "these matters, involving the most intimate and personal choices a person may make in a lifetime, choices central to personal dignity and autonomy, are central to the liberty protected by the Fourteenth Amendment. At the heart of liberty is the right to define one's own concept of existence, of meaning, of the universe, and the mystery of human life."
It is, of course, difficult to imagine choices more "central to personal dignity and autonomy" than measures to be taken for the prevention and treatment of disease -- measures that may be essential to preserve or extend life itself. Indeed, when the overwhelming moral issues that surround the abortion question are stripped away, what is left is a medical procedure determined to be "necessary" by an expectant mother and her physician.
If the government cannot proscribe -- or even "unduly burden," to use another of the Supreme Court's analytical frameworks -- access to abortion, how can it proscribe access to other medical procedures, including transplants, corrective or restorative surgeries, chemotherapy treatments, or a myriad of other health services that individuals may need or desire?
This type of "burden" analysis will be especially problematic for a national health system because, in the health area, proper care often depends upon an individual's unique physical and even genetic history and characteristics. One size clearly does not fit all, but that is the very essence of governmental regulation -- to impose a regularity (if not uniformity) in the application of governmental power and the dispersal of its largess. Taking key decisions away from patient and physician, or otherwise limiting their available choices, will render any new system constitutionally vulnerable.
It is true, of course, that forms of rationing already exist in our current system. No one who has experienced the marked reluctance to treat aggressively lethal illnesses in the elderly can doubt that. However, what may be permissible for private actors -- including doctors and insurance companies -- is not necessarily lawful when done by the government.
Obviously, the government does not have to pay for any and all services individual citizens may desire. And simply refusing to approve a procedure or treatment under applicable reimbursement rules, as under the government-run Medicare and Medicaid, does not make the system unconstitutional. But if over time, as many critics fear, a "public option" health insurance plan turns into what amounts to a single-payer system, the constitutional issues regarding treatment and reimbursement decisions will be manifold.
The same will be true of a quasi-private system where the government claims a large role in defining acceptable health-insurance coverage and treatments. There will be all sorts of "undue burdens" on the rights of patients to receive the care they may want. Then the litigation will begin.
Anyone who imagines that Congress can simply avoid the constitutional issues -- and lawsuits -- by withdrawing federal court jurisdiction over the new health system must think again. A brief review of the Supreme Court's recent war-on-terror decisions, brought by or on behalf of detained enemy combatants, will disabuse that notion. This area of governmental authority was once nearly immune from judicial intervention. Over the past five years, however, the Supreme Court (supposedly the nonpolitical branch) has unapologetically transformed itself into a full-fledged, policy-making partner with the president and Congress.
In the process, the justices blew past specific congressional efforts to limit their jurisdiction and involvement like a hot rod in the desert. Questions of basic constitutionality (however the court may define them) cannot now be shielded from judicial review.
It is, of course, impossible to predict how and when the courts will ultimately rule on the new health system. Much depends on the details and the extent to which reasonable and practical private alternatives to the national plan remain. In crafting the law, however, its White House and congressional sponsors must keep privacy -- that near absolute right to personal autonomy they have so often praised and promoted -- squarely before them. The only thing that is certain today is that the courts, and not Congress, will have the last word.
Messrs. Rivkin and Casey worked in the Justice Department under Presidents Reagan and George H.W. Bush.
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Bringing Down the House
The sobering lessons of health reform in Massachusetts.
By Darshak Sanghavi
Posted Tuesday, June 23, 2009, at 6:45 AM ET
The debate over achieving universal health care can seem hopelessly confusing. But the issues are actually pretty simple when you consider the lessons of Massachusetts.
In 2006, state lawmakers seeking to broaden health coverage made it illegal to be uninsured. It works like this: Employers have to offer you a health plan. If you are jobless or don't like your employer's plan, you must buy your own. If you don't get one, you pay a stiff fine. This strategy—known as an employer and individual "mandate"—forms the backbone of the national health reform bills now making their way through Congress.
On paper, the experiment was a resounding success. According to an Urban Institute estimate, the number of uninsured residents quickly fell from 13 percent to 7 percent following the law's passage.
And yet, something strange happened. Despite having health insurance, roughly one in 10 state residents still failed to fill prescriptions, ended up with unpaid medical bills, or skipped needed medical care for financial reasons. Hundreds of millions of dollars were spent to insure more Massachusetts citizens, but many people still weren't getting necessary care. What happened?
Assume you're looking to buy insurance. The state has a handy Web site where you can find the cheapest plan. For a young family of four, that plan costs roughly $9,500 per year, which doesn't include a minimum annual deductible of $3,500 before many benefits kick in. (The state helps cover some of the premiums for those who make very little money, but many still have to pay the other fees.) And if anyone is hospitalized or needs a lot of specialized care, you also pay 20 percent of that bill. In this relatively cheap plan, the family can be liable for an extra $10,000 per year of medical costs. This sort of "high deductible" health plan is clearly structured to discourage medical care.
Imagine, for example, that your homeowner's insurance had a $1,000 deductible. If the faucet leaks, you'll try to fix it yourself instead of calling the plumber. The same thing applies to health care. If your newborn has a fever, you might give her Tylenol and just hope there's no serious infection rather than head to the emergency room and face a hefty co-pay.
Why does a progressive state like Massachusetts strong-arm many individuals and businesses into buying expensive insurance plans that don't encourage actual visits to the doctor and hospital? According to the Kaiser Family Foundation, the average person consumes more than $5,000 per year in health care resources. No matter how you slice it, some entity—government, business, or the individual—owes a boatload of cash for medical expenses. The annual costs for the 500,000 or so uninsured Massachusetts residents would run more than $2.5 billion, far in excess of the original state subsidy of $559 million.
That left billions to be paid by businesses and individuals. So for them, a high-deductible plan was a rational gamble. You (or your employer) front just enough money to get some coverage in case of catastrophe and then hope no one actually gets sick. But someone invariably does. As a result, out-of-pocket medical bills are the leading cause of bankruptcies—even though of most affected families actually have health insurance.
The expensive Massachusetts plan is not well-designed to systematically improve anyone's health. Instead, it's a superficial effort to clear the uninsured from the books and then clumsily limit further costs by discouraging care.
This brings us to the real task facing health reformers in our nation. Atul Gawande recently observed that for too long we've been "arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks." What's more important are the doctors who write the bills. The more procedures they do, the more money they make. To fix medicine, he argues, we have to create better incentives for doctors to do right by patients instead of their own bank accounts.
But that's not the whole story. Health care costs are rising everywhere, even in places like Minnesota, which Gawande cites as a prime example of low-cost, high-quality care that should be replicated nationwide. (Per capita health spending is actually 25 percent higher in Minnesota than in Texas, which has a hospital system that Gawande criticizes for profiteering.) In Massachusetts, some employers offering high-quality plans have annual rate increases of 10 percent to 15 percent. These jumps are certainly due to some overuse of services but also indicate increasingly high-technology care.
The lesson of Massachusetts is that really good health care is also really expensive. The concern isn't who writes the checks or who writes the bills. The real question is who makes the tough decisions about the limits of the checks and bills—in other words, who ultimately rations the money. Not everybody can have everything, and the sooner we admit that, the sooner our health care debate will get realistic.
In the haphazard Massachusetts plan, rationing fell to individuals, who then skimped on important prescriptions and routine visits. Gawande would leave rationing to properly incentivized doctors, but we have no data about whether this can be done widely. Others advocate for bodies like the Medicare Payment Advisory Commission (an impartial medical Federal Reserve Board), which can make the hard calls to promote and limit certain kinds of medical care. Britain, for example, has a national institute that makes precisely these decisions, like limiting drug-eluting stents for coronary artery disease and certain pricey drugs for kidney cancer. And health insurance executives here are again talking about "capitation," or fixed global budgets in which a group of health providers gets fixed monthly fees to handle all of a person's health needs.
In the meantime, one thing is sure: Without a smart plan to ration our resources well—that is, stick to a budget—and improve health, simply mandating that employers and individuals buy health insurance will only worsen the mess.
Darshak Sanghavi is a pediatric cardiologist and assistant professor of pediatrics at the University of Massachusetts Medical School. He is the author of A Map of the Child: A Pediatrician's Tour of the Body.
Article URL: http://www.slate.com/id/2221031/
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I'm not sure I agree with all of that.
As a general economic principle it seems sound to me to have the person consuming a service be the person paying for the service. Indeed, IMHO a rather large percentage of our problems with this issue come from having someone other than the consumer pay.
It may well be that simply having a small or even no deductible combined with a higher percentage of patient participation in the bill is the way to go-- here I have no opinion.
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I've some qualms to, though my purpose in posting the piece was to demonstrate that the MA solution many are touting has serious problems with it. The whole mandating privately purchased insurance at $9,600 that has so high a deductible that users self-impose rationing seems a far cry from the idyllics being touted to sell a government mandated program. Bottom line, each place I look where government is the prime move in health care has some pretty scary elements to it.
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Wow watched the annointed one last night talk about healthcare and I threw up in my mouth. :-DDid he really say that instead of an operation that a person should take pain killers.(paraphrase).
This is the real obama plan:[youtube]http://www.youtube.com/watch?v=dGFXGwHsD_A[/youtube]
Boyo :lol:
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By JOHN E. CALFEE
President Obama and most congressional Democrats say they want to preserve private health insurance. They also want to add a "public plan" to compete with private insurance plans. Their basic argument is that a public plan would offer needed competition, save money through low administrative costs and zero profits, realize greater economies of scale, and be a superior negotiator of the prices of medical services and technology.
The first three arguments are bogus. The fourth argument is only half-bogus -- but the half that isn't reveals a great danger: If a public plan is inserted into private insurance markets, the American health-care system could rapidly evolve into a single-payer system, which would have devastating effects on R&D for new medical technology.
The first argument, that we need a public plan to spur competition, just isn't plausible. Hundreds of health insurance plans already exist, and employer benefit managers can choose among numerous alternatives. There is no lack of firms willing to compete to provide health insurance.
As to the second argument, what is to be saved by avoiding profits? Nonprofit health insurance firms are common, including many of the Blue Cross-Blue Shield plans. Nonprofit status has not proved to be a reliable source of efficiency and cost-saving. The addition of new nonprofit cooperatives and the like -- as a bipartisan group of senators has proposed -- would make little difference, unless the new plans are given the power to set prices and take on extra risk supported by government subsidies.
Would a public plan have lower administrative costs? Well, how often are public enterprises run more efficiently than private ones? Why did practically all economically advanced nations dismantle their public airlines, phone companies, and so on, invariably obtaining lower administrative costs and consumer prices?
As Stanford University health economist Victor Fuchs has pointed out, what "insurance" firms actually sell to large employers -- which account for the single largest segment of the entire health-care market -- is usually administrative services, not actual insurance. (Large companies are not insured; they pay benefits directly.) There is no reason to expect a Medicare-like public plan to match the administrative efficiency of Aetna, Blue Cross-Blue Shield, Cigna, UnitedHealth Group, and WellPoint. Medicare doesn't even try. It outsources most administrative services to the private sector.
Turning to public plans like Medicare and Medicaid for more efficient administration is a fool's errand.
What about economies of scale? Aetna currently serves about 18 million subscribers, UnitedHealth Care serves between 25 million and 30 million, and WellPoint more than 35 million. That is more than is served by the health-care monopoly of Canada (population 33.6 million), and more than the entire health-care systems of most European nations. Once a plan reaches a few million subscribers, there may not be a lot of economies of scale left that can enable public plans to provide lower prices.
Finally, there is the crucial task of negotiating prices for doctors, hospitals, clinics, drugs, devices and thousands of other items essential to modern health care. Here, there are really two arguments for a public plan. The first is about bargaining skill and the firm size, basic ingredients in any negotiating environment.
There is no reason to think the administrators of a public plan will possess skills superior to those honed by private plan personnel during years of negotiations under the pressure of competition. Nor is there any reason to think that mere size would help.
True enough, relatively small European nations routinely obtain better drug prices than are achieved by mammoth American pharmacy benefit managers such as Express Scripts (50 million patients) and Medco (60 million patients), each of whose numbers exceed the entire citizenry of all but the largest European nations. Even sparsely populated New Zealand (population four million) gets better prices than the giant drug-price negotiators in the American private market.
Their success is due to what economists call "monopsony power." Monopsony occurs when a single buyer negotiates prices with several competing sellers (as opposed to monopoly, where there are many buyers but one seller).
Thus, if you want to sell your branded drug in New Zealand, your prices are negotiated with PharMac, a branch of the government. Much the same is true when selling to Canada, Germany, the Netherlands, and essentially the entire developed world save the United States. The negotiating power of these government entities results from monopsony, not superior skill.
For example, the various sellers of cholesterol drugs (Lipitor, Crestor, and so on) have to compete with one another while they all face a single government negotiator. If one seller balks at government prices, it leaves competitors to pick up more sales. The same is true for most other drug classes and most medical devices. This uneven battle ensures that negotiated prices will be well below those in a competitive market.
But here is where the huge risks of creating a "public plan" to compete with private insurance firms come into focus. Foremost among these risks are the effects of monopsony power in the purchase of medical technology.
The U.S. is unique because it alone is the source of half of world-wide profits that provide the payoff for the complex, lengthy, and expensive process of developing new treatments. When other nations construct their health-care systems, they ignore the impact of their pricing policies on R&D incentives. As the dominant R&D funding wellhead, we do not have that option.
Competitive markets have generated the prices and the profits necessary to induce a steady flow of medical innovation in this country. A public plan option would tend to dismantle that system. The people in charge will not know how to set reimbursement levels to motivate reasonable R&D efforts, and there is no reason to expect them to try. In public plans, the tried-and-true method is to push the prices of suppliers down until something gives -- too few doctors willing to take on Medicare patients, for example -- and then to ease up. That is a destructive approach to medical technology R&D.
Who knows what drugs will not be developed if reimbursement levels for a new multiple-sclerosis treatment are too measly? In virtually every advanced economy but our own, pricing authorities simply make sure prices are high enough so that existing drugs continue to be made available. We can expect a public plan here to do the same. The inevitable result is to drastically under-incentivize R&D.
This problem would not matter if a public plan remained small -- but it would likely grow into a monster. Monopsony negotiating power will generate lower prices, so many consumers will switch to a public plan. Employers eager to offload health-care costs will also dump unwilling employees into the public plan. That is the basis for the Lewin Group's much-cited prediction that a public plan would come to dominate any market in which it is allowed to compete.
Bargaining power, however, is far from the only potential source of below-market prices for public plans. In the home mortgage market, the public plans -- known as Fannie Mae and Freddie Mac -- were for years viewed by investors as less risky because they would be bailed out by the federal government if they took on too much risk. That translated into lower prices (the interest rates paid by borrowers), which eventually translated into extraordinary and unseemly growth, culminating in bankruptcy and a federal bailout.
The lesson for health insurance is clear. All insurance plans -- especially in health-care markets -- have to take on risk. Prudent planning, including the maintenance of reasonable financial reserves, is necessary. That increases costs. It would be all too easy for a public plan to gain a competitive advantage by taking on extra risk while keeping prices low because everyone would expect the federal government to take care of financial surprises down the road.
In sum, a public plan would possess formidable and perhaps overwhelming competitive advantages -- generated not by efficiency but by the artificial advantages of "public" status. This would have two disastrous consequences. The first will be to cause most Americans now covered by private insurance to move to public insurance -- one step away from single-payer health care. The second will be to undermine incentives to develop more of the immensely valuable medical technology that is central to all of health care.
Mr. Calfee is a resident scholar at the American Enterprise Institute.
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Followup to CCP's point that the number one contributor to the Democratic party is the taxpayer: Before we turn all healthcare workers in America into public workers could we please disband all public employee unions. In the case of public employment, there is no evil capitalist, only the will of the people, and therefore there is no underlying justification for employees to organize.
Look at the proportion of teachers union money given to Democrats and imagine the new public unions of doctors, nurses, physicians assistants, radiology technicians, etc. etc. and their demands for more and more money, shorter hours, cushier benefits combined with their political contribution clout. Reagan won't be there to fire them when they go on strike.
Brit/former Brit? Mark Stein said last week that after national health care starts, all elections are about waiting times for service. In other words further diluting and obscuring your ability to reward or punish them for their votes on other issues such as war, foreign policy, taxes, spending, judicial confirmations, gun control, abortion, you name it. It all becomes about health service.
Is that what YOU want? Not me.
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Doug,
Well the idea of doctors being able to go on strike is always a topic that brings out screams and hollers.
The idea of public employees being able to unionize though for some reason does not seem to bother anyone except me and you.
I have questioned this before in my posts. There is some irony in the goernment hiring people, taxing all of us to pay for it, then allowing them to unionize to hit the taxpayers for more.
It appears it is from my googling that it is a state and local issue for most.
This is a bit out dated but I assume it applies to today:
Who Gets To Unionize?
Matt Alsdorf
Posted Tuesday, Dec. 7, 1999, at 7:14 PM ET
Last week, the National Labor Relations Board ruled that medical interns and residents at private hospitals were employees--not students--and could therefore form unions. What other types of employees can unionize?
The large majority of them. In 1935, Congress passed the National Labor Relations Act, which gives virtually every private sector employee the right to unionize and bargain collectively. (This is why last week's decision of the NLRB, which administers the act, affects only private hospitals.) Since 1935, most government employees--whether federal, state, or local--have gained the same rights through other national or state laws. So, only those workers specifically exempted from the NLRA are not guaranteed the ability to unionize. (However, this does not mean that they are prohibited from unionizing--rather, that they cannot seek federal protection if their employer refuses to recognize a union.) They include:
Small business employees: The definition of "small business" has not changed since the 1950s. As a result, there are very few companies that still qualify. (For example, a wholesale store would have to have annual sales below $50,000; a retail store, below $500,000; and a law firm, below $200,000.)
Managers and supervisors: This group includes anyone with hiring, firing, disciplinary, or compensatory authority over other workers. They are viewed as employers, not employees.
Independent contractors: These are people who are hired on an individual, project-by-project basis. They are a growing segment of the workforce, particularly in computer-related fields.
Agricultural workers: Because they are seasonal laborers and have a high turnover rate, they were excluded from the law. Only California has granted them unionization privileges.
Domestic employees: This group includes maids, butlers, and other live-in household help.
Although most American workers can join unions, a decreasing percentage are doing so. In 1998, only 13.9 percent of the workforce was unionized--down from 20.1 percent in 1983 (the first year comparable statistics were collected). And when government employees are excluded, the percentages are even lower: While 37.5 percent of public workers are unionized, only 9.5 percent of the private sector is.
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Public employees unoinizing is actually sort of silly.In Michigan it is illegal for public employees to strike, a good example are teachers or the national guard .Both have unions but they are forbidden from striking.So why bother.Oh, I know as payback to the unions. :roll:
boyo
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Indulge this old gray beard in reminding you that the Air Traffic Controllers Union, a public union, went on strike when President Reagan first took office. He shocked the excrement out of them and the Dems when he fired them. OTOH, NYC has a long and extremely expensive history of negotiating with striking public transit and sanitation unions.
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The Pitfalls of the Public Option
By N. GREGORY MANKIW
Published: June 27, 2009
IN the debate over health care reform, one issue looms large: whether to have a public option. Should all Americans have the opportunity to sign up for government-run health insurance?
Enlarge This Image
David G. Klein
President Obama has made his own preferences clear. In a letter to Senators Edward M. Kennedy of Massachusetts and Max Baucus of Montana, the chairmen of two key Senate committees, he wrote: “I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest.”
Even if one accepts the president’s broader goals of wider access to health care and cost containment, his economic logic regarding the public option is hard to follow. Consumer choice and honest competition are indeed the foundation of a successful market system, but they are usually achieved without a public provider. We don’t need government-run grocery stores or government-run gas stations to ensure that Americans can buy food and fuel at reasonable prices.
An important question about any public provider of health insurance is whether it would have access to taxpayer funds. If not, the public plan would have to stand on its own financially, as private plans do, covering all expenses with premiums from those who signed up for it.
But if such a plan were desirable and feasible, nothing would stop someone from setting it up right now. In essence, a public plan without taxpayer support would be yet another nonprofit company offering health insurance. The fundamental viability of the enterprise does not depend on whether the employees are called “nonprofit administrators” or “civil servants.”
In practice, however, if a public option is available, it will probably enjoy taxpayer subsidies. Indeed, even if the initial legislation rejected them, such subsidies would be hard to avoid in the long run. Fannie Mae and Freddie Mac, the mortgage giants created by federal law, were once private companies. Yet many investors believed — correctly, as it turned out — that the federal government would stand behind Fannie’s and Freddie’s debts, and this perception gave these companies access to cheap credit. Similarly, a public health insurance plan would enjoy the presumption of a government backstop.
Such explicit or implicit subsidies would prevent a public plan from providing honest competition for private suppliers of health insurance. Instead, the public plan would likely undercut private firms and get an undue share of the market.
President Obama might not be disappointed if that turned out to be the case. During the presidential campaign, he said, “If I were designing a system from scratch, I would probably go ahead with a single-payer system.”
Of course, we are not starting from scratch. Because many Americans are happy with their current health care, moving immediately to a single-payer system is too radical a change to be politically tenable. But for those who see single-payer as the ideal, a public option that uses taxpayer funds to tilt the playing field may be an attractive second best. If the subsidies are big enough, over time more and more consumers will be induced to switch.
Which raises the question: Would the existence of a dominant government provider of health insurance be good or bad?
It is natural to be skeptical. The largest existing public health programs — Medicare and Medicaid — are the main reason that the government’s long-term finances are in shambles. True, Medicare’s administrative costs are low, but it is easy to keep those costs contained when a system merely writes checks without expending the resources to control wasteful medical spending.
A dominant government insurer, however, could potentially keep costs down by squeezing the suppliers of health care. This cost control works not by fostering honest competition but by thwarting it.
Recall a basic lesson of economics: A market participant with a dominant position can influence prices in a way that a small, competitive player cannot. A monopoly — a seller without competitors — can profitably raise the price of its product above the competitive level by reducing the quantity it supplies to the market. Similarly, a monopsony — a buyer without competitors — can reduce the price it pays below the competitive level by reducing the quantity it demands.
This lesson applies directly to the market for health care. If the government has a dominant role in buying the services of doctors and other health care providers, it can force prices down. Once the government is virtually the only game in town, health care providers will have little choice but to take whatever they can get. It is no wonder that the American Medical Association opposes the public option.
To be sure, squeezing suppliers would have unpleasant side effects. Over time, society would end up with fewer doctors and other health care workers. The reduced quantity of services would somehow need to be rationed among competing demands. Such rationing is unlikely to work well.
FAIRNESS is in the eye of the beholder, but nothing about a government-run health care system strikes me as fair. Squeezing providers would save the rest of us money, but so would a special tax levied only on health care workers, and that is manifestly inequitable.
In the end, it would be a mistake to expect too much from health insurance reform. A competitive system of private insurers, lightly regulated to ensure that the market works well, would offer Americans the best health care at the best prices.
The health care of the future won’t come cheap, but a public option won’t make it better.
N. Gregory Mankiw is a professor of economics at Harvard. He was an adviser to President George W. Bush.
http://www.nytimes.com/2009/06/28/business/economy/28view.html?_r=3&ref=business
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One question.
We keep hearing from the talking heads that we all agree that *everyone* should have health care.
To do so means rationing from the 90% that do.
Arguments from the Bama would state that the 10% can be covered with cost savings and more efficient care.
Electronic records, more preventative care, "keeping people well", paying providers for keeping people well not for each service provided.
There is one truth. That of all these so called fixes -
No one knows if they would work.
Odds are very good they would reduce escalation of costs for a short period of time before the costs than star to go back up.
Just like the managed care of the 1990's. It only works so much before people start yelping that they are not getting what they want. Remember the Jack Nicholson movie with the criticism of HMOs?
HMO's did keep costs down, but only for a couple of years.
And their reputations plummeted. There was this constant battle between patients wanting more tests, coverage and the insurers denying them.
The insurers even put doctors in the middle by giving them bonuses to limit and deny care. Thus they were always off the hook blaming the docotr if something would go wrong.
Yet HMOs continued because they were the most affordable. Especially with extra coverage for Medicare patients.
In any case we are looking at rationed care from 90% to pay for the 10%, apparantly a quarter of whom don't even belong in the US.
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Hadn't heard about the preemie statistics keeping standards mentioned below.
Canada's Single-Prayer Health Care
By INVESTOR'S BUSINESS DAILY | Posted Tuesday, June 30, 2009 4:20 PM PT
Health Reform: A critically ill premature baby is moved to a U.S hospital to get the treatment she couldn't get in the system we're told we should emulate. Cost-effective care? In Canada, as elsewhere, you get what you pay for.
Ava Isabella Stinson was born last Thursday at St. Joseph's hospital in Hamilton, Ontario. Weighing only two pounds, she was born 13 weeks premature and needed some very special care. Unfortunately, there were no open neonatal intensive care beds for her at St. Joseph's — or anywhere else in the entire province of Ontario, it seems.
Canada's perfectly planned and cost-effective system had no room at the inn for Ava, who of necessity had to be sent across the border to a Buffalo, N.Y., hospital to suffer under our chaotic and costly system. She had no time to be put on a Canadian waiting list. She got the care she needed at an American hospital under a system President Obama has labeled "unsustainable."
Jim Hoft over at Gateway Pundit reports Ava's case is not unusual. He reports that Hamilton's neonatal intensive care unit is closed to new admissions half the time. Special-needs infants are sent elsewhere and usually to the U.S.
In 2007, a Canadian woman gave birth to extremely rare identical quadruplets — Autumn, Brooke, Calissa and Dahlia Jepps. They were born in the United States to Canadian parents because there was again no space available at any Canadian neonatal care unit. All they had was a wing and a prayer.
The Jepps, a nurse and a respiratory technician flew from Calgary, a city of a million people, 325 miles to Benefit Hospital in Great Falls, Mont., a city of 56,000. The girls are doing fine, thanks to our system where care still trumps cost and where being without insurance does not mean being without care.
Infant mortality rates are often cited as a reason socialized medicine and a single-payer system is supposed to be better than what we have here. But according to Dr. Linda Halderman, a policy adviser in the California State Senate, these comparisons are bogus.
As she points out, in the U.S., low birth-weight babies are still babies. In Canada, Germany and Austria, a premature baby weighing less than 500 grams is not considered a living child and is not counted in such statistics. They're considered "unsalvageable" and therefore never alive.
Norway boasts one of the lowest infant mortality rates in the world — until you factor in weight at birth, and then its rate is no better than in the U.S.
In other countries babies that survive less than 24 hours are also excluded and are classified as "stillborn." In the U.S. any infant that shows any sign of life for any length of time is considered a live birth.
A child born in Hong Kong or Japan that lives less than a day is reported as a "miscarriage" and not counted. In Switzerland and other parts of Europe, a baby is not counted as a baby if it is less than 30 centimeters in length.
In 2007, there were at least 40 mothers and their babies who were airlifted from British Columbia alone to the U.S. because Canadian hospitals didn't have room. It's worth noting that since 2000, 42 of the world's 52 surviving babies weighing less than 400g (0.9 pounds) were born in the U.S.
It must be embarrassing to Canada that a G-7 economy and a country of 30 million people can't offer the same level of health care as a town of just over 50,000 in rural Montana. Where will Canada send its preemies and other critical patients when we adopt their health care system?
As we have noted, in Canada roughly 900,000 patients of all ages are waiting for beds, according to the Fraser Institute. There are more than four times as many magnetic resonance imaging (MRI) units per capita in the U.S. as in Canada. We have twice as many CT scanners per capita.
Expensive? Wasteful. Just ask the Jepps or the parents of Ava Isabella Stinson.
http://www.ibdeditorials.com/IBDArticles.aspx?id=331254362316405
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By GEORGE NEWMAN
The health-care debate continues. We have now heard from nearly all the politicians, experts and interested parties: doctors, drug makers, hospitals, insurance companies, even constitutional lawyers (though not, significantly, from trial lawyers, who know full well "change" is not coming to their practices). Here is how one humble economist sees some of the main arguments, which I have paraphrased below:
- "The American people overwhelmingly favor reform."
If you ask whether people would be happier if somebody else paid their medical bills, they generally say yes. But surveys on consumers' satisfaction with their quality of care show overwhelming support for the continuation of the present arrangement. The best proof of this is the belated recognition by the proponents of health-care reform that they need to promise people that they can keep what they have now.
- "The cost of health care rises two to three times as fast as inflation."
That's like comparing the price of hamburger 30 years ago with the price of filet mignon today and calling the difference inflation. Or the price of a 19-inch, black-and-white TV 30 years ago with the price of a 50-inch HDTV today. The improvements in medical care are even more dramatic, leading to longer life, less pain, fewer exploratory surgeries and miracle drugs. Of course the research, the equipment and the training that produce these improvements don't come cheap.
Corbis
- "Health care represents a rising proportion of our income."
That's not only true but perfectly natural. Quality health care is a discretionary, income-elastic expense -- i.e. the richer a society, the larger the proportion of income that is spent on it. (Poor societies have to spend income gains on food and other necessities.) Consider the alternatives. Would we feel better about ourselves if we skimped on our family's health care and spent the money on liquor, gambling, night clubs or a third television set?
- "Shifting funds from health care to education would make for a better society."
These two services have a lot in common, including steadily rising cost. What is curious is that this rise in education costs is deemed by the liberal establishment smart and farsighted while the rise in health-care costs is a curse to be stopped at any cost. What is curiouser still is that in education, where they always advocate more "investment," past increases have gone hand-in-hand with demonstrably deteriorating outcomes. The rising cost in health care has been accompanied by clearly superior results. Thus we would shift dollars from where they do a lot of good to an area where they don't.
- "Forty-five million people in the U.S. are uninsured."
Even if this were true (many dispute it) should we risk destroying a system that works for the vast majority to help 15% of our population?
- "The cost of treating the 45 million uninsured is shifted to the rest of us."
So on Monday, Wednesday and Friday we are harangued about the 45 million people lacking medical care, and on Tuesday and Thursday we are told we already pay for that care. Left-wing reformers think that if they split the two arguments we are too stupid to notice the contradiction. Furthermore, if cost shifting is bad, wait for the Mother of all Cost Shifting when suppliers have to overcharge the private plans to compensate for the depressed prices forced on them by the public plan.
- "A universal plan will reduce the cost of health care."
Think a moment. Suppose you are in an apple market with 100 buyers and 100 sellers every day and apples sell for $1 a pound. Suddenly one day 120 buyers show up. Will the price of the apples go up or down?
- "U.S. companies are at a disadvantage against foreign competitors who don't have to pay their employees' health insurance."
This would be true if the funds for health care in those countries fell from the sky. As it is, employees in those countries pay for their health care in much higher income taxes, sales or value-added taxes, gasoline taxes (think $8 a gallon at the pump) and in many other ways, effectively reducing their take-home pay and living standards. And isn't it odd that the same people who want to lift this burden from businesses that provide health benefits also (again, on alternate days) want to impose this burden on the other firms that do not offer this benefit. What about the international competitiveness of these companies?
- "If you like your current plan you can keep it."
In other words, you can keep your current plan if it (and the company offering it) is still around. This is not a trivial qualification. Proponents have clearly learned from the HillaryCare debacle in the 1990s that radical transformation does not sell. What we have instead is what came to be dubbed "salami tactics" in postwar Eastern Europe where Communist leaders took away freedoms one at a time to minimize resistance and obscure the ultimate goal. If nothing else, a century of vain attempts to break the Post Office monopoly should teach us how welcoming Congress is to competition to one of its high-cost, inefficient wards.
- "Congress will be strictly neutral between the public and private plans."
Nonsense. Congress has a hundred ways to help its creation hide costs, from squeezing suppliers to hidden subsidies (think Amtrak). And it has even more ways to bankrupt private plans. One way is to mandate ever more exotic and expensive coverage (think hair transplants or sex-change operations). Another is by limiting and averaging premiums and outlawing advertising. And if all else fails Congress can always resort to tax audits and public harassment of executives -- all in the name of "leveling the playing field." Then, in the end, the triumphal announcement: "The private system has failed."
- "Decisions will still be made by doctors and patients and the system won't be politicized."
Fat chance. Funding conflicts between mental health and gynecology will be based on which pressure group offers the richer bribe or appears more politically correct. The closing (or opening) of a hospital will be based not on need but which subcommittee chairman's district the hospital is in. Imagine the centralization of all medical research in the country in the brand new Robert Byrd Medical Center in Morgantown, W.Va. You get the idea.
- "We need a public plan to keep the private plans honest."
The 1,500 or so private plans don't produce enough competition? Making it 1,501 will do the trick? But then why stop there? Eating is even more important than health care, so shouldn't we have government-run supermarkets "to keep the private ones honest"? After all, supermarkets clearly put profits ahead of feeding people. And we can't run around naked, so we should have government-run clothing stores to keep the private ones honest. And shelter is just as important, so we should start public housing to keep private builders honest. Oops, we already have that. And that is exactly the point. Think of everything you know about public housing, the image the term conjures up in your mind. If you like public housing you will love public health care.
Mr. Newman is an economist and retired business executive.
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July 1, 2009
"Better" Health Care?
By John Stossel
President Obama says government will make health care cheaper and better. But there's no free lunch.
In England, health care is "free" -- as long as you don't mind waiting. People wait so long for dentist appointments that some pull their own teeth. At any one time, half a million people are waiting to get into a British hospital. A British paper reports that one hospital tried to save money by not changing bedsheets. Instead of washing sheets, the staff was encouraged to just turn them over.
Obama insists he is not "trying to bring about government-run healthcare".
"But government management does the same thing," says Sally Pipes of the Pacific Research Institute. "To reduce costs they'll have to ration -- deny -- care."
"People line up for care, some of them die. That's what happens," says Canadian doctor David Gratzer, author of "The Cure". He liked Canada's government health care until he started treating patients.
"The more time I spent in the Canadian system, the more I came across people waiting for radiation therapy, waiting for the knee replacement so they could finally walk up to the second floor of their house." "You want to see your neurologist because of your stress headache? No problem! Just wait six months. You want an MRI? No problem! Free as the air! Just wait six months."
Polls show most Canadians like their free health care, but most people aren't sick when the poll-taker calls. Canadian doctors told us the system is cracking. One complained that he can't get heart-attack victims into the ICU.
In America, people wait in emergency rooms, too, but it's much worse in Canada. If you're sick enough to be admitted, the average wait is 23 hours.
"We can't send these patients to other hospitals. Dr. Eric Letovsky told us. "Every other emergency department in the country is just as packed as we are."
More than a million and a half Canadians say they can't find a family doctor. Some towns hold lotteries to determine who gets a doctor. In Norwood, Ontario, "20/20" videotaped a town clerk pulling the names of the lucky winners out of a lottery box. The losers must wait to see a doctor.
Shirley Healy, like many sick Canadians, came to America for surgery. Her doctor in British Columbia told her she had only a few weeks to live because a blocked artery kept her from digesting food. Yet Canadian officials called her surgery "elective."
"The only thing elective about this surgery was I elected to live," she said.
It's true that America's partly profit-driven, partly bureaucratic system is expensive, and sometimes wasteful, but the pursuit of profit reduces waste and costs and gives the world the improvements in medicine that ease pain and save lives.
"[America] is the country of medical innovation. This is where people come when they need treatment," Dr. Gratzer says.
"Literally we're surrounded by medical miracles. Death by cardiovascular disease has dropped by two-thirds in the last 50 years. You've got to pay a price for that type of advancement."
Canada and England don't pay the price because they freeload off American innovation. If America adopted their systems, we could worry less about paying for health care, but we'd get 2009-level care -- forever.
Government monopolies don't innovate. Profit seekers do.
We saw this in Canada, where we did find one area of medicine that offers easy access to cutting-edge technology -- CT scan, endoscopy, thoracoscopy, laparoscopy, etc. It was open 24/7. Patients didn't have to wait.
But you have to bark or meow to get that kind of treatment. Animal care is the one area of medicine that hasn't been taken over by the government. Dogs can get a CT scan in one day. For people, the waiting list is a month.
Page Printed from: http://www.realclearpolitics.com/articles/2009/07/01/better_health_care_97244.html at July 01, 2009 - 08:17:48 AM PDT
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2nd post.
Parsing the Health Reform Arguments
Some of the shibboleths we've heard in recent weeks don't make much sense.
By GEORGE NEWMAN
The health-care debate continues. We have now heard from nearly all the politicians, experts and interested parties: doctors, drug makers, hospitals, insurance companies, even constitutional lawyers (though not, significantly, from trial lawyers, who know full well "change" is not coming to their practices). Here is how one humble economist sees some of the main arguments, which I have paraphrased below:
- "The American people overwhelmingly favor reform."
If you ask whether people would be happier if somebody else paid their medical bills, they generally say yes. But surveys on consumers' satisfaction with their quality of care show overwhelming support for the continuation of the present arrangement. The best proof of this is the belated recognition by the proponents of health-care reform that they need to promise people that they can keep what they have now.
- "The cost of health care rises two to three times as fast as inflation."
That's like comparing the price of hamburger 30 years ago with the price of filet mignon today and calling the difference inflation. Or the price of a 19-inch, black-and-white TV 30 years ago with the price of a 50-inch HDTV today. The improvements in medical care are even more dramatic, leading to longer life, less pain, fewer exploratory surgeries and miracle drugs. Of course the research, the equipment and the training that produce these improvements don't come cheap.
- "Health care represents a rising proportion of our income."
That's not only true but perfectly natural. Quality health care is a discretionary, income-elastic expense -- i.e. the richer a society, the larger the proportion of income that is spent on it. (Poor societies have to spend income gains on food and other necessities.) Consider the alternatives. Would we feel better about ourselves if we skimped on our family's health care and spent the money on liquor, gambling, night clubs or a third television set?
- "Shifting funds from health care to education would make for a better society."
These two services have a lot in common, including steadily rising cost. What is curious is that this rise in education costs is deemed by the liberal establishment smart and farsighted while the rise in health-care costs is a curse to be stopped at any cost. What is curiouser still is that in education, where they always advocate more "investment," past increases have gone hand-in-hand with demonstrably deteriorating outcomes. The rising cost in health care has been accompanied by clearly superior results. Thus we would shift dollars from where they do a lot of good to an area where they don't.
- "Forty-five million people in the U.S. are uninsured."
Even if this were true (many dispute it) should we risk destroying a system that works for the vast majority to help 15% of our population?
- "The cost of treating the 45 million uninsured is shifted to the rest of us."
So on Monday, Wednesday and Friday we are harangued about the 45 million people lacking medical care, and on Tuesday and Thursday we are told we already pay for that care. Left-wing reformers think that if they split the two arguments we are too stupid to notice the contradiction. Furthermore, if cost shifting is bad, wait for the Mother of all Cost Shifting when suppliers have to overcharge the private plans to compensate for the depressed prices forced on them by the public plan.
- "A universal plan will reduce the cost of health care."
Think a moment. Suppose you are in an apple market with 100 buyers and 100 sellers every day and apples sell for $1 a pound. Suddenly one day 120 buyers show up. Will the price of the apples go up or down?
- "U.S. companies are at a disadvantage against foreign competitors who don't have to pay their employees' health insurance."
This would be true if the funds for health care in those countries fell from the sky. As it is, employees in those countries pay for their health care in much higher income taxes, sales or value-added taxes, gasoline taxes (think $8 a gallon at the pump) and in many other ways, effectively reducing their take-home pay and living standards. And isn't it odd that the same people who want to lift this burden from businesses that provide health benefits also (again, on alternate days) want to impose this burden on the other firms that do not offer this benefit. What about the international competitiveness of these companies?
- "If you like your current plan you can keep it."
In other words, you can keep your current plan if it (and the company offering it) is still around. This is not a trivial qualification. Proponents have clearly learned from the HillaryCare debacle in the 1990s that radical transformation does not sell. What we have instead is what came to be dubbed "salami tactics" in postwar Eastern Europe where Communist leaders took away freedoms one at a time to minimize resistance and obscure the ultimate goal. If nothing else, a century of vain attempts to break the Post Office monopoly should teach us how welcoming Congress is to competition to one of its high-cost, inefficient wards.
- "Congress will be strictly neutral between the public and private plans."
Nonsense. Congress has a hundred ways to help its creation hide costs, from squeezing suppliers to hidden subsidies (think Amtrak). And it has even more ways to bankrupt private plans. One way is to mandate ever more exotic and expensive coverage (think hair transplants or sex-change operations). Another is by limiting and averaging premiums and outlawing advertising. And if all else fails Congress can always resort to tax audits and public harassment of executives -- all in the name of "leveling the playing field." Then, in the end, the triumphal announcement: "The private system has failed."
- "Decisions will still be made by doctors and patients and the system won't be politicized."
Fat chance. Funding conflicts between mental health and gynecology will be based on which pressure group offers the richer bribe or appears more politically correct. The closing (or opening) of a hospital will be based not on need but which subcommittee chairman's district the hospital is in. Imagine the centralization of all medical research in the country in the brand new Robert Byrd Medical Center in Morgantown, W.Va. You get the idea.
- "We need a public plan to keep the private plans honest."
The 1,500 or so private plans don't produce enough competition? Making it 1,501 will do the trick? But then why stop there? Eating is even more important than health care, so shouldn't we have government-run supermarkets "to keep the private ones honest"? After all, supermarkets clearly put profits ahead of feeding people. And we can't run around naked, so we should have government-run clothing stores to keep the private ones honest. And shelter is just as important, so we should start public housing to keep private builders honest. Oops, we already have that. And that is exactly the point. Think of everything you know about public housing, the image the term conjures up in your mind. If you like public housing you will love public health care.
Mr. Newman is an economist and retired business executive.
Printed in The Wall Street Journal, page A13
http://online.wsj.com/article/SB124640626749276595.html
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See entry #256 :lol:
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Doh!
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Senate "Free Rider" Penalties: Taxing the Poor to Pay for Health Care
by Robert A. Book, Ph.D. and Edmund F. Haislmaier
WebMemo #2516
Congress's mad scramble to turn health care buzzwords and bumper stickers into legislation last week careened off in yet another direction.
Senators on the Finance Committee revealed that they are now considering a variant of the "play or pay" employer mandate idea--imposing so-called "free rider" penalties on businesses whose workers receive coverage through Medicaid or take advantage of new subsidies to buy health insurance elsewhere.
It is unclear whether the "free rider" penalties would to be in addition to, or a substitute for, the payroll tax "pay" part of a play-or-pay employer mandate. Either way, such penalties would in practice act as an extremely regressive tax on the working poor, reducing their cash wages and in some cases eliminating their jobs altogether.
Displacing Private Coverage
The Finance Committee seems to be engaged in the classic exercise of making new errors that compound previous ones. They are trying to solve a problem made by their proposal to create new subsidies for the currently uninsured that are larger than the existing subsides for those already insured.
Workers with employer-sponsored health insurance already get a substantial implicit subsidy because their coverage is treated as tax-free income. If Congress offers even bigger subsidies to the uninsured, many in the eligible income range who currently have coverage will try to switch to the new, more heavily subsidized coverage, meaning that new, more-subsidized coverage would "crowd-out" existing, less-subsidized coverage.
It seems that when presented by the Congressional Budget Office with enormous and unfunded cost estimates for their subsidy design--partially attributable to its significant crowd-out effects--committee members opted for a second mistake.
Unequal Treatment
Rather than equalizing the new subsidies to eliminate potential crowd-out, the committee apparently decided to enact a generous subsidy design while adding a so-called "free rider" penalty, imposed on businesses whose workers take advantage of the new subsidies or sign up for Medicaid. Presumably, the idea is to discourage employers from dropping their current health plans if enough of their employees become eligible for expanded government benefits--or at least to defray the cost to the government if they do so.
It is unclear whether the committee envisions these penalties to apply only to employers who currently offer coverage but later drop it, or to all employers who do not offer coverage after the law is enacted.
Furthermore, it is also unclear if these penalties would apply in cases where an employer offered coverage, but some employees decline it and enroll in Medicaid or other government-subsidized coverage options instead. For example, if an employee qualifies for Medicaid and signs up, would the employer be assessed a penalty? Taking that approach would effectively punish employers for decisions taken by Congress (to expand Medicaid eligibility) and workers (to sign up for coverage for which they become newly eligible) over which the employers have no control.
Taxing Workers
Of course, the biggest fallacy in all of this is the belief that somehow it will be employers, rather than workers, that bear the cost of any "play or pay" mandate or "free rider" penalty.
The reality is that either or both of these provisions will act as an extremely regressive tax on the working poor, substantially reducing their take-home pay and in some cases eliminating their jobs altogether.
When an employer decides whether to hire an employee and how much to pay, the employer has to consider the full cost of employing that person. That full cost includes not only cash wages and the employer's cost of providing benefits but also the employer's share of any employment-related taxes, such as the Social Security and Medicare taxes. When the costs of benefits or payroll taxes increase, their slices of the total compensation pie expand--forcing the cash wage slice to shrink.
Thus, if an employer is required to pay a "penalty" or "tax" for not providing health insurance, that too will reduce the amount available to pay the employee as cash wages. If the employer instead satisfies the mandate by spending more on health insurance, the effect is the same. Either way, the employee's take-home pay has to be cut.
If reports about some of the ideas being considered by the Finance Committee are correct, the actual effects could be dramatic and disastrous for low-income workers. In particular, the committee is reported to be considering "free rider" penalties that are equal to half of the national average cost of Medicaid or to the full cost of the federal subsidies for individuals with incomes above the (new, higher) Medicaid eligibility threshold.
That would, in effect, be a massively regressive tax--and one that applied only to people on the lower end of the income distribution scale. Furthermore, it would be regressive even within that subgroup. For employees eligible for Medicaid, the tax would be a fixed amount per employee (and therefore a larger percentage of income for lower-income employees). For those with incomes too high for Medicaid but low enough to quality for a health insurance subsidy, the subsidy will likely be reduced as the employee's income rises, with the "free rider" penalty being equal to the amount of the subsidy.
Consequently, the "free rider" tax will take more money--not just a higher percentage, but more actual dollars--from workers with lower incomes than from those with higher incomes. And for workers whose incomes are high enough, the tax would disappear entirely.
In essence, the Senators would be telling the poor: "If you now have to choose between food and health insurance, from now on you no longer have that choice--you have to buy the health insurance."
For some employees, the situation would be even worse. After all, what if the employee is earning only minimum wage? Or close enough to it that cutting cash wages by the amount of the tax would put the employee's pay below the minimum wage? In that case, there would be only one way for the employer to comply with the law: lay off all employees whose wages are too low.
Back to the Drawing Board
Businesses do not meet their payrolls out of magic pots of unlimited money that they dole out based on their own level of beneficence. They have to pay employees out of money they get from customers based on their employees' work. If that work does not generate enough revenue to pay at least the minimum wage plus the cost of benefits plus the taxes, then the business loses money and the employees have to be laid off. Like gravity, it is just that simple and that unalterable.
A large and regressive tax increase on low-income workers is not the solution to America's health care problems. Some people might gain coverage, but all will lose take-home pay, and many will lose their jobs entirely.
Robert A. Book, Ph.D., is Senior Research Fellow in Health Economics in the Center for Data Analysis and Edmund F. Haislmaier is Senior Research Fellow in the Center for Health Policy Studies at The Heritage Foundation.
http://www.heritage.org/Research/HealthCare/wm2516.cfm
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is expensive now, just wait until the govt makes it free.
http://abcnews.go.com:80/video/playerIndex?id=4578691
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Disabled children wait up to two years for wheelchairs
NHS accused of relying on charities to plug funding gap, leaving patients facing postcode lottery
Press Association
guardian.co.uk, Wednesday 4 March 2009 13.34 GMT
larger | smaller
The NHS was told today to stop relying on charities to fill funding gaps after figures revealed many trusts would not pay the full cost of electric wheelchairs for disabled children.
Freedom of information figures obtained by the Muscular Dystrophy Campaign found children were subject to a postcode lottery in terms of equipment.
Statistics from 54% of NHS trusts in England and Scotland revealed that disabled children in England are forced to wait five months on average for a wheelchair.
The worst performing primary care trust (PCT), East Lancashire, in the north-west of England, had an average wait of two years for an electric wheelchair.
The survey showed 58% of children in England had to wait at least three months for an electric wheelchair and 14% waited more than six months.
In the case of Westminster and Islington PCTs in London, children living just four miles apart could have a difference of 11 months in waiting time.
Overall, 50% of the PCTs that responded said they did not fund the full cost of a powered wheelchair for a disabled child.
Westminster PCT made an average contribution of only £700 towards the cost of a child's powered wheelchair, it said.
Almost all PCTs contacted by the charity said the cost of a wheelchair was around £2,000 but in fact the true cost of a basic electric wheelchair would be around £3,000.
A separate patient survey of 237 children found one in three did not receive any funding at all for their wheelchair.
Philip Butcher, chief executive of the Muscular Dystrophy Campaign, said: "Today's figures are nothing short of a national scandal.
"It is a damning indictment of the NHS that so many families across the UK are forced to rely on charities or be driven into financial hardship just to receive vital, life-improving equipment for their disabled children.
"It's time the NHS stopped relying on charities to fill the gaps left by its inadequate funding."
Two PCTs in the West Midlands – Birmingham East and North, and South Birmingham – have waiting times for a powered wheelchair of 18 months compared to a national average of just under five months, the report said.
http://www.guardian.co.uk/society/2009/mar/04/wheelchair-wait-children
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A competing Democrat operative once said of the Clintons that they lie with such ease. Now it is the Obamas. We are told that there is no harm to let a "public option" compete with "private" options. "No one is going to lose their current health plan if they choose to keep it." Of course the elephant in the room is that the public option is subsidized by the taxpayer to the tune of trillions. That's why private options won't be able to compete.
Here is David Axelrod on Meet the Press last week saying there will be no subsidy:
http://www.realclearpolitics.com/articles/2009/06/28/david_axelrod_mtt_romney_lindsey_graham_on_meet_the_press_97215.html
"Look, we believe strongly in, in a public choice; not one that's subsidized by the government, but one that will embrace the best practices, that will reduce healthcare costs and give people the best quality care."
Someone help me out here. If there is no subsidy and no unfair advantage, what the hell do we need the government for to create it? It will cost the taxpayer nothing(?), it has to paid for, no taxes are going up (except on the wealthiest among us) and it won't have any unfair advantage over private choices. (Please weigh in here if you believe them.)
Of course they are lying. All of the above are true. It will be subsidized. All government programs are. Taxes will be raised even on the brokest among us. Private choices will be squeezed out. Costs will go up, not down. Quality will suffer. Waiting will be the norm. And turning back will be next to impossible.
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"A competing Democrat operative once said of the Clintons that they lie with such ease. Now it is the Obamas"
Clinton proved that the truth doesn't matter when one is pushing agendas that are popular in the polls.
BO is just taking the ball and running with it.
It is really frustrating that he is so personally popular in the polls.
I just don't get it that lying/honesty is not important with most people.
Especially with our leaders who seem more like scam artists. When BO was *reading* his scripted 4th of July speech I really felt he was just reading lines he doesn't believe and certainly has no heart in.
He doesn't believe all those good things he says about America. He is just reading it because as Alinsky wrote, "pretend you are one of them and then you can change them".
Honesty meant something in my family when I was growing up.
At least to strive to be honest/straight and fair.
Now it is mocked for all to see.
And the Dems don't even pretend the facade of honesty.
The repubs perhaps are not much better and put on the facade.
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Speaking to the American Medical Association last month, President Obama waxed enthusiastic about countries that "spend less" than the U.S. on health care. He's right that many countries do, but what he doesn't want to explain is how they ration care to do it.
Take the United Kingdom, which is often praised for spending as little as half as much per capita on health care as the U.S. Credit for this cost containment goes in large part to the National Institute for Health and Clinical Excellence, or NICE. Americans should understand how NICE works because under ObamaCare it will eventually be coming to a hospital near you.
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Associated Press
President Barack Obama speaks about health care during a town hall meeting at Northern Virginia Community College last Wednesday.
The British officials who established NICE in the late 1990s pitched it as a body that would ensure that the government-run National Health System used "best practices" in medicine. As the Guardian reported in 1998: "Health ministers are setting up [NICE], designed to ensure that every treatment, operation, or medicine used is the proven best. It will root out under-performing doctors and useless treatments, spreading best practices everywhere."
What NICE has become in practice is a rationing board. As health costs have exploded in Britain as in most developed countries, NICE has become the heavy that reduces spending by limiting the treatments that 61 million citizens are allowed to receive through the NHS. For example:
In March, NICE ruled against the use of two drugs, Lapatinib and Sutent, that prolong the life of those with certain forms of breast and stomach cancer. This followed on a 2008 ruling against drugs -- including Sutent, which costs about $50,000 -- that would help terminally ill kidney-cancer patients. After last year's ruling, Peter Littlejohns, NICE's clinical and public health director, noted that "there is a limited pot of money," that the drugs were of "marginal benefit at quite often an extreme cost," and the money might be better spent elsewhere.
In 2007, the board restricted access to two drugs for macular degeneration, a cause of blindness. The drug Macugen was blocked outright. The other, Lucentis, was limited to a particular category of individuals with the disease, restricting it to about one in five sufferers. Even then, the drug was only approved for use in one eye, meaning those lucky enough to get it would still go blind in the other. As Andrew Dillon, the chief executive of NICE, explained at the time: "When treatments are very expensive, we have to use them where they give the most benefit to patients."
NICE has limited the use of Alzheimer's drugs, including Aricept, for patients in the early stages of the disease. Doctors in the U.K. argued vociferously that the most effective way to slow the progress of the disease is to give drugs at the first sign of dementia. NICE ruled the drugs were not "cost effective" in early stages.
Other NICE rulings include the rejection of Kineret, a drug for rheumatoid arthritis; Avonex, which reduces the relapse rate in patients with multiple sclerosis; and lenalidomide, which fights multiple myeloma. Private U.S. insurers often cover all, or at least portions, of the cost of many of these NICE-denied drugs.
NICE has also produced guidance that restrains certain surgical operations and treatments. NICE has restrictions on fertility treatments, as well as on procedures for back pain, including surgeries and steroid injections. The U.K. has recently been absorbed by the cases of several young women who developed cervical cancer after being denied pap smears by a related health authority, the Cervical Screening Programme, which in order to reduce government health-care spending has refused the screens to women under age 25.
We could go on. NICE is the target of frequent protests and lawsuits, and at times under political pressure has reversed or watered-down its rulings. But it has by now established the principle that the only way to control health-care costs is for this panel of medical high priests to dictate limits on certain kinds of care to certain classes of patients.
The NICE board even has a mathematical formula for doing so, based on a "quality adjusted life year." While the guidelines are complex, NICE currently holds that, except in unusual cases, Britain cannot afford to spend more than about $22,000 to extend a life by six months. Why $22,000? It seems to be arbitrary, calculated mainly based on how much the government wants to spend on health care. That figure has remained fairly constant since NICE was established and doesn't adjust for either overall or medical inflation.
Proponents argue that such cost-benefit analysis has to figure into health-care decisions, and that any medical system rations care in some way. And it is true that U.S. private insurers also deny reimbursement for some kinds of care. The core issue is whether those decisions are going to be dictated by the brute force of politics (NICE) or by prices (a private insurance system).
The last six months of life are a particularly difficult moral issue because that is when most health-care spending occurs. But who would you rather have making decisions about whether a treatment is worth the price -- the combination of you, your doctor and a private insurer, or a government board that cuts everyone off at $22,000?
One virtue of a private system is that competition allows choice and experimentation. To take an example from one of our recent editorials, Medicare today refuses to reimburse for the new, less invasive preventive treatment known as a virtual colonoscopy, but such private insurers as Cigna and United Healthcare do. As clinical evidence accumulates on the virtual colonoscopy, doctors and insurers will be able to adjust their practices accordingly. NICE merely issues orders, and patients have little recourse.
This has medical consequences. The Concord study published in 2008 showed that cancer survival rates in Britain are among the worst in Europe. Five-year survival rates among U.S. cancer patients are also significantly higher than in Europe: 84% vs. 73% for breast cancer, 92% vs. 57% for prostate cancer. While there is more than one reason for this difference, surely one is medical innovation and the greater U.S. willingness to reimburse for it.
* * *
The NICE precedent also undercuts the Obama Administration's argument that vast health savings can be gleaned simply by automating health records or squeezing out "waste." Britain has tried all of that but ultimately has concluded that it can only rein in costs by limiting care. The logic of a health-care system dominated by government is that it always ends up with some version of a NICE board that makes these life-or-death treatment decisions. The Administration's new Council for Comparative Effectiveness Research currently lacks the authority of NICE. But over time, if the Obama plan passes and taxpayer costs inevitably soar, it could quickly gain it.
Mr. Obama and Democrats claim they can expand subsidies for tens of millions of Americans, while saving money and improving the quality of care. It can't possibly be done. The inevitable result of their plan will be some version of a NICE board that will tell millions of Americans that they are too young, or too old, or too sick to be worth paying to care for.
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I really don't want to pay for medical care for 40 million.
Frankly my dear, I don't care.
Why others can't or just won't say this I dont' know. Lets stop beating about the Bush. Anyone think the people who are going to get covered are going to be grateful to those of us who pay for it?
Not a chance.
I have enough trouble paying for my own.
I already work 5 months a year for money that is confiscated.
I said enough.
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By LAURA MECKLER and JANET ADAMY
WASHINGTON -- It is more important that health-care legislation inject stiff competition among insurance plans than it is for Congress to create a pure government-run option, White House Chief of Staff Rahm Emanuel said.
"The goal is to have a means and a mechanism to keep the private insurers honest," he said in an interview. "The goal is non-negotiable; the path is" negotiable.
President Barack Obama has campaigned vigorously for a full public option. But he's also said that he won't draw a "line in the sand" over this point. On Tuesday, the White House issued a statement reiterating his support for a public plan.
"I am pleased by the progress we're making on health care reform and still believe, as I've said before, that one of the best ways to bring down costs, provide more choices, and assure quality is a public option that will force the insurance companies to compete and keep them honest," the president said in the statement. "I look forward to a final product that achieves these very important goals."
The jockeying over the public plan came as the Senate Finance Committee pushed for a bipartisan deal. To help pay for the package, the committee planned to announce an agreement Wednesday with hospitals and the White House for $155 billion over a decade in reductions to Medicare and charity-care payments for hospitals, according to a person familiar with the agreement. That will help pay for the legislation, expected to cost at least $1 trillion over 10 years.
One of the most contentious issues is whether to create a public health-insurance plan to compete with private companies.
Mr. Emanuel said one of several ways to meet Mr. Obama's goals is a mechanism under which a public plan is introduced only if the marketplace fails to provide sufficient competition on its own. He noted that congressional Republicans crafted a similar trigger mechanism when they created a prescription-drug benefit for Medicare in 2003. In that case, private competition has been judged sufficient and the public option has never gone into effect.
The deal with the hospitals follows a similar agreement with brand-name drug companies. And insurance companies were talking to Senate negotiators about cuts worth at least $100 billion over 10 years, according to two officials with knowledge of the negotiations.
Congressional negotiators and the White House hope to lock in support from the industry groups, which are backing a health bill in general terms but have opposed past efforts.
Hospitals and insurers hope to gain some degree of control over cuts to their federal payments. In principle, a health-care overhaul could benefit both groups by raising the number of Americans who buy and have health insurance.
"They've made an assessment reform is going to happen, so it's better to be part of that than not," Mr. Emanuel said.
However, insurers, and most Republicans, strongly oppose creation of a government-run insurance option, saying it would ultimately drive them out of business. Most Democrats support a public option.
The president and his aides already have signaled a willingness to consider an alternative to a public plan under which a network of nonprofit cooperatives would compete with for-profit insurance companies. That is the leading idea in the Senate Finance Committee.
The Senate Health, Education, Labor and Pensions Committee, meanwhile, has put forward its own version of a government-run plan, closer to what most liberals and the White House favor.
On Monday, Mr. Emanuel said the trigger mechanism would also accomplish the White House's goals. Under this scenario, a public plan would kick in under certain circumstances when competition was judged to be lacking. Exactly what circumstances would trigger the option would have to be worked out.
Some Democrats pushing for a vigorous public plan say the trigger idea isn't good enough. Sen. Charles Schumer (D., N.Y.) said in an interview, "If it's not there on day one, those of us who support a public option have a real problem with it."
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Americans unschooled in liberal health-care politics may have trouble deciphering the White House's conflicting proclamations this week about a new government insurance program for the middle class. Allow us to translate: President Obama loves this so-called public option, but he needs to sell it in a shroud of euphemism and the appearance of "compromise."
On Monday, chief of staff Rahm Emanuel told the Journal's Laura Meckler that the Administration would accept a health bill without a public option, as long as there is "a mechanism to keep the private insurers honest . . . The goal is non-negotiable; the path is." Progressives went bonkers, so on Tuesday Mr. Obama took a break from his Moscow trip to come out strongly in favor (again) of the new trillion-dollar entitlement. Meanwhile, New York's Chuck Schumer has been loudly suggesting that compromise is unnecessary given 60 Senate Democrats -- even as the likes of Ben Nelson, Evan Bayh, Joe Lieberman and Mary Landrieu back away.
The reason left-flank Democrats are so adamant about a public option is because they know it is an opening wedge for the government to dominate U.S. health care. That's also why the health-care industry, business groups, some moderates and most Republicans are opposed. Team Obama likes the policies of the first group but wants the political support of the second. And they're trying to solve this Newtonian problem -- irresistible forces, immovable objects -- by becoming less and less candid about the changes they really favor.
Mr. Emanuel echoes his boss and says a government health plan is needed to keep the private sector "honest," but then why don't we also need a state-run oil company, or nationalized grocery store chain? (Or auto maker? Never mind.) The real goal is to create a program backstopped by taxpayers that can exert political leverage over the market.
In its strongest version, the federal plan would receive direct cash subsidies, allowing it to undercut private insurers on consumer prices. This would quickly lead to "crowd out," the tendency of supposedly "free" public programs to displace private insurance. As a general rule, Congress has to spend $2 of taxpayer money to provide $1 in new benefits. More precise academic studies of expansions in Medicaid and the children's insurance program put the crowd-out effect somewhere between 25% and 60%.
Because this is so expensive, the public version Mr. Schumer favors would supposedly receive no special advantages. But this is meaningless when Democrats are planning to mandate the benefits that private insurers must provide, the patients they must accept, and how much they can charge. Oh, and a government plan would still have an implicit taxpayer guarantee a la Fannie Mae, giving it an inherent cost-of-capital advantage.
A few swing votes such as Maine's Olympia Snowe might accept a "trigger," in which a government-run plan would only come on line if certain targets aren't met, such as reducing costs. But that only delays the day of reckoning. Another pseudocompromise is North Dakota Democrat Kent Conrad's idea to give the states seed money to set up health insurance co-ops. These plans would still be run under a federal charter and managed by a federal board, so they merely split the public option into 50 pieces.
The other goal of a new public plan is to force doctors and hospitals to accept below-cost fees. This is how Medicare tries to control costs today, but it's like squeezing a balloon: Lower reimbursements mean that providers -- especially hospitals -- must recoup their costs elsewhere, either by shifting costs onto private payers or with more billable tests and procedures. The only way costs can conceivably be managed via price controls is if government is running the whole show, which naturally leads to severe restrictions on care while medical innovation withers.
A rhetorical gong Mr. Obama has been banging a lot lately is the idea that the people pointing all this out are liars. "When you hear the naysayers claim that I'm trying to bring about government-run health care," he said in one speech, "know this: They're not telling the truth." He adds that opposition to a public option isn't "based on any evidence" and that it is "illegitimate" to argue that his program is "is somehow a Trojan horse for a single-payer system."
So much for changing the political tone. Perhaps the President should check in with his more honest liberal allies. Jacob Hacker, now a professor of political science at Berkeley, came up with the intellectual architecture for the public option when he was a graduate student in the 1990s. "Someone once said to me, 'This is a Trojan horse for single payer,' and I said, 'Well, it's not a Trojan horse, right? It's just right there,'" Mr. Hacker explained in a speech last year. "I'm telling you, we're going to get there, over time, slowly."
The real question the political class is debating now is how slowly, or quickly, it takes to get there. And how they're best able to disguise this goal -- ideally as a "compromise."
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Interesting take. I don't know if he is correct or not but I haven't thought of it from this angle.
As for the AARP, now I am over 50 I get solicitations from them every two days.
I joined for one year but I don't see any great benefits from it.
I wonder how much the people who run it get.
Anyway Dick Morris article:
OBAMA WILL REPEAL MEDICARE
By Dick Morris And Eileen McGann 07.9.2009 Obama’s health care proposal is, in effect, the repeal of the Medicare program as we know it. The elderly will go from being the group with the most access to free medical care to the one with the least access. Indeed, the principal impact of the Obama health care program will be to reduce sharply the medical services the elderly can use. No longer will their every medical need be met, their every medication prescribed, their every need to improve their quality of life answered.
It is so ironic that the elderly - who were so vigilant when Bush proposed to change Social Security - are so relaxed about the Obama health care proposals. Bush’s Social Security plan, which did not cut their benefits at all, aroused the strongest opposition among the elderly. But Obama’s plan, which will totally gut Medicare and replace it with government-managed care and rationing, has elicited little more than a yawn from most senior citizens.
It’s time for the elderly to wake up before it is too late!
In our new book, Catastrophe, we explain - in detail and in depth - the consequences the elderly of Canada are feeling from just this kind of program. Limited colonoscopies have led to a 25% higher rate of colon cancer and a ban on the use of the two best chemotherapies are part of the reason why 42% of Canadians with colon cancer die while 31% of Americans, who have access to these two medications, survive the disease.
Overall, the death rate from cancer in Canada is 16% higher than in the United States and the heart disease mortality rate is 6% above ours’.
Under Obama’s program, there will be a government health insurance company that gets huge subsidies of tax money. It will compete with private insurance plans. But the subsidies will let it undercut the private plans and drive them out of business, leaving only the government plan - a single payer - in effect.
Today, 800,000 doctors struggle to treat adequately the 250 million Americans who have insurance. Obama will add 50 million more to their caseload with no expansion in the number of doctors or nurses. Indeed, his plan will likely reduce their number by lowering reimbursement rates and imposing bureaucrats above them who will force medical decisions down their throats. Fewer doctors will have to treat more patients. The inevitable result will be rationing.
And it is the elderly who rationing will most effect. Who should get a knee replacement a 40 year old or a 70 year old? Who should get a new hip, a young person or an old person? Who should have priority in the operating room a seventy year old diabetic who needs bypass surgery or a younger person? Obviously, it is the elderly who will get short shrift under his proposal.
But the interest groups that usually speak up for the elderly, particularly AARP, are in Obama’s pocket, hoping to profit from his program by becoming one of its vendors. Just as they backed Bush’s prescription drug plan because they anticipating profiting from it, so they are now helping Obama gut the medical care of their constituents.
It is high time that the elderly of America realized what the stakes are in this vital fight to preserve Medicare as we know it and keep medical care open, accessible, and free to those over 65. It is truly a battle for their very lives.
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http://hotair.com/archives/2009/07/14/an-american-government-health-care-system-you-should-know/
An American government health-care system you should know
POSTED AT 12:16 PM ON JULY 14, 2009 BY ED MORRISSEY
Over the last few months, as Barack Obama’s plans to transform the health-care industry in America have proceeded, I have written extensively on the two existing government-run health-care systems and their myriad problems: Medicare/Medicaid and the VA. It seems I missed a third that may be worse than either or perhaps both combined. Mary Clare Jalonick of the Associated Press provides an eye-opening report on Indian Health Service, a single-payer system that rations care to Native Americans on reservations across the country — and kills them through neglect and a severe lack of resources:
On some reservations, the oft-quoted refrain is “don’t get sick after June,” when the federal dollars run out. It’s a sick joke, and a sad one, because it’s sometimes true, especially on the poorest reservations where residents cannot afford health insurance. Officials say they have about half of what they need to operate, and patients know they must be dying or about to lose a limb to get serious care.
Wealthier tribes can supplement the federal health service budget with their own money. But poorer tribes, often those on the most remote reservations, far away from city hospitals, are stuck with grossly substandard care. The agency itself describes a “rationed health care system.”
The sad fact is an old fact, too.
The U.S. has an obligation, based on a 1787 agreement between tribes and the government, to provide American Indians with free health care on reservations. But that promise has not been kept. About one-third more is spent per capita on health care for felons in federal prison, according to 2005 data from the health service.
Without a doubt, the people on the reservations represent some of the poorest of the poor in America. Yet we already have a single-payer system in place to provide health care to Native Americans on these reservations. Do we properly fund it? Do we make sure that enough resources are applied to ensure good health care? Not at all. It is, as the agency itself describes, a system of rationing medical resources, and the end result is a poor population unable to seek out its own care locked into a system that only works when someone is on death’s door.
In fact, as Jalonick reports, it often doesn’t recognize when a patient faces death. Jalonick profiles the heartrending case of Ta’Shon Rain Little Light, who began complaining of stomach pains at the age of 5, and stopped eating and playing. The overwhelmed clinic diagnosed her as depressed, and ten subsequent visits to the clinic over the next several months while Ta’Shon’s symptoms worsened didn’t change the diagnosis. Only when she suffered a collapsed lung did IHS airlift her to Denver, where Ta’Shon was diagnosed with terminal cancer. Could it have been treated? We’ll never know, thanks to a diagnostic service that appears to be just above the wild-guess level on the reservation.
When government owns the nation’s health-care system, we can all look forward to the same level of care. After all, as Obama himself insists, a government-run system will “save costs,” but he never explains how those costs get saved. We will all go into the rationing-system grinder, just as veterans do with the VA, seniors and disabled do with Medicare, and Native Americans do with IHS.
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http://news.yahoo.com/s/ap/20090615/ap_on_go_ot/us_health_care_s_forgotten
Read this and tell me how great gov't health care is.
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Don't think for a second that because it is in the New england Journal of Massechussetts liberal propaganda that it is not politically biased.
Folks Health care policy self proclaimed experts like this are at the forefront of the liberal think tanks that advise Democrats.
Notice the guy is a phD who has never taken care of a patient in his life. I don't get how taxing employer provision of health care is a good idea. I just don't see it. I agree with Milton Friedman who thinks the whole concept of empolyer buying health care IS the problem. But then, what do I know compared to another self proclaimed great one from the halls of IVy league gospel.
His written piece is written like OBama speaks. Because he says it, it must be so:
*****HEALTH CARE 2009
Previous Volume 361:4-5 July 2, 2009 Number 1
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A Win–Win Approach to Financing Health Care Reform
Jonathan Gruber, Ph.D.
No hurdle facing health care reform in the United States today is more daunting than the problem of financing universal coverage. There is an inescapable logic of reform that lies behind the search for financing sources. First, moving to universal coverage is now widely acknowledged to require a mandate that individuals carry insurance coverage. Second, such a requirement is unacceptable without subsidies to make health insurance affordable for lower-income people. Third, these subsidies will require new financing on the order of $1 trillion or more over the next decade. How can the government finance such a sizeable new expenditure?
There are a number of possible sources. One is reductions in existing government spending on health care through cost controls. President Barack Obama proposed more than $300 billion of such cost controls in his budget, but it is not clear that either politicians or providers have the appetite to go further. Another is increased taxation of "sin goods" — cigarettes, alcohol, and high-sugar or high-fat foods that cause obesity — whose use raises the cost of health care for all Americans. These taxes make sense, yet it is difficult to raise sufficient revenues from them. The government can also look outside the health care system to increased revenues from taxes on carbon emissions or on other goods and services. But this approach would involve expanding the fight over health care into other realms, compounding the difficulty of passing any legislation.
There is one final potential source: the elimination or limiting of the income-tax exclusion for expenditures on employer-sponsored insurance. Ending the massive tax subsidy for such insurance would result in both the most natural source of financing for health care reform and one of the few that is clearly large enough to finance the necessary subsidies.
The $250 billion per year in foregone revenues attributable to the tax exclusion of employers' health insurance expenditures represents the federal government's second-largest health insurance expenditure (after Medicare). When my employer pays me in cash wages, I am taxed on those wages. But the roughly $10,000 per year that my employer spends on my health insurance is not taxed, and it translates into a tax break for me of about $4,000. To be clear, this exclusion represents a tax break for individuals, not for firms; firms are largely indifferent about whether they pay employees in wages or in health insurance. But employees are not indifferent: they pay taxes on the former but not on the latter.
This tax exclusion has three flaws. First, the forgone tax revenue is an enormous sum of money that could be more effectively deployed elsewhere, especially through new approaches to increasing insurance coverage. Just taxing health benefits through the income tax as we do wages would raise $2.3 trillion in federal revenues over the next decade. Second, the exclusion is a regressive entitlement, since higher-income families with higher tax rates get a bigger tax break; about three quarters of these dollars go to Americans in the top half of the income distribution. Third, this tax subsidy makes health insurance, which is bought with tax-sheltered dollars, artificially cheap relative to goods bought with taxed dollars — a phenomenon that leads to overinsurance for most Americans and overspending on medical care.
Given these limitations, no health care expert today would ever set up a health care system with such an enormous tax subsidy for a particular form of insurance coverage. So why don't we just remove it? There are four counterarguments to using limits on the exclusion to create a financing source, but each can be effectively addressed.
First, some argue that it would be administratively infeasible to reduce this tax subsidy. But the process of including spending on employer-sponsored insurance in individual income taxation is actually quite straightforward. Employers would simply report the amount they paid for each employee's insurance coverage on the employee's W-2 form. If the employer is self-insured, it would simply use the premium amount it is already required to calculate in providing continuation coverage (or Consolidated Omnibus Budget Reconciliation Act [COBRA] coverage) to displaced workers.
The second argument is that since the current predominance of employer-sponsored insurance is predicated on this tax exclusion, policymakers must be wary about removing it: many employers offer health insurance only because of this "tax bribe," and sicker and older persons are treated much more fairly in employer groups than they will be in today's nongroup insurance market. As the provision of employer-sponsored insurance declines, we could end up with a large new uninsured population that either cannot afford nongroup insurance or cannot obtain it at any price. This possibility would certainly be cause for concern if we were reducing the tax exclusion in a vacuum — but not when the policy would be financing a universal coverage plan in which all individuals would get group rates and would be subsidized as necessary. Thus, any displacement from employer-sponsored insurance will lead not to uninsurance but merely to a shift to a new insurance exchange.
The third concern is that removing the exclusion would mean an across-the-board tax increase. I prefer to view this as a progressive tax increase, with 62% of the revenues raised from families with annual incomes of more than $100,000. Yet there would still be a sizeable increase in taxation for middle-income families, with 10% of revenues coming from families with annual incomes below $50,000 and 28% from those with annual incomes of $50,000 to $100,000. For this reason, and because not all the revenues to be gained by removing the exclusion would be needed to finance reform, we should reduce, rather than remove, the exclusion.
The exclusion can be reduced, for example, by capping the amount of employer-sponsored premiums that is excluded from taxation, so that individuals are not taxed on premiums below some level (say, the average value of premiums for employer-sponsored insurance) and pay tax only on premiums in excess of that level. This approach has the advantage of addressing the bias toward excessively generous insurance without raising the taxes of people who have basic insurance. Moreover, it would be more progressive than an across-the-board removal of the exclusion, since higher-income people tend to have more expensive insurance than lower-income people. Alternatively, we could scale back the exclusion only for those in higher income groups; such a strategy could be designed to protect middle-income taxpayers from any tax increase.
Either way, the dollars involved are substantial. For example, suppose the government capped the exclusion at the level of the typical employer-sponsored–insurance premium (currently $4,700 for an individual and $12,800 for a family), starting in 2012, and indexed that cap at the rate of growth of the consumer price index (so that the cap rose, but more slowly than the premiums). Such a policy would raise $500 billion by 2019. Considerable revenues would be raised even with a higher cap. A cap set at the 75th percentile of the premium distribution, so that only insurance plans in the top quarter of the price range were subject to taxation, would raise $330 billion between 2012 and 2019. Or, more progressively, capping the tax exclusion at the level of the typical premium but only for families with annual incomes above $125,000 would raise $340 billion between 2012 and 2019.
A final criticism of reducing the tax exclusion is that it would be unfair to high-cost groups — for example, people living in states where insurance is particularly expensive or those working for employers with an older workforce. But this problem can be readily addressed by adjusting the cap to account for differences among firms in underlying cost factors. Employers, for example, could easily compute an adjustment factor, based on their firm's location or their workers' ages, that could be used to set the cap.
Despite the resistance to changing the status quo, I believe that the most sensible source of financing for universal coverage would come from reducing the expensive, regressive, and inefficient subsidization of employer-sponsored insurance. Scaling back the exclusion would be highly progressive and would have the added benefit of reducing the incentives for overinsurance and excessive health care spending. This win–win solution would ameliorate a fundamental flaw in our current system while raising the revenues required to cover the uninsured.
No potential conflict of interest relevant to this article was reported.
Source Information
From the Massachusetts Institute of Technology, Cambridge. *****
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Surprise, surprise, we already have a single payer, government administered health care plan in the US. I wonder how what it's like:
PROMISES, PROMISES: Indian health care's victims
BY MARY CLARE JALONICK, Associated Press Writer
Mon Jun 15, 8:56 am ET
CROW AGENCY, Mont. – Ta'Shon Rain Little Light, a happy little girl who loved to dance and dress up in traditional American Indian clothes, had stopped eating and walking. She complained constantly to her mother that her stomach hurt.
When Stephanie Little Light took her daughter to the Indian Health Service clinic in this wind-swept and remote corner of Montana, they told her the 5-year-old was depressed.
Ta'Shon's pain rapidly worsened and she visited the clinic about 10 more times over several months before her lung collapsed and she was airlifted to a children's hospital in Denver. There she was diagnosed with terminal cancer, confirming the suspicions of family members.
A few weeks later, a charity sent the whole family to Disney World so Ta'Shon could see Cinderella's Castle, her biggest dream. She never got to see the castle, though. She died in her hotel bed soon after the family arrived in Florida.
"Maybe it would have been treatable," says her great-aunt, Ada White, as she stoically recounts the last few months of Ta'Shon's short life. Stephanie Little Light cries as she recalls how she once forced her daughter to walk when she was in pain because the doctors told her it was all in the little girl's head.
Ta'Shon's story is not unique in the Indian Health Service system, which serves almost 2 million American Indians in 35 states.
On some reservations, the oft-quoted refrain is "don't get sick after June," when the federal dollars run out. It's a sick joke, and a sad one, because it's sometimes true, especially on the poorest reservations where residents cannot afford health insurance. Officials say they have about half of what they need to operate, and patients know they must be dying or about to lose a limb to get serious care.
Wealthier tribes can supplement the federal health service budget with their own money. But poorer tribes, often those on the most remote reservations, far away from city hospitals, are stuck with grossly substandard care. The agency itself describes a "rationed health care system."
The sad fact is an old fact, too.
The U.S. has an obligation, based on a 1787 agreement between tribes and the government, to provide American Indians with free health care on reservations. But that promise has not been kept. About one-third more is spent per capita on health care for felons in federal prison, according to 2005 data from the health service.
In Washington, a few lawmakers have tried to bring attention to the broken system as Congress attempts to improve health care for millions of other Americans. But tightening budgets and the relatively small size of the American Indian population have worked against them.
"It is heartbreaking to imagine that our leaders in Washington do not care, so I must believe that they do not know," Joe Garcia, president of the National Congress of American Indians, said in his annual state of Indian nations' address in February.
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When it comes to health and disease in Indian country, the statistics are staggering.
American Indians have an infant death rate that is 40 percent higher than the rate for whites. They are twice as likely to die from diabetes, 60 percent more likely to have a stroke, 30 percent more likely to have high blood pressure and 20 percent more likely to have heart disease.
American Indians have disproportionately high death rates from unintentional injuries and suicide, and a high prevalence of risk factors for obesity, substance abuse, sudden infant death syndrome, teenage pregnancy, liver disease and hepatitis.
While campaigning on Indian reservations, presidential candidate Barack Obama cited this statistic: After Haiti, men on the impoverished Pine Ridge and Rosebud Reservations in South Dakota have the lowest life expectancy in the Western Hemisphere.
Those on reservations qualify for Medicare and Medicaid coverage. But a report by the Government Accountability Office last year found that many American Indians have not applied for those programs because of lack of access to the sign-up process; they often live far away or lack computers. The report said that some do not sign up because they believe the government already has a duty to provide them with health care.
The office of minority health at the U.S. Department of Health and Human Services, which oversees the Indian Health Service, notes on its Web site that American Indians "frequently contend with issues that prevent them from receiving quality medical care. These issues include cultural barriers, geographic isolation, inadequate sewage disposal and low income."
Indeed, Indian health clinics often are ill-equipped to deal with such high rates of disease, and poor clinics do not have enough money to focus on preventive care. The main problem is a lack of federal money. American Indian programs are not a priority for Congress, which provided the health service with $3.6 billion this budget year.
Officials at the health service say they can't legally comment on specific cases such as Ta'Shon's. But they say they are doing the best they can with the money they have — about 54 cents on the dollar they need.
One of the main problems is that many clinics must "buy" health care from larger medical facilities outside the health service because the clinics are not equipped to handle more serious medical conditions. The money that Congress provides for those contract health care services is rarely sufficient, forcing many clinics to make "life or limb" decisions that leave lower-priority patients out in the cold.
"The picture is much bigger than what the Indian Health Service can do," says Doni Wilder, an official at the agency's headquarters in Rockville, Md., and the former director of the agency's Northwestern region. "Doctors every day in our organization are making decisions about people not getting cataracts removed, gall bladders fixed."
On the Standing Rock Reservation in North Dakota, Indian Health Service staff say they are trying to improve conditions. They point out recent improvements to their clinic, including a new ambulance bay. But in interviews on the reservation, residents were eager to share stories about substandard care.
Rhonda Sandland says she couldn't get help for her advanced frostbite until she threatened to kill herself because of the pain — several months after her first appointment. She says she was exposed to temperatures at more than 50 below, and her hands turned purple. She eventually couldn't dress herself, she says, and she visited the clinic over and over again, sometimes in tears.
"They still wouldn't help with the pain so I just told them that I had a plan," she said. "I was going to sleep in my car in the garage."
She says the clinic then decided to remove five of her fingers, but a visiting doctor from Bismarck, N.D., intervened, giving her drugs instead. She says she eventually lost the tops of her fingers and the top layer of skin.
The same clinic failed to diagnose Victor Brave Thunder with congestive heart failure, giving him Tylenol and cough syrup when he told a doctor he was uncomfortable and had not slept for several days. He eventually went to a hospital in Bismarck, which immediately admitted him. But he had permanent damage to his heart, which he attributed to delays in treatment. Brave Thunder, 54, died in April while waiting for a heart transplant.
"You can talk to anyone on the reservation and they all have a story," says Tracey Castaway, whose sister, Marcella Buckley, said she was in $40,000 of debt because of treatment for stomach cancer.
Buckley says she visited the clinic for four years with stomach pains and was given a variety of diagnoses, including the possibility of a tapeworm and stress-related stomachaches. She was eventually told she had Stage 4 cancer that had spread throughout her body.
Ron His Horse is Thunder, chairman of the Standing Rock tribe, says his remote reservation on the border between North Dakota and South Dakota can't attract or maintain doctors who know what they are doing. Instead, he says, "We get old doctors that no one else wants or new doctors who need to be trained."
His Horse is Thunder often travels to Washington to lobby for more money and attention, but he acknowledges that improvements are tough to come by.
"We are not one congruent voting bloc in any one state or area," he said. "So we don't have the political clout."
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On another reservation 200 miles north of Standing Rock, Ardel Baker, a member of North Dakota's Three Affiliated Tribes, knows all too well the truth behind the joke about money running out.
Baker went to her local clinic with severe chest pains and was sent by ambulance to a hospital more than an hour away. It wasn't until she got there that she noticed she had a note attached to her, written on U.S. Department of Health and Human Services letterhead.
"Understand that Priority 1 care cannot be paid for at this time due to funding issues," the letter read. "A formal denial letter has been issued."
She lived, but she says she later received a bill for more than $5,000.
"That really epitomizes the conflict that we have," says Robert McSwain, deputy director of the Indian Health Service. "We have to move the patient out, it's an emergency. We need to get them care."
It was too late for Harriet Archambault, according to the chairman of the Senate Indian Affairs Committee, Democratic Sen. Byron Dorgan of North Dakota, who has told her story more than once in the Senate.
Dorgan says Archambault died in 2007 after her medicine for hypertension ran out and she couldn't get an appointment to refill it at the nearest clinic, 18 miles away. She drove to the clinic five times and failed to get an appointment before she died.
Dorgan's swath of the country is the hardest hit in terms of Indian health care. Many reservations there are poor, isolated, devoid of economic development opportunities and subject to long, harsh winters — making it harder for the health service to recruit doctors to practice there.
While the agency overall has an 18 percent vacancy rate for doctors, that rate jumps to 38 percent for the region that includes the Dakotas. That region also has a 29 percent vacancy rate for dentists, and officials and patients report there is almost no preventive dental care. Routine procedures such as root canals are rarely seen here. If there's a problem with a tooth, it is simply pulled.
Dorgan has led efforts in Congress to bring attention to the issue. After many years of talking to frustrated patients at home in North Dakota, he says he believes the problems are systemic within the embattled agency: incompetent staffers are transferred instead of fired; there are few staff to handle complaints; and, in some cases, he says, there is a culture of intimidation within field offices charged with overseeing individual clinics.
The senator has also probed waste at the agency.
A 2008 GAO report, along with a follow-up report this year, accused the Indian Health Service of losing almost $20 million in equipment, including vehicles, X-ray and ultrasound equipment and numerous laptops. The agency says some of the items were later found.
Dorgan persuaded Senate Majority Leader Harry Reid, D-Nev., to consider an American Indian health improvement bill last year, and the bill passed in the Senate. It would have directed Congress to provide about $35 billion for health programs over the next 10 years, including better access to health care services, screening and mental health programs. A similar bill died in the House, though, after it became entangled in an abortion dispute.
The growing political clout of some remote reservations may bring some attention to health care woes. Last year's Democratic presidential primary played out in part in the Dakotas and Montana, where both Obama and Democrat Hillary Rodham Clinton became the first presidential candidates to aggressively campaign on American Indian reservations there. Both politicians promised better health care.
Obama's budget for 2010 includes an increase of $454 million, or about 13 percent, over this year. Also, the stimulus bill he signed this year provided for construction and improvements to clinics.
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Back in Montana, Ta'Shon's parents are doing what they can to bring awareness to the issue. They have prepared a slideshow with pictures of her brief life; she is seen dressed up in traditional regalia she wore for dance competitions with a bright smile on her face. Family members approached Dorgan at a Senate field hearing on American Indian health care after her death in 2006, hoping to get the little girl's story out.
"She was a gift, so bright and comforting," says Ada White of her niece, whom she calls her granddaughter according to Crow tradition. "I figure she was brought here for a reason."
Nearby, the clinic on the Crow reservation seems mostly empty, aside from the crowded waiting room. The hospital is down several doctors, a shortage that management attributes recruitment difficulties and the remote location.
Diane Wetsit, a clinical coordinator, said she finds it difficult to think about the congressional bailout for Wall Street.
"I have a hard time with that when I walk down the hallway and see what happens here," she says.
http://news.yahoo.com/s/ap/20090615/ap_on_go_ot/us_health_care_s_forgotten/print;_ylt=AsAiGQwA3K1f_6nUFlb3ewN2wPIE;_ylu=X3oDMTB1MjgxN2UzBHBvcwMxNARzZWMDdG9vbHMtdG9wBHNsawNwcmludA--
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Here is another one from the NEJM. This one makes more sense and I agree with it in part that the answer is very complicated.
I agree we need to do something as costs will continue escalate. Adding "47" million (if that is the number or all BS, I don't know) new people to the rolls (including nearly 10 million illegals - if the number is accurate - I suspect it may be even more) will only intensify costs, drive the economy into the gutter, result in rationed care, and make the rest of us pay for it all.
I am not sure by any means if a "value based system" is the answer but I do agree that many of the supposed answers being thrown around like electronic medical records, single payer system, government run health care, more preventative care, following guidelines (rationing) often sold as better value care, and all the other buzz phrases are just that.
I think this guy is right that it would take revolutionary new steps toward different delivery systems to even begin to control costs.
In the meantime, guaranteeing care as a right to everyone in the US, citizen or not, is also guaranteeing a collapse in quality care for the rest of us. Specialists will be forced to accept even less payments, hospitals will be rationing services, and primary doctors will be replaced by nurses. I don't see it any other way.
Somehow I feel like the majority are being made to be the slave labor for the minority who get entitlements. The concept of a "safety net" has morphed into permanent slave-entitlement classes. Bama is accelerating this and making it permanent.
****A Strategy for Health Care Reform — Toward a Value-Based System
Michael E. Porter, Ph.D.
Despite many waves of debate and piecemeal reforms, the U.S. health care system remains largely the same as it was decades ago. We have seen no convincing approach to changing the unsustainable trajectory of the system, much less to offsetting the rising costs of an aging population and new medical advances.
Today there is a new openness to changing a system that all agree is broken. What we need now is a clear national strategy that sets forth a comprehensive vision for the kind of health care system we want to achieve and a path for getting there. The central focus must be on increasing value for patients — the health outcomes achieved per dollar spent.1 Good outcomes that are achieved efficiently are the goal, not the false "savings" from cost shifting and restricted services. Indeed, the only way to truly contain costs in health care is to improve outcomes: in a value-based system, achieving and maintaining good health is inherently less costly than dealing with poor health.
True reform will require both moving toward universal insurance coverage and restructuring the care delivery system. These two components are profoundly interrelated, and both are essential. Achieving universal coverage is crucial not only for fairness but also to enable a high-value delivery system. When many people lack access to primary and preventive care and cross-subsidies among patients create major inefficiencies, high-value care is difficult to achieve. This is a principal reason why countries with universal insurance have lower health care spending than the United States. However, expanded access without improved value is unsustainable and sure to fail. Even countries with universal coverage are facing rapidly rising costs and serious quality problems; they, too, have a pressing need to restructure delivery.2,3,4
How can we achieve universal coverage in a way that will support, rather than impede, a fundamental reorientation of the delivery system around value for patients? There are several critical steps.
First, we must change the nature of health insurance competition. Insurers, whether private or public, should prosper only if they improve their subscribers' health. Today, health plans compete by selecting healthier subscribers, denying services, negotiating deeper discounts, and shifting more costs to subscribers. This zero-sum approach has given competition — and health insurers — a bad name. Instead, health plans must compete on value. We must introduce regulations to end coverage and price discrimination based on health risks or existing health problems. In addition, health plans should be required to measure and report their subscribers' health outcomes, starting with a group of important medical conditions. Such reporting will help consumers choose health plans on the basis of value and discourage insurers from skimping on high-value services, such as preventive care. Health insurers that compete this way will drive value in the system far more effectively than government monopolies can.
Second, we must keep employers in the insurance system. Employers have a vested interest in their employees' health. Daily interactions with their workforce enable employers to create value by developing a culture of wellness, enabling effective prevention and screening, and directing employees to high-value providers. Employers can also foster competition and drive broader system improvement in ways that are difficult for government entities to replicate. To motivate employers to stay in the system, we must reduce the extra amount they now pay through higher insurance costs to cover the uninsured and subsidize government programs. We must also create a level playing field for employers that offer coverage by penalizing employers that are free riders.
Third, we need to address the unfair burden on people who have no access to employer-based coverage, who therefore face higher premiums and greater difficulty securing coverage. This means first equalizing the tax deductibility of insurance purchased by individuals and through employers.
Fourth, to make individual insurance affordable, we need large statewide or multistate insurance pools, like the Massachusetts Health Insurance Connector, to spread risk and enable contracting for coverage and premiums equivalent to or better than those of the largest employer-based plans. Regional pools, instead of a national pool, will result in greater accountability to subscribers and closer interaction with regional provider networks, fostering value-based competition. We also need a reinsurance system that equitably spreads the cost of insuring Americans with very expensive health problems across both regional pools and employers.
Fifth, income-based subsidies will be needed to help lower-income people buy insurance. These subsidies can be partially offset through payments from employers that do not provide coverage but whose employees require public assistance.
Finally, once a value-based insurance market has been established, everyone must be required to purchase health insurance so that younger and healthier people cannot opt out. This will bring substantial new revenues into the system, lowering premiums for everyone and reducing the need for subsidies.
Although most U.S. health care reform efforts have focused on coverage, the far bigger long-term driver of success will come from restructuring the delivery system. That is where most of the value is created and most of the costs are incurred.
The current delivery system is not organized around value for patients, which is why incremental reforms have not lived up to expectations. Our system rewards those who shift costs, bargain away or capture someone else's revenues, and bill for more services, not those who deliver the most value. The focus is on minimizing the cost of each intervention and limiting services rather than on maximizing value over the entire care cycle. Moreover, without comprehensive outcome measurement, it is hard to know what improves value and what does not.
To achieve a value-based delivery system, we need to follow a series of mutually reinforcing steps. First, measurement and dissemination of health outcomes should become mandatory for every provider and every medical condition. Results data not only will drive providers and health plans to improve outcomes and efficiency but also will help patients and health plans choose the best provider teams for their medical circumstances.
Outcomes must be measured over the full cycle of care for a medical condition, not separately for each intervention. Outcomes of care are inherently multidimensional, including not only survival but also the degree of health or recovery achieved, the time needed for recovery, the discomfort of care, and the sustainability of recovery.5 Outcomes must be adjusted for patients' initial conditions to eliminate bias against patients with complex cases.
We need to measure true health outcomes rather than relying solely on process measures, such as compliance with practice guidelines, which are incomplete and slow to change. We must also stop using one or a few measures as a proxy for a provider's overall quality of care. Performance on a measure such as mortality within 30 days after acute myocardial infarction, for example, says little about a provider's care for patients with cancer. Active involvement of the federal government will be needed to ensure universal, consistent, and fair measurement throughout the country, like that already achieved in areas such as organ transplantation.
Since implementing outcome measurement will take time, an interim step should be to require every provider team to report its experience or the volume of patients treated for each medical condition, along with the procedure or treatment approach used. Experience reporting by providers will help patients and their doctors find the providers with the expertise that meets their needs.
Second, we need to radically reexamine how to organize the delivery of prevention, wellness, screening, and routine health maintenance services. The problem is not only that the system underinvests in these services relative to the value they can create but also that primary care providers are asked to deliver disparate services with limited staff to excessively broad patient populations. As a result, delivery of such care is fragmented and often ineffective and inefficient. We need structures for the delivery of specified prevention and wellness service bundles to defined patient populations with unified reimbursement. Employers with on-site health clinics are achieving extraordinary success in providing such services, highlighting the need for new delivery channels beyond conventional settings.
Third, we need to reorganize care delivery around medical conditions. Our system of uncoordinated, sequential visits to multiple providers, physicians, departments, and specialties works against value. Instead, we need to move to integrated practice units that encompass all the skills and services required over the full cycle of care for each medical condition, including common coexisting conditions and complications. Such units should include outpatient and inpatient care, testing, education and coaching, and rehabilitation within the same actual or virtual organization. This structure, organized around the patient's needs, will result in care with much higher value and a far better experience for patients. Government policies creating artificial obstacles to integrated, multidisciplinary care (e.g., the Stark laws) should be modified or eliminated. In a value-based system, the abuses that gave rise to such legislation will decline substantially.
Fourth, we need a reimbursement system that aligns everyone's interests around improving value for patients. Reimbursement must move to single bundled payments covering the entire cycle of care for a medical condition, including all providers and services. Bundled payments will shift the focus to restoring and maintaining health, providing a mix of services that optimizes outcomes, and reorganizing care into integrated practice structures. For chronic conditions, bundled payments should cover extended periods of care and include responsibility for evaluating and addressing complications.
Fifth, we must expect and require providers to compete for patients, based on value at the medical-condition level, both within and across state borders. This will allow excellent providers to grow and serve more patients while reducing hyperfragmentation and duplication of services. In order to achieve high value, providers need a sufficient volume of cases of a given medical condition to allow for the development of deep expertise, integrated teams, and tailored facilities. We may need to institute minimum-volume thresholds for complex medical conditions in order to jump-start consolidation and spur geographic expansion of qualified providers. At the same time, strict antitrust scrutiny must be applied to avoid excessive concentration among a small number of providers or health plans in a region.
Sixth, electronic medical records will enable value improvement, but only if they support integrated care and outcome measurement. Simply automating current delivery practices will be a hugely expensive exercise in futility. Among our highest near-term priorities is to finalize and then continuously update health information technology (HIT) standards that include precise data definitions (for diagnoses and treatments, for example), an architecture for aggregating data for each patient over time and across providers, and protocols for seamless communication among systems.
Finally, consumers must become much more involved in their health and health care. Unless patients comply with care and take responsibility for their health, even the best doctor or team will fail. Simply forcing consumers to pay more for their care is not the answer. New integrated care delivery structures, together with bundled reimbursement for full care cycles, will enable vast improvements in patient engagement, as will the availability of good outcome data.
Comprehensive reform will require simultaneous progress in all these areas because they are mutually reinforcing. For example, outcome measurement not only will improve insurance-market competition but also will drive the restructuring of care delivery. Delivery restructuring will be accelerated by bundled reimbursement. Electronic medical records will facilitate both delivery restructuring and outcome measurement.
Moving ahead now on all these fronts is also important in order to align every stakeholder's interest with value, or reform will once again fail. However, a health care strategy, like any good strategy, involves a sequence of steps over time rather than an attempt to change everything at once. Road maps will be needed for rolling out changes in each area while giving the actors time to adjust.
Some new organizations (or combinations of existing ones) will be needed: a new independent body to oversee outcome measurement and reporting, a single entity to review and set HIT standards, and possibly a third body to establish rules for bundled reimbursement. Medicare may be able to take the lead in some areas; for example, Medicare could require experience reporting by providers or combine Parts A and B into one payment.
The big question is whether we can move beyond a reactive and piecemeal approach to a true national health care strategy centered on value. This undertaking is complex, but the only real solution is to align everyone in the system around a common goal: doing what's right for patients.
Dr. Porter reports receiving lecture fees from the American Surgical Association, the American Medical Group Association, the World Health Care Congress, Hoag Hospital, and the Children's Hospital of Philadelphia, receiving director's fees from Thermo Fisher Scientific, and having an equity interest in Thermo Fisher Scientific, Genzyme, Zoll Medical, Merck, and Pfizer. No other potential conflict of interest relevant to this article was reported.****
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Here is a flow chart of the new, simplified 1000+ page Democrat Health Plan:
http://docs.house.gov/gopleader/House-Democrats-Health-Plan.pdf
It's just as simple as that. (sarc.)
Sorry I'm not able to post the image from the pdf. I hope someone else can.
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Doug's chart:
(http://docs.house.gov/gopleader/House-Democrats-Health-Plan.pdf)
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Universal Health Care Isn't Worth Our Freedom
What would Thoreau have made of the current debate?
By THOMAS SZASZ
People who seek the services of auto mechanics want car repair, not "auto care." Similarly, most people who seek the services of medical doctors want body repair, not "health care."
We own our cars, are responsible for the cost of maintaining them, and decide what needs fixing based partly on balancing the seriousness of the problem against the expense of repairing it. Our health-care system rests on the principle that, although we own our bodies, the community or state ought to be responsible for paying the cost of repairing them. This is for the ostensibly noble purpose of redistributing the potentially ruinous expense of the medical care of unfortunate individuals.
But what is health care? The concept of reimbursable health-care service rests on the premise that the medical problem in need of servicing is the result of involuntary, unwanted happenings, not the result of voluntary, goal-directed behavior. Leukemia, lupus, prostate cancer, and many infectious diseases are unwanted happenings. Are we going to count obesity, smoking, depression and schizophrenia as the same kinds of diseases?
Many Americans would willingly pay for insurance to protect them against the exorbitant cost of treating their own leukemia. But how many Americans would willingly pay for insurance to protect them from the expenses of treating their own depression?
Everyone recognizes that the more fully we wish insurance companies to defray our out of pocket expenses for our car repairs, the higher the premium they will charge for the policy. Yet foregoing reimbursement for trivial or unnecessary health-care costs in return for a more suitable health-care policy is an option unavailable under the present system. Everyone with health insurance is compelled to protect himself from risks, such as alcoholism and erectile dysfunction, that he would willingly shoulder in exchange for a lower premium.
The idea that every life is infinitely precious and therefore everyone deserves the same kind of optimal medical care is a fine religious sentiment and moral ideal. As political and economic policy, it is vainglorious delusion. Rich and educated people not only receive better goods and services in all areas of life than do poor and uneducated people, they also tend to take better care of themselves and their possessions, which in turn leads to better health. The first requirement for better health care for all is not equal health care for everyone but educational and economic advancement for everyone.
Our national conversation about curbing the cost of health care is crippled by the vocabulary in which we conduct it. We must stop talking about "health care" as if it were some kind of collective public service, like fire protection, provided equally to everyone who needs it. No government can provide the same high quality body repair services to everyone. Not all doctors are equally good physicians, and not all sick persons are equally good patients.
If we persevere in our quixotic quest for a fetishized medical equality we will sacrifice personal freedom as its price. We will become the voluntary slaves of a "compassionate" government that will provide the same low quality health care to everyone.
Henry David Thoreau famously remarked, "If I knew for a certainty that a man was coming to my house with the conscious design of doing me good, I should run for my life." Thoreau feared a single, unarmed man approaching him with such a passion in his heart. Too many people now embrace the coercive apparatus of the modern state professing the same design.
Dr. Szasz is emeritus professor of psychiatry at Upstate Medical University in Syracuse, New York. He is author of "The Myth of Mental Illness," among other books (HarperCollins, 1961).
http://online.wsj.com/article/SB124761945269242551.html
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A friend writes:
=======================
Here it is, Page 16 of the Health Care bill
"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law."
You leave a company with health care and go to a different company with a different carrier, you are screwed. You must go into the government plan.
Start up your own company, you are forced into the government plan.
Obamism is alive and well
Here it is, Page 16 of the Health Care bill
"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law."
You leave a company with health care and go to a different company with a different carrier, you are screwed. You must go into the government plan.
Start up your own company, you are forced into the government plan.
Obamism is alive and well
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SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE.
(a) Grandfathered Health Insurance Coverage Defined- Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term `grandfathered health insurance coverage' means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met:
(1) LIMITATION ON NEW ENROLLMENT-
(A) IN GENERAL- Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.
(B) DEPENDENT COVERAGE PERMITTED- Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day.
(2) LIMITATION ON CHANGES IN TERMS OR CONDITIONS- Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.
(3) RESTRICTIONS ON PREMIUM INCREASES- The issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner.
(b) Grace Period for Current Employment-based Health Plans-
(1) GRACE PERIOD-
(A) IN GENERAL- The Commissioner shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 101, including the essential benefit package requirement under section 121.
(B) EXCEPTION FOR LIMITED BENEFITS PLANS- Subparagraph (A) shall not apply to an employment-based health plan in which the coverage consists only of one or more of the following:
(i) Any coverage described in section 3001(a)(1)(B)(ii)(IV) of division B of the American Recovery and Reinvestment Act of 2009 (Public Law 111-5).
(ii) Excepted benefits (as defined in section 733(c) of the Employee Retirement Income Security Act of 1974), including coverage under a specified disease or illness policy described in paragraph (3)(A) of such section.
(iii) Such other limited benefits as the Commissioner may specify.
In no case shall an employment-based health plan in which the coverage consists only of one or more of the coverage or benefits described in clauses (i) through (iii) be treated as acceptable coverage under this division
(2) TRANSITIONAL TREATMENT AS ACCEPTABLE COVERAGE- During the grace period specified in paragraph (1)(A), an employment-based health plan that is described in such paragraph shall be treated as acceptable coverage under this division.
(c) Limitation on Individual Health Insurance Coverage-
(1) IN GENERAL- Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of Y1 as an Exchange-participating health benefits plan.
(2) SEPARATE, EXCEPTED COVERAGE PERMITTED- Excepted benefits (as defined in section 2791(c) of the Public Health Service Act ) are not included within the definition of health insurance coverage. Nothing in paragraph (1) shall prevent the offering, other than through the Health Insurance Exchange, of excepted benefits so long as it is offered and priced separately from health insurance coverage.
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Doug's chart explained:
[youtube]http://www.youtube.com/watch?v=ZHEsvwOTXaQ&eurl=http%3A%2F%2Fwww%2Ecato%2Dat%2Dliberty%2Eorg%2F2009%2F07%2F16%2Fcato%2Dhealth%2Dcare%2Dexpert%2Dexplains%2Dthe%2Dgop%2Dchart%2F&feature=player_embedded[/youtube]
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http://www.investors.com/NewsAndAnal...aspx?id=482329
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CBO Chief Criticizes Democrats' Health Reform Measures
Director Says Proposed Changes Would Weaken Economy
By Lori Montgomery
Washington Post Staff Writer
Thursday, July 16, 2009 1:51 PM
Instead of saving the federal government from fiscal catastrophe, the health reform measures being drafted by congressional Democrats would worsen an already bleak budget outlook, increasing deficit projections and driving the nation more deeply into debt, the director of the nonpartisan Congressional Budget Office said this morning.
Under questioning by members of the Senate Budget Committee, CBO director Douglas Elmendorf said bills crafted by House leaders and the Senate health committee do not propose "the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount."
"On the contrary," Elmendorf said, "the legislation significantly expands the federal responsibility for health-care costs."
Though President Obama and Democratic leaders have said repeatedly that reining in the skyrocketing growth in spending on government health programs such as Medicaid and Medicare is their top priority, the reform measures put forth so far would not fulfill their pledge to "bend the cost curve" downward, Elmendorf said. Instead, he said, "The curve is being raised."
The CBO is the official arbiter of the costs of legislation, and Elmendorf's stark testimony is certain to undermine support for the measures even as three House panels begin debate and aim to put a bill on the House floor before the August recess. Fiscal conservatives in the House, known as the Blue Dogs, were already threatening to block passage of legislation in the Energy and Commerce Committee, primarily due to concerns about the long-term costs of the House bill.
Cost is also a major issue in the Senate, where some moderate Democrats have joined Republicans in calling on Obama to drop his demand that both chambers approve a bill before the August recess. While the Senate health committee approved its bill on Wednesday with no Republican votes, members of the Senate Finance Committee were still struggling to craft a bipartisan measure that does more to restrain costs.
The chairman of the Senate Budget Committee, Kent Conrad (D-N.D.), has taken a leading role in that effort. This morning, after receiving Elmendorf's testimony on the nation's long-term budget outlook, Conrad turned immediately to questions about the emerging health care measures.
"I'm going to really put you on the spot," Conrad told Elmendorf. "From what you have seen from the products of the committees that have reported, do you see a successful effort being mounted to bend the long-term cost curve?"
Elmendorf responded: "No, Mr. Chairman."
Asked what provisions would be needed to slow the growth in federal health spending, Elmendorf urged lawmakers to end or limit the tax-free treatment of employer-provided health benefits, calling it a federal "subsidy" that encourages spending on ever more expensive health packages. Key senators, including Conrad, have been pressing to tax employer-provided benefits, but Senate leaders last week objected, saying the idea does not have enough support among Senate Democrats to win passage.
Elmendorf also suggested changing the way Medicare reimburses providers to create incentives for reducing costs.
"Certain reforms of that sort are included in some of the packages," Elmendorf said. "But the changes that we have looked at so far do not represent the sort of fundamental change, the order of magnitude that would be necessary to offset the direct increase in federal health costs that would result from the insurance coverage proposals."
Senate Majority Leader Harry M. Reid (Nev.) dismissed Elmendorf's push for the benefits tax. "What he should do is maybe run for Congress," Reid said.
But Senate Finance Chairman Max Baucus (D-Mont.) expressed frustration that the tax on employer-funded benefits had fallen out of favor, in part because the White House opposes the idea. Critics of the proposal say it would target police and firefighters who receive generous benefits packages. And if the tax is trimmed to apply only to upper income beneficiaries, it would lose its effectiveness as a cost-containment measure.
"Basically the president is not helping," Baucus said. "He does not want the exclusion, and that's making it difficult."
But he added, "We are clearly going to find ways to bend the cost curve in the right direction, including provisions that will actually lower the rate of increase in health care costs."
Ideas under consideration include health-care delivery system reform; health insurance market reform; and empowering an independent agency to set Medicare reimbursement rates, an idea the White House is shopping aggressively on Capitol Hill.
But Baucus is not giving up on the benefits tax. "It is not off the table, there's still a lot of interest in it," Baucus said.
http://www.washingtonpost.com/wp-dyn/content/article/2009/07/16/AR2009071602242.html?hpid=topnews
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Some amusing takes on health care:
[youtube]http://www.youtube.com/watch?v=yO9L3oyQhQ8&eurl=http%3A%2F%2Fwww%2Ecato%2Dat%2Dliberty%2Eorg%2F2009%2F07%2F17%2Fpenn%2Djillette%2Don%2Dhealth%2Dcare%2Dreform%2F&feature=player_embedded[/youtube]
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GOV'T CARE COSTS MORE
By JEFFREY H. ANDERSON
July 18, 2009 --
THE testimony by Congres sional Budget Office chief Douglas Elmendorf that the health-care legislation in Congress "significantly expands" costs shocked Capitol Hill. Yet the evidence shows that government-run care has always been more costly than private-sector care.
In claiming that the solution to skyrocketing health costs is more government-run care, President Obama has relied on a myth -- the belief that Medicare and Medicaid have restrained the growth in health expenses, relative to private care.
My new study, published by the Pacific Research Institute, shows that -- across four decades -- the costs of government-run health care have risen far more than the costs of private care.
My study compares the cost increases of Medicare and Medicaid with those of all other health care in the United States. The key finding: Since 1970, Medicare and Medicaid's costs have risen one-third more, per patient, than the combined costs of all other health care in America -- the vast majority of which is purchased privately.
Since 1970, Medicare and Medicaid's combined per-patient costs have risen from $344 to $8,955, while the combined per-patient costs of all other US health care have risen from $364 to $7,119.
Medicare and Medicaid used to cost $20 less per patient than other care. Now they cost $1,836 more. (And that's even without the Medicare prescription-drug benefit.)
In fact, if the costs of Medicare and Medicaid had risen only as much as the costs of all other health care in America, then, instead of costing a combined $807 billion last year, they would've cost a combined $606 billion. That savings of $201 billion would have amounted to more than $1,750 per American household last year alone.
These conclusions are true despite very generous treatment of Medicare and Medicaid. My analysis counts all Medicare prescription-drug expenditures as part of privately purchased care, rather than as part of Medicare. It doesn't adjust for billions of dollars in cost-shifting from Medicaid to the SCHIP program. And it counts health care purchased privately by Medicaid and Medicare patients (including Medicare co-payments and Medigap insurance) among the costs of private care, without counting those patients among the recipients of private care -- thereby magnifying private care's per-patient costs.
Despite such generous treatment, since 1970, Medicaid's per-patient costs have risen 35 percent more, and Medicare's 34 percent more, than all other health care in America.
President Obama says we must expand government-run health care to contain costs and that we don't have a minute to lose. But nearly 40 years of evidence shows that government-run care has succeeded only in raising costs.
During an economic downturn in which we are already running higher budget deficits than at the height of the Great Depression (even as a percentage of our gross domestic product), wishful thinking and empty rhetoric shouldn't be allowed to trump empirical evidence.
In truth, there's only one reliable pursuer of value in American health care: the American consumer. If Congress and the president are serious about improving our nation's health care, they should end the tax discrimination against the uninsured -- that is, allow others to purchase care with pre-tax dollars in the way that we now permit only for those with employer-provided insurance. They should promote a more vibrant private market with greater competition across state lines, greater consumer freedom and greater incentives for consumers to pursue value. These are the changes we need.
The empirical evidence is in, and the verdict could hardly be plainer: Government-run health care limits choice and is more expensive. Privately purchased care offers choice and is more affordable.
Only the federal government could struggle to choose between these two alternatives.
Jeffrey H. Anderson is a senior fellow in health-care studies at the Pacific Research Institute.
http://www.nypost.com/seven/07182009/postopinion/opedcolumnists/govt_care_costs_more_179841.htm
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Abridged version: (for full version see: http://www.stumblingontruth.com/main.aspx# )
What We Know That Ain't So
Will Rogers famously said, "It isn't what we don't know that gives us trouble, it's what we know that ain't so." So it is with the health care debate in this country. Quite a few "facts" offered to the public as truth are simply wrong and often intentionally misleading.
There are large groups of people in this country who want socialized medicine and they sense that the stars are aligning, and now is their time to succeed. They rarely call it socialized medicine, but instead "single payer health care" or "universal coverage" or something that their public relations people have told them sounds better. Whatever they call it, they believe (or pretend to believe) a lot of wrong-headed things, and they must be stopped. Step one is understanding how and why they are wrong. Step two is kicking their asses back to Cuba where they can get in line with Michael Moore and Al Gore for their free gastric bypasses.
Myth #1 Health Care Costs are Soaring
No, they are not. The amount we spend on health care has indeed risen, in absolute terms, after inflation, and as a percentage of our incomes and GDP. That does not mean costs are soaring.
You cannot judge the "cost" of something by simply what you spend. You must also judge what you get. I'm reasonably certain the cost of 1950's level health care has dropped in real terms over the last 60 years (and you can probably have a barber from the year 1500 bleed you for almost nothing nowadays). Of course, with 1950's health care, lots of things will kill you that 2009 health care could prevent.
In the case of health care, the fact that we spend so much more on it now is largely a positive. We spend so much more on health care, even relative to other advances, mostly because it is worth so much more to us.
In summary, if one more person cites soaring health care costs as an indictment of the free market, when it is in fact a staggering achievement of the free market, I'm going to rupture their appendix and send them to a queue in the UK to get it fixed.
Myth #2 The Canadian Drug Story
The general story is how you can buy many drugs in Canada cheaper than you can buy them in the US. This story is often, without specifically tying the logic together, taken as an obvious indictment of the US's (relatively) free market system. This is grossly misguided.
Here's what happens. We have a (relatively) free market in the US where drug companies spend a ton to develop new wonder drugs, a non-trivial amount of which is spent to satisfy regulatory requirements. The cost of this development is called a "fixed cost." Once it's developed it does not cost that much to make each pill. That's called a "variable cost." If people only paid the variable cost (or a bit more) for each pill the whole thing would not work. You see, the company would never get back the massive fixed cost of creating the drug in the first place, and so no company would try to develop one.
Drug companies that spent the enormous fixed costs to create new miracles are charging a relatively high cost in the free and still largely competitive world (the US) to recoup their fixed cost and to make a profit. But socialist societies like Canada limit the price they are allowed to charge. The US-based company is then faced with a dilemma. What Canada will pay is not enough to ever have justified creating the miracle pill. But, once created, perhaps Canada is paying more than the variable cost of each pill. Thus, the company can make some money by also selling to Canada at a lower price as it's still more than it costs them to make that last pill.
If we all tried to be Canada it's a non-working perpetual motion machine and no miracle pills ever get made because there will be nobody to pay the fixed costs.
Myth #3 Socialized Medicine Works In Some Places
This is a corollary to the "Canada as parasite" parable above. The funny part is socialized medicine has never been truly tested. Those touting socialism's success have never seen a world without a relatively (for now) free US to make their new drugs, surgical techniques, and other medical advancements for them.
To put it simply, right now the US's free system massively intellectually subsidizes the world's unfree (socialized) ones. That sucks. The only thing that would suck worse is joining them without anyone to subsidize us all.
Myth #4 A Public Option Can Co-Exist with a Private Option
Part of the current junta's plan is to add a "public option" for health insurance. That is health insurance provided by the government (actually provided by you and your neighbors). They claim this "public option" can co-exist fairly alongside private health insurance, increasing competition and keeping the private system "honest," and not deteriorate to a single payer (socialized medicine) system. They are wrong, or very dishonest, as in unguarded moments they admit that the single payer socialized system is what they really want.
By their logic the government must be a major player in every industry. Ah, just when you think you have them, you remember, they are socialists … dismantling liberty piece by piece.
The government does not co-exist or compete fairly with private enterprise. It does not play well with others. The regulator cannot be a competitor at the same time. Finally, it cannot be a fair competitor if when the "public option" screws up (can't pay its bills), the government implicitly or explicitly guarantees its debts.
Perhaps the best example of the destructive "public option" is our nation's schools. Here we clearly have a government provided "public option" competing with (and in fact dominating in size) private schooling. But, is it fair? Does it work well? Not by a long-shot.
With a "public option" things inevitably would go the horrific way of our public schools. It will be like looking in a funhouse mirror and seeing a doctor where you used to see a teacher.
Finally, let's worry a bit about the end game. We are not here yet, but in a world where the "public option" replaced all private options, would we still be allowed, if we had the resources, to pursue private medical alternatives? Some socialized countries say yes, some say no. Imagine the answer is no in this country, where freedom is valued more than anywhere else in the world. Imagine a person is to be prevented from spending their hard earned money on their or their children's health care, or a doctor was prevented from earning what he could in a parallel free system after all his training and work.
It takes literally seconds to realize that this "public option" cannot co-exist with liberty and thus will indeed lead to full-on socialization. Since the simplest answer is usually best, and the President has already declared his preference for a "single-payer" system, and since this "public option" leads there with near certainty, might I be forgiven for assuming he knows this and is lying, and has a socialized medicine end-game in mind?
Myth #5 We Can Have Health Care Without Rationing
Rationing has to occur. This sounds cold and cruel, but it is reality. If you have a material good or service, like health care, that is ever increasing in quality, and therefore cost, there is no way everyone on Earth can have the best at all times (actually the quality increases are not necessary for rationing to be needed, it just makes the example clearer). It's going to be rationed by some means. The alternatives come down to the marketplace or the government. To choose between those alternatives you judge on morality and efficacy.
It is an uncomfortable truth that tough choices will have to be made. There is no system that provides for unlimited wants with limited resources. Our choice is whether it should be rationed by free people making their own economic calculations or by a bureaucracy run by Congressional committee (whose members, like the Russian commissars, will, I guarantee you, still get the best health care the gulag hospitaligo can provide). Free people making their own choices only consume what they value above price, using funds they have earned or been given voluntarily. With socialized medicine health care is rationed by committees of politicians trying to get re-elected and increase their own power, and people consume as much of it as the commissars deem permissible. I do not find these tough alternatives to choose between.
Myth #6 Health Care is A Right
Nope, it's not.
This is more philosophy than economics, and I'm not a philosopher. But, luckily it doesn't take a superb philosopher to understand that health care simply is not a "right" in the sense we normally use that word. Listing rights generally involves enumerating things you may do without interference (the right to free speech) or may not be done to you without your permission (illegal search and seizure, loud boy-band music in public spaces). They are protections, not gifts of material goods. Material goods and services must be taken from others, or provided by their labor, so if you believe you have an absolute right to them, and others don't choose to provide it to you, you then have a "right" to steal from them. But what about their far more fundamental right not to be robbed?
So why do people scream health care is a "right" if it so obviously is not? If not a right it can still be willingly provided as charity by society.
So, Why Are These Crazy Things Believed (Or, Pretended to Be Believed)?
Lots of politicians understand that the simple free system leaves them out in the cold. No power for them. No committees to sit on to decide people's lives. No lies to tell their constituents how they (the government) brought them the health care they so desperately need. No fat checks from lobbyists as the crony capitalists pay dearly to make the only profits possible under this system, those bestowed by the government.
Finally, if the above is not enough, the rush to pass a huge expansion of government now, and limit debate and discussion, is indicative of a group that knows it is wrong, and if people have time to think they will refuse to go along, but is attempting an exercise of naked power, to impose dictatorship before the people wake up. Paraphrasing Mark Twain, a lie can travel halfway around the world while the truth puts on its shoes. They are counting on this, and they don't want to give the truth time to be shod.
And In Conclusion
We do not need a single payer (socialized medicine) system to cut confusion and inefficiency. On the contrary we need unfettered competition and clear legal standards. Another major concern is provision of basic healthcare to the needy. This is an important issue, but not an expensive one in the scheme of things, and not one that should drive the trillion-dollar healthcare debate. You do not reorganize the entire housing industry and tax policy around the need for homeless shelters, you just build enough shelters and let the market take care of, and discipline, the people who can pay for their own housing.
Finally there is the concern that healthcare costs make US workers too expensive to compete in global markets. As long as workers get full value for their healthcare dollars, it shouldn't matter whether companies pay in cash or in health benefits.
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Reformers' Claims Just Don't Add Up
By INVESTOR'S BUSINESS DAILY | Posted Friday, July 17, 2009 4:20 PM PT
Health Reform: Many extravagant claims have been made on behalf of the various health care "reforms" now emerging from Congress and the White House. But on closer inspection, virtually all prove to be false.
Yet even as many Americans start to have second thoughts about our government's possible takeover of the health care system, Congress is rushing to make it happen.
On Friday, the House Ways and Means Committee approved a bill that would radically change our current system and expand coverage for the uninsured. The action came a day after the head of the Congressional Budget Office said none of the plans under review would slow health care spending. None of them.
Still, lawmakers and the White House press on, relying on GOP weakness in the House and a new veto-proof majority in the Senate. They're also relying on a lack of awareness that claims made on behalf of national health care may be mostly false. Among them:
• America has a health care crisis.
No, we don't. Forty-seven million people lack insurance. Of the remaining 85% of the population, or 258 million people, polls show high satisfaction with the current coverage. Indeed, a 2006 poll by ABC News, the Kaiser Family Foundation and USA Today found 89% of Americans were happy with their own health care.
As for the estimated 47 million not covered by health insurance, 20 million can afford to buy it, according to a study by former CBO Director June O'Neill. Most of the other 27 million are single and under 35, with as many as a third illegal aliens.
When it's all whittled down, as few as 12 million are unable to buy insurance — less than 4% of a population of 305 million. For this we need to nationalize 17% of our nation's $14 trillion economy and change the current care that 89% like?
• Health care reform will save money.
Few of the plans now coming out of Congress will save anything, says the CBO's current chief, Douglas Elmendorf. In fact, he says, they'll lead to substantially higher costs in the future — costs that will be "unsustainable."
As it is, estimates for reforming health care range from $1 trillion to $3.6 trillion. Much will be spent on subsidies to make a so-called public option more attractive to consumers than private plans.
To pay for it, the president has suggested about $600 billion in new taxes, meaning that $500 billion to $2.1 trillion in new health care spending over the next decade will be unfunded. This could push up the nation's already soaring deficit, expected to reach $10 trillion through 2019 without health care reform. Massive new tax hikes will probably be needed to close the gap.
• Only the rich will pay for reform.
The 5.4% surtax on millionaires the president is pushing gets all the attention, but everyone down to $280,000 in income will pay more. Doesn't that still leave out the middle class and poor? Sorry. Workers who decline to take part will pay a tax of up to 2% of earnings. And small-businesses must pony up 8% of their payrolls.
The poor and middle class must pay in other ways, without knowing it. The biggest hit will be on small businesses, which, due to new payroll taxes, will be less likely to hire workers. Today's 9.5% jobless rate may become a permanent feature of our economy — just as it is in Europe, where nationalized health care is common.
• Government-run health care produces better results.
The biggest potential lie of all. America has the best health care in the world, and most Americans know it. Yet we hear that many "go without care" while in nationalized systems it is "guaranteed."
U.S. life expectancy in 2006 was 78.1 years, ranking behind 30 other countries. So if our health care is so good, why don't we live as long as everyone else?
Three reasons. One, our homicide rate is two to three times higher than other countries. Two, because we drive so much, we have a higher fatality rate on our roads — 14.24 fatalities per 100,000 people vs. 6.19 in Germany, 7.4 in France and 9.25 in Canada. Three, Americans eat far more than those in other nations, contributing to higher levels of heart disease, diabetes and some cancers.
These are diseases of wealth, not the fault of the health care system. A study by Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa found that if you subtract our higher death rates from accidents and homicide, Americans actually live longer than people in other countries.
In countries with nationalized care, medical outcomes are often catastrophically worse. Take breast cancer. According to the Heritage Foundation, breast cancer mortality in Germany is 52% higher than in the U.S.; the U.K.'s rate is 88% higher. For prostate cancer, mortality is 604% higher in the U.K. and 457% higher in Norway. Colorectal cancer? Forty percent higher in the U.K.
But what about the health care paradise to our north? Americans have almost uniformly better outcomes and lower mortality rates than Canada, where breast cancer mortality is 9% higher, prostate cancer 184% higher and colon cancer 10% higher.
Then there are the waiting lists. With a population just under that of California, 830,000 Canadians are waiting to be admitted to a hospital or to get treatment. In England, the list is 1.8 million deep.
Universal health care, wrote Sally Pipes, president of the Pacific Research Institute in her excellent book, "Top Ten Myths Of American Health Care," will inevitably result in "higher taxes, forced premium payments, one-size-fits-all policies, long waiting lists, rationed care and limited access to cutting-edge medicine."
Before you sign up, you might want to check with people in countries that have the kind of system the White House and Congress have in mind. Recent polls show that more than 70% of Germans, Australians, Britons, Canadians and New Zealanders think their systems need "complete rebuilding" or "fundamental change."
• The poor lack care.
Many may lack insurance, but that doesn't mean they lack care. The law says anyone who walks into a hospital emergency room must be treated. America has 37 million people in poverty, but Medicaid covers 55 million — at a cost of $350 billion a year.
Moreover, as many as 11 million of the uninsured qualify for programs for the indigent, including Medicaid and SCHIP. But for some reason, they don't sign up. Are they likely to sign up for the "public option" when it's made available?
http://www.ibdeditorials.com/IBDArticles.aspx?id=332723342557746
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July 20, 2009
Welcome to Mexico, Gringos!
By James Lewis
I once had a minor medical procedure done in Mexico. The doc wanted to be paid in cash, and I obliged. Then I asked for a receipt. What followed was Keystone Cops. It took a while for me to realize I was being stupid. By asking for a receipt in the double economy of Mexico I was asking the doc to sign a confession to the tax police. He was right, I was wrong, and I learned something about the underground economy in socialized medicine.
Welcome to Mexico, friends, where the people are warm and wonderful, the drug gangs ruthless (but mostly gun for each other), and the medical profession is a sign of things to come in the US of A. Rich people get pretty good medical care in Mexico. Poor people? So-so to dreadful. Same thing in Italy, and most of the Left-dominated world. Want to get pretty good medical care in Russia? How many dollars you got?
The trouble with socialized medicine is that it corrupts the doctors. They start living a double life. So do the patients. And irony of ironies, it doesn't hurt the rich one little bit.
If ObamaCare is given the bum's rush through Congress in the next couple of weeks, first thing I'm going to do is check out medical travel. Hong Kong has first-rate hospitals, inspected and rated by the British Health Authority. Israel has more qualified doctors per square inch than New York City. Taiwan, Singapore, the big cities in India, Thailand, the Philippines. Eastern Europe is heading that way. If they provide excellent care at lower cost than the US, it can only grow. Nobody in Congress has repealed the laws of supply and demand.
Want to build a great new business? Go into the medical travel game. Guarantee your clients only the best and most highly accredited doctors and hospitals in the world. Sell them medical and travel insurance. And tie it in with sunny retirement communities for Boomers. It will be a Gold Rush.
Insurance companies can undersell any US government monopoly, just by sending their patients to high-quality hospitals abroad. The United States may lose General Motors, but we'll get International Blue Cross instead. And do you have any idea how much you can do diagnostically these days over the web? Your highly qualified offshore doc can just send you the testing kit, you send it back, and have long, cozy conversations over the free VoIP service. In five years we'll have EKGs plugged into your home computer to be read by Indian doctors in Hyderabad. Virtual microsurgery is in the cards. Computing is going to keep getting cheaper, the web will get faster and more interactive, and you'll be able to do some virtual medical travel without moving from home. Indian psychiatrists are so comforting, and they will talk with you for hours for $9.95, special rate just for you.
Obama and the Democrats will try to stop you -- but they will take advantage of medical travel themselves, of course. The Left will raise your US taxes whether you use ObamaCare or not -- and no, the tax increases won't be limited to the upper five percent. Everybody will pay more, either in money or rationing of health care.
It will be a huge incentive for older Americans to retire abroad, and that could be a gigantic favor for developing countries. You can love this country from afar, and hope that when things get bad enough, some of the voters will wake up. It could take a while if LeftiMed gets passed next week at some midnight session between Nancy and Harry Reid.
So when every American doctor's income is capped by price controls, when the paperwork is coming out of their ears, when their workload is up and their income is down --- just let them know you'll pay cash.
And don't ask for a receipt.
Hasta la vista, baby.
I'm off to Costa Rica!
Page Printed from: http://www.americanthinker.com/2009/07/welcome_to_mexico_gringos.html at July 20, 2009 - 01:53:49 PM EDT
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The implication is that this is some sort of scandal.
600 million doses at a cost of 2.6 billion. Isn't that cheap - ~$4 a dose.
What does it cost to drive the tunnel from NJ to NYC - 10 dollars for the port authority tax? Ten dollars to drive into NYC???!!!
What is the tax on a single pack of cigarettes?
So why are the pharmaceutical companies not entitled to ~4 bucks for a squirt of influenza vaccine?
****Drug groups to reap swine-flu billions
By Andrew Jack in London
Published: July 20 2009 19:40 | Last updated: July 20 2009 23:43
Some of the world’s leading pharmaceutical companies are reaping billions of dollars in extra revenue amid global concern about the spread of swine flu.
Analysts expect to see a boost in sales from GlaxoSmithKline, Roche and Sanofi-Aventis when the companies report first-half earnings lifted by government contracts for flu vaccines and antiviral medicines.
EDITOR’S CHOICE
In depth: Swine flu - Apr-28Health Blog: The advice about swine flu - Jul-21Date put on school swine flu decision - Jul-20WHO backlog hampers swine flu battle - Jul-21Swine flu warning to pregnant women - Jul-19UK braces for 100,000 swine flu cases a day - Jul-03The fresh sales – on top of strong results from Novartis of Switzerland and Baxter of the US, which both also produce vaccines – come as the latest tallies show that more than 740 people have died from the H1N1 virus, and millions have been affected around the world.
GlaxoSmithKline of the UK confirmed it had sold 150m doses of a pandemic flu vaccine – equivalent to its normal sales of seasonal flu vaccine – to countries including the UK, the US, France and Belgium, and was gearing up to boost production.
GSK also produces Relenza, an antiviral medicine that reduces the length and severity of the infection, and is preparing to increase manufacturing towards 60m annual doses. The UK placed an order for 10m treatments this year.
One beneficiary of the fears about the pandemic has been Roche of Switzerland, which sells Tamiflu, the leading antiviral drug, and has seen a sharp rise in orders from private companies as well as governments.
A report last week from JPMorgan, the investment bank, estimated that governments had ordered nearly 600m doses of pandemic vaccine and adjuvant – a chemical that boosts its efficacy – worth $4.3bn (€3bn, £2.6bn) in sales, and there was potential for 342m more doses worth $2.6bn.
It forecast that fresh antiviral sales could boost sales for GSK and Roche by another $1.8bn in the developed world, and potentially up to $1.2bn from the developing world.
But there were also uncertainties for the pharmaceutical manufacturers. With demand likely to outstrip supply, and initial production suggesting that the yield for the pandemic vaccine is relatively low, they may face difficult choices in determining how much to supply to the countries seeking orders.
They are also under pressure to provide more drugs and vaccines for free, or extremely cheaply, to the developing world.
Copyright The Financial Times Limited 2009
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Arrogance. Its crazy for a group of mere mortals to try to design 15% of US economy [John Stossel]
Townhall | July 22, 2009 | John Stossel
It's crazy for a group of mere mortals to try to design 15 percent of the U.S. economy. It's even crazier to do it by August.
Yet that is what some members of Congress presume to do. They intend, as the New York Times puts it, "to reinvent the nation's health care system".
Let that sink in. A handful of people who probably never even ran a small business actually think they can reinvent the health care system.
Politicians and bureaucrats clearly have no idea how complicated markets are. Every day people make countless tradeoffs, in all areas of life, based on subjective value judgments and personal information as they delicately balance their interests, needs and wants. Who is in a better position than they to tailor those choices to best serve their purposes? Yet the politicians believe they can plan the medical market the way you plan a birthday party.
Leave aside how much power the state would have to exercise over us to run the medical system. Suffice it say that if government attempts to control our total medical spending, sooner or later, it will have to control us.
Also leave aside the inevitable huge cost of any such program. The administration estimates $1.5 trillion over 10 years with no increase in the deficit. But no one should take that seriously. When it comes to projecting future costs, these guys may as well be reading chicken entrails. In 1965, hospitalization coverage under Medicare was projected to cost $9 billion by 1990. The actual price tag was $66 billion.
The sober Congressional Budget Office debunked the reformers' cost projections. Trust us, Obama says. "At the end of the day, we'll have significant cost controls," presidential adviser David Axelrod said. Give me a break.
Now focus on the spectacle of that handful of men and women daring to think they can design the medical marketplace. They would empower an even smaller group to determine -- for millions of diverse Americans -- which medical treatments are worthy and at what price.
How do these arrogant, presumptuous politicians believe they can know enough to plan for the rest of us? Who do they think they are? Under cover of helping uninsured people get medical care, they live out their megalomaniacal social-engineering fantasies -- putting our physical and economic health at risk in the process.
Will the American people say "Enough!"?
I fear not, based on the comments on my blog. When I argued last week that medical insurance makes people indifferent to costs, I got comments like: "I guess the 47 million people who don't have health care should just die, right, John?" "You will always be a shill for corporate America."
Like the politicians, most people are oblivious to F.A. Hayek's insight that the critical information needed to run an economy -- or even 15 percent of one -- doesn't exist in any one place where it is accessible to central planners. Instead, it is scattered piecemeal among millions of people. All those people put together are far wiser and better informed than Congress could ever be. Only markets -- private property, free exchange and the price system -- can put this knowledge at the disposal of entrepreneurs and consumers, ensuring the system will serve the people and not just the political class.
This is no less true for medical care than for food, clothing and shelter. It is profit-seeking entrepreneurship that gave us birth control pills, robot limbs, Lasik surgery and so many other good things that make our lives longer and more pain free.
To the extent the politicians ignore this, they are the enemy of our well-being. The belief that they can take care of us is rank superstition.
Who will save us from these despots? What Adam Smith said about the economic planner applies here, too: The politician who tries to design the medical marketplace would "assume an authority which could safely be trusted, not only to no single person, but to no council or senate whatever, and which would nowhere be so dangerous as in the hands of a man who had folly and presumption enough to fancy himself fit to exercise it."
http://townhall.com/columnists/JohnStossel/2009/07/22/arrogance?page=full&comments=true
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2nd Post.
July 22, 2009, 4:00 a.m.
Doctor’s Orders
Sen. (and Dr.) John Barrasso makes the case for market-based health-care reform.
By Michael Warren
One of the most important opponents of Barack Obama’s health-care agenda may be a relatively unknown senator from America’s least populous state. Republican John Barrasso of Wyoming, who entered the Senate only two years ago, had little name recognition outside his home state until a few weeks ago. Yet he is emerging as a GOP expert on a hot-button issue. Barrasso brings a special perspective to the health-care debate: He is one of only two MDs in the Senate, the other being his Republican colleague Tom Coburn of Oklahoma.
You’ll find Dr. Barrasso on page 87 of The 50 Most Positive Doctors in America, a 1996 book profiling physicians across the country. An orthopedic surgeon from Casper, he has been called “Wyoming’s doctor,” a reference to his prominence on local radio and television as a medical expert. He has served as president of the Wyoming Medical Society and was once named Wyoming Physician of the Year. In his 25 years of practicing medicine in the Cowboy State, Barrasso has treated everyone from rodeo riders to senior citizens in Wyoming’s most remote rural areas. Even as he pursues his new career in public service, Barrasso remains a practicing surgeon, just as Coburn remains a practicing obstetrician. “I’m still licensed, I still get the medical journals, and I was in an operating room on Thursday with my old partners in a trauma case and a knee replacement,” Barrasso tells me in his Washington office. Like Coburn, Barrasso speaks knowledgeably and confidently about the details of health-care reform, making a strong case against expanding government management of the system.
So how did a rodeo doctor end up in the U.S. Senate? Barrasso had served nearly five years in the Wyoming state senate when the governor appointed him to fill the seat of GOP senator Craig Thomas, who died in June 2007. Barrasso promised to run for the seat in a special election in 2008, which he won by a large margin. One of the most conservative Republicans in the Senate, Barrasso says his values come from his parents. “I was raised in a solid American family that had great respect for our country, great respect for freedom, for the military, and for the free-market system.”
His family also instilled in him a love of politics and political institutions. “When I was eight, my dad took me to John Kennedy’s inauguration,” Barrasso says. “It has been a family tradition for us. We were at Kennedy’s, Johnson’s, all the way through. Our respect for the country and love of the country was such that our family came to every inauguration, no matter which party won.” As a high-school student, Barrasso came back to the capital on his own when he attended the Presidential Classroom for Young Americans program. He later graduated from Georgetown Medical School.
Despite all this Washington exposure — or perhaps because of it — Barrasso still flies home to Casper every weekend. “I still live in Wyoming and just work in Washington,” he says. “That’s the best way to stay connected.” This may be standard rhetoric from a politician, but the cowboy boots beneath his trouser legs suggest that his sentiments are genuine.
At the same time, Barrasso is willing and able to play the Washington media game. As the health-care debate has revved up, he has graduated from local to national television, appearing on Fox News and MSNBC. During a recent appearance on Ed Schultz’s show, Barrasso outlined the potential costs of a single-payer system while the liberal host struggled to get a word in. The Republican party would be smart to get Barrasso on TV more often; he sounds as trustworthy as your own doctor when he explains why government does not belong in the health-care industry. “If you have the government taking over the whole thing, it’s going to lead to increased costs and increased taxes and the rationing of care,” he says. “It’s denying care.”
Barrasso agrees that the high cost of American health care is a problem that requires fixing, but he stresses that individuals must maintain the freedom to make medical decisions in consultation with their doctors. “I think most people are very smart when it comes to their own money,” he says. “When they make decisions about their own spending, they make smart decisions. With health care, for the most part, people aren’t spending their own money. Even if they are paying for their insurance, they’re not spending their own money on the health care.”
To underscore the point, he relates a story about eight patients he once saw on New Year’s Eve. All the patients had met their deductible for the year and wanted to have operations that they would not have to pay for out of pocket. “They were very smart consumers using their own dollars with no necessary focus on the insurance company’s dollars,” he says.
The Wyoming senator is a voracious reader. He recently finished The Forgotten Man, Amity Shlaes’s book on the Great Depression, and is currently ripping through Paul Johnson’s monster A History of the American People. A self-professed “big fan” of William F. Buckley Jr., Barrasso says he has been reading National Review since the 1960s. In the course of our conversation about health care he cited no fewer than five recent NR articles.
When Barrasso looks at the current American health-care scene, his diagnosis is that Medicare is on course to break the whole system. “Medicare has never focused on trying to keep people healthy,” he explains. “It focuses on paying doctors and hospitals to do things to people.” He believes this neglect of prevention is Medicare’s biggest flaw, and he considers it a preview of what could happen to the entire health-care system if the Democrats get their way. “If a government single-payer system is anything like Medicare, there is going to be significant waste, fraud, and abuse — as well as a lack of coordinated care, and a lack of prevention,” he warns. However, he scoffs at the attempts by some liberals to insert “community” prevention provisions into a government plan. These programs, he says, aren’t about health; they are just ways of spreading a little pork around. “They’re gonna build sidewalks, jungle gyms, and street lights,” he says. “It’s like midnight basketball with Clinton.”
Barrasso isn’t interested in “smarter” government intervention; he wants to keep government out of the way of patients and doctors. “I think you want to tie a person’s own personal health to incentives to work toward a healthy lifestyle,” he says. He points to the company health-care plan used by grocery giant Safeway. “They individualize the incentives so if you get your weight down and your blood pressure under control, and your cholesterol and blood sugar, if you don’t use tobacco products, they know that will help save the company money, and they share that with you. So it’s money in your pocket to stay healthy. And the company saves money too.”
Barrasso stresses the importance of education. For years he has participated in Wyoming health fairs that seek to educate state residents about their own health by providing inexpensive blood tests and information on treatments. “We get lots of letters,” he says, “from folks that say, ‘If it weren’t for the health fair, we would have never detected this problem early.’”
John Barrasso thinks the key to reform is more information, not more government management. “It’s about getting people information they can use to stay healthy and keep down the costs of their care,” he says. As the health-care debate moves into a critical stage, look for Barrasso to play a prominent role in crafting and explaining the Republican message. His expertise is just what the doctor ordered.
— Michael Warren, a Collegiate Network intern at National Review, studies economics and history at Vanderbilt University.
National Review Online - http://article.nationalreview.com/?q=ODFiZTFjOTczZDlhZWQ0NDBjOGYyMjhlMjgyNTA2NzI=
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3rd post.
The only way this statement can prove true is if services are provided without any compensation:
http://www.realclearpolitics.com/video/2009/07/22/pelosi_health_care_reform_has_cap_on_costs_no_cap_on_benefits.html
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Hey Igot this fromdefendyourhealthcare.us (http://defendyourhealthcare.us)
O'S BROKEN PROMISES
HEALTH BILLS V. PREZ'S WORDS
By BETSY MCCAUGHEY
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July 17, 2009 - President Obama promises that "if you like your health plan, you can keep it," even after he reforms our health-care system. That's untrue. The bills now before Congress would force you to switch to a managed-care plan with limits on your access to specialists and tests.
Two main bills are being rushed through Congress with the goal of combining them into a finished product by August. Under either, a new government bureaucracy will select health plans that it considers in your best interest, and you will have to enroll in one of these "qualified plans." If you now get your plan through work, your employer has a five-year "grace period" to switch you into a qualified plan. If you buy your own insurance, you'll have less time.
And as soon as anything changes in your contract -- such as a change in copays or deductibles, which many insurers change every year -- you'll have to move into a qualified plan instead (House bill, p. 16-17).
When you file your taxes, if you can't prove to the IRS that you are in a qualified plan, you'll be fined thousands of dollars -- as much as the average cost of a health plan for your family size -- and then automatically enrolled in a randomly selected plan (House bill, p. 167-168).
It's one thing to require that people getting government assistance tolerate managed care, but the legislation limits you to a managed-care plan even if you and your employer are footing the bill (Senate bill, p. 57-58). The goal is to reduce everyone's consumption of health care and to ensure that people have the same health-care experience, regardless of ability to pay.
Nowhere does the legislation say how much health plans will cost, but a family of four is eligible for some government assistance until their household income reaches $88,000 (House bill, p. 137). If you earn more than that, you'll have to pay the cost no matter how high it goes.
The price tag for this legislation is a whopping $1.04 trillion to $1.6 trillion (Congressional Budget Office estimates). Half of the tab comes from tax increases on individuals earning $280,000 or more, and these new taxes will double in 2012 unless savings exceed predicted costs (House bill, p. 199). The rest of the cost is paid for by cutting seniors' health benefits under Medicare.
There's plenty of waste in Medicare, but the Congressional Budget Office estimates only 1 percent of the savings under the legislation will be from curbing waste, fraud and abuse. That means the rest will likely come from reducing what patients get.
One troubling provision of the House bill compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care (House bill, p. 425-430). The sessions cover highly sensitive matters such as whether to receive antibiotics and "the use of artificially administered nutrition and hydration."
This mandate invites abuse, and seniors could easily be pushed to refuse care. Do we really want government involved in such deeply personal issues?
Shockingly, only a portion of the money accumulated from slashing senior benefits and raising taxes goes to pay for covering the uninsured. The Senate bill allocates huge sums to "community transformation grants," home visits for expectant families, services for migrant workers -- and the creation of dozens of new government councils, programs and advisory boards slipped into the last 500 pages.
The most recent ABC News/Washington Post poll (June 21) finds that 83 percent of Americans are very satisfied or somewhat satisfied with the quality of their health care, and 81 percent are similarly satisfied with their health insurance.
They have good reason to be. If you're diagnosed with cancer, you have a better chance of surviving it in the United States than anywhere else, according to the Concord Five Continent Study. And the World Health Organization ranked the United States No. 1 out of 191 countries for being responsive to patients' needs, including providing timely treatments and a choice of doctors.
Congress should pursue less radical ways to cover the uninsured. We have too much to lose with this legislation.
Betsy McCaughey is founder of the Committee to Reduce Infection Deaths and a former lieutenant governor of New York.
Check it out
Boyo
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This sales job reminds me of a Tom Wait's tune I've posted at the end of this editorial.
Snake Oil
By the Editors
President Obama’s press conference Wednesday night offered an ideal encapsulation of the Democrats’ case for their health-care-reform proposals: outlandish promises about benefits and patently dishonest denials of the costs. He said essentially all of the uninsured would be covered, the insured could keep their existing coverage and would be guaranteed to keep it if they lost or changed jobs, the quality of care would rise, waste and fraud would be slashed, the deficit would decline, and no one would have to pay a price for all this except a few millionaires. Oh, and by the way, the plan would also “keep government out of health-care decisions.”
If the president can persuade the American public of all that, then maybe we don’t even need medical care — we can just have him tell us all we’re perfectly healthy and we’ll go on our way.
But in the end, the president does not in fact seem capable of persuading the public that he and congressional Democrats have found the magic cure-all for our health-care ills. Increasingly, the American people aren’t buying what Obama is selling. Support for his approach to health care has begun to fall below 50 percent in recent polls, as worries about cost, harming the quality and availability of health care, displacing millions who are satisfied with their insurance, increasing the tax burden on employers in the midst of a recession, and creating an enormous new entitlement are adding up.
These worries are justified. The cost of the health-care bills now coming out of the key congressional committees is staggering, and the Congressional Budget Office has said these bills will not reduce health-care-cost inflation in the long run, so that even the trillion-dollar ten-year cost estimates do not begin to describe the full burdens taxpayers will assume. The notion, again repeated by the president, that anyone who is happy with his health insurance now will be able to keep it is patently at odds with every study and analysis of the Democrats’ proposals, all of which foresee many millions displaced. And even the president himself seems no longer to believe that only the rich will pay a price: His language Wednesday night was carefully calibrated. He said reform should not be “completely shouldered on the backs of middle-class families,” or “primarily funded through taxing middle-class families.”
But the greatest weakness of the Democrats’ plans, and the most important concern regarding their implementation, has to do with the rationing of care and the centralization of treatment decisions. While President Obama claimed, preposterously, that the proposals he supports would limit the government’s role, he also made clear that decisions about the availability of care — especially for the elderly at first, but for all in the long run — would be made by a panel of experts in Washington, setting one-size-fits-all rules that would govern doctors’ decisions. This was held up as a model of efficiency, but it is a recipe for disaster, as the public seems increasingly to understand.
The next few weeks are clearly crucial to the fate of these misbegotten plans. Obamacare is in trouble, but it is by no means down for the count. The Democrats control both houses of Congress quite comfortably and are keen to avoid embarrassing their new president or appearing feckless and divided. They are trying to rush a bill through in the hope that no one pays too much attention to the details and that they can claim victory before the smoke has cleared.
But the politics of health care has clearly changed for the better in the past month. Passage of an Obama-style plan is now by no means inevitable, and the more time passes the greater the obstacles to passage appear. Republicans should make it clear that they do not intend to abet the approach the Democrats are contemplating, and that better options are available which would harness consumer choice to control costs and therefore to broaden access to health insurance.
President Obama and the Democrats have given Washington Republicans the perfect opportunity to illustrate for the public what it means to stand for fiscal responsibility, economic growth, individual liberty, and free markets, and how that combination can also point the way to creative and constructive policy solutions. The public is growing wary of the Democrats’ approach and eager to be shown a better way. Republicans should oblige: Stop Obamacare, and make the case for conservative health-care reform.
National Review Online - http://article.nationalreview.com/?q=NGMwNmRmNmFlMTNiNjVlYjc0MTRjYTM0YTNjYTM0ZGI=
[youtube]http://www.youtube.com/watch?v=9Txqmgr1k0Y[/youtube]
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Question 1: What is done and what should be done about people with pre-existing conditions looking for health care?
Question 2: Is/should an insurance company be allowed to discontinue someone who develops a problem?
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Here's Cato's answer to your questions, Marc, or at least a synopsis thereof. Full .pdf file at the link:
Health-Status Insurance: How Markets Can Provide Health Security
by John H. Cochrane
John H. Cochrane is the Myron S. Scholes Professor of Finance at the University of Chicago Booth School of Business and a Research Associate at the National Bureau of Economic Research.
None of us has health insurance, really. If you develop a long-term condition such as heart disease or cancer, and if you then lose your job or are divorced, you can lose your health insurance. You now have a preexisting condition, and insurance will be enormously expensive—if it's available at all.
Free markets can solve this problem, and provide life-long, portable health security, while enhancing consumer choice and competition. "Health-status insurance" is the key. If you are diagnosed with a long-term, expensive condition, a health-status insurance policy will give you the resources to pay higher medical insurance premiums. Health-status insurance covers the risk of premium reclassification, just as medical insurance covers the risk of medical expenses.
With health-status insurance, you can always obtain medical insurance, no matter how sick you get, with no change in out-of-pocket costs. With health-status insurance, medical insurers would be allowed to charge sick people more than healthy people, and to compete intensely for all customers. People would have complete freedom to change jobs, move, or change medical insurers. Rigorous competition would allow us to obtain better medical care at lower cost.
Most regulations and policy proposals aimed at improving long-term insurance—including those advanced in Barack Obama's presidential campaign— limit competition and consumer choice by banning risk-based premiums, forcing insurers to take all comers, strengthening employer-based or other forced pooling mechanisms, or introducing national health insurance.
The individual health insurance market is already moving in the direction of health-status insurance. To let health-status insurance emerge fully, we must remove the legal and regulatory pressure to provide employer-based group insurance over individual insurance and remove regulations limiting risk-based pricing and competition among health insurers.
http://www.cato.org/pubs/pas/pa-633.pdf
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Interesting.
Is there any "health status insurance" currently available?
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House healthcare talks break down in anger
By Jared Allen, Mike Soraghan and Lauren Burke
Posted: 07/24/09 03:27 PM [ET]
House healthcare negotiations dissolved in acrimony on Friday, with Blue Dog Democrats saying they were “lied” to by their Democratic leaders.
In advance of a subsequent press conference called by House leadership, Blue Dog liaison Rep. Dennis Cardoza (D-Calif.) said the healthcare bill should be staying in committee.
"I expect the committee process to proceed," Cardoza said.
The seven Blue Dogs on the Energy and Commerce Committee stormed out of a Friday meeting with their committee chairman, Henry Waxman (D-Calif.), saying Waxman had been negotiating in bad faith over a number of provisions Blue Dogs demanded be changed in the stalled healthcare bill.
“I’ve been lied to,” Blue Dog Coalition Co-Chairman Charlie Melancon (D-La.) said on Friday. “We have not had legitimate negotiations.
“Mr. Waxman has decided to sever discussions with the Blue Dogs who are trying to make this bill work for America,” Melancon said.
Although those Blue Dogs were supposed to be headed back into another meeting of the Energy and Commerce Democrats, their anger was visible.
If the two sides cannot reach an agreement, the only hope for passage of the bill in the House will be to go straight to the floor, an option leaders shied away from endorsing but said was an option.
But the Blue Dogs issued dire warnings to leaders contemplating that approach.
"Waxman simply does not have votes in committee and process should not be bypassed to bring the bill straight to floor,” Rep. Mike Ross (D-Ark.), the lead Blue Dog negotiator, said on Friday. “We are trying to save this bill and trying to save this party.”
Melancon said there would be 40-45 “solid no” votes from the 52-strong Blue Dogs, among other problems throughout the caucus. And Melancon said there are more Democrats who will vote against the bill.
“If they try to bring it to the floor, I think they’ll find out they have more problems than the Blue Dogs.”
A leadership aide said no decisions have been made on how to proceed.
This story was updated at 4:20 p.m.
http://thehill.com/leading-the-news/house-healthcare-talks-break-down-in-anger-2009-07-24.html
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As best as I can tell IMHO the Blue Dogs and the Reps are playing what was once said of Republican Sen. Bob Dole-- "tax collector for the welfare state".
In this case, they are trying to eliminate the worst stupidities but the cost is that they too become tied to this process-- AND they "improve" it for His Glibness. The acede to the continuing trend to statism.
I would much rather they take up the ideological battle for free market orientation.
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Just for argument sakes.
Chuck Schumer made a statement that doctors should make no more than 80K a year.
Sure that is of course because we should be all about caring for our fellow men.
If that is his argument lawyers who require far less schooling should make no more than 40K per year.
Everyone knows they should be *in* law profession to protect the legal rights of all.
Afterall they are there to uphold justice, and our "legal rights".
Additionally the media should stop corrupting our politicians who have to raise obscene amounts of money to pay for obscene costs of advertising.
The politicians who are in "public service" to better the lives of all Americans and our way of life should stop cashing in by writing or at least profiting from books, speeches, working as pundits, getting jobs at hedge funds, lobbyists the minute they leave office.
Working in pulbic office has now become a roadmap to "richdom".
Teachers, police officers, firemen, and other government employees should stop accepting pensions, and other benefits after they stop working since of course they are doing what they do to better and protect mankind.
Can I go on.
My message is clear.
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Pg 22 of the HC Bill MANDATES the govt. will audit books of ALL EMPLOYERS that self insure!!
Pg 30 Sec 123 of HC bill - THERE WILL BE A GOVT COMMITTEE that decides what treatments/benefits you get.
Pg 29 lines 4-16 in the HC bill - YOUR HEALTHCARE IS RATIONED!!!
Pg 42 of HC Bill - The Health Choices Commissioner will choose your HC Benefits for you. YOU have no choice!
PG 50 Section 152 in HC bill - HC will be provided to ALL non US citizens, illegal or otherwise
Pg 58 HC Bill - Govt will have real-time access to individual's finances & a National ID Healthcard will be issued! [Mark of the Beast? Rev 13]
Pg 59 HC Bill lines 21-24 Govt will have direct access to your bank accounts for elective funds transfer
PG 65 Sec 164 is a payoff subsidized plan for retirees and their families in labor unions & community organizations [such as ACORN].
Pg 72 Lines 8-14 Govt is creating an HC Exchange to bring private HC plans under Govt control.
PG 84 Sec 203 HC bill - Govt mandates ALL benefit packages for private HC plans in the Exchange
PG 85 Line 7 HC Bill - Specifies Benefit Levels for all Plans [The Govt will ration your Healthcare].
PG 91 Lines 4-7 HC Bill - Govt mandates linguistic services. Example - Translation for illegal aliens
Pg 95 HC Bill Lines 8-18 The Govt will use groups i.e., ACORN & Americorps to sign up individuals For Govt HC plan
PG 85 Line 7 HC Bill - Specifics of Benefit Levels for Plans. [AARP members - your health care WILL be rationed]
-PG 102 Lines 12-18 HC Bill - Medicaid Eligible Individuals (redefined elsewhere as all those under 133% of poverty level) will be automatically enrolled in Medicaid. [No choice]
Pg 124 lines 24-25 HC No company can sue Govt for price fixing. No "judicial review" against Govt Monopoly.
Pg 127 Lines 1-16 HC Bill - Doctors/ AMA - The Govt will tell you what you can earn.
Pg 145 Line 15-17 An Employer MUST auto enroll employees into public option plan. [NO CHOICE]
Pg 126 Lines 22-25 Employers MUST pay for HC for part time employees AND their families. (this will cut a lot of jobs)
Pg 149 Lines 16-24 ANY Employer with payroll of 400k & above who does not provide public option Pays 8% additional tax on all payroll.
Pg 150 Lines 9-13 Business w payroll between 251k & 400k who doesn't provide public option pays 2-6% additional tax on all payroll
Pg 167 Lines 18-23 ANY individual who doesn't have acceptable (who decides what is acceptable?) HC according to Govt will be taxed additional 2.5% of income
Pg 170 Lines 1-3 HC Bill Any NONRESIDENT Alien is exempt from individual Taxes. [however, Americans will pay]
Pg 195 HC Bill -officers & employees of HC Administration [GOVT] will have access to ALL Americans' finance/personal records
PG 203 Line 14-15 HC - "The tax imposed under this section shall not be treated as tax" [Yes, it says that]
Pg 239 Line 14-24 HC Bill Govt will reduce physician services for Medicaid, Seniors, low income, poor, affected [Pay attention seniors]
Pg 241 Line 6-8 HC Bill - Doctors, doesn't matter what specialty you have, you'll all be paid the same salary
PG 253 Line 10-18 Govt sets value of Dr's time, professional judgment, etc. [literally value of humans].
PG 265 Sec 1131Govt mandates & controls productivity for private HC industries
PG 268 Sec 1141 Fed Govt regulates rental & purchase of power driven wheelchairs
PG 272 SEC. 1145. TREATMENT BY CERTAIN CANCER HOSPITALS - [Cancer patients - welcome to rationing!]
Page 280 Sec 1151 The Govt will penalize hospitals for what Govt deems preventable readmissions.
Pg 298 Lines 9-11 Drs, treat a patient during initial admission that results in a readmission-Govt will penalize you.
Pg 317 L 13-20 PROHIBITION on ownership/investment. Govt tells Drs. what/how much they can own.
Pg 317-318 lines 21-25,1-3 PROHIBITION on expansion- Govt is mandating hospitals cannot expand
Pg 321 2-13 Hospitals have opportunity to apply for exception BUT community input required. [govt permission]
Pg335 L 16-25 Pg 336-339 - Govt mandates establishment of outcome based measures. [HC the way they want. Rationing]
Pg 341 Lines 3-9 Govt has authority to disqualify Medicare Advantage Plans, HMOs, etc. Forcing people into Govt plan
Pg 354 Sec 1177 - Govt will RESTRICT enrollment of Special needs people [such as Downs Syndrome]
Pg 379 Sec 1191 Govt creates more bureaucracy - Telehealth Advisory Committee. [HC by phone?]
PG 425 Lines 4-12 Govt mandates Advance Care Planning Consult. [Think Senior Citizens: end of life]
Pg 425 Lines 17-19 Govt will instruct & consult regarding living wills, durable powers of atty. Mandatory!
PG 425 Lines 22-25, 426 Lines 1-3 Govt provides approved list of end of life resources, guiding you in death [think mandatory Kervorkian]
PG 427 Lines 15-24 Govt mandates program for orders for end of life. The Govt has a say in how your life ends
Pg 429 Lines 1-9 An "advocate care planning consult" will be used frequently as patients health deteriorates
PG 429 Lines 10-12 "advocate care consultation" may include an ORDER for end of life plans. [An ORDER from GOV]
Pg 429 Lines 13-25 - The govt will specify which Doctors can write an end of life order.
PG 430 Lines 11-15 The Govt will decide what level of treatment you will have at end of life
Pg 469 - Community Based Home Medical Services = Non profit organizations. [ACORN Medical Services]
Page 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED ORG. Monthly payment to a community-based organization. [like ACORN]
PG 489 Sec 1308 The Govt will cover Marriage & Family therapy. [Which means they will insert Govt into your marriage]
Pg 494-498 Govt will cover Mental Health Services including defining, creating, rationing those services.
Here's the full Health Care bill that sits in the House.
http://frwebgate.access.gpo.gov/cgi-...=f:h3200ih.pdf
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Repeating my post of the 23rd:
Question 1: What is done and what should be done about people with pre-existing conditions looking for health care?
Question 2: Is/should an insurance company be allowed to discontinue someone who develops a problem?
==========================================
My favorite cartoon strip-- highly recommended as a daily read!
http://www.daybydaycartoon.com/
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Let's do Question 2 first, much easier: "Is/should an insurance company be allowed to discontinue someone who develops a problem?"
No. That is what I was insuring against when I was healthy and bought the policy.
"Question 1: What is done and what should be done about people with pre-existing conditions looking for health care?"
Very tough question and deeply intertwined with whatever your own view is for a role for government and the role for consequences for personal choices.
I don't think any serious conservatives with political aspirations totally opposes a safety net, so if you exhaust your personal wealth, the state is going to take care of you at about the level of care that all of us would receive under Obamacare. The bigger question then is should someone be able to NOT use their own resources to pay for their own health problem IF they previously chose not to insure against it, then arrange to have someone else pay for it and keep their own wealth or other uses. Sounds troublesome to me.
In the real-politic world of risk pooling, an insurer or group can take in people with known problems as long as they are random proportions with people without known problems.
Crafty, what is our view?
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One more shot at the Obama/Democrat House healthcare chart. I found it as an image rather than a pdf this time:
(http://www.powerlineblog.com/archives/media/ChartHealth771.jpg)
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The health status insurance mentioned in the Cato piece strikes me as a worthwhile option to explore. Currently I don't think it's an option as various federal and state regulations prevent the creation of pools large enough to dilute the risk. If they were made possible, I expect they'd be introduced into health insurance much the same way insurance options are introduced into auto policies: comprehensive, collision, uninsured driver, health status, etc.
As for cancellation of existing policies, I think that would be subject to contract law. If you contract with someone to provide health insurance who then fails to provide it due to the circumstances that lead you to seek it in the first place, that would strike me as actionable malfeasance that should be treated that way.
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Does anyone offer insurance that does not allow cancelation?
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I've a guess. I presume you have the answer?
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Obama's Misleading Medicine
By Robert J. Samuelson
Monday, July 27, 2009
The most misused word in the health care debate is "reform." Everyone wants "reform," but what constitutes "reform" is another matter. If you listen to President Obama, his "reform" will satisfy almost everyone. It will insure the uninsured, control runaway health spending, subdue future budget deficits, preserve choice for patients and improve quality of care. These claims are self-serving exaggerations and political fantasies. They have destroyed what should be a serious national discussion of health care.
The health-care conundrum involves a contradiction that the administration steadfastly obscures: In the short run -- meaning four to eight years -- government cannot both insure the uninsured and rein in health spending. Here's why. The notion that the uninsured get little or no care is a myth: They now receive about 50 to 70 percent as much health care as the insured. If they become insured, they would use more health care, possibly as much as today's insured. That would increase both government and private health spending, depending on how the insurance is provided.
Until health-care costs are better controlled, expanding insurance coverage will be expensive. The president talks endlessly about the need to limit spending and eliminate waste. These are worthy goals. But changing the way medical care is delivered and paid for would take years and involve disruptive and unpopular measures. Patient co-payments might increase; networks of doctors and hospitals might displace individual practices; the tax exclusion for employer-paid health insurance might be curbed. Obama downplays the obstacles. His "reform" isn't likely to compel needed changes, partly because it's not clear what will work.
Evaluations of proposals reflect this reality. The Congressional Budget Office judges that the legislation in the House would, through expanded Medicaid and subsidies for private insurance, reduce the uninsured from 46 million in 2007 to 17 million in 2019. But the cost would be $1 trillion over a decade; of that, $239 billion would add to the budget deficit. Worse, the costs would rise faster than the sources of financing, including a tax on the wealthy. In 2019, the projection's last year, the deficit would be $65 billion. Assuming that the deficit rises 4 percent a year, the cumulative shortfall in the second decade would total about $800 billion.
But Obama sees all blue sky. "Here's what reform will mean for you," he said at a recent rally. "It will mean lower costs and more choices and coverage you can count on. Health insurance reform will save you and your family money," he said. (Note: Except for subsidies, it's doubtful families will experience savings anytime soon.) And later: "We'll also change incentives so that our doctors and our nurses can finally start providing patients with the best care and not just the most expensive care. And if we do that, then reform . . . will lower our deficits in the long run."
Contrast Obama's reassuring rhetoric with this exchange at a congressional hearing between Sen. Kent Conrad (D-N.D.), chairman of the Senate Budget Committee, and Douglas Elmendorf, head of the CBO.
Conrad: "From what you have seen from the product of the committees that have reported, do you see a successful effort being mounted to bend the long-term cost curve?"
Elmendorf: "No, Mr. Chairman. In the legislation that has been reported, we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount. And on the contrary, the legislation significantly expands the federal responsibility for health care costs. . . . The (cost) curve is being raised."
Judged objectively, "reform" may do exactly the opposite of what Obama says. But because the president is so well-spoken, he has the ability to make misleading statements sound reasonable or sophisticated. Still, they're misleading.
The administration had to make choices; it could emphasize expanded insurance coverage ("access") or cost control, but not both. It chose coverage, embracing the long-standing liberal grail of "universal" insurance. Millions of Americans would receive more health care, though how much their health would improve is uncertain (the administration can't logically argue that much health care is wasteful and also that the uninsured will automatically benefit from more of it). Many with insurance would gain the peace of mind that they won't lose it.
But what helps many Americans as individuals may hurt society as a whole. That's the paradox. Unchecked health spending is depressing take-home pay, squeezing other government programs -- state and local programs as well as federal -- and driving up taxes and budget deficits. The president has said all of this; he simply isn't doing much about it. He offers the illusion of "reform" while perpetuating the status quo of four decades: expand benefits, talk about controlling costs. The press should put "reform" in quote marks, because this is one "reform" that might leave the country worse off.
http://www.washingtonpost.com/wp-dyn/content/article/2009/07/26/AR2009072602188.html?hpid%3Dopinionsbox1&sub=AR
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2nd Post.
July 27, 2009
Speculators Bet Reform Won’t Hurt Industry
By DON JOHNSON
Speculators seem to be betting that a watered down health insurance reform bill won't hurt health insurers, hospitals, drug makers or medical device and supply manufacturers.
Stocks for almost all of these health sectors and for exchange trade funds that track health stock indexes turned higher last week. Why?
1. Congress is not going to get health bills through the Senate or the House in face of strong opposition by a minority of Democrats in both houses. This means opponents of the health insurance reform bills will have at least 45 days to convince members of Congress and the public that the bills favored by the president and his hard left supporters in Congress are a bad idea.
2. It is very unlikely that Congress will create a public option health plan, or Government HMO (Fannie Med). The votes aren't there. This is a bit bullish for health insurers over the short term. White House talk about taxing insurers that offer gold plated health benefit plans makes no sense because few do. If such taxes were enacted, insurers would stop offering or administering such plans, and self-insured employers probably would drop them as long as union contracts didn't lock them into such plans.
3. If the very liberal Coastal Democrats who lead Congress and most of the five commitees drafting health insurance legislation want to get the support of Democrats from Western, Midwestern and Southern states, they'll have to up Medicare payments to providers in those states. This is bullish for hospital chains, which operate mostly in the fly-over states.
4. The Congressional Budget Office Saturday threw cold water on the idea of putting MedPac, a panel of self-interested health care and medical experts who would be subject to tremendous political pressure from Congress, in charge of deciding what insurers would cover and how much they would pay for procedures. The panel would save only $2 billion out of trillions over 10 years, the CBO guessed. And it was being generous to the idea that MedPac would save anything. This is good for drug and medical device makers, because it lessens the threat of new price and utilization controls on their products.
5. While www.intrade.com bettors think there's at least a 46% chance that some kind of health insurance reform will be enacted before year end, the polls are showing Americans are increasingly opposing the bills before Congress. The politicians who created the laws and regulations that make Medicare, Medicaid, SCHIP and state and federal regulations of health insurance markets unworkable failures are promising to fix the health markets. They have less and less credibility every day.
6. Proposals to tax millionaires to pay for covering the uninsured and increasing benefits for others are in trouble, if not dead on arrival. The economy's in no shape to be stalled by tax hikes, and there appear to be enough Democrats opposed to the tax to stop it.
7. While the so-called Blue Dog Democrats are stalling health insurance reform for economic and ideological reasons, the Congressional Black Caucus has made it clear that it won't support a bill that the Blue Dogs will support. Throw in the opposition by anti-abortionists who don't want the legislation to use taxpayers money to pay for abortions, and you have a pretty complex political problem for President Obama, Sen. Majority Leader Harry Reid (D-NV) and Speaker Nancy Pelosi (D-CA). While the Speaker claimed Sunday that she has the votes to pass health insurance reform, few believe her.
Some Democrats are saying that drafting health insurance reform bills is 70% to 80% done and it won't take long to get a bill. Other Democrats are saying they want to take the time to write good legislation. The question is, can the Democrats and a few Republicans resolve the last 20% to 30% of the issues that need to be agreed upon to get a bill? It doesn't look very good for health insurance reform at the moment, but some kind of a bill may pass in the next year or so, if not this year. Presidents Reagan, Clinton and Bush II all enacted major health legislation in their third and later years in office. All three bills have been financial and health care disasters.
Charts for health insurers are here.
Charts for hospital chains are here.
Charts for drug makers are here.
Charts for medical device and supply makers are here.
Charts for long-term care stocks are here.
Chart for health stock exchange traded funds are here.
Click on a chart to see a gallery of charts for a stock or ETF. Disclosure: I own BDX and options on STJ.
Don Johnson blogs at The Business Word Inc. Between 1976 and 1986 he was editor of Modern Healthcare magazine. As its top editor, Don helped build Modern Healthcare, a Crain Communications Inc. publication, into the hospital industry's leading business magazine and one of the top magazines in the country.
http://www.thehealthcareblog.com/the_health_care_blog/2009/07/speculators-bet-reform-wont-hurt-industry.html#more
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Reparations By Way Of Health Care Reform
By INVESTOR'S BUSINESS DAILY | Posted Monday, July 27, 2009 4:20 PM PT
Legislation: Still believe in post-racial politics? Read the health care bill. It's affirmative action on steroids, deciding everything from who becomes a doctor to who gets treatment on the basis of skin color.
President Obama is on the record as being officially opposed to reparations for slavery. But as with other issues, you have to sift through his eloquent rhetoric and go beyond the teleprompter to get at what he really means.
His opposition to reparations is based on the fact they don't go far enough. In a 2004 questionnaire, he told the NAACP, "I fear that reparations would be an excuse for some to say, 'We've paid our debt,' and to avoid the much harder work."
Never mind there are those who thought we apologized at Gettysburg and that an African-American president is a recognition of the hard work that has been done.
At a press conference with minority journalists last fall, candidate Obama was pressed for more detail on his reparations position. He said he was more interested in taking action to help people who were just getting by. Because many of them are minorities, he said, that would help the same people who would benefit from reparations.
"If we have a program, for example, of universal health care, that will disproportionally affect people of color, because they are disproportionally uninsured," Obama said.
This may be a goal of Obama's health care plan: the redress of health care disparities on the basis of race and the punishment of those believed to be responsible, such as greedy doctors who perform unnecessary tests and procedures and greedy insurance and drug companies lusting for profits.
In his health care plan published during the campaign, it was written that Obama and Biden will "challenge the medical system to eliminate inequities in health care by requiring hospitals and health plans to collect, analyze and report health care quality for disparity populations and holding them accountable for any differences found."
House Speaker Nancy Pelosi repeated this when she addressed the NAACP this month, saying: "It is a moral issue for our country to reduce health disparities, whether in diabetes, asthma, heart disease, cancer and HIV/AIDS."
The racial grievance industry under health care reform could be calling the shots in the emergency room, the operating room, the medical room, even medical school. As Terence Jeffrey, editor at large of Human Events puts it, not only our wealth, but also our health will be redistributed.
Under the Democrats' plans, if a medical school wants to receive contracts and grants from the federal government, it must operate under a quota system and be able to prove it. On Page 909, the House bill states: "In awarding grants or contracts under this section, the (HHS) secretary shall give preference to entities that have a demonstrated record of the following: . . . training individuals who are from underrepresented minority groups or disadvantaged backgrounds."
Jeffrey points out that in the name of eliminating "disparities" in health care, under the House version of the bill, payment to providers under the public option becomes a sort of Pavlovian reward and punishment system.
"The secretary," says Section 224, "shall design and implement the payment mechanisms and policies under this section in a manner that — (1) seeks to . . . reduce health disparities (including racial, ethnic and other disparities)."
Everyone deserves the best health care and doctors. That will not happen under a plan that emphasizes affirmative action and leads to rationing.
As the case of the New Haven, Conn., firefighters shows, reverse discrimination is wrong and dangerous.
Whether it's that firefighter coming up the ladder, or the brain surgeon about to remove that tumor in your head, everybody wants that person to be the best regardless of race or ethnicity — and not admitted by quotas and promoted by political correctness.
That's what all Americans are owed.
http://www.ibdeditorials.com/IBDArticles.aspx?id=333586760867927
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2nd post:
July 28, 2009
The universal health care dogs that aren't barking
Thomas Lifson
Oddly enough, as the nation considers ObamaCare, the press is completely uninterested in the experience of Massachusetts and Hawaii, both of which have ambitious, and failed, experiments in trying to provide universal health care. Mitt Romney, the architect of the Bay State's health care plan, which is costing far more than expected, is largely absent from the airwaves, despite his legitimate claim to be an expert. The Boston Globe calls the plan a "failure" and notes "The state's plan flunks on all counts."
Spending for the Commonwealth Care subsidized program has doubled, from $630 million in 2007 to an estimated $1.3 billion for 2009, which is not sustainable.
As for Hawaii, the President's home state, Steve Gilbert of Sweetness & Light highlights the great hopes for Hawaii as a "model" (according to the New York Times) for the nation. He cites several articles over the years, which make illuminating background for considering ObamaCare. As usual, he highlights the relevant texts. View all of them here.
In Hawaii, as in Mass, once again, universal care has not been achieved, but costs have ballooned. Steve cites (and highlights) the following from the Honolulu Advertiser less than a month ago:
A law enacted in Hawai'i in 1974 that requires employers to provide health insurance for employees working at least 20 hours a week is being cited by researchers who are skeptical of similar mandates being suggested in the argument for universal health care.
The result of Hawai'i's Prepaid Health Care Act has been that businesses have relied more on employees who work fewer than 20 hours a week and thus aren't covered under the requirement, wrote San Francisco Federal Reserve Bank research adviser Rob Valletta and co-authors Tom Buchmueller and John DiNardo, both University of Michigan professors.
The results of the research into health insurance coverage in Hawai'i "imply that an employer mandate is not an effective means for achieving universal coverage," they wrote.
"Although overall insurance coverage rates are unusually high in Hawai'i, a substantial number of people remain uninsured, suggesting a need for alternative approaches if universal coverage is the ultimate goal," they said...
Isn't it time that everyone agrees that ill-considered plans turn out to be disasters when it comes to achieving universal health care? Federalism really is the laboratory of democracy, and the lab results are in. The president and his lapdog media need to be honest about what we have already learned.
Page Printed from: http://www.americanthinker.com/blog/2009/07/the_universal_health_care_dogs.html at July 28, 2009 - 01:50:16 PM EDT
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Romney’s Folly
Health-care mandates are a middle-class tax.
By Michael F. Cannon
Amid negotiations with leading Democrats over health-care reform, Iowa senator Chuck Grassley, ranking Republican on the Senate Finance Committee, commented, “The federal government is in the process of nationalizing banks, nationalizing General Motors — I’m going to make sure we don’t nationalize health insurance, and the ‘public option’ is the first step to doing that.”
Grassley is correct, and conservatives are right to oppose Pres. Barack Obama’s proposal to create a “Fannie Med.” But when it comes to nationalizing health insurance, there is more than one way to skin the patient. Indeed, there is talk on Capitol Hill that Grassley and other Senate Republicans may be close to a deal that would nationalize health care smack dab in the middle of the private sector. For an example of how that can be done, look to Massachusetts.
In 2006, Gov. Mitt Romney teamed up with Beacon Hill Democrats and the Heritage Foundation to enact the most sweeping health-care reform in the nation. Governor Romney made Massachusetts the first state to require that its residents purchase health insurance under penalty of law (the “individual mandate”) and the second state (after Hawaii) to require that employers make a minimum level of health insurance part of employee compensation (the “employer mandate”). Romney created new government subsidies and expanded Medicaid to help residents comply with those mandates. He also created a health-insurance “exchange” — a government-managed marketplace — called the Commonwealth Connector.
Although Romneycare included no insurance program explicitly run by the government, it gave Beacon Hill politicians so much power over the health care of Massachusetts residents that it might as well have. The individual and employer mandates, operating entirely within the private sector, imposed what amount to new tax burdens, gave government the power to regulate all aspects of health insurance and medical practice, and subjected residents’ access to medical care to political calculation. Moreover, the fruits of Romneycare have been exactly what you’d expect from a government program. Before reform, Massachusetts’s health-care sector was rigid and expensive, with some of the longest waiting times in the nation. Since reform, it has grown even more rigid and expensive — though the politicians have managed to hide more than half of its $2 billion cost. Waits are longer as well, though they hardly merit a mention compared with the more odious forms of rationing involved.
All of this makes Massachusetts a case study in the reforms that President Obama and congressional Democrats are trying to ram through Congress. Both the House and Senate health-care plans include individual and employer mandates, new government subsidies, a broader Medicaid program, and a new government-managed health-insurance exchange — as might a deal betwen Grassley and Finance Committee chairman Max Baucus (D., Mont.). As goes Massachusetts, so would go the nation.
Like any government health-care program, Romneycare has spurred its share of garden-variety “send a check to Uncle Sam” tax increases. Yet those taxes don’t account for even half of Romneycare’s costs. Individual and employer mandates are the taxes that politicians prefer when they don’t want you to realize they’re taxing you. As President Obama’s National Economic Council chairman, Larry Summers, wrote in 1989, employer mandates “are like public programs financed by benefit taxes. . . . There is no sense in which benefits become ‘free’ just because the government mandates that employers offer them to workers.” The same is true of an individual mandate: To the extent that government forces people to purchase something they do not value, it is a tax, even if the money never enters the treasury.
That means that Romneycare achieves near-universal coverage mostly by taxing middle-class earners. Massachusetts forces employers to offer workers a minimum level of health benefits or pay an annual $295-per-worker penalty, while individuals who do not obtain coverage face annual penalties as high as $1,068. Since employers pay for employment taxes and employee benefits by reducing wages, Massachusetts residents can face a tax of nearly $1,400. Depending on their income, married couples pay up to twice that.
Obama is hardly oblivious to the coercive nature of mandates. Take him at his own word: During the presidential campaign, he attacked Hillary Clinton’s proposal for an individual mandate by likening it to Romney’s Massachusetts model. Under an individual mandate, Obama explained, “you can have a situation, which we are seeing right now in the state of Massachusetts, where people are being fined for not having purchased health care but choose to accept the fine because they still can’t afford it, even with the subsidies. And they are then worse off. They then have no health care and are paying a fine above and beyond that.”
Since individual and employer mandates are simply disguised taxes, imposing them would violate Obama’s pledge not to tax the middle class. During the presidential campaign, he vowed, “I can make a firm pledge: Under my plan, no family making less than $250,000 a year will see any form of tax increase.” Yet House Democrats would force non-compliant employers to pay a tax equal to 8 percent of payroll, while uninsured individuals would pay a tax equal to 2.5 percent of income.
An uninsured worker earning $50,000 per year with no offer of coverage from his employer would therefore face a 15.3 percent federal payroll tax, plus a 25 percent federal marginal income-tax rate, plus an 8 percent reduction in his wages, plus a 2.5 percent uninsured tax. In total, his effective marginal federal tax rate would reach 50.8 percent.
In late June, Obama declared, “If any bill arrives from Congress that is not controlling costs, that’s not a bill I can support. It’s going to have to control costs.” Last week, Congressional Budget Office director Douglas Elmendorf explained that simply forcing people to purchase health insurance would bend the “cost curve” — in the wrong direction. No one who has been paying attention to Massachusetts was surprised.
Prior to reform, Massachusetts already was known for extravagant health-care spending. In 2004, per capita spending was a quarter to a third higher than the national average and was growing faster to boot. According to a study funded by the BlueCross BlueShield Foundation of Massachusetts, Romneycare caused spending growth to accelerate further. The study indicates that without reform, spending would have grown by just 6.4 percent in 2007. Instead, it grew by 10.7 percent — two-thirds faster.
A report by the Massachusetts Taxpayers Foundation titled “Massachusetts Health Reform: The Myth of Uncontrolled Costs” tried to put a happy face on the reform’s expense. It explained that in 2009 Romneycare is covering 432,000 previously uninsured residents while increasing state outlays by just $409 million — which seems like a bargain. Of course, the full cost of Romneycare includes not only increased state spending but increased federal spending (in the form of matching Medicaid funds) and mandated private spending by individuals and employers. In total, the foundation conservatively estimates that the full cost will exceed $2.1 billion this year. That is, Romneycare is covering the uninsured at a cost of about $6,700 each. For comparison, in 2007 the average cost nationally of an individual policy was just $2,600. That’s a bad deal, even by government standards.
Note also that only about 40 percent of the cost of Romneycare actually appears in any government budget. The lion’s share is borne by the private sector. Massachusetts politicians are nonetheless struggling to scrape together the 20 percent they must raise themselves. Of necessity, they have begun rationing access to care.
For all that additional spending, many Massachusetts residents are finding it harder to see a doctor. One survey of wait times to see a specialist, such as a cardiologist or orthopedic surgeon, reads like a dispatch from Canada. In 2004, specialist wait times in Boston were already among the highest in the nation. Over the next five years, wait times fell in most U.S. cities to an average of 21 days, but in Boston they rose to an average of 50 days, even though Massachusetts has more doctors per resident than any other state. Those wait times may be exacerbated by state officials’ decision to impose price controls in Medicaid. When the Massachusetts legislature needed to trim $130 million from the cost of Romneycare, it canceled coverage for 30,000 legal immigrants — a stark reminder that governments ration care by targeting those who wield the least political power.
The individual and employer mandates, on the other hand, give Massachusetts the power to ration care in a deliberate and systemic fashion. When government mandates that individuals purchase health insurance, it must define “health insurance” so that people can know whether they are complying with the mandate. That not only gives government the power to dictate what types of coverage health plans must offer but also enables it to regulate the relationships between insurers and health-care providers. In July, a legislative commission recommended that Massachusetts use that power to impose price controls in the private sector as a means of rationing care.
At first, the proposed price-control regime would dictate the unit of payment that insurers and providers must use. Instead of paying providers a fee for each particular medical service — $50 for a flu shot, $300 for patching up a broken finger, whatever — Massachusetts would dictate that all insurers pay providers a “global payment” that covers all of the patient’s medical needs for an entire year. There’s nothing dangerous about this method of paying providers as long as insurers using other payment methods are free to compete. But if government mandates that “global payment” is the only legal payment method, you get Canada. In effect, “global payment” becomes the government’s way of delegating medical-rationing decisions to doctors and hospitals, which must accept a flat fee per customer and then decide what they will and will not do for the money they receive.
Of course, to have any real impact on spending, the state would have to control not only the method of payment but the prices themselves.
In 1989, Summers wrote, “Conservatives tend to prefer mandated benefits to public provision, as evidenced, for example . . . in proposals in the 1970s to mandate employer health insurance as the ‘conservative’ alternative to national health insurance.” The experience in Massachusetts should teach conservatives that individual and employer mandates are socialized medicine with a private façade. We’ll know by watching Senator Grassley whether conservatives have learned that lesson.
— Mr. Cannon is director of health-policy studies at the Cato Institute and co-author of Healthy Competition: What’s Holding Back Health Care and How to Free It.
National Review Online - http://article.nationalreview.com/?q=YWU1MGZkNmM5OWNhYzI0MzhjZGM5ZTZjMWM2ZjZlY2M=
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Obama’s Great Health Scare
The president resorts to the politics of fear.
By KARL ROVE
On the campaign trail last year, Barack Obama promised to end the “politics of fear and cynicism.” Yet he is now trying to sell his health-care proposals on fear.
At his news conference last week, he said “Reform is about every American who has ever feared that they may lose their coverage, or lose their job. . . . If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket. If we do not act, 14,000 Americans will continue to lose their health insurance every single day. These are the consequences of inaction.”
A Fox News Poll from last week shows that 84% of Americans who have health insurance are happy with their coverage. And because 91% of all Americans have insurance, that means that 76% of all Americans will be concerned about anything that threatens their current coverage. By a 2-1 margin, according to the Fox Poll, Americans want coverage from a private provider rather than the government.
Facing numbers like these, Mr. Obama is dropping his high-minded rhetoric and instead trying to scare voters. During last week’s news conference, for example, he said that doctors routinely perform unnecessary tonsillectomies on children simply to fatten their wallets. All that was missing was the suggestion that the operations were conducted without anesthesia.
This is not a healthy way to wage a policy debate. It also risks making the president look desperate at a time when his proposals are looking increasingly too expensive for Americans to accept.
Last weekend, the Congressional Budget Office (CBO) demolished Mr. Obama’s claims that his plan cuts the growth of future health spending and won’t add to the deficit. Responding to a White House proposal to create an independent panel to recommend Medicare cuts, the CBO said on Saturday that “The probability is high that no savings would be realized” in the next decade, while entitlement spending would rise $1.042 trillion. The CBO did say there might be $2 billion in savings in the second decade of the program—a pittance.
White House Budget Director Peter Orszag shot back at the CBO with a blog posting on the White House’s Web site arguing, “the point of the proposal . . . was never to generate savings over the next decade.” Really? The White House rolled out the proposal hoping to give cover to Blue Dog Democrats in Congress barking about the cost of overhauling health care.
The House version of ObamaCare adds to the deficit even though the new taxes to pay for part of it begin two years before the program itself kicks in. That head start puts ObamaCare in the black through 2013. But net new spending after that overwhelms future revenue to add to the deficit each year.
Keith Hennessey, who was a National Economic Council director for George W. Bush, estimates the annual deficits in Mr. Obama’s plan will grow to $64 billion a year by 2019. And this assumes that Mr. Obama gets all the tax increases and Medicare cuts he wants.
On Sunday, the CBO released another torpedo at the burning hull of USS ObamaCare. Responding to an inquiry by Rep. David Camp (R., Mich.) about whether the House bill would run a deficit in its second decade, the CBO reported it would “probably generate substantial increases in federal budget deficits during the decade beyond the current 10-year budget window.” The CBO does not believe that Mr. Obama’s proposal “bends” health-care spending down, as the president has repeatedly claimed it would. The CBO says it escalates above today’s rate.
By 2029, Mr. Hennessey estimates that new taxes will bring in $143 billion a year, while net new health spending will have increased by $348 billion a year.
Damaging reports from the CBO had earlier provoked some Chicago-style intimidation, with the president summoning CBO Director Douglas Elmendorf to the Oval Office. It’s safe to assume that they didn’t talk about the Chicago White Sox. Imagine if Mr. Bush had done that after the CBO released numbers that undercut the centerpiece of his domestic agenda. “White House thuggery” and “intimidation” would have been the theme of nearly every editorial writer in the country.
Team Obama’s pressure, however, might have caused the CBO to release its latest missives on a weekend, when fewer people are paying attention to the news.
Mr. Obama’s problem is that nine out of 10 Americans would likely get worse health care if ObamaCare goes through. Of those who do not have insurance—and who therefore might be better off—approximately one-fifth are illegal aliens, nearly three-fifths make $50,000 or more a year and can afford insurance, and just under a third are probably eligible for Medicaid or other government programs already.
For the slice of the uninsured that is left—perhaps about 2% of all American citizens—Team Obama would dismantle the world’s greatest health-care system. That’s a losing proposition, which is why Mr. Obama is increasingly resorting to fear and misleading claims. It’s all the candidate of hope has left.
Mr. Rove is the former senior adviser and deputy chief of staff to President George W. Bush.
http://online.wsj.com/article/SB10001424052970204619004574318334081271414.html#mod=rss_opinion_main
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This post is about the healthcare debate but my interest is really about keeping an eye on the players for 'the way forward for conservatives - with a big question mark. The author Mitt Romney is the presumed front runner to challenge Obama and he has a history as governor of perhaps the most liberal state and architect of a government health plan. In his defense, his 'plan' could be argued as within 'state's rights' unlike Hillary, Barack and Pelosi who just make up constitutional federal government powers. His plan offered no 'public option', just compulsion and meddling. To a more moderate voter than me it could be argued that Governor Romney's experience with healthcare policy and politics is a strength and an accomplishment.
http://blogs.usatoday.com/oped/2009/07/mr-president-whats-the-rush.html
Mr. President, what's the rush?
Obama could learn a thing or two about health care reform from Massachusetts. One, time is not the enemy. Two, neither are the Republicans.
By Mitt Romney
Because of President Obama's frantic approach, health care has run off the rails. For the sake of 47 million uninsured Americans, we need to get it back on track.
(Now insured: Francisco Diaz of Boston consults with nurse practitioner Anna Hackett Peterson./Josh T. Reynolds for USA TODAY; Mitt Romney./AP)
Health care cannot be handled the same way as the stimulus and cap-and-trade bills. With those, the president stuck to the old style of lawmaking: He threw in every special favor imaginable, ground it up and crammed it through a partisan Democratic Congress. Health care is simply too important to the economy, to employment and to America's families to be larded up and rushed through on an artificial deadline. There's a better way. And the lessons we learned in Massachusetts could help Washington find it.
No other state has made as much progress in covering their uninsured as Massachusetts. The bill that made it happen wasn't a rush job. Shortly after becoming governor, I worked in a bipartisan fashion with Democrats to insure all our citizens. It took almost two years to find a solution. When we did, it passed the 200-member legislature with only two dissenting votes. It had the support of the business community, the hospital sector and insurers. For health care reform to succeed in Washington, the president must finally do what he promised during the campaign: Work with Republicans as well as Democrats.
Massachusetts also proved that you don't need government insurance. Our citizens purchase private, free-market medical insurance. There is no "public option." With more than 1,300 health insurance companies, a federal government insurance company isn't necessary. It would inevitably lead to massive taxpayer subsidies, to lobbyist-inspired coverage mandates and to the liberals' dream: a European-style single-payer system. To find common ground with skeptical Republicans and conservative Democrats, the president will have to jettison left-wing ideology for practicality and dump the public option.
The cost issue
Our experience also demonstrates that getting every citizen insured doesn't have to break the bank. First, we established incentives for those who were uninsured to buy insurance. Using tax penalties, as we did, or tax credits, as others have proposed, encourages "free riders" to take responsibility for themselves rather than pass their medical costs on to others. This doesn't cost the government a single dollar. Second, we helped pay for our new program by ending an old one — something government should do more often. The federal government sends an estimated $42 billion to hospitals that care for the poor: Use those funds instead to help the poor buy private insurance, as we did.
When our bill passed three years ago, the legislature projected that our program would cost $725 million in 2009. At $723 million, next year's forecast is pretty much on target. When you calculate all the savings, including that from the free hospital care we eliminated, the net cost to the state is approximately $350 million. The watchdog Massachusetts Taxpayers Foundation concluded that our program's cost is "relatively modest" and "well within initial projections."
And if subsidies and coverages are reined in, as I've suggested, the Massachusetts program could actually break even. One thing is certain: The president must insist on a program that doesn't add to our spending burden. We simply cannot afford another trillion-dollar mistake.
The Massachusetts reform aimed at getting virtually all our citizens insured. In that, it worked: 98% of our citizens are insured, 440,000 previously uninsured are covered and almost half of those purchased insurance on their own, with no subsidy. But overall, health care inflation has continued its relentless rise. Here is where the federal government can do something we could not: Take steps to stop or slow medical inflation.
At the core of our health cost problem is an incentive problem. Patients don't care what treatments cost once they pass the deductible. And providers are paid more when they do more; they are paid for quantity, not quality. We will tame runaway costs only when we change incentives. We might do what some countries have done: Require patients to pay a portion of their bill, except for certain conditions. And providers could be paid an annual fixed fee for the primary care of an individual and a separate fixed fee for the treatment of a specific condition. These approaches have far more promise than the usual bromides of electronic medical records, transparency and pay-for-performance, helpful though they will be.
Try a business-like analysis
I spent most of my career in the private sector. When well-managed businesses considered a major change of some kind, they engaged in extensive analysis, brought in outside experts, exhaustively evaluated every alternative, built consensus among those who would be affected and then moved ahead. Health care is many times bigger than all the companies in the Dow Jones combined. And the president is rushing changes that dwarf what any business I know has faced.
Republicans are not the party of "no" when it comes to health care reform. This Republican is proud to be the first governor to insure all his state's citizens. Other Republicans such as Rep. Paul Ryan and Sens. Bob Bennett and John McCain, among others, have proposed their own plans. Republicans will join with the Democrats if the president abandons his government insurance plan, if he endeavors to craft a plan that does not burden the nation with greater debt, if he broadens his scope to reduce health costs for all Americans, and if he is willing to devote the rigorous effort, requisite time and bipartisan process that health care reform deserves.
Mitt Romney was governor of Massachusetts from 2003 to 2007.
The Massachusetts plan
• Everyone must buy health insurance or face tax penalties.
• Hundreds of millions of dollars being spent on free hospital care were converted into subsidies to help the needy buy insurance.
• A health insurance "exchange" was established to help connect the uninsured with private health plans at more affordable rates.
• Health plans can offer consumers higher deductibles and more restrictive physician and hospital networks in order to lower costs.
• Businesses with 11 or more workers that do not offer insurance must pay a $295 per employee fee.
Source: Massachusetts Health Connector Authority
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"And providers could be paid an annual fixed fee for the primary care of an individual and a separate fixed fee for the treatment of a specific condition"
Hospitals are already paid by Medicare this way. It is called the diagnostic related groups.
As for providers our reimbursements have continually gone down for years.
The incentive for doctors is to see more patients if you are a thinking type doctor and do more procedures if that is how you get paid.
I am not sure how up front or say yearly payments to treat overall conditions would work.
Certainly the incentive is then to do less.
Is that good? I don't know.
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Why cant' a company or a group of people (like a co-op) hire their own doctor? Pay the doc a salary and that would take care of general healthcare. Then as a group negotiate with some other entity, insurance co. or hospital,l for catastrophic care? Why not pay for the education of med students for their agreement to work for the group for a fixed time? This might lower cost. Maybe the group could self insure for procedures the on staff medial personnel could not perform. It seems to me there are ways to get what you want from the free market without the government getting involved.
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Here’s a Second Opinion
By Scott W. Atlas
Ten reasons why America’s health care system is in better condition than you might suppose. By Scott W. Atlas.
Medical care in the United States is derided as miserable compared to health care systems in the rest of the developed world. Economists, government officials, insurers, and academics beat the drum for a far larger government role in health care. Much of the public assumes that their arguments are sound because the calls for change are so ubiquitous and the topic so complex. Before we turn to government as the solution, however, we should consider some unheralded facts about America’s health care system.
1. Americans have better survival rates than Europeans for common cancers. Breast cancer mortality is 52 percent higher in Germany than in the United States and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the United Kingdom and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.
2. Americans have lower cancer mortality rates than Canadians. Breast cancer mortality in Canada is 9 percent higher than in the United States, prostate cancer is 184 percent higher, and colon cancer among men is about 10 percent higher.
3. Americans have better access to treatment for chronic diseases than patients in other developed countries. Some 56 percent of Americans who could benefit from statin drugs, which reduce cholesterol and protect against heart disease, are taking them. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons, and 17 percent of Italians receive them.
4. Americans have better access to preventive cancer screening than Canadians. Take the proportion of the appropriate-age population groups who have received recommended tests for breast, cervical, prostate, and colon cancer:
Nine out of ten middle-aged American women (89 percent) have had a mammogram, compared to fewer than three-fourths of Canadians (72 percent).
Nearly all American women (96 percent) have had a Pap smear, compared to fewer than 90 percent of Canadians.
More than half of American men (54 percent) have had a prostatespecific antigen (PSA) test, compared to fewer than one in six Canadians (16 percent).
Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with fewer than one in twenty Canadians (5 percent).
5. Lower-income Americans are in better health than comparable Canadians. Twice as many American seniors with below-median incomes self-report “excellent” health (11.7 percent) compared to Canadian seniors (5.8 percent). Conversely, white, young Canadian adults with below-median incomes are 20 percent more likely than lower-income Americans to describe their health as “fair or poor.”
6. Americans spend less time waiting for care than patients in Canada and the United Kingdom. Canadian and British patients wait about twice as long—sometimes more than a year—to see a specialist, have elective surgery such as hip replacements, or get radiation treatment for cancer. All told, 827,429 people are waiting for some type of procedure in Canada. In Britain, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.
7. People in countries with more government control of health care are highly dissatisfied and believe reform is needed. More than 70 percent of German, Canadian, Australian, New Zealand, and British adults say their health system needs either “fundamental change” or “complete rebuilding.”
8. Americans are more satisfied with the care they receive than Canadians. When asked about their own health care instead of the “health care system,” more than half of Americans (51.3 percent) are very satisfied with their health care services, compared with only 41.5 percent of Canadians; a lower proportion of Americans are dissatisfied (6.8 percent) than Canadians (8.5 percent).
9. Americans have better access to important new technologies such as medical imaging than do patients in Canada or Britain. An overwhelming majority of leading American physicians identify computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade—even as economists and policy makers unfamiliar with actual medical practice decry these techniques as wasteful. The United States has thirty-four CT scanners per million Americans, compared to twelve in Canada and eight in Britain. The United States has almost twenty-seven MRI machines per million people compared to about six per million in Canada and Britain.
10. Americans are responsible for the vast majority of all health care innovations. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other developed country. Since the mid- 1970s, the Nobel Prize in medicine or physiology has gone to U.S. residents more often than recipients from all other countries combined. In only five of the past thirty-four years did a scientist living in the United States not win or share in the prize. Most important recent medical innovations were developed in the United States.
Despite serious challenges, such as escalating costs and care for the uninsured, the U.S. health care system compares favorably to those in other developed countries.
This essay appeared on the website of the National Center for Policy Analysis on March 24, 2009. An earlier version was published in the Washington Times.
Available from the Hoover Press is Power to the Patient: Selected Health Care Issues and Policy Solutions, edited by Scott W. Atlas. To order, call 800.935.2882 or visit www.hooverpress.org.
Scott W. Atlas is a senior fellow at the Hoover Institution and a professor of radiology and chief of neuroradiology at Stanford University Medical School.
Find this article at:
http://www.hoover.org/publications/digest/49525427.html
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Thanks for previous post BBG. These Americans advantages disappear when we emulate worse systems.
Tim Penny, was Democratic Congressman for Rochester MN, home of the Mayo clinic, and Rudy Boschwitz became a two term Republican senator of the 'blueist' state when Democrats overreached here:
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Gov't-Run Care Is A Study In Soaring Costs
By RUDY BOSCHWITZ AND TIM PENNY | Posted Friday, July 31, 2009 4:20 PM PT
This article appeared in Thursday's issue. We repeat it here because of the importance of the information provided and also so it will be seen by our weekend-only readers.
In considering whether to expand the government's role in the delivery of health care or in health care insurance, it is worth looking at Medicare and Medicaid.
These two huge programs already make the government the largest player in the health care industry. The profligate nature of these two programs should raise lots of doubt about the Obama program doing anything but "busting" the budget.
In 1968 total spending by the federal government was $178.1 billion dollars. Forty years later in 2007, total spending had risen to $2,728.9 billion dollars. So the budget of the U.S. increased in dollar terms 15.3 times in that 40-year span.
But all programs did not rise in unison. Some rose more, others less.
Outlays for Social Security rose from $23.3 billion in 1968 to $581.4 billion in 2007, an increase of 25 times. So Social Security drove the budget higher at a substantially faster rate than the budget rose as a whole.
ObamaCare plans to expand the government's role in insuring the American people. The government is already the largest insurer in the health care business through Medicare. We are now told ObamaCare will save money.
What kind of impact did Medicare, the first large government health insurance plan have in budgetary terms? Medicare rose from $5.1 billion in 1968 to $436.0 billion in 2007 an astounding increase of 85.5 times over the 40-year period. Will ObamaCare be better?
Fiscally Wreckless
Beware of government estimates about the future cost of ObamaCare. When Medicare was being considered in the mid-1960s, the government projected that the outlays for the program 25 years down the road would be $10 billion. Instead, in 1990, 25 years later, the outlays were $107 billion. Government estimates were off by a factor of more than 10!
Medicaid, the other large medical program currently in effect, outdid Medicare. Medicaid outlays in 1968 were $1.8 billion. In 2007 they had risen to $190.6 billion, an increase in dollar terms of 105.9 times.
And that is only the Federal outlay number. There is a roughly equal Medicaid amount spent by the states due to federal mandates.
Without those mandates we would not be reading about the large deficits that most states endure.
The idea of expanding the federal role in the medical arena is truly fiscally irresponsible. The claim that money will be saved through government competition with the private insurance system (with government setting the rules!) is the height of fantasy.
If 45 million Americans are now uninsured, that means 265 million are insured privately, and the government should not disrupt that. If the government becomes the insurer of most Americans, the impact on the budget would be absolutely awesome. Rationing of medical care that is so often mentioned would surely result.
Rich Will Provide
If in the 40-year span from 1968 through 2007 Social Security went up 25 times, Medicare 85.5 and Medicaid 105.9, why did the total federal budget increase overall only 15.3 times? What held the budget back?
It was largely defense. Defense outlays rose from $82.2 billion in 1968 (or 46.1% of the total budget) to $547.9 billion in 2007 (20.1% of the total budget). In dollars, that is an increase of a bit less than 6.7 times.
Yet on a recent talk show Rep. Barney Frank assured us that we can pay for these new medical programs by decreases in defense outlays and additional taxes on the "rich" — those with incomes exceeding $250,000, he explained.
Medicine over our lifetime has made extraordinary progress. New discoveries and advances continue to be announced almost weekly. Most — but not all — have occurred here in the U. S. where medicine has always attracted the best and the brightest.
The government has played a most significant role by funding research through the National Institute of Health to the tune presently of $30 billion annually. It is a proper role for government and among the best and most admired of programs that receives the broadest bipartisan support.
Will the best and brightest young people be attracted to a career run by government rules, regulations and financial dictates that may well frown upon individual initiative? Our fear is that they will not, and the extraordinary progress of medicine will slow.
That alone is reason enough to oppose the government's further immersion into the field of medicine.
Boschwitz, a Republican, served in the Senate from 1978 to 1991 and was a member of the Budget Committee throughout. Penny, a Democrat, served in the House from 1983 to 1995. Both are from Minnesota.
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A couple of comments on recent posts: I posted Mitt Romney's view on 7/30 with my caveats, but without noticing or mentioning BBG posted 'Romney's Folly' the day before. FWIW both are worthwhile reads. I oppose all extra government involvement in healthcare but free markets have been lost from health care since 1945 and the politics today is very, very complicated.
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Freki posted a great question: "Why cant' a company or a group of people (like a co-op) hire their own doctor? Pay the doc a salary and that would take care of general healthcare. Then as a group negotiate with some other entity, insurance co. or hospital,l for catastrophic care? Why not pay for the education of med students for their agreement to work for the group for a fixed time? This might lower cost. Maybe the group could self insure for procedures the on staff medial personnel could not perform. It seems to me there are ways to get what you want from the free market without the government getting involved."
You are correct. A friend of mine, he might rather call it a multi-decade acquaintance, is a left wing union organizer / official who now manages their health group. They have about 100,000 in the group and they self-insure. Instead of paying an insurance company they contract they products services and rates that they need and use. They make tough decisions like the insurance companies do or like the government will have to. I don't know a lot of details but know he is opinionated about things like most MRI's being wasteful. For example, he says we have more MRI scanners along one corner of the Twin Cities freeway loop than in all of Canada. Because these providers have the expensive equipment they order the unnecessary and expensive images. I imagine there is a smidgen of truth in that, but still you have a form of bureaucrat limiting your choice of diagnosis and treatment. In the case of these workers and their families, at least the decisions are a little closer to home and open to petition or change than if they were entrusted the federal government.
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The Perfect Solution to Senior Health Care
While discussing the upcoming Universal Health Care Program with my sister-in-law the other day, I think we have found the solution. I am sure you have heard the ideas that if you're a senior you need to suck it up and give up the idea that you need any health care. A new hip? Unheard of. We simply can't afford to take care of you anymore. You don't need any medications for your high blood pressure, diabetes, heart problems, etc. Let's take care of the young people. After all, they will be ruling the world very soon.
So here is the solution. When you turn 70, you get a gun and 4 bullets. You are allowed to shoot 2 senators and 2 representatives. Of course, you will be sent to prison where you will get 3 meals a day, a roof over your head and all the health care you need!!! New teeth, great!!! Need glasses, no problem. New hip, knee, kidney, lung, heart? Well bring it on. And who will be paying for all of this. The same government that just told you that you are too old for health care. And, since you are a prisoner, you don't have to pay any income tax.
I really think we have a Perfect Solution!!! :-D
Boyo
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http://www.reason.com/blog/show/135240.html
Democrats Decline to Listen to Unhappy Constituents, Decide to Label Them Nuts Instead
Amanda Carey | August 5, 2009, 12:40pm
A handful of Democratic lawmakers have decided that rather than engage in intelligent conversation and debate with actual constituents who are protesting nationalized health care, it would be better just to label them crazy.
"It is a small fringe group, and if we let a small group of people who want to monopolize the conversation and not listen to the facts win, you may as well hang it up," said Sen. Chuck Schumer (D-NY). Sen. Dick Durbin (D-Ill) took it one step further by saying, "These town hall meetings have been orchestrated by the tea baggers and the birthers to just be a free-for-all, make a lot of noise, go on YouTube and show discord. I mean that is what they are determined to do. But that is not going to accomplish what we need to accomplish: real health care reform."
Always the optimist, Senate Majority Leader Harry Reid responded, "In spite of the loud, shrill voices trying to interrupt town hall meetings and just throw a monkey wrench into everything we’re going to continue to be positive and work hard." However Pollyanna-ish that sounds, what Reid is really saying is that he doesn't want to listen to the opposition—even if they are his constituents. Good luck in 2010!
While some fringe elements will always exist when opposition this passionate arises against a single issue like health care, that shouldn't overshadow the broader, not-so-fringe message. Nor should the Democrats focus only on those elements while ignoring the genuine antipathy against Obama's plan for health care.
Trying to link together Americans who have legitimate concerns with groups like the birthers is largely strategic misdirection on the part of lawmakers who are, in theory, supposed to answer to their constituents. A lot of Americans, in fact, are wary of the Senate's grasp of health care. But that doesn't really matter, does it?
The fact that Durbin brought up the "tea baggers" only illustrates this point further. What was so "fringe" about the tea party protests, anyway?
In the end, I'm a tad skeptical about a messaging strategy that consists of throwing around ad hominem attacks before taking the time to listen to constituent concerns. Hopefully, these members of Congress will use the August recess as a time for a little self-reflection.
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Democrats Decline to Listen to Unhappy Constituents, Decide to Label Them Nuts Instead
<snip>
[youtube]http://www.youtube.com/watch?v=NJxmpTMGhU0[/youtube]
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August 06, 2009
ObamaCare and me
By Zane F Pollard, MD
I have been sitting quietly on the sidelines watching all of this national debate on healthcare. It is time for me to bring some clarity to the table by explaining many of the problems from the perspective of a doctor.
First off, the government has involved very few of us physicians in the healthcare debate. While the American Medical Association has come out in favor of the plan, it is vital to remember that the AMA only represents 17% of the American physician workforce.
I have taken care of Medicaid patients for 35 years while representing the only pediatric ophthalmology group left in Atlanta, Georgia that accepts Medicaid. For example, in the past 6 months I have cared for three young children on Medicaid who had corneal ulcers. This is a potentially blinding situation because if the cornea perforates from the infection, almost surely blindness will occur. In all three cases the antibiotic needed for the eradication of the infection was not on the approved Medicaid list.
Each time I was told to fax Medicaid for the approval forms, which I did. Within 48 hours the form came back to me which was sent in immediately via fax, and I was told that I would have my answer in 10 days. Of course by then each child would have been blind in the eye.
Each time the request came back denied. All three times I personally provided the antibiotic for each patient which was not on the Medicaid approved list. Get the point -- rationing of care.
Over the past 35 years I have cared for over 1000 children born with congenital cataracts. In older children and in adults the vision is rehabilitated with an intraocular lens. In newborns we use contact lenses which are very expensive. It takes Medicaid over one year to approve a contact lens post cataract surgery. By that time a successful anatomical operation is wasted as the child will be close to blind from a lack of focusing for so long a period of time.
Again, extreme rationing. Solution: I have a foundation here in Atlanta supported 100% by private funds which supplies all of these contact lenses for my Medicaid and illegal immigrants children for free. Again, waiting for the government would be disastrous.
Last week I had a lady bring her child to me. They are Americans but live in Sweden, as the father has a job with a big corporation. The child had the onset of double vision 3 months ago and has been unable to function normally because of this. They are people of means but are waiting 8 months to see the ophthalmologist in Sweden. Then if the child needed surgery they would be put on a 6 month waiting list. She called me and I saw her that day. It turned out that the child had accommodative esotropia (crossing of the eyes treated with glasses that correct for farsightedness) and responded to glasses within 4 days, so no surgery was needed. Again, rationing of care.
Last month I operated on a 70 year old lady with double vision present for 3 years. She responded quite nicely to her surgery and now is symptom free. I also operated on a 69 year old judge with vertical double vision. His surgery went very well and now he is happy as a lark. I have been told -- but of course there is no healthcare bill that has been passed yet -- that these 2 people because of their age would have been denied surgery and just told to wear a patch over one eye to alleviate the symptoms of double vision. Obviously cheaper than surgery.
I spent two year in the US Navy during the Viet Nam war and was well treated by the military. There was tremendous rationing of care and we were told specifically what things the military personnel and their dependents could have and which things they could not have. While I was in Viet Nam, my wife Nancy got sick and got essentially no care at the Naval Hospital in Oakland, California. She went home and went to her family's private internist in Beverly Hills. While it was expensive, she received an immediate work up. Again rationing of care.
For those of you who are over 65, this bill in its present form might be lethal for you. People in England over 59 cannot receive stents for their coronary arteries. The government wants to mimic the British plan. For those of you younger, it will still mean restriction of the care that you and your children receive.
While 99% of physicians went into medicine because of the love of medicine and the challenge of helping our fellow man, economics are still important. My rent goes up 2% each year and the salaries of my employees go up 2% each year. Twenty years ago, ophthalmologists were paid $1800 for a cataract surgery and today $500. This is a 73% decrease in our fees. I do not know of many jobs in America that have seen this sort of lowering of fees.
But there is more to the story than just the lower fees. When I came to Atlanta, there was a well known ophthalmologist that charged $2500 for a cataract surgery as he felt the was the best. He had a terrific reputation and in fact I had my mother's bilateral cataracts operated on by him with a wonderful result. She is now 94 and has 20/20 vision in both eyes. People would pay his $2500 fee.
However, then the government came in and said that any doctor that does Medicare work cannot accept more than the going rate ( now $500) or he or she would be severely fined. This put an end to his charging $2500. The government said it was illegal to accept more than the government-allowed rate. What I am driving at is that those of you well off will not be able to go to the head of the line under this new healthcare plan, just because you have money, as no physician will be willing to go against the law to treat you.
I am a pediatric ophthalmologist and trained for 10 years post-college to become a pediatric ophthalmologist (add two years of my service in the Navy and that comes to 12 years).A neurosurgeon spends 14 years post -college, and if he or she has to do the military that would be 16 years. I am not entitled to make what a neurosurgeon makes, but the new plan calls for all physicians to make the same amount of payment. I assure you that medical students will not go into neurosurgery and we will have a tremendous shortage of neurosurgeons. Already, the top neurosurgeon at my hospital who is in good health and only 52 years old has just quit because he can't stand working with the government anymore. Forty-nine percent of children under the age of 16 in the state of Georgia are on Medicaid, so he felt he just could not stand working with the bureaucracy anymore.
We are being lied to about the uninsured. They are getting care. I operate at least 2 illegal immigrants each month who pay me nothing, and the children's hospital at which I operate charges them nothing also.This is true not only on Atlanta, but of every community in America.
The bottom line is that I urge all of you to contact your congresswomen and congressmen and senators to defeat this bill. I promise you that you will not like rationing of your own health.
Furthermore, how can you trust a physician that works under these conditions knowing that he is controlled by the state. I certainly could not trust any doctor that would work under these draconian conditions.
One last thing: with this new healthcare plan there will be a tremendous shortage of physicians. It has been estimated that approximately 5% of the current physician work force will quit under this new system. Also it is estimated that another 5% shortage will occur because of the decreased number of men and women wanting to go into medicine. At the present time the US government has mandated gender equity in admissions to medical schools .That means that for the past 15 years that somewhere between 49 and 51% of each entering class are females. This is true of private schools also, because all private schools receive federal funding.
The average career of a woman in medicine now is only 8-10 years and the average work week for a female in medicine is only 3-4 days. I have now trained 35 fellows in pediatric ophthalmology. Hands down the best was a female that I trained 4 years ago -- she was head and heels above all others I have trained. She now practices only 3 days a week.
Page Printed from: http://www.americanthinker.com/2009/08/obamacare_and_me.html at August 06, 2009 - 11:39:57 AM EDT
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2nd post.
http://www.reason.com/news/show/135266.html
Impossible Promises
Obama say his health care plan will cut costs and increase patient choice. It won't.
John Stossel | August 6, 2009
I keep reading about health-care "reform," but I have yet to see anyone explain how the government can make it easier for more people to obtain medical services, control the already exploding cost of those services, and not interfere with people's most intimate decisions.
You don't need to be a Ph.D. in economics to understand that government cannot do all three things. (Judging by what Paul Krugman writes, a Ph.D. may be an obstacle.)
The New York Times describes a key part of the House bill: "Lawmakers of both parties agree on the need to rein in private insurance companies by banning underwriting practices that have prevented millions of Americans from obtaining affordable insurance. Insurers would, for example, have to accept all applicants and could not charge higher premiums because of a person's medical history or current illness."
No more evil "cherry-picking." No more "discrimination against the sick. But that's not insurance. Insurance is the pooling of resources to cover the cost of a possible but by no means certain misfortune befalling a given individual. Government-subsidized coverage for people already sick is welfare. We can debate whether this is good, but let's discuss it honestly. Calling welfare "insurance" muddies thinking.
Such "reform" must increase the demand for medical services. That will lead to higher prices. Obama tells us that reform will lower costs. But how do you control costs while boosting demand?
The reformers make vague promises about covering the increased demand by cutting other costs. We should know by now that such promises aren't worth a wooden nickel. The savings never materialize.
Some of the savings are supposed to come from Medicare. The Times reports "Lawmakers also agree on proposals to squeeze hundreds of billions of dollars out of Medicare by reducing the growth of payments to hospitals and many other health care providers."
With the collapse of the socialist countries, we ought to understand that bureaucrats cannot competently set prices. When they pay too little, costs are covertly shifted to others, or services dry up. When they pay too much, scarce resources are diverted from other important uses and people must go without needed goods. Only markets can assure that people have reasonable access to resources according to each individual's priorities.
Assume Medicare reimbursements are cut. When retirees begin to feel the effects, AARP will scream bloody murder. The elderly vote in large numbers, and their powerful lobbyists will be listened to.
The government will then give up that strategy and turn to what the Reagan administration called "revenue enhancement": higher taxes on the "rich." When that fails, because there aren't enough rich to soak, the politicians will soak the middle class. When that fails, they will turn to more borrowing. The Fed will print more money, and we'll have more inflation. Everyone will be poorer.
The Times story adds: "They are committed to rewarding high-quality care, by paying for the value, rather than the volume, of [Medicare] services."
Value to whom? When someone buys a service in the market, that indicates he values it more than what he gives up for it. But when the taxpayers subsidize the buyer, the link between benefit and cost is broken. Market discipline disappears.
Listening to the health-care debate, I hear Republicans and Democrats saying it's wrong to deny anyone anything. That head-in-the-sand attitude is why Medicare has a $36-trillion unfunded liability. It's not sustainable—and they know it.
They've given us a system that now can be saved only if bureaucrats limit coverage by second-guessing retirees' decisions. Government will decide which Medicare services have value and which do not. Retirees may have a different opinion.
One may be willing to give up the last year of life if he's in pain and has little hope for recovery. Another may want to fight to the end. But when taxpayers pay, the state will make one choice for all retirees.
Now, to reduce the financial burden of the medical system, Obama proposes a plan that inevitably will extend the second-guessing to the rest of us. So much for his promise not to interfere with our medical decisions.
John Stossel is co-anchor of ABC News' 20/20 and the author of Myth, Lies, and Downright Stupidity. He has a new blog at http://blogs.abcnews.com/johnstossel.
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3rd post.
How to Fix the Health-Care ‘Wedge’
There is an alternative to ObamaCare.
By ARTHUR B. LAFFER
President Barack Obama is correct when he says that “soaring health-care costs make our current course unsustainable.” Many Americans agree: 55% of respondents to a recent CNN poll think the U.S. health-care system needs a great deal of reform. Yet 70% of Americans are satisfied with their current health-care arrangements, and for good reason—they work.
Consumers are receiving quality medical care at little direct cost to themselves. This creates runaway costs that have to be addressed. But ill-advised reforms can make things much worse.
An effective cure begins with an accurate diagnosis, which is sorely lacking in most policy circles. The proposals currently on offer fail to address the fundamental driver of health-care costs: the health-care wedge.
The health-care wedge is an economic term that reflects the difference between what health-care costs the specific provider and what the patient actually pays. When health care is subsidized, no one should be surprised that people demand more of it and that the costs to produce it increase. Mr. Obama’s health-care plan does nothing to address the gap between the price paid and the price received. Instead, it’s like a negative tax: Costs rise and people demand more than they need.
To pay for the subsidy that the administration and Congress propose, revenues have to come from somewhere. The Obama team has come to the conclusion that we should tax small businesses, large employers and the rich. That won’t work because the health-care recipients will lose their jobs as businesses can no longer afford their employees and the wealthy flee.
The bottom line is that when the government spends money on health care, the patient does not. The patient is then separated from the transaction in the sense that costs are no longer his concern. And when the patient doesn’t care about costs, only those who want higher costs—like doctors and drug companies—care.
Thus, health-care reform should be based on policies that diminish the health-care wedge rather than increase it. Mr. Obama’s reform principles—a public health-insurance option, mandated minimum coverage, mandated coverage of pre-existing conditions, and required purchase of health insurance—only increase the size of the wedge and thus health-care costs.
According to research I performed for the Texas Public Policy Foundation, a $1 trillion increase in federal government health subsidies will accelerate health-care inflation, lead to continued growth in health-care expenditures, and diminish our economic growth even further. Despite these costs, some 30 million people will remain uninsured.
Implementing Mr. Obama’s reforms would literally be worse than doing nothing.
The president’s camp is quick to claim that his critics have not offered a viable alternative and would prefer to do nothing. But that argument couldn’t be further from the truth.
Rather than expanding the role of government in the health-care market, Congress should implement a patient-centered approach to health-care reform. A patient-centered approach focuses on the patient-doctor relationship and empowers the patient and the doctor to make effective and economical choices.
A patient-centered health-care reform begins with individual ownership of insurance policies and leverages Health Savings Accounts, a low-premium, high-deductible alternative to traditional insurance that includes a tax-advantaged savings account. It allows people to purchase insurance policies across state lines and reduces the number of mandated benefits insurers are required to cover. It reallocates the majority of Medicaid spending into a simple voucher for low-income individuals to purchase their own insurance. And it reduces the cost of medical procedures by reforming tort liability laws.
By empowering patients and doctors to manage health-care decisions, a patient-centered health-care reform will control costs, improve health outcomes, and improve the overall efficiency of the health-care system.
Congress needs to focus on reform that promotes what Americans want most: immediate, measurable ways to make health care more accessible and affordable without jeopardizing quality, individual choice, or personalized care.
Because Mr. Obama has incorrectly diagnosed the problems with our health-care system, any reform based on his priorities would worsen the current inefficiencies. Americans would pay even more for lower quality and less access to care. This doesn’t sound like reform we can believe in.
Mr. Laffer is the chairman of Laffer Associates and co-author of “The End of Prosperity: How Higher Taxes Will Doom the Economy—If We Let It Happen” (Threshold, 2008). His research on health care can be viewed at www.lafferhealthcarereport.org.
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***The bottom line is that when the government spends money on health care, the patient does not. The patient is then separated from the transaction in the sense that costs are no longer his concern. And when the patient doesn’t care about costs, only those who want higher costs—like doctors and drug companies—care.***
Well the know it all Harvard types expect that the ultimate goal - single payer and governement controlled - and conversion of all health information onto the internet will give them the control to ration, and, in that way hold down costs.
***A patient-centered approach focuses on the patient-doctor relationship and empowers the patient and the doctor to make effective and economical choices.
A patient-centered health-care reform begins with individual ownership of insurance policies and leverages Health Savings Accounts, a low-premium, high-deductible alternative to traditional insurance that includes a tax-advantaged savings account. It allows people to purchase insurance policies across state lines and reduces the number of mandated benefits insurers are required to cover. It reallocates the majority of Medicaid spending into a simple voucher for low-income individuals to purchase their own insurance. And it reduces the cost of medical procedures by reforming tort liability laws.
By empowering patients and doctors to manage health-care decisions, a patient-centered health-care reform will control costs, improve health outcomes, and improve the overall efficiency of the health-care system.***
To some extent that already takes place. Pts all the time ask for the cheapest drugs that will work. Some would rather pay more, if they can or choose to take the expense.
I am less clear that doctors go out of their way to hold down costs when they do get paid to do more especially when they get paid for tests.
Of course if the patient pays for a substantial part of it then they might dissuade the doctor.
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It really is astouding. After witnessing decades of liberal rallies, anti war protests (their glory days were back when they got to rally against the Iraq war) to watch the left howl and scream over protests against the Democrat health care bill.
Almost no comments about the many deceptions of the bill itself, or Bo himself saying clearly he is for single government sponsered single payer and implying that to get there will take years of maniulation, tricks, and deception.
Here was BO on the cover of TIME in a doctor's outfit - all about a bill he neither wrote or read.
***Can't Blame Liberal Media for Health Bill Stall
BMI Study: 70 Percent of ABC, CBS and NBC Coverage Promoted Obama's Huge Health Care Takeover
By: Rich Noyes and Julia Seymour | View PDF Version
July 28, 2009 10:48 ET
Liberal hopes for a quick health care bill are in collapse, as Senate Democrats push any floor action off until the fall, a move House Democrats may match this week. But if the Obama White House is upset that their plans for a huge expansion of government health care have been delayed, they surely cannot complain about the media coverage.
Last week, a new study by the Media Research Center’s Business & Media Institute (BMI) found broadcast coverage during the first six months of 2009 tilted heavily in favor of Barack Obama’s big government plan. BMI’s analysts looked at 224 health care stories on the ABC, CBS and NBC morning and evening news shows from Obama’s January 20 inauguration through his June 24 prime time special on ABC.
Among the key findings:
# Fully 70% of soundbites (243 out of 347 total) supported Obama’s liberal health care ideas. Only nine percent of stories (21) suggested the total price tag for Obama’s “reform” would top $1 trillion.
# Reporters exaggerated the number of uninsured Americans. Omitting non-citizens, those capable of paying, or those eligible for assistance programs already in place, a reasonable figure would be between 8 million and 14 million uninsured, not the “50 million Americans” statistic BMI’s analysts found touted by the networks.
# The networks also spent virtually no time investigating states that had experimented with big government health schemes — just one story on how Massachusetts’ plan for mandatory health insurance is working out (costs are rising faster than expected), and no stories on Hawaii’s already-cancelled program to insure all children.
BMI’s study period ended in late June, but the networks’ favors for Obama have continued in July, even as public sentiment shifted against both the President and his plan. On July 16, for example, both the NBC Nightly News and CBS Evening News skipped over how, in the words of ABC White House correspondent Jake Tapper on World News, “the President's case was dealt a blow today” when the Congressional Budget Office chief told Congress the health care plans will require massive additional spending.
The next morning, after the House Ways and Means Committee had formally passed an estimated $554 billion tax increase to help pay for the ambitious health plans, CBS skipped that development, too, as ABC and NBC’s morning news shows offered only a single sentence. NBC’s Natalie Morales, on her network’s four-hour Today, gave it just 12 seconds: “During the night, the House Ways and Means committee voted to increase taxes on higher income earners as part of a health care reform bill.”
If these had been setbacks for a big Bush administration initiative, do you think the network coverage would have been so paltry?
Reporter commentary has also betrayed a lack of objectivity. In a July 22 interview with California’s Arnold Schwarzenegger on Good Morning America, ABC's Chris Cuomo painted Republicans as endangering Americans’ health: “Do you believe that Republicans are playing politics here, at the risk of people's health care....Is this getting to be a little bit of a reckless situation?”
That night on MSNBC, after the President’s press conference, NBC medical reporter Nancy Snyderman confessed she was “rooting” for him: “As a physician, you know, I felt like I understood the complexity of the problem. As an American citizen, I was rooting for the President to hit a home run.”
The public’s anxiety seems to have delayed the day of reckoning on health care until at least this fall. The big questions: Will network reporters continue their favors for ObamaCare? And will the tilted media landscape be enough to make liberals’ policy dreams come true?***
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http://hotair.com/archives/2009/08/08/video-worlds-worst-tv-interview/
At least the left is willing to have an honest debate. :roll:
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You know the crats are dissecting every criticism on their health care reform.
They will be coming out all over the airwaves with the complicit media bombarding us with denials of all the legitimate criticisms.
The cans will have to continue to expose the deceit for what it is - just that.
They should not harp on just the cost issue as I hear some talking heads saying lately.
BO's doctor from Chicago was originally quoted as saying he was against this reform.
He was on one station this weekend. He certainly sounded like a bonified BO supporter of Democratic health reform to me.
Someone got to him and persuaded him to change his tune. I wonder what he got.
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August 10, 2009
Surprise! Preventive care will raise, not lower health care costs
Rick Moran
It's actually been known for quite a while that the panacea of so-called "preventive care" might save lives but not much money. That's because any savings in health care dollars from catching some diseases early is more than offset by the fact that the treatment is given to a huge percentage of people who will never get the disease.
If doctors had a crystal ball and were able to give the tests only to those who would eventually get sick, it would obviously save a bundle. But medicine is science, not magic, and the numbers tell a different story.
Director Douglas Elmendorf of the CBO quoted by Jack Tapper of ABC News:
"Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall," Elmendorf wrote. "That result may seem counterintuitive.
"For example, many observers point to cases in which a simple medical test, if given early enough, can reveal a condition that is treatable at a fraction of the cost of treating that same illness after it has progressed. In such cases, an ounce of prevention improves health and reduces spending - for that individual," Elmendorf wrote. "But when analyzing the effects of preventive care on total spending for health care, it is important to recognize that doctors do not know beforehand which patients are going to develop costly illnesses. To avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway. ... Researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness."
Even Republicans have been caught up in this idea that preventive care could be one way to pay for health care reform. Unfortunately, it appears to be a dry hole. This is not to say that on an individual basis, preventive care can't be very beneficial and contribute to a longer, healthier life.
But as a means to bring down health care costs, it is a mirage.
Page Printed from: http://www.americanthinker.com/blog/2009/08/surprise_preventive_care_will.html at August 10, 2009 - 01:49:53 PM EDT
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Yes a lot of what is being claimed is unproven.
Even the concept of getting people to quit smoking may not reduce costs in thelong term.
From a long term financial cost vs benefit analysis it may be better to pay for the emphysema and lung and bladder cancers and till the patient dies than pay for them to live much longer lives and health cost, medicare, and social security utilization.
Surely I am not adocating this I am just stating the probable false premise that it is a cost saver.
"Even Republicans have been caught up in this idea that preventive care"
Your right. So is the idea of moving everything to IT data based (a Gingrich focus).
No one has proven to me that this would save costs either in the short term or the long term.
I do agree it has theoretical benefits in this day of fragmented care, ie, people going to multiple hospitals, seeing multiple doctors, labs, imaging centers. And it may have cost benefits.
But the more I read about computer systems the harder it seems to determine if they are beneficial. Doctors' accounts that I read about are somewhat mixed.
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CCP: "They should not harp on just the cost issue..."
I think this piece by T. Sowell goes beyond cost:
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http://jewishworldreview.com/cols/sowell080509.php3
Care versus control
By Thomas Sowell
As someone who was once rushed to a hospital in the middle of the night, because of taking a medication that millions of people take every day without the slightest problem, I have a special horror of life and death medical decisions being made by bureaucrats in Washington, about patients they have never laid eyes on.
On another occasion, I was told by a doctor that I would have died if I had not gotten to him in time, after an allergic reaction to eating one of the most healthful foods around. On still another occasion, I was treated with a medication that causes many people big problems and was urged to come back to the hospital immediately if I had a really bad reaction. But I had no reaction at all, went home, felt fine and slept soundly through the night.
My point is that everybody is different. Millions of children eat peanut butter sandwiches every day but some children can die from eating peanut butter. Some vaccines and medications that save many lives can also kill some people.
Are decisions made by doctors who have treated the same patient for years to be over-ruled by bureaucrats sitting in front of computer screens in Washington, following guidelines drawn up with the idea of "bringing down the cost of medical care"?
The idea is even more absurd than the idea that you can add millions of people to a government medical care plan without increasing the costs. It is also more dangerous.
What is both dangerous and mindless is rushing a massive new medical care scheme through Congress so fast that members of Congress do not even have time to read it before voting on it. Legislation that is far less sweeping in its effects can get months of hearings before Congressional committees, followed by debates in the Senate and the House of Representatives, with all sorts of people voicing their views in the media and in letters to Congress, while ads from people on both sides of the issue appear in newspapers and on television.
If this new medical scheme is so wonderful, why can't it stand the light of day or a little time to think about it?
The obvious answer is that the administration doesn't want us to know what it is all about or else we would not go along with it. Far better to say that we can't wait, that things are just too urgent. This tactic worked with whizzing the "stimulus" package through Congress, even though the stimulus package itself has not worked.
Any serious discussion of government-run medical care would have to look at other countries where there is government-run medical care. As someone who has done some research on this for my book "Applied Economics," I can tell you that the actual consequences of government-controlled medical care is not a pretty picture, however inspiring the rhetoric that accompanies it.
Thirty thousand Canadians are passing up free medical care at home to go to some other country where they have to pay for it. People don't do that without a reason.
But Canadians are better off than people in some other countries with government-controlled medical care, because they have the United States right next door, in case their medical problems get too serious to rely on their own system.
But where are Americans to turn if we become like Canada? Where are we to go when we need better medical treatment than Washington bureaucrats will let us have? Mexico? The Caribbean?
Many people do not understand that it is not just a question of whether government bureaucrats will agree to pay for particular medical treatments. The same government-control mindset that decides what should and should not be paid for can also decide that the medical technology or pharmaceutical drugs that they control should not be for sale to those who are willing to pay their own money.
Right now, medications or treatments that have not been approved by the Food and Drug Administration are medications or treatments that you are not allowed to buy with your own money, no matter how desperate your medical condition, and no matter how many years these medications or treatments may have been used without dire effects in other countries.
The crucial word is not "care" but "control."
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Doug, I agree with you. I got that idea from a few Rep. pundits on cable were saying it is the cost issue over the weekend though clearly others are pointing out just as Mr. Sowell is with regards to some of the other issues.
The problem as I see it is I am just not sure how many people read Sowell who are not already inclined to agree.
Same is true for Fox and right talk radio.
It is truly a fight for the ears and minds of those in the middle.
BO and the msm still have the advantage.
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CCP: "...I am just not sure how many people read Sowell who are not already inclined to agree." - True. Like continuing ed for professional licenses, registered voters should be required to read Thomas Sowell and Victor Hanson...
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Also going beyond cost is the forgotten privacy issue. Do we want all personal info going to the government and another enforcement mechanism going to the IRS?? I have yet to see a liberal vehicle with a bumper sticker saying 'US Government out of my Bedroom' as it relates to health plan coercion and privacy loss.
Nearly all states require car insurance. I went recently to change just the bank account tied to my insurance and was amazed, offended, and outraged at the voluminous private information I was required to give up just to make a minor change. Is it my choice to business with these people? No, state law requires that I do business with one of these companies.
When the state first passed mandatory insurance, there was an option to post bond or assets up to the minimum financial responsibility instead of insurance, now that provision is gone. Two states still have that and 48 do not. In 48 states you HAVE do do business with and give up privacy to a state licensed insurance company (or not own or drive a vehicle) no matter what means you have available to cover your potential losses.
Back to health insurance, I am currently satisfied carrying a major medical policy with very high deductible instead having the much higher monthly cost of a more inclusive policy. Mine is one of the choices likely to go away as the authors of the new bill such as Waxman, Dodd or Kennedy will not deem my plan to be adequate coverage. They would add a 2300 fine, people won't accept that, so my plan would disappear altogether.
So much for the promise (lie) that we can keep our current plan.
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http://hotair.com/archives/2009/08/10/protester-my-family-was-threatened-after-i-spoke-up-at-dingell-town-hall/comment-page-1/#comments
Gotta love the Chicago politics that have been brought to the national level. Obama's Purple Shirts are attacking and threatening Obamacare protesters.
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Interesting. CBS is dissing some back room negotiations between BHO and drug companies. Mayhaps the MSM is starting to catch on.
White House & Big Pharma: What's the Deal?
Critics Accuse Obama and Drug Companies of Making a Backroom Deal that Could End Up Costing Seniors More for Drugs
Font size Print Share 38 Comments By Sharyl Attkisson
(CBS) While much of the health care debate has been carried out publicly, some very private negotiations have gone on too - between the White House and the pharmaceutical industry. So private, neither side will release all the details, yet they potentially involve millions of Americans, reports CBS News correspondent Sharyl Attkisson.
Sources say negotiations involving the White House and the pharmaceutical industry shifted to fast-forward in mid-June. President Obama had just taken a serious hit on the escalating cost of his health care plan and needed a shot in the arm. Days later, he got it with the full backing of the pharmaceutical industry and its promise to save Americans $80 billion in health care costs.
"This is just part of the legislative process - working with industry, part of getting this done," said Nancy-Ann Deparle, director of the White House Office of Health Reform. "And the great thing is the pharmaceutical industry and others in the health care sector are supporting reform this time."
But what did the pharmaceutical industry get in return? Initial reports said the White House agreed not to seek price controls on drugs for seniors on Medicare and would not support importing cheaper drugs from Canada. Both the White House and the pharmaceutical industry now dispute that.
But news of a backroom deal riled even some fellow Democrats, including a key committee chairman Henry Waxman.
"We're not bound by that agreement," Waxman said. "We weren't part of it and we feel strongly that the drug companies shouldn't get off with a windfall at the expense of our seniors."
Whatever the case, the pharmaceutical industry is now so firmly in the president's camp, it's developing plans to spend up to $150 million dollars promoting it with TV ads.
"The president and Congress have a plan," reads one ad.
Consumer watchdog Dr. Sidney Wolfe says there's reason for the public to be skeptical.
"We'll give you this, you'll give us this," Wolfe says. "All sort of off the record, not really incorporated in any kind of legislation and I believe in the long run a very bad deal for the American public even if it's a good deal for the drug industry."
The president may have won crucial support from the pharmaceutical industry but the question is whether that could jeopardize support among Democrats and the public.
http://www.cbsnews.com/stories/2009/08/10/eveningnews/main5231143.shtml?tag=contentBody;featuredPost-PE
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Health Care’s Taxing Problem
By starting with the tax system, Congress can ultimately achieve true reform.
By Regina Herzlinger
Mainstream economists generally agree that current U.S. tax policy for health insurance is fundamentally irrational, regressive, and ultimately destructive. Fixing this system should be one of Congress’s top priorities when it comes to health reform. Sadly, the current Congressional health-reform proposals would leave the worst feature of the current system in place and make a bad situation worse.
Current tax policy generally permits employers, but not individuals, to use pre-tax income for buying health insurance. Therefore, it is much cheaper to buy insurance through an employer than in the individual market. Because tax-exempted employer-based insurance is not portable — workers can’t take it with them when they change jobs — this harms labor mobility: People hesitate to leave jobs at big firms that provide health insurance to work for small firms that might not. The phenomenon, known as “job lock,” robs small firms of talent and slows U.S. job growth, because small, entrepreneurial firms have generated 70 percent of new jobs.
Uneven tax treatment also may cause employees to prefer health insurance to other forms of income. This is one of the reasons that the Congressional Budget Office estimated that in 2007, the tax break for employer-provided insurance was worth a staggering sum — about $246 billion in foregone tax revenues. Further, wealthier employees, because they’re in higher tax brackets, get more of a tax benefit than lower-wage workers.
The current congressional tax proposals do not solve any of these problems. The American people smell a rat when they read about proposals to tax health benefits — but only for the rich (sometimes defined as families earning above $250,000). They worry that tax increases on the rich will eventually become tax increases on the middle class. Further, current legislation in the House and Senate to tax employers who don’t offer “creditable” health insurance includes a host of small employers, making the proposal a job-killing measure.
But a simple solution would level the tax treatment of health insurance, make it portable, and appeal instantly to taxpayers: Congress could simply extend the present tax exclusion to all employees.
Here is how that would work. An employer who today spends $17,000 on health insurance for the family of an employee, for example, could instead offer her $17,000 in wages — provided the employee purchases at least a catastrophic health-insurance plan that is appropriate for her income. The amount spent on health insurance would remain tax-free. If any was left over (say $5,000 after the purchase of a $12,000 comprehensive family policy), it would be taxable.
Those who didn’t want to opt out could maintain their employer-sponsored plans, though union bosses and others would have to explain why their members were better off with high-cost health insurance than higher wages. (Middle-class families have seen their take-home pay stagnate in recent years due to insurance premiums, which have nearly doubled since 2000.) On net, this proposal would raise pay for the vast majority of American workers. The cash-out of employer-sponsored health insurance would have caused the 90 percent of joint 2006 tax filers who earned less than $73,000 after taxes to enjoy an average 16 percent increase in their after-tax incomes. Even after these taxpayers bought insurance in the private market, it’s likely that much of their gains would remain: In Switzerland, about a quarter of the market has opted for lower-cost high-deductible plans, and another quarter buys lower-priced managed care.
Over time, the availability of these funds, adjusted for health-insurance price increases, would lift wages; encourage employees to shop for affordable, portable insurance that met their needs; and — as a bonus for Washington — produce an infusion of new taxable income. Critics might argue that people would buy less insurance than they really need — but the requirement to purchase an income-adjusted catastrophic plan obviates that possibility. Insurance companies would still have powerful incentives to market comprehensive policies to employees. In Switzerland, where consumers are the sole purchasers of health insurance, the majority choose to buy comprehensive policies; but competition holds Swiss insurers’ general and administrative expenses to 5 percent of revenues, as compared to 12–18 percent for ours. To protect the sick against outrageous pricing, employers could require insurers to guarantee issue to their employees at community prices. The IRS could monitor the accuracy of this transfer.
This approach is virtually costless, requires very little new regulation, and helps control health-care costs by encouraging employees to think carefully about their health-insurance options. (The Swiss consumer-driven system costs 40 percent less than ours, and its health-care price index has decreased, yet it achieves universal coverage and very good health care.) It could also help reverse income stagnation by putting more money in the average employee’s pocket. As for job lock, workers at small firms that didn’t offer health insurance could set aside part of their take-home pay (tax-free) for buying insurance.
Rather than taking a trillion-dollar gamble on everything at once, Congress should focus on fixing what’s broken. Important additional reforms — expanding coverage for the uninsured and eliminating waste, fraud, and abuse in Medicare and Medicaid — could be added as health-care cost inflation moderates. By starting with the tax treatment of health insurance, Congress can ultimately achieve true health-care reform.
— Regina Herzlinger is the McPherson professor at Harvard Business School and a senior fellow of the Manhattan Institute.
National Review Online - http://article.nationalreview.com/?q=YmYwY2E1YmQwN2YwZWZlMTg0NDc5YjRkNjA5MWY2Y2U=
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http://hotair.com/archives/2009/08/12/ama-to-obama-stop-accusing-us-of-wanting-to-hack-off-peoples-body-parts-champ/
Obama and fearmongering.
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http://patterico.com/2009/08/12/roxana-mayer-im-not-a-doctor-but-i-play-one-at-town-hall-meetings/
A proud Obama supporter!
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The IBD editorial in question was previously quoted in this thread. Here is a frontal challenge which seems to make sense. Comments?
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More from www.factcheck.org.
Private Insurance Not Outlawed
August 13, 2009
Q: Will the House’s proposed health care plan outlaw private insurance?
A: No. Those who are claiming that the plan would get rid of private insurance or make it illegal are misinterpreting the bill.
FULL QUESTION
President Obama claims that we will be able to keep our current private health care insurance, but I have heard that on page 16 of the health insurance initiative that after one year private health insurance providers will no longer be able to accept new individual policy holders. Where does this leave me if I need to change insurance companies after the first year? The president insinuates that there are no restrictions on having an individual policy. Is this true?
FULL ANSWER
It’s nonsense to say that private insurance will be outlawed, but it will be regulated. In fact, the bill envisions a wide variety of private policies being offered to the public through a new national health insurance exchange resembling the Federal Employee Health Benefits plan, which makes 269 different private plans in total available to federal workers, including members of Congress.
What page 16 actually says is that those who like their current policies are "grandfathered" and can keep them, even if the policies don’t meet new standards.
The false idea that H.R. 3200 would prohibit insurance companies from accepting new policyholders stems from the conservative Investors’ Business Daily, which made the claim in a July editorial:
Investor’s Business Daily, July 15: It didn’t take long to run into an "uh-oh" moment when reading the House’s "health care for all Americans" bill. Right there on Page 16 is a provision making individual private medical insurance illegal. … The provision would indeed outlaw individual private coverage. Under the Orwellian header of "Protecting The Choice To Keep Current Coverage," the "Limitation On New Enrollment" section of the bill clearly states:
"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.
So we can all keep our coverage, just as promised – with, of course, exceptions: Those who currently have private individual coverage won’t be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.
Here, however, is the paragraph immediately preceding IBD’s quote:
H.R. 3200: Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term “grandfathered health insurance coverage” means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met.
In other words, the quote IBD references is part of the definition of “grandfathered” health insurance coverage. That quote doesn’t say that insurers can’t take on new enrollees; it says that if they do, that won’t be considered grandfathered coverage. In other words, any new individual policies would have to meet minimum standards and be offered through the new health insurance exchange.
The proposed health care model would indeed encourage individuals not already covered by employer-provided health policies to buy coverage through the nationwide insurance exchange. The choices would include a range of private plans meeting the new standards, as well as a new federal plan, as the House bill is currently written. People with individually purchased insurance who wish (or need) to change their grandfathered plans will have to purchase insurance through the exchange. If an individual would rather keep his plan, he can do so for as long as the insurance company keeps offering it. At any rate, nobody will be forced into the federal health insurance option – they’ll have their pick of private ones.
In fact, some say the biggest change will be that individual insurance gets better. "In a lot of ways it would improve options for people buying coverage on the individual market right now," said Sara Collins, vice president of the Commonwealth Fund, a nonpartisan organization that supports “a high performing health care system." The exchange plans would not be underwritten, and would be required to provide a minimum level of service to everybody. There would also be subsidies available for individuals and small employers to offset the cost of purchasing insurance through the exchange.
IBD won’t admit that it misread page 16, but says "we’re standing by our story," which it now attempts to justify this way:
IBD, July 21: But the exchange will not be a private market. It will be a program in which Americans can buy individual plans from private companies in competition with the "public option" provision of the bill that will provide taxpayer-subsidized coverage.
But whether or not one considers the insurance exchange to be a "private market," the fact is what is sold in that market would include a variety of plans sold by private insurance companies. So IBD’s original claim that the bill would make "individual private medical insurance illegal" is wrong.
– Jess Henig
Sources
U.S. House. "H.R. 3200." (as introduced 14 Jul 2009.)
Collins, Sara. Interview with FactCheck.org. 21 Jul 2009.
"It’s Not an Option." Editorial. Investors Business Daily 15 Jul 2009.
"Still Not an Option." Editorial. Investors Business Daily 21 Jul 2009.
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Well with last I heard 4-thousand page plus versions of the bill floating around I guess I'd rather take Fact Checks word than parse all those pages.
BBG: I insert my comments here so that you next post gets the attention it deserves from being the current post. In short, I heard that it may be that Factcheck was using a different version of the bill than was IBD-- but at the moment this remains unverified. OTOH, if IBD misread as claimed, that is worth noting about its credibility.
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Some interesting takes:
A Long, Long Post About My Reasons For Opposing National Health Care
28 Jul 2009 11:26 am
I know, most of you have already figured out why I oppose national health care. In a nutshell, I hate the poor and want them to die so that all my rich friends can use their bodies as mulch for their diamond ranches. But y'all keep asking, so here goes the longer explanation.
Basically, for me, it all boils down to public choice theory. Once we've got a comprehensive national health care plan, what are the government's incentives? I think they're bad, for the same reason the TSA is bad. I'm afraid that instead of Security Theater, we'll get Health Care Theater, where the government goes to elaborate lengths to convince us that we're getting the best possible health care, without actually providing it.
That's not just verbal theatrics. Agencies like Britain's NICE are a case in point. As long as people don't know that there are cancer treatments they're not getting, they're happy. Once they find out, satisfaction plunges. But the reason that people in Britain know about things like herceptin for early stage breast cancer is a robust private market in the US that experiments with this sort of thing.
So in the absence of a robust private US market, my assumption is that the government will focus on the apparent at the expense of the hard-to-measure. Innovation benefits future constituents who aren't voting now. Producing it is very expensive. On the other hand, cutting costs pleases voters this instant. This is, fundamentally, what cries to "use the government's negotiating power" with drug companies is about. Advocates of such a policy spend a lot of time arguing about whether pharmaceutical companies do, or do not, spend too much on marketing. This is besides the point. The government is not going to price to some unknowable socially optimal amount of pharma market power. It is going to price to what the voters want, which is to spend as little as possible right now.
It's not that I think that private companies wouldn't like to cut innovation. But in the presence of even rudimentary competition, they can't. Monopolies are not innovative, whether they are public or private.
Advocates of this policy have a number of rejoinders to this, notably that NIH funding is responsible for a lot of innovation. This is true, but theoretical innovation is not the same thing as product innovation. We tend to think of innovation as a matter of a mad scientist somewhere making a Brilliant Discovery!!! but in fact, innovation is more often a matter of small steps towards perfection. Wal-Mart's revolution in supply chain management has been one of the most powerful factors influencing American productivity in recent decades. Yes, it was enabled by the computer revolution--but computers, by themselves, did not give Wal-Mart the idea of treating trucks like mobile warehouses, much less the expertise to do it.
In the case of pharma, what an NIH or academic researcher does is very, very different from what a pharma researcher does. They are no more interchangeable than theoretical physicists and civil engineers. An academic identifies targets. A pharma researcher finds out whether those targets can be activated with a molecule. Then he finds out whether that molecule can be made to reach the target. Is it small enough to be orally dosed? (Unless the disease you're after is fairly fatal, inability to orally dose is pretty much a drug-killer). Can it be made reliably? Can it be made cost-effectively? Can you scale production? It's not a viable drug if it takes one guy three weeks with a bunsen burner to knock out 3 doses.
Once you've produced a drug, found out that it's active on your targets, and produced more than a few milligrams of the stuff, you have to put it into animals, then people. Does your drug do anything in animal studies? Does it do too much, like, say, killing the patient? How about humans? Oral dosing is just the start. Does your drug actually get somewhere after it's swallowed, or do the stomach/liver chew it up? Is there any way to wrap it in a protective package long enough to let it reach its target? Do clinical trials show efficacy compared to placebo, or other drugs? How big is the market (in other words, how many people want it, how badly, and how much of an improvement is your drug)?
This is the stuff academic pharma doesn't do, and as you can see, without it, you don't have a drug; you have a theory. What the NIH does is supremely valuable. But so is all that "useless" effort at the pharmas.
Now, maybe government institutions could be made to produce innovations; I certainly think it's worth trying Dean Baker's suggestion that we should let the government try to set up an alternate scheme for drug discovery. Prizes also seem promising. But I want to see them work first, not after we've permanently broken the system. The one industry where the government is the sole buyer, defense, does not have an encouraging record of cost-effective, innovative procurement.
At this juncture in the conversation, someone almost always breaks in and says, "Why don't you tell that to an uninsured person?" I have. Specifically, I told it to me. I was uninsured for more than two years after grad school, with an autoimmune disease and asthma. I was, if anything, even more militant than I am now about government takeover of insurance.
But you can also turn this around: why don't you tell some person who has a terminal condition that sorry, we can't afford to find a cure for their disease? There are no particularly happy choices here. The way I look at it, one hundred percent of the population is going to die of something that we can't currently cure, but might in the future . . . plus the population of the rest of the world, plus every future generation. If you worry about global warming, you should worry at least as hard about medical innovation.
The other major reason that I am against national health care is the increasing license it gives elites to wrap their claws around every aspect of everyone's life. Look at the uptick in stories on obesity in the context of health care reform. Fat people are a problem! They're killing themselves, and our budget! We must stop them! And what if people won't do it voluntarily? Because let's face it, so far, they won't. Making information, or fresh vegetables, available, hasn't worked--every intervention you can imagine on the voluntary front, and several involuntary ones, has already been tried either in supermarkets or public schools. Americans are getting fat because they're eating fattening foods, and not exercising. How far are we willing to go beyond calorie labelling on menus to get people to slim down?
These aren't just a way to save on health care; they're a way to extend and expand the cultural hegemony of wealthy white elites. No, seriously. Living a fit, active life is correlated with being healthier. But then, as an economist recently pointed out to me, so is being religious, being married, and living in a small town; how come we don't have any programs to promote these "healthy lifestyles"? When you listen to obesity experts, or health wonks, talk, their assertions boil down to the idea that overweight people are either too stupid to understand why they get fat, or have not yet been made sufficiently aware of society's disgust for their condition. Yet this does not describe any of the overweight people I have ever known, including the construction workers and office clerks at Ground Zero. All were very well aware that the burgers and fries they ate made them fat, and hitting the salad bar instead would probably help them lose weight. They either didn't care, or felt powerless to control their hunger. They were also very well aware that society thought they were disgusting, and many of them had internalized this message to the point of open despair. What does another public campaign about overeating have to offer them, other than oozing condescension?
Of course, the obese aren't the only troublesome bunch. The elderly are also wasting a lot of our hard earned money with their stupid "last six months" end-of-life care. Eliminating this waste is almost entirely the concern of men under 45 or 50, and women under 25. On the other hand, that describes a lot of the healthcare bureaucracy, especially in public health.
Once the government gets into the business of providing our health care, the government gets into the business of deciding whose life matters, and how much. It gets into the business of deciding what we "really" want, where what we really want can never be a second chocolate eclair that might make us a size fourteen and raise the cost of treating us.
I realize that to most people, these are airy-fairy considerations that should be overridden by the many "practical" considerations of the awesomenes of central health care. Well, I'm actually pretty underwhelmed by that awesomeness, for reasons I'll happily elaborate elsewhere. But not here, because fundamentally, to me, the effect on the tax code and the relative efficiency of various sorts of bureaucracy are mostly beside the point. The real issue is the effect on future lives, and future freedom. And in my opinion, they way in overwhelmingly on the side of stopping further government encroachments into health care provision.
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http://meganmcardle.theatlantic.com/archives/2009/07/a_long_long_post_about_my_reas.php
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The Great 'Prevention' Myth
By Charles Krauthammer
Friday, August 14, 2009
In the 48 hours of June 15-16, President Obama lost the health-care debate. First, a letter from the Congressional Budget Office to Sen. Edward Kennedy reported that his health committee's reform bill would add $1 trillion in debt over the next decade. Then the CBO reported that the other Senate bill, being written by the Finance Committee, would add $1.6 trillion. The central contradiction of Obamacare was fatally exposed: From his first address to Congress, Obama insisted on the dire need for restructuring the health-care system because out-of-control costs were bankrupting the Treasury and wrecking the U.S. economy -- yet the Democrats' plans would make the problem worse.
Accordingly, Democrats have trotted out various tax proposals to close the gap. Obama's idea of limits on charitable and mortgage-interest deductions went nowhere. As did the House's income tax surcharge on millionaires. And Obama dare not tax employer-provided health insurance because of his campaign pledge of no middle-class tax hikes.
Desperation time. What do you do? Sprinkle fairy dust on every health-care plan, and present your deus ex machina: prevention.
Free mammograms and diabetes tests and checkups for all, promise Democratic leaders Nancy Pelosi and Steny Hoyer, writing in USA Today. Prevention, they assure us, will not just make us healthier, it also "will save money."
Obama followed suit in his Tuesday New Hampshire town hall, touting prevention as amazingly dual-purpose: "It saves lives. It also saves money."
Reform proponents repeat this like a mantra. Because it seems so intuitive, it has become conventional wisdom. But like most conventional wisdom, it is wrong. Overall, preventive care increases medical costs.
This inconvenient truth comes, once again, from the CBO. In an Aug. 7 letter to Rep. Nathan Deal, CBO Director Doug Elmendorf writes: "Researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness."
How can that be? If you prevent somebody from getting a heart attack, aren't you necessarily saving money? The fallacy here is confusing the individual with society. For the individual, catching something early generally reduces later spending for that condition. But, explains Elmendorf, we don't know in advance which patients are going to develop costly illnesses. To avert one case, "it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway." And this costs society money that would not have been spent otherwise.
Think of it this way. Assume that a screening test for disease X costs $500 and finding it early averts $10,000 of costly treatment at a later stage. Are you saving money? Well, if one in 10 of those who are screened tests positive, society is saving $5,000. But if only one in 100 would get that disease, society is shelling out $40,000 more than it would without the preventive care.
That's a hypothetical case. What's the real-life actuality? In Obamaworld, as explained by the president in his Tuesday town hall, if we pour money into primary care for diabetics instead of giving surgeons "$30,000, $40,000, $50,000" for a later amputation -- a whopper that misrepresents the surgeon's fee by a factor of at least 30 -- "that will save us money." Back on Earth, a rigorous study in the journal Circulation found that for cardiovascular diseases and diabetes, "if all the recommended prevention activities were applied with 100 percent success," the prevention would cost almost 10 times as much as the savings, increasing the country's total medical bill by 162 percent. That's because prevention applied to large populations is very expensive, as shown by another report Elmendorf cites, a definitive review in the New England Journal of Medicine of hundreds of studies that found that more than 80 percent of preventive measures added to medical costs.
This doesn't mean we shouldn't be preventing illness. Of course we should. But in medicine, as in life, there is no free lunch. The idea that prevention is somehow intrinsically economically different from treatment -- that treatment increases costs and prevention lowers them -- is simply nonsense. Prevention is a wondrous good, but in the aggregate it costs society money. Nothing wrong with that. That's the whole premise of medicine. Treating a heart attack or setting a broken leg also costs society. But we do it because it alleviates human suffering. Preventing a heart attack with statins or breast cancer with mammograms is costly. But we do it because it reduces human suffering.
However, prevention is not, as so widely advertised, healing on the cheap. It is not the magic bullet for health-care costs.
You will hear some variation of that claim a hundred times in the coming health-care debate. Whenever you do, remember: It's nonsense -- empirically demonstrable and CBO-certified.
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/13/AR2009081302898.html?hpid=opinionsbox1
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http://online.wsj.com/article/SB1000...072865070.html
The Whole Foods Alternative to ObamaCare
Eight things we can do to improve health care without adding to the deficit.
By JOHN MACKEY
"The problem with socialism is that eventually you run out
of other people's money."
—Margaret Thatcher
With a projected $1.8 trillion deficit for 2009, several trillions more in deficits projected over the next decade, and with both Medicare and Social Security entitlement spending about to ratchet up several notches over the next 15 years as Baby Boomers become eligible for both, we are rapidly running out of other people's money. These deficits are simply not sustainable. They are either going to result in unprecedented new taxes and inflation, or they will bankrupt us.
While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system. Instead, we should be trying to achieve reforms by moving in the opposite direction—toward less government control and more individual empowerment. Here are eight reforms that would greatly lower the cost of health care for everyone:
• Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs). The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all our team members who work 30 hours or more per week (about 89% of all team members) for our high-deductible health-insurance plan. We also provide up to $1,800 per year in additional health-care dollars through deposits into employees' Personal Wellness Accounts to spend as they choose on their own health and wellness.
Money not spent in one year rolls over to the next and grows over time. Our team members therefore spend their own health-care dollars until the annual deductible is covered (about $2,500) and the insurance plan kicks in. This creates incentives to spend the first $2,500 more carefully. Our plan's costs are much lower than typical health insurance, while providing a very high degree of worker satisfaction.
• Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.
• Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.
• Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.
• Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.
• Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor's visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?
• Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.
• Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid or the State Children's Health Insurance Program.
Many promoters of health-care reform believe that people have an intrinsic ethical right to health care—to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?
Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That's because there isn't any. This "right" has never existed in America
Even in countries like Canada and the U.K., there is no intrinsic right to health care. Rather, citizens in these countries are told by government bureaucrats what health-care treatments they are eligible to receive and when they can receive them. All countries with socialized medicine ration health care by forcing their citizens to wait in lines to receive scarce treatments.
Although Canada has a population smaller than California, 830,000 Canadians are currently waiting to be admitted to a hospital or to get treatment, according to a report last month in Investor's Business Daily. In England, the waiting list is 1.8 million.
At Whole Foods we allow our team members to vote on what benefits they most want the company to fund. Our Canadian and British employees express their benefit preferences very clearly—they want supplemental health-care dollars that they can control and spend themselves without permission from their governments. Why would they want such additional health-care benefit dollars if they already have an "intrinsic right to health care"? The answer is clear—no such right truly exists in either Canada or the U.K.—or in any other country.
Rather than increase government spending and control, we need to address the root causes of poor health. This begins with the realization that every American adult is responsible for his or her own health.
Unfortunately many of our health-care problems are self-inflicted: two-thirds of Americans are now overweight and one-third are obese. Most of the diseases that kill us and account for about 70% of all health-care spending—heart disease, cancer, stroke, diabetes and obesity—are mostly preventable through proper diet, exercise, not smoking, minimal alcohol consumption and other healthy lifestyle choices.
Recent scientific and medical evidence shows that a diet consisting of foods that are plant-based, nutrient dense and low-fat will help prevent and often reverse most degenerative diseases that kill us and are expensive to treat. We should be able to live largely disease-free lives until we are well into our 90s and even past 100 years of age.
Health-care reform is very important. Whatever reforms are enacted it is essential that they be financially responsible, and that we have the freedom to choose doctors and the health-care services that best suit our own unique set of lifestyle choices. We are all responsible for our own lives and our own health. We should take that responsibility very seriously and use our freedom to make wise lifestyle choices that will protect our health. Doing so will enrich our lives and will help create a vibrant and sustainable American society.
Mr. Mackey is co-founder and CEO of Whole Foods Market Inc.
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Two Questions:
1) What is to be done about people with pre-existing conditions who cannot get health insurance?
2) What happens now when an insurance company discontinues insurance when someone develops a problem? Is this right? What should be done?
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http://www.reason.com/blog/show/135454.html
Why "Reading the Bill" Won't Matter
Radley Balko | August 16, 2009, 10:47am
USA Today notes that even forcing legislators to read the health care legislation in the House probably wouldn't do much good. The bill is so bogged down with bureaucrat-eze, few of them are likely to understand it.
Take the opening lines of one of the bill's most controversial sections, the one about voluntary "end of life" counseling:
"SEC. 1233. ADVANCE CARE PLANNING CONSULTATION. (a) Medicare. — (1) IN GENERAL. — Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended — (A) in subsection (s)(2) — (i) by striking 'and' at the end of subparagraph (DD); (ii) by adding 'and' at the end of subparagraph (EE); and (iii) adding at the end the following new subparagraph: '(FF) advance care planning consultation (as defined in subsection (hhh)(1) … "
Complex bills like these are generally written with heavy input from the lobbyists and interest groups who have so much at stake in them. The public doesn't find out exactly what the implication of striking "and" from subparapraph (DD) might be until the bill has already been implemented.
This is another argument in favor of posting bills in their final form online for a considerable period of time before voting on them, or before they're signed into law. Crowdsourcing by people who have experience wading through the parentheses and em-dashes might at least help decipher some of the mess to get a clearer picture of what it all means. As it stands, we're left with the few politicians who helped craft the bill saying, "Just trust us."
That rarely works out well.
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1. It is my understanding that you can always buy insurance, but it may be expensive depending on your circumstances.
2. I believe that 50 different states have 50 laws that define what insurance companies can and can't do in those circumstances, as well as federal laws on the topic.
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GM: How do YOU think those questions should be answered?
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Sent to me by a friend who is to the right of Attila the Hun:
August 16, 2009
Health Care in Britain: An Expat Goes for a Checkup
By SARAH LYALL
LONDON - There are times when, viewed from afar, American political discourse looks like nothing more than a huge brawl conducted by noisy, ill-informed polemicists. This is one of them, as Britain found last week when the renowned physicist Stephen Hawking was, bizarrely, drawn into the raucous debate over the health care proposals of President Obama and Congress.
Mr. Hawking, 67, has Lou Gehrig's disease, is paralyzed, speaks through a voice synthesizer and needs a great deal of medical attention. He also lives in Britain. This makes him a spectacularly unfortunate choice to pick as an example of the evils of the National Health Service, which has provided free health care - to him, and to millions of other people here - for 61 years.
But that is what Investor's Business Daily did on Aug. 3, in an editorial opposing Mr. Obama's proposals by accusing him of wanting to institute an N.H.S.-style system in America. Mr. Hawking "wouldn't have a chance in the U.K.," the newspaper declared, because the health service would declare his life "essentially worthless."
The paper printed a correction, and Mr. Hawking issued a statement saying that, actually, the health service had helped keep him alive.
Debates about health care are often personal. Policy is full of statistics - mortality rates, spending per capita, cost of drugs, length of hospital stays - and full of hysterical predictions of what disasters change will bring. But in discussing which system is best, patients turn to their own experiences and those of their families, friends and acquaintances. People believe in the hospital and doctors where they had good outcomes; they deplore those that have let them down.
As an American who now lives in Britain, occasionally writes about the health service, and uses public and private medicine here (as well as back home, occasionally), I have seen firsthand the arguments from all sides. Certainly, as someone who in the 1980s paid $333 to have an emergency room doctor at Georgetown University Hospital remove a piece of toilet paper from my ear after I had unsuccessfully tried to use it as an earplug, I applaud a system that is free.
Founded in 1948 during the grim postwar era, the National Health Service is essential to Britain's identity. But Britons grouse about it, almost as a national sport. Among their complaints: it rations treatment; it forces people to wait for care; it favors the young over the old; its dental service is rudimentary at best; its hospitals are crawling with drug-resistant superbugs.
All these things are true, sometimes, up to a point.
The N.H.S. is great at emergency care, and great at pediatric care. My children have enjoyed thorough treatment for routine matters - vaccines, eye tests and the like. A friend who had cancer received the same drugs and the same treatment, I was assured, as she would have in the United States. When, heartbreakingly, she died, her family was not left with tens of thousands of dollars of outstanding bills, or with the prospect of long, bitter fights with hardened insurance companies.
But there are limits. Without an endless budget, the N.H.S. does have to ration care, by deciding, for instance, whether drugs that might add a few months to the life of a terminal cancer patient are worth the money. Its hospitals are not always clean. It is bureaucratic. Its doctors and nurses are overworked. Patients sometimes are treated as if they were supplicants rather than consumers. Women in labor are advised to bring their own infant's diapers and their own cleaning products to the hospital. Sick people routinely have to wait for tests or for treatment.
Because resources are finite and each region allocates care differently, waiting times can vary widely from place to place. So can treatment, as in the United States, regardless of how it is paid for.
Limited in what treatments they can offer, doctors sometimes fail to advise patients of every option available - or every possible complication. American doctors, conversely, often seem strangely alarmist about your future and overeager to prescribe more expensive treatment.
After I had my first baby, Alice, a National Health nurse came to my house regularly to weigh and examine her and to lecture me about breast-feeding. It was all free, a matter of course. The baby seemed to have mild eczema, but the nurse was relaxed about it. When I took Alice, at 3 months, to New York and we went to a Park Avenue pediatrician for a minor, unrelated complaint, the doctor seemed unaccountably exercised.
"This baby has ECZEMA!" he said accusingly, pointing to a few reddish spots. "What are you doing about it?"
Britons are well aware of the limitations of their system. But do they appreciate having the N.H.S. held up by Americans on the right as Exhibit A in discussions of the complete failure of socialized medicine? Do they want to hear that it is "Orwellian," that it is a breeding ground for terrorism, or that, in the words of Senator Charles Grassley, Republican of Iowa, it would refuse to treat everyone from "Granny" to Senator Edward M. Kennedy?
No, they do not.
Like squabbling family members who band together against outside criticism, Britons have reacted to the barrage of American attacks on the N.H.S. with collective nationalist outrage.
A new Twitter campaign, "We Love the NHS," has become one of the most popular topics on the site, helped by Prime Minister Gordon Brown himself, as well as the leader of the opposition Conservative Party, David Cameron.
Mr. Brown's eyesight was saved by a National Health surgeon after a rugby accident when he was in college; Mr. Cameron's 6-year-old son, Ivan, who died in February, was severely disabled and received loving care from the service.
The Twitter campaign is full of testimonials from recipients of successful treatment for brain abscesses, complicated pregnancies, mangled toes, liver disease, hernias, car accidents, nervous breakdowns, cancer - you name it.
For me, the health service was a godsend when my husband suffered a severe stroke in the 1990s. He got exemplary critical care; I did not get a bill. It was only in the aftermath - when I learned that, unusually in Britain, my husband's job came with private health insurance - that I came to realize what it could and could not do. A little over one in 10 Britons have some sort of private supplemental insurance; others pick and choose when to use the N.H.S. and when to pay out of pocket for the top specialists or speedier care.
Told my husband needed a sophisticated blood test from a particular doctor, I telephoned her office, only to be told there was a four-month wait.
"But I'm a private patient," I said.
"Then we can see you tomorrow," the secretary said.
And so it went. When it came time for my husband to undergo physical rehabilitation, I went to look at the facility offered by the N.H.S. The treatment was first rate, I was told, but the building was dismal: grim, dusty, hot, understaffed, housing 8 to 10 elderly men per ward. The food was inedible. The place reeked of desperation and despair.
Then I toured the other option, a private rehabilitation hospital with air-conditioned rooms, private bathrooms and cable televisions, a state-of-the-art gym, passably tasty food and cheery nurses who made a cup of cocoa for my husband every night before bed.
We chose the private hospital, where the bills would be paid in their entirety by insurance. My husband lived there for nearly two months. We saw the other patients only when they were in the gym for treatment when my husband was. Most of them seemed to be from rich countries in the Middle East. Perhaps they were the only ones who could afford to pay.
Sarah Lyall, a London correspondent for The Times, is author of "The Anglo Files: A Field Guide to the British."
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Still hoping for a substantive discussion of my two questions:
Two Questions:
1) What is to be done about people with pre-existing conditions who cannot get health insurance?
2) What happens now when an insurance company discontinues insurance when someone develops a problem? Is this right? What should be done?
Folks, we need to be able to answer these questions and others like them. Simply going NO to BO's liberal fascist agenda will not be enough.
In a similar vein, here is this:
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Saving Grandma
ROSS DOUTHAT
Published: August 16, 2009
When Democratic congressmen dream these days, they’re tongue-tied in town halls, fumbling with their microphones while they’re shouted down by slavering, pitchfork-wielding Limbaugh listeners.
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Susan Etheridge for The New York Times
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But Barack Obama is wiser than most Democratic congressmen, and his nightmares are savvier. Instead of right-wing protesters, he dreams about old people.
He’s in the White House briefing room, presiding over a health care press conference. In the front row are the ancients of the D.C. media, and behind them is a sea of septuagenarians: some in wheelchairs, some clutching walkers, some dragging dialysis machines and the rest holding up Medicare cards like lighters at a Doors concert.
And everybody has a question.
If the Democratic Party’s attempt at health care reform perishes, senior citizens will have done it in, not talk-radio listeners and Glenn Beck acolytes. It’s the skepticism of over-65 Americans that’s dragging support for reform southward. And it’s their opposition to cost-cutting that makes finding the money to pay for it so difficult.
That’s because they’re the ones whose benefits are on the chopping block. At present, Medicare gives its recipients all the benefits of socialized medicine, with few of the drawbacks. Once you hit 65, the system pays and pays, without regard for efficiency or cost-effectiveness.
For liberals trying to find the money to make health insurance universal, these inefficiencies make Medicare an obvious place to wring out savings. But you can’t blame the elderly if “savings” sound a lot like “cuts.” When the president talks about shearing waste from Medicare, and empowering an independent panel to reduce the program’s long-term costs — well, he isn’t envisioning a world where seniors get worse care, but he’s certainly envisioning a world in which they receive less of it.
This is politically perilous, to say the least — and Republicans have noticed.
Conservatives have marshaled various briefs against the Democratic health care proposals. They’ve argued that the plans will be too expensive, that they’ll cramp innovation and raise premiums for the already-insured, that they’ll encourage employers to drop coverage and discourage them from hiring.
These arguments have been effective, up to a point. But they aren’t nearly as effective as warning senior citizens that Barack Obama wants to take away their health care.
That’s why Republicans find themselves tiptoeing into an unfamiliar role — as champions of old-age entitlements. The Democrats are “sticking it to seniors with cuts to Medicare,” Mitch McConnell declared. They want to “cannibalize” the program to pay for reform, John Cornyn complained. It’s a “raid,” Sam Brownback warned, that could result in the elderly losing “necessary care.”
The controversy over “death panels” is just the most extreme manifestation of this debate. Obviously, the Democratic plans wouldn’t euthanize your grandmother. But they might limit the procedures that her Medicare will pay for. And conservative lawmakers are using this inconvenient truth to paint the Democrats as enemies of Grandma.
You can understand why Republicans, after decades of being demagogued for proposing even modest entitlement reforms, would relish the chance to turn the tables. But this is a perilous strategy for the right.
Medicare’s price tag, if trends continue, will make a mockery of the idea of limited government. For conservatives, no fiscal cause is more important than curbing this exponential growth. And by fighting health care reform with tactics ripped from Democratic playbooks, and enlisting anxious seniors as foot soldiers, conservatives are setting themselves up to win the battle and lose the longer war.
Maybe Republicans will be able to cast themselves as the protectors of entitlements today, and then impose their own even more sweeping reforms tomorrow. That’s the playbook that McConnell, Brownback and others seem to have in mind: first, save Medicare from Obama; then, save Medicare from itself.
But for now, their strategy means the country suddenly has two political parties devoted to Mediscaring seniors — which in turn seems likely to make the program more untouchable than ever.
And if you think reform is tough today, just wait. We’re already practically a gerontocracy: Americans over 50 cast over 40 percent of the votes in the 2008 elections, and half the votes in the ’06 midterms. As the population ages — by 2030, there will be more Americans over 65 than under 18 — the power of the elderly and nearly elderly may become almost absolute.
In this future, somebody will need to stand for the principle that Medicare can’t pay every bill and bless every procedure. Somebody will need to defend the younger generation’s promise (and its pocketbooks). Somebody will need to say “no” to retirees.
That’s supposed to be the Republicans’ job. They should stick to doing it.
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Here is an example of research that is the kind of thing we do need more of.
There is a procedure called vertebroplasty wherein a cement is surgically or radiographically injected into a vertebra that has collapsed as a result of osteoporosis.
Two studies just published and released call into question whether or not this procedure is of any value whatsoever.
I have sent a few patients for kyphoplasty ( a related procedure) with some mixed though sometimes beneficial results - there pain was reduced. Yet these two studies with a total of around 100 patients suggests the treatment may have no more benefit over a placebo sham procedure.
So these procedures may be a total wast of money except to those who perform them or supply the cement.
Isn't it remarkable these procedures get approved without better evidence they work?
Why should we pay for this?
How much more do we do that is a waste of money?
We do need more data on these kinds of things:
Orthopedic and Dental Industry News Complete Archive »
NEJM Studies Challenge the Efficacy of Vertebroplasty
BY LAUREN UZDIENSKI, AUGUST 7, 2009
Two studies published this week in the New England Journal of Medicine cast doubts over the efficacy of vertebroplasty.
The first study, conducted in Australia, randomized 78 patients in a multicenter, double-blind, placebo-controlled trial in which participants with one or two painful osteoporotic vertebral fractures were assigned to vertebroplasty or a sham procedure. The authors found that "similar improvements were seen in both groups with respect to pain at night and at rest, physical functioning, quality of life, and perceived improvement." No significant advantage was found for vertebroplasty at any time point during follow-up.
The second study, conducted by the Mayo Clinic, found similar results. 131 patients with one to three painful osteoporotic vertebral fractures were randomized to undergo either vertebroplasty or a sham procedure. Improved disability and pain scores were noted immediately following both procedures, with the study authors noting a trend toward a higher rate of clinically meaningful improvement in pain (a 30% decrease from baseline) in the vertebroplasty group.
These results have been met with some surprise and disbelief among physicians treating VCF patients. The Wall Street Journal quoted Allan Brook, the director of interventional neuroradiology at Montefiore Medical Center in New York City, as saying, “We take a patient who’s been lying in bed in a hospital, bedridden, you do the procedure and they’re home the next day. That is not a placebo."
Some of the limitations of the analysis include a small sample size and crossover between the groups (that is, patients were able to guess they had a sham procedure and proceeded to have the vertebroplasty.) Additionally, the Wall Street Journal noted a type of enrollment bias in that the patients in the most pain, and therefore the most to gain from the procedure, may not have been willing to risk being randomized to the simulated procedure. Enrollment may also have been limited by physicians' concerns that the study was unethical, and the WSJ reported that some hospitals did not allow their doctors to participate.
In an editorial also published in the NEJM, James N. Weinstein (SPORT's principal investigator) described some of the possible adverse events associated with vertebroplasty, which, while rare, include soft-tissue damage and nerve-root pain and compression related specifically to the leakage of bone cement as well as pulmonary embolism, respiratory and cardiac failure and death. He also used the editorial as an opportunity to encourage collaborative decision-making between the physician and patient, stressing that patients prefer to be more informed and will make decisions based on the best available evidence, echoing a an opportunity for further study of vertebroplasty.
Among the companies that may be affected by this data, Orthovita CFO Nancy Broadbent told Reuters, "We don't expect our Cortoss business to be affected at all by this." The company recently launched Cortoss for use in vertebroplasty and closed down 25% yesterday afternoon, just a day after reporting a strong 2Q:09 and beating both top and bottom-line estimates.
Medtronic was also slightly down at the close. Their Kyphon business contributed $609 million to total spinal and biologics sales of $3.4 billion in fiscal year 2009, though it should be noted that kyphoplasty differs from vertebroplasty in several key aspects. Vertebroplasty involves the delivery of bone cement into a vertebral fracture; kyphoplasty first inserts a balloon to create space in the fractured vertebra, restoring its height and shape, before the balloon is removed and the bone cement is delivered to the resulting space. Both procedures are typically performed by interventional radiologists. Medtronic has not commented publicly on these results. Stryker and JNJ, who are among several companies developing VCF treatments, have also not commented.
While investors may be wary, it's unclear how these studies will affect procedure volumes or product penetration. The Wall Street Journal offered examples of other cases where study results questioned established treatments, including a 2002 study that found no benefit to arthroscopic knee surgery, which appears to have only a limited effect on practice habits. While we don't expect procedure volumes to change overnight, these studies may signal a different trend: level I evidence is somewhat rare in orthopedics, but similarly rigorous studies may become more common as payers and other stakeholders demand increasingly strong data and comparative effectiveness gains traction.
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A third question to add to my other two:
3) What do we make of the proposed exchanges?
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Marc, I don't understand the remaining question on "2) What happens now when an insurance company discontinues insurance when someone develops a problem?"
I carry a catastrophic policy. I bought it and have been paying for it since I was young and healthy. If I am tomorrow discovered to have a hugely expensive disease, I assume that I have coverage for as long as I keep the policy up to the limits of my coverage. If not, there is certainly a role for government regulation because anything short of paying according to the agreed terms is IMO theft by swindle. Why would anyone buy health insurance while healthy if coverage is canceled when diagnosed?
On point 1), very few people and no serious, electable politicians oppose some sort of a safety net. We already have that. The point would be that if you decline insurance while healthy you may have to exhaust your own resources before submitting your bill to the other taxpayers. I know there are those who think ordinary people shouldn't be troubled to pay their own living expenses like college or health care. Margaret Thatcher put it best: "Margaret Thatcher quote: "The trouble with socialism is that you eventually run out of other people's money."
3) Health care exchanges could be a way to energize a free market that is sorely lacking in health care or could be just another way to bring the heavy hand of government down on health care, dependinig on how they are set up. From a jurisdictional point of view, I would like to see a federal plan written to help consumers-patients-providers that allow states to OPT-IN rather create more coercion from Washington. This recent discussion sheds only a little light on the subject:
http://www.pbs.org/nbr/site/onair/transcripts/health_insurance_exchange_090605/
Transcripts: "Reviving the Economy"-Health Insurance Exchange
Friday, June 05, 2009 (PBS Nightly Business Report)
PAUL KANGAS: Next week, lawmakers on Capitol Hill are expected to roll out proposals to overhaul the country's health care system. President Obama wants to hold down costs and provide health coverage for 50 million uninsured Americans. To help make that happen, one idea in the works is what's called a health insurance exchange. In tonight's installment of "Reviving the Economy," Dana Bate explains what that exchange might look like and how it would work.
DANA BATE, NIGHTLY BUSINESS REPORT CORRESPONDENT: Whether it's shopping on eBay or searching for a phone plan, Americans love a good deal. But if you decided to shop around for a health care plan today, chances are it wouldn't be easy. Health economist Linda Blumberg says that's because the health insurance market is broken.
LINDA BLUMBERG, HEALTH ECONOMIST, URBAN INSTITUTE: It's kind of the wild, wild west out there, particularly in the non-group insurance market, but also in the small group market and people who are making purchasing decisions don't have the information they need to make good choices.
BATE: That's why she and many others in the health care community want to bring a sheriff to town in the form of a health insurance exchange. The idea is to create one-stop shopping for health insurance. Consumers could go to this insurance marketplace, compare local plans, find out what government aid is available and figure out which plans are best. Former Medicare director Mark McClellan says an exchange would spread risk across plans so that it's easier and cheaper to insure more people.
MARK MCCLELLAN, DIR., HEALTH CARE REFORM, BROOKINGS: So the idea is to try to set up a system in which people could have guaranteed access to coverage that they can afford, that doesn't necessarily charge them more just because they have existing health problems.
BATE: So who would be eligible to use this exchange? That's for Congress to decide. But to start, the exchange would probably focus on small businesses and individuals who can't get insurance through their employer. How much the government will regulate the exchange is also a question.
MCCLELLAN: On the one hand, you want to try to give people clear, comparable choices, so anything that you can do to simplify the range of choices and the number of choices can potentially help with that. On the other hand, the point of competition is to encourage people to be able to sign up for plans that do health care better.
BATE: Blumberg worries too little regulation could lump high risk people together, defeating the system's purpose.
BLUMBERG: The way that insurers behave is in their interest to have the lowest cost, lowest risk enrollees in their plans. The more that they can differentiate the plans that they're offering, the more they can attempt to attract individuals of different risk.
BATE: Lawmakers also need to decide who would run a health care exchange, whether there would be a single national marketplace or whether states would create their own. And, of course, there's the question of whether the government will offer its own health plan to compete with private insurers. Dana Bate, NIGHTLY BUSINESS REPORT, Washington.
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A doctor responds to Obama's NYT op-ed
G. Wesley Clark, MD
Mr. President, I just read your op-ed in the New York Times. You must either be incredibly ignorant (e.g., pediatricians performing tonsillectomies, surgeons being paid $50,000 for an amputation), or else you believe that Americans are incredibly stupid.
You justify a hasty and massive healthcare "reform" to save money, by spending an additional trillion dollars. You would fix a "broken" and broke Medicare system by adding another 47 million beneficiaries to government programs while arguing this will reduce overall costs.
I've itemized your inaccurate claims, with my comments in italics.
You assert that your healthcare reform will:
Force insurance companies to insure pre-existing conditions. That's like allowing bettors to wait till after the race has been run, to place their bets. That won't cut costs.
Eliminate lifetime limits on coverage. Unlimited lifetime coverages must increase premiums to pay for them and will raise total costs.
Require insurance companies to pay for routine examinations, preventive care, and screening tests like mammograms and colonoscopies. Once again, how can you be insured against a sure thing? The only way my company can pay for a colonoscopy is to add enough onto the premium to pay for it, plus their overhead.
Make Medicare more efficient, so tax dollars won't enrich insurance companies. Insurance companies do not derive income from Medicare, because it is a federal program. Incidentally, its costs per patient have increased much faster than private insurance.
Cut hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid. These programs have been in effect over 40 years -- and I've seen the waste and inefficiency for most of that interval. Did you just find out about the waste and inefficiency now, and why hasn't something already been done about it?
You claim that:
"If you like your health care plan, you can keep your health care plan." But didn't you just imply this week that Medicare Advantage subsidizes insurance companies and should be eliminated to save money?
"If you like your doctor, you can keep your doctor." But large numbers of doctors have indicated that they will quit or retire if this plan is enacted
"You will not be waiting in any lines." Maybe you won't but we will. Your plan will add up to 47 million new insureds, with no increase in the supply of primary care physicians that are already in short supply.
We physicians live with our healthcare system, all day and every day. We care about being able to heal. We hate disputing with insurance companies, and especially with government bureaucrats. Certainly changes in insurance practices are needed, and would have occurred long ago, absent a government record of 60 years of meddling with the market.
As you say, "...let's disagree over issues that are real, and not wild misrepresentations" such as those in your op-ed, "that bear no resemblance to anything that anyone has actually proposed."
And I agree, this is about America's future: whether Americans will remain free, or be ruled by an increasingly intrusive and authoritarian statist government.
G. Wesley Clark, MD
(Doctor Clark is not related to the retired general of the same name)
Page Printed from: http://www.americanthinker.com/blog/2009/08/a_doctor_responds_to_obamas_ny.html at August 17, 2009 - 06:56:56 PM EDT
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BBG, What a great letter! Crafty wrote earlier that "Simply going NO to BO's liberal fascist agenda will not be enough." This is true of course but the first step is to persuasively and emphatically say NO to Obama' liberal, fascist agenda.
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Jumpin' the gun here, IMO, but an interesting read nonetheless.
How the Battle of ObamaCare Was Won
By Daniel Greenfield Monday, August 17, 2009
With Obama’s allies sounding the retreat on the public option, ObamaCare has taken a decisive blow. And Obama has taken his first major political defeat. What is particularly extraordinary is that he has suffered this defeat, despite interrupted media sycophancy delivering programming that reflected every single White House talking point.
From smearing Republicans as in the pockets of the insurance industry and Town Hall protesters as extremist racists, to treating ObamaCare as the only reasonable thing that only lunatics would resist-- the media delivered on its end of the propaganda. And yet minds kept getting changed in the other direction.
So how did it happen?
We can turn for starters to the man whose shadow Obama has occasionally sought to fill (when he isn’t filling the shadows of FDR, JFK, Ronald Reagan and the Messiah of all Mankind), Abraham Lincoln. It was Honest Abe who said, “You can fool some of the people all of the time, you can fool all of the people some of the time, but you can’t fool all of the people all of the time.” With Obamacare, Barry Hussein discovered that he couldn’t fool all of the people, all of the time after all.
The media’s great faith in itself notwithstanding, most Americans don’t put very much faith in what they hear on the news. The media’s propaganda works best when it’s going the way they want to go. For years Americans tuned out the media’s Bush bashing, except when they came to feel frustrated about the war and the economy. This resulted in the media taking credit for something that didn’t have nearly as much to do with them, as they would like to believe. The media may pride themselves on playing the liberal Iago to the flyover country Othello, but the rumors and lies they feed only work when Othello is already suspicious of Desdemona.
This time around the American public sided with critics of ObamaCare and with the Town Hall protesters, despite the media’s White House orchestrated smear campaigns against them, because the American public was itself suspicious of ObamaCare and found some of the issues that were raised to be valid. The hurt and baffled stories in the press only demonstrate the cluelessness of the liberal bi-coastal elites and their inability to understand that they are not actually in control of the American people.
And what goes for the media, goes double for the Obama Administration, who’s commitment to style over substance, and image over reality, blinded it to the fact that many of those mainstream Americans who did vote for Obama, were giving him a chance, rather than an open ended mandate. With ObamaCare, Barry trotted out a high flying media campaign and did what he’s always done, put on a show. But the show never went on as scheduled because ordinary Americans, including those who voted for him, had actual questions they wanted answered.
If up till now Obama had successfully played the slick car salesman, waving banners, hiding behind grand but hollow phrases, and showing off how shiny the car was-- with ObamaCare, the customers for the first time began asking questions about what’s under the hood. And that’s not something Obama is equipped to answer in anything but vague generalities. Obama has shown himself to be a Master of Distractions, but with all the money that Americans had spent on Stimulus packages and the automaker bailouts, for the first time the American taxpayer put his hand on his wallet and asked, “So tell me pal, how much is all of this gonna cost me.”
But public skepticism alone may not have been enough, the key ingredient was that for the first time in his career, Obama ran into some serious opposition that he couldn’t gladhandle his way out of. Not opposition from the Republican party, which has become too fixated on finding new ways to lose gracefully, while trying not to piss off its base too much. But from a growing grass roots movement.
One of the fatal mistakes of the Obama Administration was its attempt to demonize and suppress that grass roots movement. The first phase of the mistake got the media to focus on the protesters, by smearing them as extremists, violent disruptors and all around dangerous folk. This was par for the course in the Obama camp, but it put a vocal protest movement on television, and as Obama should have known from his own radical roots, once you put people on television, even in order to smear them, their message can’t help but be heard.
Obama’s people understood their mistake a little too late, and released a followup meme which blasted the media for focusing on the protesters, a message delivered from the top down from Obama himself, to his media stooges like Jon Stewart. But it was too little, too late. The damage had been done.
Obama’s people had sought to frame the ObamaCare debate as being between the reasonable health care reform advocates, and the ugly extremists protesting it. Marginalizing them was meant to marginalize criticism of ObamaCare itself, which would make mainstream conservatives distance themselves from it. It was a classic Alinsky tactic, but this time it backfired badly, even before Obama’s bussed in SIEU thugs began beating people up at Town Halls.
From the start Obama’s people had sought to create the image of a Republican party split between a helpless leadership and an extremist base. It was the tactic used in targeting Rush Limbaugh with the meme that he was the real head of the Republican party. It was the tactic used in giving airtime to the likes of Meghan McCain. And the Republican party appeared to be living up to it.
Michael Steele and all too many GOP Senators seemed willing to provide the helpless leadership side of the ticket, as recently as the Sotomayor debacle. No wonder then that the Obama Administration was caught flatfooted by the opposition they faced at Town Halls when it came time to try and sell ObamaCare to the American public.
Liberals have never taken seriously the idea that anyone but them is capable of fielding a grass roots movement, which is why the initial smear campaigns against the Town Hall critics claimed that they were astroturfed Republican operatives in Brooks Brothers suits, apparently the same ones who kept that nice Mr. Gore from becoming President and saving all the Polar Bears.
When this quickly exposed itself as ludricious nonsense, the panicked left dragged out the race card, condemning critics as racists and neo-nazis. Newspapers described a photoshopped image of Obama as the Joker with the tagline ‘Socialism’, as racist, a claim that never made sense to anyone. Not even them. Pelosi conjured up Swastika bearing mobs descending on Town Halls.
Not only did these tactics fail, but they backfired badly. The American public wanted a serious discussion of health care reform. Instead what they got was FUD that had absolutely nothing to do with the issue. The American public, on either side of the aisle, had very little interest in hearing about the paranoid ravings of the Democratic party. They wanted answers. What they got were already unpopular Senators and Congressmen trying to rush people through the process, yelling at constituents and admitting they had no idea what the legislation actually said.
The game was over even before the SIEU purple mobs got on the scene. The relative passivity of the Republican leadership had suckered the Obama Administration into believing they were facing a cakewalk. It was seemingly obvious that the same inept Republican leadership that had let the Chrysler, GM nationalizations and the Sotomayor nomination slide by, could not seriously challenge them on an issue that they were certain had such broad appeal.
But the defanged Republican leadership had opened the way for the grass roots to play a larger role than ever. Congress’ falling ratings had made many representatives nervous about going into an election, and the split between conservative and liberal Democrats did not help matters. Obama had thrown the ball to congress, forgetting that congress had been unpopular for a while. What emerged was a tremendous disaster.
The Republican party may have been paralyzed at the top, but Town Hall protesters demonstrated that its ideas were quite vital, active and alive. The public was faced with the sight of already unpopular politicians being confronted by people demanding answers. And since they wanted answers too, the entire situation pushed them to do the research better. The internet had made a media monopoly of limited use, which allowed people to bypass the press in many cases, and allowed anyone interested to read contrary opinions very easily.
The resulting outcome demonstrated that while the Democratic party may be stronger than the Republican party, the grass roots of people who are suspicious of big government may be stronger than either one. The war is not over, but Obama has suffered a series crisis of both image and legislation, as shifting poll numbers quickly convinced him to retreat. Like Clinton’s own health care defeat, this shows a sign of weakness, and one that should embolden congressional Republicans who until now have been far too inept at seizing opportunities, particularly in comparison to party figures such as Sarah Palin, Newt Gingrich and Rudy Giuliani, who do not even hold any actual public office at the moment.
Obama meanwhile has been shown an extremely painful lesson about the limits of his cult of personality. Whether or not he has actually learned that lesson is something we have yet to see. But what is truly important is that the Republican party learn the lesson that its strength lies not in media consultants or grappling for some middle ground, but by confronting, challenging, risking and daring. The public does not reward political complacency for very long. To be average in politics, all you need to do is warm a chair and return some political favors. To triumph you must dare to do great things.
The protesters who went out to confront their politicians, did so against the odds. No one in Washington D.C. thought they would succeed or even make an impact. And once again Washington D.C. on both sides of the aisle, proved to be wrong. Lincoln’s timeless words represent a warning to would be monarchs and messiahs in American politics, that they cannot long succeed in controlling an entire nation with their lies. Americans may given in to the political circus of elections, but eventually the tents are rolled up, the elephants lie down to sleep and the public demands more than entertainment, they demand results.
The focus on specific issues, on questioning actual legislation and being in tune with the public’s own questions helped bring us here. The Town Hall protesters became the standardbearers for growing American skepticism toward the Obama administration. Harnessing that skepticism through grass roots movements marks the path toward victory.
Daniel Greenfield is a New York City based writer and freelance commentator. “Daniel comments on political affairs with a special focus on the War on Terror and the rising threat to Western Civilization. He maintains a blog at Sultanknish.blogspot.com.
Daniel can be reached at: sultanknish@yahoo.com
http://canadafreepress.com/index.php/article/13815
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It's not like there are not a lot of examples out there demonstrating convincingly what single payer systems inevitably bring.
Agency to rule on new cures
By TRACY WATKINS - The Dominion Post
A powerful agency will decide which treatments to provide at public hospitals under a major revamp of the health system.
The Government yesterday made public a long-awaited report on the health system after details of a Ministerial Review Group's recommendations were leaked to The Dominion Post last week.
The report recommends gutting the Health Ministry by shifting many of its functions to a new National Health Board. It also recommends extending the powers of the national drug-buying agency, Pharmac, to decide which medical equipment should be bought and significantly boosting the powers of the existing National Health Committee to decide what new diagnostic procedures and treatment should be provided by the public health system.
It recommends that hospital services be decided on a region-wide basis, rather than leaving it to individual district health boards to decide saying "parochial interests" risked leading to poor decisions and determining access to services and treatment by "post code".
The report was written against the backdrop of warnings that New Zealand's ability to pay for world-class health treatment is increasingly under threat.
It recommends putting the National Health Committee in charge of determining what new treatments should be eligible for public funding "and the conditions under which they should be applied".
"For example, as well as defining the patient group most likely to benefit, a new treatment might only be suitable for trial, or use in tertiary hospitals, or where everything has failed an individual patient.
"As part of its reprioritisation process, the National Health Committee should also be asked to identify and assess a number of existing interventions annually that ... appear to be low priority."
The group appears to be using a Pharmac-like model for the plan. Pharmac determines what drugs should be subsidised on the basis of cost and effectiveness, but it has courted controversy for refusing to fund some drugs. The most recent example was the breast cancer drug Herceptin, which the Government eventually agreed to fund.
Labour MP Ruth Dyson said the recommendations "dangerously point to a rationing of frontline health services". "Mothers, the elderly and others not in paid employment should be extremely worried by any suggestion of rationing healthcare to those in paid work."
Green MP Kevin Hague said the idea that healthcare should be rationed on the basis of an ability "to contribute to economic growth" was "obnoxious in the extreme".
But the Ministerial Review Group, which was headed by former Treasury secretary Murray Horn, said it was only proposing "service prioritisation at the margin", acknowledging that experience in New Zealand and overseas showed that any attempt to identify which core services should be publicly funded was "unlikely to succeed in the current environment".
Association of Salaried Medical Specialists executive director Ian Powell said the proposals were radical and destabilising. "It has the feel of a Stalinist monolith about it."
It was "bananas" to suggest that "creating more bureaucracy reduces bureaucracy".
Health Minister Tony Ryall said the Government was not obliged to accept any of the report's 170 recommendations, and he would not support any that increased bureaucracy. The Cabinet is likely to consider the report in the next few months.
FINGER ON THE PULSE:
New Zealand on average spends less per person on health than other developed countries.
Spending on health has been growing much faster in New Zealand than overseas up 30 per cent since 1995, compared with an OECD average of 18 per cent.
The number of senior medical staff has increased by 46 per cent in the past 10 years but more than half of the doctors were born overseas and only 50 per cent of international medical graduates are still working in New Zealand after a year.
Real health costs are set to almost double if they continue to grow at the current rate in the next 20 years, requiring nearly twice as many hospitals, doctors and nurses.
GPs are working fewer hours, not more, since the Government put a cap on GP fees.
Medical error is estimated to harm 44,000 people a year at a cost of $570 million.
http://www.stuff.co.nz/national/politics/2757505/Agency-to-rule-on-new-cures
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The Waxman Inquisition
David Jeffers
In what can only be described as Soviet-style intimidation of the free market, Rep. Henry Waxman (D-Ca), Chairman of the House Energy and Commerce Committee, along with Rep. Bart Stupak (D-Mich), Chairman of House Energy and Commerce investigations and oversight subcommittee, have sent letters to 52 of nation's largest health insurance companies demanding to see these companies detailed financial records.
Is this just good congressional oversight or something more sinister? FOXNews reports:
Nick Choate, a spokesman for Stupak, said 52 letters were sent late Monday to the nation's largest health insurers, those with $2 billion or more in annual premiums. He said letters were not sent to other industry groups, some of which have been airing television advertising in support of Obama's call for legislation. (Emphasis added)
These Stalinist punitive measures should be aggressively opposed by these 52 companies and the GOP needs to publicly castigate the Democrats for these Chicago-style gangster tactics. I cannot imagine anything more intimidating to a businessman than the fear of congressional oversight into your private enterprise if you decide to oppose invasive legislation.
It is time to let Congressmen Waxman and Stupak know that this type of intimidation of American business men will not be tolerated.
Page Printed from: http://www.americanthinker.com/blog/2009/08/the_waxman_inquisition.html at August 19, 2009 - 11:04:46 PM EDT
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***WASHINGTON – President Barack Obama guaranteed Thursday that his health care overhaul will win approval and said any bill he signs will have to reduce rapidly rising costs, protect consumers from insurance abuses and provide affordable choices to the uninsured — while not adding to the federal deficit.***
He still doesn't get it.
Who is going to pay for this???
He still is not being honest with the public.
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Who is going to pay for this???
Easy, the Tooth Fairy, that's who.
Amuses me that Obamacare supporters get so wrapped around the axle over "death panel" claims, when the very ambiguity of the nebulous yet sweeping overhaul they seek just about assures that kind of extrapolation will occur. Their gonna insure more people, claim to pay for it by by forcing saving, though they'll need 80 billion dollars a year to do so in a fiscal climate where we've already run up $2,000,000,000,000 deficit, and in spite of the fact we already have similar programs like Medicare that are rife with waste and abuse. Something's gotta give and the quality of care for older folk is as likely a candidate as anything.
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Can anyone think of any other profession whose pay is and will become even more complicated?
I would rather sit and attempt to invent calculus that try to figure this out.
One real concern is the incentive under these situations to with hold care.
Otherwise it is so complex I have no clue whether I should be for or against. Whether it would save money, improve care, make my life better or God knows what.
All the more reason not to ram 1000 pages of craziness down our throats.
****Building a Bridge from Fragmentation to Accountability — The Prometheus Payment Model
Posted by NEJM • August 19th, 2009 • Printer-friendly
François de Brantes, M.S., M.B.A., Meredith B. Rosenthal, Ph.D., and Michael Painter, J.D., M.D.
In the current debate over health care reform, many observers are proposing new delivery structures to move U.S. health care away from fragmentation, poor performance, and dysfunction toward accountability for high-value care. Ideally, these new structures would promote clear accountability for both improving quality and controlling costs and would encourage health care professionals to organize themselves into teams working on behalf of patients. For such structures to be sustainable, however, the payment system must reward professionals for the quality and efficiency of services, rather than the quantity.
Our fee-for-service payment schemes have contributed to, if not largely created, the current fragmentation. Fee-for-service payments create incentives to provide high volume rather than high value — more, not better, care. So what kinds of payment could promote and sustain high-value care and motivate the development of accountable care organizations? Most experts agree that some sort of bundled, episode-based payment would help to move the system in the right direction. Our own approach, the Prometheus Payment model, for instance, bundles services and provides a budget with three components: evidence-informed base payment with patient-specific severity adjustments and an allowance for potentially avoidable complications (see box, “The Prometheus Model”).1,2 The model has been developed and evaluated through several small pilot projects, which offer some lessons about the ability of episode-based payment to improve cost and quality within the current fee-for-service system. This kind of payment aims to foster outcomes-focused collaboration among otherwise unaffiliated providers and offers a bridge from our fragmented system to a more integrated, accountable one.
The model encourages two behaviors that fee for service discourages: collaboration of physicians, hospitals, and other providers involved in a patient’s care; and active efforts to reduce avoidable complications of care (and the costs associated with them). It accomplishes these goals by paying for all the care a patient needs over the course of a defined clinical episode or a set period of management of a chronic condition, rather than paying for discrete visits, discharges, or procedures.
When incentives are used to drive changes in behavior, it is important that people and organizations are held accountable only for the variables that are actually under their control.3 That’s why, in designing the Prometheus model, we decided to focus on the potentially avoidable costs of patient care. We separated the costs attributable to patient-related factors from those attributable to providers’ actions. These latter costs are critically important in terms of accountability. In Prometheus, these potentially avoidable costs are called PACs and are recognized as the result of “care defects” — problems necessitating technical care that are under the professionals’ control and that, with the best professional standards, could have been avoided. PACs might include the cost of hospitalization of a patient with uncontrolled diabetes or the readmission for a wound infection of a patient who had recently been discharged after cardiac bypass surgery.
The opportunities for improving quality while reducing costs are substantial, reaching far beyond the well-publicized problem of avoidable readmissions. Our analyses of several national and regional data sets, in addition to our pilot work, show that PACs account for 22% of all private-sector health care expenditures in the United States.4,5 The data show that PACs can account for as much as 80% of all dollars spent for conditions such as congestive heart failure that require intensive management and that there are significant regional variations in PACs. On the basis of our current findings, we project that even a modest reduction in PACs from one year to the next would have a considerable effect on the private sector’s portion of health care spending over the next 10 years (see graph). If such results were replicated in a Medicare population, the potential savings would double, reducing the country’s health care bill by more than $700 billion over 10 years.
Projected Private-Sector National Health Expenditures under Current Assumptions and If Potentially Avoidable Costs Were Reduced by Either 10% or 15% Per Year.
Data are from the Department of Health and Human Services 2009 and our own analysis. PAC denotes potentially avoidable cost.
Unlike the current payment system, Prometheus provides larger profit margins for providers who can eliminate these complications, since they keep any unused PAC allowance — they profit by delivering optimal care, not a greater volume of care. Prometheus also avoids some of the classic pitfalls of capitation. Capitation has the unfortunate effect of transferring essentially all risk (including insurance risk) to providers and then encouraging them to pursue undifferentiated reductions in services in order to maximize financial gain. Prometheus mitigates those capitation problems — in part because the occurrence of a new case simply triggers a new patient-specific, severity-adjusted case rate and in part because typical costs and PACs are tracked and accounted for separately and, for now, opportunities for increasing financial gain are limited to decreases in PACs.
Clinical integration may be one way for providers to succeed under Prometheus, but it’s not the only way. In fact, for most of the delivery system, the changes that are required to achieve full integration are neither feasible nor desired by many potential participants. Though there may be minimal organizational requirements for managing patient care in ways that minimize PACs, it is the act of collaboration, not a particular form of organization, that Prometheus attempts to promote.
One lesson from our pilots is that hospital-centric provider organizations can expect increased internal tension when they implement an episode-of-care payment system. Prometheus does provide a sort of bonus to the hospital and physicians for working together to avoid readmission (see box, “Prometheus in Practice”). However, physician groups that are paid under the model for managing chronic conditions have substantial opportunities to increase the profits that come from avoiding expensive hospitalizations. This incentive can highlight potential conflicts between the financial interests of physicians and those of hospitals and cause us to question the proposition that hospital-centric provider organizations will deliver the best results for the country.
Prometheus does not require that a single integrated organization accept payment for an entire episode of care; we recognize that unrelated providers often overtly or tacitly comanage a patient’s care. A limitation of many episode-payment programs is their reliance on prospective payment, which forces the payer to find organizations that will accept the global fee. The Prometheus model, by contrast, can be implemented in a fragmented, largely fee-for-service delivery system if the payer retains the role of financial integrator. Over time, as providers collaborate to improve patient care and optimize their margins, they could more formally integrate into accountable organizations. However, it will and should be their choice to do so.
To facilitate this transition, the current Prometheus pilot sites are not using prospective payment. Instead, budgets are set prospectively, and payers reimburse providers for all fee-for-service claims submitted. Quarterly actual spending for typical and potentially avoidable care is reconciled against the budgets, and detailed reports are made available. Yet the incentives are the same as they would be with prospective payment: if actual spending is under budget, the difference is paid out as a bonus; if it is over budget, some payment is withheld.
Prometheus is not appropriate for reimbursements for all conditions, but there is sufficient evidence to define both typical care and PACs for types of episodes that account for half to two thirds of health care expenditures. At a minimum, our efforts to translate our conceptual model into practice suggest that it can effectively provide a bridge from the current fragmented delivery system to an accountable care system in which collaboration and the pursuit of excellence are the norm.
The Prometheus Model
Developed in 2006, the Prometheus Payment model now has three pilot programs in operation, supported by the Robert Wood Johnson Foundation. The model attempts to go beyond pay-for-performance approaches to pay for individual, patient-centered treatment plans that reward providers fairly for coordinating and providing high-quality and efficient care. Prometheus packages paymentaround a comprehensive episode of medical care that covers all patient services related to a single illness or condition. Decisions about which services will be covered for a given type of episode are made according to commonly accepted clinical guidelines or expert opinions that outline the tested, medically accepted best method for treating the condition from the beginning of an episode to the end. The prices of all included treatments are tallied to generate an “evidence-informed case rate” (ECR),which becomes a patient-specific budget for the entire care episode. ECRs include all the covered services related to the care of a single condition — services provided by everyone who would typically be involved (hospital, physicians, laboratory, pharmacy, rehabilitation facility, and so forth). The ECR isadjusted for the severity and complexity of the individual patient’s condition, and it incorporates an allowance for a portion of the current costs associated with potentially avoidable complications.
Prometheus in Practice
A 63-year-old white man with chest pain and a history of unstable angina is admitted to a teaching hospital. The patient has hypertension and diabetes. An electrocardiogram reveals ST-segment elevation in the lateral leads. The man is taken to the cardiac catheterization laboratory, where coronary angiography reveals severe triple-vessel disease as well as 60% stenosis of the left main coronary artery. A left ventriculogram shows mitral regurgitation (grade 2 to 3) with papillary muscle dysfunction. The patient is then taken urgently to the operating room, where he receives two venousgrafts and a left-internal-thoracic-artery graft. In addition, a mitral-valve reconstruction procedure is performed to correct the mitral regurgitation. The surgery is a success, and the patient returns to the intensive care unit in stable condition. However, his blood sugar is out of control, and he requires an insulin drip. His stay in the intensive care unit is prolonged by 2 days, and he must stay another day in the step-down unit. He is discharged 8 days after surgery in stable condition. One week after discharge, he is readmitted for a wound infection in his leg from the vein harvest site. He requires wound débridement and a course of antibiotics.
Under fee-for-service payment, the hospital would receive $47,500 for the bypass surgery, and the surgeon would receive $15,000 for performing the procedure. The extended hospital stay that was necessitated by the uncontrolled diabetes would result in an additional $12,000 for the hospital and $2,000 for the physician, and the readmission costs would total $25,000, for a grand total of $101,500.
Under Prometheus, the case-payment rate for this patient would include a severity-adjusted budget for typical costs of $61,000 for the hospital and $13,000 for the physician. The severity-adjusted allowance for PACs would be $15,300, for a total budget of $89,300. Had the readmission been prevented, the hospital and physician would effectively have earned a bonus of $12,800 ($101,500 – $25,000 = $76,500, which is $12,800 less than the Prometheus budget).
Mr. de Brantes reports serving as chief executive officer of Bridges to Excellence, which runs the Prometheus Payment model. Dr. Rosenthal reports having served on the original design team for Prometheus Payment and on the board of Prometheus Payment and participating in the evaluation of Prometheus pilots with funding from the Robert Wood Johnson Foundation. Dr. Painter reports supervising the implementation grant for the Prometheus Payment pilots for the Robert Wood Johnson Foundation. No other potential conflict of interest relevant to this article was reported.
Source Information
From Bridges to Excellence, Newtown, CT (F.B.); the Harvard School of Public Health, Boston (M.B.R.); and the Robert Wood Johnson Foundation, Princeton, NJ (M.P.).
This article (10.1056/NEJMp0906121) was published on August 19, 2009, at NEJM.org.
References
de Brantes F, Camillus J. Evidence-informed case rates: a new health care payment model. Washington, DC: The Commonwealth Fund, April 17, 2007. (Accessed August 13, 2009, at http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007/Apr/Evidence-Informed-Case-Rates–A-New-Health-Care-Payment-Model.aspx.)
Gosfield A. Making Prometheus Payment rates real: ya’ gotta start somewhere. Princeton, NJ: Robert Wood Johnson Foundation, June 2008. (Accessed August 13, 2009, at http://www.rwjf.org/pr/product.jsp?id=32051.)
Rosenthal MB, Fernandopulle R, Song HR, Landon B. Paying for quality: providers’ incentives for quality improvement. Health Aff (Millwood) 2004;23:127-141. [Free Full Text]
Rastogi A, Mohr BA, Williams JO, Soobader MJ, de Brantes F. Prometheus payment model: application to hip and knee replacement surgery. Clin Orthop Relat Res 2009 June 23 (Epub ahead of print).
de Brantes F, D’Andrea G, Rosenthal MB. Should health care come with a warranty? Health Aff (Millwood) 2009;28:w678-w687. [Free Full Text]***
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Another NEJM:
01:53:23 PM August 20, 2009
from web
Reform, Regulation, and Research — An Interview with Gail Wilensky
Posted by NEJM • August 19th, 2009 • Printer-friendly
John K. Iglehart
Gail Wilensky, Ph.D., is an economist who served in the administration of President George H.W. Bush, first as the administrator of the Health Care Financing Administration (forerunner to the Centers for Medicare and Medicaid Services) and later as White House health policy advisor. In 1997, she became the first chair of the Medicare Payment Advisory Commission, and during the 2008 presidential campaign, she was an advisor to Senator John McCain (R-AZ). She is a senior fellow at Project HOPE. John Iglehart, a national correspondent for the Journal, interviewed Dr. Wilensky on August 7, 2009.
John Iglehart: Many Republicans oppose reform proposals put forward by Democrats. Do you consider the pursuit of health care reform an urgent matter?
Gail Wilensky: There is obviously a deep divide between the parties about what reform legislation should look like, but I do believe it is important that we press on with reform. We can’t continue the unsustainable health care spending of the past several decades, not to mention problems regarding the value of care, its clinical appropriateness, and a large and growing uninsured population.
Iglehart: How confident are you that by the end of 2009 a reform measure will be signed into law?
Wilensky: I think it’s likely that we will see a significant expansion in insurance coverage, maybe get to 93 to 95% of the population, through reform legislation. I’m quite discouraged that we will do anything significant about the other problems — slowing spending or improving value and clinical outcomes.
Iglehart: There are provisions in the Democratic reform bills that you oppose.1 Of them, which one gives you the greatest pause?
Wilensky: The public plan is one of the most contentious issues, and I hope it will not be in a final bill. I believe that a public plan would ultimately unravel private insurance coverage in the United States.
Iglehart: Do you favor the increased regulation of private insurance plans that their advocates, America’s Health Insurance Plans, volunteered to accept early in the negotiating process, such as guaranteed issue of insurance, elimination of preexisting-condition requirements, and so forth? Is that good public policy?
Wilensky: I believe it is good policy. I favor regulations that would guarantee renewability of insurance policies, place limits on how much premium rates could vary according to the health status of an individual, and eliminate preexisting-condition exclusions, as long as most people are covered. If large blocks of people are allowed to remain uncovered, the system could saddle some insurers with a higher risk profile of covered lives that could make their products unaffordable. But as long as most people are covered, these regulations are an appropriate quid pro quo, and they should be adopted.
Iglehart: Over the past generation, the GOP’s interest in health-related legislation has been modest compared with the emphasis that Democrats have placed on these issues. One exception was the relentless drive of President George W. Bush to enact a Medicare outpatient prescription-drug benefit, a pursuit that most Democrats opposed because of the enhanced role it gave private health plans. In your view, what’s the reason for the modest Republican record on health care issues?
Wilensky: People sometimes accuse the Republicans of not having any ideas in health care. But I don’t think that’s true; it’s more a failure to aggressively promote their ideas once they are introduced. For example, the first President Bush introduced a very good proposal that would have provided coverage to every individual whose income was below 133% of the federal poverty level, reformed private insurance, and changed the medical liability system. But it was released too late in his term, and perhaps even more importantly, the passion for health care reform that President Clinton demonstrated and that now engages President Obama has never been articulated by Republican leadership in the executive branch or, in some instances, the Congress.
Similarly, you could say that George W. Bush put forward a reasonable reform proposal to expand coverage by providing tax deductions for people without employer-sponsored insurance. John McCain offered a plan that called for taxing the employer-paid insurance premiums of workers, just as their salaries are taxed. At the same time, his plan would have granted refundable tax credits to employees so they could purchase their own coverage rather than accept the insurance offered by their employers. Don’t forget, during the election campaign, Obama attacked McCain repeatedly for this proposal, although equalizing the tax treatment of all workers has long been supported by virtually all economists because the current policy favors people with higher incomes. Health issues have just not been a primary focus for Republicans. Even on an issue that Republicans feel passionate about — reforming how professional liability issues are addressed — they have been unable to enact legislation during the brief periods when they controlled Congress and the White House, or at least Congress, in the past decade or so.
Health care reform is a difficult challenge for both parties, as the August [2009] town hall meetings are underscoring. We can see it now with our Democratic president and substantial Democratic majorities in the House and Senate, and still some uncertainty about if, let alone what kind of, health care reform may be enacted.
Iglehart: The Obama administration has been promoting the idea of creating an Independent Medicare Advisory Council within the executive branch,2 with the authority to make recommendations to the president on annual Medicare payment rates and other reforms, shifting some power from Congress to the executive branch. If the president disapproved the recommendations or Congress passed a resolution of disapproval, the recommendations would be null and void, although Congress would have to enact a bill with comparable savings within a short period. What’s your view of that idea?
Wilensky: I think it’s a bad idea. It would be trading off the difficulty Congress encounters when legislators face tough choices for granting power to a body that is unaccountable to the electorate. I find it very odd that the Congress has been unwilling to grant greater discretionary authority to the Centers for Medicare and Medicaid Services [CMS] at the same time that a few legislators — Senator Jay Rockefeller [D-WV] and Representative Jim Cooper [D-TN] — are sponsoring measures that would provide almost unlimited authority to an independent body of individuals who, once appointed, would be completely unaccountable to the American people. I think the right strategy is for Congress to approve the general structure of provider payment and the spending it deems appropriate, enact payment reforms, broadly defined, that it favors — bundling payments for physicians, moving to more accountable alignment between physicians and hospitals or between physicians and health care plans — and grant CMS far greater discretionary authority to implement these changes. After all, the CMS administrator is a presidential appointee, subject to confirmation by the Senate, reporting to a secretary who is similarly subject, who reports to the president, who is ultimately accountable to the American people.
Iglehart: So you favor providing CMS with greater resources to administer Medicare and Medicaid, even though members of Congress seem to criticize its performance at every turn?
Wilensky: Yes, and I’ve been one of a number of Republicans and Democrats3,4 who have indicated that all recent administrations — and Congress as well — have starved CMS in terms of providing the kind of management resources and administrative support the agency needs to capably run Medicare and Medicaid.
Iglehart: You’ve been a strong advocate of greatly expanding the government’s investment in comparative-effectiveness research [CER].5 The administration’s stimulus package included $1.1 billion to fund an accelerated CER program. Do you anticipate that reform legislation will expand the available CER resources? And what kind of impact will such research have on practicing physicians and the content of medical care?
Wilensky: I am hopeful that we will continue to see additional funding and program implementation policies for CER in whatever reforms are passed by Congress. There are many questions — about governance, about where an entity should be located, about how priority setting should occur, about the involvement of patient advocates and industry in some of these deliberations — that were not addressed in the stimulus package. That was a jump-starting action for CER, but these critical questions of place and priorities must soon be resolved.
We invest so much in the NIH’s pursuit of basic research but often fail to rapidly translate the results of those efforts into clinical care. It is just enormously frustrating to me that many interests, including quite a few physicians, do not recognize CER as a companion project to NIH’s basic research that would help doctors and patients determine what are the most effective therapies for a particular condition or disease. And I am frustrated and disappointed by some of the Republican posturing, too, which asserts that additional information provided through CER is a threat or a first step to rationing care. I believe that providing information about what works when, and allowing that information to be used as part of a reimbursement decision, is reasonable and sensible.
Iglehart: You have been emphatic that, initially, a CER agenda should focus its greatest attention on medical and surgical procedures and their value, rather than on drugs and devices. Why?
Wilensky: Because that’s where the money is. I’m looking at this as a way to learn how to spend smarter and treat better, and that involves the use of medical procedures because we’ve had so little investment in comparative-effectiveness information in that area.
Dr. Wilensky reports serving on the boards of Cephalon, Quest Diagnostics, SRA International, and UnitedHealth Group.
Source Information
This article (10.1056/NEJMp0907415) was published on August 19, 2009, at NEJM.org.
References
Antos J, Wilensky GR, Kuttner H. The Obama plan: more regulation, unsustainable spending. Health Aff (Millwood) 2008;27:w462-w471. [Free Full Text]
Orszag PR. Letter to House Speaker Nancy Pelosi, July 17, 2009. Washington, DC: Executive Office of the President, 2009.
Butler SM, Danzon PM, Gradison B, et al. Crisis facing HCFA & millions of Americans. Health Aff (Millwood) 1999;18:8-10. [CrossRef][Medline]
Iglehart JK. Doing more with less: a conversation with Kerry Weems. Health Aff (Millwood) 2009;28:w688-w696. [Free Full Text]
Wilensky GR. The policies and politics of creating a comparative clinical effectiveness research center. Health Aff (Millwood) 2009;28:w719-w729. [Free Full Text]
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Hmm, it appears a vast Federal medical care system has already drafted and circulated end of life planning guides. Perhaps some of the "death panel" hysteria is not quite as fictional as some claim.
The Death Book for Veterans
Ex-soldiers don't need to be told they're a burden to society.
By JIM TOWEY
If President Obama wants to better understand why America's discomfort with end-of-life discussions threatens to derail his health-care reform, he might begin with his own Department of Veterans Affairs (VA). He will quickly discover how government bureaucrats are greasing the slippery slope that can start with cost containment but quickly become a systematic denial of care.
Last year, bureaucrats at the VA's National Center for Ethics in Health Care advocated a 52-page end-of-life planning document, "Your Life, Your Choices." It was first published in 1997 and later promoted as the VA's preferred living will throughout its vast network of hospitals and nursing homes. After the Bush White House took a look at how this document was treating complex health and moral issues, the VA suspended its use. Unfortunately, under President Obama, the VA has now resuscitated "Your Life, Your Choices."
Who is the primary author of this workbook? Dr. Robert Pearlman, chief of ethics evaluation for the center, a man who in 1996 advocated for physician-assisted suicide in Vacco v. Quill before the U.S. Supreme Court and is known for his support of health-care rationing.
"Your Life, Your Choices" presents end-of-life choices in a way aimed at steering users toward predetermined conclusions, much like a political "push poll." For example, a worksheet on page 21 lists various scenarios and asks users to then decide whether their own life would be "not worth living."
The circumstances listed include ones common among the elderly and disabled: living in a nursing home, being in a wheelchair and not being able to "shake the blues." There is a section which provocatively asks, "Have you ever heard anyone say, 'If I'm a vegetable, pull the plug'?" There also are guilt-inducing scenarios such as "I can no longer contribute to my family's well being," "I am a severe financial burden on my family" and that the vet's situation "causes severe emotional burden for my family."
When the government can steer vulnerable individuals to conclude for themselves that life is not worth living, who needs a death panel?
One can only imagine a soldier surviving the war in Iraq and returning without all of his limbs only to encounter a veteran's health-care system that seems intent on his surrender.
I was not surprised to learn that the VA panel of experts that sought to update "Your Life, Your Choices" between 2007-2008 did not include any representatives of faith groups or disability rights advocates. And as you might guess, only one organization was listed in the new version as a resource on advance directives: the Hemlock Society (now euphemistically known as "Compassion and Choices").
This hurry-up-and-die message is clear and unconscionable. Worse, a July 2009 VA directive instructs its primary care physicians to raise advance care planning with all VA patients and to refer them to "Your Life, Your Choices." Not just those of advanced age and debilitated condition—all patients. America's 24 million veterans deserve better.
Many years ago I created an advance care planning document called "Five Wishes" that is today the most widely used living will in America, with 13 million copies in national circulation. Unlike the VA's document, this one does not contain the standard bias to withdraw or withhold medical care. It meets the legal requirements of at least 43 states, and it runs exactly 12 pages.
After a decade of observing end-of-life discussions, I can attest to the great fear that many patients have, particularly those with few family members and financial resources. I lived and worked in an AIDS home in the mid-1980s and saw first-hand how the dying wanted more than health care—they wanted someone to care.
If President Obama is sincere in stating that he is not trying to cut costs by pressuring the disabled to forgo critical care, one good way to show that commitment is to walk two blocks from the Oval Office and pull the plug on "Your Life, Your Choices." He should make sure in the future that VA decisions are guided by values that treat the lives of our veterans as gifts, not burdens.
Mr. Towey, president of Saint Vincent College, was director of the White House Office of Faith-Based Initiatives (2002-2006) and founder of the nonprofit Aging with Dignity.
http://online.wsj.com/article/SB10001424052970204683204574358590107981718.html
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2nd post.
Killing Obamacare -- By: Andrew C. McCarthy
Earlier this week, some of my National Review colleagues recoiled from Sarah Palin’s bracing allegation that Obamacare would foist government “death panels” on vulnerable Americans. I recoiled from the recoil, which I thought exemplified the same sort of “hysteria” the editorial in question, “Rationing and Rationality,” condemned. There followed a debate (see The Corner archives for August 17 and 18), largely a fine parsing of how -- rationally, of course -- the term “death panel” ought to be defined. As we went back and forth, I kept having this nagging thought:
We could still blow this thing.
Obamacare and its proponents have taken a drubbing in the polls. Americans are passionate about matters of life and death and who gets to decide them. Unlike appropriations for the F-22 or another billion or so in “stimulus” so the NEA can underwrite simulated-sex dances, the health-care issue aroused the public. Citizens read the bill (something their legislators haven’t been anxious to do) and blew a gasket. Saul Alinsky’s bag of tricks doesn’t say what to do when the opponent to be smeared in the public mind is the public itself. So our organizer-in-chief is adrift at sea, and sinking.
But this battle is far from over. Since Barack Obama first emerged in national politics, it’s been chattering-class wisdom to throw both caution and Occam’s Razor to the wind. No need for concern, the pundits proclaimed, about Ayers and Dohrn and Khalidi and Wright and Pfleger and Frank Marshall Davis and ACORN and the Chicago New Party and infanticide and#...#and#...#and#...#. No matter the fever swamps of his past, they insisted, Obama has a first-rate intellect and a winning temperament -- why, he even writes his own books (about himself) and knows who Reinhold Niebuhr was. Once he takes the reins and grapples with the concrete complexities of governing, we were assured, ideology will dissolve. He’ll become moderate and pragmatic, if for no other reason than his own political survival.
But we knuckle-draggers figured that if it walks like a radical and quacks like a radical it’s probably not all that moderate and pragmatic. Nothing we’ve seen so far calls for revising that assessment. If anything, these last seven months ought to tell us that the usual political rules don’t apply when predicting this president’s behavior. His purpose is revolutionary change in an American society he grew up understanding to be fundamentally unjust, racist, materialist, imperialist, and the agent of global misery. He is in Washington to transform the nation from the top down. Nationalized health care is key for him. If he gets it, sovereignty shifts from the citizen to the state. By law, government will be empowered to manage minute details of our lives. Over time -- when, as the American Thinker’s Joseph Ashby observes, a “1,000-page health-care law explodes into many thousands of pages of regulatory codes” -- that is precisely what government will do.
Obama is not a normal politician. He’s a visionary, and using health care to radically expand the scope of government happens to be central to his vision. For my money (if I have any left), achieving it is more important to him than is getting reelected. His poll numbers and those of congressional Democrats may keep plunging (for the latter, there must come a point where that is statistically impossible), but they have the votes to Rahm this thing through.
To be sure, Washington is still populated with normal politicians, and that is why you can almost touch the Democrats’ desperation. They don’t want to walk this plank, and they are praying to Gaia, night and day, for that magic moment when the usual RINO rabbits spring from the bipartisan hat to give them cover from their fuming constituents. But at its highest levels, this Democratic government is being steered by the party’s most extreme leftists. Obamacare is their life’s dream, they have the power to make it happen, and if they have to go it alone, they will try going it alone.
Even if Obama were a normal politician, 2012 is three years away, and he’ll worry about that later, if he has to worry at all: With his Justice Department green-lighting election fraud, ACORN and the New Black Panther party riding high, and amnesty for millions of illegal aliens on the horizon, 2012 may take care of itself.
Things may appear to be going well at the moment for opponents of Obamacare, but the stubborn fact remains that only one thing can stop this monstrosity: wavering congressional Democrats’ discovery that they have more to fear from their districts than from their leadership and the White House. The ardor of public opposition will determine whether this battle is won or lost.
That’s why I found our “death panel” debate so disconcerting. The editorial that pooh-poohed the label acknowledged, as my friend Rich Lowry later emphasized, that the legislation gave great reason (I’d say grave reason) to be concerned about “government rationing and a general slide toward euthanasia.” The editorial’s contention was that there wouldn’t “literally” be death panels. To me, that’s not much different from quibbling over “what the meaning of ‘is’ is.” The stakes here couldn’t be higher, time is short, and “death panel” cuts to the chase.
What, after all, is “end of life” counseling in a bill that, we here all agree, rations care (i.e., redirects it away from those who consume most of it now: the elderly and the infirm) and raises fast-track-to-euthanasia worries? In the Wall Street Journal, former Bush White House official Jim Towey alerts us that, at the Veterans Administration, Obama has reinstated a 52-page “end of life planning document” authored by a medical ethicist who has advocated doctor-assisted suicide in a Supreme Court brief. This Orwellian “Your Life, Your Choices” questionnaire, in the familiar “push poll” manner, methodically steers the patient toward the notion that he is a malingering near-vegetable causing a “severe emotional burden” for his family. I don’t know what the correct, non-hysterical term for such a process is, but “Grim Government Reaper” strikes me as more accurate than “Your Life, Your Choices.”
Imagine a woman lying dead of stab wounds and a man holding a bloody knife in his hand. If the reaction of the first cop on the scene is, “You killed her,” I don’t think that’s hyperbole. Most of us would find it weird if he instead said, “Well, now, wait just a second. There are complex issues of causation here, to say nothing of the epistemology of mind -- intentional, involuntary, insanity, crime of passion? Let’s scrutinize this dispassionately, have the five-week trial with all the due-process trimmings, and then rationally decide what to call this. No point in leaping to rash conclusions.”
The second reaction might be sound, but it’s neither natural nor practical. Like your health, murder is a gripping matter -- it’s not your everyday material misstatement in the exchange of commercial paper. “You killed her” gets to the heart of the matter, to the big things you need to think about. Plus, most of us don’t have a year for scrutiny, discovery, and settlement negotiations. We have lives to live. What we need to know is whether he probably did kill her, so we can evaluate some practical concerns, like whether he should be free to walk the streets while he waits for his five-week trial.
Obama, of course, wanted health-care “reform” done -- all 1,000-plus pages of it -- before the summer recess. In essence, Democrats want to repeal individual liberty; move one-sixth of the private sector into the same government-controlled model that has produced bankruptcy in Social Security, Medicare, and Medicaid; add additional trillions to the already exploded national debt; and they want to do it all right now -- no discovery, no settlement negotiations, no five-week trial, no delays.
Given this Democratic whirlwind, I don’t see why we owe them better than “death panels.” They are what we’re sure to get if Obamacare isn’t killed first.
http://article.nationalreview.com/?q=NTAwNTIwODgzOWJhYjI0ZTZlMGQ4MTMzZWRmMWNlNWU=
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3rd post. Oh my, the following graph would seem to tinkle on some of the predatory insurance company narratives currently being foisted to inspire a single payer stampede.
Longest. Lives. Ever.
Quit griping about health-care costs.
By Jerry Bowyer
(http://www2.nationalreview.com/images/chart_bowyer_082109.jpg)
The Centers for Disease Control released its “National Vital Statistics Report” this week, and BuzzCharts was especially interested in the latest figures for life expectancy. It turns out that Americans are living longer than they did at any time in the nation’s history. The average lifespan is just shy of 78 years, with women living slightly longer than 80 years. Males and females, blacks and whites — we’re all living longer than ever before.
So what’s all this noise coming out of D.C. and the left-wing media about how terrible our health-care system is? Why are we told of its unsustainability, its inherent greed and corruption, and its tolerance for tonsillectomy mills? Watching all this hand-wringing, one might think that Americans had the highest death rates ever recorded, rather than the lowest. But men who are ambitious for power find good news to be the least useful news of all. Hence, four-score life expectancies — the dream of previous generations — go unheralded.
Our chattering classes chatter on about derivative abstractions, such as the increase in the percentage of GDP that we allot to health care. The cable-television pundits remind us that we’re spending about 16 percent of our national output on health care, and conclude that this is some kind of national scandal. Why? What percentage should we be spending? Is 10 percent more acceptable? Is 5 percent?
Let’s be clear: Prosperous countries spend more on doctors and medicine than non-prosperous ones. The poor allocate almost everything they earn to food, rent, and clothes, and have little to spend on medicine and even less to squander on fun. When a nation gets wealthy, however, food, roofs, and pants become less of a cost issue, while more money is funneled to matters such as health.
Our great-grandparents spent much less than 16 percent of GDP on health care, and they barely made it into their 60s. Would any of you willingly give back 20 years in exchange for less health-care spending?
— Jerry Bowyer is an economist, CNBC contributor, and author of the upcoming Free Market Capitalist’s Survival Guide.
National Review Online - http://article.nationalreview.com/?q=NWE4ZGIzMDk1NzE3NWJjN2I3NmIzYTI0YjhiNDQxOTc=
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And yet another post. I'd throw in some massive tort reform on top of this all of which would make sure it would never get past this congress, but it would sure short circuit the whole "Republicans don't have an alternative" snivel.
We Need a Republican Response to ObamaCare
By Paul Shlichta
The current attempt to steamroller a drastic healthcare reform bill through Congress has created a rift between the Obama-Pelosi (OP) Democrats and what might be called the "blue-chip" (BC) faction---the moderate mainstream Democrats whose alliance, or at least acquiescence, is probably essential for the passage of any legislation. These two factions have very different ideas of what "healthcare reform" should mean.
It is difficult to pin down exactly what BCs want. Caught in the crossfire between the Chicago-style strong-arming of the White House and the anger of the electorate, they have become evasive [1]. But it is likely that most would accept, as a minimum:
B1. Available healthcare insurance for all citizens who want it, with most BCs being willing to exclude illegal aliens.
B2. A reasonable level of healthcare with no rationing or curtailment for the elderly or chronically ill.
B3. The deletion of a "public option" to compete with private insurers, although there is considerable divergence of opinion on this point.
B4. Avoidance of controversial issues such as abortion, medical rationing, and assisted suicide.
B5. A convincing estimate of a total cost that will not aggravate our huge deficit or endanger the economy.
In contrast, the OP agenda, as set forth in House Bill 3200 and diagrammed by the staff of Rep. Kevin Brady, is vastly more grandiose [2]. It includes:
O1. Mandatory healthcare insurance for everyone, including illegal aliens.
O2. Federally set standards of healthcare, leading to inevitable rationing, restriction to "cost-effective" treatments, and exclusion of preventative measures such as prostate cancer screening
O3. Mandatory inclusion of abortion coverage and provisions for "end-of-life" counseling that smell suspiciously like medical rationing and/or assisted suicide.
O4. Inclusion of a government-run public option and a delayed-action "poison pill" calculated to force private insurers out of business.
O5. A frighteningly high cost with no convincing plan for cost management except arm-waving and evasion [3].
In short, the ObamaCare plan would create an elaborate political machine that would give the federal government total control of a bureaucratic healthcare empire so far-reaching and destructive of existing private institutions that, like a deeply rooted and metastasized cancer, once established, it would be impossible to remove. The czar of this empire, the Health Care Administration Commissioner, answerable only to the President, would set benefit rates, select and regulate participating insurance companies, and administer a rival Public Health Plan that Obama and his colleagues have previously admitted would be merely a stepping stone to a federal single payer system.
(http://www.americanthinker.com/Shlichta%201.JPG)
Diagram of HR 3200 as analyzed by the staff of Rep. Kevin Brady
BC Democrats are justifiably alarmed by many of these provisions. Moreover, with an apprehensive eye on the 2010 elections, they are concerned about the vigorous voter resistance they have encountered in town meetings. But, since they are still committed to universal healthcare insurance and will need party support for next year's election campaigns, they may be arm-twisted or bludgeoned into acquiescence to the passage of HR 3200.
But what have the Republicans proposed? A few, such as Kevin Brady, have acknowledged the need for reform and published detailed proposals. But most Republicans, although dissenting about questionable aspects of HR 3200, have either made no counterproposals of their own (thereby implying that they regard the status quo is acceptable) or have introduced alternative legislation, such as the Patients' Choice Act, that does not meet BC expectations and has no chance of passage through a Democratic congress.
This is political suicide. A majority of Democrats do want some sort of healthcare reform, almost all of the Democratic candidates campaigned for it, the Democrats control both houses of Congress and virtually all its committees---and so, like it or not, we will almost certainly have some form of healthcare reform measure enacted this year.
Therefore, it is urgently necessary that Republican leaders unite in a counterproposal that will gain widespread BC acceptance. By way of example, I hereby suggest a provisional plan based on:
(a) modifying an existing bill, e.g. using the HR 3200 organizational plan as a starting point,
(b) paring down the ObamaCare empire, so that it conforms to the basic aims of the BC Democrats while eliminating anything that is not essential to those aims, and
(c) proceeding cautiously and economically by making every change potentially reversible and by using existing agencies and institutions as much as possible.
These guidelines lead to deletions and changes in the current structure of HR 3200 such as the following:
There is no need for a Health Choices Administration or HCA commissioner. In fact, these duties would conflict with those of state agencies and might even be a violation of the tenth amendment. Instead, the federal government should begin by accepting any insurance company and/or professional certification that is already accepted by a state agency. This might be facilitated, without excessive federal regulation, by establishing interstate health insurance as proposed last year by McCain and more recently by several members of Congress.
There is no need for a federal one-size-fits-all standard for healthcare insurance. In fact, as Robert Veach has pointed out in Patient, Heal Thyself, this would be a gross violation of the bioethical right of a patient to chose an insurance plan that fits his own set of value judgments.
There is no need for a "Public Health Plan" insurance organization. Instead, the insurance of otherwise uninsurable families and individuals, such as people thrown out of work, would be assigned to existing private insurers by a system similar to the assigned-risk methods currently used for auto insurance. This would be the primary function of the so-called Health Insurance Exchange and could be handled by the proposed "Reinsurance Program" office [4].
There is no need to create a National Health Service Corps or Public Health Workforce Corps. There are numerous private volunteer and faith-based agencies that already carry out the activities proposed for these 'corpses' and that have frequently demonstrated their superiority to federal agencies in effectiveness and efficiency. Such organizations should be encouraged and honored, instead of being shoved aside.
There is no urgent need for a Bureau of Health Information or for the related IT, civil rights, and minority offices. Other federal and state agencies currently carry out these functions and can continue to do so. Similarly, there is no urgent need for any of the special offices colored yellow in the Brady diagram. Offices and agencies of this kind could be added later, when and if they prove to be necessary.
There is an urgent need for assurance of cost reduction. Therefore the Obamacare machinery must be reduced by at least 50%.
When these deletions are made, the Brady diagram begins to look more reasonable, while still fulfilling the basic requirements of most BC Democrats.
(http://www.americanthinker.com/Shlichta%202.JPG)
Proposals like this, which reduce healthcare reform to its essentials and make maximum use of existing federal, state, and private agencies and institutions, would greatly reduce the proposed levels of administration costs and the inevitable tax burden. Moreover, in sharp contrast to the Obamacare empire, such a system would be emendable and would be ultimately answerable to Congress and the American people rather than solely to the POTUS.
I therefore hope that Republican congressional leaders will, in the few weeks remaining, draft, publicize, and introduce a counterproposal of this type and implement it by major amendments to pending bills. Otherwise, it is probable that some virulent form of HR 3200 will be rammed down our throats (or some other orifice) and that the prognosis of our healthcare system will change from "serious" to "critical" while the costs continues to soar [5]. When this happens, Doctor Obama, like any other quack, will simply yell for more turpentine.
NOTES:
[1] The "blue chip" faction may be substantially larger than the 52 member Blue Dog Coalition of House members that have vocally criticized HR 3200. Some, caught between OP coercion and voter rebellion, are "closet BCs", as evidenced by the disparity between what they proclaim on their websites and what they say to voters at town meetings.
[2] HR 3200 is an excellent example of Hilaire Belloc's observation that:
...three characters appear which are the concomitants of all revolutions, and the right management of which alone can prevent catastrophe. The first character is [that] change of every kind and every degree is proposed simultaneously, from reforms which are manifestly just and necessary---being reversions to the right order of things---to innovations which are criminal and mad.
[3] Even the advocates of Obamacare admit that:
We're not sure it's even possible to nail down a firm answer to the cost question. The president's health-care plan is a work in progress, relying on a host of long-term projections...Can Obama and the Democrats really squeeze $70 billion of waste out of Medicare? The Congressional Budget Office, looking at earlier drafts of health-care reform, has expressed doubts.
These doubts are exacerbated by the "now or never, all or nothing, take it or lose it forever" urging of the POTUS, which has a strong odor of con-man hustle.
[4] As part of his retreat strategy, Obama has proposed replacing the public option with co-op insurance organizations. This might be an acceptable compromise, but looks suspiciously like one of the Trojan horses for which the Obama administration is so justly famous.
[5] All of the healthcare reforms discussed to date are concerned primarily with insurance, which is only one of the factors driving up healthcare costs. No plan, least of all HR 3200, has yet directly addressed the basic issue that is the root of all of our concerns about healthcare -- the high and ever-spiraling costs of physicians' fees, clinical tests, medicines, hospitalization, and medical schools. Alleviation of this burden would require basic but not infeasible changes in our healthcare system that are not at all addressed in current legislation. This issue will be discussed elsewhere.
Page Printed from: http://www.americanthinker.com/2009/08/we_need_a_republican_response.html at August 22, 2009 - 02:03:18 AM EDT
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With regard to post 363 please take note of the increase in life expectancy from around 70 to close to 80 since the 1970s.
This is true. Yet we have the self promoting Andrew Weil, the constantly reminding us guy who graduated Harvard Medical school poinint out that medical htechnology only saves about one in 16,000 lives. That was what I read in his post on the Huffington Post about a week ago.
Almost all the increase in lifespan since 1900 is imporved sanitation vaccines etc.
Well the last statement is true and obvious.
That was the easy gain.
But what about the increase since 1970? Is he telling me that is from a decrease in cholera, typhoid, better sanitation and hepatitis B vaccine?
And the increase since than while only a couple of years is still an increase and no one would argue it is due to healthier life styles.
In fact the average lifespan would be even greater if it were not for less healthy lifestyles.
The only major killer that kills more today than then is diabetes obviously because of the epidemic of this from obesity.
So DESPITE less healthy lifestyles the field of medicine has achieved an increase in lifespan.
Anyone who denies this is a total blow hard - as is Weil.
Perhaps this post would be better on the Huffington Post but I don't really want to bother.
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"the increase in life expectancy from around 70 to close to 80 since the 1970s"
We may not know precisely the reasons for increased longevity but it also weakens the arguments that our food supply, drinking water, air quality, CO2 level and climate change are increasingly unhealthy to human life.
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The more I think about it the more I believe Obamacare opponents should be highlighting the lack of tort reform in all versions of the bill as nothing is more emblematic of the complex, convoluted usurpation of all medical spending and placing it in the hand of bureaucrats and lawyers than the failure to reform the structures than inspire defensive medicine.
Palin: 'No Health Care reform without legal reform'
Ethel C. Fenig
Fresh from spurring a discussion of end of life issues with her mention of death panels under Obamacare in Facebook, former Governor Sarah Palin (R-Alaska) is at it again:
No Health Care Reform Without Legal Reform
(snip)
[W]e cannot have health care reform without tort reform. The two are intertwined. For example, one supposed justification for socialized medicine is the high cost of health care. As Dr. Scott Gottlieb recently noted, "If Mr. Obama is serious about lowering costs, he'll need to reform the economic structures in medicine-especially programs like Medicare." [1] Two examples of these "economic structures" are high malpractice insurance premiums foisted on physicians (and ultimately passed on to consumers as "high health care costs") and the billions wasted on defensive medicine.
Quoting Dr. Stuart Weinstein of the American Academy of Orthopedic Surgeons she praises him as he
details the costs that our out-of-control tort system are causing the health care industry and notes research that "found that liability reforms could reduce defensive medicine practices, leading to a 5 percent to 9 percent reduction in medical expenditures without any effect on mortality or medical complications."
(Got that former tort lawyer, senator and vice presidential candidate John Edwards; known for channeling the words of a fetus unfortunately born with cerebral palsy that helped him win $6.5 million for his client--of which he kept a third.)
She then asks some questions about Obamacare.
Why no legal reform? Why continue to encourage defensive medicine that wastes billions of dollars and does nothing for the patients? Do you want health care reform to benefit trial attorneys or patients?
Aha! Did that last question--and its answer--strike home?
That can be solved, she proves, by citing her non community organizer experience from her state and Texas.
Many states, including my own state of Alaska, have enacted caps on lawsuit awards against health care providers. Texas enacted caps and found that one county's medical malpractice claims dropped 41 percent, and another study found a "55 percent decline" after reform measures were passed. [4] That's one step in health care reform. Limiting lawyer contingency fees, as is done under the Federal Tort Claims Act, is another step. The State of Alaska pioneered the "loser pays" rule in the United States, which deters frivolous civil law suits by making the loser partially pay the winner's legal bills. Preventing quack doctors from giving "expert" testimony in court against real doctors is another reform.Texas Gov. Rick Perry noted that, after his state enacted tort reform measures, the number of doctors applying to practice medicine in Texas "skyrocketed by 57 percent" and that the tort reforms "brought critical specialties to underserved areas." These are real reforms that actually improve access to health care. [5]
She concludes
Dr. Weinstein's research shows that around $200 billion per year could be saved with legal reform. That's real savings. That's money that could be used to build roads, schools, or hospitals. If you want to save health care, let's listen to our doctors. There should be no health care reform without legal reform. There can be no true health care reform without legal reform.
Stay tuned for further Facebook and Twitter insights.
hat tip: Mark Tapscott
Page Printed from: http://www.americanthinker.com/blog/2009/08/palin_no_health_care_reform_wi.html at August 22, 2009 - 02:31:17 PM EDT
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Here comes the Dem response from those who benefit from big government who will give their case for big gov health care.
Here comes the big push back. We'll see who shouts the loudest I guess - because that is what it is in our daily politics now.
Bo makes it worse. The wolf in lambs clothing. Pretend you are one of them and you can subtly shove your radical agenda through.
Then when the opposition voices dissent - blame them for not coming to the compromise table.
Yeah yeah.
anyway - here it comes.
***"Health care reform supporters will hold more than 500 events between Wednesday and when lawmakers return Sept. 8.
Faced with a souring public mood on health care reform, Democrats and their supporters are launching a national grassroots push Wednesday to show lawmakers that the majority of Americans still support overhauling the system.
Reform supporters are planning to hold more than 500 events between Wednesday and when lawmakers return to Washington Sept. 8, ranging from neighborhood organized phone banks to professionally staffed rallies with hundreds of people.
The Democratic National Committee and its grassroots arm, Organizing for America, are helping to organize the effort along with the Health Care for America Now, a group pushing to create government-run insurance plan.
“In these last few weeks of recess we want to demonstrate the energy, passion and commitment that the American people have to health insurance reform so that when members return after Labor Day they know that they can turn their attention to getting this done because they have the backing of the American people,” said DNC spokesman Brad Woodhouse.
Supporters have their work cut out for them. Many lawmakers were thunderstruck over the August recess by the anger and outrage expressed by their constituents in town hall meetings across the country. And in poll after poll, support for reform has eroded throughout the month.
But Democrats and their allies insist that the majority of Americans still support reform and have organized the grassroots campaign to buck up lawmakers as they get ready to head back to Washington.
A health-insurance-reform-now bus will travel the country starting Wednesday and anchor events in 11 cities: Phoenix, Albuquerque, Denver, Des Moines, Pittsburgh, Raleigh, Charlotte, Milwaukee, St. Louis, Indianapolis and Columbus, Ohio.
But the talk of broad health insurance reform does mean that progressives have backed off their push for a government-run insurance option.
“We want members of Congress to get back to work and pass reform that means something. We need affordable care. We need real insurance regulation. And we need a strong public health insurance option,” said HCAN spokeswoman Jacki Schechner. “It’s doable and we expect it to get done now.”***
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Sen Kent Conrad (D) on Face the Nation: "...the country heading for the cliff, and we're headed for a cliff because costs in health care are spiraling out of control."
Yes but the mechanism that controls costs with every other product and service in every other industry is not in place - supply and demand. You cannot charge what your customers are not able or willing to pay for anything - until you open the door for third party money to make up an ever-expanding difference.
So the answer is open the rest of the system to the backing of unlimited third party pay. That is NOT how innovation flourishes or how costs are best controlled.
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Re. Death Panels: CCP, as an industry professional you know better than the rest of us that difficult choices are faced and difficult decisions are made every day every moment somewhere about the life and death of a patient. Those difficult times in our lives don't go away under any plan. The difference with this is to enter the government, uninvited, into the room during the discussions, holding all the cards, on a mission to control costs - for the children... sounds like a death panel to me.
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****The difference with this is to enter the government, uninvited, into the room during the discussions, holding all the cards, on a mission to control costs - for the children... sounds like a death panel to me.****
Well the problem is that governement already does foot a huge proportion of our health care bill through medicaid / medicare.
And we doctors don't often do our jobs. and patients and sometimes the families have unrealistic expectations.
So it is not totally unreasonable that payers have a right to some input.
And that IS part of the problem when we have others paying for the health care of others and the costs are not with the people using the care.
To say we should spare no dollars at the end of life is a nice thought from Shawn Hannity but in the meatime we are going broke.
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A must see video depicting America under ObamaCare:
http://aclu.org/pizza/images/screen.swf
Maybe written as humor but not very far fetched!
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CCP: "So it is not totally unreasonable that payers have a right to some input."
Totally agree. And also to gather information and limit choices regarding behaviors that add risk to health care costs.
As a limited government advocate, I oppose expanding the gov't footprint into areas where the private customer was already satisfied with their plan. IMO people like Hannity earned the right to spend his own money on their own services, just as I have 'earned' the right to spend up to my Blue Cross coverage limits. :-( From Canada they drive into Duluth MN and Mayo Clinic and countless other areas across the border to get the things their own panel denied or delayed. In the US, we won't just drive across the border and find a freer and richer country with wider choices and immediate availability.
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Obamacare bails out union pension plans, too
By: KEVIN MOONEY
Commentary Staff Writer
08/25/09 4:19 PM EDT
Union bosses who have mismanaged benefits for their own members are poised to receive a $10 billion bailout from U.S. taxpayers in the form of a “reinsurance program” that has been folded into the healthcare bill, according to the Workforce Fairness Institute (WFI).
This provision should be viewed as part of a larger payback effort the Obama White House and top congressional figures have set up in exchange for the support they have received from organized labor, Katie Packer, executive director of WFI said.
Section 164 of the Affordable Health Choices Act of 2009 provides that the government pay 80 cents on the dollar to corporate and union insurance plans for claims between $15,000 and $90,000 for retirees age 55 to 64. Union health insurance funds only have about 30 cents available to cover each dollar of anticipated claims, according to the Lewin Group and other research outfits.
If this provision were to be passed as part of the overhaul package favored by the Obama Administration, the $10 billion figure would probably expand overtime as union plans continue to come under financial pressure, Packer said.
“What we want to see is some kind of accountability,” she said. “These union bosses make promises that they can’t keep. I don’t know what exactly they are doing with union dues and other money but they seem to have hundreds of millions of dollars to spend every time there is a campaign. It’s the labor bosses that have put the companies over a barrel and extracted commitments that they know were unsustainable. Now they expect the taxpayers to bail them out and they use their own workers as victims.”
In an email letter to supporters, the United Auto Workers (UAW) urged their membership to support the Obama plan and specifically cites the benefits outlined in section 164. It concludes with a call for activism that draws from key alliances.
“Not surprisingly, insurance companies and various right-wing groups are mounting a campaign to block health care reform. To counter their dishonest, disruptive scare tactics, UAW activists need to join with our progressive allies in sending a strong message to members of Congress that NOW is the time to pass genuine health care reform,” the letter says.
The union bailout provision can be found in multiple versions of the bill, which indicates it is being pushed by powerful labor officials who maintain influence with the White House and Congress, Packer said.
In the 2008 election cycle, labor union political action committees (PACS) contributed over $66 million dollars to congressional candidates with 92 percent of those contributions going to Democrats, according to OpenSecrets.org.
The Employee Free Choice Act, which includes the controversial Card Check and binding arbitration measures, remains the major priority for labor bosses, Packer said. But the bailout money labor backers in Congress attempted to conceal in the healthcare bill shows that union paybacks remain in motion, Packer said.
“We see paybacks to labor bosses over and over again,” she said. “We saw it with the bailout to General Motors and Chrysler, we also saw it with the restrictions on companies that don’t use union workers with the stimulus bill. The Employee Free Choice Act is the coup de grace, but the payback remains on going.”
President Obama received almost $28 million in independent expenditures from the Service Employees International Union (SEIU) for his 2008 campaign, while Labor Secretary Hilda Solis received $10,000 from the SEIU’s PAC for her congressional race.
SEIU has been a leading proponent of Card Check and binding arbitration.
http://www.washingtonexaminer.com/opinion/blogs/beltway-confidential/54816897.html
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"IMO people like Hannity earned the right to spend his own money on their own services, just as I have 'earned' the right to spend up to my Blue Cross coverage limits."
I agree.
I am sick and tired of endless instrusion by government into our lives and am not for expanding medicare/medicaid at all.
I read through about 1/4 of Mark Levin's bestseller Liberty and Tyranny and agree with most of what I read.
To me he is a hero for opening our eyes to what is going on with the increasing and sometimes subtle and sometimes not so subtle encroahment of the government into every aspect of our lives.
On the other hand I was personally offended by Rush Limbaugh telling the "moderates" who ciriticized him that the recent uproar against Bama et al's health plan has caused a cratering of the Dems and BO in the polls that "let this be a lesson to you".
I love Levin but I am sick of Rush. While they both come from the right Levin makes more sense to me for reasons that I am not even totally clear about. Maybe because he is not such an egotist as Limbaugh who also comes off as a blowhard.
As far as Hannity all I can say he is one of the world's greatest salesman. He could sell anything from a potion that cures all sexual dysfunction to promoting eternal life.
Can't you just picture walking into any retail store and seeing him standing there ready to move in for the kill (I mean sale)?
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Obamacare: The Only Exit Strategy
Hook us with government-subsidized universal and virtually unlimited coverage.
By Charles Krauthammer
Obamacare Version 1.0 is dead. The 1,000-page monstrosity that emerged in various editions from Congress was done in by widespread national revulsion not just at its expense and intrusiveness but at the mendacity with which it is being sold. You don’t need a Ph.D. to see that the promise to expand coverage and reduce costs is a crude deception, or that cutting $500 billion from Medicare without affecting care is a fiction.
But there is an exit strategy. And a politically clever one, if the Democrats are smart enough to seize it.
(1) Forget the public option. Whatever the merits, and they are few, it is political poison. It dies by the Liasson Logic, the unassailable observation by NPR’s Mara Liasson that there are no liberal Democrats who will lose their seats if the public option is left out, while there are many moderate Democrats who could lose their seats if the public option is included.
(2) Jettison any reference to end-of-life counseling. People see (correctly) such Medicare-paid advice as subtle encouragement to voluntarily refuse treatment. People don’t want government involvement in a process they consider the private province of patient, family, and doctor. The Senate is already dropping it. The House must follow.
(3) Soft-pedal the idea of government committees determining “best practices.” President Obama’s Federal Coordinating Council for Comparative Effectiveness Research was sold as simply government helping doctors choose the best treatments. But there are dozens of medical journal review articles that do just that. The real purpose of the FCCCER is ultimately to establish official criteria for denying reimbursement to less favored (because presumably less effective) treatments — precisely the triage done by the NICE committee in Britain, the Orwellian body that once blocked access to a certain expensive anti-blindness drug until you went blind in one eye.
(4) More generally, abandon the whole idea of Obamacare as cost-cutting. True, it was Obama’s original rationale for creating a whole new entitlement at a time of a sinking economy and a bankrupt Treasury. But, as many universal-health-care liberals complain, selling pain is poor salesmanship.
(5) Promise nothing but pleasure — for now. Make health insurance universal and permanently protected. Tear up the existing bills and write a clean one — Obamacare 2.0 — promulgating draconian health-insurance regulation that prohibits (a) denying coverage for pre-existing conditions, (b) dropping coverage if the client gets sick, and (c) capping insurance company reimbursement.
What’s not to like? If you have insurance, you’ll never lose it. Nor will your children ever be denied coverage for pre-existing conditions.
The regulated insurance companies will get two things in return. Government will impose an individual mandate that will force the purchase of health insurance on the millions of healthy young people who today forgo it. And government will subsidize all the others who are too poor to buy health insurance. The result? Two enormous new revenue streams created by government for the insurance companies.
And here’s what makes it so politically seductive: The end result is the liberal dream of universal and guaranteed coverage — but without overt nationalization. It is all done through private insurance companies. Ostensibly private. They will, in reality, have been turned into government utilities. No longer able to control whom they can enroll, whom they can drop, and how much they can limit their own liability, they will live off government largesse — subsidized premiums from the poor; forced premiums from the young and healthy.
It’s the perfect finesse — government health care by proxy. And because it’s by proxy, and because it will guarantee access to (supposedly) private health insurance — something that enjoys considerable Republican support — it will pass with wide bipartisan backing and give Obama a resounding political victory.
Isn’t there a catch? Of course, there is. This scheme is the ultimate bait-and-switch. The pleasure comes now, the pain later. Government-subsidized universal and virtually unlimited coverage will vastly compound already out-of-control government spending on health care. The financial and budgetary consequences will be catastrophic.
However, they will not appear immediately. And when they do, the only solution will be rationing. That’s when the liberals will give the FCCCER regulatory power and give you end-of-life counseling.
But by then, resistance will be feeble. Why? Because at that point the only remaining option will be to give up the benefits we will have become accustomed to. Once granted, guaranteed universal health care is not relinquished. Look at Canada. Look at Britain. They got hooked; now they ration. So will we.
— Charles Krauthammer is a nationally syndicated columnist.
National Review Online - http://article.nationalreview.com/?q=MWQyZWYxYjE3ZjAzYjlhY2MzMDg3ZDNmMTk4MDBjMDc=
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CK wrote:
BEGIN
(5) Promise nothing but pleasure — for now. Make health insurance universal and permanently protected. Tear up the existing bills and write a clean one — Obamacare 2.0 — promulgating draconian health-insurance regulation that prohibits (a) denying coverage for pre-existing conditions, (b) dropping coverage if the client gets sick, and (c) capping insurance company reimbursement.
What’s not to like? If you have insurance, you’ll never lose it. Nor will your children ever be denied coverage for pre-existing conditions.
END
So my fellow free marketeers, what do we think about the three proposed ideas by CK? In particular,
What is to be done about pre-existing conditions?
What is to be done when someone gets sick and gets cancelled?
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"What’s not to like? If you have insurance, you’ll never lose it. Nor will your children ever be denied coverage for pre-existing conditions."
Well we will still go broke and care will be rationed.
That is what is not to like.
Crafty your questions need TO BE answered by the cans and I have not heard any of them do that explicitly.
Not even supersalesman Shawn Hannity. He can sit there and rattle off five changes he would make to health care and not one addresses these issues directly.
That is why I can barely stand him. He is just another blowhard - but from the right.
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I too find Hannity a blowhard.
Waiting for the Reps to come up with answers to these questions seems rather futile to me (BTW childcare allowing, we will be going to a Tea Party event tomorrow night) and I would like to challenge our little braintrust here to come up with good answers-- ideally that are also politically plausible too-- to these questions.
I would also like to add the question of what to do about the overspending of Medicare and Medicaid.
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Sat all day in an air rifle range/4 bay garage in 90 degree heat with high humidity learning how to reload ammo, so a member of the brain trust I am currently not. Be that as it may, CK wasn't making the proposal, though he was suggesting the means by which BHO might turn the debate around.
Me, I'm all about market mechanisms so that's what I'd be trying to engineer into the system.
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Understood about CK's point.
Agreed that free market/market mechanisms is the way to go.
So let us brain storm.
Is our answer to be purely economic, or are there any additional analytical variables to be brought to bear?
What IS our answer to the unaffordable spending of Medicare and Medicaid? Have a bigger mesh in the safety net so more can slip through? Simply set a finite amount to be set instead of the current (and fraudulent IMHO) baseline budgeting? Would this not mean that a decreasing % of price would be paid by the govt and concurrently an increasing % paid by the consumer/patient and therefore that some people would not receive care that they currently receive?
I'm sorry, but as best as I can tell at present all the attack on BO's liberal fascist proposals fails to address this question.
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You're right, the current attack on Obamacare does not address looming fiscal train wrecks. Unfortunately this train wreck and the one that looms for social security are based on ill-advised, fiscally unsustainable entitlements that get passed by politicians for political reasons that then have to be lived with as they morph into political third rails. This reality won't be altered by a single piece of legislation or response; instead we need start by changing the terms of the debate.
The Republicans are already in disarray so perhaps it's time to urge them to reform around straight forward principles by asking questions like: so you want to be in charge of making your own medical decisions and utilize the most innovative and advanced medical system in the world, or do you want your government to make those decisions for you and control costs by limiting innovation and ceding advance status? Similar questions could be asked about social security and those who favor autonomy and sustainable fiscal structures could coalesce into a new voting block.
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While finding an acceptable proposal let's not forget underlying principles regarding what is the state and county role, what role does charity play, and what is a constitutionally-based federal government role. If we decide that health care is a constitutionally unenumerated right, it will be the vaguest right ever established with denial of service decisions made in every state and every hospital, every minute or so, challenging that right, with costs spirally up to economic collapse, not down to containment. It will be the first right I know of that creates a burden on someone else to perform an act of service for you, like having freedom of speech require people to tune in and pay attention while you speak, with federal enforcement.
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Seems to me Feds could make a huge difference with tort reform. A doctor does not need the threat of punitive damages because he/she can be punished through state licensing (lose your license you lose your income) and because the doctor doesn't pay, malpractice insurance does and its all wrapped in the cost.
I can see a federal role in encouraging insurance competition across state lines.
Feds play a role in the federal tax code.
Feds could play a role in mandating easy access for consumers to know costs before treatment choices.
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For the most part we are not arguing health care, we are arguing about finance and control, who decides and who pays. Insurance is designed to protect your assets against large unforeseen future costs, so that you won't have to pay your life savings on catastrophic costs or so that your up and down medical costs as needed can be budgeted nicely into predictable monthly costs. If you have no significant income, assets or likelihood of future income or assets, you are already covered by public plans and receive treatment today not only in emergency rooms.
The only thing that really controls cost other than rationing/denying service is the extent that INFORMED consumers make their own choices and pay their own bills. (Current bills stomp out Health Saving Accounts and catastrophic coverage only - high deductible plans.)
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"Universal" should refer to the availability of choices for everyone, not the mandate that you take one of them.
To one of Crafty's questions, people already diagnosed with diabetes for example while not covered might expect a higher cost than signing up healthy. A millionaire with colon cancer or in need of heart surgery but no health plan might have to exhaust his own assets before qualifying for public assistance. Or be offered a plan for people in that circumstance more expensive than was available to him before he was diagnosed. That seems logical to me. Making providers cover you for what they insure after you are diagnosed and keep you as long as you continue to pay the premium is only common sense as a regulation IMO. If I find out that is not already the case I would cancel my plan today.
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The current healthcare system is built very largely off of Medicare reimbursement schedules even for private coverage outside of Medicare. Because of this, there is almost no innovation in the system in terms of lower cost ways to administer common services that we all need.
Under the current system even a self-paying customer has NO IDEA what kind of money he is spending while being treated until after the bill comes. Better consumer cost disclosure requirements and regulations are a proper role for government at some level and we certainly want to be treated across state lines so a common sense federal standard seems justified to me.
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Proposals under consideration don't add to the number of doctors, nurses, facilities, hospitals, etc. because that would add to the total cost. True - but bringing down the cost per procedure using market pressure can never happen in a zero competition environment.
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National Health Insurance of any kind will totally wipe out every aspect of any libertarian's view of their informational privacy. Please review again the 'humor' video of national pizza ordering that both Freki and I posted. You call and they already know where you live, where you work, what you make, what you drive, what foods and activities you need to stay away from and on and on and on. Not very funny.
Once everything is under the federal government responsibility, does anyone think a bill to end mountain climbing shouldn't follow? Motorcycle jumping, obviously out. Then what? French fries? I hate to even be facetious because nothing is out of the realm. Soccer players with federal helmets or banning the header altogether...
Gentlemen, do you really think MARTIAL ARTS will still be legal in a few years as acceptable risk? Sparring with knives?
As this is a finance/insurance bill, does everyone understand that the enforcement agency is the IRS? That is no joke or exaggeration and they cannot perform their federally mandated duties without more agents, larger budgets and more powerful informational tools. Let's poll that question and see how many favor 'universal' coverage.
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If the CBO says the cost of this will be a trillion, the cost will be tens of trillions. Go back to original social security projections and original medicare projections and learn to translate government numbers. If it doesn't grow at double-digit, compound rates, it is a cut that will kill innocent people.
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I disagree with Crafty that we have to offer specific alternatives right now more than "NO". IMHO moving forward now starts with a resounding defeat of the current takeover attempts. Let's get real clear and articulate on 'no' and why 'no'. Then proposals and solutions will be offered by the candidates and parties who want to compete in 2010 and 2012.
I quibble with CCP over the idea that the 'cans (Republicans) need to answer to all these questions. It is the party in power that currently needs to answer the objections raised - and they haven't! The 'cans who need to figure out a better way are the Ameri-cans, including 'blue-dog' Democrats, blue-collar Democrats, non-class-envy Democrats (if there are any) who don't have a goal of making someone else pay for their expenses, deficit-weary Democrats who previously railed against fiscal irresponsibility and independent voters who make up about a third of the electorate and need to sort out what kind of country they want to live in and who always swing the outcomes of the elections.
JMHO. - Doug
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Gentlemen, thanks for getting the conversation going.
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When and where has the federal gov't ever gotten involved in anything and the end result was that it became cheaper and more effective?
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Here are some things that occur to me:
The situation with Medicaid and Medicare (btw, someone please define each for me please) is unsustainable. Even if we succeed in knocking BO back, this problem remains (similar to the Dems knocking back Bush's substantial and sincere efforts to reform Social Security)
The problem is that the structure of an entitlement creates a consumer unrestrained by cost. (Indeed, the dynamic of insurance itself creates a consumer little restrained by cost). If we stay within the entitlement structure AND limit our spending to what we can afford, then as best as I can tell, are not death panels inevitable?
If we cannot answer this connundrum, are not our criticisms full of sound and fury that lacks substance on this essential point?
Two part question:
A) What do we think should be done?
B) How do we get there?
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Some different thoughts on the matter:
Political considerations
Obama must pull a Clinton - "triangulate" if that is what you want to call and move to the center guided strictly aka D. Morris style by daily polls.
If he wants to maintain power this is what he will do. This is what I suspect he will do; esp. with the armey of Clintonites in his administration.
I really doubt he will continue to shove his radical agenda down Americans and throw away his power - and the Dems.
The cans can only gain so much by being the party of NO. They really gain traction then thye do need to come up with alternatives.
I guess the risk to them if they do is BO will steal their thunder aka CLinton with welfare reform.
Economic considerations
with or without trying to cover 50 million new peopel the system is broke.
First are there really 50 million people or is it the rights alleged much lower number that can't get insurance?
I don't know who to believe.
As Body points out
"so you want to be in charge of making your own medical decisions and utilize the most innovative and advanced medical system in the world, or do you want your government to make those decisions for you and control costs by limiting innovation and ceding advance status?"
I think most would agree that people would rather be able to choose though I am speculating.
We must ration somehow.
either insurance will decide for us or we have some sort of tiered system wherein people can decide with their doctors what they are willing to pay for meds, procedures, etc.
People who get dropped from insurance need to be albe to get it somewhere.
Those with preexisting conditions need to get it somewhere without having to go into poverty and get medicaid or go on disability.
We do need to decide what we are doing with illegals who are here.
WE do need to know in the medical field which things we do are more expensive than less cheaper alternatives if the option exists. We need more studies but as Charles Kruathammer points out the publication of these in journals is not enoght for us doctors who neither pay attention or don't want to be bothered with cost savings when it doesn't do anything for ourselves.
We do need some tort reform.
There is no quesiton we order tests "just in case" the one person in front of us is the one that happens to have the cancer or other hidden though rare condition. Miss it and our lives and carreers are in jeopardy.
But when is rare 'rare enough' to not justify a an expensive test? It depends who you talk to.
I think it a terrible mistake to make health care a gigantic government entiltilement though a lot of it already is.
I prefer reversing this not expanding this.
Of course those in this country who like to have others pay for them thnk the opposite.
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Sorting Fact From Fiction on Health Care
By JEROME GROOPMAN
AND PAMELA HARTZBAND
In recent town-hall meetings, President Barack Obama has called for a national debate on health-care reform based on facts. It is fact that more than 40 million Americans lack coverage and spiraling costs are a burden on individuals, families and our economy. There is broad consensus that these problems must be addressed. But the public is skeptical that their current clinical care is substandard and that no government bureaucrat will come between them and their doctor. Americans have good reason for their doubts—key assertions about gaps in care are flawed and reform proposals to oversee care could sharply shift decisions away from patients and their physicians.
Consider these myths and mantras of the current debate:
• Americans only receive 55% of recommended care. This would be a frightening statistic, if it were true. It is not. Yet it was presented as fact to the Senate Health and Finance Committees, which are writing reform bills, in March 2009 by the Agency for Healthcare Research and Quality (the federal body that sets priorities to improve the nation's health care).
The statistic comes from a flawed study published in 2003 by the Rand Corporation. That study was supposed to be based on telephone interviews with 13,000 Americans in 12 metropolitan areas followed up by a review of each person's medical records and then matched against 439 indicators of quality health practices. But two-thirds of the people contacted declined to participate, making the study biased, by Rand's own admission. To make matters worse, Rand had incomplete medical records on many of those who participated and could not accurately document the care that these patients received.
For example, Rand found that only 15% of the patients had received a flu vaccine based on available medical records. But when asked directly, 85% of the patients said that they had been vaccinated. Most importantly, there were no data that indicated whether following the best practices defined by Rand's experts made any difference in the health of the patients.
In March 2007, a team of Harvard researchers published a study in the New England Journal of Medicine that looked at nearly 10,000 patients at community health centers and assessed whether implementing similar quality measures would improve the health of patients with three costly disorders: diabetes, asthma and hypertension. It found that there was no improvement in any of these three maladies.
Dr. Rodney Hayward, a respected health-services professor at the University of Michigan, wrote about this negative result, "It sounds terrible when we hear that 50 percent of recommended care is not received, but much of the care recommended by subspecialty groups is of a modest or unproven value, and mandating adherence to these recommendations is not necessarily in the best interest of patients or society."
• The World Health Organization ranks the U.S. 37th In the world in quality. This is another frightening statistic. It is also not accurate. Yet the head of the National Committee for Quality Assurance, a powerful organization influencing both the government and private insurers in defining quality of care, has stated this as fact.
The World Health Organization ranks the U.S. No. 1 among all countries in "responsiveness." Responsiveness has two components: respect for persons (including dignity, confidentiality and autonomy of individuals and families to make decisions about their own care), and client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider). This is what Americans rightly understand as quality care and worry will be lost in the upheaval of reform. Our country's composite score fell to 37 primarily because we lack universal coverage and care is a financial burden for many citizens.
• We need to implement "best practices." Mr. Obama and his advisers believe in implementing "best practices" that physicians and hospitals should follow. A federal commission would identify these practices.
On June 24, 2009, the president appeared on "Good Morning America" with Diane Sawyer. When Ms. Sawyer asked whether "best practices" would be implemented by "encouragement" or "by law," the president did not answer directly. He said that he was confident doctors "want to engage in best practices" and "patients are going to insist on it." The president also said there should be financial incentives to "allow doctors to do the right thing."
There are domains of medicine where a patient has no control and depends on the physician and the hospital to provide best practices. Strict protocols have been developed to prevent infections during procedures and to reduce the risk of surgical mishaps. There are also emergency situations like a patient arriving in the midst of a heart attack where standardized advanced treatments save many lives.
But once we leave safety measures and emergency therapies where patients have scant say, what is "the right thing"? Data from clinical studies provide averages from populations and may not apply to individual patients. Clinical studies routinely exclude patients with more than one medical condition and often the elderly or people on multiple medications. Conclusions about what works and what doesn't work change much too quickly for policy makers to dictate clinical practice.
An analysis from the Ottawa Health Research Institute published in the Annals of Internal Medicine in 2007 reveals how long it takes for conclusions derived from clinical studies about drugs, devices and procedures to become outdated. Within one year, 15 of 100 recommendations based on the "best evidence" had to be significantly reversed; within two years, 23 were reversed, and at 5 1/2 years, half were contradicted. Americans have witnessed these reversals firsthand as firm "expert" recommendations about the benefits of estrogen replacement therapy for postmenopausal women, low fat diets for obesity, and tight control of blood sugar were overturned.
Even when experts examine the same data, they can come to different conclusions. For example, millions of Americans have elevated cholesterol levels and no heart disease. Guidelines developed in the U.S. about whom to treat with cholesterol-lowering drugs are much more aggressive than guidelines in the European Union or the United Kingdom, even though experts here and abroad are extrapolating from the same scientific studies. An illuminating publication from researchers in Munich, Germany, published in March 2003 in the Journal of General Internal Medicine showed that of 100 consecutive patients seen in their clinic with high cholesterol, 52% would be treated with a statin drug in the U.S. based on our guidelines while only 26% would be prescribed statins in Germany and 35% in the U.K. So, different experts define "best practice" differently. Many prominent American cardiologists and specialists in preventive medicine believe the U.S. guidelines lead to overtreatment and the Europeans are more sensible. After hearing of this controversy, some patients will still want to take the drug and some will not.
This is how doctors and patients make shared decisions—by considering expert guidelines, weighing why other experts may disagree with the guidelines, and then customizing the therapy to the individual. With respect to "best practices," prudent doctors think, not just follow, and informed patients consider and then choose, not just comply.
• No government bureaucrat will come between you and your doctor. The president has repeatedly stated this in town-hall meetings. But his proposal to provide financial incentives to "allow doctors to do the right thing" could undermine this promise. If doctors and hospitals are rewarded for complying with government mandated treatment measures or penalized if they do not comply, clearly federal bureaucrats are directing health decisions.
Further, at the AMA convention in June 2009, the president proposed linking protection for physicians from malpractice lawsuits if they strictly adhered to government-sponsored treatment guidelines. We need tort reform, but this is misconceived and again clearly inserts the bureaucrat directly into clinical decision making. If doctors are legally protected when they follow government mandates, the converse is that doctors risk lawsuits if they deviate from federal guidelines—even if they believe the government mandate is not in the patient's best interest. With this kind of legislation, physicians might well pressure the patient to comply with treatments even if the therapy clashes with the individual's values and preferences.
The devil is in the regulations. Federal legislation is written with general principles and imperatives. The current House bill H.R. 3200 in title IV, part D has very broad language about identifying and implementing best practices in the delivery of health care. It rightly sets initial priorities around measures to protect patient safety. But the bill does not set limits on what "best practices" federal officials can implement. If it becomes law, bureaucrats could well write regulations mandating treatment measures that violate patient autonomy.
Private insurers are already doing this, and both physicians and patients are chafing at their arbitrary intervention. As Congress works to extend coverage and contain costs, any legislation must clearly codify the promise to preserve for Americans the principle of control over their health-care decisions.
—Dr. Groopman, a staff writer for the New Yorker, and Dr. Hartzband are on the staff of Beth Israel Deaconess Medical Center in Boston and on the faculty of Harvard Medical School.
http://online.wsj.com/article/SB10001424052970203706604574378542143891778.html
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CCP: "I think it a terrible mistake to make health care a gigantic government entitlement though a lot of it already is. I prefer reversing this not expanding this." Couldn't agree more. Like most of politics, it would be something of an accomplishment to just stop moving in the wrong direction.
Medicaid - free health care for poor people, Medicare - government plan for older people. And S-CHIP which goes up to something like 3 times the poverty level, was supposed to be aimed at children but means all kinds of different things now. No one proposes to end any of these so reform can only mean to tighten up eligibility, ration care more or raise taxes in an upward spiral until we collapse (even worse than now).
Crafty: "If we stay within the entitlement structure AND limit our spending to what we can afford, then as best as I can tell, are not death panels inevitable?
- Yes. The success rate of saving lives in the long run is zero so death panels are part of the ordeal. That panel is hopefully is small room of people you trust including loved ones and a second medical opinion. They will come to tell me or you someday that we've got til Friday if untreated, but if we take the aggressive million dollar treatment we have until maybe next Tuesday. Then we look at coverage and options and make the hard choices. We just don't want the government in the room as we sort it out. Besides inefficiencies and incompetencies, they would come in with other biases, such as the fact that you are taking up one of their beds in short supply, or that someone else has more income tax paying years left than you and should move past you in the line.
Instead we plan ahead hopefully and get the best advice on the best plans and coverage to anticipate our future circumstance and hopefully match coverage to the type of aggressiveness that we will want to fight off whatever nasty ailment is going to attack us. When we go to one size fits all, then for sure it will be third parties instead of us deciding the size of the coverage and the level of cost.
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Does Obama Take Health Costs Seriously?
His stand on generic competition for biotech drugs will provide the answer.
By James K. Glassman
Revelations of an $80 billion bargain between the White House and PhRMA (Pharmaceutical Research and Manufacturers of America) are upsetting many Democrats. “We were never part of that deal,” said Rep. Henry Waxman (D., Calif.), chairman of the House Energy and Commerce Committee, one of three panels that wrote the House bill. “We are not bound by that deal. It was not particularly a deal I would have made.” As the Daily Kos, a popular left-wing blog, put it, “Congressional Democrats should say ‘hell, no’ to this deal.”
But the deal may have a bigger problem than anger on the left. It threatens to come apart over a seemingly arcane question: When a company develops a drug called a “biologic” — a complex medicine derived from living plant and animal cells — how long should it keep its exclusive right to sell said drug? “Drug companies that had agreed to support the Obama administration on healthcare reforms have found themselves once more at odds with the president” on this issue, FoxNews.com reported recently.
The reason for the possible unraveling is evident: The companies PhRMA represents have an immense interest in keeping the profits that come with exclusivity. But if the president can’t show he wants to tame drug expenses through competition — the best and simplest means to an important end — it’s hard for anyone to take him seriously on the critical issue of controlling health-care costs overall.
Aside from biologics, the deal seems to be going well. PhRMA agreed to cut drug costs by $80 billion over ten years, mainly by offering discounts for medicines in the “donut hole” not covered by the Medicare drug benefit enacted during the Bush administration and by paying out higher rebates for drugs under Medicaid. PhRMA also agreed to run advertisements — reportedly valued at $150 million — in support of health-care reform. (Some of those ads were produced by AKPD Message and Media, formerly headed by Obama adviser David Axelrod.)
In return, the White House agreed to retain restrictions on importing cheaper drugs from abroad and to continue to deny the government the ability to negotiate drug prices downward by using the enormous bargaining power of Medicare. These are both important concessions by Obama.
But the biologics issue was so contentious that the White House and the large drug companies could not reach a consensus. Ryan Grim, a former Politico.com reporter who now covers Congress for The Huffington Post, revealed the contents of a memo, dated July 7, that described the terms of the White House–PhRMA deal. One clause said this: “Agree to get FOBs done (but no agreement on details . . . ).”
The issue involves what are called “follow-on biologics” (FOBs) — essentially generic versions of biologic drugs that are currently patented (drug patents last 20 years). The big question is over drug companies’ retention of exclusive access to the data they compiled in testing the drug — data that competitors can use to speed along FDA approval of generic drugs. Until this period of exclusivity ends, FOBs can’t compete, and the makers of the original drugs effectively keep monopolies.
Monopoly is appropriate and crucial to innovation — and enshrined in Article I, Section 8, of the U.S. Constitution: “Congress shall have power . . . To promote the progress of science and useful arts, by securing for limited times to authors and inventors the exclusive right to their respective writings and discoveries.” The difficult matter is how long the “exclusive right” should last — how long should we give drug inventors monopoly power to make research profitable before introducing competition to bring down prices?
In 1984, the Hatch-Waxman Act (named for Republican senator Orrin Hatch and Waxman) created just such a pathway for conventional, or “small-molecule,” drugs, and the result has been billions of dollars in savings for consumers and, it is generally agreed, a great deal of innovation as well. It did this by giving companies five years of test-data exclusivity.
So what about biologics? A quarter-century ago, there was no inkling that biologics would register $40 billion in annual sales in the United States alone and account for one in seven prescriptions — a proportion that is rising rapidly. So no provision was made in Hatch-Waxman for FOBs, and to this day they receive no test-data exclusivity at all.
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Everyone agrees that some exclusivity is in order, but patented biologics can be expensive — Remicade, which treats rheumatoid arthritis, costs $20,000 for a year’s course of treatment, and some cancer-fighting biologics cost more than twice that — and enduring monopolies put a enormous burden on consumers and government programs. Peter Orzag, the president’s budget director, and Nancy-Ann DeParle, who heads the White House health-care reform effort, said in a June letter to Waxman that “seven years of exclusivity . . . strikes the appropriate balance between innovation and competition.”
Drug companies have been lobbying hard for an exclusion of 12 to 14 years. A National Journal article on August 11 said that PhRMA “spent $13 million lobbying in the first six months of 2009, compared with $8.63 million for the first half of 2008. . . . Forms list that PhRMA used the funds to promote comparative effectiveness research, health information technologies and patent procedures and regulatory approval pathways for biologics.”
Individual drug firms have spent heavily as well. Amgen, the largest biologic maker, pledged $5 million recently to help create the Edward M. Kennedy Institute for the United States Senate. The late Senator Kennedy supported an exclusion of at least twelve years.
On the other side is a remarkably diverse collection of actors. The Obama administration opposed such a lengthy period, as did organizations ranging from the AARP, AFL-CIO, and Consumers Union on the left to the Council of Citizens Against Government Waste, the Competitive Enterprise Institute, and FreedomWorks on the right.
But efforts by the long-exclusion forces — led by the Biotechnology Industry Organization (BIO) under former Democratic congressman Jim Greenwood, and including such notables as former Vermont governor Howard Dean — have so far paid off. On July 13, the panel that Senator Kennedy chaired, the Senate Education, Labor and Pension Committee, approved a twelve-year exclusion, and on July 31, the House Energy and Commerce Committee, by a vote of 47–11, did the same.
The argument of PhRMA and BIO is that a long exclusion is needed to provide drug companies with the incentive to invest the large sums needed to bring a biologic to market. As already mentioned, the Constitution itself acknowledges that innovators need a term of monopoly status as an incentive to invest and create. But a twelve-year exclusion is clearly excessive. It will almost certainly mean no competition for biologics at all.
What’s required, especially at a time when health-care costs are preoccupying the nation, is balance. A Federal Trade Commission study released June 10 said flatly that a 12-to-14-year exclusion is “too long . . . particularly since [biologics makers] likely will retain substantial market share after FOB entry.” That’s because of other restrictions on competition, including a prohibition on pharmacies’ automatically substituting FOBs for biologics.
No wonder there’s tension between the administration and the drug companies. Still, the White House has not explicitly attacked the long-exclusion measures that Senate and House committees have passed and, until lately, it has seemed reluctant to draw attention to what has become an important battle.
In an op-ed in the New York Times on August 16, Obama wrote that “reform will finally bring skyrocketing health care costs under control.” But if the president and members of Congress can’t take a firm stand against a twelve-year ban on competition with biologic drugs — the medicines of the future — how can the public possibly take them seriously on broader matters of cost control?
— James K. Glassman, former undersecretary of state for public diplomacy and public affairs, writes frequently about technology, health, and public policy.
National Review Online - http://article.nationalreview.com/?q=MGQzZTU2MjBkNTRmZjY3YmU0YTkwZGI2Mjk5ZGVjNjk=
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"Americans only receive 55% of recommended care."
Well it depends on what measures. Probably they are looking at flu vac. rates, objective BP, cholesterol, diabetes goals, cancer screening, such as pap smears, mammograms and colononoscopies.
It could very well be that 55% are not at the goals that are recommended.
But there are many reasons for this, including but not limited to patients simply refusing such tests. I have many patients who outright refuse flu shots.
"In March 2007, a team of Harvard researchers published a study in the New England Journal of Medicine that looked at nearly 10,000 patients at community health centers and assessed whether implementing similar quality measures would improve the health of patients with three costly disorders: diabetes, asthma and hypertension. It found that there was no improvement in any of these three maladies."
Actually, my experience is somewhat different. I believe there can be some improvement in measures and some patients can be caught that fall throught the cracks. However the improvement may be only short lived and the long term cost savings is still rather dubious despite what anyone may tell you as far as I know at least.
I do care coordination work and results are mixed and so far appear to be somewhat short lived though this is just one small experience. There are probably many reasons for this and multifactorail.
"Even when experts examine the same data, they can come to different conclusions. For example, millions of Americans have elevated cholesterol levels and no heart disease. Guidelines developed in the U.S. about whom to treat with cholesterol-lowering drugs are much more aggressive than guidelines in the European Union or the United Kingdom, even though experts here and abroad are extrapolating from the same scientific studies. An illuminating publication from researchers in Munich, Germany, published in March 2003 in the Journal of General Internal Medicine showed that of 100 consecutive patients seen in their clinic with high cholesterol, 52% would be treated with a statin drug in the U.S. based on our guidelines while only 26% would be prescribed statins in Germany and 35% in the U.K. So, different experts define "best practice" differently. Many prominent American cardiologists and specialists in preventive medicine believe the U.S. guidelines lead to overtreatment and the Europeans are more sensible. After hearing of this controversy, some patients will still want to take the drug and some will not."
The above is so true of how complicated it is. For example, we could treat 100 people with a drug for the rest of their lives and perhaps to extend one person's life. Some including the greats from the Cleveland Clinic who are now proponents of their own supposed cost saving system might say this is great. Some years ago there was a debate between two editorialists on which clost busting drug was better TPA vs streptokinase. The guy from the Cleveland clinic who did research on TPA (the newer one and ten times more expensive one) would state how it could save one or two more lives per at best 100 people. The article writer suggested that if we don't take a stand against the extra cost to society we "NEVER WILL". We as a profession have to say enough already. We can't keep spending more and more for trivial gains. In my opinion he was right. But it is just that - my opinion. It is not unreasable for some to say that any gain in human life has no limits on how much we spend.
Needless to say the expensive drug won out. Streptokinase was essential never ever used again. What Er doctor or cardiologist would use a drug that is 1 or 2% inferior for no other reason than to save money. If YOUR patient dies no one can say THAT was the one who would not have died if only the more expensive drug was used. No one wants to be sued. And no lawyer will mind loking at taking such a case and arguing their client died because a drug known to be "inferior" was used.
And the other side of it is if you, or I are lying in the ER with a massive heart attack and you or I can choose which drug to use AND if the cost goes to someone else which would you or I pick??
The answer is obvious.
"Dr. Rodney Hayward, a respected health-services professor at the University of Michigan, wrote about this negative result, "It sounds terrible when we hear that 50 percent of recommended care is not received, but much of the care recommended by subspecialty groups is of a modest or unproven value, and mandating adherence to these recommendations is not necessarily in the best interest of patients or society."
I would say this statement is for the most part certainly true - at least the second half of the sentence.
• The World Health Organization ranks the U.S. 37th In the world in quality. This is another frightening statistic. It is also not accurate. Yet the head of the National Committee for Quality Assurance, a powerful organization influencing both the government and private insurers in defining quality of care, has stated this as fact.
By some measures this is probably true.
But why?
probably many reasons one being some don't or can't pay to see a doctor.
I am not sure how much is obesity, drug addiction, too many people refuse to bother to get health care for whatever reason.
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Dialysis treatment in USA: High costs, high death rates
By Rita Rubin, USA TODAY
Deb Lustman was late getting to work a few days every week, and often felt she wasn't thinking as clearly as she once did.
PHOTOS: Dialysis at home
The reason: Lustman, 50, was spending four hours a day, three days a week, undergoing kidney dialysis at a dialysis center, where a machine filtered toxins and fluids from her blood. Normally, that's the job of the kidneys, but for reasons doctors have never figured out, hers had failed.
Nine months into her treatment, as soon as her doctor raised the possibility of home dialysis, Lustman decided to switch. So, in July 2008, after she and her husband learned the ins-and-outs from a nurse, she began dialyzing five evenings a week at her Magnolia, N.J., home, with her two Maltese, Sophie and Jake, often lounging next to her. Now Lustman, an optician, dialyzes on her own schedule, not the center's, and she's not late for work anymore. And, she says, "I'm healthier."
Thanks to more frequent dialysis, totaling 15 or 16 hours a week, "I feel not only physically better but … mentally better" and no longer "loopy," she says.
Lustman is a rarity, however: Only 8% of U.S. dialysis patients treat themselves at home. The vast majority of the more than 350,000 Americans on dialysis are treated in centers, where three treatments a week, three or four hours each, is the norm — not because it's optimal but because that's the way it has been done for nearly four decades.
A growing body of evidence suggests that longer and/or more frequent dialysis treatments, either at home or in a dialysis center, are far superior to the status quo. Although the USA spends more per dialysis patient than other countries, that does not result in higher survival rates or even, many argue, a better quality of life.
"The standard of care is really inappropriate," says Brenda Kurnik, Lustman's doctor, who practices in Marlton, N.J. "Basically, it prevents people from dying, and that's about all it does."
So why doesn't the USA do better? Many blame Medicare's End Stage Renal Disease Program. Launched in 1973, it's the only federal program that entitles people of all ages to health-care coverage on the basis of a single diagnosis: chronic kidney failure. By paying for lifesaving care for hundreds of thousands of Americans, the program is a testament to what health insurance reform might achieve if Congress were to adopt it.
But it also may be a cautionary tale: Its cost has far exceeded initial projections, and some doctors and other analysts question whether Medicare get its money's worth and whether patients get the best treatment. Less than one-quarter of dialysis patients ages 18 to 54 are well enough to work or go to school.
In 2007, Medicare spent $8.6 billion on the treatment and medications of dialysis patients, from babies to the elderly, according to the Medicare Payment Advisory Commission's March report to Congress.
In addition, Medicare pays billions each year for the hospitalization of dialysis patients. Although they are younger on average than most Medicare beneficiaries, who must be 65 to qualify for coverage, "this is an incredibly sick population," says epidemiologist Paul Eggers of the National Institute of Diabetes and Digestive and Kidney Diseases. Such patients, Eggers says, enter the hospital six times more often than Medicare beneficiaries who don't have chronic kidney failure.
Despite the costs, a substantial proportion of dialysis patients die every year. In 2006, 20.1% of U.S. dialysis patients died, most often of heart disease or infections. In Japan, the death rate was about half that; Australia's rate was halfway between the USA's and Japan's.
Explanations for why the USA has the highest dialysis death rate in the world vary. Some U.S. kidney doctors say that countries with national health programs, such as Britain, withhold dialysis from the oldest, sickest patients, while the Medicare program takes all comers. But foreign doctors deny that their countries ration dialysis. They — and many of their U.S. colleagues — attribute the higher U.S. death rate in part to Medicare's own payment system and the resulting "one-size-fits-all" treatment.
The standard of care has become the three treatments a week for which Medicare pays, usually in a dialysis center, and no longer than four hours each. Home dialysis, which allows for longer, more frequent treatments, is more common in most countries with better survival rates.
'Capable of doing better'
The status quo has many critics. In June, a group of nephrologists, or kidney doctors, who had met at a Harvard teaching hospital to discuss the issue sent a letter to White House and Medicare officials urging "substantial changes in the delivery and financing of care … to improve patient outcomes" for those with chronic kidney failure.
"We are capable of doing better," they wrote to White House health policy czar Nancy-Ann DeParle and Barry Straube, chief medical officer at the federal Centers for Medicare & Medicaid Services, or CMS. "Small, incremental improvements in the outcomes for patients with kidney failure are no longer acceptable."
When Medicare's kidney-failure program started in the early 1970s, "the science was such that somewhere between three and six hours of dialysis three days a week was sufficient. Things sort of settled into that pattern," says Dallas nephrologist Thomas Parker III, co-organizer of the conference at Harvard's Beth Israel Deaconess Medical Center.
But normal kidneys work 24/7, not a few shifts a week, so the standard treatment replaces only 10% to 13% of their function, Parker says. How much dialysis is enough isn't clear, he says, because few studies have randomly assigned patients to different amounts to test which approach is more effective.
In his July 22 prime-time press conference, President Obama endorsed the use of such studies, called comparative effectiveness research, to ensure that the U.S. health-care system gets the most value for its money. The economic stimulus package has earmarked $400 million for such research. "If doctors and patients have the best information about what works and what doesn't, then they're going to want to pay for what works," Obama said.
In a report issued June 30, the Institute of Medicine listed its top 100 priorities for comparative effectiveness research. Dialysis and kidney transplantation were high on the list.
Parker said Friday that the nephrologists had received a "very promising" response from Straube, indicating that federal officials "are open to further communications" about the future of dialysis.
Only the wealthy had dialysis
When President Nixon signed the 1972 bill establishing the End Stage Renal Disease Program, only 10,000 Americans were on dialysis, and more than one-third were doing it at home. Only the wealthy could afford long-term treatment.
The world's first outpatient dialysis center, the three-bed Seattle Artificial Kidney Center, predated Medicare by 11 years. There wasn't enough money or machines to go around. So an anonymous committee of Seattle community leaders decided which candidates would get dialysis and live and which would not and die.
The Medicare program opened up treatment to thousands who would have died without it. "We were naive in estimating how much this was going to cost," says Brandeis University professor Stuart Altman, an economist who advised Nixon on health policy and now advises Obama. "People didn't realize how many more people were going to go on it, how much longer we were going to keep these people alive."
It soon became clear: If you pay for it, they will come. "All of a sudden, large numbers of people who were not traditionally on Medicare qualified," Altman says. "We created this giant money machine that made a lot of nephrologists and entrepreneurs rich."
Dialysis became big business, with free-standing centers established in hundreds of cities by corporations, not hospitals. The number of U.S. centers has increased 4% every year, according to a June report by the Medicare Payment Advisory Commission. In 1998, there were 3,394; in 2008, 4,957. About 60% are owned by Denver-based DaVita, a Fortune 500 company, and Fresenius Medical Care North America, a Waltham, Mass.-based subsidiary of a German company that operates centers in 28 countries and also sells dialysis machines and other supplies.
And about 70% of Medicare dollars spent on dialysis and injectable drugs goes to DaVita, which runs more than 1,500 U.S. dialysis centers, and Fresenius, which runs more than 1,700. In the first quarter of this year, DaVita's revenues were $1.45 billion, up more than 8% from the first quarter of 2008. Fresenius' revenues from dialysis in North America were $1.57 billion, up 5% over the first quarter of 2008.
Since 1983, Medicare has paid dialysis providers, whether for-profit centers, non-profit centers or hospitals, a "composite rate" per treatment, which averaged about $155 in 2007. And because Medicare pays the same amount no matter how long the treatment, there's no financial incentive to dialyze patients longer than a few hours at a time.
On top of the composite rate, Medicare pays extra for newer, expensive injectable drugs — namely erythropoietin, or EPO, a hormone that stimulates red blood cell production, and vitamin D, which plays a role in bone health — and lab tests. These extras added an average of $75, or 50%, to the cost of each treatment in 2007. Countries with national health systems don't use the injectables nearly as much. They use less EPO and prescribe oral vitamin D pills that cost about one-quarter of the injectable versions but, their doctors say, are equally effective.
Longer, more frequent dialysis
Longer and/or more frequent dialysis can improve quality of life and survival and reduce hospitalizations, some doctors and patients believe, although the government isn't yet convinced.
"If you ever see patients who are dialyzing six or seven times a week, they are totally different" from those who receive the standard three treatments, says nephrologist Christopher Blagg, a University of Washington professor emeritus who for many years served as director of the Northwest Kidney Centers in Seattle.
Besides improved blood pressure control and lower use of EPO, they generally feel better, with more energy. And chances are they live longer, Blagg says. As he told the House Committee on Ways and Means in March, "dialysis patient deaths and cardiac incidents are significantly more frequent on the day after the two-day gap between treatments that occurs with three dialyses in the seven-day week."
From Medicare's point of view, though, the End Stage Renal Disease Program "is a pretty expensive program, and it needs the best justification imaginable that more dialysis would be better," says Eggers, the kidney disease institute epidemiologist.
Most of the evidence that longer and/or more frequent dialysis is superior has come from observational studies, in which patients decided on their own to try it. Perhaps some characteristic of the patients who choose to dialyze at home or overnight in a center — and not the dialysis itself — explains why they feel better and require less hospitalization than patients at centers.
A randomized trial, in which patients are randomly assigned to a particular therapy, is generally considered the gold standard for comparing treatments. Eggers is the project manager for two such dialysis trials, funded by the National Institutes of Health. One is comparing traditional thrice-weekly, four-hour dialysis treatments with six short daily treatments, adding up to about 16 or 17 hours a week. The other is comparing the traditional in-center approach to six nocturnal, or overnight, treatments a week.
Yet, neither of the trials enrolled as many patients as had been hoped, Eggers says, and he figures he knows why. "You have to go to a patient and say, 'here is something that you do three times a week that you hate,' " he says, and then tell them that they might have to do it twice as often. "It's a pretty significant thing you're asking a patient to do without a huge guarantee."
Because of the studies' limited size, they won't be able to determine conclusively whether more dialysis saves lives, Eggers says. "We might show that patients feel a lot better and have better heart function."
Blagg says he is so convinced of the benefits of more dialysis that he felt it was unethical to enroll patients in Eggers' trials, in which they had a 50-50 chance of getting the standard treatment.
30% could be treated at home
Home is a convenient setting for longer or more frequent treatments. About 30% of U.S. dialysis patients are candidates for home treatment, though only 8% now do it, Blagg says. By comparison, about 55% of dialysis patients in New Zealand dialyze at home, as do 30% in Australia and 20% in Canada.
Some U.S. patients don't even know home dialysis is an option. To fix that, Congress passed a law last year requiring dialysis providers to tell patients about all dialysis methods, beginning Jan. 1.
Home dialysis may also be more cost-effective, according to a May report by the U.S. Government Accountability Office which collected information from the large for-profit chains and non-profit and hospital-based dialysis providers. All of them said their per-treatment costs are lower when patients dialyze at home.
Centers recoup the "serious upfront costs," mainly for the machine they provide, after the patient has been dialyzing at home for a year or 18 months, Blagg says.
J. Michael Lazarus, Fresenius Medical Care North America's chief medical officer, says he wishes more patients would dialyze at home, because it would cut his company's overhead and help it deal with a nursing shortage. But, he says, home dialysis is a hard sell to U.S. patients. "When you build enough dialysis units so there's one on every corner," Lazarus says, patients think " 'why should I go home when I can go to your dialysis unit that's 10 minutes away?' "
Some patients find home dialysis too disruptive for their families. After doctors in 2007 had to remove the kidney her oldest son had donated to her, Michelle Adams-Walton, 46, tried hemodialysis at her Seaside, Calif., home for a couple of months. Her youngest son, now 20, served as her dialysis partner, a requirement for home dialysis.
"That machine did not work out for me," Adams-Walton recalls. "We were both starting to feel the dialysis was taking over our entire lives." However, she says, she had seen enough evidence to convince her that the more dialysis, the better. For her, nocturnal dialysis has been the answer.
On Mondays, Wednesdays and Fridays, Adams-Walton, who works full time as a librarian, drives 90 minutes to one of the few centers set up to provide overnight treatment. She goes on the machine at about 8 p.m. and is taken off at 4 a.m. Then she drives home and tries to catch some more sleep.
Since starting nocturnal dialysis, she says, "I certainly feel so much better." Before, "I was able to function, but just function."
What happens next
Congress has ordered Medicare to revamp the current pricing system. Payments for injectable drugs and lab tests not currently covered by the composite payment are to be "bundled" into it, effective Jan. 1, 2011. Details aren't expected to be released for a few weeks, so the potential impact on dialysis care is difficult to predict.
The open questions:
• Will Medicare keep home dialysis training costs outside the composite payment? Home dialysis advocates fear that rolling such costs into the bundle will discourage centers from offering the home option.
• Will the expanded composite payment be based on what Medicare already pays for dialysis and injectable drugs? That wouldn't result in any savings but could lead to an excessive reduction in the drugs' use, says Bill Peckham, 45, a Seattle dialysis patient and blogger.
• Will Medicare start paying on a weekly or monthly basis, instead of per treatment? Peckham fears that would lead to fewer, not more, treatments.
Straube of CMS emphasizes that a "quality incentive program" will accompany the new payment structure. Instead of paying only on the basis of quantity, he says, Medicare will also begin rewarding dialysis providers on the basis of quality standards, such as how well they manage patients' side effects.
Lazarus, of Fresenius, predicts "a number of (dialysis) units will close because of the bundle. Where are they and who's going to be deprived?" If they're rural, for example, that could greatly impact some patients.
Still, expanding the composite payment is "the right move," Lazarus says. "We have to do something about cost. We have to do something with a system that's out of control. It's a broken system, and we need to fix it."
Find this article at:
http://www.usatoday.com/news/health/2009-08-23-dialysis_N.htm
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September 3, 2009
NHS may need to lose 137,000 staff to meet £20 billion savings target
David Rose, Health Correspondent
The NHS may need to cut its workforce by about 10 per cent — the equivalent of 137,000 staff — to help to meet planned savings of £20 billion, according to a leaked Department of Health report.
A study commissioned from the consultancy firm McKinsey and Company recommends cutting clinical staff posts as well as administrators to meet efficiency savings by 2014, suggesting a knock-on effect to patient care.
The report, seen by the Health Service Journal (HSJ), recommends a range of possible actions, such as a recruitment freeze starting in the next two years, a reduction in medical school places from October and an early retirement programme to encourage older GPs and community nurses to make way for “new blood/talent”.
The report was presented to the Department of Health in March, the HSJ says today. It carries the department’s logo and has been distributed among senior NHS managers.
The study said £2.4 billion could be saved if hospitals with the lowest levels of staff productivity improved to become nearer the average levels. It added that almost 40 per cent of patients in a typical hospital did not need to be there.
Productivity is notoriously difficult to measure in an organisation as large as the NHS, which employs 1.5 million staff, but the biggest causes for patients staying unnecessarily long in hospital were delays in receiving tests or therapies, or a lack of suitable carers or facilities that meant patients could not go home.
The report also said that if four million of the 29 million outpatient appointments each year could be cut, it would save £600 million.
A further £700 million could be saved if procedures with limited clinical benefits — such as tonsillectomies, varicose vein removal and some hysterectomies — were no longer performed.
The analysis also suggests that up to £8.3 billion of hospital estates could be “freed up” or sold to generate income.
Andrew Lansley, the Shadow Health Secretary, said: “Yet again Labour ministers are failing to be straight with the British people.
“Andy Burnham [the Health Secretary] promised to protect the NHS, but now we find out that his department has been drawing up secret plans for swingeing cuts.
“Clearly, we need to get better value for money from the NHS, so we applaud any drive for greater efficiency, but it is extraordinary that Labour plan to take an axe to the hospital budget rather than to the bloated health bureaucracy.
“Only a fifth of job cuts would be within the bureaucracy, meaning the vast majority to go would be frontline NHS staff.
“After years of declining productivity, this report shows that Labour still doesn’t get it.
“Instead of relying on plans drawn up by management consultants for top-down cuts, they should be looking to create incentives through the way hospitals are paid, which would drive up standards and drive down costs.”
http://www.timesonline.co.uk/tol/life_and_style/health/article6818817.ece
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Second post:
Health care: while government dithers, private enterprise delivers
Nicholas J. Kaster
While Barack Obama schemes to enlarge the government's control over health care, private enterprise has stepped in to provide low cost, quality health care to Americans. Since 2000, over 1,200 private in-store clinics, typically staffed by nurse practitioners, have been opened by such companies as Wal-Mart, Walgreens, Target, and CVS and have served more than 3.5 million patients, providing treatment for minor ailments, routine physicals, immunizations, and the like, and doing so more cost-effectively than traditional medical facilities.
A new study, to be published in the September edition of the Annals of Internal Medicine, found that clinics in drug stores provide care for minor ailments "on par with, or better than, other medical facilities at significantly lower costs."
The quality of care offered at the in-store clinics was in line with doctors' offices and urgent care centers and slightly better than at emergency departments, Dr. Ateev Mehrotra of the University of Pittsburgh School of Medicine and the Rand research institute and colleagues found.
And the health care is being delivered at a lower cost. Nearly all of the clinics treat both the insured and uninsured. With a more price-sensitive market, it is not surprising to find that "the fees are low - and conspicuously posted." According to the study, the average cost for treatment at private drug store clinics was $110, including the evaluation, pharmacy, laboratory and other costs. This compares to an average cost of $156 at an urgent care facility, $166 at a doctor's office and $570 at an emergency department. What's more, "there is little or no waiting time."
Mehrotra characterized the retail clinics as "an innovative new way of delivering health care." Its just the kind of innovation sure to be stifled under a one-size-fits-all regime of socialized medicine.
Page Printed from: http://www.americanthinker.com/blog/2009/09/health_care_while_government_d.html at September 03, 2009 - 10:22:43 AM EDT
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I can only hope OBama is as stupid as Weiner. Then we are assured of acute total destruction of BO and the Dems in the next election cycle. But I doubt he could be that stupid. This guy Weiner is in total denial lala land. From yesterday's (I think) Rachel Maddow show:
****Rep. Anthony Weiner (D-N.Y.) said Obama has been hurting the cause of health care reform by sitting out the fight.
"David Axelrod said on your show that this is like we're in the ninth inning," he told MSNBC's Rachel Maddow last night. "That's not true. Our cleanup hasn't even come to the plate."
Weiner is a forceful advocate of a public health insurance option. He's said he thinks about 100 Democratic House members would vote against a bill that didn't include it.
"We've been in a scrap through the month of August, but we really haven't had presidential leadership in the way we need it most," Weiner told Maddow. He told he thought Obama's speech next week would turn things around. "If he stands up Wednesday and says to the country, we need to have a public option and here's why, it's going to get done. If he don't we'll settle for less and that will be a tragedy."
Weiner dismissed talk of an incremental approach or a bill that only deals with some problems of the health care industry. "That's not the change that a lot of people think they voted for," he said****
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Dying patient scheme should be examined, campaigners warn
Campaigners have called for an investigations into an NHS scheme which helps to end the lives of terminally patients after a group of leading doctors warned that some were dying prematurely.
By Kate Devlin, Medical Correspondent
Published: 7:00AM BST 04 Sep 2009
In a letter to The Daily Telegraph the medical experts warned that Britain was facing a “national crisis in care” because some patients were having fluids and drugs removed after being wrongly judged to be close to death.
Many were also being sedated, making it more difficult for doctors to tell their true condition.
The experts warned that the scheme was encouraging a "tick box" culture in which healthcare staff stopped questioning whether a patient was really dying or not.
The scheme, called the Liverpool Care Pathway, is being used in more than 300 hospitals across the country to advise staff on how to deal with the dying.
Dignity in Dying, which campaigns for patients to have a choice in all aspects of their end of life care and death, called on ministers and the health service to investigate how the system was being used in practice.
Sarah Wootton, the chief executive of the group, formerly the Voluntary Euthanasia Society, said: “Further research on the practice of the Liverpool Care Pathway is needed.
"The concerns raised ... suggest that some health care professionals need further training in the care of dying patients and on communication with both patients at the end of life, and their families and loved ones."
She added: "People approaching the end of life need to feel confident that their wishes will be respected and that they will be given the best care possible.
“All efforts to improve the care and support available to dying patients should be welcomed - including programmes such as the Liverpool Care Pathway, which aims to bring the best practice of hospice care to patients dying in hospital.”
She added that the recent finding that 16.5 per cent of deaths in Britain involved continuous deep sedation was “concerning”.
The Liverpool Care Pathway (LCP) was drawn up by Marie Curie and has been recommended for use across the NHS.
A spokesman for the charity said: "The letter talks about death being an inexact science and that is absolutely right. The Liverpool Care Pathway is not about ticking boxes, all decisions are made by a multi-disciplinary team so they're constantly reviewed and any decisions are made by a range of experts in palliative care.
"The Liverpool Care Pathway we know has already improved the end of life experience for thousands of people,” he added.
http://www.telegraph.co.uk/health/healthnews/6132912/Dying-patient-scheme-should-be-examined-campaigners-warn.html
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http://jammiewearingfool.blogspot.com/2009/09/i-think-racists-in-right-wing-are-upset.html
Barry's pastor of 20 years speaks.
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Whoa, Trigger
The latest gimmick to disguise a health-care 'public option.'
President Obama has decided that another oration will rejuvenate his health-care agenda—despite having given 27 speeches entirely on health care, and another 92 in which it figured prominently. We'll see how tomorrow night's Congressional appeal works out, but the important maneuvers are taking place in the cloak rooms, as the White House tries to staple together a majority.
The latest political gimmick is the notion of a "trigger" for the public option: A new government program for the middle class would only come on line if private insurance companies fail to meet certain benchmarks, such as lowering overall health spending or shrinking the number of the uninsured. This is supposed to appeal to Maine Republican Olympia Snowe, who could end up as ObamaCare's 60th Senator, while still appeasing the single-payer left.
Liberals should love the idea because a trigger isn't a substantive concession; it merely ensures that the public option will arrive eventually, instead of immediately. Democrats will goose the tests so that private insurers can't possibly meet them, mainly by imposing new regulations and other costly burdens.
Keep in mind that every version of ObamaCare now under consideration essentially turns all private insurers into subsidiaries of Congress. All coverage will be strictly regulated down to the fine print, and politics will dictate the level of benefits as well as premiums, deductibles and copays. Under the House bill, a "health choices commissioner" will have the final say, no doubt with Democrats Henry Waxman and Pete Stark at his elbow, if not another part of his anatomy.
The same bill also rewrites the 1974 federal law known as Erisa that lets large and mid-sized employers offer insurance with little regulation. Many businesses—including Safeway, General Mills and Marriott—are finding innovative ways to drive down spending, largely with worker incentives to live healthier and be more sensitive to the costs of care. Many Democrats call this discriminatory.
In the individual insurance market, Democrats intend to outlaw medical underwriting: Everyone must be charged the same rate or close to it for the same policies, regardless of health status or history. But this "community rating" tends to price younger and low-risk consumers out of the market. In a 2006 NBER paper, Bradley Herring of John Hopkins and Mark Pauly of the University of Pennsylvania found that community rating results in an overall increase in the uninsured in the individual market, maybe as high as 7.4%. For that reason, 35 states have no community rating at all, and another six allow very wide variations.
The larger reality is that private insurance won't be less expensive until overall health-care costs go down. Democrats may be confused on this point because government, which paid nearly 47 cents of every medical dollar in 2007, simply sets lower prices when Congress feels like it. On average, doctors and hospitals are forced to accept 20% to 30% less for their services in Medicare. That's another reason insurers wouldn't meet a trigger's thresholds, given that providers shift costs onto private under-65 patients to make up government shortfalls.
Conceivably insurers could make their products more affordable by cracking down on treatments and refusing payment more often, much as HMOs held down spending in the 1990s. But both patients and doctors hated this "managed care"—and in any case, Democrats would find a new rationale for the public option in the inevitable voter outcry about private "rationing."
It's true that there was a trigger in the Medicare prescription drug benefit and the world didn't end. But recall the dynamics in 2003: The GOP decided that private stand-alone or Medicare Advantage plans should manage the benefit. As a concession to Democrats, they agreed to trigger a "public option" for drugs—in which the government would have bought them directly, with its typical "negotiating" tactics—if seniors didn't have more than two plans in a given region.
Today, there are 1,689 stand-alone and 2,099 Advantage plans, and on average seniors have 50 to choose from—and costs in 2007 were $26 billion lower than expected. For all its problems, the Medicare drug plan created more choice for seniors and more competition among providers to offer packages that they found most attractive, holding down costs. In short, it created the incentives for multiple "private options."
ObamaCare doesn't bother with incentives, instead merely increasing government command and control of private insurance while making it more expensive in the process. That's why a trigger will inevitably lead to the public option, and also why ObamaCare will make all of our current health problems worse.
http://online.wsj.com/article/SB10001424052970203585004574392660067471896.html
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Executive summary of a long piece that addresses many of the questions Crafty has raised:
Political Malpractice
By Gregory Conko
Created 09/08/2009 - 16:42
subhead:
Health Insurance Misdiagnosis and the Destruction of Medical Wealth
Full Document Available in PDF [1]
President Barack Obama and congressional Democrats have proposed a major restructuring of the American health care system. They argue that Americans spend too much for health care of often dubious quality and that tens of millions of Americans lack meaningful access to health insurance. In turn, they have proposed structural reforms to the existing private and public health care financing systems that are intended to increase coverage, lower costs, and improve health care quality.
Most Americans agree that our health care system is broken and must be fixed. But it is increasingly clear that what ails health care is not too little, but too much government intervention. Federal and state tax preferences for employer-sponsored health insurance distort the market in a way that limits choices for individuals, reduces competition among insurers, and artificially inflates costs for health care services. For most working Americans, switching jobs often entails switching health plans and doctors or losing coverage altogether, while many others find non-employer-sponsored insurance unaffordable or difficult to obtain.
Efforts by federal and state governments over the past few decades to solve these problems have generated additional burdens and distortions, leading to increasingly bigger problems. To ensure affordable coverage for those in poor health or with potentially expensive medical conditions, governments have implemented guaranteed renewability, guaranteed issue, and community rating laws that force healthy individuals to subsidize those with higher health care costs. Many states require insurance policies to pay for niche specialists, including acupuncturists, pastoral counselors, and massage therapists, or to cover alcoholism and substance abuse treatment, smoking cessation, and in vitro fertilization. But these regulations further raise the price of insurance coverage, leading many healthy individuals to forgo insurance altogether.
Similarly, numerous state and federal restrictions on who may provide medical services and how they must be delivered have hindered the development of innovative ways for medical professionals to offer more convenient and lower-cost health services to consumers. A combination of government and medical professional lobbying has restricted the supply of new doctors, creating an artificial scarcity and contributing to rising prices. And medical products regulation substantially raises the cost of producing new drugs and medical devices, often without increasing their safety.
Instead of reducing these burdens, Democratic health reform proposals would impose more regulations on insurers, place mandates on individuals and employers to purchase health insurance, provide subsidies for individuals to pay for health care coverage, expand Medicaid, and create a new government-run “exchange” through which individuals and businesses could purchase strictly defined coverage from private insurers. But more government intervention will only add cost and complexity to the health care system; without solving the underlying problems.
As an alternative, policy makers should eliminate the many layers of market-distorting government regulation that have produced our current crisis. To truly reform America’s health care system, policy makers should:
Modify tax policy to eliminate the disincentives for individual purchase of health insurance and health care.
Eliminate regulatory barriers that prevent small businesses from cooperatively pooling and self-insuring their health risks by liberalizing the rules that govern voluntary health care purchasing cooperatives.
Eliminate laws that prevent interstate purchase of health insurance by individuals and businesses.
Eliminate rules that prevent individuals and group purchasers from tailoring health insurance plans to their needs, including federal and state benefit mandates and community rating requirements.
Eliminate artificial restrictions on the supply of health care services and products, such as the overregulation of drugs and medical devices, as well as state and federal restrictions on who may provide medical services and how they must be delivered.
Improve the availability of provider and procedure-specific cost and quality data for use by individual health consumers.
Reform the jackpot malpractice liability system that delivers windfall punitive damage awards to small numbers of injured patients while it raises malpractice insurance costs for doctors and incentivizes the practice of defensive medicine.
Each of these changes would help to fix our broken health care system by reducing costs and enabling better informed, cost-conscious decision making. By themselves, they will not guarantee access to health insurance among those with chronic preexisting conditions. But if we reform the existing maze of federal and state regulation, we will then be able to address the problem of the truly chronically uninsured. Because they are a fraction of the 46 million individuals who now lack insurance or government health coverage, it would then be possible to create targeted programs to help subsidize their health insurance costs without breaking the bank and without distorting the rest of the health care and health insurance markets.
Source URL: http://cei.org/issue-analysis/2009/09/08/political-malpractice
Links:
[1] http://cei.org/cei_files/fm/active/0/Conko-Klein-PoliticalMalpractice.pdf
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ObamaCare: First, Do Some Harm — Then, Exploit the Crisis
Posted By James Lewis On September 10, 2009 @ 12:51 am In . Column2 01, Health, Money, Politics, Science, Science & Technology, Stem Cells, Biotech, US News | 91 Comments
“First, do no harm” has been the guiding philosophy for the medical profession since Hippocrates. It still dominates medical science, technology, and clinical practice. That is why I trust my doctor to do his or her best for me, and that is why at times I have changed doctors when I thought they fell short of that standard.
That is why the cost of developing one medication to FDA standards is about a billion dollars. Entire technical professions have grown up over the past century, dedicated to finding and developing new medical molecules with remarkable sophistication. They are constantly testing thousands of promising drugs, digging into life’s basic biochemical pathways, and finding ways to make precise changes in body chemistry to save lives. We benefit from that extraordinary science every time we take an aspirin.
It’s an amazing success story, and by far most people in it are personally admirable and dedicated. Needless to say, our pop media understands nothing about it. Sheer ignorance is a big reason the media and political elites can’t think straight about medical care. They just don’t understand even the basics. There are no scientists, no engineers, and few physicians in Congress.
We live in an amazingly arrogant age, at least in politics and the more self-indulgent fields of academia.
Obama is a product of the non-scientific academic world, where Marxist pseudo-philosophy is popular, as long as the colleges themselves can live off the fat of the (capitalist) land. Our academics are revolutionaries who never take a personal risk, just like our Democrats. That’s why the philosophy behind Obama’s Marxoid takeover of our health care seems to be:
Who cares if we do harm? We’ll fix it later! If it’s politically convenient! Whatever we do cannot hurt the apparatchiks, the ruling elite, who will have their own medical system.
Congress and federal bureaucrats will keep their current insurance plans. Academics will keep their tenure and their soft lifestyle at the expense of taxpayers. It’ll be a two-layered system straight out of Soviet Moscow: the nomenklatura versus the workers.
ObamaCare is really, really cheap compared to that one billion dollars for testing a single drug. The cost of testing and developing HR 3200, the current and ever-changing plan for ObamaCare, is zero dollars — because no testing and development has ever been done on more than 1,000 complicated pages. The bill has been thrown together in back-room deals between lobbyists and staffers in Congress. It’s like a hugely complex computer program that’s never been tested to see if it will run.
How likely is it to work? It won’t, which is why there will be tens of thousands of pages of regulations. And if it runs, how likely is it to make one-sixth of the U.S. economy cheaper and better, as Obama claims?
This is the ultimate snake oil.
ObamaCare is a really sweet deal – if you believe in abysmal ignorance and wild guesswork as a basis for turning over control of a half-trillion-dollar-per-year medical system to a Central Committee of Wise Heads. No sane real-world organization could work this way. But power has its perks, and one of them is to dictate a revolution in the United States without ever trying to understand its consequences.
If Obama were running a drug company he would be criminally liable for fraud. Morally he is no different from a drug maker who skips all the testing, peddling thalidomide [1] around 1960, when 10 to 20 thousand people died from a poorly tested drug.
Nobody knows what will happen if this amazing coup d’etat passes. The European models are much smaller, took half a century to evolve to their present size, and have significant, life-threatening failures that Americans would never accept — including state euthanasia of the elderly, even if it is not called that in public. [2]
China, which owns a chunk of our sky-rocketing debt, is alarmed by U.S. money printing. The Chinese understand very clearly that Obama must raise taxes to prevent dollar devaluation if the O-Care bill passes. They see it as doing harm. He sees it as an historic opportunity [3].
“First, do some harm. Then, claim to fix it.”
In Britain the NHS is draining the public treasury — and all too often failing its patients at the same time. Just in the last weeks the British newspapers have published a slew of scandalous exposes on the National Health Service:
“Restrictions on prescription of osteoporosis drugs ‘defy belief’, says leading doctor [4]”
Professor David Reid, a world expert in brittle bones, said that government guidelines are so stringent that GPs are often prevented from giving alternative treatments to those who have suffered side-effects on the first pill they’ve been prescribed.
“Sentenced to death on the NHS [5]”
Patients with terminal illnesses are being made to die prematurely under an NHS scheme to help end their lives, leading doctors have warned.
A free product is always over-utilized. If gasoline were free, you might be driving a lot more. You’d be using gasoline for backyard barbecues, to heat your house, and to generate home electricity, because the other fuels would be driven out of the market. You can’t compete with free.
The British socialist state has ended up importing hundreds of thousands of Pakistanis from the badlands of Peshawar to vote Labour in order to keep the welfare elites in power. Those are the same Pakistanis who now make up a hotbed of terrorist indoctrination against Britain and the United States — in the middle of London and Birmingham. But anybody who criticizes Britain’s suicidal immigration policies is denounced as a racist. Ordinary citizens have been frightened into submission. Britain is losing its sovereignty to the EU, it can no longer control its borders, and its politicians look forward to fat new careers in Brussels as soon as the ship of state goes belly up.
That is the logical outcome of the socialist establishment in the UK, and it is why we are now importing millions of third world immigrants into the United States. Those are automatic Democrat votes. This is not an accident, but a deliberate policy; it was Ted Kennedy and the Senate Democrats who made it happen. ObamaCare will speed up the flow of easily-bought voters from poor and unstable countries, because we will be giving away free goodies that are inconceivable over there. Those people are just vote-fodder for the left.
This is just your friendly Federales at work.
And yet Obama cannot be wrong, even if he prescribes a dose of poison to our society. That’s because Obama is compassionate by definition. The history of medicine is full of over-confident doctors who ended up killing their patients. We have a special word for physician-caused disease: “iatrogenic.”
Most “grand-scale” politics is iatrogenic.
Lyndon Johnson’s Great Society created decades of welfare pathology among the poor it was supposed to help. FDR’s New Deal is believed to have lengthened the suffering of the Great Depression by almost a decade. Grand politics all.
Mr. Obama is both ignorant and superstitious about the reality of modern medicine. He really seems to believe in bizarre and vile urban myths that demonize doctors. He has alleged in public that doctors take out tonsils just for the money and that diabetics are denied medications because those bloody-minded docs make more bucks by amputating legs. That is unbelievably ignorant and malevolent — slanders against a profession that is generally highly ethical and enormously hard-working. It’s that cheap kind of cynicism that is now seeking to control the future of American medicine.
Notice what Barack Obama does not do. As the first black president Obama could have a huge impact on epidemic drug abuse in the black community, a true scourge that destroys families and individuals in every single city in America every single day. AIDS is a big problem in the black community, probably because young men are poorly informed about high-risk anal intercourse. Or they just don’t believe what they’re told, or they live in such despair that they are vulnerable to self-harm. Or maybe drug addiction makes them desperate for money to get another fix.
Whatever the reasons may be, Obama could use his fabled preaching talents to bring about genuine, positive change among people who live self-destructive lives, both white and black.
Inner city violence is a huge problem. Out-of-wedlock births are still the biggest predictor of social pathology. Chaotic schools fail to teach children and leave them handicapped for life. All those endemic social pathologies could be helped if the first black president focused on changing self-destructive behavior.
Obama could be a great teacher for vulnerable populations — most of which are on the left. Gays, blacks, Hispanics, the multi-generational poor — they all could use better life education from an inspirational leader. Bill Cosby understands that. Oprah Winfrey does, too. Obama does not.
In fact, the first black president is doing exactly the opposite by whipping up the blame game that keeps the underclass fixated on non-solutions to their own, painfully urgent problems. Obama’s veto of the Washington, D.C., school voucher program shows his working philosophy: “First, do some harm.”
Killing welfare reform [6] is the same. That was just as destructive and just as ignorant of the real effects of welfare policies. Those Obama decisions are either malignant or, more likely, just ignorant and harmful. Our self-proclaimed national physician is running loose with a scalpel and he doesn’t know where to cut. But he is bound and determined to have a dramatic surgery.
The Obama “health plan” claims there aren’t enough medical outcome studies, so a special federal bureaucracy has been set up to do more, using Porkulus money. The fact is that Google Scholar shows 3,260,000 citations for the phrase “medical treatment outcome study.” PubMed is the online database for biomedical science, and it shows more than 70,000 published studies in peer-reviewed journals on medical treatments and best practice recommendations. Doctors are swamped with information about the outcomes of their treatments. Far more than any single person can read.
I invite Mr. Obama to read and understand just one medical outcome study — you can get them with just one click on your PC keyboard using Google Scholar. Apparently he has never read a single one. Yes, Mr. Obama has a health prescription for all of humanity, but he hasn’t understood even one study of one medical treatment.
That’s his out-of-control Napoleon complex. Mere human doctors can’t compete with a messiah.
The fact is there is no “Obama Plan” at all, because Obama is abysmally ignorant about real medicine and real science. He is a man who can act like a very thoughtful guy on TV. The liberals love it, because most of them are just as ignorant, and they confuse the act for the real thing.
Marxist scapegoating has nothing to do with real understanding. It is pseudo-understanding. Its prescriptions can only do harm. Yet the left has convinced millions of half-educated Americans that they are the “physicians to society.”
This is the worst kind of cocksure and malignant ignorance. If we had any journalists worthy of the name, they would be telling us that. What we are seeing is a scary and ignorant power-grab, following the ancient political slogan:
First, do some harm. Then, exploit the crisis.
Article printed from Pajamas Media: http://pajamasmedia.com
URL to article: http://pajamasmedia.com/blog/obamacare-first-do-some-harm-%e2%80%94-then-exploit-the-crisis/
URLs in this post:
[1] thalidomide: http://en.wikipedia.org/wiki/Thalidomide
[2] in public.: http://www.americanthinker.com/2009/09/talking_seniors_to_death.html
[3] historic opportunity: http://pajamasmedia.com http://www.telegraph.co.uk/finance/economics/6146957/China-alarmed-by-US-money-printing.html
[4] Restrictions on prescription of osteoporosis drugs ‘defy belief’, says leading doctor: http://www.dailymail.co.uk/health/article-1211754/Restrictions-prescription-osteoporosis-drugs-defy-belief-says-leading-doctor.html
[5] Sentenced to death on the NHS: http://www.telegraph.co.uk/health/healthnews/6127514/Sentenced-to-death-on-the-NHS.html
[6] Killing welfare reform: http://article.nationalreview.com/?q=NTY3NzZhNDBkNjU5MjAzZTE4YmQ4MmU5MTk2YTIxNTQ=
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Does anyone else see THIS as remarkable? While the media of course focus on the exclamation of the Congressman calling Obama's statement about illegals a lie I don't hear one ioda from the msm about this:
"Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple."
I don't recall ever hearing a President call those who disagree with HIM liars in a speech to Congress.
Is this a first?
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Obama’s Trouble with Numbers
The funniest parts about Obama’s speech.
By Mona Charen
Let’s stipulate that it was wrong of Rep. Joe Wilson (R., S.C.) to shout “You lie” during President Obama’s health-care speech. It was a violation of courtesy and etiquette. Wilson apologized — which is more than the Democrats who booed President Bush’s State of the Union address in 2005 ever did.
But I confess that watching at home, similar exclamations were heard. Some seemed to have burst, irrepressible, from my own lips.
There was, for starters, this misleading assertion: “If you are among the hundreds of millions of Americans who already have health insurance through your job, or Medicare, or Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have.” Ah, shades of Clintonesque lawyerly evasion. No, it won’t “require” you to change, but if the tax treatment changes (and Obama proposes, among other things, to tax high-end plans) and the public option is available, employers may choose to change their offerings and employees will then no longer get to keep their current insurance.
The president then adverted to “more than 30 million American citizens who cannot get coverage.” As the Washington Examiner’s Byron York notes, the 30 million figure represents a climb down from the president’s oft-repeated claim (most recently in August) that there are “47 million uninsured in this country.” (The president’s track record on numbers is not inspiring. Remember his claim — since debunked — that medical expenses caused a bankruptcy every 30 seconds? Even ABC News called it “unsupportable.”)
Perhaps by downgrading to 30 million, President Obama is attempting to exclude an estimated 9.3 million illegal aliens. But look closely at the rest of the uninsured. According to Census and HHS data, 10 million have incomes more than three hundred percent of the poverty line, meaning they could afford coverage but for some reason choose to forgo it. And speaking of those who forgo, 5 million are single childless adults between the ages of 18 and 34. An estimated 6.4 million are “Medicaid undercount,” meaning they receive Medicaid or SCHIP but tell census takers otherwise. Another 4.3 million are eligible for Medicaid or other government health programs but have failed to enroll. That leaves just 10.6 million U.S. citizens below 300 percent of the poverty line, not eligible for an existing government program, and not between 18 and 34.
So the president’s claim that 30 million Americans “cannot get coverage” is, not to say more, inaccurate. So too was his statement, uncivil accusation really, that opponents of health-care reform have “lied” about his plan’s providing coverage for illegals. The supposed bar on illegals’ receiving health coverage applies only to a section of the bill. And Democrats rejected a Republican proposal that would have required verification of eligibility. Ditto for the claim that the Obama plan would not cover abortion expenses. It would not explicitly do so. But money is fungible and it would be impossible to prevent public funds from subsidizing abortions. Again, Republican amendments to prevent taxpayer money from paying for abortions failed. That’s revealing.
And then there was this: “Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan.” I didn’t think until now that President Obama had much of a sense of humor. Perhaps I was wrong. He also claimed that his plan will 1) extend coverage to all; 2) force insurance companies to cover “at no extra charge” routine check ups and screening tests like mammograms and colonoscopies; 3) place limits on how much people can be charged for out-of-pocket expenses; 4) forbid yearly or lifetime caps on coverage — and 5) spend less than we are currently spending! He’s not a president — he’s a wizard.
But no, the funniest part of the speech was Obama’s supposed overture to Republicans on malpractice reform. He is directing the secretary of HHS, he grandly offered, to pursue local “demonstration projects” in tort reform. But states like Texas have already proved the effectiveness of, for example, caps on pain and suffering damages. In any case the idea that some piddly demonstration project that would take several years to complete should be offered as a sop to Republicans while Democrats go about the business of revamping the entire health delivery system today is pretty much a joke.
The rationale for the speech — that lies, distortions, and misunderstandings account for public opposition to a health-care overhaul — was misconceived. This administration — anodyne phrases about bipartisanship notwithstanding — does not see beyond its narrow ideological keyhole. That weakness may prove crippling.
— Mona Charen is a nationally syndicated columnist.
National Review Online - http://article.nationalreview.com/?q=ZTkyYTdlYzk1Y2IyNjkwYzQ0MjRmYTcwNGU1ZmY0ZTk=
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Also the part that doctors and nurses support him and his plan.
Some undoubtedly do. But many do not.
The msm continues to back him:
All the opponents are liars, distorters, and playing the "fear" card.
Everything he says is truth.
Has anyone noticed the countless fact checks and the keeping em honest CNN stuff?
Yet always the facts and the honesty concludes that the right is wrong and the leftist views are the truth.
He still has the msm media in his back pocket.
Ideologically they are all one in the same.
I doubt his speech will win people over long term.
Yet the Dems will try to ram this through nonetheless.
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Not one ioda about Bamas calling his opponents claims as "lies" "distortions" and "bogus" as *erroding* debate.
As always he is off the hook. The opponents can never get away with his and his parties tactics.
Typical AP writer.
****Analysis: 'You lie!' further erodes discourse
Associated Press Writer Liz Sidoti, Associated Press Writer – 1 hr 17 mins ago
WASHINGTON – Screams of "Socialism!" Conservative talk show hosts peddling debunked "death panels." Placards likening Barack Obama to Hitler. And now, to the president's face: "You lie!" A breach of civility? Absolutely. A strategic political mistake? Maybe.
Republican Rep. Joe Wilson's personal attack on Obama and jeering from other GOP lawmakers as the president spoke to Congress escalated the opposition's outrage machine that over the summer framed the health care debate and knocked the White House back on its heels.
The rare lack of decorum on the House floor as Obama addressed lawmakers could provide him with a much-needed opening to retake control of the national conversation over a health care overhaul by turning off Americans to his critics' acerbic claims.
Or, people could dismiss derisive laughter and head-shaking from Republicans and embrace the opposition's broader argument that Obama's prescription for the ailing health care system would expand the government's reach into people's lives.
At the very least, Wednesday night marked the further erosion of long deteriorating discourse in a country where political opponents increasingly try to out-yell each other, vocal extremes of each political party shape the debate and a 24/7 media focused on ratings amplifies the tit for tat while latching onto phrases that fan the flames.
"What we've seen all summer was the worst of debate," said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania and an expert on political communication. "It does suggest a decline."
That's not lost on voters.
"We are becoming more adversarial and more shrill," says Jeffrey Howell of Cincinnati, 43. "We don't have discourse anymore."
It's become so bad that Donna Schwinghammer of Washington, Pa., 54, has stopped listening — to both sides. "I'm tired of all of it. There's so much fingerpointing," she says.
The latest low point in the nation's political dialogue came Wednesday when the vitriol of the summer's town-hall style events spilled into the Capitol as Obama addressed a joint session of Congress, saying: "The time for bickering is over ... Now is the season for action."
Some Republicans applauded and gave standing ovations through the speech. But, at times, GOP critics also shouted "not true" and "shame." There were boos, hisses and grumbles. One Republican, Rep. John Shimkus of Illinois, left the chamber, his spokesman says in frustration, even before the president had finished.
But it was Wilson's boorish outburst that froze Republicans in their seats.
"You lie!" the South Carolina congressman shouted and jabbed a finger in the air when Obama said that Democratic plans do not cover illegal immigrants.
Taking advantage of the extraordinary accusation, Obama calmly replied, "That's not true," and went on with his speech.
Will personal attacks on a president who people generally like — even if they disagree with his policies — ultimately prove to have gone too far?
Certainly, in the short-term, the chorus of criticism painted an unflattering — many Republicans say embarrassing — picture of the GOP. Wilson apologized shortly after the speech, which some say may have limited the fallout.
But the outbursts also gave Obama an opportunity that he seized, pleading for civil discourse and bipartisan solution-making. And they added fuel to Democratic arguments that Republicans simply belong to "The Party of No."
The Democratic-aligned Americans United for Change quickly rolled out a Web video, saying: "It's Official — The Party of NO Has Become the Party of No Shame."
What's more: the behavior highlighted personal volleys coming from the GOP's far right wing just as party leaders in Congress are trying to position themselves as centrists debating policy. The Republican base and right flank may be energized by what they saw and heard but independents and moderates may have cringed.
That could spell trouble for Republicans looking ahead to next year's midterm elections.
While midterms typically are base elections and vitriol will get hard-core party loyalists to turn out, Republicans also don't want to look too extreme as they try to pick up seats in Congress.
Several Republicans called the outbursts unhelpful — particularly Wilson's.
"It combined two things that just aren't the same: legitimate outrage people feel over government-run health care and manufactured vitriol that I think most people dismiss," veteran Republican communications strategist Todd Harris said. That, he said, plays into the Democrats' hands.
But Republicans also are betting that there's no long-term damage to the GOP's strategy because Republicans have tapped into fear among Americans about the government intruding into their lives.
"Intemperate and clearly a mistake," Phil Musser, the former executive director of the Republican Governor's Association, said of Wilson's remark. But, he added: "It didn't shift the debate."
___
EDITOR'S NOTE — Liz Sidoti has covered national politics for The Associated Press since 2003.****
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Where Is Obama’s ‘Center’?
Look at his Rolodex and then figure out just where such a man would estimate it to be.
By Mark Steyn
So why can’t the silver-tongued post-partisan healer seal the deal on this health-care business? Surely it should be the work of moments for the greatest orator in American history to whip up a little medicinal Gettysburg, a touch of Henry V-in-the-Agincourt-casualty-tent, and put this thing away. Yet there he was the other night with the usual leaden medley of tinny grandiosity (all the this-is-the-moment, now-is-the-hour stuff), slippery reassurances (don’t worry, you won’t be “required” to change your present health arrangements), imputations of bad faith to anyone who takes a different view (they’re playing “games”), and the copper-bottomed guarantee that you can have it all for no money down, no interest, no monthly payments, no nuthin’ (“I will not sign it if it adds one dime to the deficit”).
This would barely have passed muster four months back. After a summer of seething town halls and sliding approval numbers, it was a joke. Or, rather, it would be a joke if the president’s intention was to persuade an increasingly skeptical if not downright hostile electorate. On the other hand, if the intention is to ram it down America’s throat whatever the citizenry thinks, then the joke’s on us.
If it was about “health care,” it would be easier. It was assumed, for example, that the president’s sly revision of “47 million people without health insurance” in his summer speeches to the substantially lower 30 million was a concession to those who said that his “plan” (he hasn’t actually produced one, but why get hung up on details?) will cover gazillions of illegal immigrants.
If so, it’s a rhetorical feint that’s otherwise meaningless. The minute a first-world country has “free” health care, it becomes the provider of choice to anyone who can get there, particularly for any long-term ailments requiring state-of-the-art medications. In 2004, Britain’s Health Protection Agency revealed that 44 percent of HIV patients being treated by the National Health Service were not residents of the United Kingdom at all, but from southern Africa. In essence, a huge number of AIDS patients in South Africa, Zimbabwe, Zambia, Malawi, Swaziland, and Lesotho have decided to outsource their health-care needs to British taxpayers. Similar trends will manifest themselves here in nothing flat.
But, for the sake of argument, let us concede the president’s current number of 30 million. In order to do something for the 10 percent of the population outside the current system, why is it necessary to destabilize the arrangements of the 90 percent within it?
Well, says the president, not so fast. Lots of people with insurance run into problems when they change jobs or move to another state. Okay, In that case, why not ease the obstacles to health-care portability?
Well, says the president, shuffling his cups and moving the pea under another shell, we’re spending too much on health care. By “we’re,” he means you and you and you and you and millions of other Americans making individual choices over which he casually claims collective jurisdiction.
And that, ultimately, gets closer than anything else he says to giving the game away. For most of the previous presidency, the Left accused George W. Bush of using 9/11 as a pretext to attack Iraq. Since January, his successor has used the economic slump as a pretext to “reform” health care. Most voters don’t buy it: They see it as Obama’s “war of choice,” and the more frantically he talks about it as a matter of urgency the weirder it seems. If he’s having difficulty selling it, that’s because it’s not about “health.” As I’ve written before, the appeal of this issue to him and to Nancy Pelosi, Barney Frank, et al., is that governmentalization of health care is the fastest way to a permanent left-of-center political culture — one in which elections are always fought on the Left’s issues and on the Left’s terms, and in which “conservative” parties no longer talk about small government and individual liberty but find themselves retreating to one last pitiful rationale: that they can run the left-wing state more effectively than the Left can. Listen to your average British Tory or French Gaullist on the campaign trail pledging to “deliver” government services more “efficiently.”
Three stories bubbled up in the last week, although if you read the New York Times and the administration’s other airbrushers you’ll be blissfully unaware of them; the resignation of Van Jones — former (?) Communist and current 9/11 “truther” — from his post as Obama’s “Green Jobs Czar”; the “re-assignment” of Yosi Sergant at the National Endowment for the Arts after he was found to be urging government-funded arts groups to produce “art” in support of Obama policy positions; and, finally, the extraordinary undercover tape from Andrew Breitbart’s Big Government website in which officials from ACORN (the Obama chums who’ll be “helping” with the next census) offer advice on how pimps can get government housing loans for brothels employing underage girls from El Salvador.
What do all these Obama associates have in common? I mean, aside from the fact that Glenn Beck played a key role in exposing them. We are assured by the airbrushing media and “moderate” conservatives that Beck is crazy, a frothing spokesnut for the lunatic fringe. By contrast, Van Jones, Yosi Sergant, and ACORN are all members of the lunatic mainstream, embedded philosophically and actually in the heart of Obamaland.
What all these individuals share is a supersized view of the state, from a makework gig coordinating the invention of phony-baloney “green jobs” to Soviet-style government-licensed art in support of heroic government programs to government-funded “community organizers” organizing government funding for jailbait bordellos. Okay, government-funded child prostitution’s a bit of an outlier even for this crowd — for the moment. But you get the general idea.
The New York Times’s in-house conservative David Brooks was an early champion of Obama and is profiled in the current edition of The New Republic cooing paeans to the then-senator”s “pant leg and perfectly creased pant.” Alas, for David Brooks, the bottom has dropped out of Obama’s perfectly creased pants. The other day he was tutting that the Obama administration is in trouble because “it joined itself at the hip to the liberal leadership in Congress.” My National Review colleague Jay Nordlinger was reminded of an old observation by the great Theodore Dalrymple. During his time as an English prison doctor, Dalrymple frequently met ne’er-do-wells who said they’d “fallen in with the wrong crowd,” but, oddly enough, in all those years, he never met the wrong crowd.
Likewise, Obama didn’t “join” himself to the liberal leadership; he is the liberal leadership. The administration didn’t fall in with the wrong crowd; they are the wrong crowd. Van Jones, Yosi Sergant, and ACORN are where Barack Obama has chosen to live all his adult life. Even if he wanted to be the bipartisan centrist of David Brooks’s fantasies, look at his Rolodex and then figure out just where such a man would estimate the “center” to be.
My sense from Wednesday’s speech is that the president’s gonna shove this through in some form or other. It may cause a little temporary pain in Blue Dog districts in 2010, but the long-term gains will be transformative and irreversible.
— Mark Steyn, a National Review columnist, is author of America Alone. © 2009 Mark Steyn
National Review Online - http://article.nationalreview.com/?q=ZTI2Y2YyMzExNGI2OWNjNWU2YWM2NTdiYzY2OTIzNGQ=
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By SCOTT HARRINGTON
In his speech to Congress last week, President Barack Obama attempted to sell a reform agenda by demonizing the private health-insurance industry, which many people love to hate. He opened the attack by asserting: "More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won't pay the full cost of care. It happens every day."
Clearly, this should never happen to anyone who is in good standing with his insurance company and has abided by the terms of the policy. But the president's examples of people "dropped" by their insurance companies involve the rescission of policies based on misrepresentation or concealment of information in applications for coverage. Private health insurance cannot function if people buy insurance only after they become seriously ill, or if they knowingly conceal health conditions that might affect their policy.
.Traditional practice, governed by decades of common law, statute and regulation is for insurers to rely in underwriting and pricing on the truthfulness of the information provided by applicants about their health, without conducting a costly investigation of each applicant's health history. Instead, companies engage in a certain degree of ex post auditing—conducting more detailed and costly reviews of a subset of applications following policy issue—including when expensive treatment is sought soon after a policy is issued.
This practice offers substantial cost savings and lower premiums compared to trying to verify every application before issuing a policy, or simply paying all claims, regardless of the accuracy and completeness of the applicant's disclosure. Some states restrict insurer rescission rights to instances where the misrepresented or concealed information is directly related to the illness that produced the claim. Most states do not.
To highlight abusive practices, Mr. Obama referred to an Illinois man who "lost his coverage in the middle of chemotherapy because his insurer found he hadn't reported gallstones that he didn't even know about." The president continued: "They delayed his treatment, and he died because of it."
Although the president has used this example previously, his conclusion is contradicted by the transcript of a June 16 hearing on industry practices before the Subcommittee of Oversight and Investigation of the House Committee on Energy and Commerce. The deceased's sister testified that the insurer reinstated her brother's coverage following intervention by the Illinois Attorney General's Office. She testified that her brother received a prescribed stem-cell transplant within the desired three- to four-week "window of opportunity" from "one of the most renowned doctors in the whole world on the specific routine," that the procedure "was extremely successful," and that "it extended his life nearly three and a half years."
The president's second example was a Texas woman "about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne." He said that "By the time she had her insurance reinstated, her breast cancer more than doubled in size."
The woman's testimony at the June 16 hearing confirms that her surgery was delayed several months. It also suggests that the dermatologist's chart may have described her skin condition as precancerous, that the insurer also took issue with an apparent failure to disclose an earlier problem with an irregular heartbeat, and that she knowingly underreported her weight on the application.
These two cases are presumably among the most egregious identified by Congressional staffers' analysis of 116,000 pages of documents from three large health insurers, which identified a total of about 20,000 rescissions from millions of policies issued by the insurers over a five-year period. Company representatives testified that less than one half of one percent of policies were rescinded (less than 0.1% for one of the companies).
If existing laws and litigation governing rescission are inadequate, there clearly are a variety of ways that the states or federal government could target abuses without adopting the president's agenda for federal control of health insurance, or the creation of a government health insurer.
Later in his speech, the president used Alabama to buttress his call for a government insurer to enhance competition in health insurance. He asserted that 90% of the Alabama health-insurance market is controlled by one insurer, and that high market concentration "makes it easier for insurance companies to treat their customers badly—by cherry-picking the healthiest individuals and trying to drop the sickest; by overcharging small businesses who have no leverage; and by jacking up rates."
In fact, the Birmingham News reported immediately following the speech that the state's largest health insurer, the nonprofit Blue Cross and Blue Shield of Alabama, has about a 75% market share. A representative of the company indicated that its "profit" averaged only 0.6% of premiums the past decade, and that its administrative expense ratio is 7% of premiums, the fourth lowest among 39 Blue Cross and Blue Shield plans nationwide.
Similarly, a Dec. 31, 2007, report by the Alabama Department of Insurance indicates that the insurer's ratio of medical-claim costs to premiums for the year was 92%, with an administrative expense ratio (including claims settlement expenses) of 7.5%. Its net income, including investment income, was equivalent to 2% of premiums in that year.
In addition to these consumer friendly numbers, a survey in Consumer Reports this month reported that Blue Cross and Blue Shield of Alabama ranked second nationally in customer satisfaction among 41 preferred provider organization health plans. The insurer's apparent efficiency may explain its dominance, as opposed to a lack of competition—especially since there are no obvious barriers to entry or expansion in Alabama faced by large national health insurers such as United Healthcare and Aetna.
Responsible reform requires careful analysis of the underlying causes of problems in health insurance and informed debate over the benefits and costs of targeted remedies. The president's continued demonization of private health insurance in pursuit of his broad agenda of government expansion is inconsistent with that objective.
Mr. Harrington is professor of health-care management and insurance and risk management at the University of Pennsylvania's Wharton School and an adjunct scholar at the American Enterprise Institute.
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Health-Care Reform and the Constitution
Why hasn't the Commerce Clause been read to allow interstate insurance sales?
By ANDREW P. NAPOLITANO
Last week, I asked South Carolina Congressman James Clyburn, the third-ranking Democrat in the House of Representatives, where in the Constitution it authorizes the federal government to regulate the delivery of health care. He replied: "There's nothing in the Constitution that says that the federal government has anything to do with most of the stuff we do." Then he shot back: "How about [you] show me where in the Constitution it prohibits the federal government from doing this?"
Rep. Clyburn, like many of his colleagues, seems to have conveniently forgotten that the federal government has only specific enumerated powers. He also seems to have overlooked the Ninth and 10th Amendments, which limit Congress's powers only to those granted in the Constitution.
One of those powers—the power "to regulate" interstate commerce—is the favorite hook on which Congress hangs its hat in order to justify the regulation of anything it wants to control.
Unfortunately, a notoriously tendentious New Deal-era Supreme Court decision has given Congress a green light to use the Commerce Clause to regulate noncommercial, and even purely local, private behavior. In Wickard v. Filburn (1942), the Supreme Court held that a farmer who grew wheat just for the consumption of his own family violated federal agricultural guidelines enacted pursuant to the Commerce Clause. Though the wheat did not move across state lines—indeed, it never left his farm—the Court held that if other similarly situated farmers were permitted to do the same it, might have an aggregate effect on interstate commerce.
James Madison, who argued that to regulate meant to keep regular, would have shuddered at such circular reasoning. Madison's understanding was the commonly held one in 1789, since the principle reason for the Constitutional Convention was to establish a central government that would prevent ruinous state-imposed tariffs that favored in-state businesses. It would do so by assuring that commerce between the states was kept "regular."
The Supreme Court finally came to its senses when it invalidated a congressional ban on illegal guns within 1,000 feet of public schools. In United States v. Lopez (1995), the Court ruled that the Commerce Clause may only be used by Congress to regulate human activity that is truly commercial at its core and that has not traditionally been regulated by the states. The movement of illegal guns from one state to another, the Court ruled, was criminal and not commercial at its core, and school safety has historically been a state function.
Applying these principles to President Barack Obama's health-care proposal, it's clear that his plan is unconstitutional at its core. The practice of medicine consists of the delivery of intimate services to the human body. In almost all instances, the delivery of medical services occurs in one place and does not move across interstate lines. One goes to a physician not to engage in commercial activity, as the Framers of the Constitution understood, but to improve one's health. And the practice of medicine, much like public school safety, has been regulated by states for the past century.
The same Congress that wants to tell family farmers what to grow in their backyards has declined "to keep regular" the commercial sale of insurance policies. It has permitted all 50 states to erect the type of barriers that the Commerce Clause was written precisely to tear down. Insurers are barred from selling policies to people in another state.
That's right: Congress refuses to keep commerce regular when the commercial activity is the sale of insurance, but claims it can regulate the removal of a person's appendix because that constitutes interstate commerce.
What we have here is raw abuse of power by the federal government for political purposes. The president and his colleagues want to reward their supporters with "free" health care that the rest of us will end up paying for. Their only restraint on their exercise of Commerce Clause power is whatever they can get away with. They aren't upholding the Constitution—they are evading it.
Mr. Napolitano, who served on the bench of the Superior Court of New Jersey between 1987 and 1995, is the senior judicial analyst at the Fox News Channel. His latest book is "Dred Scott's Revenge: A Legal History of Race and Freedom in America" (Nelson, 2009).
http://online.wsj.com/article/SB10001424052970203917304574412793406386548.html
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Young Adults Likely to Pay Big Share of Reform's Cost
By Shailagh Murray
Washington Post Staff Writer
Wednesday, September 16, 2009
As health-care legislation advances through Congress, the young adults who were so vital to President Obama's election are emerging as a significant beneficiary of his top domestic priority, but they are also likely to play a major role in funding any reform.
In a campaign-style rally Thursday at the University of Maryland at College Park, Obama will aim to tap his richest vein of support -- voters younger than 30 -- to help sell his reform plan to a more skeptical general public. "We're at an important turning point in our push for real reform," read the e-mailed invitation, "and it's critical that we seize this moment."
A 2008 study by the Urban Institute found that more than 10 million young adults ages 19 to 26 lack health insurance coverage. For many of those people, health-care reform would offer the promise of relatively inexpensive individual policies, which do not exist in many states today.
The trade-off is that young people would no longer be permitted to bet on their good health: All the reform legislation before Congress would require individuals to buy at least minimal coverage.
Another bill will be introduced Wednesday by the chairman of the Senate Finance Committee. Sen. Max Baucus (D-Mont.) will offer in it a proposal to keep premiums manageable: a bare-bones catastrophic policy that would protect young people from financial calamity while providing basic preventive care.
Drafting young adults into any health-care reform package is crucial to paying for it. As low-cost additions to insurance pools, young adults would help dilute the expense of covering older, sicker people. Depending on how Congress requires insurers to price their policies, this group could even wind up paying disproportionately hefty premiums -- effectively subsidizing coverage for their parents.
An array of Democratic senators continued to complain Tuesday about the affordability of reform, insisting that the final package should include much larger tax credits to help people cover the cost of insurance premiums.
"I want to make clear that in its current form I cannot put my support behind the Finance bill -- it will not have my vote," said Sen. John D. Rockefeller IV (D-W.Va.).
In part, young adults are uninsured because they are less likely to work for employers who offer coverage; they may not qualify for public programs such as Medicaid; and even the skimpiest private insurance plans may be too expensive alongside hefty student loan payments and credit card debt.
But some young people -- nicknamed the "young invincibles" -- are also likelier than other Americans to assume that they won't need health insurance or to decide that they'd rather spend their money on other things.
To discourage that attitude, the Finance Committee bill would fine individuals who do not purchase coverage. An early draft of the proposal set the penalty at $750 or $950 per year for single people, depending on income. But according to various insurance experts, even the least expensive plan under the bill could cost more than $100 per month, making it cheaper for people to pay the fine than to buy insurance.
All the bills seek to blunt the additional cost to young adults, mainly through subsidies, but it is not clear what effect that would have. "The primary question is what the premium is and what people get for that," said Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution and a former senior Bush administration official.
Adding preventative care to a catastrophic policy makes the Finance Committee bill's bare-bones coverage more appealing, McClellan noted. But for many young adults, health care will become a significant new expense. "It's important for people to know what they're getting into," he said.
But it's also essential that young, healthy people participate, said Linda J. Blumberg, a health-care expert at the Urban Institute, because the requirement that people have insurance "is really a mechanism for financing health-care reform."
The more people steered into the system through such a mandate, Blumberg and others explained, the lower the total subsidies that the government must provide to keep insurance affordable. But if young people slip through the cracks -- or if Congress, facing political pressure, provides generous exemptions from the mandate -- then the government and people who buy coverage will face higher costs.
The Finance Committee proposal also focuses on broadening access to health insurance. For uninsured people without affordable employer coverage, it would open new insurance "exchanges," offering a menu of options at different cost and benefit levels. Additionally, all adults with incomes below 133 percent of the federal poverty level -- or about $14,400 for an individual -- would be eligible for Medicaid.
One group that policy experts worry could be squeezed by reform is young adults with health problems, whose incomes are not high enough to afford the expensive policies they may need to manage chronic conditions. Blumberg said young adults with asthma, diabetes, hay fever and even high school sports injuries are systematically rejected by insurers in states without protections for people with preexisting conditions.
Krisja Hendricks, 28, is a waitress in Brooklyn whose thyroid cancer was diagnosed shortly before she graduated from college, while she was still covered under her father's plan. Crohn's disease was later diagnosed, causing insurers to turn her away. She finally found a health plan for $245 per month, but she just discovered that it will not cover the tests she needs to monitor her health. "I'm willing to pay $400 a month, even though that's a lot," she said. "But I know I have to. I really don't think everyone should required to."
According to a Washington Post-ABC News poll last week, young adults are more optimistic about the outcome of health-care reform than those age 30 and older, but they are evenly divided on the cost implications, with 32 percent expecting their costs to decline and 27 percent expecting an increase.
About 52 percent of young adults support the idea of the individual mandate, about the same proportion as in other age groups. But in terms of the overall package, the under-30 group broadly supports the Democratic effort, with 60 percent favoring the proposed reforms vs. 42 percent among older adults.
And while the number is down from its high point, 63 percent of under-30s approve of Obama's overall job performance, significantly more than in other age groups.
Given the implications of reform, advocates for young voters wonder why they haven't commanded special attention from the White House and Congress, as have seniors, union households and industry stakeholders.
"We can do our part, but we need to hear from the people who are making the policy decisions," said Heather Smith, executive director of Rock the Vote, a nonprofit group aimed at drawing young people into the political process.
Along with other pro-reform organizations, Rock the Vote has begun a national advertising and grass-roots campaign to educate young adults about the emerging legislation. But Smith said she was frustrated that Obama offered few assurances to young adults in his speech before Congress last week, instead chastising as "irresponsible" those who don't buy coverage.
The under-30 crowd remains by far the president's most loyal following, Smith noted. "He needs to talk to them," she said. "Writ large, they are struggling; they are the uninsured."
Staff writer Lori Montgomery and polling director Jon Cohen contributed to this report.
http://www.washingtonpost.com/wp-dyn/content/article/2009/09/15/AR2009091503716.html
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Public Option Lite
The Baucus plan would make insurance even more expensive.
Senate Finance Chairman Max Baucus finally unveiled his health-care plan yesterday to a chorus of bipartisan jeers. The reaction is surprising given that President Obama all but endorsed the outlines of the Baucus plan last week. But the hoots are only going to grow louder as more people read what he's actually proposing.
The headline is that Mr. Baucus has dropped the unpopular "public option," but this is a political offering without much policy difference. His plan remains a public option by other means, imposing vast new national insurance regulation, huge new subsidies to pay for the higher insurance costs this regulation will require and all financed by new taxes and penalties on businesses, individuals and health-care providers. Other than that, Hippocrates, the plan does no harm.
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The centerpiece of the Obama-Baucus plan is a decree that everyone purchase heavily regulated insurance policies or else pay a penalty. This government mandate would require huge subsidies as well as brute force to get anywhere near the goal of universal coverage. The inevitable result would be a vast increase in the government's share of U.S. health spending, forcing doctors, hospitals, insurance companies and other health providers to serve politics as well as or even over and above patients.
The plan essentially rewrites all insurance contracts, including those offered by businesses to their workers. Benefits and premiums must be tailored to federal specifications. First-dollar coverage would be mandated for many services, and cost-sharing between businesses and employees would be sharply reduced, though this is one policy that might reduce health spending by giving consumers more skin in the game. Nor would insurance be allowed to bear any relation to risk. Inevitably, costs would continue to climb.
Everyone would be forced to buy these government-approved policies, whether or not they suit their needs or budget. Families would face tax penalties as high as $3,800 a year for not complying, singles $950. As one resident of Massachusetts where Mitt Romney imposed an individual mandate in 2006 put it in a Journal story yesterday, this is like taxing the homeless for not buying a mansion.
The political irony here is rich. If liberal health-care reform is going to make people better off, why does it require "a very harsh, stiff penalty" to make everyone buy it? That's what Senator Obama called it in his Presidential campaign when he opposed the individual mandate supported by Hillary Clinton. He correctly argued then that many people were uninsured not because they didn't want coverage but because it was too expensive. The nearby mailer to Ohio primary voters gives the flavor of Mr. Obama's attacks.
And the Baucus-Obama plan will only make insurance even more expensive. Employers will be required to offer "qualified coverage" to their workers (or pay another "free rider" penalty) and workers will be required to accept it, paying for it in lower wages. The vast majority of households already confront the same tradeoff today, except Congress will now declare that there's only one right answer.
The subsidies in the Baucus plan go to people without a job-based plan and who earn under three times the federal poverty level, or about $66,000 for a family of four. Yet according to a Congressional Budget Office analysis we've seen, the plan isn't much of an improvement over the current market.
Take a family of four making $42,000 in 2016. While government would subsidize 80% of their premium and pay $1,500 to offset cost-sharing, they'd still pay $6,000 a year or 14.3% of their total income. A family making $54,000 could still pay 18.1% of their income, while an individual earning $26,500 would be on the hook for 15.5%, and one earning $32,400 for 17.3%. So lower-income workers would still be forced to devote huge portions of their salaries to expensive policies that they may not want or be able to afford.
Other Democrats want to make the subsidies even bigger, but Mr. Baucus told reporters on Monday that, "We're doing our very best to make an insurance requirement as affordable as we possibly can, recognizing that we're trying to get this bill under $900 billion total." Another way of putting this is that he is hiding the real cost of his bill by pinching pennies to meet a less politically toxic overall spending number. In that sense, the House health bill which clocked in at $1.042 trillion because it was more generous upfront was more honest, though not by much.
Like the House bill, Mr. Baucus uses 10 years of taxes to fund about seven years of spending. Some $215 billion is scrounged up by imposing a 35% excise tax on insurance companies for plans valued at more than $21,000 for families and $8,000 for individuals. This levy would merely be added to the insurers' "administrative load" and passed down to all consumers in higher prices. Ditto for the $59 billion that Mr. Baucus would raise by taxing the likes of clinical laboratories and drug and device makers.
Mr. Baucus also wants to cut $409 billion from Medicare, according to CBO, though the only money that is certain to see the budget ax is $123 billion from the Medicare Advantage program. Liberal Democrats hate Advantage because it gives 10.2 million seniors private options. The other "savings" come from supposedly automatic cuts that a future Congress is unlikely to ever approve that is, until this entitlement spending swamps the federal budget. Then the government will have no choice but to raise taxes to European welfare-state levels or impose drastic restrictions on patient care. Or, most likely, both.
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To sum up, the Baucus-Obama plan would increase the cost of insurance and then force people to buy it, requiring subsidies. Those subsidies would be paid for by taxes that make health care and thus insurance even more expensive, requiring even more subsidies and still higher taxes. It's a recipe to ruin health care and bankrupt the country, and that's even before liberal Democrats see Mr. Baucus and raise him, and then attempt to ram it all through the Senate.
Printed in The Wall Street Journal, page A22
http://online.wsj.com/article/SB10001424052970204518504574416930475823324.html
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A doctor friend writes:
I have decided to offer a Mea Culpa for my part of the healthcare spending debacle. The government made me do it.
A general explanation of some of the high costs of medical care.
Example: 65 yr old male with difficulty voiding
1990 treatment course.
Office visit for initial assessment.
Urine flow rate and cystoscopy to assess for obstruction ($500).
Transurethral Resection of the Prostate was least invasive treatment available and was used for almost everyone. 95% success rate with 3 day hospital stay and 90 f/u for surgical fee of $1500 in 1990 dollars.
Pt was happy and urologist was gratified.
Patient returned to PCP for follow up as the Urologist’s work was done.
2009 treatment course.
Office visit for initial assessment.
PSA, prostate symptom score, flow rate and US postvoid residual determined ($250).
Pt started on alpha blocker($50/mo).
F/U in 2 weeks for prostate symptom score and flow rate ($200). Partial improvement noted.
Pt started on finasteride or avodart ($50-$100/mo).
F/U in 3 months for PSA, prostate symptom score, flow rate and PVR ($250).
Still some symptoms.
Cystoscopy performed. Evidence of obstruction is noted ($250).
Pt is offered minimally invasive treatment with microwave or radiofrequency ablation therapy ($3800).
F/U at 6 months for PSA, prostate symptom score, flow rate and PVR ($250).
Pt not happy with persistent irritative symptoms and inability to get off of medications.
Urodynamics performed ($1200). Obstruction confirmed.
Transurethral resection is performed for $700 in 2009 dollars. 95% success rate. Pt is happy and system is broke.
The alternate scenario is that the patient gets acceptable results with medical therapy and returns for q6month office visits ($100-$250) with the urologist on top of the PCP visits for the next 15 years ($3000-$8000 total) with periodic reassessment with symptom scores, PVR’s, flow rates, Urinalysis and PSA’s on top of the ongoing cost of his one or two medications.
For probably 80% of the male patients that I see for obstructive voiding symptoms, a Transurethral resection of the prostate will provide excellent relief of symptoms with relatively few severe side effects. Incontinence 1%, Impotence in 5-10% (this is an older populations that is prone to ED anyway and 90% retrograde ejaculation (clean sheets and who cares)
Minimally invasive and medical therapy often increases costs without necessarily providing better outcomes or a reduction in complications.
The change in treatment has been driven by patient choice, industry marketing and physician’s desire to maintain revenue. A TURP in 1990 was reimbursed by Medicare at $1500. A TURP (which takes an hour of my time during the procedure with 1-2 postop hospital visits of 15 minutes plus travel time) in 2009 is reimbursed by Medicare is $700 and included 90 days of follow up care. A flow rate (pee in a device that measures the rate) reimburses $150. Urodynamics which is a functional test that is the best evaluation for voiding dysfunction is reimbursed at $1200 and is done in my office by a tech under my supervision. Minimally invasive therapy with microwave or radiofrequency ablation (which takes about an hour in my office) is reimbursed at $3800 in my office with a net after equipment and disposable costs of about $1200.
This pattern in urology is repeated in many fields. Cardiac surgery is better than cardiac stenting and the bar for performing the procedure is much higher so additional surgical procedures are not offered as cavalierly as additional cath stent procedures.
If TURP reimbursement had remained high enough, medical and minimally invasive therapy for BPH would have never taken off, because every urologist really knows that a TURP is by far the most efficient and effective way to take care of bladder outlet obstruction but the economics don’t favor it anymore, and I have tuition to pay.
If you find yourself in a situation where you have a hard time peeing and you want it taken care of, just tell your urologist that you just want it taken care of and have them do a TURP. 95% of my patients will tell you that they wish they had had it done long ago.
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If the obama healthcare plan passes and everybody has "healthcare" can some one explain to me why it is that we would continue to need medicade,medicare,the VA or that childerens plan(s-chip I believe it is called).Since everyone would allegedly(lol) have care why would these redundant agencies continue to exist and absorb money better spent else where?
Boyo :evil:
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Crafty,
the urologists note is interesting.
The advent of PSAs is also driving up urologic care with questionable outcomes.
One huge study suggested we reduce the rate of death from prostate cancer by 20% because of PSA screeing.
Another study suggested there is absolutely no difference.
For every life we may save with PSA screening there are probably at least many more men who go through screening testing anxiety for nothing.
The problem is we still can't tell which is the occasional patient who may benefit from the one who will never have had any problem with his prostate if we didn't go on fishing expeditions.
Yet we have parades of famous people with prostate cancer getting on Larry KIng telling their stories as though it applies to anything in reality to large populations of people.
Cardiology costs have also gone crazy and out of control.
Cardiologists are in my view the biggest spenders in medicine that are not a surgical specialty.
It used to be a stress test once every two years or only if there were symptoms or other specific reasons to get them.
Now I see some cardiologists who are part or wholly owners of stress nuclear machines getting them as often as yearly.
They are ordering tests on everyone.
Their reimbursements per procedure etc are down so they simply order more.
Patients think they are being more thorough and as long as a third party pays they are delighted to get more and more tests.
Another example from the drug industry. Plavix a blood thinner is marginally better than a two cent aspirin - roughly 20% at preventing heart or stroke events in selected patients. Sound like a big difference? We may be talking a reduction in "events" from five per hundred to four per hundred total patients treated. Doesn't sound like as big a gain now does it? The cost between using plavix and aspirin would be huge. State it a different way though and if we treat say one milliion people per year and reduce the "event" rate from 50,000 to 40,000 we could be "preventing" 10,000 more events (stroke, heart attack, death). Now it sounds like alot again. People who push for tiny incrementle gains as being "huge" or great progress are happy to state the statistics either the first or thrid way and always avoid the latter.
To add insult to injury recent publication of an even newer drug then plavix points that it now reduces event rates by again by "20%". Again that sounds like a lot from that point of view. The people on wall street who invest and the bitg shot carediologists who researched the drug make it sound like it is a huge breakthrough (noted is that the newer drug does have an increased risk of bleeding that may hold down use of it to some extent). But the actual reduction number is from around 5.8% to something like 4.5%. So for every hundred people treated we could prevent only *one* more event. The kicker is plavix may go generic in a few years (I am not sure) while this newer drug will of course be mega bucks.
All the cardiologists will of course want and brag how they give there patients the most modern and perfect care without consideration of cost. Patients are fine with this as long as the pill is covered. A few patients will have to pay more for it out of pocket and are willing.
So where does it end?
Answer: it doesn't.
Small incremental gains made in modern medicine have huge costs.
People want to live for ever, everyone one perfect cutting edge care and no one wants to pay for it.
Nothing new.
Now we have a government who believes it is everyone's right to have equal access and equal care.
Yet they can't pay for it either. They even want to extend it to millions of people who don't even belong here.
Their argument/idea is rationed care is smarter care.
There is some truth to that argument. Is it smart to spend endless billions for small incremental gains?
At present the health system says yes.
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I don't doubt Crafty's friend or his example but Dr. CCP's example is more instructive for the health care choices we face.
In the first example we order more tests, receive more treatments and pay far more and receive no gain. In that scenario it was bogus to order the tests, treatments and expenses that yielded no gain so the answer is simple - stop doing it.
CCP's example is far more instructive: Pay a zillion more (rounded numbers) and your chances improve from 5.8 to 4.5 per hundred.
To me the question is not should we pay the zillion to make the one in a hundred improvement, the question is WHO should make that decision.
The more that we can get good information on the choices and their consequences and the more that we pay with our own money, the more accurately we will value that gain in our health or quality of life.
If you ask me how much of YOUR money is it worth to me to improve my chances by one in a hundred, it will be very hard to get a good number.
As Margaret Thatcher said (I think I read it here): The problem with socialism is that you will eventually run out of other people's money.
Remove third party pay as much as possible and the price will likely fall and fall rapidly. Very people will choose to pay the introductory price for such a small gain. Or leave the artificial subsidy and the price stays high or escalates. (cf. college tuition, healthcare costs, 'affordable housing', etc.etc.)
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"The more that we can get good information on the choices and their consequences and the more that we pay with our own money, the more accurately we will value that gain in our health or quality of life"
My little opinion FWIW is that I couldn't agree more.
Instead OBama wants to obtain the information so HE can make the choice for all of us.
And it is THAT reason along with the rest of his big government philosophy that we must stop. It ain't because he is black.
Do any of these idiots in the MSM, Carter, Dowd, and the rest think we who are on the right would be any less fighting mad if the President who was pushing this sutff was a white like Biden, Pelosi, or Reid??
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Long piece examining US mortality rates that concludes mortality is impacted more by lifestyle choices than by medical efficacy.
Abstract
Life expectancy in the United States fares poorly in international comparisons, primarily
because of high mortality rates above age 50. Its low ranking is often blamed on a poor
performance by the health care system rather than on behavioral or social factors. This paper
presents evidence on the relative performance of the US health care system using death
avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well
in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and
strokes, and medication of individuals with high levels of blood pressure or cholesterol. We
consider in greater depth mortality from prostate cancer and breast cancer, diseases for which
effective methods of identification and treatment have been developed and where behavioral
factors do not play a dominant role. We show that the US has had significantly faster declines in
mortality from these two diseases than comparison countries. We conclude that the low longevity
ranking of the United States is not likely to be a result of a poorly functioning health care system.
http://repository.upenn.edu/cgi/viewcontent.cgi?article=1012&context=psc_working_papers
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Second post that interprets the previous piece:
To Explain Longevity Gap, Look Past Health System
By JOHN TIERNEY
If you’re not rich and you get sick, in which industrialized country are you likely to get the best treatment?
The conventional answer to this question has been: anywhere but the United States. With its many uninsured citizens and its relatively low life expectancy, the United States has been relegated to the bottom of international health scorecards.
But a prominent researcher, Samuel H. Preston, has taken a closer look at the growing body of international data, and he finds no evidence that America’s health care system is to blame for the longevity gap between it and other industrialized countries. In fact, he concludes, the American system in many ways provides superior treatment even when uninsured Americans are included in the analysis.
“The U.S. actually does a pretty good job of identifying and treating the major diseases,” says Dr. Preston, a demographer at the University of Pennsylvania who is among the leading experts on mortality rates from disease. “The international comparisons don’t show we’re in dire straits.”
No one denies that the American system has problems, including its extraordinarily high costs and unnecessary treatments. But Dr. Preston and other researchers say that the costs aren’t solely due to inefficiency. Americans pay more for health care partly because they get more thorough treatment for some diseases, and partly because they get sick more often than people in Europe and other industrialized countries.
An American’s life expectancy at birth is about 78 years, which is lower than in most other affluent countries. Life expectancy is about 80 in the United Kingdom, 81 in Canada and France, and 83 in Japan, according to the World Health Organization.
This longevity gap, Dr. Preston says, is primarily due to the relatively high rates of sickness and death among middle-aged Americans, chiefly from heart disease and cancer. Many of those deaths have been attributed to the health care system, an especially convenient target for those who favor a European alternative.
But there are many more differences between Europe and the United States than just the health care system. Americans are more ethnically diverse. They eat different food. They are fatter. Perhaps most important, they used to be exceptionally heavy smokers. For four decades, until the mid-1980s, per-capita cigarette consumption was higher in the United States (particularly among women) than anywhere else in the developed world. Dr. Preston and other researchers have calculated that if deaths due to smoking were excluded, the United States would rise to the top half of the longevity rankings for developed countries.
As it is, the longevity gap starts at birth and persists through middle age, but then it eventually disappears. If you reach 80 in the United States, your life expectancy is longer than in most other developed countries. The United States is apparently doing something right for its aging population, but what?
One frequent answer has been Medicare. Its universal coverage for people over 65 has often been credited with shrinking the longevity gap between the United States and other developed countries.
But when Dr. Preston and a Penn colleague, Jessica Y. Ho, looked at mortality rates in 1965, before Medicare went into effect, they found an even more pronounced version of today’s pattern: middle-aged people died much more often in the United States than in other developed countries, but the longevity gap shrunk with age even faster than today. In that pre-Medicare era, an American who reached 75 could expect to live longer than most people elsewhere.
Besides smoking, there could be lots of other reasons that Americans are especially unhealthy in middle age. But Dr. Preston says he saw no evidence for the much-quoted estimates that poor health care is responsible for more preventable deaths in the United States than in other developed countries. (Go to nytimes.com/tierneylab for details.)
For all its faults, the American system compares well by some important measures with other developed countries, as Dr. Preston and Ms. Ho enumerate. Americans are more likely to be screened for cancer, and once cancer is detected, they are more likely to survive for five years.
It’s been argued that the survival rate for cancer appears longer in America merely because the disease is detected earlier, but Dr. Preston says that earlier detection can be an advantage in itself, and that Americans might also receive better treatment. He and Ms. Ho conclude that the mortality rates from breast cancer and prostate cancer have been declining significantly faster in the United States than in other industrialized countries.
Americans also do relatively well in surviving heart attacks and strokes, and some studies have found that hypertension is treated more successfully in the United States. Compared with Europeans, Americans are more likely to receive medication if they have heart disease, high cholesterol, lung disease or osteoporosis.
But even if the American system does provide more treatment for more sick people, couldn’t it do something to reduce its workload?
When I brought up Dr. Preston’s work to Ellen Nolte and C. Martin McKee, two prominent European critics of the American system, they suggested that he was taking too limited a view of health care. They said the system should take responsibility for preventing disease, not just treating it.
Dr. Preston acknowledges that the United States might do more to keep young and middle-aged people from getting sick, but he says it’s not clear that other countries’ systems are more effective.
“The U.S. has had one spectacular achievement in preventive medicine,” he says. “It has had the largest drop in cigarette consumption per adult of any developed country since 1985.” If Americans keep shunning cigarettes, the longevity gap could shrink no matter what happens with the health care system.
http://www.nytimes.com/2009/09/22/science/22tier.html?_r=3&hpw=&pagewanted=print
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U.S. health insurers say they face gov't gag
By Susan Heavey
Reuters
Tuesday, September 22, 2009 9:14 PM
WASHINGTON (Reuters) - Health insurers accused the U.S. Medicare agency on Tuesday of political interference in a battle over whether the industry can lobby its customers directly over healthcare legislation.
The Centers for Medicare & Medicaid Services (CMS), which oversees the Medicare program for the elderly and disabled as well as privately run Medicare alternatives, said on Monday it was investigating a letter Humana Inc <HUM.N> sent enrollees about efforts to overhaul the nation's healthcare system.
Humana's letter, sent in an envelope citing important plan information, told customers the Democrats' bills could hurt "millions of seniors and disabled individuals could lose many of the important benefits and services that make Medicare Advantage health plans so valuable," according to CMS.
The agency also warned other insurers against sending potentially misleading health reform mailings to customers.
America's Health Insurance Plans, the industry lobby group, called the CMS action a "gag order."
The group argued that any cuts, including those in various Democratic proposals, would raise costs and reduce benefits for those who want private plans.
"Seniors have a right to know how the current reform proposals will affect the coverage they currently like and rely on," said AHIP spokesman Robert Zirkelbach.
Republicans seized on the spat. "It looks likes CMS is engaged in government intimidation, pure and simple," said Representative Dave Camp, the ranking Republican on the U.S. House of Representatives Ways and Means Committee.
Senate Republican Leader Mitch McConnell of Kentucky, where Humana is based, also blasted the CMS "effort to squelch free speech."
A spokesman for Senate Majority Leader Harry Reid said it was "indefensible for insurance companies to send out propaganda" to scare the elderly.
"It's clear that we are closer than ever to meaningful reform because defenders of the status quo are ginning up scare tactics to stand in the way of fixing our broken system," Jim Manley said.
CMS dismissed the criticism, saying it wanted to ensure companies do not violate marketing rules or improperly use protected Medicare mailing lists.
"Our goal is to safeguard beneficiaries' personal information," agency spokesman Peter Ashkenaz told Reuters.
BILL AUTHOR WELCOMES CMS ACTION
Democratic Senator Max Baucus had urged CMS to get involved and later welcomed the investigation of what he called "scare tactics" by Humana.
The Senate Finance Committee that Baucus chairs began work on his health reform bill on Tuesday.
The Wall Street Journal criticized Baucus in an opinion piece, saying he had sicced federal regulators onto Humana for daring to criticize one part of his health bill.
But consumer advocacy groups welcomed the CMS move, saying private Medicare customers should not be directly targeted over political issues.
"It's about time... that CMS is cracking down on plans using their enrollees as a captive audience for their political agenda," said Medicare Rights Center spokesman Paul Precht.
Precht said CMS did not forbid Humana from stating its position. "What they're saying is they cannot send letters to their plan members under the guise of plan communication that is really political propaganda."
CMS warned Humana it would take necessary enforcement action but it is unclear when the investigation will conclude. The company said it is cooperating.
PRIVATE PLANS
Privately run Medicare plans, also known as Medicare Advantage, make up more than 20 percent of Medicare coverage, with more than 10 million elderly or disabled Americans choosing them over government-run fee-for-service plans.
CMS' Ashkenaz said the agency is not yet aware of other companies that have sent direct political mailings to enrollees. Aetna Inc <AET.N>, Cigna Corp <CI.N> and WellPoint Inc <WLP.N> also offer Medicare plans.
Medicare Advantage plans are already under scrutiny because they cost more than traditional Medicare. An advisory group has urged Congress to curb payments to help lower the overall costs of Medicare, which could run out of money as early as 2017.
Representative Camp said AARP, the nation's largest lobby group for older Americans which offers its own Medicare plan with UnitedHealth Group Inc <UNH.N>, touts Democratic healthcare reform efforts on its website.
"CMS may be selectively and inappropriately using its regulatory powers," he wrote in a letter to CMS.
AARP Executive Vice President Nancy LeaMond said her group is a membership organization that regularly advocates on a variety of issues and contacts members accordingly. AARP does not sell insurance directly but lends its name to other plans, she added.
(Additional reporting by Donna Smith, editing by Gerald E. McCormick, Tim Dobbyn, Gary Hill)
http://www.washingtonpost.com/wp-dyn/content/article/2009/09/22/AR2009092203471_pf.html
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I find a lot on the Mises site to be esoteric and often dogmatic, but this presents a exploration of how to deal with the uninsured I hadn't seen and, in doing so, addresses questions Crafty has asked in the past.
Is Emergency Care a Failed Market?
Mises Daily by Eric M. Staib | Posted on 9/24/2009 12:00:00 AM
"Those who are most in need of low-cost care are forced out of the market in the name of social justice."
In response to my recent article on health-insurance mandates, I received many emails from readers who argued that mandates, as unappealing as they may be, are necessary to prevent market failure in emergency medical services.
Specifically, they argued that there is a "free-rider problem" in emergency care because individuals are currently able to visit the emergency room (ER) without insurance or the means to pay, receive care, and then skip out on the bill. Such free riders force the hospital to either accept the losses or spread the costs to other patients. Therefore, the readers reasoned, there is a market failure in that health insurance is under-demanded and ER care is over-demanded, increasing health care costs and dumping them onto those consumers who do purchase insurance and pay for their visits.
As accurate as this common depiction of the symptom is, however, it misdiagnosis the disease. The free-rider problem in ER care is not a market failure, but a government failure. The Hippocratic Oath notwithstanding, hospitals only accept all patients irrespective of their ability to pay because they are required to by government regulations. These laws, which are in place in countries around the planet, result in a simple welfare scheme whereby the costs of the uninsured are transferred to insured patients. With this reality in mind, it is easy to see that the free-rider problem in ER services is not a market failure, but rather a government failure.
A Libertarian Alternative
How, then, would truly free-market hospitals handle patients who are now free riders? There is every reason to expect that these uninsured, mostly low-income people would be treated more humanely and with greater dignity than they are in the current quasi-socialist system.
Without government regulations on their payment collection methods, hospitals would be free to offer more flexible prices and payment options, and to negotiate contracts with individual consumers. Those patients with little financial leverage would be able to form creative payment plans, and those without any savings or insurance could even contract to pay for their services with labor.
Furthermore, in a truly free market for medical care, even patients who intentionally try to skip payments and thus dump the costs on others cannot. This is because, in the absence of supposedly compassionate hospital legislation, to admit oneself or someone else to emergency care is to agree to the terms and conditions of service at that hospital — most importantly, to pay for treatment.
Thus, in the libertarian society, checking out without arranging payment would constitute a violation of contract, and therefore these malicious free riders would be held accountable. In the current situation, however, such predatory patients are subsidized by others in the name of social compassion.
Another advantage of contractual enforcement of payment for ER services on the free market is that it removes hospitals from financial responsibility for those patients who are admitted to the ER by another party while incapacitated. Which party will be held responsible for the hospital bill in each case would be decided by negotiation between the two parties and perhaps even by court arbitration. Which party eventually pays is not important for this matter, though; what matters is that the hospital will be paid either way, and that other patients will no longer be stuck with the bill.
Now that we've seen that the free rider problem does not exist in a free market for medical care, we can address other readers' concern that the profit-driven market process is unsympathetic to the suffering of those patients who are truly unable to pay in any way and can't afford market insurance, but who shouldn't simply be left to suffer.
The Market for Free Riders?
To argue that the market discards those it regards as undesirable is to both ignore the prevalence of private charity and deny the existence of the entire public-relations industry. Indeed, setting socialist doctrines aside, we can see that affectionate treatment of the poor and downtrodden is actually a very profitable endeavor.
In every market, firms of all sizes expend resources to maintain a positive public image. There are few actions better received by a community than healing and treating their vulnerable and disabled at a discounted or zero price. As such, it is absolutely foolish to believe that hospitals would not take in such customers for treatment.
In fact, if we examine the nature of prices and income differentials closely, we arrive at another instance of destructive government intervention. Price discrimination of almost every form is illegal in almost every market, and health care is certainly no exception.
Price discrimination may feel unfair, but if allowed by law it can lead to much more efficient market outcomes and higher market quantities of all goods and services. Using price discrimination, hospitals would be free to provide additional and cheaper services to low-income consumers without decreasing the price for high-income consumers.
Price discrimination would benefit the hospitals as well, because they would not only increase the quantity of services they perform and add potentially loyal new customers, but would also be able to increase the price of services to their high-income patients without losing their business.
Viewing the converse of this market outcome, then, we can observe that laws against price-fixing necessarily decrease quantities of goods and services, and squeeze marginal consumers out of the market. In the health care market, this means that those who are most in need of low-cost care are forced out of the market in the name of social justice.
In contemplating competition between medical service providers, we can deduce that the market will indeed treat people who are now free riders with dignity, but that those consumers will no longer actually be free riding on others. Instead, they will provide a valuable good to society — namely, the satisfaction that comes with supporting others in their time of need. While it may seem strange to think of this as an economic good, it certainly is, as evidenced by consumers' willingness to forgo other forms of consumption in favor of charity.
While caring for these patients would still redistribute costs to other consumers, it would do so only to the extent that these paying consumers would tolerate it by continuing to purchase care and services. That is to say that consumers' choices between competing hospitals' services would, just as in any market, force those hospitals to provide equilibrium quantities of charitable care.
This efficient market quantity would therefore be determined by the charitable inclinations of insured and higher-income patients. And in a truly libertarian market, which would lack taxes, we can say that these individuals would inarguably be more giving of their own income.
Perhaps the best feature of the free-market process in a libertarian health market is that it would allocate charitable funds to their best use. In our emergency services case, this axiom of market behavior implies that hospitals will spend their charity budgets on the most destitute and impoverished patients.
Whereas government funds are allocated according to political cronyism and electoral opportunism, free-market hospitals will always attempt to maximize the benefit to their public image — nothing more than profit maximization — by providing for those patients who are most in need.
Conclusion
With rigorous examination, we can see that emergency medical services function like any other market, and that the free-rider problem is the result of a government failure. Furthermore, we can safely expect that the free market would treat the most deserving of these free riders more humanely than does the supposedly compassionate central health administration.
http://mises.org/story/3699
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The Baucus Health Bill: A Medicare Physician Payment Shell Game
by Dennis G. Smith
WebMemo #2629
My colleagues, this is our opportunity to make history. Our actions here, this week, will determine whether we are courageous enough and skillful enough to change things for the better.
--Senator Max Baucus, addressing the Senate Finance Committee on September 22, 2009
For all of the bold talk of reform, the provisions of the Senate Finance Committee bill are simply more of the same. This is evident in the way the committee is evading the systemic problems that Congress created with its updates to its flawed Medicare physician fee schedule.
Since the federal government apparently cannot ensure beneficiary access in the current Medicare program--and since government price controls like those used in Medicare do not work--trapping more Americans into such a system through a government health insurance plan does not make sense.
Medicare Payment Update
Medicare reimburses doctors and other medical professionals for their services according to a congressionally created fee schedule that is annually adjusted by the Sustainable Growth Rate (SGR) formula. Enacted in the 1990s, the SGR is primary evidence of how Congress tries and ultimately fails to "bend the curve" of the health care costs in Medicare.
The idea is relatively simple: If Medicare spending grows faster than our overall economy (which is almost always the case), then payments to Medicare providers are to be reduced proportionately to keep expenditures in line over a period of time. Each year, the Centers for Medicare and Medicaid Services estimates how much the physician fee schedule update will have to be reduced the following year in order to meet the target Medicare expenditures on physician payment. The 2010 update, for instance, reflects expenditures from April 1, 1996, to December 31, 2009.
A Political Volcano
If the SGR update goes into effect in 2010 as planned under current law, it will result in massive Medicare payment cuts. But every year, Congress--under both Democratic and Republican leadership--routinely blocks the cuts from going into effect for a year or two at a time. At the same time, House and Senate leaders have left intact the underlying requirement to keep doctor payment below the rate of GDP growth.
Subsequently, the necessary cumulative cut in Medicare payments grows bigger. Without a change to current law, payments to physicians would be reduced by 21.5 percent as of January 1, 2010, and by an additional 5.5 percent each year from 2011 through 2014 (and a small reduction in 2015).[1]
The Baucus Proposal
In his opening statement to the Senate Finance Committee on September 22, Chairman Baucus acknowledged the failure to address the problem: "On one point, I want to acknowledge up front that we did not do as much to correct the payment of doctors under the incredibly misnamed 'Sustainable Growth Rate.' The SGR needs to be fixed permanently."[2]
But instead of fixing the SGR, the Senate Finance Committee bill repeats the prior pattern by providing a payment increase for 2010 and then pretending it did not happen. The reason for this one-year change in the update is obvious: Fixing the problem long-term would cost $200 billion over 10 years.[3] Steny Hoyer (D-MD), the House majority leader, rightfully called the Senate Finance Committee proposal a façade.[4]
Earlier this summer, the American Medical Association told its members that Congress would "erase" the SGR problem.[5] Fat chance.
The Price of Price Controls
The SGR issue should be appropriately viewed as a microcosm of current efforts to overhaul the health care system. The inclusion of the SGR provisions in the Senate and House bills is a tactical admission that Medicare beneficiaries' access to care is being threatened--potentially a form of rationing. Two years ago, when proposed SGR reductions were more modest than they are now, a poll of physicians found that 60 percent would limit the number of Medicare patients they accept and 14 percent would stop seeing Medicare patients entirely if these cuts went into effect.[6]
The SGR does not even accomplish the objective it was created to achieve: to bend the cost curve in Medicare. Payments to physicians continue to exceed overall economic growth. Two years ago, Dr. Cecil B Wilson testified that "spending targets cannot achieve their goal of restraining volume growth by discouraging inappropriate care. Spending targets apply to a whole group and, therefore, do not provide an incentive at the individual physician level to control spending. In addition, they do not distinguish between appropriate and inappropriate growth because they apply across-the-board to all services. In addition, spending target systems are based on the fallacious premise that physicians alone can control the utilization of health care services, while ignoring patient demand, government policies, technological advances, epidemics, disasters, and the many other contributors to volume growth."[7]
Special Interest Lobbies
In addition to the budget problem, fixing the SGR poses a problem for seniors as well. Physicians are paid out of Medicare Part B, the Supplementary Medical Insurance Trust Fund (SMI) portion of Medicare. Even though SMI is heavily subsidized by taxpayers, non-disabled Medicare enrollees are required to pay 25 percent of Part B costs. (Originally, beneficiaries paid 50 percent of the costs.) So if physician payments go up, the cost of the entire program goes up, increasing the amount of the 25 percent share that beneficiaries must pay.
Congress enacted a temporary "hold harmless" provision to shield most seniors from a premium increase in 2010 because they will not receive an increase in their Social Security benefits. The cost, however, is passed along to other Medicare beneficiaries. Of course, now that that reality approaches, Congress is considering spending another $2 billion to pick up the tab.
Central Planning Failures
As SGR and the history of Medicare demonstrate, the federal government has constantly intervened in the payment systems and increased massive cost shifting. The classic scenario is constantly repeated: Politicians over-promise (more benefits, lower costs to the beneficiary), the budget hemorrhages, politicians apply a tourniquet to stop the fiscal bleeding, and the short-term fixes create even greater long term problems.
History, not hysteria, is why so many Americans (especially seniors) are skeptical of the political promises of more while achieving budget neutrality. Government cannot deliver more services for less than the value of what is being provided. Government surpasses the private sector only in its ability to hide the true cost by forcing someone else to pick up the tab. Someone has to pay, which means politicians are constantly trying to pass the burden around like a hot potato among providers, beneficiaries, current taxpayers, and future taxpayers. Whoever is left with the unwanted cost protests, and the contest starts all over again.
The very idea that government is more efficient than the private sector is comical. Why did so many state and local governments get out of the direct delivery of health care services in the 1960s and 1970s? Because of government inefficiencies.
Medicare's SGR problem is another chapter in the big book of government central planning, an epic failure and a fountain of unintended consequences.
Dennis G. Smith is Senior Fellow in the Center for Health Policy Studies at The Heritage Foundation.
[1]2009 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, May 12, 2009, p. 22, at http://www.cms.hhs.gov/reportstrustfunds/downloads/tr2009.pdf (September 24, 2009).
[2]Press release, "Opening Statement of Senator Max Baucus (D-Mont.) at Today's Mark-Up of the America's Healthy Future Act," September 22, 2009, at http://finance.senate.gov/hearings/statements/092209mb.pdf (September 25, 2009).
[3]Douglas W. Elmendorf, director, Congressional Budget Office, letter to Charles B. Rangel, chairman, Committee on Ways and Means, U.S. House of Representatives, July 17, 2009, at http://www.cbo.gov/ftpdocs/104xx/doc10464/hr3200.pdf (September 25, 2009).
[4]Corey Boles, "Rep Hoyer Calls for 10-Year Fix for Medicare Payments," Nasdaq.com, September 22, 2009, at http://www.nasdaq.com/aspx/stock
-market-news-story.aspx?storyid=200909221654dowjonesdjonline000425&t
itle=update-rep-hoyer-calls-for-10-year-fix-for-medicare-payments (September 25, 2009).
[5]American Medical Association, "AMA Support for H.R. 3200: Answers to Frequently Asked Questions," July 20, 2009, at http://www.dcmsonline.org
/HR3200FAQs_72009_AMA.pdf (September 24, 2009).
[6]Medical News Today, "60% of Physicians Would Limit Number of New Medicare Patients If Scheduled Payment Cut Is Enacted, AMA Survey Finds," June 7, 2007, at http://www.medicalnewstoday.com/articles/73237.php (September 24, 2009).
[7]Ibid.
http://www.heritage.org/Research/HealthCare/wm2629.cfm
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Wow. Simply wow. If you only read one more article about healthcare, let it be this one.
After the needless death of his father, the author, a business executive, began a personal exploration of a health-care industry that for years has delivered poor service and irregular quality at astonishingly high cost. It is a system, he argues, that is not worth preserving in anything like its current form. And the health-care reform now being contemplated will not fix it. Here’s a radical solution to an agonizing problem.
by David Goldhill
How American Health Care Killed My Father
Illustration by Mark Hooper
ALMOST TWO YEARS ago, my father was killed by a hospital-borne infection in the intensive-care unit of a well-regarded nonprofit hospital in New York City. Dad had just turned 83, and he had a variety of the ailments common to men of his age. But he was still working on the day he walked into the hospital with pneumonia. Within 36 hours, he had developed sepsis. Over the next five weeks in the ICU, a wave of secondary infections, also acquired in the hospital, overwhelmed his defenses. My dad became a statistic—merely one of the roughly 100,000 Americans whose deaths are caused or influenced by infections picked up in hospitals. One hundred thousand deaths: more than double the number of people killed in car crashes, five times the number killed in homicides, 20 times the total number of our armed forces killed in Iraq and Afghanistan. Another victim in a building American tragedy.
About a week after my father’s death, The New Yorker ran an article by Atul Gawande profiling the efforts of Dr. Peter Pronovost to reduce the incidence of fatal hospital-borne infections. Pronovost’s solution? A simple checklist of ICU protocols governing physician hand-washing and other basic sterilization procedures. Hospitals implementing Pronovost’s checklist had enjoyed almost instantaneous success, reducing hospital-infection rates by two-thirds within the first three months of its adoption. But many physicians rejected the checklist as an unnecessary and belittling bureaucratic intrusion, and many hospital executives were reluctant to push it on them. The story chronicled Pronovost’s travels around the country as he struggled to persuade hospitals to embrace his reform.
It was a heroic story, but to me, it was also deeply unsettling. How was it possible that Pronovost needed to beg hospitals to adopt an essentially cost-free idea that saved so many lives? Here’s an industry that loudly protests the high cost of liability insurance and the injustice of our tort system and yet needs extensive lobbying to embrace a simple technique to save up to 100,000 people.
And what about us—the patients? How does a nation that might close down a business for a single illness from a suspicious hamburger tolerate the carnage inflicted by our hospitals? And not just those 100,000 deaths. In April, a Wall Street Journal story suggested that blood clots following surgery or illness, the leading cause of preventable hospital deaths in the U.S., may kill nearly 200,000 patients per year. How did Americans learn to accept hundreds of thousands of deaths from minor medical mistakes as an inevitability?
My survivor’s grief has taken the form of an obsession with our health-care system. For more than a year, I’ve been reading as much as I can get my hands on, talking to doctors and patients, and asking a lot of questions.
Keeping Dad company in the hospital for five weeks had left me befuddled. How can a facility featuring state-of-the-art diagnostic equipment use less-sophisticated information technology than my local sushi bar? How can the ICU stress the importance of sterility when its trash is picked up once daily, and only after flowing onto the floor of a patient’s room? Considering the importance of a patient’s frame of mind to recovery, why are the rooms so cheerless and uncomfortable? In whose interest is the bizarre scheduling of hospital shifts, so that a five-week stay brings an endless string of new personnel assigned to a patient’s care? Why, in other words, has this technologically advanced hospital missed out on the revolution in quality control and customer service that has swept all other consumer-facing industries in the past two generations?
I’m a businessman, and in no sense a health-care expert. But the persistence of bad industry practices—from long lines at the doctor’s office to ever-rising prices to astonishing numbers of preventable deaths—seems beyond all normal logic, and must have an underlying cause. There needs to be a business reason why an industry, year in and year out, would be able to get away with poor customer service, unaffordable prices, and uneven results—a reason my father and so many others are unnecessarily killed.
Like every grieving family member, I looked for someone to blame for my father’s death. But my dad’s doctors weren’t incompetent—on the contrary, his hospital physicians were smart, thoughtful, and hard-working. Nor is he dead because of indifferent nursing—without exception, his nurses were dedicated and compassionate. Nor from financial limitations—he was a Medicare patient, and the issue of expense was never once raised. There were no greedy pharmaceutical companies, evil health insurers, or other popular villains in his particular tragedy.
Indeed, I suspect that our collective search for villains—for someone to blame—has distracted us and our political leaders from addressing the fundamental causes of our nation’s health-care crisis. All of the actors in health care—from doctors to insurers to pharmaceutical companies—work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate ensurer of value.
These are the impersonal forces, I’ve come to believe, that explain why things have gone so badly wrong in health care, producing the national dilemma of runaway costs and poorly covered millions. The problems I’ve explored in the past year hardly count as breakthrough discoveries—health-care experts undoubtedly view all of them as old news. But some experts, it seems, have come to see many of these problems as inevitable in any health-care system—as conditions to be patched up, papered over, or worked around, but not problems to be solved.
That’s the premise behind today’s incremental approach to health-care reform. Though details of the legislation are still being negotiated, its principles are a reprise of previous reforms—addressing access to health care by expanding government aid to those without adequate insurance, while attempting to control rising costs through centrally administered initiatives. Some of the ideas now on the table may well be sensible in the context of our current system. But fundamentally, the “comprehensive” reform being contemplated merely cements in place the current system—insurance-based, employment-centered, administratively complex. It addresses the underlying causes of our health-care crisis only obliquely, if at all; indeed, by extending the current system to more people, it will likely increase the ultimate cost of true reform.
I’m a Democrat, and have long been concerned about America’s lack of a health safety net. But based on my own work experience, I also believe that unless we fix the problems at the foundation of our health system—largely problems of incentives—our reforms won’t do much good, and may do harm. To achieve maximum coverage at acceptable cost with acceptable quality, health care will need to become subject to the same forces that have boosted efficiency and value throughout the economy. We will need to reduce, rather than expand, the role of insurance; focus the government’s role exclusively on things that only government can do (protect the poor, cover us against true catastrophe, enforce safety standards, and ensure provider competition); overcome our addiction to Ponzi-scheme financing, hidden subsidies, manipulated prices, and undisclosed results; and rely more on ourselves, the consumers, as the ultimate guarantors of good service, reasonable prices, and sensible trade-offs between health-care spending and spending on all the other good things money can buy.
These ideas stand well outside the emerging political consensus about reform. So before exploring alternative policies, let’s reexamine our basic assumptions about health care—what it actually is, how it’s financed, its accountability to patients, and finally its relationship to the eternal laws of supply and demand. Everyone I know has at least one personal story about how screwed up our health-care system is; before spending (another) $1trillion or so on reform, we need a much clearer understanding of the causes of the problems we all experience.
Illustration by Stephen Savage
Health Care Isn’t Health (Or Happiness)
“Money is honey,” my grandmother used to tell me, “but health is wealth.” She said “health,” not “health care.” Listening to debates over health-care reform, it is sometimes difficult to remember that there is a difference.
Medical care, of course, is merely one component of our overall health. Nutrition, exercise, education, emotional security, our natural environment, and public safety may now be more important than care in producing further advances in longevity and quality of life. (In 2005, almost half of all deaths in the U.S. resulted from heart disease, diabetes, lung cancer, homicide, suicide, and accidents—all of which are arguably influenced as much by lifestyle choices and living environment as by health care.) And of course even health itself is only one aspect of personal fulfillment, alongside family and friends, travel, recreation, the pursuit of knowledge and experience, and more.
Yet spending on health care, by families and by the government, is crowding out spending on almost everything else. As a nation, we now spend almost 18 percent of our GDP on health care. In 1966, Medicare and Medicaid made up 1 percent of total government spending; now that figure is 20 percent, and quickly rising. Already, the federal government spends eight times as much on health care as it does on education, 12 times what it spends on food aid to children and families, 30 times what it spends on law enforcement, 78 times what it spends on land management and conservation, 87 times the spending on water supply, and 830 times the spending on energy conservation. Education, public safety, environment, infrastructure—all other public priorities are being slowly devoured by the health-care beast.
It’s no different for families. From 2000 to 2008, the U.S. economy grew by $4.4 trillion; of that growth, roughly one out of every four dollars was spent on health care. Household expenditures on health care already exceed those on housing. And health care’s share is growing.
By what mechanism does society determine that an extra, say, $100 billion for health care will make us healthier than even $10 billion for cleaner air or water, or $25 billion for better nutrition, or $5 billion for parks, or $10 billion for recreation, or $50 billion in additional vacation time—or all of those alternatives combined?
The answer is, no mechanism at all. Health care simply keeps gobbling up national resources, seemingly without regard to other societal needs; it’s treated as an island that doesn’t touch or affect the rest of the economy. As new tests and treatments are developed, they are, for the most part, added to our Medicare or commercial insurance policies, no matter what they cost. But of course the money must come from somewhere. If the amount we spend on care had grown only at the general rate of inflation since 1970, annual health-care costs now would be roughly $5,000 less per American—that’s about 10 percent of today’s median income, to invest for the future or to spend on all the other things that contribute to our well-being. To be sure, our society has become wealthier over the years, and we’d naturally want to spend some of this new wealth on more and better health care; but how did we choose to spend this much?
The housing bubble offers some important lessons for health-care policy. The claim that something—whether housing or health care—is an undersupplied social good is commonly used to justify government intervention, and policy makers have long striven to make housing more affordable. But by making housing investments eligible for special tax benefits and subsidized borrowing rates, the government has stimulated not only the construction of more houses but also the willingness of people to borrow and spend more on houses than they otherwise would have. The result is now tragically clear.
As with housing, directing so much of society’s resources to health care is stimulating the provision of vastly more care. Along the way, it’s also distorting demand, raising prices, and making us all poorer by crowding out other, possibly more beneficial, uses for the resources now air-dropped onto the island of health care. Why do we view health care as disconnected from everything else? Why do we spend so much on it? And why, ultimately, do we get such inconsistent results? Any discussion of the ills within the system must begin with a hard look at the tax-advantaged comprehensive-insurance industry at its center.
Health Insurance Isn’t Health Care
How often have you heard a politician say that millions of Americans “have no health care,” when he or she meant they have no health insurance? How has a method of financing health care become synonymous with care itself?
The reason for financing at least some of our health care with an insurance system is obvious. We all worry that a serious illness or an accident might one day require urgent, extensive care, imposing an extreme financial burden on us. In this sense, health-care insurance is just like all other forms of insurance—life, property, liability—where the many who face a risk share the cost incurred by the few who actually suffer a loss.
But health insurance is different from every other type of insurance. Health insurance is the primary payment mechanism not just for expenses that are unexpected and large, but for nearly all health-care expenses. We’ve become so used to health insurance that we don’t realize how absurd that is. We can’t imagine paying for gas with our auto-insurance policy, or for our electric bills with our homeowners insurance, but we all assume that our regular checkups and dental cleanings will be covered at least partially by insurance. Most pregnancies are planned, and deliveries are predictable many months in advance, yet they’re financed the same way we finance fixing a car after a wreck—through an insurance claim.
Comprehensive health insurance is such an ingrained element of our thinking, we forget that its rise to dominance is relatively recent. Modern group health insurance was introduced in 1929, and employer-based insurance began to blossom during World War II, when wage freezes prompted employers to expand other benefits as a way of attracting workers. Still, as late as 1954, only a minority of Americans had health insurance. That’s when Congress passed a law making employer contributions to employee health plans tax-deductible without making the resulting benefits taxable to employees. This seemingly minor tax benefit not only encouraged the spread of catastrophic insurance, but had the accidental effect of making employer-funded health insurance the most affordable option (after taxes) for financing pretty much any type of health care. There was nothing natural or inevitable about the way our system developed: employer-based, comprehensive insurance crowded out alternative methods of paying for health-care expenses only because of a poorly considered tax benefit passed half a century ago.
In designing Medicare and Medicaid in 1965, the government essentially adopted this comprehensive-insurance model for its own spending, and by the next year had enrolled nearly 12 percent of the population. And it is no coinci dence that the great inflation in health-care costs began soon after. We all believe we need comprehensive health insurance because the cost of care—even routine care—appears too high to bear on our own. But the use of insurance to fund virtually all care is itself a major cause of health care’s high expense.
Insurance is probably the most complex, costly, and distortional method of financing any activity; that’s why it is otherwise used to fund only rare, unexpected, and large costs. Imagine sending your weekly grocery bill to an insurance clerk for review, and having the grocer reimbursed by the insurer to whom you’ve paid your share. An expensive and wasteful absurdity, no?
Is this really a big problem for our health-care system? Well, for every two doctors in the U.S., there is now one health-insurance employee—more than 470,000 in total. In 2006, it cost almost $500 per person just to administer health insurance. Much of this enormous cost would simply disappear if we paid routine and predictable health-care expenditures the way we pay for everything else—by ourselves.
Illustration by Stephen Savage
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The Moral-Hazard Economy
Society’s excess cost from health insurance’s administrative expense pales next to the damage caused by “moral hazard”—the tendency we all have to change our behavior, becoming spendthrifts and otherwise taking less care with our decisions, when someone else is covering the costs. Needless to say, much medical care is unavoidable; we don’t choose to become sick, nor do we seek more treatment than we think we need. Still, hospitals, drug companies, health insurers, and medical-device manufacturers now spend roughly $6 billion a year on advertising. If the demand for health care is purely a response to unavoidable medical need, why do these companies do so much advertising?
Medical ads on TV typically inform the viewer that a specific treatment—a drug, device, surgical procedure—is available for a chronic condition. Many also note that the product or treatment is eligible for Medicare or private-insurance reimbursement. In some cases, the advertiser will offer to help the patient obtain that reimbursement. The key message: you can benefit from this product and pass the bill on to someone else.
Every time you walk into a doctor’s office, it’s implicit that someone else will be paying most or all of your bill; for most of us, that means we give less attention to prices for medical services than we do to prices for anything else. Most physicians, meanwhile, benefit financially from ordering diagnostic tests, doing procedures, and scheduling follow-up appointments. Combine these two features of the system with a third—the informational advantage that extensive training has given physicians over their patients, and the authority that advantage confers—and you have a system where physicians can, to some extent, generate demand at will.
Do they? Well, Medicare spends almost twice as much per patient in Dallas, where there are more doctors and care facilities per resident, as it does in Salem, Oregon, where supply is tighter. Why? Because doctors (particularly specialists) in surplus areas order more tests and treatments per capita, and keep their practices busy. Many studies have shown that the patients in areas like Dallas do not benefit in any measurable way from all this extra care. All of the physicians I know are genuinely dedicated to their patients. But at the margin, all of us are at least subconsciously influenced by our own economic interests. The data are clear: in our current system, physician supply often begets patient demand.
Moral hazard has fostered an accidental collusion between providers benefiting from higher costs and patients who don’t fully bear them. In this environment, trying to control costs is awfully tough. When Medicare cut reimbursement rates in 2005 on chemotherapy and anemia drugs, for instance, it saved almost 20 percent of the previously billed costs. But Medicare’s total cancer-treatment costs actually rose almost immediately. As The New York Times reported, some physicians believed their colleagues simply performed more treatments, particularly higher-profit ones.
Want further evidence of moral hazard? The average insured American and the average uninsured American spend very similar amounts of their own money on health care each year—$654 and $583, respectively. But they spend wildly different amounts of other people’s money—$3,809 and $1,103, respectively. Sometimes the uninsured do not get highly beneficial treatments because they cannot afford them at today’s prices—something any reform must address. But likewise, insured patients often get only marginally beneficial (or even outright unnecessary) care at mind-boggling cost. If it’s true that the insurance system leads us to focus on only our direct share of costs—rather than the total cost to society—it’s not surprising that insured families and uninsured ones would make similar decisions as to how much of their own money to spend on care, but very different decisions on the total amount to consume.
The unfortunate fact is, health-care demand has no natural limit. Our society will always keep creating new treatments to cure previously incurable problems. Some of these will save lives or add productive years to them; many will simply make us more comfortable. That’s all to the good. But the cost of this comfort, and whether it’s really worthwhile, is never calculated—by anyone. For almost all our health-care needs, the current system allows us as consumers to ask providers, “What’s my share?” instead of “How much does this cost?”—a question we ask before buying any other good or service. And the subtle difference between those two questions is costing us all a fortune.
There’s No One Else to Pay the Bill
Perhaps the greatest problem posed by our health-insurance-driven regime is the sense it creates that someone else is actually paying for most of our health care—and that the costs of new benefits can also be borne by someone else. Unfortunately, there is no one else.
For fun, let’s imagine confiscating all the profits of all the famously greedy health-insurance companies. That would pay for four days of health care for all Americans. Let’s add in the profits of the 10 biggest rapacious U.S. drug companies. Another 7 days. Indeed, confiscating all the profits of all American companies, in every industry, wouldn’t cover even five months of our health-care expenses.
Somebody else always seems to be paying for at least part of our health care. But that’s just an illusion. At $2.4 trillion and growing, our nation’s health-care bill is too big to be paid by anyone other than all of us.
In 2007, employer-based health insurance cost, on average, more than $12,000 per family, up 78 percent since 2001. I’ve run several companies and company divisions of various sizes over the course of my career, so I can confidently tell you that raises (and even entry-level hiring) are tightly limited by rising health-care costs. You may think your employer is paying for your health care, but in fact your company’s share of the insurance premium comes out of your potential wage increase. Where else could it come from?
Let’s say you’re a 22-year-old single employee at my company today, starting out at a $30,000 annual salary. Let’s assume you’ll get married in six years, support two children for 20 years, retire at 65, and die at 80. Now let’s make a crazy assumption: insurance premiums, Medicare taxes and premiums, and out-of-pocket costs will grow no faster than your earnings—say, 3 percent a year. By the end of your working days, your annual salary will be up to $107,000. And over your lifetime, you and your employer together will have paid $1.77 million for your family’s health care. $1.77 million! And that’s only after assuming the taming of costs! In recent years, health-care costs have actually grown 2 to 3 percent faster than the economy. If that continues, your 22-year-old self is looking at an additional $2 million or so in expenses over your lifetime—roughly $4 million in total.
Would you have guessed these numbers were so large? If not, you have good cause: only a quarter would be paid by you directly (and much of that after retirement). The rest would be spent by others on your behalf, deducted from your earnings before you received your paycheck. And that’s a big reason why our health-care system is so expensive.
The Government Is Not Good at Cost Reduction
Every proposal for health-care reform has featured some element of cost control to “balance” the inflationary impact of expanding access. Yet it goes without saying that in the big picture, all government efforts to control costs have failed.
Why? One reason is a fixation on prices rather than costs. The government regularly tries to cap costs by limiting the reimbursement rates paid to providers by Medicare and Medicaid, and generally pays much less for each service than private insurers. But as we’ve seen, that can lead providers to perform more services, and to steer patients toward higher-priced, more lightly regulated treatments. The government’s efforts to expand “access” to care while limiting costs are like blowing up a balloon while simultaneously squeezing it. The balloon continues to inflate, but in misshapen form.
Cost control is a feature of decentralized, competitive markets, not of centralized bureaucracy—a matter of incentives, not mandates. What’s more, cost control is dynamic. Even the simplest business faces constant variation in its costs for labor, facilities, and capital; to compete, management must react quickly, efficiently, and, most often, prospectively. By contrast, government bureaucracies set regulations and reimbursement rates through carefully evaluated and broadly applied rules. These bureaucracies first must notice market changes and resource misallocations, and then (sometimes subject to political considerations) issue additional regulations or change reimbursement rates to address each problem retrospectively.
As a result, strange distortions crop up constantly in health care. For example, although the population is rapidly aging, we have few geriatricians—physicians who address the cluster of common patient issues related to aging, often crossing traditional specialty lines. Why? Because under Medicare’s current reimbursement system (which generally pays more to physicians who do lots of tests and procedures), geriatricians typically don’t make much money. If seniors were the true customers, they would likely flock to geriatricians, bidding up their rates—and sending a useful signal to medical-school students. But Medicare is the real customer, and it pays more to specialists in established fields. And so, seniors often end up overusing specialists who are not focused on their specific health needs.
Many reformers believe if we could only adopt a single-payer system, we could deliver health care more cheaply than we do today. The experience of other developed countries suggests that’s true: the government as single payer would have lower administrative costs than private insurers, as well as enormous market clout and the ability to bring down prices, although at the cost of explicitly rationing care.
But even leaving aside the effects of price controls on innovation and customer service, today’s Medicare system should leave us skeptical about the long-term viability of that approach. From 2000 to 2007, despite its market power, Medicare’s hospital and physician reimbursements per enrollee rose by 5.4 percent and 8.5 percent, respectively, per year. As currently structured, Medicare is a Ponzi scheme. The Medicare tax rate has been raised seven times since its enactment, and almost certainly will need to be raised again in the next decade. The Medicare tax contributions and premiums that today’s beneficiaries have paid into the system don’t come close to fully funding their care, which today’s workers subsidize. The subsidy is getting larger even as it becomes more difficult to maintain: next year there will be 3.7 working people for each Medicare beneficiary; if you’re in your mid-40s today, there will be only 2.4 workers to subsidize your care when you hit retirement age. The experience of other rich nations should also make us skeptical. Whatever their histories, nearly all developed countries are now struggling with rapidly rising health-care costs, including those with single-payer systems. From 2000 to 2005, per capita health-care spending in Canada grew by 33 percent, in France by 37 percent, in the U.K. by 47 percent—all comparable to the 40 percent growth experienced by the U.S. in that period. Cost control by way of bureaucratic price controls has its limits.
Uncompetitive
In 2007, health companies in the Fortune 1,000 earned $71 billion. Of the 52 industries represented on Fortune’s list, pharmaceuticals and medical equipment ranked third and fourth, respectively, in terms of profits as a share of revenue. From 2000 to 2007, the annual profits of America’s top 15 health-insurance companies increased from $3.5 billion to $15 billion.
In competitive markets, high profits serve an important social purpose: encouraging capital to flow to the production of a service not adequately supplied. But as long as our government shovels ever-greater resources into health care with one hand, while with the other restricting competition that would ensure those resources are used efficiently, sustained high profits will be the rule.
Health care is an exceptionally heavily regulated industry. Health-insurance companies are regulated by states, which limits interstate competition. And many of the materials, machines, and even software programs used by health-care facilities must be licensed by state or federal authorities, or approved for use by Medicare; these requirements form large barriers to entry for both new facilities and new vendors that could equip and supply them.
Many health-care regulations are justified as safety precautions. But many also result from attempts to redress the distortions that our system of financing health care has created. And whatever their purpose, almost all of these regulations can be shaped over time by the powerful institutions that dominate the health-care landscape, and that are often looking to protect themselves from competition.
Take the ongoing battle between large integrated hospitals and specialty clinics (for cardiac surgery, orthopedics, maternity, etc.). The economic threat posed by these facilities is well illustrated by a recent battle in Loma Linda, California. When a group of doctors proposed a 28-bed private specialty facility, the local hospitals protested to the city council that it was unnecessary, and launched a publicity campaign to try to block it; the council backed the facility anyway. So the nonprofit Loma Linda University Medical Center simply bought the new facility for $80 million in 2008. Traditional hospitals got Congress to include an 18-month moratorium on new specialty hospitals in the 2003 Medicare law, and a second six-month ban in 2005.
The hospitals’ argument has some merit: less complicated surgical cases (the kind specialty clinics typically take on) tend to be more profitable than complex surgeries and nonsurgical admissions. Without those profitable cases, hospitals can’t subsidize the cases on which they lose money. But why are simple surgeries more profitable? Because of the nonmarket methods by which Medicare sets prices.
The net effect of the endless layers of health-care regulation is to stifle competition in the classic economic sense. What we have instead is a noncompetitive system where services and reimbursement are negotiated above consumers’ heads by large private and government institutions. And the primary goal of any large noncompetitive institution is not cost control or product innovation or customer service: it’s maintenance of the status quo.
Our Favored Hospitals
In 1751, Benjamin Franklin and Dr. Thomas Bond founded Pennsylvania Hospital, the first in America, “to care for the sick-poor and insane who were wandering the streets of Philadelphia.” Since then, hospitals have come to dominate the American medical landscape. Yet in recent decades, the rationale for concentrating so much care under one roof has diminished steadily. Many hospitals still exist in their current form largely because they are protected by regulation and favored by government payment policies, which effectively maintain the existing industrial structure, rather than encouraging innovation.
Between 1970 and 2006, annual Medicare payments to hospitals grew by roughly 3,800 percent, from $5 billion to $192 billion. Total annual hospital-care costs for all patients grew from $28 billion to almost $650 billion during that same period. Since 1975, hospitals’ enormous revenue growth has occurred despite a 35 percent decline in the number of hospital beds, no meaningful increase in total admissions, and an almost 50 percent decline in the average length of stay. High-tech equipment has been dispersed to medical practices, recovery periods after major procedures have shrunk, and pharmaceutical therapies have grown in importance, yet over the past 40 years, hospitals have managed to retain the same share (roughly one-third) of our nation’s health-care bill.
Hospitals have sought to use the laws and regulations originally designed to serve patients to preserve their business model. Their argument is the same one that’s been made before by regulated railroads, electric utilities, airlines, Ma Bell, and banks: new competitors, they say, are using their cost advantages to skim off the best customers; without those customers, the incumbents will no longer be able to subsidize essential services that no one can profitably provide to the public.
Hospitals are indeed required to provide emergency care to any walk-in patient, and this obligation is a meaningful public service. But how do we know whether the charitable benefit from this requirement justifies the social cost of expensive hospital care and poor quality? We don’t know. Our system of health-care law and regulation has so distorted the functioning of the market that it’s impossible to measure the social costs and benefits of maintaining hospitals’ prominence. And again, the distortions caused by a reluctance to pay directly for health care—in this case, emergency medicine for the poor—are in large part to blame.
Consider the oft-quoted “statistic” that emergency-room care is the most expensive form of treatment. Has anyone who believes this ever actually been to an emergency room? My sister is an emergency-medicine physician; unlike most other specialists, ER docs usually work on scheduled shifts and are paid fixed salaries that place them in the lower ranks of physician compensation. The doctors and other workers are hardly underemployed: typically, ERs are unbelievably crowded. They have access to the facilities and equipment of the entire hospital, but require very few dedicated resources of their own. They benefit from the group buying power of the entire institution. No expensive art decorates the walls, and the waiting rooms resemble train-station waiting areas. So what exactly makes an ER more expensive than other forms of treatment?
Perhaps it’s the accounting. Since charity care, which is often performed in the ER, is one justification for hospitals’ protected place in law and regulation, it’s in hospitals’ interest to shift costs from overhead and other parts of the hospital to the ER, so that the costs of charity care—the public service that hospitals are providing—will appear to be high. Hospitals certainly lose money on their ERs; after all, many of their customers pay nothing. But to argue that ERs are costly compared with other treatment options, hospitals need to claim expenses well beyond the marginal (or incremental) cost of serving ER patients.
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In a recent IRS survey of almost 500 nonprofit hospitals, nearly 60 percent reported providing charity care equal to less than 5 percent of their total revenue, and about 20 percent reported providing less than 2 percent. Analyzing data from the American Hospital Directory, The Wall Street Journal found that the 50 largest nonprofit hospitals or hospital systems made a combined “net income” (that is, profit) of $4.27 billion in 2006, nearly eight times their profits five years earlier.
How do we know whether the value of hospitals’ charitable services compensates for the roughly 100,000 deaths from hospital-borne disease, their poor standards of customer service, and their extraordinary diseconomies of both scale and scope? Might we be better off reforming hospitals, and allowing many of them to be eliminated by competition from specialty clinics? As a society, couldn’t we just pay directly for the services required by the poor? We don’t know how many hospitals would even survive if they were not so favored under the law; anyone who has lost a loved one to a preventable hospital death will wonder how many should.
You Are Not the Customer
What amazed me most during five weeks in the ICU with my dad was the survival of paper and pen for medical instructions and histories. In that time, Dad was twice taken for surgical procedures intended for other patients (fortunately interrupted both times by our intervention). My dry cleaner uses a more elaborate system to track shirts than this hospital used to track treatment.
Not every hospital relies on paper-based orders and charts, but most still do. Why has adoption of clinical information technology been so slow? Companies invest in IT to reduce their costs, reduce mistakes (itself a form of cost-saving), and improve customer service. Better information technology would have improved my father’s experience in the ICU—and possibly his chances of survival.
But my father was not the customer; Medicare was. And although Medicare has experimented with new reimbursement approaches to drive better results, no centralized reimbursement system can be supple enough to address the many variables affecting the patient experience. Certainly, Medicare wasn’t paying for the quality of service during my dad’s hospital stay. And it wasn’t really paying for the quality of his care, either; indeed, because my dad got sepsis in the hospital, and had to spend weeks there before his death, the hospital was able to charge a lot more for his care than if it had successfully treated his pneumonia and sent him home in days.
Of course, one area of health-related IT has received substantial investment—billing. So much for the argument, often made, that privacy concerns or a lack of agreed-upon standards has prevented the development of clinical IT or electronic medical records; presumably, if lack of privacy or standards had hampered the digitization of health records, it also would have prevented the digitization of the accompanying bills. To meet the needs of the government bureaucracy and insurance companies, most providers now bill on standardized electronic forms. In case you wonder who a care provider’s real customer is, try reading one of these bills.
For that matter, try discussing prices with hospitals and other providers. Eight years ago, my wife needed an MRI, but we did not have health insurance. I called up several area hospitals, clinics, and doctors’ offices—all within about a one-mile radius—to find the best price. I was surprised to discover that prices quoted, for an identical service, varied widely, and that the lowest price was $1,200. But what was truly astonishing was that several providers refused to quote any price. Only if I came in and actually ordered the MRI could we discuss price.
Several years later, when we were preparing for the birth of our second child, I requested the total cost of the delivery and related procedures from our hospital. The answer: the hospital discussed price only with uninsured patients. What about my co-pay? They would discuss my potential co-pay only if I were applying for financial assistance.
Keeping prices opaque is one way medical institutions seek to avoid competition and thereby keep prices up. And they get away with it in part because so few consumers pay directly for their own care—insurers, Medicare, and Medicaid are basically the whole game. But without transparency on prices—and the related data on measurable outcomes—efforts to give the consumer more control over health care have failed, and always will.
Here’s a wonderful example of price opacity. Advocates for the uninsured complain that hospitals charge uninsured patients, on average, 2.5 times the amount charged to insured patients. Hospitals defend themselves by contending that they earn from uninsured patients only 25 percent of the amount they do from insured ones. Both statements appear to be true!
How is this possible? Well, hospitals bill according to their price lists, but provide large discounts to major insurers. Individual consumers, of course, don’t benefit from these discounts, so they receive their bills at full list price (typically about 2.5 times the bill to an insured patient). Uninsured patients, however, pay according to how much of the bill the hospital believes they can afford (which, on average, amounts to 25 percent of the amount paid by an insured patient). Nonetheless, whatever discount a hospital gives to an uninsured patient is entirely at its discretion—and is typically negotiated only after the fact. Some uninsured patients have been driven into bankruptcy by hospital collections. American industry may offer no better example of pernicious “price discrimination,” nor one that entails greater financial vulnerability for American families.
It’s astonishingly difficult for consumers to find any health-care information that would enable them to make informed choices—based not just on price, but on quality of care or the rate of preventable medical errors. Here’s one place where legal requirements might help. But only a few states require institutions to make this sort of information public in a usable form for consumers. So while every city has numerous guidebooks with reviews of schools, restaurants, and spas, the public is frequently deprived of the necessary data to choose hospitals and other providers.
The Strange Beast of Health-Care Technology
One of the most widely held pieces of conventional wisdom about health care is that new technology is relentlessly driving up costs. Yet over the past 20 years, I’ve bought several generations of microwave ovens, personal computers, DVD players, GPS devices, mobile phones, and flat-screen TVs. I bank mostly at ATMs, check out my own goods at self-serve supermarket scanners, and attend company meetings by video conference. Technology has transformed much of our daily lives, in almost all cases by adding quantity, speed, and quality while lowering costs. So why is health care different?
Well, for the most part, it isn’t. Whether it’s new drugs to control previously untreatable conditions, diagnostic equipment that enhances physician productivity, or minimally invasive techniques that speed patient recovery, technology-driven innovation has been transforming care at least as greatly as it has transformed the rest of our lives.
But most health-care technologies don’t exist in the same world as other technologies. Recall the MRI my wife needed a few years ago: $1,200 for 20 minutes’ use of a then 20-year-old technology, requiring a little electricity and a little labor from a single technician and a radiologist. Why was the price so high? Most MRIs in this country are reimbursed by insurance or Medicare, and operate in the limited-competition, nontransparent world of insurance pricing. I don’t even know the price of many of the diagnostic services I’ve needed over the years—usually I’ve just gone to whatever provider my physician recommended, without asking (my personal contribution to the moral-hazard economy).
By contrast, consider LASIK surgery. I still lack the (small amount of) courage required to get LASIK. But I’ve been considering it since it was introduced commercially in the 1990s. The surgery is seldom covered by insurance, and exists in the competitive economy typical of most other industries. So people who get LASIK surgery—or for that matter most cosmetic surgeries, dental procedures, or other mostly uninsured treatments—act like consumers. If you do an Internet search today, you can find LASIK procedures quoted as low as $499 per eye—a decline of roughly 80 percent since the procedure was introduced. You’ll also find sites where doctors advertise their own higher-priced surgeries (which more typically cost about $2,000 per eye) and warn against the dangers of discount LASIK. Many ads specify the quality of equipment being used and the performance record of the doctor, in addition to price. In other words, there’s been an active, competitive market for LASIK surgery of the same sort we’re used to seeing for most goods and services.
The history of LASIK fits well with the pattern of all capital-intensive services outside the health-insurance economy. If you’re one of the first ophthalmologists in your community to perform the procedure, you can charge a high price. But once you’ve acquired the machine, the actual cost of performing a single procedure (the marginal cost) is relatively low. So, as additional ophthalmologists in the neighborhood invest in LASIK equipment, the first provider can meet new competition by cutting price. In a fully competitive marketplace, the procedure’s price will tend toward that low marginal cost, and ophthalmologists looking to buy new machines will exert downward pressure on both equipment and procedure prices.
No business likes to compete solely on price, so most technology providers seek to add features and performance improvements to new generations of a machine—anything to keep their product from becoming a pure commodity. Their success depends on whether the consumers will pay enough for the new feature to justify its introduction. In most consumer industries, we can see this dynamic in action—observe how DVD players have moved in a few years from a high-priced luxury to a disposable commodity available at discount stores. DVD players have run out of new features for which customers will pay premium prices.
Perhaps MRIs have too. After a long run of high and stable prices, you can now find ads for discount MRIs. But because of the peculiar way we pay for health care, this downward price pressure on technology seems less vigorous. How well can insurance companies and government agencies judge the value of new features that tech suppliers introduce to keep prices up? Rather than blaming technology for rising costs, we must ask if moral hazard and a lack of discipline in national health-care spending allows health-care companies to avoid the forces that make nonmedical technology so competitive.
In 2002, the U.S. had almost six times as many CT scanners per capita as Germany and four times as many MRI machines as the U.K. Traditional reformers believe it is this rate of investment that has pushed up prices, rather than sustained high prices that have pushed up investment. As a result, many states now require hospitals to obtain a Certificate of Need before making a major equipment purchase. In its own twisted way, this makes sense: moral hazard, driven by insurance, for years allowed providers to create enough demand to keep new MRI machines humming at any price.
But Certificates of Need are just another Scotch-tape reform, an effort to maintain the current system by treating a symptom rather than the underlying disease. Technology is driving up the cost of health care for the same reason every other factor of care is driving up the cost—the absence of the forces that discipline and even drive down prices in the rest of our economy. Only in the bizarre parallel universe of health care could limiting supply be seen as a sensible approach to keeping prices down.
The Limits of “Comprehensive” Health-care Reform
A wasteful insurance system; distorted incentives; a bias toward treatment; moral hazard; hidden costs and a lack of transparency; curbed competition; service to the wrong customer. These are the problems at the foundation of our health-care system, resulting in a slow rot and requiring more and more money just to keep the system from collapsing.
How would the health-care reform that’s now taking shape solve these core problems? The Obama administration and Congress are still working out the details, but it looks like this generation of “comprehensive” reform will not address the underlying issues, any more than previous efforts did. Instead it will put yet more patches on the walls of an edifice that is fundamentally unsound—and then build that edifice higher.
A central feature of the reform plan is the expansion of comprehensive health insurance to most of the 46 million Americans who now lack private or public insurance. Whether this would be achieved entirely through the extension of private commercial insurance at government-subsidized rates, or through the creation of a “public option,” perhaps modeled on Medicare, is still being debated.
Regardless, the administration has suggested a cost to taxpayers of $1 trillion to $1.5 trillion over 10 years. That, of course, will mean another $1 trillion or more not spent on other things—environment, education, nutrition, recreation. And if the history of previous attempts to expand the health safety net are any guide, that estimate will prove low.
The reform plan will also feature a variety of centrally administered initiatives designed to reduce costs and improve quality. These will likely include a major government investment to promote digitization of patient health records, an effort to collect information on best clinical practices, and changes in the way providers are paid, to better reward quality and deter wasteful spending.
All of these initiatives have some theoretical appeal. And within the confines of the current system, all may do some good. But for the most part, they simply do not address the root causes of poor quality and runaway costs.
Consider information technology, for instance. Of course the health system could benefit from better use of IT. The Rand Corporation has estimated that the widespread use of electronic medical records would eventually yield annual savings of $81 billion, while also improving care and reducing preventable deaths, and the White House estimates that creating and spreading the technology would cost just $50 billion. But in what other industry would an investment with such a massive annual return not be funded by the industry itself? (And while $50 billion may sound like a big investment, it’s only about 2 percent of the health-care industry’s annual revenues.)
Technology is effective only when it’s properly applied. Since most physicians and health-care companies haven’t adopted electronic medical records on their own, what makes us think they will appropriately use all this new IT? Most of the benefits of the technology (record portability, a reduction in costly and dangerous clinical errors) would likely accrue to patients, not providers. In a consumer-facing industry, this alone would drive companies to make the investments to stay competitive. But of course, we patients aren’t the real customers; government funding of electronic records wouldn’t change that.
I hope that whatever reform is finally enacted this fall works—preventing people from slipping through the cracks, raising the quality standard of the health-care industry, and delivering all this at acceptable cost. But looking at the big picture, I fear it won’t. So I think we should at least begin to debate and think about larger reforms, and a different direction—if not for this round of reform, then for the next one. Politics is, of course, the art of the possible. If our health-care crisis does not abate, the possibilities for reform may expand beyond their current, tight limits.
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A Way Forward
The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system. I believe if the government took on the goal of better supporting consumers—by bringing greater transparency and competition to the health-care industry, and by directly subsidizing those who can’t afford care—we’d find that consumers could buy much more of their care directly than we might initially think, and that over time we’d see better care and better service, at lower cost, as a result.
A more consumer-centered health-care system would not rely on a single form of financing for health-care purchases; it would make use of different sorts of financing for different elements of care—with routine care funded largely out of our incomes; major, predictable expenses (including much end-of-life care) funded by savings and credit; and massive, unpredictable expenses funded by insurance.
For years, a number of reformers have advocated a more “consumer-driven” care system—a term coined by the Harvard Business School professor Regina Herzlinger, who has written extensively on the subject. Many different steps could move us toward such a system. Here’s one approach that—although it may sound radical—makes sense to me.
First, we should replace our current web of employer- and government-based insurance with a single program of catastrophic insurance open to all Americans—indeed, all Americans should be required to buy it—with fixed premiums based solely on age. This program would be best run as a single national pool, without underwriting for specific risk factors, and would ultimately replace Medicare, Medicaid, and private insurance. All Americans would be insured against catastrophic illness, throughout their lives.
Proposals for true catastrophic insurance usually founder on the definition of catastrophe. So much of the amount we now spend is dedicated to problems that are considered catastrophic, the argument goes, that a separate catastrophic system is pointless. A typical catastrophic insurance policy today might cover any expenses above, say, $2,000. That threshold is far too low; ultimately, a threshold of $50,000 or more would be better. (Chronic conditions with expected annual costs above some lower threshold would also be covered.) We might consider other mechanisms to keep total costs down: the plan could be required to pay out no more in any year than its available premiums, for instance, with premium increases limited to the general rate of inflation. But the real key would be to restrict the coverage to true catastrophes—if this approach is to work, only a minority of us should ever be beneficiaries.
How would we pay for most of our health care? The same way we pay for everything else—out of our income and savings. Medicare itself is, in a sense, a form of forced savings, as is commercial insurance. In place of these programs and the premiums we now contribute to them, and along with catastrophic insurance, the government should create a new form of health savings account—a vehicle that has existed, though in imperfect form, since 2003. Every American should be required to maintain an HSA, and contribute a minimum percentage of post-tax income, subject to a floor and a cap in total dollar contributions. The income percentage required should rise over a working life, as wages and wealth typically do.
All noncatastrophic care should eventually be funded out of HSAs. But account-holders should be allowed to withdraw money for any purpose, without penalty, once the funds exceed a ceiling established for each age, and at death any remaining money should be disbursed through inheritance. Our current methods of health-care funding create a “use it or lose it” imperative. This new approach would ensure that families put aside funds for future expenses, but would not force them to spend the funds only on health care.
What about care that falls through the cracks—major expenses (an appendectomy, sports injury, or birth) that might exceed the current balance of someone’s HSA but are not catastrophic? These should be funded the same way we pay for most expensive purchases that confer long-term benefits: with credit. Americans should be able to borrow against their future contributions to their HSA to cover major health needs; the government could lend directly, or provide guidelines for private lending. Catastrophic coverage should apply with no deductible for young people, but as people age and save, they should pay a steadily increasing deductible from their HSA, unless the HSA has been exhausted. As a result, much end-of-life care would be paid through savings.
Anyone with whom I discuss this approach has the same question: How am I supposed to be able to afford health care in this system? Well, what if I gave you $1.77 million? Recall, that’s how much an insured 22-year-old at my company could expect to pay—and to have paid on his and his family’s behalf—over his lifetime, assuming health-care costs are tamed. Sure, most of that money doesn’t pass through your hands now. It’s hidden in company payments for premiums, or in Medicare taxes and premiums. But think about it: If you had access to those funds over your lifetime, wouldn’t you be able to afford your own care? And wouldn’t you consume health care differently if you and your family didn’t have to spend that money only on care?
For lower-income Americans who can’t fund all of their catastrophic premiums or minimum HSA contributions, the government should fill the gap—in some cases, providing all the funding. You don’t think we spend an absurd amount of money on health care? If we abolished Medicaid, we could spend the same money to make a roughly $3,000 HSA contribution and a $2,000 catastrophic-premium payment for 60 million Americans every year. That’s a $12,000 annual HSA plus catastrophic coverage for a low-income family of four. Do we really believe most of them wouldn’t be better off?
Some experts worry that requiring people to pay directly for routine care would cause some to put off regular checkups. So here’s a solution: the government could provide vouchers to all Americans for a free checkup every two years. If everyone participated, the annual cost would be about $30 billion—a small fraction of the government’s current spending on care.
Today, insurance covers almost all health-care expenditures. The few consumers who pay from their pockets are simply an afterthought for most providers. Imagine how things might change if more people were buying their health care the way they buy anything else. I’m certain that all the obfuscation over prices would vanish pretty quickly, and that we’d see an end to unreadable bills. And that physicians, who spend an enormous amount of time on insurance-related paperwork, would have more time for patients.
In fact, as a result of our fraying insurance system, you can already see some nascent features of a consumer-centered system. Since 2006, Wal-Mart has offered $4 prescriptions for a month’s supply of common generic medications. It has also been slowly rolling out retail clinics for routine care such as physicals, blood work, and treatment for common ailments like strep throat. Prices for each service are easily obtained; most are in the neighborhood of $50 to $80. Likewise, “concierge care,” or the “boutique” style of medical practice—in which physicians provide unlimited services and fast appointments in return for a fixed monthly or annual fee—is beginning to spread from the rich to the middle class. Qliance Medical Group, for instance, now operates clinics serving some 3,000 patients in the Seattle and Tacoma, Washington, areas, charging $49 to $79 a month for unlimited primary care, defined expansively.
It’s worth pausing over this last example. Many experts believe that the U.S. would get better health outcomes at lower cost if payment to providers were structured around the management of health or whole episodes of care, instead of through piecemeal fees. Medicare and private insurers have, to various degrees, moved toward (or at least experimented with) these sorts of payments, and are continuing to do so—but slowly, haltingly, and in the face of much obstruction by providers. But aren’t we likely to see just these sorts of payment mechanisms develop organically in a consumer-centered health-care system? For simplicity and predictability, many people will prefer to pay a fixed monthly or annual fee for primary or chronic care, and providers will move to serve that demand.
Likewise, what patient, when considering getting an artificial hip, would want to deal with a confusion of multiple bills from physicians, facilities, and physical therapists? Aren’t providers likely to organize themselves to provide a single price to the consumer for care and rehabilitation? And won’t that, in itself, put pressure on providers to work together as efficiently as possible, and to minimize the medical errors that would eat into their joint fee? I suspect we would see a rapid decline in the predominance of the fee-for-service model, making way for real innovation and choice in service plans and funding. And the payment system would not be set by fiat; it would remain responsive to treatment breakthroughs and changes in consumer demand.
Many consumers would be able to make many decisions, unaided, in such a system. But we’d also probably see the rise of health-care agents—paid by, and responsible to, the consumer—to help choose providers and to act as advocates during long and complex care episodes.
How else might the system change? Technological innovation—which is now almost completely insensitive to costs, and which often takes the form of slightly improved treatments for much higher prices—would begin to concern itself with value, not just quality. Many innovations might drive prices down, not up. Convenient, lower-cost specialty centers might proliferate. The need for unpaid indigent care would go away—everyone, recall, would have both catastrophic insurance and an HSA, funded entirely by the government when necessary—and with it much of the rationale for protecting hospitals against competition.
Of course, none of this would happen overnight. And the government has an essential role to play in arming consumers with good information. Congress should require maximum transparency on services, prices, and results (and some elements of the Obama administration’s reform plan would move the industry in this direction). We should establish a more comprehensive system of quality inspection of all providers, and publish all the findings. Safety and efficacy must remain the cornerstone of government licensing, but regulatory bias should favor competition and prevent incumbents from using red tape to forestall competition.
Moving from the system we’ve got now to the one I’ve outlined would be complicated, and would take a long time. Most of us have been paying into an insurance system for years, expecting that our future health-care bills would be paid; we haven’t been saving separately for these expenses. It would take a full generation to completely migrate from relying on Medicare to saving for late-life care; from Medicaid for the disadvantaged to catastrophic insurance and subsidized savings accounts. Such a transition would require the slow reduction of Medicare taxes, premiums, and benefit levels for those not yet eligible, and a corresponding slow ramp-up in HSAs. And the national catastrophic plan would need to start with much broader coverage and higher premiums than the ultimate goal, in order to fund the care needed today by our aging population. Nonetheless, the benefits of a consumer-centered approach—lower costs for better service—should have early and large dividends for all of us throughout the period of transition. The earlier we start, the less a transition will ultimately cost.
Many experts oppose the whole concept of a greater role for consumers in our health-care system. They worry that patients lack the necessary knowledge to be good consumers, that unscrupulous providers will take advantage of them, that they will overspend on low-benefit treatments and under-spend on high-benefit preventive care, and that such waste will leave some patients unable to afford highly beneficial care.
They are right, of course. Whatever replaces our current system will be flawed; that’s the nature of health care and, indeed, of all human institutions. Our current system features all of these problems already—as does the one the Obama reforms would create. Because health care is so complex and because each individual has a unique health profile, no system can be perfect.
I believe my proposed approach passes two meaningful tests. It will do a better job than our current system of controlling prices, allocating resources, expanding access, and safeguarding quality. And it will do a better job than a more government-driven approach of harnessing medicine’s dynamism to develop and spread the new knowledge, technologies, and techniques that improve the quality of life. We won’t be perfect consumers, but we’re more likely than large bureaucracies to encourage better medicine over time.
All of the health-care interest groups—hospitals, insurance companies, professional groups, pharmaceuticals, device manufacturers, even advocates for the poor—have a major stake in the current system. Overturning it would favor only the 300 million of us who use the system and—whether we realize it or not—pay for it. Until we start asking the type of questions my father’s death inspired me to ask, until we demand the same price and quality accountability in health care that we demand in everything else, each new health-care reform will cost us more and serve us less.
$636,687.75
Ten days after my father’s death, the hospital sent my mother a copy of the bill for his five-week stay: $636,687.75. He was charged $11,590 per night for his ICU room; $7,407 per night for a semiprivate room before he was moved to the ICU; $145,432 for drugs; $41,696 for respiratory services. Even the most casual effort to compare these prices to marginal costs or to the costs of off-the-shelf components demonstrates the absurdity of these numbers, but why should my mother care? Her share of the bill was only $992; the balance, undoubtedly at some huge discount, was paid by Medicare.
Wasn’t this an extraordinary benefit, a windfall return on American citizenship? Or at least some small relief for a distraught widow?
Not really. You can feel grateful for the protection currently offered by Medicare (or by private insurance) only if you don’t realize how much you truly spend to fund this system over your lifetime, and if you believe you’re getting good care in return.
Would our health-care system be so outrageously expensive if each American family directly spent even half of that $1.77 million that it will contribute to health insurance and Medicare over a lifetime, instead of entrusting care to massive government and private intermediaries? Like its predecessors, the Obama administration treats additional government funding as a solution to unaffordable health care, rather than its cause. The current reform will likely expand our government’s already massive role in health-care decision-making—all just to continue the illusion that someone else is paying for our care.
But let’s forget about money for a moment. Aren’t we also likely to get worse care in any system where providers are more accountable to insurance companies and government agencies than to us?
Before we further remove ourselves as direct consumers of health care—with all of our beneficial influence on quality, service, and price—let me ask you to consider one more question. Imagine my father’s hospital had to present the bill for his “care” not to a government bureaucracy, but to my grieving mother. Do you really believe that the hospital—forced to face the victim of its poor-quality service, forced to collect the bill from the real customer—wouldn’t have figured out how to make its doctors wash their hands?
The URL for this page is http://www.theatlantic.com/doc/200909/health-care
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Its the NYT, so caveat lector. That said, this seems interesting.
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Swiss Health Care Thrives Without Public Option
D. SCHWARTZ
Published: September 30, 2009
ZURICH — Like every other country in Europe, Switzerland guarantees health care for all its citizens. But the system here does not remotely resemble the model of bureaucratic, socialized medicine often cited by opponents of universal coverage in the United States.
Swiss private insurers are required to offer coverage to all citizens, regardless of age or medical history. And those people, in turn, are obligated to buy health insurance.
That is why many academics who have studied the Swiss health care system have pointed to this Alpine nation of about 7.5 million as a model that delivers much of what Washington is aiming to accomplish — without the contentious option of a government-run health insurance plan.
In Congress, the Senate Finance Committee is dealing with legislation proposed by its chairman, Max Baucus, Democrat of Montana, which would require nearly all Americans to buy health insurance, but stops short of the government-run insurance option that is still strongly supported by liberal Democrats.
Two amendments that would have added a public option to the Baucus bill were voted down on Tuesday. But another Senate bill, like the House versions, calls for a public insurance option.
By many measures, the Swiss are healthier than Americans, and surveys indicate that Swiss people are generally happy with their system. Switzerland, moreover, provides high-quality care at costs well below what the United States spends per person. Swiss insurance companies offer the mandatory basic plan on a not-for-profit basis, although they are permitted to earn a profit on supplemental plans.
And yet, as a potential model for the United States, the Swiss health care system involves some important trade-offs that American consumers, insurers and health care providers might find hard to swallow.
The Swiss government does not “ration care” — that populist bogeyman in the American debate — but it does keep down overall spending by regulating drug prices and fees for lab tests and medical devices. It also requires patients to share some costs — at a higher level than in the United States — so they have an incentive to avoid unnecessary treatments. And some doctors grumble that cost controls are making it harder these days for a physician to make a franc.
The Swiss government also provides direct cash subsidies to people if health insurance equals more than 8 percent of personal income, and about 35 to 40 percent of households get some form of subsidy. In some cases, employers contribute part of the insurance premium, but, unlike in the United States, they do not receive a tax break for it. (All the health care proposals in Congress would provide a subsidy to moderate-income Americans.)
Unlike the United States, where the Medicare program for the elderly costs taxpayers about $500 billion a year, Switzerland has no special break for older Swiss people beyond the general subsidy.
“Switzerland’s health care system is different from virtually every other country in the world,” said Regina Herzlinger, a Harvard Business School professor who has studied the Swiss approach extensively.
“What I like about it is that it’s got universal coverage, it’s customer driven, and there are no intermediaries shopping on people’s behalf,” she added. “And there’s no waiting lists or rationing.”
Since being made mandatory in 1996, the Swiss system has become a popular model for experts seeking alternatives to government-run health care. Indeed, it has attracted some unlikely American admirers, like Bill O’Reilly, the Fox News talk show host. And it has lured some members of Congress on fact-finding trips here to seek ideas for overhauling the United States system.
The Swiss approach is also popular with patients like Frieda Burgstaller, 72, who says she likes the freedom of choice and access that the private system provides. “If the doctor says it has to be done, it’s done,” said Mrs. Burgstaller. “You don’t wait. And it’s covered.”
While many patients seem content, the burdens fall more heavily on doctors, especially general practitioners and pediatricians.
Dr. Gerlinde Schurter, Mrs. Burgstaller’s physician, says she feels squeezed by government regulators and insurance companies that have fought to hold down costs — most recently with a 15 percent cut in lab fees that forced her five-member group to lay off its principal technician.
Dr. Schurter also fears a so-called blue letter, a warning from an insurance company that she is prescribing too many drugs or expensive procedures.
If doctors cannot justify their treatments, they can be forced to repay insurers for a portion of the medical services prescribed. And while prescriptions are covered, the government has insisted that consumers fork over a 20 percent co-payment if they want brand-name drugs, rather than 10 percent for generics.
Similarly, the government health office also lowered reimbursements across the board for medical devices in 2006.
These are among the reasons health care costs consume 10.8 percent of gross domestic product in Switzerland, compared with 16 percent in the United States, the highest level of spending among industrial countries, according to the Organization for Economic Cooperation and Development.
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Still, along with lower costs and the freedom to choose doctors come bigger bills for individual patients. On average, out-of-pocket payments come to $1,350 annually. That is the highest among the 30 countries tracked by the O.E.C.D. and well above the $890 average for the United States, which comes in second.
Then there are the hefty prices of the insurance policies themselves, which can top 14,000 Swiss francs a year for a family of four in Zurich, or about $13,600. That is roughly comparable to the national average annual premium for a family policy under employer-sponsored group plans in the United States, but in high-cost American cities the figure can be much higher.
Direct comparisons are hard to make, however, because in the American system, employers and employees share the cost of premiums, which are also exempt from individual and corporate income taxes.
Nevertheless, Swiss citizens relish the lack of bureaucracy, especially compared with systems in Britain and Germany, even if their doctors grumble.
As in the United States, practitioners typically are paid on a fee-for-service basis, rather than on salary. But they make less than their American counterparts. According to the O.E.C.D., specialists in Switzerland earn three times more than the nation’s average wage, compared with 5.6 times for American specialists. General practitioners in Switzerland make 2.7 times more than the average wage, versus 3.7 in the United States.
That is partly because the Swiss health insurers are not shy about using their muscle with physicians.
Pius Gyger, director of health economics and health policy at Helsana, the country’s biggest insurer, cannot suppress a smile when asked about the effectiveness of the so-called blue letters.
“If there’s something strange, we knock at the doctor’s door,” he said. “For doctors, it’s an incentive to treat economically, but often perceived as a threat.”
He estimates that only about 3 percent of doctors get the letters and that fewer than 1 percent actually have to return money. Still, Mr. Gyger said, “it’s an easy exercise for us and it has an effect.”
Despite pressure on general practitioners, hospital physicians like Edouard Battegay at the University of Zurich say universal coverage also lowers costs by reducing emergency room visits.
Indeed, his E.R. is as quiet and efficient as a Swiss watch, and he still expresses amazement at what he saw when he worked briefly in Seattle.
“I’ve seen things in the U.S. that I’ve never seen here; it was a state of disaster,” he said. “Chronic disease management is better here. If you don’t treat hypertension, you treat strokes. Not treating patients is expensive.”
And even Dr. Schurter — who says her income has been flat for the last five years — praises the virtues of the Swiss system for patients struck by catastrophe.
When her daughter was found to have leukemia seven years ago, “I never worried for a second how and if she’d get treatment and if it would be paid for,” she said. “All was granted as naturally as the air we breathe.”
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Controlling health care by targeting the costliest. That conclusion is the easy part. Now for the hard part. Actually doing it. Keep people out of the hospital have nurses become an extended family member and of course all the while improve the "quality" of care.
Controlling Expenditures by Improving Care for Patients Needing Costly Services
Posted by NEJM • September 30th, 2009 •
Thomas Bodenheimer, M.D., M.P.H., and Rachel Berry-Millett, B.A.
In the United States today, 10% of patients account for 70% of total health care expenditures. Many patients who require high-cost care are people with multiple chronic conditions, many medications, frequent hospitalizations, and limitations on their ability to perform basic daily functions due to physical, mental, or psychosocial challenges. Some well-researched programs have been shown to reduce costs for these patients with complex health care needs, but major payment reform would be needed to spread these programs throughout the United States.
In 2002, Medicare beneficiaries with five or more chronic conditions accounted for 76% of Medicare expenditures. Health care spending for people with five or more chronic conditions is 17 times as high as that for people with no chronic conditions (see graph).1 Because Medicare expenditures will soon become unsustainable, we urgently need to find a way to reduce the cost of care for this rapidly growing group.
As we found when we reviewed the evidence for a forthcoming report from the Robert Wood Johnson Foundation Synthesis Project (www.policysynthesis.org), care management may be a health care delivery innovation that can reduce costs while enhancing quality for people with complex health care needs. Care management is a set of activities designed to assist patients and their support systems in managing medical conditions and related psychosocial problems more effectively, with the aims of improving patients’ functional health status, enhancing the coordination of care, eliminating the duplication of services, and reducing the need for expensive medical services. Care management is generally provided by a registered-nurse care manager, often working with a multidisciplinary team.
The specific activities of such care managers include assessing the risks and needs of each patient; working with the patient, his or her family, and the primary care physician to prepare a care plan; teaching patients and their families about their diseases and medications; coaching patients and families on how to respond to worsening symptoms in order to avoid emergency department visits and hospital admissions; tracking patients’ status over time; and revising care plans as needed.
Because care management is an intensive and expensive service, it should be targeted to people with complex health care needs who are at high risk for requiring costly care, but not to patients who are too sick to benefit. A number of predictive models have been introduced to risk-stratify populations of patients to identify those who are most likely to benefit from care management. Models that incorporate diagnostic and medication information are better at predicting future costs than models limited to measuring past costs.
Many controlled studies of care management targeting the transition from hospital to home have demonstrated that this approach results in substantial reductions in hospital utilization and costs. In one study, there was a 38% reduction in total costs during a 12-month period, as compared with usual care. Advanced practice nurses, who underwent 2 months of care-management training, made daily in-hospital visits and at least three home visits, and then followed up through telephone encounters.2 In a different type of intervention, nurses were trained as “transition coaches” and then helped patients and their families to actively participate in their care. After only five contacts between the coaches and patients or their families, the rate of rehospitalization and associated hospital costs were significantly reduced.3 In-hospital discharge planning alone does not reduce hospital costs; the success of these two interventions in reducing readmissions depends on the employment of well-trained care managers and the extension of care management into the home.
Care management that is provided in a primary care setting, if carefully implemented, can also reduce hospital use and cut health care costs. Two models currently under study — Care Management Plus and Guided Care — feature well-trained nurse care managers working closely with primary care physicians. The Care Management Plus intervention resulted in a significant reduction in hospital use by the subgroup of patients with multiple diagnoses. During the first 8 months of a 32-month, multisite, randomized, controlled trial, Guided Care reduced the number of hospital days by 24% and insurers’ net health care costs by 11% for the intervention group, though the differences were not statistically significant; final results have not yet been published.4 A third model that was the subject of a positive study, Geriatric Resources for Assessment and Care of Elders (GRACE), involved the use of a team consisting of a nurse practitioner and a social worker who worked closely with primary care physicians and a geriatrician. The higher-risk intervention subgroup had a significantly lower hospitalization rate than the higher-risk patients who received usual care. Each of these programs has placed substantial emphasis on training the care managers, keeping care managers’ patient panels reasonably small, fostering a close relationship between care managers and primary care physicians, and including interactions between care managers and patients in medical settings and at home. Telephonic care management has been effective when combined with face-to-face visits but has not worked by itself.5
Several organizations have launched innovative care-management programs for patients with complex health care needs. Such programs have appeared to reduce costs but have not yet been fully evaluated. Kaiser Permanente, recognizing that traditional primary care may lack the resources to offer high-intensity care management to its highest-risk patients, is creating high-risk clinics. In Kaiser’s Ohio region, the 1% of patients who were identified by predictive models as accounting for 27% of Kaiser’s total costs were referred to a high-risk clinic in which a geriatrician-led multidisciplinary team provided home care for a small panel of 150 patients. As compared with similar patients receiving usual care, high-risk clinic patients had fewer hospitalizations, fewer emergency department visits, and lower hospital expenses; since the numbers have been small, the changes have not yet reached statistical significance.
Capital Health Plan in Florida opened a high-risk clinic, staffed by a geriatrician and two registered nurses, for the 1% of the health plan’s enrollees who account for 25% of its total expenditures. The team can manage the care of 300 patients. Hospital admissions, emergency department visits, and total costs were substantially lower for the patients in the high-risk clinic than for those receiving traditional primary care.
The Veterans Health Administration, SCAN Health Plan in Southern California, PeaceHealth Oregon Region, and a number of projects in the Program of All-Inclusive Care for the Elderly (PACE) have also invested in intensive primary care that is focused on patients with complex health care needs, with the aim of providing better care at a lower total cost through reductions in the use of hospitals and emergency departments.
Care management, with its cost-reducing potential, will not spread widely in the health care system without substantial changes in payment policy. If hospitals profit from unnecessary readmissions, they are unlikely to adopt effective hospital-to-home care-management programs. If primary care practices are not reimbursed for the work of a registered-nurse care manager, they will not hire one unless they share in the savings generated by reducing hospital admissions and emergency department visits. Other obstacles include nursing shortages and the paucity of training programs for nurses to become effective care managers.
The evidence is strong that well-designed care management can substantially reduce costs for patients with complex health care needs. Cost-control measures, particularly in Medicare, must be targeted to the group of patients who account for the great majority of health care expenditures. Investment in care management should become a focus of the cost-containment discussion that is now dominating the debate over health care reform.
No potential conflict of interest relevant to this article was reported.
Source Information
From the Center for Excellence in Primary Care in the Department of Family and Community Medicine, University of California, San Francisco, School of Medicine, San Francisco.
This article (10.1056/NEJMp0907185) was published on September 30, 2009, at NEJM.org.
References
Anderson G. Chronic conditions: making the case for ongoing care. Baltimore: Johns Hopkins University, November 2007. (Accessed September 11, 2009, at http://www.fightchronicdisease.com/news/pfcd/documents/ChronicCareChartbook_FINAL.pdf.)
Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc 2004;52:675-684. [CrossRef][Web of Science][Medline]
Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med 2006;166:1822-1828. [Free Full Text]
Leff B, Reider L, Frick KD, et al. Guided care and the cost of complex healthcare: a preliminary report. Am J Manag Care 2009;15:555-559. [Medline]
Bodenheimer T, Berry-Millett R. Care management of patients with complex healthcare needs. Princeton, NJ: Rober
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By MATT MILLER
As health reform legislation hurtles toward its finale, corporate America has rushed to the barricades to make sure that big business remains at the heart of the welfare state. The Business Roundtable, the Chamber of Commerce and the National Association of Manufacturers are united in their belief that Sen. Ron Wyden's (D., Ore.) "free choice amendment" must be stopped.
Mr. Wyden's measure, which is being offered as an amendment to the Baucus bill in the Senate Finance Committee, would come into play if employers failed to offer their workers meaningful choice of affordable plans. In that case, employees would be allowed to turn the cash employers currently spend on their health benefits into vouchers with which they could buy coverage from newly created insurance exchanges.
Big business thinks that giving employees this choice would be a calamity. To which one can only ask: Have these business lobbies lost their minds?
When the post-mortems on the health-care reform debate are written, the biggest mystery will be why big business fought so hard to stay in the health-care business even as soaring health costs surpassed corporate profits and diverted executive time better devoted to actually running companies.
America's employer-based health-care system may have made sense 50 years ago, when care was cheap, U.S. business faced little global competition, and fending off socialism was a Cold War priority. Circumstances have changed radically since that time. Yet corporate America—egged on by human resources executives threatened by change—remains caught in a time warp.
It's bad enough that business didn't do the smart thing up front and urge President Barack Obama to move the nation beyond employer-based care. That was major lost opportunity No. 1.
But on what possible theory does big business now assert that the 175 million Americans who get coverage on the job deserve no new choices? Most firms offer just one insurance plan, or narrow set of plans, to their workers. Why shouldn't these Americans also benefit from the myriad options that will become available from newly established competitive insurance exchanges?
The language used in a letter sent Tuesday to the Senate Finance Committee from something called the "National Coalition on Benefits"—a body controlled by corporate HR execs—reveals the confusion and paternalism still permeating the executive suite when it comes to the employer's role.
Mr. Wyden's proposal, the coalition asserts, would "fundamentally frustrate employers' attempts to administer integrated health improvement strategies." As a factual matter, this is incorrect. But why should "health improvement strategies" be the job of American businesses? Sounds more like a job for American doctors, in conjunction with their patients.
The status quo crowd also writes that Mr. Wyden's measure "would likely harm employer-employee relations because most employees have a longstanding expectation that their employer will be their primary source for health coverage." But employees already chafe at the shrinking coverage now available on the job. And who wouldn't want more options?
It's clear to anyone who looks that the edifice of employer-based coverage is crumbling. A recent survey sponsored by the Committee for Economic Development, a business-led think tank, showed that 62% of senior executives think the system is unsustainable. While the under-65 population has grown by 25 million since 1999, the number of people who get health care from their employers has declined. Numerous CEOs have told me privately that they'd just as soon get out of the benefits business altogether, which makes one wonder who the National Benefits Coalition really represents.
Mr. Wyden's measure would strike a modest but meaningful blow for modernity by making it possible, for the first time, for American workers to access group coverage outside their jobs. Once the infrastructure of these insurance exchanges is established, more firms will offer more people more choices over time. If business is smart, it will then strike a grand bargain in which government picks up the costs of the health-care voucher in exchange for business lending its support to the modest consumption tax needed to replace the corporate money being withdrawn from the system.
If this plays out as it should, the result will not be the single-payer system of Britain or Canada, but an American version of the Swiss or Dutch model of universal coverage in which private insurers and providers organize and deliver care. A decade or so from now, finally freed from this antiquated health-care system, everyone in corporate America should be happy.
Except for HR executives at big companies, who will have surrendered the commanding heights of the welfare state. So here's a thought, Sen. Wyden: Sweeten your amendment with a generous buyout plan for HR chiefs at the Fortune 500. And watch opposition to more freedom and choice for millions of Americans melt away.
Mr. Miller, a management consultant, is the author of "The Tyranny of Dead Ideas: Letting Go of The Old Ways of Thinking To Unleash a New Prosperity," (Times Books, 2009).
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Making the World Safe for Medicaid Fraud
Democrats don't believe in identity fraud.
By JOHN FUND
Americans expect to show a photo ID when they board a plane, enter many office buildings, cash a check or even rent a video -- but rarely in voting or applying for government benefits such as Medicaid. Many Democrats seem to view asking citizens for proof of identity as an invasion of privacy -- though what's really being protected is the right to commit identity fraud.
Exhibit A is Tuesday's 13 to 10 party-line vote in the Senate Finance Committee rejecting a proposal to require that immigrants prove their identity when signing up for federal health care programs. Chuck Grassley, the ranking Republican on the committee, said current procedures make it easy for illegal immigrants to use false or stolen identities to get benefits. But he ran into a buzz saw of opposition. Democratic Sen. Jeff Bingaman of New Mexico insisted such fraud was too rare to be worth worrying about: "The way I see the amendment, it's a solution without a problem."
Mr. Grassley admits to being "very perplexed as to why anyone would oppose this amendment." So does Senator Tom Coburn, one of the only two physicians in the Senate. He cites studies suggesting that fraud will cost Medicare and Medicaid about $100 billion this year. Harvard's Dr. Malcolm Sparrow, author of the book "License to Steal," estimates that the losses could easily be higher -- as much 20% or 30% of the trillion-plus dollars of spending represented by Medicaid and Medicare.
You'd think Senate Democrats would be interested in finding out just who is committing that fraud. But Tuesday's vote puts them firmly in the "see no evil, hear no evil, speak no evil" camp when it comes to the misuse of taxpayer dollars.
http://online.wsj.com/article/SB10001424052748704471504574449192073386128.html
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By DONALD J. PALMISANO, WILLIAM G. PLESTED II AND DANIEL H. JOHNSON JR.
We aren't among the doctors invited to a Rose Garden event today to "join the President in pushing for health insurance reform this year and [who] have offered their help and support," as a White House press release put it. It's unfortunate only supporters of the president's plans will be there. Mr. Obama has missed an opportunity to learn more about the real issues facing patients and doctors and to formulate a plan that truly puts patients in control with doctors as trusted advisers.
The United States has the best health care in the world today, and thanks to the ever-expanding frontiers of science and medical innovation the brightest days are ahead. It is true that there are Americans who fall through the cracks of our medical system every day—and as a caring nation, we must do what we can to expand access to medical care to those who need it. But this can be accomplished without a costly and inefficient government overhaul of the entire system. One easy reform would be to enable individuals to buy policies offered in any state, not just where they live. This will enhance competition. But more government-run health insurance will only lead to disaster.
Government cost-cutting would threaten medical innovation.
.Today, Medicare already reimburses doctors less than what many of their treatments cost to provide. Now the government is saying that additional Medicare cuts are coming—thus forcing doctors to try and make up the difference in volume, by seeing more patients. If you ask patients about this, they understand that more volume means less time with the doctor. That's something that all patients and doctors should oppose. In time, it will be difficult to find a physician.
If the goal of reform is to provide the best possible patient care, let's take the government-controlled "public option"—and any legislative trick that could lead to a public option—off the table. It will result in long waiting lines to see a doctor, substandard care, and an end to medical discovery.
There are many other ways to expand access to health care for uninsured Americans. We could strengthen incentives to purchase low-cost health savings accounts, provide tax credits for individuals and families buying health policies on their own, and extend subsidies for those who need financial help. Also, the right of patients to privately contract with physicians to ensure they have the medical care they want, without penalty—regardless of what the government pays—must be recognized and protected. Today, if a doctor wants to bill a patient for additional payment over the Medicare reimbursement, he has to withdraw from Medicare entirely for two years. A patient who agrees with this arrangement can't receive any Medicare money for that service, either.
We need to maintain a plentiful supply of medical expertise. But cuts in payments and bureaucracy could mean fewer individuals entering the medical field—and a dearth of health-care professionals down the road as specialists retire early or limit their practice. Every patient wants to be taken care of by the best medical professional possible. A patient with cancer wants to see a doctor who has had years of training in oncology and is knowledgeable about the latest ways to beat the cancer. But in some provisions in the proposed legislation (such as the medical home model of HR 3200), physician assistants and nurse practitioners may get the authority to make important medical decisions.
The federal government should also continue its investment in medical research through agencies like the National Institutes of Health, and it should better reward innovative discovery in the private sector with tax incentives and patent protection. Americans are living longer, healthier lives thanks to the trillions of dollars in public and private research investment in medical devices, pharmaceuticals, and advanced surgical techniques. We must not put future progress in jeopardy.
Finally, the nation needs comprehensive medical malpractice reform. It is the surest and quickest way to slow down the rising cost of health care. Statistics from private insurers, as well as a Justice Department report of 2007, indicate that upwards of 80% of malpractice cases are closed without payment—and when there is a trial, the physician-defendant wins 89% of the time. Yet these lawsuits, even when dismissed or closed without payment, cost doctors time and money, and encourage defensive medicine. This adds billions to the cost of medical care. It also increases malpractice insurance premiums, the costs of which get passed on to patients. In too many cases, the malpractice environment forces doctors to leave communities, depriving patients of their trusted medical advisers or specialists whom they might need in an accident or other crisis.
The drive to reform health care has led to an acrimonious and often divisive debate. Yet we still believe that doctors, patients and legislators working together with goodwill can improve the medical system and extend its benefits to all Americans.
Dr. Palmisano, president of the American Medical Association from 2003-2004, is spokesman for the Coalition to Protect Patients' Rights, a group of more than 10,000 physicians. Drs. Plested and Johnson were presidents of the American Medical Association from 2006-2007 and 1996-1997 respectively.
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"Today, Medicare already reimburses doctors less than what many of their treatments cost to provide. Now the government is saying that additional Medicare cuts are coming—thus forcing doctors to try and make up the difference in volume, by seeing more patients. If you ask patients about this, they understand that more volume means less time with the doctor. That's something that all patients and doctors should oppose. In time, it will be difficult to find a physician."
Well the left has answers for this too. It is called bundling payments for outcomes and better quality care.
There is some merit to this concept yet it is also a veiled way of pushing through a form of rationed care.
Salaries for all doctors is also discussed. This way there is less incentive to see more and more and do more and more.
Yet I have no illusions. We will have capped salaries and still be asked to do more for less. No one is kidding me.
Why don't we discuss other fields salaries and driving up costs to all of us.
Thanks to baseball players and owners take people who go to a ballgame have to pay 6 bucks for a lousy hotdog.
What does it cost in NY to see a game? Go with two kids and we are talking what a 100 bucks?
How about accountant fees?
How about the fees realtors use? They should make less no? It would help the ailing real estate market.
Do I even need to mention lawyer fees? Why is the best legal care cost several hundred dollars per hour?
Is that fair?
Why do people have to pay several dollars to cross a lousy bridge from NJ to NY?
Is that fair? It is nuts, no?
Why are politicians getting any more than life support pay? They can all make a bundle any time they want with books, lecture tours, lobbying, peddling their influence.
Do I even need to bring up bankers, and financiers?
It is fair for me to make less but ok for people in this country who employ illegals, knowingly for slave wages and make money off their sweat and pass the benefits they receive to every other single tax payer?
What would be damn hard about going after employers who hire illegals? They know they are doing it. Cut off the jobs and illegals would stop coming here.
OK lets talk about fairness.
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Doctors are not a single block anymore than any other group. Some will love Obama some will not.
There is something absurd about him surrounding himself with all these guys with white coats.
It is reminicent of both Reb and Dem presidents surrounding themselves with soldiers for photo ops.
How bizzare - a bunch of live doctor props.
****Surrounded by doctors, Obama pitches overhaul
Barack Obama AP – Doctors, wearing lab coats, who were audience members, take photos in the Rose Garden of the White House …
Slideshow:President Barack Obama By CHARLES BABINGTON, Associated Press Writer Charles Babington, Associated Press Writer – 1 hr 30 mins ago
WASHINGTON – On the cusp of a key legislative push, President Barack Obama on Monday filled the Rose Garden with doctors supportive of his health care overhaul, saying "nobody has more credibility with the American people on this issue than you do."
Obama's White House event gave him another chance to frame the debate on his terms as his top domestic priority enters its most critical phase.
The Senate Finance Committee is expected to approve its long-debated, intensely scrutinized bill this week. Then, Senate Democratic leaders will meld it with a more liberal-leaning version passed by the Senate Health, Education, Labor and Pensions Committee. The House also must combine differing versions of its own bills.
For a visual plug from some medical pros, the White House arranged for Obama to have some 150 doctors representing all 50 states arrayed in the sunsplashed lawn area just outside the West Wing. To make sure no one watching at home or catching news footage later would miss the point, the physicians wore their white medical coats for the cameras.
"When you cut through all the noise and all the distractions that are out there, I think what's most telling is that some of the people who are most supportive of reform are the very medical professionals who know the health care system best," said Obama, flanked by four doctors on stage for good measure.
But Sen. John Barrasso, R-Wyo., an orthopedic surgeon for 25 years, said many doctors, nurses and patients strongly oppose Obama's proposals.
They are greatly alarmed at proposed cuts in Medicare, which is the main source of health care for many people in Wyoming and elsewhere, Barrasso said in an interview Monday. He said doctors and hospitals also want provisions to protect them against "abusive lawsuits" by people claiming malpractice.
Obama broke no ground in his comments. He outlined the tenets of his health reform plan: expanded and affordable health coverage options for tens of millions of people, strengthened protections for those who already have insurance, and more time for health professionals to help patients with preventative and healing care.
Obama said the country has heard all sides of the debate over the last few months and the time to act is now.
"I want to thank every single doctor who is here," Obama said. "And I especially want to thank you for agreeing to fan out across the country and make the case about why this reform effort is so desperately needed. You are the people who know this system best. You are the experts."****
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Baucus Bill Would Cost More than $2 Trillion
Posted by Michael F. Cannon
Sen. Max Baucus’s (D-MT) health care overhaul would cost more than $2 trillion. It would expand the deficit. But he has carefully and methodically hidden those facts – so well that he has completely hoodwinked nearly all the major media.
The media are reporting that the Baucus bill would reduce the deficit by $81 billion over 10 years. Wrong.
The Baucus bill assumes that Congress will allow the “sustainable growth rate” cuts in Medicare’s physician payments to occur beginning in 2012. Yet Congress has routinely and repeatedly blocked those cuts, making Baucus’s assumption preposterous. The CBO handled the issue delicately, but essentially said, “Sure, provided that the sun rises in the west in 2012, then yes, this bill would reduce the deficit.”
That means Baucus will come up at least $200 billion short on the revenue side, making his bill a budget-buster.
The media are reporting that the Baucus bill would cost just $829 billion over 10 years. Wrong.
As Donald Marron observes, that number omits as much as $75 billion in new federal spending. It also omits a $33 billion unfunded mandate on state governments.
But the worst part is that the Congressional Budget Office’s preliminary cost estimate omits the cost of the private sector mandates in the Baucus bill. In Massachusetts, those costs accounted for 60 percent of the total cost of reform. That suggests the actual cost of the Baucus bill – $829 billion plus $75 billion plus $33 billion, times 2.5 – is well over $2 trillion.
Yet the CBO score pretends those costs aren’t even there. It’s like a mystery novel that’s missing the last 50 pages. And the media aren’t even curious.
In the words of Brad DeLong, why, oh why, can’t we have a better press corps?
Cross-posted at Politico’s Health Care Arena.
http://www.cato-at-liberty.org/2009/10/08/baucus-bill-would-cost-more-than-2-trillion/
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"The Baucus bill assumes that Congress will allow the “sustainable growth rate” cuts in Medicare’s physician payments to occur beginning in 2012."
I don't see why they can't or won't.
The claim that doctors would leave medicine or retire is just a lot of hot air.
Where are we going to go?
Most can't retire. Sure some have done well and may be able to walk away if they are near retirement and have planned well.
I don't think most of my Indian colleagues are really going to pack their bags and return to India though I have heard some say that.
If government said to every lawyer in the US, or say every accountant in the US: you will have to take an immediate 15% pay cut, sure they would rumble, they would huff and puff, but then what?
They would have to eat it. Just like most of the non procedure oriented doctors, including me have had to do for years.
Nothing new. No one cared about primary care then. So what's the beef with the specialists?
So, in conclusion I am not so sure pay cuts won't happen.
That said adding 27 million to the rolls, one third of them not even citizens, will have NO chance of reducing costs UNLESS rationed health care occurs.
OTOH watching my own health care costs going up year after year with zero end it sight is also unsustainable.
So what the hell.
I got to watch dozens and dozens make millions or less off my wife's song lyrics while she is locked sitting in the house and rotting away.
But I still have spirit in me. LIke the Chinese general said, "what doesn't kill you makes you stronger." (or close to that)
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"The claim that doctors would leave medicine or retire is just a lot of hot air."
If I understand correctly, the plan isn't in place until 'Obama's 2nd term'. I think the more the plan looks like public employee union civil service work in place of private practice, the more likely a certain number will be to re-evaluate their future during the interim rather than join and learn the new system. it wouldn't take too many planned retirees plus early retirees to totally screw up the already screwed up numbers in the plan IMO. The same number of doctors and nurses at the same cost are already planning to treat 20-30 million more people as it stands? As I look for a Dr. myself it seems all the ones I know are already too close to retirement to be of much use to me in my upcoming old age.
If they eased the burden of malpractice lawsuits and insurance, an aging MD could continue to practice on an eased up schedule longer instead of taking normal retirement. Seems to me that keeping them in practice a little longer would be a better course than forcing them out if we were trying to give better treatment to more patients. But we aren't headed in that direction right now.
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"I think the more the plan looks like public employee union civil service work in place of private practice,"
Well that's it exactly.
It would be like a higher end civil service job like a police officer, teacher, federal beauracracy employee, fireman, city hall worker.
Is it worth going through 11 to 17 years of school and training? Is it worth the regulation, the oversight, the liability, the control, the loss of autonomy, and the endless pressure, stress, aggravation, etc.
Certainly foreign born immigrants think so.
2/3 of medical students in NJ are from other countries or are the offspring of immigrants.
A wonderful Egyptian couple who I consider to be friends as well as my patients came in with their 2 yr. old son. They said they want him to be just like me. A doctor.
What can I say?
As a side note, they came here to make a life for themselves. To work hard and live the American dream.
They didn't come here illegally. They don't ask for handouts.
They don't come over the boarder and demand rights and privileges of citizens and have their offspring here who are thus automatic citizens and then send them to public schools paid for by property tax payers, and the rest we are all familiar with....
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Why the Democrats’ Health Care Overhaul May Die
Posted by Michael F. Cannon
The problem that Democrats have faced from Day One is finally coming to a head.
The Left and the health care industry both want universal health insurance coverage. The industry, because universal coverage means massive new government subsidies. The Left, because that’s their religion.
But universal coverage is so expensive that Congress can’t get there without taxing Democrats.
Sen. Jay Rockefeller (D-WV) is the biggest opponent of Sen. Max Baucus’ (D-MT) tax on expensive health plans because that tax would hit West Virginia coal miners.
Unions vigorously oppose that tax because it would hit their members.
Moderate Democrats in the House oppose Rep. Charlie Rangel’s (D-NY) supposed “millionaires surtax” because they know it would hit small businesses in their districts.
And on and on…
But if congressional leaders pare back those taxes, they lose the support of the health care industry, which wants its subsidies.
That’s why the health insurance lobby funded this PriceWaterhouseCoopers study saying that premiums would rise under the Baucus bill: the $500 billion bailout they would receive isn’t enough. They also want – they demand – steep taxes on Americans who don’t buy their products.
The drug companies, the hospitals, and the physician groups are likewise demanding big subsidies, and will run ads to kill the whole effort if those subsidies aren’t big enough.
As always, health economist Uwe Reinhardt put it colorfully:
It’s no different from Iraq with all the different tribes…‘How does it affect the money flow to my interest group?’ They are all sitting in the woods with their machine guns, waiting to shoot.
Once the shooting starts, industry opposition will sway even Democratic members, because there are physicians and hospitals and employers and insurance-industry employees in every state and congressional district.
Can President Obama and the congressional leadership satisfy both groups? My guess is, probably not, and this misguided effort at “reform” will therefore die. Again.
http://www.cato-at-liberty.org/2009/10/12/why-the-democrats-health-care-overhaul-may-die/
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The Dems like to throw around the idea that Medicare is much more efficient than private industry. I have not heard any mainstream media types question this assertion. So where is CNNs bogus "keeping them honest" look at this?
Here is one analysis of this:
http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf
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The Senate Finance Health Bill Has No Clothes
Readers of this blog know that I have lots of concerns for the Senate Finance health bill primarily because it does not so much represent health care reform as just an expensive entitlement expansion.
Readers also know the insurance lobby--AHIP--is not one of my favorite organizations.
But I will tell you the report by Pricewaterhouse Coopers (PwC) commissioned by the AHIP and released this morning is accurate. The Senate Finance bill would do nothing short of blowing up the insurance market.
You don't need to be Einstein or a PwC actuary to come to that conclusion. Common sense is all the credential you need.
Beginning in 2013, the Senate Finance bill would make uninsured individuals eligible for premium credits to buy a health policy. But those credits would leave these people far short of being able to really afford a health insurance policy. A family of four at 250% of poverty and making $55,000 a year ($52,000 is the median household income in the U.S.) would have to pay about $4,000 toward their premiums and that for a policy with a $1,000 deductible and a maximum of about $7,000 in out-of-pocket costs each year.
At 300% of poverty, $66,150, a family would be required to pay $8,000 in premium for a policy with a $3,000 deductible!
How many families making $55,000 a year or $66,000 a year do you know that could add this kind of expense to their annual budgets?
It is really no better for a family making 400% of poverty, or $88,200 a year. They would have to pay $10,600 a year in insurance premiums for that policy with a $3,000 deductible!
Senate Finance, knowing they could not enforce this kind of individual mandate to buy health insurance then set about to exempt many from paying a fine (if it costs more than 8% of income) or just gutting the fine if they did not buy the coverage.
In 2013, for example, there would be no fine for not having insurance. By 2014 the penalty would be $200 per adult and it would rise to $400 in 2015, $600 in 2016, and $750 by 2017.
But starting in 2013 the Senate Finance bill says that the insurance companies have to get rid of medical underwriting and pre-existing conditions provisions.
So in 2013, any consumer could simply go to the health insurance company and demand to be covered under any one of the mandated benefit plans. No medical underwriting before getting in and no pre-existing condition limitations. Just sign the application and go to the doctor.
In one sense you can understand the political logic here--the Democrats can't very well mandate middle class families to pony-up $4,000, or $8,000, or $10,000 out of their already challenged budgets. So they just found a way to exempt them or make the fine a tiny one.
But they left the insurance reforms in place.
Let me ask you a question. Why would any family buy health insurance under such a scheme?
I will suggest the answer is that they will buy it when they need it. No sooner. Even in 2017, a family with two adults would pay no more than a $1,500 annual fine against a premium that would be $4,000 to $10,000 a year in these middle class income brackets.
I'll give you another one. Why would any small employer provide health insurance?
I will suggest the answer to that one is the smart small employer will just cash-out any benefits they do provide today and tell the employee t0 pay the fine until they need it and then go to the exchange and get it (there is also no small employer mandate in the bill to provide coverage). The worker would likely be thousands of dollars ahead each year!
The problem the Democrats have here is that they are trying to get a health bill to cost under $1 trillion. That has made them back off on premium subsidies and policy benefits. They have had to back so far off that the Democratic proposals are not offering health insurance policies anything close to being affordable for middle class families.
The political response in Senate Finance has been to waive the individual mandates but keep the underwriting reforms.
The sum of it all is a health insurance market disaster in the making. In the business we refer to it as a "death spiral." Simply, the higher the premiums go the fewer that will buy, the sicker the pool, the higher the premiums go once again, even fewer people are left in the pool, and so on until all of the sick are in the pool and all of the healthy have left it.
The PwC report says that average family premiums of $12,300 today will rise to $25,900 under the Senate Finance proposals in 2019. They say premiums would be driven by these underwriting reforms, cost shifting from Medicare cuts, and new insurance taxes simply being passed through to consumers.
I don't know if the PwC report is exactly correct, but as to its conclusions regarding the gutting of the mandate to buy insurance and that insurance company taxes will be passed through to customers, common sense certainly takes one to about the same conclusion. Frankly, I thought it would be worse.
The Senate Finance Democrats could not have created a bigger insurance pool train wreck in the making than the one they have devised here.
What is really amazing is how all of these Senators sitting around that Senate Finance table have just sleep walked their way through all of this as if they don't have the common sense to figure this out on their own.
http://healthpolicyandmarket.blogspot.com/2009/10/senate-finance-health-bill-has-no.html
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Now I see Obama offering seniors $250 on Drudge.
In my other post in the music thread I noted that anyone could be bought off.
So Obama thinks he will win over the senior vote with this.
Folks I don't know how you all feel but the endless give aways, taxes, spending proposals from the Democrats on a daily basis
is to me just so depressing.
I know I am going to be holding the bill.
Our country is screwed.
The entitlements are expanding exponentially, the number of people who are giving in and jumping on the dole is exploding and those left holding the bag like myself just have to sit and watch them GIVE our money all away.
Example,
I have a pt. in his 50s who came to me with wear and tear arthritis of his shoulders.
He does do a very physical job.
I suggested he can't do that work anymore and needs to think of something else.
Supervisory etc.
He comes back in a few weeks later with a permanent disability form from Social Security and says to me "you told me I am disabled".
I think to myself I never said that but it is difficult to tell him no when I am his, his wife's, his childrens primary doctor.
So I filled out the form that he has some worn rotator cuffs thinking and I thought SSI will have him evaluated by their own doctor and he will be denied. This has always been the case in the past.
Low and behold within a few short months he is approved. I assume his case was reviewed and they didn't go by only what I wrote but I admit I don't know what the details of the events were in the process.
He has no more arthritis then me. But because I am a doctor I must work forever while this guy goes on the dole.
I hear stories all the time about people getting endless 6 month extensions on their unempolyement. They can get jobs but since they are lower wage from what they are used to they decide they may as well stay on unemployment.
Yet we have millions and millions of illegals working here also using services. A Russian doctor just told me she prefers to care for Americans over Russians. I said really? She said yes, care in Russia is free and they come here expecting free care. Like I said the immigrants of today are not like those of my ancestors at the turn of 1900.
And because the Democrats are all about taxing and spending to buy votes and as long as people decide they may as well get on the dole this country is screwed.
From where I sit there is NO END in sight.
For those of us who are working and paying all these bills I don't want to pay for the health care of all these other people.
Why do the 90% have to suffer for the 10%? I am tired of it. I agree with Levin. Health care is *not a right* and I don't care about all these other people. I have had enough.
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Just a thought.
We are not a country of haves and have nots.
We are a country of earners vs takers.
or perhaps earners vs. handouts.
or earners vs spongers.
or workers vs. spongers.
It is all out of control.
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OF course the headlines suggest doctors will get raises (of course) when in reality the proposal postpones CUTS.
And no I can't be bought off either.
No Dem gets my support. Go screw yourselves.
Senate Dems seek higher doctor payments
By DAVID ESPO (AP) – 19 hours ago
WASHINGTON — Maneuvering to boost prospects for sweeping health care legislation, Senate Democrats hope first to win quick approval for a bill that grants doctors a $247 billion increase in Medicare fees over a decade but raises federal deficits in the process, officials said Wednesday.
By creating a two-bill approach, Democrats intend to claim the more comprehensive health care measure meets President Barack Obama's conditions — that it will neither add to deficits nor exceed $900 billion in costs over 10 years.
If approved and signed into law, the legislation would avert a 21 percent reduction in Medicare fees paid to doctors that is scheduled to take effect in January as well as additional cuts in future years.
Lawmakers frequently draft budgets that assume payment rates for doctors treating Medicare patients will fall rather than rise, part of a sleight of hand set of assumptions to make deficits appear smaller than they actually are. They then convene the following year and restore the money.
The disclosure of Senate Democrats' plans came as senior lawmakers sat down with White House chief of staff Rahm Emanuel and other top administration officials for the first time to draft a health care bill expected to be voted on in the full Senate beginning in about two weeks.
Two Senate committees have approved different versions of the legislation, requiring the unusual set of negotiations.
The bill to restore planned Medicare cuts for doctors was introduced without fanfare in the Senate on Tuesday and set aside for swift floor action next week, rather than sent to the Senate Finance Committee for hearings as would normally be the case.
"This is a bill that would permanently change the payment system for physicians to a fairer system," Sen. Debbie Stabenow, D-Mich., said as she introduced the bill.
Jim Manley, spokesman for Senate Majority Leader Harry Reid, D-Nev., said the decision to move quickly and apart from the health care bill was made in consultation with the White House. House Democratic leaders were also involved in the discussions.
House Democrats, in particular, have grumbled about trying to adhere to Obama's price tag.
In the Senate, the immediate impact of a two-bill approach is to slice $10.7 billion from the cost of the health care bill that cleared the Finance Committee bill, money that could then be spent on other priorities.
A 60-vote Senate majority will be required to pass the measure, potentially placing Republican senators in a quandary.
If they oppose it, they may anger doctors who have made restoration of the planned payment cuts a top priority. If they support it, they may open themselves up to charges they helped raise deficits and facilitated passage of a health care bill that conservatives oppose vigorously.
Stabenow's office did not immediately return a call seeking additional information.
Dr. J. James Rohack, president of the American Medical Association, issued a statement welcoming the developments. "Without repeal, the current formula projects steep cuts of about 40 percent over the next five years. As we work to improve the health system, permanent repeal of the payment formula is an essential element of health reform to ensure the security and stability of Medicare," he said.
Manley said the measure does not need to be offset by spending cuts or higher taxes because "it does not increase spending. It simply restores a more honest picture of what future physician spending will actually be."
But Democrats saw the issue differently more than a year ago, the last time Congress acted to head off a cut in payment rates.
Then, they insisted on cutting payments to insurance companies providing private Medicare coverage in order to cover the $13.5 billion cost of the increase in doctor payments. The result was a showdown in which the legislation was passed over President George W. Bush's veto.
Copyright © 2009 The Associated Press. All rights reserved.
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"Enlightened statesmen will not always be at the helm." --James Madison
Baucus and Pelosi work on their health care potionGovernment & Politics
Double, Double, Toil and Trouble
The headlines triumphantly announced Tuesday that the Senate Finance Committee had passed its version of the health care takeover bill with the help of Republican-In-Name-Only Olympia Snowe of Maine. But as the Heritage Foundation's Brian Darling writes, there is no bill. In fact, Darling says, "The Senate is using a non-transparent and rare -- if not unique -- process to pass Obamacare."
Though Sen. Max Baucus (D-MT) gathered Democrats and Republicans to craft a bill, they couldn't do it, even after weeks of meetings. So, Darling continues, "Baucus then scheduled a markup of an outline of his version of health care reform. Many call it a 'Vapor Bill,' because it's only a description of legislation. No member of the Committee has seen actual legislation, just a 262-page description. That Vapor Bill never will be voted on in the Senate, so many detractors are calling this a 'make believe markup.' It's to fool people into thinking the Senate is actually crafting a bill."
Not only that, but Darling adds, "I have called around Capitol Hill to find out who has a copy of the bill and none of my high-level contacts know." Now that's transparency.
Meanwhile, based on what language is actually accessible, the PricewaterhouseCoopers accounting firm performed an analysis commissioned by America's Health Insurance Plans (AHIP), a group representing the industry. Warning that the Baucus bill will saddle everyone who has insurance (including the Democrats' beloved middle class) with a load of new taxes in various forms, the report highlights an excise tax on employer-provided high-value health plans, Medicare payment cuts that would result in cost-shifting to the private market, and new taxes on the health industry that will inevitably be passed on to consumers.
According to Investor's Business Daily, "The study estimates that the average family-coverage cost of about $12,300 [per year] could reach $17,200 in 2013 if these provisions were implemented, $21,300 in 2016 and $25,900 in 2019. Meanwhile, average single coverage -- $4,600 today -- could reach nearly $10,000 in 2019." No wonder Democrats are afraid to discuss the details of this witch's brew.
Still, AHIP is no stalwart defender of the Constitution and Rule of Law. As The Wall Street Journal writes, "The irony is that AHIP is now arguing for a more left-wing bill, claiming the Baucus plan isn't 'universal' enough." Obviously, insurance companies are looking out for their own best interests. It's too bad they don't understand that those interests are best served by the free market.
The BIG Lie
"[The AHIP report is a] hatchet job ... bought and paid for by the same health insurance companies that have been gouging too many consumers for too long as they stand in the way of reform yet again." --Sen. Max "The Gouger" Baucus, who predicts that all Democrats and possibly more than one Republican will support his bill
This Week's 'Braying Jenny' Award
"When you think of the campaign that's been launched against the public option by the insurance industry -- because they can't take the competition. Anyone who had any doubts about the need for such an option need only look at the health insurance industry this week." --House Speaker Nancy Pelosi (D-CA)
Pelosi is reduced to taunting and threatening anyone opposed to her schemes, saying that it only further makes the case for a government-run "public option" for health insurance. But how could any industry compete with the federal government's ability to run at a deficit forever? She went on to mock the "discredited" AHIP report. No one has actually discredited the report, mind you, Pelosi only says it's been discredited.
Hope 'n' Change: About That Free Lunch
Creative accounting allows Washington to get away with a lot, and the current health care debacle is no exception. Recent analyses of House and Senate proposals by the Congressional Budget Office rely upon static scoring (i.e., not factoring in behavioral changes caused by the legislation,) fantastically optimistic projections and simple omissions of unfavorable facts that trumpet deficit-neutral bills having no basis in reality. The libertarian Cato Institute, for example, took a close look at the CBO's numbers and discovered a variety of unsupportable claims.
For starters, the 10-year projection that measures out the trillion-dollar House bill in itself is misleading. Most of the bill's major provisions don't kick in until 2014, making for a 6-year projection in which costs ramp up slowly. After the first three years of the program, around the time of the 2012 election, costs would accumulate to about $100 billion, relative chump change that will allow Obama's re-election campaign the opportunity to pledge that health care has been a cost-saving success. But four years beyond that, long after the current president passes the threshold of electoral accountability (assuming he wins, perish the thought), costs catch a fever. Cato estimates a $2.4 trillion tab (even Sen. Harry Reid admits as much), double what the House bill and the CBO project. And what happens after 2019 is a true horror story.
The Baucus bill, all the rage on Capitol Hill these days, is another fraud of epic proportions. It claims to have no impact on the deficit by assuming, in part, that growth rate cuts in Medicare's physician payments will help offset its $829 billion price tag. All well and good, but Congress never makes those cuts because no one wants to be on record as cutting an entitlement for one of America's most powerful voting blocs. Just by taking these cuts out of the equation, the bill automatically goes $200 billion into the red. Additionally, there is no reckoning of the built-in costs that will hit consumers, including penalties for high-price insurance plans, penalties for not having insurance and the general rise in cost of various health care procedures over the span of several years.
Obama and his Democrat lackeys have either bullied or beguiled the CBO, once a reliably non-partisan entity, into fabricating analyses concluding that Congress has produced sweeping legislation that does not negatively affect the deficit. If ever the phrase "voodoo economics" applied, it's now.
This Week's 'Alpha Jackass' Award
"I will actually give you a speech made up entirely -- almost at the spur of the moment, of what a candidate for president would say if that candidate did not care about becoming president. In other words, this is what the truth is, and a candidate will never say, but what candidates should say if we were in a kind of democracy where citizens were honored in terms of their practice of citizenship, and they were educated in terms of what the issues were, and they could separate myth from reality in terms of what candidates would tell them:
'Thank you so much for coming this afternoon. I'm so glad to see you, and I would like to be president. Let me tell you a few things on health care. Look, we have the only health care system in the world that is designed to avoid sick people. [laughter] That's true, and what I'm going to do is I am going to try to reorganize it to be more amenable to treating sick people. But that means you -- particularly you young people, particularly you young, healthy people -- you're going to have to pay more. [applause] Thank you.'
'And by the way, we are going to have to -- if you're very old, we're not going to give you all that technology and all those drugs for the last couple of years of your life to keep you maybe going for another couple of months. It's too expensive, so we're going to let you die.' [applause]
'Also, I'm going to use the bargaining leverage of the federal government in terms of Medicare, Medicaid -- we already have a lot of bargaining leverage -- to force drug companies and insurance companies and medical suppliers to reduce their costs. But that means less innovation, and that means less new products and less new drugs on the market, which means you are probably not going to live that much longer than your parents. [applause] Thank you.'" --Robert Reich, President Clinton's labor secretary, in a speech at Berkeley in 2007. Democrats, death panels and dying early -- it's all in there, folks.
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By JAMES TARANTO
Yesterday we received an email from a loyal reader who nonetheless seems to disagree with everything we write--a type of reader for whom we have a special, if slightly perverse, affection. Our correspondent included a quote that he attributed to Aristotle:
If we believe men have any personal rights at all, then they must have an absolute moral right to such a measure of good health as society can provide.
Could an ancient philosopher, a man who lived and died many centuries before the advent of either socialism or modern medicine, really have been in favor of socialized medicine? We were skeptical, to say the least, and decided to do a bit of Web sleuthing.
We punched the quote into Google, and up popped a series of references, mostly from left-liberal outfits like truthout.org and Bill Moyers Journal. This heightened our suspicion that the quote is a "progressive" urban legend, but it didn't prove it.
Podcast
James Taranto on the supposed Aristotle quote.
.Then we tried searching Google Books, figuring that if this appeared anywhere in Aristotle's works, it would turn up there. The only reference to the quote was from Thurston Clarke's 2008 book, "The Last Campaign: Robert F. Kennedy and 82 Days That Inspired America." Clarke reports that RFK, during his 1968 presidential campaign, attributed the quote to Aristotle in a speech at the "University of Indiana Medical School" (presumably he means the Indiana University School of Medicine).
Of course, Aristotle wrote in ancient Greek, not modern English, so it's possible that Kennedy was using his own translation. But a March 2008 paper by Edmund D. Pellegrino, a professor of medicine and philosophy at Georgetown University, suggests that in fact RFK was using a fabricated quote. Here is what Pellegrino, with the assistance of the staff at the National Reference Center for Bioethics Literature, found:
In attempts to establish the provenance of the text in question we have conducted an extensive search for its source and original wording. We have not been able to locate it. Our initial curiosity was aroused by several things, including that rights language did not seem to have the Aristotelian context, and health care, as such, was not included in Aristotle's works. We searched Nicomachean Ethics and Eudemian Ethics, and the Magna Moralia without successfully locating the quote. Nor could we find it in other of works of Aristotle: On Length and Shortness of Life, De Anima, Economics or the Fragments. "Rights" language certainly would stick out in Aristotle's virtue-based ethics.
Curiously, the earliest reference to the purported quote that Pellegrino was able to find was from an article published in 1979, more than a decade after RFK's death, whose author claimed to have translated it himself from a Latin edition of the Nicomachean Ethics. We haven't been able to find a transcript of the RFK speech, or any contemporaneous account of his quoting Aristotle in it.
Maybe he was quoting Aristotle Onassis.
'Futile' Vassals
Whatever Aristotle might or might not have said, the flip side of establishing a "right" to medical care is that it also entails empowering the government to define the limits of that right. An Associated Press story offers a chilling hint of the potential implications:
A surprising number of frail, elderly Americans in nursing homes are suffering from futile care at the end of their lives, two new federally funded studies reveal.
One found that putting nursing home residents with failing kidneys on dialysis didn't improve their quality of life and may even push them into further decline. The other showed many with advanced dementia will die within six months and perhaps should have hospice care instead of aggressive treatment.
Medical experts say the new research emphasizes the need for doctors, caregivers and families to consider making the feeble elderly who are near death comfortable rather than treating them as if a cure were possible--more like the palliative care given to terminally ill cancer patients.
We have no basis on which to quarrel with the findings of the study, and certainly it is true that some treatments are futile and circumstances exist in which palliative care is the least bad of all available options. But when government becomes the decision-maker, you end up with stories like the one we noted Wednesday, in which a British hospital manager tried to persuade a woman to make her grandmother "comfortable" (read dead) when, as it turned out, the old lady's breathing difficulties were easily treatable.
In that same item Wednesday, we called attention to a speech Robert Reich, President Clinton's labor secretary, gave, in which he set forth what he described--approvingly--as the "truth" about so-called health-care reform: that it amounts to telling old people, "We're going to let you die," forcing young people to pay more for insurance, and suppressing medical innovation.
We weren't the only one to notice this Reich speech, and Reich has posted a response on his blog to the commentary that has ensued:
Lou Dobbs, Sean Hannity, Rush, and the right-wing blogosphere seem interested in a talk I gave in September, 2007 to students in a political science class here at Berkeley, in which I played the role of a presidential candidate so politically incorrect and tone-deaf as to pummel every sacred cow in sight--including the notion that our society could afford and would continue forever to pay whatever amount of money was required to keep everyone alive forever. The whole point of the mock exercise was to show that presidential candidates can't state what everyone knows to be the truth because they'll be taken apart by the Right or the Left. I slew many other sacred cows in that mock exercise, some of which are held dearly by the Left. Nonetheless, two years later the Right has exhumed the lecture and taken my words completely out of context purportedly to show that Obama and the Democrats plan death panels.
If their desperation weren't so pathetic it would be funny. After all, they have proven the whole point of my lecture. UC Berkeley maintains an archive of webcasts and my speech is available there verbatim, should you wish to listen to it in its entirety.
This is bizarre. We don't know exactly what Dobbs, Hannity and Rush Limbaugh said, but we were in complete agreement with "the whole point" of Reich's lecture, at least as it applies to President Obama and other politicians currently pushing "health-care reform": that they are not telling the truth about their intentions. Reich almost certainly gave a far more accurate description of how ObamaCare would work in practice than Obama has ever given.
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This New England Journal of Medicine article. Note all these studies addressing end of life issues showing up in this journal now while we debate end of life care. It is no coincidence. Republicans I think would want to leave this a private decision for patients and their doctors. Liberal/radical Democrats of course want to transfer the decision making to government. I have no problem with this being discussed in the medical journal. Caveat emptor from those who don't usually read the NEJM. Its editors are clearly and obviously big liberals up in Boston academia so they are not unbiased. They do have the say in what does and what does not get published so I don't trust them fully. Many of them have their agendas like all of us to an extent.
Infections, Eating Problems Signal The End in Advanced Dementia
By John Gever, Senior Editor, MedPage Today
Published: October 14, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Earn CME/CE credit
for reading medical news
The final months of advanced dementia are marked by "distressing symptoms and burdensome interventions," investigators concluded in the first systematic, prospective investigation of the disease's late-stage clinical course.
Among 323 patients with advanced dementia in nearly two dozen nursing homes who were followed for 18 months, more than 40% developed pneumonia, while half had at least one febrile episode, and 85% suffered eating problems, according to Susan L. Mitchell, MD, MPH, of the Hebrew Senior Life Institute for Aging Research in Boston, and colleagues.
Some 55% of the sample died during follow-up, the researchers reported in the Oct. 14 New England Journal of Medicine. Most suffered from Alzheimer's.
Action Points
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Explain to interested patients that advanced dementia is irreversible and eventually fatal.
Explain that although earlier studies had suggested that pneumonia and other infections, fractures, eating problems, and agitation are common in advanced dementia, they were not as rigorous as the current study.
Explain that when serious illnesses are considered incurable and terminal, the focus of care usually shifts to making the patient comfortable.
During their final three months of life, 41% of dying patients underwent at least one intensive intervention, such as hospitalization, transport to an emergency room, tube feeding, or parenteral treatment.
"Patients, families, and health care providers must understand and be prepared to confront the end stage of this disease, which is estimated to afflict more than 5 million Americans currently and is expected to afflict more than 13 million by 2050," Mitchell and colleagues wrote.
They also found that when patients' surrogates and guardians understood the expected clinical course, burdensome interventions were much less likely during the final three months of life (adjusted odds ratio 0.12, 95% CI 0.04 to 0.37), relative to proxies with poor understanding.
In an accompanying editorial, Greg A. Sachs, MD, of Indiana University School of Medicine in Indianapolis, said the study "moves the field forward in major ways with respect to both prognosis and the terminal nature of advanced dementia."
Not only should clinicians, nursing home staff, and patients' families be aware of the study results, Sachs suggested, but so should Congress and the government's major health agencies.
"Much more research is needed on the use of palliative care for these patients, including studies on prognosis, patients in less advanced stages of dementia, alternative care settings, intervention trials, and, eventually, the effects of implementing programs designed to improve current systems of care," he wrote.
The study focused on nursing home patients in the Boston area who could no longer recognize family members or walk independently.
About 72% had scores of zero on the Test for Severe Impairment, and the mean scores on the Bedford Alzheimer's Nursing Severity subscale was 21.0 (SD 2.3). The mean age of the group was 85, and patients had been in nursing home care for a median of three years.
Dementia was related to vascular insufficiency in 17% of the patients and to Alzheimer's disease in 72%. Symptoms in the remainder had other causes.
Patients underwent exams every three months. Caregivers and guardians or other surrogate decision-makers were also interviewed regularly.
In particular, each guardian or surrogate was asked whether he or she thought the patient would survive another six months. Also, at study baseline they were asked whether they understood the general clinical complications that might be expected in advanced dementia and whether they had discussed these issues with a nursing home physician.
Median patient survival was 478 days, Mitchell and colleagues reported. They calculated the following probabilities of complications:
Pneumonia: 41.1%
Febrile episode: 52.6%
Eating problems: 85.8%
Patients developing these problems had relatively high mortality rates in the following six months: 46.7% after a bout of pneumonia, 44.5% after a fever, and 38.6% after eating problems began.
On the other hand, patients who could eat normally were very unlikely to die. Only about 10% of these patients died during the entire follow-up period, compared with about 70% of those who developed eating problems at some point.
Other sentinel events included 14 cases of seizure, 11 gastrointestinal bleeds, and seven hip or other bone fractures. But only seven of the 42 sentinel events occurred during the last three months of life for those who died during follow-up.
Symptoms causing acute distress were also common in the study. From 40% to 45% of patients suffered one or more of the following: dyspnea or pain for at least five days per month, pressure ulcers at stage II or higher, and aspiration. Nearly 54% experienced periods of agitation, the researchers found.
Among the entire study sample, about one-third received parenteral therapy, while 17% were admitted to a hospital, 10% had an emergency room visit, and 8% were tube-fed.
Pneumonia accounted for more than two-thirds of the hospitalizations, Mitchell and colleagues said.
Only 30% of those who died during follow-up had been referred to hospice care, and 22% of the overall sample.
The interviews with surrogates and guardians showed that 96% believed that comfort was the primary goal of therapy. Less than 20% said a nursing home physician had discussed prognosis with them.
About 80% indicated that they understood the medical complications likely to occur, but only 33% said they had discussed them with a physician.
Mitchell and colleagues noted that most of these findings had been observed in previous studies, but those were either retrospective or cross-sectional analyses or had focused on hospitalized patients. "The clinical course of advanced dementia has not been described in a rigorous, prospective manner," they said, prompting their study.
They said their results "can be used to inform families and care providers that infections and eating problems should be expected and that their occurrence often indicates that the end of life is near."
They added, "Families and providers should also understand that although these complications may be harbingers or even precipitants of death, as they are in other terminal diseases (e.g., the acquired immunodeficiency syndrome, cancer, and emphysema), it is the major illness, in this case dementia, that is the underlying cause of death."
In his editorial, Sachs said it was important that clinicians and patients' families approach advanced dementia "as a terminal illness requiring palliative care." He argued that these patients should qualify for hospice care whether or not they have other serious illnesses.
He also criticized moves by the government to restrict hospice care in nursing homes. "Although no one can argue against the need to root out fraud and unseemly conflicts of interest, it would be a shame to take hospice away from patients with dementia, who could truly benefit from it," Sachs wrote.
Mitchell and colleagues noted that their study was limited by its narrow geographic focus and its reliance on charts and nursing reports for some data. They also emphasized that their reported survival times do not represent survival from onset of advanced dementia.
They also noted, "We can report only the associations between the health care proxies' perceptions of prognosis and of the complications expected and the use or nonuse of aggressive interventions -- we cannot draw conclusions about cause and effect."
The National Institute of Aging funded the study.
No potential conflicts of interest were reported by study authors.
Sachs reported a relationship with CVS Caremark.
Primary source: New England Journal of Medicine
Source reference:
Mitchell S, et al., "The clinical course of advanced dementia" N Engl J Med 2009; 361: 1529-38.
Additional source: New England Journal of Medicine
Source reference:
Sachs G, "Dying from dementia" N Engl J Med 2009; 361: 1595-96.
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Taking Obamacare Off the Books
By the Editors
You don’t have to be a Washington insider to understand what the Democrats are up to with their last-minute plan to run the “doc fix” — postponing scheduled cuts to doctors’ Medicare payments — on a separate legislative track. It’s all about Obamacare, as is so much this year. The Obama administration and its allies in Congress will do just about anything to get a health-care bill to the president’s desk, and that certainly includes spending whatever amount of taxpayer money they deem necessary — and doing so through a shameless ploy, offloading $247 billion in Obamacare costs onto a separate, standalone, unfinanced piece of legislation. Obama promised not to add “one dime” to the deficit for health care: Democrats now plan to dump $247 billion onto the nation’s already staggering pile of debt, using this piece of accounting trickery to cover their tracks.
The “doc fix” is political shorthand for repeal of the discredited “sustainable growth rate” (SGR) Medicare-payment formula, which determines the annual update of physicians’ fees. A comprehensive failure as a cost-cutting measure, SGR is a prime example of the bureaucratic central planning that Democrats now want to extend across all of American health care. SGR was supposed to keep Medicare spending on doctors’ services in line with economic growth by limiting the annual increases in the prices paid for each particular physician service. The trouble is that Medicare’s total cost is determined by both prices and volume, and the government has no way to control the use of physicians’ services. As fees have been cut, volume has soared — necessitating even deeper cuts to keep spending in line with SGR targets.
The sensible course is a thorough reform of how Medicare operates. So long as the program is dependent on payment schemes devised in Washington, we are doomed to endure SGR-style disasters over and over again.
But the Obama administration isn’t interested in serious entitlement reform. They just want to make the SGR nuisance go away, which is why the House health-care bill included a full repeal of it. Sen. Max Baucus’s plan, however, only delayed the SGR cuts for another year so that he could claim his plan comes in under the $900 billion ceiling the president established for a health-care bill.
Now, as Democrats prepare to take their plans to the House and Senate floors, they are looking to spend even more money to buy votes and to make political problems go away. The catch is that pesky budget limit the president endorsed. The solution? Simply moving some of the spending out of the health-care bills and into other pieces of legislation. Presto! Now there’s even more money to spend!
Fortunately, there is still some sanity on the Democratic side of the aisle. Senate Budget Committee chairman Kent Conrad has restated his opposition to repealing SGR without an offset to cover the $247 billion hole that would blow in the federal budget. Indiana Sen. Evan Bayh says he will join Conrad in opposing the Democratic plan.
So the question is, What will Republicans do when the SGR repeal is called up in the Senate? If they stick together and join Conrad and Bayh, they can defeat it and force the Democrats to address the issue responsibly. No one likes SGR, but there is no real danger of doctors’ facing a Medicare fee cut in 2010 — a bipartisan consensus will ensure that doesn’t happen. So the last thing Republicans should do now is to support an unfinanced repeal outside of a health-care bill. That will undermine any effort to secure meaningful Medicare reform — this year or ever. Worse, it will give Democrats cover to spend even more on Obamacare, buying off special interests and greasing the political machinery.
This is a tactical ploy by Democrats to secure a government takeover of American health care. Republicans have no choice but to oppose it.
National Review Online - http://article.nationalreview.com/?q=NDgxMmJlMzI4ODNiNzNlNjZjY2ZhMGRiNDE5ZjMyOTU=
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Second Post
Congress Keeps Gold-Plated Health Care... For Themselves
Jillian Bandes
Monday, October 19, 2009
Personal doctors on call 24/7. Coverage that knows no caps. No exemptions for pre-existing conditions.
Those are the sorts of benefits members of Congress currently enjoy on the taxpayer’s dime, and the kinds of benefits Americans on a government-run public health care plan will never see if Obamacare passes.
“One thing is certain: Congress will exempt itself from whatever lousy health care system it forces on us little people,” said Michael Cannon, director of health policy studies at the Cato Institute. “Congress will get better insurance than you do because politicians always get a better deal under government-run health care.”
While it’s not news that Congressional health insurance plans are posh, CBS News recently uncovered the details of plans – right as the details of the Baucus health care bill are being hashed out.
Members of Congress can choose from five different plans, and have access to both the VIP Bethesda Naval Hospital and a reserved spot Ward 72 at Walter Reed Army Medical Center, an elite division usually reserved for military members. Their everyday medical concerns can be taken care of at a doctors office located inside of Congress.
Their premiums are the same as those of insurance plans with half the benefits, and the plans last a lifetime; not until Medicare kicks in do ex-Members or loose their Congressional health benefits. Congress has repeatedly voted down any provision that would switch their insurance plans to the lower-grade public option if Obamacare goes through.
Helen Evans, the director of Nurses for Reform, a campaign for more consumer-led, sustainable healthcare systems in Britain, said that this sort of elite care for the bureaucracy – and low-brow care for the plebes – is the same thing that happens in the government-run British health care system.
“Independent academic research has shown that on average the professional and managerial types obtain 40% more resource per illness episode than lower down the social spectrum” in Britain, she said.
Evans is certain that the exact same thing would happen in the U.S. if Obamacare was installed.
“The National Health Service, is famous for being a highly politicised bureaucracy that whilst it legitimises itself on the basis of equality favours the powerful, articulate and well connected,” she said. Nurses for Reform is unsurprised that American politicians are pushing for government-run health care “while of course attempting to secretly perpetuate their own elitist system funded by ordinary taxpayers.”
At least one U.S. Congressman is speaking out.
"If we pass a law that says a public option will be made available, I think people like myself should get out of this plan and go into the public option," Sen. Lindsey Graham, (R-S.C.), told CBS.
http://townhall.com/columnists/JillianBandes/2009/10/19/congress_keeps_gold-plated_health_care_for_themselves
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"Their premiums are the same as those of insurance plans with half the benefits, and the plans last a lifetime; not until Medicare kicks in do ex-Members or loose their Congressional health benefits"
It seems reasonable that members of our government get the best health care. But for life?
Wow. What a racket? I suppose their families are also covered under the posh plan? For life as well?
I am sure they get better and more immediate care than our veterans.
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Democrats issued a statement saying their 1,990-page measure "lowers costs for every patient" and would not add to federal deficits. They put the cost of coverage at under $900 billion over 10 years, a total that excludes several items designed to improve benefits for Medicare and Medicaid recipients and providers, as well as public health programs and more.
What lies.
Decrease the deficit AND lower costs for "every" patient AND cover another God knows how many millions and of course care will not be rationed, will be better "quality".
What a joke.
As always those of us who work and pay taxes have more taken to pay for those who don't, or are on some sort of dole.
Hopefully it won't get through the Senate.
And no, I don't want to pay for the medicines of that sob story lady who spoke after Pelosi.
We have got to stop the entitlements. People have got to stop expecting to retire at their convenience, and expecting governemnt to pick up their lives.
I had someone come in requesting disability the other day. I was astonished. I asked I thought you retired from your turnpike job?
He said I did. On pension. So I asked what is the disability for? He says a friend told him he could get more money that way.
I told him he is not disabled and would not write that he is. He admitted he agreed with me and sheepishly left the office.
I have another daughter of a pt. who told me that one of the first English words the immigrants legal or illegal learn when they come to the US is "medicaid".
Where is the outrage? When will this all stop? I am becoming to hate my own country.
We are broke in spirit, in ethics, in honesty, as a nation.
The crats keep making it worse.
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I share the feelings.
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Cato Institute - 1000 Massachusetts Avenue, N.W. - Washington D.C 20001
State ‘Opt-Out’ Proposal: a Ruse within a Ruse
Posted by Michael F. Cannon
President Obama and his congressional allies want to create yet another government-run health insurance program (call it Fannie Med) to cover yet another segment of the American public (the non-elderly non-poor).
The whole idea that Fannie Med would be an “option” is a ruse.
Like the three “public options” we’ve already got – Medicare, Medicaid, and the State Children’s Health Insurance Program – Fannie Med would drag down the quality of care for publicly and privately insured patients alike. Yet despite offering an inferior product, Fannie Med would still drive private insurers out of business because it would exploit implicit and explicit government subsidies. Pretty soon, Fannie Med will be the only game in town – just ask its architect, Jacob Hacker.
Now the question before us is, “Should we allow states to opt out of Fannie Med?” It seems a good idea: if Fannie Med turns out to be a nightmare, states could avoid it.
But the state opt-out proposal is a ruse within a ruse.
Taxpayers in every state will have to subsidize Fannie Med, either implicitly or explicitly. What state official will say, “I don’t care if my constituents are subsidizing Fannie Med, I’m not going to let my constituents get their money back”? State officials are obsessed with maximizing their share of federal dollars. Voters will crucify officials who opt out. Fannie Med supporters know that. They’re counting on it.
A state opt-out provision does not make Fannie Med any more moderate. It is not a concession. It is merely the latest entreaty from the Spider to the Fly.
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"you can force insurance companies to "cover" preexisting conditions, but the resulting product is not insurance. You cannot insure against something that has already happened. It is merely a bill-paying mechanism."
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Do They Need the Public Option?
October 30, 2009 John Hinderacker, Powerlineblog.com
Much discussion of the House Democrats' health care bill has focused on its inclusion of the "public option," which most observers see as a Trojan Horse intended to serve, ultimately, as the vehicle for socialized medicine as private insurers are driven from the market--a process that President Obama has said may take ten to twenty years.
What strikes me as I read the House bill, however, is how closely it approximates socialized medicine even without the public option. The bill is classic national socialist legislation, in that it takes ostensibly private entities, the health insurance companies, and perverts them into instruments of the state, run top-down and barred from competing among themselves.
Under the House bill private health insurance companies will still exist, but to what end? They will be legally prohibited from competing in any meaningful sense. They will be required to issue substantially the same coverages at substantially the same rates, changes in which must be justified to the government. They will be prohibited from underwriting insurance risks in any rational way: they must pay all bills resulting from preexisting conditions, and they will be prohibited from charging lower-risk customers lower rates.
As I wrote here, you can force insurance companies to "cover" preexisting conditions, but the resulting product is not insurance. You cannot insure against something that has already happened. It is merely a bill-paying mechanism. Likewise, the House bill prohibits insurance companies from charging premiums on any rational basis. Section 213, titled "Insurance Rating Rules," provides:
The premium rate charged for a qualified health benefits plan that is health insurance coverage may not vary except as follows:
(1) LIMITED AGE VARIATION PERMITTED.--By age (within such age categories as the Commissioner shall specify) so long as the ratio of the highest such premium to the lowest such premium does not exceed the ratio of 2 to 1.
So young people--who, remember, will now be forced to buy health insurance--will subsidize older people.
(2) BY AREA.--By premium rating area (as permitted by State insurance regulators or, in the case of Exchange-participating health benefits plans, as specified by the Commissioner in consultation with such regulators).
(3) BY FAMILY ENROLLMENT.--By family enrollment (such as variations within categories and compositions of families) so long as the ratio of the premium for family enrollment (or enrollments) to the premium for individual enrollment is uniform, as specified under State law and consistent with rules of the Commissioner.
That's it. A lower premium for non-smokers or the non-obese? Forget about it. It's illegal.
Under the House bill, it is scarcely an exaggeration to say that health insurance companies are no longer in the insurance business. They can't rate and underwrite risks, which is the essence of insurance. That's illegal. They can't decide to whom they will issue policies; that's illegal, too. They can't offer novel or innovative coverages; their coverages are dictated by law. To a limited extent they can make decisions on paying claims, but under the watchful eye of government regulators. Meaningful competition among insurance companies will be, in effect, illegal. (In that context, it is a sick joke that the Pelosi bill also subjects health insurance companies to the antitrust laws, from which they had been exempted in consideration of their regulation by state, not federal, authorities.)
In the world that the House bill would create, the money we will pay to insurance companies won't really be insurance premiums. Insurance premiums are contractual payments which the parties voluntarily agree upon and which are based on a mutual assessment of risk. Rather, the checks we write to insurance companies will be taxes--legally compelled, at rates set by the federal government that are designed to punish some and subsidize others.
Isn't this socialized medicine in all but name? The only difference, perhaps, is that when things start to go badly, as they inevitably will--spiraling costs, long waits for treatment--Nancy Pelosi and her colleagues will have someone to blame: the insurance companies. Maybe old-fashioned socialized medicine would be better. Then, at least, the government would have to take responsibility for its folly.
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Obama's Fight to Win or Lose
Mitch McConnell takes a shrewd tack in the battle over Obamacare.
by Fred Barnes
11/09/2009, Volume 015, Issue 08
The easy life is about to end for President Obama. For the first time, he can't defer or delegate or depend on the media to bail him out. He has to stand and fight for the policy that defines his presidency--liberal health care reform. And the fight won't be pleasant.
Obama is exactly where he didn't expect to be. His popularity has declined at a record rate. His supposed power of persuasion has turned out to be nonexistent. More Americans oppose his health care initiative than support it. And Republicans are prepared to combat him and Democrats on every major provision of it.
The large Democratic majorities in the Senate and House may look overwhelming, but they're not. At least a half-dozen Democratic senators are queasy about Obama-style reform. If two of them bolt, Republicans should be assured of the 41 votes that would block a motion to end debate on the legislation. If only a single renegade Democrat emerges, that will suffice so long as all 40 Republican senators, including Maine's Olympia Snowe, hang together.
There's less for Obama to worry about in the House. Speaker Nancy Pelosi can afford to lose about 40 Democrats and still pass Obamacare. Yet there is significant uneasiness in her ranks. When Democrats met last week, 47 said they're opposed to the bill, and four or five sneaked out of the room to avoid declaring themselves. Pelosi softened it ever-so-slightly, and Republicans figure she'll have the votes for passage.
The Senate is the battleground. Republicans are mounting a nonstop, full-court press against Obamacare. Minority leader Mitch McConnell has made an issue of the normally routine "motion to proceed" with discussion of the bill on the Senate floor.
It's at this point that Democrats with misgivings about Obamacare have what McConnell calls their "maximum leverage." Democrats who want non-trivial changes in the bill--Blanche Lincoln of Arkansas opposes the public option, Evan Bayh of Indiana the tax on medical devices--would have great difficulty getting them approved once the bill reaches the Senate floor. It will take 60 votes to remove anything from the bill Senate majority leader Harry Reid introduces at the start of deliberations.
Chances are, the motion to proceed will pass, though 41 votes are enough to defeat it. If it were to lose because of Democratic defections, the bill would have to be altered to accommodate the dissenters, upsetting the balance of taxes, Medicare cuts, and benefits. Liberals would be furious. Reid would be fit to be tied. Obamacare would be thrown off track.
Discombobulating Reid is part of the Republican strategy. Reid is mistake-prone, as he demonstrated recently in trying unsuccessfully to repeal cuts in doctors' fees under Medicare. He is anxious over his dicey reelection prospects next year in Nevada. He's erratic under pressure.
Given the Senate's rules, it's easy for Republicans to prolong the debate into next year. There are two likely benefits. The longer the debate, the more snarled up the Senate becomes in procedural matters and the more likely Reid is to blunder. Even more important is the time it will give Republicans to educate and arouse the public about Obamacare.
They already have a receptive audience. As pollsters Frank Luntz and Lowell Baker noted last week:
The untold story of the past six months is the collapse in support among independents and moderates. Republicans always hated the Obama approach, while Democrats were always in his corner. But to see Americans in the political center turn from cautiously supportive to increasingly opposed is the most significant political consequence of the debate.
Republicans need help from outside Washington to succeed, particularly in states whose senators are less than committed to Obamacare. Grassroots opposition can be pivotal. In 2007, it was largely responsible for derailing an immigration reform bill that might otherwise have been enacted.
Over the past summer, noisy protests at town hall meetings and tea parties had an enormous impact. But the intensity of that opposition has subsided just as counterpressure by liberal interest groups has risen. Republican leaders believe that fervor must be jacked up once more, reminding key Democratic senators of the risk of voting for Obamacare.
There's one tricky part for Republicans in the health care fight. They don't want the bill to be improved--that is, made a bit less sweeping and draconian. The bill can't be improved sufficiently to satisfy Republicans, but it might become more palatable to worried Democrats. Republicans can probably count on liberal Democrats to prevent this by rejecting moderate amendments (which would face the 60-vote hurdle).
The shrewdness of McConnell's emphasis on the vote to proceed will become clear when the final cloture vote--which would end debate on the bill--is taken. Democratic senators with qualms about Obamacare are likely to have voted for the motion to proceed, explaining they'll seek changes in the bill. In all likelihood, those changes won't be approved. Obamacare will have emerged from weeks of debate roughly the same. Will moderate Democrats then vote for cloture on the motion to end debate?
This is the key vote. Reid will likely need to hold all the Democrats. Here Obama's role is crucial. It may be up to him alone to keep Democrats from defecting. One or two votes could decide the outcome. If Obama fails, his health care initiative may die.
We know what the president will say in one-on-one meetings or phone calls. My presidency and our party's future are at stake. So is yours. If I lose, you lose too. If we don't pass health care reform now, we never will. We have to pass a bill. I promise I'll support the changes you want later--after the bill passes. Your constituents who oppose us now will come around. I'll help your reelection. And so on. If that doesn't work, Obama's aides can take the Chicago approach: Vote against us, and we'll make sure you regret it.
In a pinch, a president can usually get the one or two votes he needs on an important issue. The office of the presidency gives him the prestige and influence to do this. But influence can slip away. We'll find out soon if Obama's has.
Fred Barnes is executive editor of THE WEEKLY STANDARD.
http://www.weeklystandard.com/Content/Public/Articles/000/000/017/145bixdq.asp?pg=2
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Link to the mis-named house bill 'Affordable Health Care for America Act' of October 29, 2009
http://energycommerce.house.gov/index.php?option=com_content&view=article&id=1687&catid=156&Itemid=55
Just a note to remember as you read the 2000 pages, the poor in America already have free health care, totally free. Without any thanks, YOU are already paying for it.
This bill is about the CONTROL of the rest of the health care system - toward COERCION and away from personal responsibility and market choices.
If you have a doubt, please word search the coercive proclamation "Shall" and you will find it 3,424 times! The framers used the word shall to organize the government, there shall be 2 senators from each state etc. and for what the government 'shall not' do, such as congress 'shall not' pass any law infringing on free speech or right to bear arms, or so it says. This bill states what 'shall' be more than 3000 times more than does the U.S. Constitution.
From my count, God only needed the word 'Shall' 8 times in the Ten Commandments to guide our behavior as humans.
Maybe that answers the obvious question about this political machine, who do they think they are?
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November 3, 2009
The "Costs" of Medical Care
By Thomas Sowell
http://www.realclearpolitics.com/articles/2009/11/03/the_costs_of_medical_care_98986.html
We are incessantly being told that the cost of medical care is "too high"-- either absolutely or as a growing percentage of our incomes. But nothing that is being proposed by the government is likely to lower those costs, and much that is being proposed is almost certain to increase the costs.
There is a fundamental difference between reducing costs and simply shifting costs around, like a pea in a shell game at a carnival. Costs are not reduced simply because you pay less at a doctor's office and more in taxes-- or more in insurance premiums, or more in higher prices for other goods and services that you buy, because the government has put the costs on businesses that pass those costs on to you.
Costs are not reduced simply because you don't pay them. It would undoubtedly be cheaper for me to do without the medications that keep me alive and more vigorous in my old age than people of a similar age were in generations past.
Letting old people die would undoubtedly be cheaper than keeping them alive-- but that does not mean that the costs have gone down. It just means that we refuse to pay the costs. Instead, we pay the consequences. There is no free lunch.
Providing free lunches to people who go to hospital emergency rooms is one of the reasons for the current high costs of medical care for others. Politicians mandating what insurance companies must cover is another free lunch that leads to higher premiums for medical insurance-- and fewer people who can afford it.
Despite all the demonizing of insurance companies, pharmaceutical companies or doctors for what they charge, the fundamental costs of goods and services are the costs of producing them.
If highly paid chief executives of insurance companies or pharmaceutical companies agreed to work free of charge, it would make very little difference in the cost of insurance or medications. If doctors' incomes were cut in half, that would not lower the cost of producing doctors through years of expensive training in medical schools and hospitals, nor the overhead costs of running doctors' offices.
What it would do is reduce the number of very able people who are willing to take on the high costs of a medical education when the return on that investment is greatly reduced and the aggravations of dealing with government bureaucrats are added to the burdens of the work.
Britain has had a government-run medical system for more than half a century and it has to import doctors, including some from Third World countries where the medical training may not be the best. In short, reducing doctors' income is not reducing the cost of medical care, it is refusing to pay those costs. Like other ways of refusing to pay costs, it has consequences.
Any one of us can reduce medical costs by refusing to pay them. In our own lives, we recognize the consequences. But when someone with a gift for rhetoric tells us that the government can reduce the costs without consequences, we are ready to believe in such political miracles.
There are some ways in which the real costs of medical care can be reduced but the people who are leading the charge for a government takeover of medical care are not the least bit interested in actually reducing those costs, as distinguished from shifting the costs around or just refusing to pay them.
The high costs of "defensive medicine"-- expensive tests, medications and procedures required to protect doctors and hospitals from ruinous lawsuits, rather than to help the patients-- could be reduced by not letting lawyers get away with filing frivolous lawsuits.
If a court of law determines that the claims made in such lawsuits are bogus, then those who filed those claims could be forced to reimburse those who have been sued for all their expenses, including their attorneys' fees and the lost time of people who have other things to do. But politicians who get huge campaign contributions from lawyers are not about to pass laws to do this.
Why should they, when it is so much easier just to start a political stampede with fiery rhetoric and glittering promises?
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"Britain has had a government-run medical system for more than half a century and it has to import doctors, including some from Third World countries where the medical training may not be the best."
Well we have been doing this since the 1970s to some extent here.
There are many doctors who are here trained elsewhere and two thirds of those in NJ medical schools and residency programs were born overseas.
There is no doubt part of the allowance for this was to increase supply of doctors and to increase supply of those who were willing to take less AND accept Medicare when that was having problems finding doctors accepting "assignment". There was a day believe it or not that those doctors who were willing to take Medicare pay (which was I think around 70% of usual pay) were considered traitors. The start of the slippery slope to where we are inevitably heading - single payer, government controlled health care.
The concept of importing those from around the world who will accept what we won't is certainly not new.
Why so many born Americans complain including minorities, yet there are those from overseas who are willing to work their behinds off and are kicking our own asses with accomplishments I am not sure.
But it is only recently I have heard some foreign born colleagues actually say they would consider returning to their native country to practice medicine at the rate things keep going.
As for the lawsuits stuff I am not defending doctors or blaming lawyers. There are enough in all fields that are bilking the "system" that can share some blame as well as those in all fields who do an excellent and ethical job.
Yet the idea that the House bill actually makes everyone payfor this stuff, and regulates everybody and everything BUT the lawyers and fails to address malpractice if obviously a gross injustice and just pure slime.
I am really bnot sure how much of costs are in any way related to malpractice. How many have merit and how many are just ambulance chasers trying to make a buck I really don't know. Personally I don't think there is a flood of "frivolous" lawsuits although there are some.
As far as us ordering tests that can be considered really unneeded and are purely defensive in nature is totally a sugjective call.
When is a test defensive and not really needed? If the risk of a serious disease is 1/2 of one percent or 2 percent or 5 percent?
If the doctor really thinks it very unlikely a patient has a disease but orders a test "just in case this is the rare person who really does have it" is this defensive or just carefull and cautious and safe medicine being sure a person doesn't have a uncommon or rare disorder?
Ask five doctors on five different scenerios and you might get five answers. So what is defensive medicine? I read a big shot doctor who wrote and article and scoffed at the idea of "defensive testing" altogether. His theory was if the doctor was worried enough to get a test because if he missed something he would get sued - well then he should order the test. With that theory in mind the country can go broke ordering tests. Yet this was some professor at some IVY league place who had an opinion just like he had an Ahole.
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Is ObamaCare Constitutional?
Posted on 18 August 2009
by Rob Natelson
During the Bush administration, many within the dominant culture expressed concern about the constitutionality of detaining several hundred alleged enemy combatants in Guantanamo.
Whenever legal restrictions on abortion are proposed, many express doubt about the constitutionality of interjecting government between patients and their doctors.
But those voices have been mostly silent about the constitutionality of empowering the federal government with decisions over the life, death, and health of three hundred million Americans.
In fact, the constitutional difficulties are profound. This is certainly so for those who believe the Constitution means what our Founders understood it to mean. But it is even true for those interested only in modern Supreme Court jurisprudence.
Following are some of the ways in which current health care proposals potentially clash with our nation’s Basic Law:
Enumerated powers. The Constitution grants the federal government about thirty-five specific powers – eighteen in Article I, Section 8, and the rest scattered throughout the document. (The exact number depends on how you count.) None of those powers seems to authorize control of the health care system outside the District of Columbia and the federal territories.
To be sure, since the late 1930s, the Supreme Court has been tolerant of the federal welfare state, usually justifying federal ad hoc programs under specious interpretations of the congressional Commerce Power. But, except in wartime, the Court has never authorized an expansion of the federal scope quite as large as what is being proposed now. And in recent years, both the Court and individual justices – even “liberal” justices – have said repeatedly that there are boundaries beyond which Congress may not go.
The greatest Chief Justice, John Marshall, once wrote that if Congress were to use its legitimate powers as a “pretext” for assuming an unauthorized power, “it would become the painful duty” of the Court “to say that such an act was not the law of the land.”
But health care bills such as the Obama-favored HB 3200 do not even offer a pretext. The only reference to the Constitution in HB 3200 is a severability clause that purports to save the remainder of the bill if part is declared unconstitutional. HB 3200 contains no reference to the Commerce Power or to any other enumerated power.
Excessive Delegation. The Constitution “vests” legislative authority in Congress. Congress is not permitted to delegate that authority to the executive branch. This is another realm in which the modern Supreme Court has been lenient, while affirming that there are limits.
Thus, in Schecter Poultry Corp. v. United States (1935), a unanimous court struck down a delegation of authority that looked much like the delegations in some current health care proposals.
Substantive Due Process. The Substantive Due Process doctrine was not contemplated by the Founders, but the courts have engrafted onto constitutional jurisprudence. The courts employ this doctrine to invalidate laws they think are unacceptably intrusive of personal liberty or privacy.
The most famous modern Substantive Due Process case is Roe v. Wade, which struck down state abortion laws that intruded into the doctor-patient relationship. But the intrusion invalidated in Roe was insignificant compared to the massive intervention contemplated by schemes such as HB 3200. “Global budgeting” and “single-payer” plans go even further, and seem clearly to violate the Supreme Court’s Substantive Due Process rules.
Tenth Amendment. Technically, the Tenth Amendment is merely a declaration that the federal government has no powers beyond those enumerated in the Constitution. However, the modern Supreme Court has cited the Tenth Amendment in holding that Congress may not “commandeer” state decision making in the service of federal goals.
It is permissible for Congress to condition grants of funds to the states, if the conditions are related to the funding program and are not “coercive.” Thus, in 1986 the Court ruled that Congress may, because of highway safety issues, reduce highway grants by five percent to states refusing to raise their drinking ages to 21.
But the mandates that some health care plans would impose on states certainly could be found “coercive,” both because they are excessive (HB 3200, for instance, would withdraw all Public Health Service Act money from non-cooperating states) and because they are unrelated to the program.
A major goal of our Constitution and Bill of Rights is to limit government power, especially federal power. National health care proposals would increase that power greatly, so it is not surprising that those proposals have constitutional difficulties.
Whatever the merits of federal control of health care, moving in that direction is (as former Justice David Souter might say) a change of “constitutional dimension.” The proper way to make such a change is not through an ordinary congressional bill. The proper way is by constitutional amendment.
Rob Natelson is Professor of Law at The University of Montana, and a leading constitutional scholar. (See www.umt.edu/law/faculty/natelson.htm.) His opinions are his own, and should not be attributed to any other person or institution.
http://www.tenthamendmentcenter.com/2009/08/18/is-obamacare-constitutional/
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BBG, Interesting piece. In the abortion debate, everything was about total privacy between woman and her doctor. Same folks now have no qualm about opening everything else to do with your health care decisions up to the bureaucrats, policy makers and even the IRS. Third party pay means third party decision making - mandated. This crowd isn't curious if their bill is constitutional; remaking the court and the meaning of that 'outdated' document is next on their agenda.
CCP, Thanks always for insights from the inside. I agree that pretending to quantify frivolous lawsuits or unnecessary tests in the aggregate isn't going to give you good numbers - just like measuring jobs created or saved. Is a one in a hundred or one in a million test worth it and at what cost? All you really can do is judge it intuitively and anecdotally, compare it with other risks we take on like putting the car on the road in difficult conditions, or martial arts, sports, etc. and keep the decision with the person who has to live with it, both cost and consequence. I don't want or need anyone from DMV there when I consider difficult choices with my doctor.
Seems to me that without malpractice lawsuits, you can still have doctors by the short hairs with licensing. If their practices are not up to snuff, if their errors are excessive, if their procedures are sloppy, etc. the state can investigate and pull their license. That I assume is a multimillion dollar penalty and then some. I know of a situation right now that involves state licensing but not an MD - one bogus complaint in a half century of practice and everything is under review.
If there is a shortage of doctors, it is a managed or contrived shortage. Seem to me that medical schools do everything they can to keep people who want to be doctors out. In most cases, thank goodness, but I'm sure plenty of capable and competent applicants get turned away. The Hillary-Obama-socialist view is that more doctors mean more pay and cost, so we need to get by with fewer. In a market based world, more supply to keep up with demand is what keeps the cost per visit or procedure down and affordable. If drought causes food prices to go up, and oil shortage or refinery outages shoots gas prices go up, why would an adequate supply of available doctors and specialists cause a higher cost to the patient (if there was any semblance of a market in place)?
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Wow. Reminds me of this Tom Waits tune:
[youtube]http://www.youtube.com/watch?v=qpUbX2-lJWw[/youtube]
November 03, 2009
Oh joy. 108 new federal bureaucracies created by health care reform bill
Rick Moran
The list comes to us via The Weekly Standard who cribbed it from a press release issued by the office of Rep. Mike Pence.
What was it Obama said on the stump about not wanting to grow the size of government?
Doesn't matter. People had to deliberately delude themselves to believe him anyway. Here's the list of new federal health care bureaucracies:
1. Retiree Reserve Trust Fund (Section 111(d), p. 61)
2. Grant program for wellness programs to small employers (Section 112, p. 62)
3. Grant program for State health access programs (Section 114, p. 72)
4. Program of administrative simplification (Section 115, p. 76)
5. Health Benefits Advisory Committee (Section 223, p. 111)
6. Health Choices Administration (Section 241, p. 131)
7. Qualified Health Benefits Plan Ombudsman (Section 244, p. 138)
8. Health Insurance Exchange (Section 201, p. 155)
9. Program for technical assistance to employees of small businesses buying Exchange coverage (Section 305(h), p. 191)
10. Mechanism for insurance risk pooling to be established by Health Choices Commissioner (Section 306(b), p. 194)
11. Health Insurance Exchange Trust Fund (Section 307, p. 195)
12. State-based Health Insurance Exchanges (Section 308, p. 197)
13. Grant program for health insurance cooperatives (Section 310, p. 206)
14. "Public Health Insurance Option" (Section 321, p. 211)
15. Ombudsman for "Public Health Insurance Option" (Section 321(d), p. 213)
16. Account for receipts and disbursements for "Public Health Insurance Option" (Section 322(b), p. 215)
17. Telehealth Advisory Committee (Section 1191 (b), p. 589)
18. Demonstration program providing reimbursement for "culturally and linguistically appropriate services" (Section 1222, p. 617)
19. Demonstration program for shared decision making using patient decision aids (Section 1236, p. 648)
20. Accountable Care Organization pilot program under Medicare (Section 1301, p. 653)
21. Independent patient-centered medical home pilot program under Medicare (Section 1302, p. 672)
22. Community-based medical home pilot program under Medicare (Section 1302(d), p. 681)
23. Independence at home demonstration program (Section 1312, p. 718)
24. Center for Comparative Effectiveness Research (Section 1401(a), p. 734)
25. Comparative Effectiveness Research Commission (Section 1401(a), p. 738)
26. Patient ombudsman for comparative effectiveness research (Section 1401(a), p. 753)
27. Quality assurance and performance improvement program for skilled nursing facilities (Section 1412(b)(1), p. 784)
28. Quality assurance and performance improvement program for nursing facilities (Section 1412 (b)(2), p. 786)
29. Special focus facility program for skilled nursing facilities (Section 1413(a)(3), p. 796)
30. Special focus facility program for nursing facilities (Section 1413(b)(3), p. 804)
31. National independent monitor pilot program for skilled nursing facilities and nursing facilities (Section 1422, p. 859)
32. Demonstration program for approved teaching health centers with respect to Medicare GME (Section 1502(d), p. 933)
33. Pilot program to develop anti-fraud compliance systems for Medicare providers (Section 1635, p. 978)
34. Special Inspector General for the Health Insurance Exchange (Section 1647, p. 1000)
35. Medical home pilot program under Medicaid (Section 1722, p. 1058)
36. Accountable Care Organization pilot program under Medicaid (Section 1730A, p. 1073)
37. Nursing facility supplemental payment program (Section 1745, p. 1106)
38. Demonstration program for Medicaid coverage to stabilize emergency medical conditions in institutions for mental diseases (Section 1787, p. 1149)
39. Comparative Effectiveness Research Trust Fund (Section 1802, p. 1162)
40. "Identifiable office or program" within CMS to "provide for improved coordination between Medicare and Medicaid in the case of dual eligibles" (Section 1905, p. 1191)
41. Center for Medicare and Medicaid Innovation (Section 1907, p. 1198)
42. Public Health Investment Fund (Section 2002, p. 1214)
43. Scholarships for service in health professional needs areas (Section 2211, p. 1224)
44. Program for training medical residents in community-based settings (Section 2214, p. 1236)
45. Grant program for training in dentistry programs (Section 2215, p. 1240)
46. Public Health Workforce Corps (Section 2231, p. 1253)
47. Public health workforce scholarship program (Section 2231, p. 1254)
48. Public health workforce loan forgiveness program (Section 2231, p. 1258)
49. Grant program for innovations in interdisciplinary care (Section 2252, p. 1272)
50. Advisory Committee on Health Workforce Evaluation and Assessment (Section 2261, p. 1275)
51. Prevention and Wellness Trust (Section 2301, p. 1286)
52. Clinical Prevention Stakeholders Board (Section 2301, p. 1295)
53. Community Prevention Stakeholders Board (Section 2301, p. 1301)
54. Grant program for community prevention and wellness research (Section 2301, p. 1305)
55. Grant program for research and demonstration projects related to wellness incentives (Section 2301, p. 1305)
56. Grant program for community prevention and wellness services (Section 2301, p. 1308)
57. Grant program for public health infrastructure (Section 2301, p. 1313)
58. Center for Quality Improvement (Section 2401, p. 1322)
59. Assistant Secretary for Health Information (Section 2402, p. 1330)
60. Grant program to support the operation of school-based health clinics (Section 2511, p. 1352)
61. Grant program for nurse-managed health centers (Section 2512, p. 1361)
62. Grants for labor-management programs for nursing training (Section 2521, p. 1372)
63. Grant program for interdisciplinary mental and behavioral health training (Section 2522, p. 1382)
64. "No Child Left Unimmunized Against Influenza" demonstration grant program (Section 2524, p. 1391)
65. Healthy Teen Initiative grant program regarding teen pregnancy (Section 2526, p. 1398)
66. Grant program for interdisciplinary training, education, and services for individuals with autism (Section 2527(a), p. 1402)
67. University centers for excellence in developmental disabilities education (Section 2527(b), p. 1410)
68. Grant program to implement medication therapy management services (Section 2528, p. 1412)
69. Grant program to promote positive health behaviors in underserved communities (Section 2530, p. 1422)
70. Grant program for State alternative medical liability laws (Section 2531, p. 1431)
71. Grant program to develop infant mortality programs (Section 2532, p. 1433)
72. Grant program to prepare secondary school students for careers in health professions (Section 2533, p. 1437)
73. Grant program for community-based collaborative care (Section 2534, p. 1440)
74. Grant program for community-based overweight and obesity prevention (Section 2535, p. 1457)
75. Grant program for reducing the student-to-school nurse ratio in primary and secondary schools (Section 2536, p. 1462)
76. Demonstration project of grants to medical-legal partnerships (Section 2537, p. 1464)
77. Center for Emergency Care under the Assistant Secretary for Preparedness and Response (Section 2552, p. 1478)
78. Council for Emergency Care (Section 2552, p 1479)
79. Grant program to support demonstration programs that design and implement regionalized emergency care systems (Section 2553, p. 1480)
80. Grant program to assist veterans who wish to become emergency medical technicians upon discharge (Section 2554, p. 1487)
81. Interagency Pain Research Coordinating Committee (Section 2562, p. 1494)
82. National Medical Device Registry (Section 2571, p. 1501)
83. CLASS Independence Fund (Section 2581, p. 1597)
84. CLASS Independence Fund Board of Trustees (Section 2581, p. 1598)
85. CLASS Independence Advisory Council (Section 2581, p. 1602)
86. Health and Human Services Coordinating Committee on Women's Health (Section 2588, p. 1610)
87. National Women's Health Information Center (Section 2588, p. 1611)
88. Centers for Disease Control Office of Women's Health (Section 2588, p. 1614)
89. Agency for Healthcare Research and Quality Office of Women's Health and Gender-Based Research (Section 2588, p. 1617)
90. Health Resources and Services Administration Office of Women's Health (Section 2588, p. 1618)
91. Food and Drug Administration Office of Women's Health (Section 2588, p. 1621)
92. Personal Care Attendant Workforce Advisory Panel (Section 2589(a)(2), p. 1624)
93. Grant program for national health workforce online training (Section 2591, p. 1629)
94. Grant program to disseminate best practices on implementing health workforce investment programs (Section 2591, p. 1632)
95. Demonstration program for chronic shortages of health professionals (Section 3101, p. 1717)
96. Demonstration program for substance abuse counselor educational curricula (Section 3101, p. 1719)
97. Program of Indian community education on mental illness (Section 3101, p. 1722)
98. Intergovernmental Task Force on Indian environmental and nuclear hazards (Section 3101, p. 1754)
99. Office of Indian Men's Health (Section 3101, p. 1765)
100. Indian Health facilities appropriation advisory board (Section 3101, p. 1774)
101. Indian Health facilities needs assessment workgroup (Section 3101, p. 1775)
102. Indian Health Service tribal facilities joint venture demonstration projects (Section 3101, p. 1809)
103. Urban youth treatment center demonstration project (Section 3101, p. 1873)
104. Grants to Urban Indian Organizations for diabetes prevention (Section 3101, p. 1874)
105. Grants to Urban Indian Organizations for health IT adoption (Section 3101, p. 1877)
106. Mental health technician training program (Section 3101, p. 1898)
107. Indian youth telemental health demonstration project (Section 3101, p. 1909)
108. Program for treatment of child sexual abuse victims and perpetrators (Section 3101, p. 1925)
109. Program for treatment of domestic violence and sexual abuse (Section 3101, p. 1927)
110. Native American Health and Wellness Foundation (Section 3103, p. 1966)
111. Committee for the Establishment of the Native American Health and Wellness Foundation (Section 3103, p. 1968)
Please note the "issues" that many of these agencies address. Every single liberal complaint about American society over the last 40 years will now have its own, special bureaucratic office to which the left can go to plead for relief, or seek redress, or initiate more legislation. The bureaucracies listed will worm their way into every corner of American life - snooping, hectoring, issuing grandiose proclamations, initiating "public service" campaigns - a nightmare of government intervention and it will lead to the death of the individual - and individual rights - in America.
No behavior will go uncriticized. No habit, left alone. No little personal joy will escape notice. We are ready to become a nation that walks on eggshells lest we offend some bureaucracy. Already thick with laws and regulations, American life will become a nightmare of looking over one's shoulder to make sure the government has its eyes trained elsewhere.
To call what the Democrats are doing by creating this gaggle of nanny state health nazis irresponsible is a given. More than that, it is a recipe to drastically curtail human freedom - all done with the excuse that your "freedom" doesn't give you the right to do anything that might cost the government more than a fair share of resources and money.
Will Americans sit still for this? Sure. We are mostly a nation now of children who like the idea of government taking care of us. Most will accept the new regime on that basis. Others are too apathetic to care one way or another. This is what the Democrats are counting on - and it appears that they will succeed.
Hat Tip: Ed Lasky
Page Printed from: http://www.americanthinker.com/blog/2009/11/oh_joy_108_new_federal_bureauc.html at November 03, 2009 - 03:42:41 PM EST
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http://reason.com/blog/2009/11/04/the-public-option-is-displacin
Reason Magazine
"The public option is displacing private insurance."
Peter Suderman | November 4, 2009
What happened when Florida instituted a government-run insurance option in response to rising property insurance premiums? Alex Tabarrok points us to the following history lesson by the Independence Institute's Randall Holcombe:
After Hurricane Andrew hit Florida in 1992 some Floridians were having difficulty purchasing homeowners’ insurance. (The reason: rates are regulated, and at the regulated rates some properties are too great a risk.) So, the state government formed Citizens Property Insurance Corporation, which is owned and operated by the State of Florida.
As originally envisioned, Citizens would charge rates above those charged by private insurers, to make Citizens the insurer of last resort. Nevertheless, Citizens found plenty of customers.
After two bad hurricane seasons in 2004 and 2005 property insurance rates in Florida rose, and in his campaign for the office, current Governor Charlie Crist promised voters that if elected he would see that their property insurance bills “dropped like a rock.”
One tactic he used was to change Citizens’ rate structure so it was competitive with private insurers. His idea, like President Obama’s idea with health insurance, is that with a public option, private insurers would have to keep their rates in line or risk losing customers to the government insurer.
That’s what’s happened in Florida. Today about 30% of homeowners’ policies are written by Citizens, which is the largest property insurer in the state. It’s about to get bigger too. The largest private insurer, State Farm, had a rate request rejected last year, and now is pulling out of the state altogether (for property insurance; they’ll still insure your car). As the largest private insurer pulls out over a three-year period (that period negotiated with the state), Citizens will get an even larger share of Florida’s property insurance.
Everybody in Florida knows Citizens is a fiscal time bomb. Already, every Florida insurance policy (on homes, boats, cars, etc.) pays a surcharge that goes to Citizens, but Citizens still doesn’t have sufficient reserves to weather a major hurricane. When one comes, Florida taxpayers will be on the hook for the bill.
The legislature knows this, and actually passed a bill last year that would have done a great deal to solve the problem by partially deregulating rates private insurers could charge. State Farm would have stayed in Florida had that bill taken effect, but it was vetoed by the Governor. The public option is displacing private insurance.
Now, it's not clear that something similar would happen immediately if the House's variant on the public option for health insurance became law. According to the CBO, under the House bill, the public plan would actually have higher premiums than private insurance options, and only about 6 million people would be enrolled. But if Congress eventually decided to "fix" this by forcing premium rates down by, say, pegging reimbursement fees to Medicare, as many of the most liberal legislators want to do now, it's more than plausible that we could see a similar situation develop in the health insurance market.
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The Central-Planning Conceit
This weekend, House Democrats are planning to pass two health-care bills. One is a sweeping plan that would shift nearly all power over the organization of American health care to Washington, D.C. The other — a full repeal of the “sustainable growth rate” (SGR) formula governing Medicare physician fee payments — is proof positive that the first bill’s strategy of centralized planning is ill-conceived and dangerous to the quality of U.S. medical care.
To understand why, it is worth reviewing how the SGR came to be. In the late 1980s and 1990s, the Medicare bureaucracy set out to reform the way physicians are reimbursed for providing services to the program’s enrollees. The idea was to shift more resources toward generalists, who were then thought to be undercompensated for spending time with patients, and to control overall costs by limiting the growth of aggregate payments to growth in the size of the U.S. economy. After several years of study, lengthy payment regulations were issued, including a predecessor to the SGR formula, which had immediate and profound financial consequences for nearly every practicing physician in the United States.
And so what happened? The exact opposite of what was intended. Instead of encouraging more physicians to enter into primary care, the Medicare physician-fee schedule has rewarded more specialization. The fee schedule only controls prices, not volume. As Medicare’s administrators have tried to hold down costs with fee cuts, specialists increased their share of the pie with more tests and procedures, at the expense of primary-care reimbursement rates. Not surprisingly, the trend of physicians entering specialist practices has accelerated dramatically in the last twenty years. Moreover, overall costs have never been brought under control. With volume soaring, the SGR formula governing annual fee updates has gone completely off the rails. In 2010, fees are supposed to get cut by 21 percent unless Congress overrides it yet again. To secure the AMA’s endorsement of their health-care bill, House leaders are planning to scrap the SGR component of the physician fee system altogether, at a cost of more than $200 billion over a decade.
The irony of the situation seems to be lost on House Democrats: Congress is moving to repeal a prime example of health-care central planning run amok while simultaneously extending federal control to every corner of American health care.
For its part, the Obama administration has been promising for months that it would deliver new and improved central planning to “bend the cost-curve.” The White House Budget Director, Peter Orszag, in a February interview with Politico, suggested that the incoming Obama team was working on groundbreaking ideas that would use the levers of government payment policy to painlessly eliminate inefficiency in American health care. As Orszag put it, “Medicare and Medicaid are big enough to change the way medicine is practiced.”
Now, nine months later, it turns out the Obama administration doesn’t actually have any new ideas of what to do. It is instead proposing to empower an unelected, unaccountable commission to come up with the whiz-bang ideas, which would go into effect automatically without further congressional action. But House Democrats found the commission approach unacceptable, as it would take too much of the central planning power away from them. And so they have instead filled their bill with assorted pilot projects and tests of new Medicare payment approaches. Orszag touts these as good ideas with potential, too. But these ideas would have virtually no impact on federal spending, according to the Congressional Budget Office, and they certainly are not up to the task of offsetting the costs of the massive increase in entitlement spending contemplated in the House leadership bill.
Instead of clever new ideas that painlessly root out waste and inefficiency, the House bill finds savings the same way all central planners ultimately do: with deep and arbitrary across-the-board payment rate cuts. Despite all of the talk of delivery system reform, there’s no real effort to make distinctions based on the quality of patient care. Everyone gets cut the same.
And that’s the real danger of the House bill. There’s no prospect that the federal government will become more nimble overnight at managing the vast and complex health sector in the United States. To control costs in health care, the federal government will do what it always does — it will set prices. In time, that will have the predictable result of driving out willing suppliers of services, leading to queues and access problems. Call it centrally-planned rationing of care.
http://www.thenewatlantis.com/blog/diagnosis/the-central-planning-conceit
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The writer in this article somewhat contradicts himself.
ON one hand he states the ONE is appointing a commission to come up with plans to cut costs.
On the other hand he states the plan is to ration care.
As far as I am concerned there are MANY radical ideas out there and the goal IS for single payer government controlled with an eye to ration care by looking at what gets statistical improvement over POPULATIONS of patients.
For example, get infant mortality down, vaccination levels up, screening tests up etc.
This is nice but if a person gets really sick the US is the place to be for the most advanced technology, medicines, specialty access etc.
Obama has not a clue other than the above = single payer, government control over distribution, payment, and everyone is covered and gets same access whether they like it or not.
There are many liberal think tanker liberals in health care - most of whom are at the IVy League liberal meccas who know what is best for everyone (including their own interests) who have worked this all out a long time ago.
Don't let them fool you into thinking the goals and plans are not already there. Sure there may be wrinkles to iron out but the overall goal and methods are already very well outlined, and in the dogma for all of us.
The ONE is just their spokesman; there front man.
So some of what this guy writes is silly and wrong.
Folks - as far as the ONE and the rest of the big time liberals - it is a done deal. The goal is etched in stone.
It is just how we get there in their minds.
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What Anthony (A)Weiner today says:
There are no provisions for illegals in the House bill.
What AWeiner doesn't say:
One cannot verify if the person who is asking for health insurance is legal or not.
In other words if the illegal simply asks for it - then well....
What a scumbag.
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I am still on the road and was shaken to see that the house passed the Pelosi bill. What are the prospects looking like in the Senate?
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Lindsey Graham (gag) and Joe Lieberman have promised to filibuster it.
Then there is this:
http://www.politico.com/livepulse/1109/Dr_No_threatening_to_have_bill_read_on_Senate_floor.html?showall
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"shaken to see that the house passed the Pelosi bill. What are the prospects looking like in the Senate?"
We are at the fork in the road and the precipice of the cliff. There are large forces pushing in at least two directions. Dems have their own 60 possible plus an unknown number of RINOs. If they pass anything, it goes to conference.
Whether there are any conservative Dems with a backbone remains to be seen, maybe Lieberman. The opposing force is that we know more than 50 senators that do not represent far left states. The polls vary greatly and they have their own polls to tell them how to survive this.
The abortion amendment was the opposite of a poison pill. They left out increased abortion funding certain to go back in, just like they failed to address health care for illegals - sure to be provided, and they removed a few ojjections of the swing votes. Same type of thing will happen in the senate. The controversial aspects will be watered down just to get the vote and get the program started.
The opposition strategists need to find the wedge that kills the deal. I'd like to see an amendment to keep the federal government from seeing any private medical records, making government management of the system impossible, and an amendment to preclude the IRS from taking part in any enforcement mechanism.
Better than 'improving' the bill would be load it up with ALL of what the far left wants, attach a full honest price tag and then vote it up or down. (That isn't what's going to happen.)
The worst part of having our freedoms hinge on a stand taken by L. Graham or Lieberman is that after they hold out for their demands, their demands will be met and we are headed off the cliff.
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Speaker Nancy Pelosi defied policy logic and public opinion late Saturday night, ramming through the House a nearly 2,000-page health-care leviathan that counts as the biggest expansion of the federal government since the New Deal. As President Obama likes to say, this was a "teachable moment" about our current government.
The vote was 220 to 215, with 39 House Democrats joining all but one Republican in opposition. Mrs. Pelosi had to cajole and bribe her way to the magic 218, and the list of her promises must be stacked to the ceiling.
The lone Republican, Joseph Cao, represents a Democratic-leaning Louisiana district and extracted a promise that Mr. Obama would increase Medicaid payments to his state, and even then he only voted after Democrats had already hit 218. Let no one suggest this was the "bipartisan" health reform that Mr. Obama has long promised.
The bill is instead a breathtaking display of illiberal ambition, intended to make the middle class more dependent on government through the umbilical cord of "universal health care." It creates a vast new entitlement, financed by European levels of taxation on business and individuals. The 20% corner of Medicare open to private competition is slashed, while fiscally strapped states are saddled with new Medicaid burdens. The insurance industry will have to vet every policy with Washington, which will regulate who it must cover, what it can offer, and how much it can charge.
We have little sympathy for the insurers, or for that matter most of the other medical providers who signed on to this process only to claim now to be appalled by the result. The insurance lobby—led by Aetna CEO Ron Williams—made the Faustian bet that it could trade new regulations for more new subsidized customers who would face a tax penalty if they didn't buy their insurance. The Pelosi bill includes the regulation but guts the tax penalty because it's unpopular. Insurers will thus have to cover more sick people with fewer dollars, as healthy folk opt out of coverage until they are sick.
This writing was on the wall months ago, but the insurers chose to play an inside game rather than shape public opinion. Judging by their weekend statement—criticizing the House bill but vowing to seek "bipartisan" reform—they will now throw themselves at the mercy of the Senate. Good luck with that. The real victims are their customers, most of whom will pay more for insurance as the new mandates raise costs.
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Associated Press
House Speaker Nancy Pelosi.
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Mrs. Pelosi's craftiest political turn was a last-minute compromise to strip federal funds from insurance plans that cover abortions. The deal—negotiated by Michigan Democrat Bart Stupak and supported by the National Right to Life Committee—gave cover to 40-some Democrats to support the larger bill.
However, as subsidized costs soar, government will have no choice but to ration medical care, starting with the aged and grievously ill. Is pre-natal life more valuable than the elderly? We're reminded of the way pro-lifers supported Anthony Kennedy over Laurence Silberman for the Supreme Court in 1987 merely because Mr. Kennedy was a Catholic who claimed to personally oppose abortion. Mr. Stupak played the right-to-lifers like a Stradavarius.
The real importance of the abortion uproar is as preview of the politics that will dominate every medical coverage issue if ObamaCare becomes law. Every decision of what to insure or not—when an MRI can be used, or whether a stage-four breast cancer patient can get Avastin or some future expensive drug—will become subject to political intervention over moral disputes or budget constraints. Heretofore, these decisions have largely been made between a doctor and patient. This is the real "right to life" issue.
Perhaps the most unsurprising news in this drama was the collapse of the Blue Dog "deficit hawks." Enough of them always cave in the end to give Mrs. Pelosi her way. It's nonetheless worth noting the surrender of that most vocal scourge of deficits, Tennessee's Jim Cooper, who voted aye on grounds that the bill can be improved in the Senate.
But Max Baucus's Finance Committee bill includes a similar gimmick of making the numbers look good by using 10 years of new taxes to finance only seven years of spending (six in the House). The deficits explode in the second decade and beyond in both bills.
The House also contains a new government long-term insurance program that starts collecting premiums in 2011 but doesn't starting paying benefits until 2016 and then runs out of money in 2029. North Dakota Democrat Kent Conrad called it "a Ponzi scheme of the first order, the kind of thing that Bernie Madoff would have been proud of" in an interview with the Washington Post in late October. Mr. Cooper has with a single vote made his entire career irrelevant.
Yet 39 other Democrats were given a pass on the vote, as the leadership knows how unpopular this bill is in most of America. They know this legislation is not the result of some national consensus in favor of expanding state power. Its passage was possible only because of temporary liberal majorities that are intent on fulfilling their dreams of a cradle-to-grave entitlement state. If they lose Blue Dog seats, or even their majority, in the short term, so be it. As the party of government, Democrats believe they will benefit in the long run from a much larger government.
Unless the Senate has an epiphany of common sense, Americans will be paying the bills for this willful exercise for generations to come.
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Democrats Checkmate Themselves
November 10th, 2009
Liberals are fond of calling Republicans “the stupid party.” That might need revision. It appears to me that Democrats have checkmated themselves. Here is the logic:
If Obamacare makes it through the Senate, American small businesses will continue to shrink their payrolls to avoid the awful choice of paying higher health care insurance premiums or the 8% added payroll tax. Unemployment is sure to rise. The Dems will face the November 2010 elections with 12% unemployment ... closer to Depression levels of 20% by the so-called broader measures.
If Obamacare fails to pass, the left-wing base will be so demoralized as to not show up at the polls in 2010. Or they will be so angry that they might start a 1968-like interparty war.
My Checkmate Theory is based on small-business fear of Obama’s signature issues--health care, cap-and-trade and union card check. Health care is at the plate now. The fate of health care in the U.S. Senate will set the passage odds for cap-and-trade and union card check next year. All three of Obama's signature issues are opposed by most small businesses, including the American Chamber of Commerce.
Here are two revealing stories reporting the economic struggles and political fears of small businesses:
USA Today
Small businesses often lead the nation out of recession. Not this time.
The unemployment rate jumped to 10.2% in October from 9.8% in September, and economists say a big reason is small businesses. With sales weak, they're still slashing jobs and faring worse than their larger rivals.
"Small business tends to lead the way out, and that's just not happening here," says Mark Zandi of Moody's Economy.com.
The Wall Street Journal
W. Michael Brown has scaled back hiring plans in his Virginia auto-parts stores. Carl Redman halted an expansion project at his Oregon contracting business. Bill Hammack is preparing layoffs at his road-construction company in Georgia.
The economy remains unsteady 22 months after the recession began, with banks restricting credit and consumers hunkering down. For these small businesses, and many others across the country, there's an additional dark cloud: uncertainty created by Washington's bid to reorganize a wide swath of the U.S. economy.
If American small businesses stay hunkered down, unemployment will stay up. That’s because small businesses historically have created the majority of net jobs in any economy. They've created almost all net jobs in the first two years of a recovery. But not this time. Not yet.
The liberal writer Michael Lind is happy to see government put the screws to small businesses. In Lind’s opinion, small businesses are nothing more than a collection of Scrooges and Marleys. No doubt his opinion of small business is shared by many in the Democratic Party’s activist wing:
The solution may be corporatism or corporate paternalism--by which I mean the mandatory universalization of private employer benefits. If the politics of ethnic diversity makes movement in a universalist, social democratic direction impossible in the U.S., then the alternative might be to mandate that all employers provide certain benefits to all employees, with no exceptions. The costs of such unfunded mandates might drive some small businesses out of existence. But small-business owners are the most vocal opponents of wage and benefit reform in the U.S. The replacement of Scrooge & Marley by a smaller number of bigger private and public employers who treat Bob Cratchit and Tiny Tim better would not necessarily be a tragedy.
Not a tragedy? Don't be so quick, Democrats. You can’t have it both ways. Stick it to small businesses (through higher payroll taxes, cap-and-trade and union card check) and the assaulted will trim their payrolls until conditions clear, if ever. But if you don't stick it to small businesses, your party’s activist base will go nuts.
You have checkmated yourselves, Democrats.
http://blogs.forbes.com/digitalrules/2009/11/democrats-checkmate-themselves/
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Publius vs. Obamacare
Let the Senate be the Senate.
By Rich Lowry
Supporters of Obamacare have their next target for obloquy and shame. It’s the United States Senate, an institution whose villainy will almost match that of the insurers and Fox News if the health-care bill sinks there.
The anti-senatorial campaign is already revving up. Liberal columnist Harold Meyerson stamped his feet in frustration yesterday in the Washington Post at the cussed balkiness of the Senate: “Dithering Heights.” “Proceeds glacially and produces next to nothing.”
This amounts to raging at the Senate for its very nature and purpose. It’s supposed to be slow-paced and unproductive. Everyone has their moments of frustration at the Senate (I’ve had plenty) because it is designed to be frustrating, especially when a majority in the House is electric with ideological excitement. Conservatives spent most of 1995 hurling epithets at the Senate.
So it’s not surprising that the Left is upset at it at a time when “Iron Nancy” is using her solid majority to muscle massive pieces of legislation through the House by a handful of votes. Why can’t the Senate do the same, goes the cry, entirely missing the point. It’s not just that the Senate is built differently from the House: It won’t truly be fulfilling its role in our constitutional scheme if doesn’t deep-six Obamacare.
The Senate exists to keep temporarily enlarged and inflamed majorities from rushing through far-reaching pieces of legislation that don’t command broad and deep public support. In its institutional DNA, the Senate should regard Obamacare the way a cheetah regards a gazelle — prey to be killed.
The Democrats enjoy such a large House majority thanks partly to an accident of timing. The election was held in uniquely disastrous circumstances for the Republicans, in the immediate wake of the collapse of Lehman and the ensuing financial panic. Piled on top of the other causes of Republican woe (some of them quite well-deserved), the crisis allowed Democrats to run up the score. But in a matter of months public opinion began snapping back to its center-right state. So we have a House majority that is caught in amber circa October 2008 when the nation’s mood has already moved on.
Hey, you might say, such is the dumb luck of timing in elections. True. But in their wisdom our Founders devised a check to keep a majority augmented by temporary circumstances from running amok. It’s called the Senate.
The House stands for election all at once, capturing public opinion at one moment in time. In contrast, only one-third of the Senate stands for election at once. Originally, its members were selected by state legislatures, further shielding it from public opinion (a feature done away with by the Seventeenth Amendment, of course). It was supposed to be more elite than the House. And the very fact of its existence, in a bicameral legislature, added complexity to the legislative process.
The Senate is protection against rashness. As the great historian Daniel Walker Howe writes of Publius — the collective author of the Federalist Papers — in his book Making the American Self: “The branches of government he wanted to strengthen were ones he associated with the most rationality: the judiciary, the executive, and the Senate; the elements he wanted to limit he associated with narrow self-interest and the passions: the state governments and all popular assemblies, including the House of Representatives.”
Howe continues, “Of course, factions could be majorities as well as minorities. Indeed, the factions Publius was chiefly worried about were the ones that commanded a majority; minority factions were easily limited. But ‘when a majority is included in a faction, the form of popular government . . . enables it to sacrifice to its ruling passion or interest both the public good and the rights of other citizens.’”
The Senate — among other aspects of our complex government — helps protect us from such abuses by slowing things down, and simply stopping dubious legislation. Here’s Federalist No. 73 (it’s discussing the executive and the veto power, but it’s the sentiment that is important):
The oftener the measure is brought under examination, the greater the diversity in the situations of those who are to examine it, the less must be the danger of those errors which flow from want of due deliberation, or of those missteps which proceed from the contagion of some common passion or interest. It is far less probable, that culpable views of any kind should infect all the parts of the government at the same moment and in relation to the same object, than that they should by turns govern and mislead every one of them.
It may perhaps be said that the power of preventing bad laws includes that of preventing good ones; and may be used to the one purpose as well as to the other. But this objection will have little weight with those who can properly estimate the mischiefs of that inconstancy and mutability in the laws, which form the greatest blemish in the character and genius of our governments. They will consider every institution calculated to restrain the excess of law-making, and to keep things in the same state in which they happen to be at any given period, as much more likely to do good than harm; because it is favorable to greater stability in the system of legislation. The injury which may possibly be done by defeating a few good laws, will be amply compensated by the advantage of preventing a number of bad ones.
This essential wisdom of the Founders is now the Democrats’ enemy. They want to rush because they know their legislation won’t bear long, careful scrutiny; because they know the public will soon demand that they focus on things of more pressing concern (the economy); and because they know it would be folly to keep debating the bill in an election year. So they want to pass major social legislation on basically a party-line vote and forge ahead even though almost every poll shows more people opposing than supporting it. It’s hard to think of major, defining legislation that has ever passed this way.
Liberals recall how long they have talked about national health insurance: No rush here, it’s the work of decades. But this plan has, relatively speaking, been sprung on the American public. Barack Obama did not campaign on huge tax increases to pay for health-care reform, or large Medicare cuts, or premium increases, or even the individual mandate. He talked of health-care reform in the most anodyne way.
If Obamacare is so necessary and wise, there’s no true need to hurry. If it fails to pass the Senate, Democrats should campaign on it around the country. They should keep talking of its wonders, and build up public support for it, turning around the polls. They should enhance their majority in the House and the Senate, bringing new Obamacare Democrats to Washington. That’s how you build toward passing historic legislation in a system such as ours naturally resistant to large-scale change.
Democrats don’t want to do that because, in their heart of hearts, they know they can’t do that. They want to jam it through instead. Here’s hoping the Senate does its proper work and — slowly, frustratingly — assigns the health-care bill to the grave.
— Rich Lowry is the editor of National Review.
National Review Online - http://article.nationalreview.com/?q=OTMwNzg2MzZmNmNjYzE2ZGZkMGMxYmZlMmNlZDFmNjg
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Very interesting take. Democrat Senators in red and split states might as well vote yes on the Pelosi-Obama agenda, against their constituents, because otherwise they will be destroyed by their own parties and activists. That doesn't bode well for defeating the bill. Voting against health care in the Dem party would be like one of us leaving our country. They could switch parties but I don't any of them are in a position or interest to do that.
I would not want to be in the situation of these moderates, R or D, trying to figure out what to do politically without having any backbone or principles of their own.
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From everything I have read so far mammograms before age 50 have not been shown to save any lives though this article suggests that one life could be saved in around 1900 of them. No where does it point out the increased burden from the extra CUMULATIVE dose of radiation that undoubtedly will cause some breast cancers by starting radiation screening at age 40 rather than 50.
Make no mistake about it - this is and has been more of a political decision. There are potent lobbying groups from the Susan Kormen foundation, NOW and others, primarily womens groups who lobby and claims that breast cancer researched lagged ( because of course most researchers are men and therefore they don't give a hoot about what is mostly a woman's disease and any politician that disputes this is of course going to incur the wrath of woman at the polls. I always felt groups like the American Cancer Society who support mammos from 40 to 50 were succumbing more to political pressure than to science.
Now of course with the USPSTF new rec. that screening mammos be done in normal risk pts only after age 50 the screams and outcries are all over the news. It is more obvious than ever health decisions are no longer just that - they are political decisions.
And the questions begs to be answered - WHEN IF EVER IS COST TO SOCIETY AN ISSUE?????
So we SHOULD do nearly 20,000 mammograms (1,900 babes screened over ten years) to save one life?
The cost is not an issue??
Well by that logic why do we even do mammograms??? Why not do MRIs which are more sensitive and safer (no radiation) than mammos ( and probably less painful)??
Why not do them every 6 months? Where do we draw the line??? This is EXACTLY a perfect example of individuals screaming they they want everything done known to man at a cost that is acceptable because why?? Someone else pays for it.
Who if anyone will take the leadership and ask us where to draw the line???
Folks this is one reason we go broke. No one is addressing this.
http://www.webmd.com/breast-cancer/news/20091116/panel-breast-screening-should-start-50
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The Rationing Commission
Meet the unelected body that will dictate future medical decisions.
As usual, the most dangerous parts of ObamaCare aren't receiving the scrutiny they deserve—and one of the least examined is a new commission to tell Congress how to control health spending. Democrats are quietly attempting to impose a "global budget" on Medicare, with radical implications for U.S. medicine.
Like most of Europe, the various health bills stipulate that Congress will arbitrarily decide how much to spend on health care for seniors every year—and then invest an unelected board with extraordinary powers to dictate what is covered and how it will be paid for. White House budget director Peter Orszag calls this Medicare commission "critical to our fiscal future" and "one of the most potent reforms."
On that last score, he's right. Prominent health economist Alain Enthoven has likened a global budget to "bombing from 35,000 feet, where you don't see the faces of the people you kill."
As envisioned by the Senate Finance Committee, the commission—all 15 members appointed by the President—would have to meet certain budget targets each year. Starting in 2015, Medicare could not grow more rapidly on a per capita basis than by a measure of inflation. After 2019, it could only grow at the same rate as GDP, plus one percentage point.
The theory is to let technocrats set Medicare payments free from political pressure, as with the military base closing commissions. But that process presented recommendations to Congress for an up-or-down vote. Here, the commission's decisions would go into effect automatically if Congress couldn't agree within six months on different cuts that met the same target. The board's decisions would not be subject to ordinary notice-and-comment rule-making, or even judicial review.
Yet if the goal really is political insulation, then the Medicare Commission is off to a bad start. To avoid a senior revolt, Finance Chairman Max Baucus decided to bar his creation from reducing benefits or raising the eligibility age, which meant that it could only cut costs by tightening Medicare price controls on doctors and hospitals. Doctors and hospitals, naturally, were furious.
So the Montana Democrat bowed and carved out exemptions for such providers, along with hospices and suppliers of medical equipment. Until 2019 the commission will thus only be allowed to attack Medicare Advantage, the program that gives 10 million seniors private insurance choices, and to raise premiums for Medicare prescription drug coverage, which is run by private contractors. Notice a political pattern?
But a decade from now, such limits are off—which also happens to be roughly the time when ObamaCare's spending explodes. The hard budget cap means there is only so much money to be divvied up for care, with no account for demographic changes, such as longer life spans, or for the increasing incidence of diabetes, heart disease and other chronic conditions.
Worse, it makes little room for medical innovations. The commission is mandated to go after "sources of excess cost growth," meaning treatments that are too expensive or whose coverage will boost spending. If researchers find a pricey treatment for Alzheimer's in 2020, that might be banned because it would add new costs and bust the global budget. Or it might decide that "Maybe you're better off not having the surgery, but taking the painkiller," as President Obama put it in June.
In other words, the Medicare commission would come to function much like the National Institute for Health and Clinical Excellence, which rations care in England. Or a similar Washington state board created in 2003 to control costs. Its handiwork isn't pretty.
The Washington commission, called the Health Technology Assessment, is manned by 11 bureaucrats, including a chiropractor and a "naturopath" who focuses on alternative, er, remedies like herbs and massage therapy. They consider the clinical effectiveness but above all the cost of medical procedures and technologies. If they decide something isn't worth the money, then Olympia won't cover it for some 750,000 Medicaid patients, public employees and prisoners.
So far, the commission has banned knee arthroscopy for osteoarthritis, discography for chronic back pain, and implantable infusion pumps for pain not related to cancer. This year, it is targeting such frivolous luxuries as knee replacements, spinal cord stimulation, a specialized autism therapy and MRIs of the abdomen, pelvis or breasts for cancer. It will also rule on routine ultrasounds for pregnancy, which have a "high" efficacy but also a "high" cost.
Currently, the commission is pushing through the most restrictive payment policy in the nation for drug-eluting cardiac stents—simply because bare metal stents are cheaper, even as they result in worse outcomes. If a patient is wheeled into the operating room with chest pains in an emergency, doctors will first have to determine if he's covered by a state plan, then the diameter of his blood vessels and his diabetic condition to decide on the appropriate stent. If they don't, Washington will not reimburse them for "inappropriate care."
If Democrats impose such a commission nationwide, it would constitute a radical change in U.S. health care. The reason that physician discretion—not Washington's cost-minded judgments—is at the core of medicine is that usually there are no "right" answers. The data from large clinical trials produce generic conclusions that rarely apply to individual patients, who have vastly different biologies, response rates to treatments, and often multiple conditions. A breakthrough drug like Herceptin, which is designed for a certain genetic subset of breast-cancer patients, might well be ruled out under such a standardized approach.
It's possible this global budget could become an accounting fiction, like the automatic Medicare cuts Congress currently pretends it will impose on doctors. But health care's fiscal pressures will be even stronger than they are today if ObamaCare passes in anything like its current form. And that is when politicians will want this remote, impersonal and unaccountable central committee to do the inevitable dirty work of denying care.
The only way to take the politics out of health care is to give individuals more power to control medical dollars. And the first step should be not to create even more government spending commitments. The core problem with government-run health care is that it doesn't make decisions in the best interests of patients, but in the best interests of government.
http://online.wsj.com/article/SB10001424052748703792304574504020025055040.html
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Health 'Reform' Gets a Failing Grade
The changes proposed by Congress will require more draconian measures down the road. Just look at Massachusetts.
By JEFFREY S. FLIER
As the dean of Harvard Medical School I am frequently asked to comment on the health-reform debate. I'd give it a failing grade.
Instead of forthrightly dealing with the fundamental problems, discussion is dominated by rival factions struggling to enact or defeat President Barack Obama's agenda. The rhetoric on both sides is exaggerated and often deceptive. Those of us for whom the central issue is health—not politics—have been left in the lurch. And as controversy heads toward a conclusion in Washington, it appears that the people who favor the legislation are engaged in collective denial.
Our health-care system suffers from problems of cost, access and quality, and needs major reform. Tax policy drives employment-based insurance; this begets overinsurance and drives costs upward while creating inequities for the unemployed and self-employed. A regulatory morass limits innovation. And deep flaws in Medicare and Medicaid drive spending without optimizing care.
Speeches and news reports can lead you to believe that proposed congressional legislation would tackle the problems of cost, access and quality. But that's not true. The various bills do deal with access by expanding Medicaid and mandating subsidized insurance at substantial cost—and thus addresses an important social goal. However, there are no provisions to substantively control the growth of costs or raise the quality of care. So the overall effort will fail to qualify as reform.
In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care's dysfunctional delivery system. The system we have now promotes fragmented care and makes it more difficult than it should be to assess outcomes and patient satisfaction. The true costs of health care are disguised, competition based on price and quality are almost impossible, and patients lose their ability to be the ultimate judges of value.
Worse, currently proposed federal legislation would undermine any potential for real innovation in insurance and the provision of care. It would do so by overregulating the health-care system in the service of special interests such as insurance companies, hospitals, professional organizations and pharmaceutical companies, rather than the patients who should be our primary concern.
In effect, while the legislation would enhance access to insurance, the trade-off would be an accelerated crisis of health-care costs and perpetuation of the current dysfunctional system—now with many more participants. This will make an eventual solution even more difficult. Ultimately, our capacity to innovate and develop new therapies would suffer most of all.
There are important lessons to be learned from recent experience with reform in Massachusetts. Here, insurance mandates similar to those proposed in the federal legislation succeeded in expanding coverage but—despite initial predictions—increased total spending.
A "Special Commission on the Health Care Payment System" recently declared that the Massachusetts health-care payment system must be changed over the next five years, most likely to one involving "capitated" payments instead of the traditional fee-for-service system. Capitation means that newly created organizations of physicians and other health-care providers will be given limited dollars per patient for all of their care, allowing for shared savings if spending is below the targets. Unfortunately, the details of this massive change—necessitated by skyrocketing costs and a desire to improve quality—are completely unspecified by the commission, although a new Massachusetts state bureaucracy clearly will be required.
Yet it's entirely unclear how such unspecified changes would impact physician practices and compensation, hospital organizations and their capacity to invest, and the ability of patients to receive the kind and quality of care they desire. Similar challenges would eventually confront the entire country on a more explosive scale if the current legislation becomes law.
Selling an uncertain and potentially unwelcome outcome such as this to the public would be a challenging task. It is easier to assert, confidently but disingenuously, that decreased costs and enhanced quality would result from the current legislation.
So the majority of our representatives may congratulate themselves on reducing the number of uninsured, while quietly understanding this can only be the first step of a multiyear process to more drastically change the organization and funding of health care in America. I have met many people for whom this strategy is conscious and explicit.
We should not be making public policy in such a crucial area by keeping the electorate ignorant of the actual road ahead.
Dr. Flier is dean of the Harvard Medical School.
http://online.wsj.com/article/SB10001424052748704431804574539581994054014.html#
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Of course the parade of women on the news networks, who have had breast cancer parading, and with their anecdotal stories mostly explaining their outrage at the recent task force recommendations which are just that - recommendations based on the data.
One woman this morning agreed and actually commended the USPSTF for their courageous decision only to be questioned with disbelief from the CNN announcer.
Question to all here:
Would anyone want to say no to a mob of angry women about the advisability of mammos between 40 and 50, OR is it easier and more politically expedient to just say OK - we rec. mammos between 40 and 50?
Based on any numbers I have read we could just as easily be causing just as many breast cancers with the additional 5 or 10 mammograms in a person's lifetime then we *may* be saving. I admit it seems hard to believe but if we are saving so many lives who come we can't prove it with hundreds of thousands of people in the studies?
No one wants to be called sexist, a murderer, a piece of dirt who just wants to save money while many women die needlessly because heartless insurance companies don't want to pay for the mammograms.
So we have been paying for them even when the science doesn't show evidence they help more than they harm.
FWIW there is similar controversy with prostate cancer screening.
And by the way my mother and aunt both had breast cancer.
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http://reason.com/blog/2009/11/18/harry-reid-happy-with-cbo-scor
Reason Magazine
Harry Reid Happy With CBO Score He Worked to Guarantee He'd Be Happy With
Peter Suderman | November 18, 2009
Ezra Klein is reporting that Senate Majority Leader Harry Reid has seen the CBO scores for the Senate's health care bill, and is "very pleased." Of course he is: It's doubtful that we'd be getting a score today if he weren't; according to one of Klein's recent posts, the reason we didn't see the score last Friday, as originally expected, is that the CBO's numbers came back to Reid, but weren't what was hoped. As a result, the bill, according to Klein, was "tweaked and trimmed until CBO [gave] Reid the answer he's looking for." Indeed, this is often how the scoring process works: Legislators work closely with CBO to push and pull at various elements of the bill until the CBO's math produces the desired result. So given that Reid knows exactly what it will be in advance (he sees preliminary numbers), can choose to release the score or resubmit again, and has been working with the CBO to make sure the numbers are to his liking, it's hardly surprising to see that, on a high profile bill like this, Reid is happy with the result.
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Second post:
That Darn Mandate
Shikha Dalmia, 11.18.09, 12:01 AM ET
ObamaCare has nothing going for it anymore. With unemployment touching double digits, its economic timing is bad; with polls showing tanking support in every group outside of the narrow sliver of die-hard liberal reformers, its political timing is bad; and with the Center for Medicare and Medicaid Services last week saying that it'll add billions to the already out-of-control deficit, its fiscal timing has gone from bad to awful.
So how are Comrades Pelosi, Reid and Obama able to march ahead with their grand designs undeterred? One reason is that Republicans have done precious little to seize the moral high ground from them. By insisting on the removal of the public option--instead of the individual mandate--as the price of doing business, Republicans have missed a major opportunity to put Democrats on the defensive and change the terms of the debate.
Republicans threw down the gauntlet on the public option--a government-funded, Medicare-style insurance plan that will compete with private insurance--in a June letter to Obama. "Washington-run programs undermine market-based competition through their ability to impose price controls and shift costs to other purchasers," they said. "The end result would be a federal government takeover of our health care system, taking decisions out of the hands of doctors and patients and placing them in the hands of a Washington bureaucracy."
True. But the problem is that Democrats don't need the public option to engineer a "federal takeover of our health care system." All they need is the power to force Americans to purchase insurance.
A mandate will fundamentally alter the relationship between Americans and their government. Instead of the government being accountable to them, they will become accountable to their government. No less than the Congressional Budget Office--a non-partisan government agency--once admitted as much. "A mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action," it noted. "The government has never required people to buy any good or service as a condition of lawful residence in the United States."
If the government can force Americans to buy coverage on the threat of fines or even imprisonment--an option that Nancy Pelosi has pointedly refused to rule out--every other government diktat becomes small potatoes by contrast. In fact, it becomes necessary. If uninsured Americans must buy coverage, why shouldn't other Americans be taxed to subsidize them? Why shouldn't the insurance industry be required to sell them coverage? Why shouldn't government set insurance prices to ensure affordability? Why shouldn't doctors and hospitals be asked to charge only "reasonable" rates--or offer only government-sanctioned treatments? Nothing about ObamaCare fundamentally changes so long as the individual mandate remains intact.
Therefore, instead of wonkishly droning about the public option, Republicans should counter Democrats' grand appeals for "universal coverage for all" with equally grand appeals for "medical freedom for all." They should stand together on the Capitol steps and issue the health care equivalent of Reagan's Berlin Wall ultimatum: "Mr. President: Tear up this mandate."
During the campaign, Obama himself successfully stopped poor Hillary dead in her tracks by reminding voters at every turn of her tyrannical plans to force them to purchase coverage. So why aren't Republicans doing the same to Obama?
The main reason is that they themselves are deeply conflicted about the mandate. On the one hand, every Republican on the Senate Finance Committee voted against it--except, of course, for Maine's Sen. Olympia Wavering-Heart Snowe. On the other hand, many Republicans, led by their intellectual lights at the conservative Heritage Foundation, among others, have long accepted--no, championed--the notion that unless people are forced to carry insurance, freeloaders who land in emergency rooms will cripple the health care system. Legislate personal responsibility, in other words. It was a Heritage plan for forced coverage that formed the blueprint for the Massachusetts universal care debacle that the then Republican Gov. Mitt Romney enacted.
Thus Republicans have no leg to stand on now that Obama, pulling one of his many switcheroos, has embraced the individual mandate. Heritage folks are trying to pull their own switcheroo by opposing Obama's mandate, saying what they had originally proposed for Massachusetts was not really a mandate but actually a self-insurance scheme under which an uninsured person would have to post a personal bond before being treated in an emergency room.
But countering mandates with bonds doesn't exactly make for a rousing rallying cry. Indeed, both ideas are based on the mistaken diagnosis that the central cause of our health care woes is the cost of uncompensated care that the uninsured get. The fact of the matter is that this care accounts for no more than $40 billion of the country's $2.26 trillion health care bill--or less than 3% of total health care spending. This is less than what department stores lose to shoplifting every year. Several private hospitals that I visited in India last month make a fraction of the profits that American hospitals do but still reported treating up to 10% of their patients for free.
The mandate barring American hospitals from denying treatment to anyone who lands in emergency--the root of the supposed freeloader problem--certainly imposes a heavy burden on some hospitals, especially in inner cities. But it is far from clear that it forces American hospitals as a whole to provide more charitable care to the uninsured than what they would have without it. It would certainly be worthwhile at some point to consider policy options to replace this mandate with mechanisms to strengthen voluntary charity by hospitals and others. In the meantime, however, there is zero evidence to suggest that this mandate is imposing a crippling enough burden on hospitals to warrant mandates on everyone else as well.
The Republican strategy for defeating ObamaCare consists of notifying: seniors that they will face rationing and loss of private Medicare options; the uninsured that they will face fines and possibly jail; the young and healthy that they will have to subsidize the old and sick, etc. Alerting Americans to the personal dangers they will confront under ObamaCare is certainly a legitimate part of the political process.
However, the downside of a strategy based entirely on fear is that even if it succeeds now, it won't help to define the proper terms for a genuine solution in the future. For that, Republicans have to offer a principled critique of ObamaCare that delineates the sharp moral choices that Americans face. The current health care battle is the domestic policy equivalent of the Cold War. Democrats are on the side of command-and-control mandates that deprive individuals of choice. Republicans should position themselves on the side of market-based solutions that empower--not enchain--patients.
Shikha Dalmia is a senior analyst at Reason Foundation and a bi-weekly Forbes columnist.
http://www.forbes.com/2009/11/17/obamacare-health-democrats-republicans-opinions-columnists-shikha-dalmia_print.html
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"However, the downside of a strategy based entirely on fear is that even if it succeeds now, it won't help to define the proper terms for a genuine solution in the future. For that, Republicans have to offer a principled critique of ObamaCare that delineates the sharp moral choices that Americans face. The current health care battle is the domestic policy equivalent of the Cold War. Democrats are on the side of command-and-control mandates that deprive individuals of choice. Republicans should position themselves on the side of market-based solutions that empower--not enchain--patients."
EXACTLY SO.
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Reid Health Bill Perpetuates the $1.5 Trillion Fraud
Posted By Michael F. Cannon On November 19, 2009 @ 9:05 am In Health, Welfare & Entitlements | Comments Disabled
Senate Majority Leader Harry Reid (D-NV) has finally unveiled his massive 2,074-page health care bill [1]. The Congressional Budget Office reports [2] that the insurance-expansion provisions would cost the feds $848 billion over 10 years. To raise those funds, the bill would tax [3] wages, medical devices, prescription drugs, sick people, health insurance premiums (twice), HSAs, FSAs, HRAs, and — why not? — cosmetic surgery. The remainder would supposedly come from $491 billion of Medicare cuts, even though Medicare’s chief actuary says [4] such cuts are “unrealistic” and “doubtful.” But don’t worry. Somehow, this thing’s gonna reduce the deficit.
Of course, that $848 billion only accounts for part of the federal government’s share of the tab. There is other new federal spending. My read is that the CBO estimates $998 billion of total new federal spending — though I’ll be waiting for former CBO director Donald Marron [5] to provide a more authoritative tally.
And then there are costs that Reid and his comrades have pushed off the federal budget. For example, the $25 billion unfunded mandate that Reid would impose on states. Total so far: just over $1 trillion.
But the biggest hidden cost is that of the private-sector mandates. In both the Clinton health plan [6] and the Massachusetts health plan [7], the private-sector mandates –- the legal requirements that individuals and employers purchase health insurance [8] –- accounted for 60 percent of total costs. That suggests that if the Reid bill’s cost to federal and state governments is $1 trillion, then the total cost is probably $2.5 trillion, and Harry Reid — like House Speaker Nancy Pelosi — is hiding $1.5 trillion of the cost of his bill.
Without a cost estimate of the private-sector mandates, Reid has not yet satisfied the request made by eight Democratic senators [9] for a “complete CBO score” of the bill 72 hours prior to floor consideration.
Fortunately, by law, the CBO must eventually score the private-sector mandates. When that happens, the CBO will reveal costs that the bills’ authors are trying to hide. When that happens, the CBO will present the new federal spending on page 1, new state spending maybe on page 10, and the cost of the private-sector mandates on page 20 or something. Democrats will tout the figure on page 1. But the bill’s total cost will the sum of those three figures -– a sum that will reveal the costs that the bill’s authors have been hiding.
The House passed its bill without a complete CBO score. The Senate should not follow suit.
I’ve written previously about this massive fraud here [10], here [11], here [12], and here [13].
(Cross-posted at Politico’s Health Care Arena [14].)
Article printed from Cato @ Liberty: http://www.cato-at-liberty.org
URL to article: http://www.cato-at-liberty.org/2009/11/19/reid-health-bill-perpetuates-the-1-5-trillion-fraud/
URLs in this post:
[1] 2,074-page health care bill: http://democrats.senate.gov/reform/patient-protection-affordable-care-act.pdf
[2] reports: http://bit.ly/UCAIk
[3] tax: http://jct.gov/publications.html?func=startdown&id=3635
[4] says: http://bit.ly/3DmEEJ
[5] Donald Marron: http://dmarron.com/
[6] Clinton health plan: http://www.cbo.gov/ftpdocs/48xx/doc4882/doc07.pdf
[7] Massachusetts health plan: http://www.cato.org/pub_display.php?pub_id=10488
[8] that individuals and employers purchase health insurance: http://www.cato.org/pub_display.php?pub_id=10576
[9] eight Democratic senators: http://blog.sunlightfoundation.com/2009/10/07/eight-senators-want-the-public-to-read-the-health-care-bill/
[10] here: http://www.cato.org/pub_display.php?pub_id=10439
[11] here: http://www.cato.org/pub_display.php?pub_id=10631
[12] here: http://www.cato.org/pub_display.php?pub_id=10944
[13] here: http://www.cato.org/pub_display.php?pub_id=10959
[14] Health Care Arena: http://www.politico.com/arena/healthcare/
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Guidelines Push Back Age for Cervical Cancer Tests
New guidelines for cervical cancer screening say women should
delay their first Pap test until age 21, and go for screening
less often than had been previously recommended.
Read More:
http://www.nytimes.com/2009/11/20/health/20pap.html?emc=na
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What can I say? For anyone who works hard and keeps getting robbed by the government this should be infuriating. But it doesn't matter because the number of people who are on the receiving end of government dole outs keeps rising and they certainly don't give a crap. This makes me wish there were enough people who are willing to stand up and just say enough and simply not pay their taxes. What are they going to do arrest 100 million people.
We just keep getting robbed more and more. There is no end in sight.
Obama has hated America as it was and barely still is for 200 years. So now I can hate what he is turning it into.
In his mind that is justice.
I can only hope we kick this guy out of office in time and can restrict his power next year in the elections.
***ABC News' Jonathan Karl reports:
What does it take to get a wavering senator to vote for health care reform?
Here’s a case study.
On page 432 of the Reid bill, there is a section increasing federal Medicaid subsidies for “certain states recovering from a major disaster.”
The section spends two pages defining which “states” would qualify, saying, among other things, that it would be states that “during the preceding 7 fiscal years” have been declared a “major disaster area.”
I am told the section applies to exactly one state: Louisiana, the home of moderate Democrat Mary Landrieu, who has been playing hard to get on the health care bill.
In other words, the bill spends two pages describing would could be written with a single world: Louisiana. (This may also help explain why the bill is long.)
Senator Harry Reid, who drafted the bill, cannot pass it without the support of Louisiana’s Mary Landrieu.
How much does it cost? According to the Congressional Budget Office: $100 million.
Here’s the incredibly complicated language:
SEC. 2006. SPECIAL ADJUSTMENT TO FMAP DETERMINATION FOR CERTAIN STATES RECOVERING FROM A MAJOR DISASTER.
Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by sections 2001(a)(3) and
2001(b)(2), is amended— (1) in subsection (b), in the first sentence, by striking ‘‘subsection (y)’’ and inserting ‘‘subsections (y) and (aa)’’; and (2) by adding at the end the following new subsection:
‘‘(aa)(1) Notwithstanding subsection (b), beginning January 1, 2011, the Federal medical assistance percentage for a fiscal year for a disaster-recovery FMAP adjustment State shall be equal to the following:
‘(A) In the case of the first fiscal year (or part of a fiscal year) for which this subsection applies to the State, the Federal medical assistance percentage determined for the fiscal year without regard to this subsection and subsection (y), increased by 50 percent of the number of percentage points by which the Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection and subsection (y), is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year after the application of only subsection (a) of section 5001 of Public Law 111–5 (if applicable to the preceding fiscal year) and without regard to this subsection, subsection (y), and subsections (b) and (c) of section 5001 of Public Law 111–5.
‘‘(B) In the case of the second or any succeeding fiscal year for which this subsection applies to the State, the Federal medical assistance percentage determined for the preceding fiscal year under this subsection for the State, increased by 25 percent of the number of percentage points by which the Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection and subsection (y), is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year under this subsection.
‘‘(2) In this subsection, the term ‘disaster-recovery FMAP adjustment State’ means a State that is one of
the 50 States or the District of Columbia, for which, at any time during the preceding 7 fiscal years, the President has declared a major disaster under section 401 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act and determined as a result of such disaster that every county or parish in the State warrant individual and public assistance or public assistance from the Federal Government under such Act and for which— ‘‘(A) in the case of the first fiscal year (or part of a fiscal year) for which this subsection applies to the State, the Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection and subsection (y), is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year after the application of only subsection (a) of section 5001 of Public Law 111–5 (if applicable to the preceding fiscal year) and without regard to this subsection, subsection (y), and subsections (b) and (c) of section 5001 of Public Law 111–5, by at least 3 percentage points; and ‘‘(B) in the case of the second or any succeeding fiscal year for which this subsection applies to the State, the Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection and subsection (y), is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year under this subsection by at least 3 percentage points.
‘‘(3) The Federal medical assistance percentage determined for a disaster-recovery FMAP adjustment State under paragraph (1) shall apply for purposes of this title (other than with respect to disproportionate share hospital payments described in section 1923 and payments under this title that are based on the enhanced FMAP described in 2105(b)) and shall not apply with respect to payments under title IV (other than under part E of title IV) or payments under title XXI.’’.****
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Welcome to the Vast Right-Wing Conspiracy
A team of NPR reporters unearths the truth about health care.
By Stephen Spruiell
In May 2008, Chicago Public Radio teamed up with National Public Radio (NPR) to produce an episode of the show This American Life called “The Giant Pool of Money.” The episode garnered widespread praise and won several awards for explaining the subprime-mortgage crisis with clarity and concision. It was such a success that NPR created a podcast, Planet Money, featuring the same team of reporters and producers. Planet Money covered the financial collapse last fall and continues to file jargon-free reports on the economy three times a week.
A few weeks ago, that crew put together another big project, this time a two-parter of This American Life and several subsequent podcasts devoted to the subject of health care. As in “The Giant Pool of Money,” the reporting was clear and even-handed. The team’s correspondents sought out industry professionals, economists, and patients. (They ignored politicians, by and large.) They surveyed the history of the American health-care system and drew some conclusions about why it has so many problems. And, if you’re someone who expects a certain amount of leftishness from NPR, those conclusions might surprise you.
1. Medical-malpractice lawsuits drive up the cost of health care. The first episode began by defining the problem: The average cost of a health-insurance policy for a family of four doubled between 2000 and 2007, host Ira Glass said, and it is projected to double again in the next seven years. Health-care costs are spiraling out of control, eating into the wages of those who have insurance and making it harder for the uninsured to buy it. Why? The answer is complex, but one of the problems the NPR team identified is that doctors practice what’s known as defensive medicine. That is to say, they order tests and perform procedures that their patients might not need, out of fear that otherwise they might get sued.
The NPR team produced several stories on how defensive medicine drives up costs, including one about a doctor named Dan Merenstein. As a third-year resident, Merenstein counseled a 53-year-old man on the benefits and risks of getting a PSA screening (a common test for prostate cancer). Merenstein told his patient that he thought the risks outweighed the benefits: False positives are common, follow-ups invasive and potentially harmful. The man declined the test.
The man was later diagnosed with a fatal prostate cancer, a kind that early detection probably would not have helped. He nevertheless sued Merenstein and his residency program. The plaintiff’s lawyers argued that Merenstein shouldn’t have given the man a choice on whether to have the test. “The jury . . . rejected the idea of following the guidelines based on evidence,” Merenstein said. “They took this approach that this thing called evidence-based medicine is just a way to save money, just a way to ration care.”
The verdict left Merenstein alone, but found his residency program liable for $1 million. He told NPR that it’s hard not to see patients as potential plaintiffs. He says he still counsels patients on the potential drawbacks of the expensive, not-always-necessary screening, but he admits that he gives patients a little push by telling them that most people do get the test.
2. Insurance companies are not evil. This summer, amid all the town-hall pushbacks against Obamacare, Nancy Pelosi lashed out at private insurance companies: “They are the villains in this,” she said. “They’ve been immoral all along in how they have treated the people. . . . You know, the litany of it all.”
Many mainstream reporters know the litany of it all, or at least they think they do. But NPR actually probed this received wisdom, and found a lot of holes. For instance, a former insurance executive named Wendell Potter had a conversion experience and now goes around the country talking about all the bad things insurance companies do to save money. Potter is fond of telling one story about how Aetna purged 8 million people from its insurance rolls and subsequently saw its stock price go up. Taking away people’s coverage for profit: proof positive of insurance-company greed.
“The truth of the story,” producer Sarah Koenig explained, “is a little more complicated, a little less Machiavellian.” In 2001, Aetna was losing $1 million a day. Aetna did two things to turn the company around: It raised premiums, and it pulled out of markets where it did not have a large presence. It turns out, the less competition an insurance company faces in a particular market, the cheaper it can price its products, and the lower premiums are for the insured. Why? Because insurance companies have to wield a lot of clout in order to bargain effectively with the large health-care provider groups in a given area.
Obama says, “One of the best ways to bring down costs, provide more choices, and assure quality is a public option that will force the insurance companies to compete and keep them honest.” But if the public option would actually weaken dominant players in the insurance market and concentrate more pricing power in the hands of provider groups, it would drive health-care costs up.
3. Our reliance on third-party payers is at the heart of the problem. So if insurance-company greed isn’t to blame, what does ail our health-care system? NPR’s reporting points to what economists call the “third-party-payer problem.” As David Goldhill pointed out in a must-read article for The Atlantic earlier this year, you don’t get the bill for your medical care. Someone else gets the bill, and that distorts incentives for payers, providers, and consumers of health care.
The NPR team put together a couple of stories that illustrated this problem, but the most succinct explanation came from Adam Davidson and Alex Blumberg in a segment on the history of American health care. “We the consumers are totally separated from the cost of what we’re consuming,” Davidson said. “We get tests and procedures we don’t need because, well, why not? We’re not paying for it a la carte. Our employers are paying for part of it, our government is paying for part of it through . . . tax incentives.”
How did we end up with such an inefficient system? Prior to World War II, health insurance existed, but most people paid for medical care out of their own pockets. The government instituted price and wage controls during the war, but placed no controls on benefits, so companies turned to benefit packages as a means of competing for workers.
Wage and price controls made the third-party-payer system possible, but a different policy set it in stone: a change in the tax law allowing employers to deduct the cost of health benefits from their taxes. After the IRS ruled that employers did not have to pay taxes on health benefits for their workers, the proportion of the population getting health insurance through their employers went from 9 percent in 1940 to 63 percent of the population in 1953.
4. Obamacare won’t fix it. The NPR team did not come right out and say it, but its reporting points to this conclusion. Alex Blumberg put it this way:
Markets are usually really good at controlling costs. When they work best, products come into existence like cell phones or stockings, they start expensive and then they get cheaper and better. But markets don’t guarantee that everyone can afford the things they need. Government can be good at that, ensuring universal access. But when you’re paying for everybody, it’s hard to control costs.
For [economic historian] Melissa Thomasson, she says that either extreme — a competitive market system where consumers know what price they’re paying and what they’re getting, which would drive the cost of health care down, or a government-run system which would cover everyone — would be better than the accidental mixture that we have today: a really expensive system that doesn’t cover us all.
Obamacare would pour even more cement over this broken system. It’s not a single-payer system that would cover everyone and control costs through price controls and rationing. Nor is it a market-oriented reform that would empower consumers by equalizing the tax treatment of health insurance and reducing the role of government in the market. Instead, it makes health insurance mandatory for everyone. It bends the cost curve up by subsidizing insurance without putting any real cost-control measures in place. And it creates a public option that would weaken the power of insurance companies to bargain with hospitals for better rates.
Democrats have accused conservatives of spreading fear and misinformation about their health-care legislation. They might want to look into this new and most insidious propaganda arm of the conservative movement: NPR.
— Stephen Spruiell is an NRO staff reporter.
National Review Online - http://article.nationalreview.com/?q=ZDlhOWMxMWM0NjI0Y2RmYTUwNzQ4YmJjMTIyYTA5MWE=
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About the best that can be said about the Senate health-care bill that Harry Reid revealed this week is that it's marginally less destructive than the House monster. By a hair. Its $1.2 trillion cost (more like $2.5 trillion if you discount the accounting gimmicks), multiple and damaging new taxes, and new regulations will make health insurance more expensive for most Americans while reducing the quality of medical care.
We'll dissect the damage in the days to come. But for today let's focus on the damage the bill would do to consumer-driven health plans—the kind that give individuals more control over their health dollars and insurance choices. The 2,074-page bill crushes them with malice-aforethought.
Start with its attack on flexible spending accounts that are an important part of many employer plans. Flex accounts let employees set aside some portion of their pre-tax pay for out-of-pocket costs or medical services that their insurance plan doesn't cover, such as a child's orthodontics or testing supplies for diabetics. The Reid bill caps these now-unlimited accounts at $2,500 per year and imposes new restrictions on qualifying medical expenses, raising some $5 billion by exposing income above the non-indexed cap to taxes.
Democrats say flex accounts encourage wasteful spending, because an arbitrary "use it or lose it" rule doesn't allow balances to roll over year to year. But they really hate them because they give consumers a more active role in managing spending, instead of having the government decide.
The Reid bill also assaults health savings accounts, or HSAs, which allow individuals to accumulate tax-free funds for future medical expenses when coupled with low-premium, high-deductible insurance. The Reid bill changes tax provisions to make HSAs less attractive, but the real threat comes via increased regulation.
These insurance products will likely be barred from the insurance "exchanges" that will demolish and supplant today's individual market. Employers will also find them more difficult if not illegal to offer once the government has new powers to "define the essential health benefits" that all plans must eventually offer. Plans that focus mainly on catastrophic health expenses, instead of routine procedures, aren't generous enough for Democrats.
Liberals claim people who choose these options aren't helping as much to finance a common pool and may encourage adverse selection if too many young or healthy people opt out. While all insurance involves some degree of risk-sharing, Democrats want to impose true social insurance a la Europe by obliterating the flexibility of insurers to design products that are tailored to suit different individual needs.
In fact, about 40% of tax filers with HSAs earn under $60,000, according to the IRS. The Employee Benefit Research Institute reports that 4% of adults with private insurance have an HSA this year—up from 1% in 2006—and about 9% are enrolled in some form of consumer-directed health plan. It also found that beneficiaries are evenly split between those with health problems and those without.
The Blue Cross Blue Shield Association, whose members dominate the HSA market, says that enrollees are more likely than those with traditional insurance to be better consumers. They're more likely to track expenses (63% to 43%), save for the future (47% to 18%), and search for information on physician quality (20% to 14%). They're also more likely to participate and see results from wellness programs like weight loss, fitness and smoking cessation. This makes intuitive sense: They've got skin directly in the game.
David Goldhill, a media executive, recently wrote in the Atlantic Monthly that if a 22-year-old starts at his company today earning $30,000 and health costs grow at 3%, by the time he retires he'll have paid out $1.77 million in premiums, lower wages, out-of-pocket costs and both sides of the Medicare payroll tax.
If all that money were instead available via an HSA, including by borrowing against future contributions, "wouldn't you be able to afford your own care?" Mr. Goldhill asks. "And wouldn't you consume health care differently if you and your family didn't have to spend that money only on care?"
This is precisely the future liberals fear because it would make health care less susceptible to political control. The Reid bill makes it impossible for people to choose better reform alternatives, the ones that can only be discovered through innovation and competition in a dynamic marketplace.
Not that any of this seems to matter at this stage of the health-card debate. The polls show the public opposes the Democratic bills, President Obama is below 50% job approval in the Gallup poll, and business and medical providers are increasingly horrified at what reform will do to consumers and patients. But so what? This is about putting government in charge of health care, whether Americans like it or not.
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I have a question...
What happens to a religous hospital ,once a govt run healthcare sysytem is in place, when they refuse to perform abortions?The Roman Catholic Council of Bishops have said they will not kill the unborn or euthanise the elderly and now with the Manhattan declaration being signed by religous leaders from around the country ....are battle lines being drawn? And what ever happened to the seperation of church and state thingy ,guess that only works one way.
Boyo
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The Manhattan Declaration has the potential to become something important in taking a stand against the arrogance of liberal fascism.
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A shining example of Washington corruption and how our government is totally out of control. Use my tax dollars to bribe a Senator to vote for a bill I don't want. Obviously this has been going on forever. Any Consititutional protection against this? I guess not or we would have seen it by now.
By Dana Milbank
Sunday, November 22, 2009
Staffers on Capitol Hill were calling it the Louisiana Purchase.
On the eve of Saturday's showdown in the Senate over health-care reform, Democratic leaders still hadn't secured the support of Sen. Mary Landrieu (D-La.), one of the 60 votes needed to keep the legislation alive. The wavering lawmaker was offered a sweetener: at least $100 million in extra federal money for her home state.
And so it came to pass that Landrieu walked onto the Senate floor midafternoon Saturday to announce her aye vote -- and to trumpet the financial "fix" she had arranged for Louisiana. "I am not going to be defensive," she declared. "And it's not a $100 million fix. It's a $300 million fix."
It was an awkward moment (not least because her figure is 20 times the original Louisiana Purchase price). But it was fairly representative of a Senate debate that seems to be scripted in the Southern Gothic style. The plot was gripping -- the bill survived Saturday's procedural test without a single vote to spare -- and it brought out the rank partisanship, the self-absorption and all the other pathologies of modern politics. If that wasn't enough of a Tennessee Williams story line, the debate even had, playing the lead role, a Southerner named Blanche with a flair for the dramatic.
After Landrieu threw in her support (she asserted that the extra Medicaid funds were "not the reason" for her vote), the lone holdout in the 60-member Democratic caucus was Sen. Blanche Lincoln of Arkansas. Like other Democratic moderates who knew a single vote could kill the bill, she took a streetcar named Opportunism, transferred to one called Wavering and made off with concessions of her own. Indeed, the all-Saturday debate, which ended with an 8 p.m. vote, occurred only because Democratic leaders had yielded to her request for more time.
Even when she finally announced her support, at 2:30 in the afternoon, Lincoln made clear that she still planned to hold out for many more concessions in the debate that will consume the next month. "My decision to vote on the motion to proceed is not my last, nor only, chance to have an impact on health-care reform," she announced.
Landrieu and Lincoln got the attention because they were the last to decide, but the Senate really has 100 Blanche DuBoises, a full house of characters inclined toward the narcissistic. The health-care debate was worse than most. With all 40 Republicans in lockstep opposition, all 60 members of the Democratic caucus had to vote yes -- and that gave each one an opportunity to extract concessions from Senate Majority Leader Harry M. Reid.
Sen. Ron Wyden (D-Ore.) won a promise from Reid to support his plan to expand eligibility for health insurance. Sen. Ben Nelson (D-Neb.) got Reid to jettison a provision stripping health insurers of their antitrust exemption. Landrieu got the concessions for her money. And Lincoln won an extended, 72-hour period to study legislation.
And the big shakedown is yet to occur: That will happen when Reid comes back to his caucus in a few weeks to round up 60 votes for the final passage of the health bill.
Republicans also knew that a single defection would kill the bill, so they tried to pressure the holdouts. "That's what we've got to choose today: Do we choose life or do we choose death?" declared Sen. Sam Brownback (R-Kan.). "We just need one vote, one vote on the other side."
But Landrieu had already made up her mind. She went to the floor during the lunch hour to say that she would vote to proceed with the debate -- but that she'd be looking for much bigger concessions before she gives her blessing to a final version of the bill.
"My vote today," she said in a soft Southern accent that masked the hard politics at play, "should in no way be construed by the supporters of this current framework as an indication of how I might vote as this debate comes to an end." Among the concessions she'll seek: more tax credits for small business and a removal of the version of the "public option" now in the bill.
That turned all the attention to the usually quiet Lincoln, who emerged from the cloakroom two hours later to announce her decision. Her attire was school-principal prim -- blue suit with knee-length skirt, orange silk scarf tied tightly at the neck -- and she was clearly uncomfortable in the spotlight. She spoke with the diction of somebody giving a dramatic reading, and she stumbled more than once as she read, botching the crucial line: "I will vote to support, of, the, the, will vote in support of cloture on the motion to proceed to this bill."
She argued, a bit too strenuously, that "I'm not thinking about my reelection" in 2010. All the same, she made clear that Democratic leaders would have to give more if they want her to vote yes as the health-care debate continues. Specifically, she demanded removal of the public option. "I am opposed to a new government-administered health-care plan," she warned, further cautioning that "I will not vote in favor of the proposal . . . as it is written."
By the time this thing is done, the millions for Louisiana will look like a bargain.
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A video from Reason-TV:
[youtube]http://www.youtube.com/watch?v=3E29LD98ruo&feature=player_embedded[/youtube]
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Commentary Mammogram advice based on science
Breast Cancer
Hospitals and Clinics By Miriam Alexander
December 4, 2009
We at the American College of Preventive Medicine support the updated United States Preventive Services Task Force recommendations on breast cancer screening. On Nov. 17, the task force released recommendations that women age 50 and older should have screening mammography every two years, and women in their 40s should decide whether to have screening mammography on an individual basis after talking with their doctors. Since then, misinformation and conspiratorial rumors have been rampant, including allegations that the task force is a mechanism for government or insurance industry cost-cutting at the expense of women's health.
Much of the response by media, pundits and policymakers is a result of two converging factors. The first is a lack of understanding about how the task force operates and how to interpret its findings. The second is a politically charged environment generated by the health care reform debates.
Let's set the record straight: The task force is not a government body. It is an independent panel of health care professionals, mostly primary care physicians - pediatricians, family physicians, internists, obstetricians and gynecologists - many of whom teach at prestigious academic medical centers. To characterize the task force as a collection of stooges for the insurance industry is simply disingenuous. In fact, the task force does not consider cost as a factor in making its recommendations. It conducts rigorous evaluations of the evidence to provide primary care clinicians with evidence-based guidance on using patient-directed clinical preventive services.
The task force concerns itself with clinical services aimed at patients who are healthy or do not have symptoms; it therefore deals with screening to detect early disease in which treatment or intervention will make a difference in ultimate health outcomes. The recommendations are not intended for people who are already ill or have symptoms. We agree with the task force that the tolerance for risk vs. the benefit of any service delivered in an asymptomatic population is different than in individuals who may already be ill.
Any competent doctor will tell you how important it is to consider both the benefits and the drawbacks of any treatment or screening service that they offer. The task force, using rigorous methodologies, examines the scientific evidence for preventive services. It carefully weighs the benefits and the drawbacks before making its recommendations - based on what's best for whole populations, not each individual.
Ideal preventive care for healthy individuals should "do no harm," as is stated in the Hippocratic Oath. Mammography may lead to harms such as false positives and subsequent unnecessary tests and biopsies. Furthermore, though unquestionably able to pick up true disease that needs treating, mammography also detects certain breast cancers will never spread and will never cause signs or symptoms. Our challenge in the medical community is that at the time of diagnosis, we do not know which cancers will lie dormant or regress and which will go on to cause significant suffering. We therefore move forward on treating essentially all cancers detected. A recent study suggests that 1 in 3 breast cancers detected on screening results in unnecessary surgery, chemotherapy and/or radiation therapy.
This recommendation also has nothing to do with health care reform. The task force voted on this recommendation more than a year ago - before the current administration took office and before health reform became a centerpiece of public policy. This recommendation is not about rationing, health care costs or politics. It is all about making intelligent decisions from a scientific perspective as to what works and what does not, and weighing medical benefits against negative outcomes.
As preventive medicine physicians, we support the value of mammograms for early detection of breast cancer. We know mammography screening saves lives. But it is important for women to be informed about the risks and benefits and make their decision in conjunction with their doctors. Let's not politicize this issue and these recommendations. Too many lives are at stake.
Dr. Miriam Alexander is president-elect of the American College of Preventive Medicine. She is on the faculty at the Johns Hopkins Bloomberg School of Public Health and is director of the school's General Preventive Residency Program. Her e-mail is mhalexan@jhsph.edu.
Copyright © 2009, The Baltimore Sun
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Blue Cross Blue Patients
Another study predicts higher insurance prices..ArticleComments (5)more in Opinion ».EmailPrinter
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. Text .Another day, another study confirming that ObamaCare will increase the price of health insurance. The Blue Cross Blue Shield Association has found that premiums in the individual market will rise on average by 54% over the status quo, which translates into an extra $3,341 a year for families and $1,576 for singles. The White House denounced the report as a "sham" before it was even released, which shows how seriously it takes such concerns.
The Congressional Budget Office also found this week that ObamaCare will boost premiums in the individual market by as much as 13%. But the White House called that a triumph because the higher costs will be offset by taxpayer subsidies that will be transferred to the federal balance sheet.
The Blue Cross study is in fact more precise than CBO's because it is based on real market data, rather than modeling assumptions. The association mined the actuarial data from its six million individual or small-business policies, nearly one-eighth of those sold in the U.S.
OpinionJournal Related Stories:
ObamaCare at Any Cost
The $1.9 Trillion Gimmick
The WellPoint Revelation
.Lo and behold, Blue Cross found costs will rise if Democrats force insurers to cover anyone who applies and then limit how much insurers are allowed to charge based on age or health condition. Economists call this adverse selection; people will wait until they're sick to buy coverage, and the Democratic rules make it perfectly rational for them to do so.
"And you can bet as we continue to make progress," communications director Dan Pfeiffer wrote on the White House blog, "the insurance industry will continue to try and distract and misinform because they know their very profitable status quo is in grave danger." He must be referring to the industry's overall profit margin of 2.2% in 2008.
The reality is that all health-care costs are ultimately borne by consumers, whether through more expensive premiums, lower wages or higher taxes. The regulatory schemes favored by Democrats can't change that law of economics but they will ensure that insurance is even more costly than it is today.
When that day comes, the political class will of course blame the insurance companies, and all of the current White House denials will fall down the memory hole.
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http://hotair.com/archives/2009/12/07/california-moves-to-ration-mammograms/
California moves to ration mammograms
posted at 10:12 am on December 7, 2009 by Ed Morrissey
ObamaCare advocates claim that putting government in charge of health care coverage and treatments won’t result in care rationing, while its opponents say rationing will be the inevitable result. The latter can point to California as evidence for their position. Facing enormous budget shortfalls, the state has ended subsidies for mammograms for poor women between 40-50 years of age, and will also freeze enrollments in a breast-cancer screening program for its Medicaid recipients:
The eligibility age for state-subsidized breast cancer screening has been raised from 40 to 50 by the California Health and Human Services Agency, which will also temporarily stop enrollment in the breast cancer screening program.
Advocates for low-income women, whose health care the department helps pay for, say the cuts put a two-tier system in place that is based on money rather than medical standards.
The cuts will greatly harm the clinic’s mammogram program, said Natasha Riley, manager of Vista Community Clinic’s Breast Health Outreach and Education Program.
The clinic and others like it in San Diego County provide reduced-cost care, mostly to low-income people, with money from the state and some private donations.
“More than 50 percent of the women we give breast exams and mammograms to are in their 40s,” Riley said. “The majority of our current breast cancer survivors are women in their 40s.”
The state followed the recommendation of the US Preventive Services Task Force, which claimed that regular mammograms created too much anxiety for women between 40 and 50. It also linked the decision to declining revenues from tobacco sales — no, really — which cut into funding for anti-cancer screening programs:
In its announcement, the state said the cuts were needed because of a projected budget shortfall for the California Department of Public Health, and from declining revenue from tobacco taxes.
However, it did not say how much money it expected to save.
Gee, what else have we built on the shifting sands of tobacco taxes? I wonder how the S-CHIP program is faring these days.
This is a great example of the difference between static and dynamic tax analyses. The former predicts a revenue from a tax that assumes that the tax won’t change the environment which produces the revenue, while dynamic tax analysis accounts for behavior changes when tax policies are applied. In this case, it’s actually worse; the tobacco-tax advocates argued both that increased taxes would discourage smoking while relying on a constant increase of revenue from the boost in tobacco taxes.
And now what we get is rationing, because the government created these programs based on rosy revenue projections that can’t be met.
Given Carly Fiorina’s recent statement on her experiences with breast cancer, I asked her campaign for a reaction to this decision:
“This is an example of what happens when the government’s role in healthcare decisions grows and the role of doctors and patients diminishes. With more government involvement cutting costs becomes paramount over quality of care. This situation underscores what is so critically wrong with the health reform legislation making its way through Congress now. It increases the role of government in our healthcare which is a recipe for higher taxes and lower quality of care. Instead, Carly believes any reform to our healthcare system should be focused on market-based reforms that prioritize quality of care and increasing access and choice.”— Julie Soderlund, Deputy Campaign Manager for Communications
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I am not sure I get the just. Why should insurers pay for a test that is unproven to have value?
A mammogram is only a couple hundred dollars - if women want it why can't they pay for it?
Or pay for the cadillac insurance that would cover it?
There are woman who are at higher risk who might benefit from it but not woman of avergae risk.
GM you are using this for political purposes.
I don't agree.
It was pure politics that led to mammograms before 50 to be approved by some groups years ago.
It continues to be a political football.
Who are the powers to be who decided it is ok to have mammograms every 1 to 2 yrs is a great idea?
Why not MRIs every one to two years? They are better tests than mammos and don't cause cancer like the radiation spewing mammograms? So they are too costly yet mammograms are acceptable cost?
Who decided this?
My pointy is someone has to make these decisions or we all go broke.
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Just pointing out how gov't healthcare works. Rationing is inevitable.
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"It was pure politics that led to mammograms before 50 to be approved by some groups years ago. "
I don't know enough to argue statistically, but know kids who grew up without a mom because of breast cancer in her 40s, and just lost a friend to colon cancer prior to his first recommended screening also. I don't know the answer but I do know that the latest word from the best professionals in the world on matters like these changes over time. Which brings us to your other point:
"A mammogram is only a couple hundred dollars - if women want it why can't they pay for it?"
Close to my view, get the cost of all healthcare down and let people decide how much of it they want.
New jewelry, Mammogram? New jewelry, Mammogram? I can't decide. Maybe the government knows better. Maybe I can buy the frivolous and get the entitlement free...
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CCP, My favorite analyst might well be Scott Ott over at Scappleface :-) We report, You decipher
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Obama Brings Afghan Strategy to Health Care Reform
by Scott Ott for ScrappleFace
(2009-12-02) — President Barack Obama announced he would apply his Afghanistan war strategy to domestic health care reform.
“It’s important that we seize the initiative,” the president said, “and put the resources in place so that we can withdraw them in 18 months, leaving the uninsured with the capacity to take care of themselves, to buy their own health insurance on the open market.”
The president said he’ll commit 30,000 new bureaucrats to this effort, who will begin deploying in early 2010, to train the uninsured in how to buy health insurance, and to equip the unemployed to find work, or to start businesses, so that they, too, can buy health insurance.
The president said the entire objective of his health care reform plan is to “hand over responsibility to the people, and then get our government forces out of their lives as quickly as possible.”
“This effort must be based on performance,” said Mr. Obama. “The days of providing a blank check are over. And going forward, we will be clear about what we expect from those who receive our assistance.“
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Hi Doug,
"I don't know enough to argue statistically, but know kids who grew up without a mom because of breast cancer in her 40s, and just lost a friend to colon cancer prior to his first recommended screening also. I don't know the answer but I do know that the latest word from the best professionals in the world on matters like these changes over time."
Breast cancer before age 50 is not rare. ie the parade of woman telling us their stories on the news.
I agree with you -
That said, no one thinks they should all get cancer and die just to save a few bucks.
Yet -
if doing mammograms were saving lives before age 50 then why is it so hard to show the benefits?
It seems against common sense to think that it doesn't catch some cancers earlier than otherwise would be found and hence earlier treatment and hopefully earlier treatment means less deaths. I even ask myself how could it not save lives?
Yet the studies fly in the face of expectations. And we see little comment on the cancers all the extra radiation may be causing.
We do this a lot in our society. We aggravate and make the majority pay for the few or even rare problems that occur. Get a couple of outbreaks of salmonella and we get the calls the FDA is not doing their jobs, we are all at risk of dying. And yet there are millions of eateries all over the US who have no problem.
We all cater to those with disabilities.
We sue and torture pharm companies for the rare side effects of drugs.
Where does it end?
We expect perfection from our police officers.
We are expecting perfection in every corner of our society. The cost is obvious. We are all forced to pay for every little ditsel of imperfection. And we go broke.
Thanks to the liberals who see financial opportunity with every "cause" they can uncover from under every rock.
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Some correspondence amongst friends:
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One very easy solution to this type of problem is to change the tax laws. Take away the huge incentive for everyone to get their insurance from their employer, and people would end up getting their own policies from day one. They could keep these policies forever, as long as they paid for them. Nobody would lose his coverage because he or she lost his job. You could even buy insurance against losing your job, so that your insurance premium would still be paid. There is absolutely no reason I can see for the US government to reorganize the entire healthcare system in order to address the problems that a relatively small number of people like this have.
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Yes, yes, yes.
And given this kind of freedom, people would tend to actually buy "insurance" -- protection against catastrophic medical bills -- instead of prepaid medical plans. With people actually paying for their own routine health care, they would take an interest in the cost of diagnostic medicine and many of today's abuses would disappear.
===========================
Your similar suggestions -- to focus on the insurance portion of an extended equation -- is a good first step... but only that, a first step.
Look there is so much (what's the word I want here: collusion? No, too emotional. Games-playing? How about...) linkage between vendors: insurance companies, doctors, government, and employers. Whether the issue is capitation counts (gee, tell me again why the doctor fails to respect MY time), balance billing, negotiated prices, the bottom line (pun intended) falls to that constituency left out of the loop: patients (consumers).
Some additional steps to your first step:
1) Abolish the AMA. Its primary purpose (though it will claim otherwise) is to limit the number of doctors and thus drive up, or provide a floor, on doctors' pricing. Let the winds of competition flow through that guild.
2) Reform the tort laws. However, make transparent (public) claims against the doctor for malpractice, whether arbitrated, mediated, or heard in a court.
3) Doctors MUST provide transparent pricing. Place prominently a placard that betrays prices for many common procedures. (No different from pricing at auto repair shops -- even though that is a sham.)
4) End the cozy relationship between the ethical and proprietary drug manufacturers and doctors. Really, how many scandals can one profession endure before consumers cry, "Enough!" (Well, apart from the Catholic church. :-)
Some flesh on my bullet points:
Patient A requires a procedure. Dr charges $1,000. Patient A has insurance so he or she pays a co-pay, insurance company pays its portion of a negotiated amount between, simplistically, Dr A and the insurance company. Balance is either billed to patient or 'eaten' by Dr A. We all are savvy to the fact that in any 'negotiation' you inflate your price to settle on a lower, perhaps more realistic charge, and everyone leaves the table happy: doctor, insurance company, and consumer... Right? Now consider Patient B, who requires the same procedure, but because he lacks insurance he must pay 100% of the Dr's inflated $1,000 fee. Hmmm. I understand that volume offers discounted pricing, but the assessed cost is not a true cost; instead it is a sham between doctor and insurance company as opening offer in a negotiation. Even so, this result on its face sure argues for single payer as one option among many.
A patient requires a procedure. His Dr says the cost will be $1,800, but his insurance company will cover only 100% of the first $1,000. Patient is thus on the hook for a balance of $800. With competition comes greater transparency; in such a universe, patients could open his procedure to bids, best price wins. Of course, the doctors (AMA) will warn that quality trumps price... but those same doctors will not, and do not, provide quality ratings in their performance. Why not? Patients (consumers) should trust doctors are well-trained and professional. But, then, why so many malpractice claims...?
I am no fan of the medical-industrial complex (to paraphrase Eisenhower); I make no secret of my feelings in this regard. Whether the issue be the drug manufacturers that hide study results (Vytorin or Zetia, anyone?), doctors who offer zero transparency re their practice and pricing, employers who tweak their company plan to make it affordable (seemingly affordable; most employees -- consumers! -- look only at price and not the lessened coverages, etc, that result from the tweaks and/or the or insurance companies that deny coverage for this or that reason (examples on request), seemingly arbitrarily that smacks of capriciousness.
The oddity for me is that I invest heavily in this sector, especially medical technology, despite my disgust. One of my most profitable positions was/is Intuitive Surgical/ISRG. I ask myself, though, whether in the world I hope for -- complete transparency for and by all constituencies-- such a company would even exist. Oh well, that is not a problem I will ever have to worry about.
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http://reason.com/archives/2009/12/10/the-problem-is-cost-of-care
Reason Magazine
The Problem is Cost of Care
Understanding America's dysfunctional health care system
Michael Munger | December 10, 2009
The problem with health care is not that we can’t afford insurance. The problem is that we can’t afford health care.
The U.S. has the world’s most expensive health care, $8,000 per person per year, eating up 16 percent of our GDP. There are many ways of paying these costs, of course, ranging from private insurance such as Blue Cross to public insurance such as Medicare. Many people pay out of their pockets, and local and state taxpayers pick up the rest.
The problem is that health care costs have increased at an annual rate double, or more than double, the rate of inflation for the last two decades. Right now, our attempts at reform are doomed by a law of accounting physics: Insurance can’t cost less than the health care it insures. That means that subsidizing insurance likely makes the problem worse.
Consider: I have car insurance. But my insurance doesn’t pay for oil changes.
Instead, I go down to the Happy Lube, without an appointment, get a diagnosis of the needs of my car, and choose services based on a price list published online. Some of these services are complex, and require large expensive machines and equipment. But I don’t have to pay a separate bill, or go wait in another line, at another office or lab.
Now, if I fail to get my car’s oil changed, or to perform other needed services, the engine will be damaged. That’s expensive to fix, but my insurance does not cover the costs. I bear the costs, so I care for the engine.
Health care is a little different. Many of us have “engines,” or other parts, that may not work very well, especially as we grow older. Things happen that may not be our fault, and even if they are we’d like to be able to buy some insurance against the worst consequences, the catastrophic injuries or illnesses that are part of every human society. The problem is that how we pay affects how much we pay.
Again, compare it to car insurance, for two people. Imagine neither of us has to pay for our car repairs, from accidents or engine wear. We can go to the garage as often as we like, and get whatever service we want, for free. The car repair shop can charge our insurance whatever they want, because insurance pays everything. An oil change would bill out at $600; an alignment would bill our insurance $2,200, with another $800 tacked on to pay for micro-digital wheel axis imaging.
Of course, the services aren’t really free. At the end of every year, we sum the total repair costs for both people, and each of us pays half of that total.
The cost of that free car care would be enormous, because of all the unnecessary and overly expensive charges. Of course, the government could subsidize the final bill; would that help? The answer is no, for two clear reasons.
First, having the government (meaning taxpayers) subsidize the total would do nothing to reduce the runaway cost increases. Buyers won’t shop around if they don’t know or care about real costs. Subsidies mean I don’t pay if I spend, and I don’t save if I’m frugal.
Second, let’s expand the example from two people (each paying half) to 300 million people getting free care (but paying an equal share of total costs). We have met the public option, and it is us! Once we are all paying ourselves, there is no one else to hit up to help with the costs. We are simply taking each person’s money in taxes, then giving some of it back in subsidies. There is no saving, even to individuals.
The French economist, Frederic Bastiat, diagnosed the problem long ago when he said, “The public option is the conceit that each of us should have free health care at the expense of all of us.” Okay, he didn’t say that, exactly, but it was the same idea.
The solution is out there, but it will require a fundamental change in the way we think. Competition among insurers, without decreases in underlying medical costs, may actually harm people through bad service and arbitrary denial of claims. Instead, we need competition among medical providers, just like oil change services now. LASIK surgery, one of the few areas of medical services open to competition and listed prices, has fallen in cost by 70 percent or more in the last 15 years. And quality has gone up dramatically. Walk-in clinics and fee-for-service arrangements for check-ups, or simple diagnoses like strep throat or infected thumbs, are already widely available, cost relatively little, and require no appointment.
Subsidizing insurance is a terrible idea. But that is the main focus of the health care reform bills passed by the House, and now being considered in the Senate. Why pin all our hopes on an approach that can’t possibly succeed?
Michael Munger is a professor of economics, and the chair of the political science department, at Duke University. He has written on policy analysis and cost benefit analysis of government programs.
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By JOSEPH RAGO
Watertown, Mass.
'It's a little bit like talking to a young prince," says Jonathan Bush, chairman and CEO of Athenahealth, a major player in information technology services for physicians, of his recent visits to Capitol Hill. "'So—tell me about this market thing that your people use,'" he says, mimicking the political royalty with a grin and extending his forearm. "'Wait: I must catch my falcon!'"
Athenahealth's headquarters, on the banks of the Charles River outside Boston, is a world away from D.C., and it's clear, as he continues his metaphor, that Mr. Bush enjoys the distance: "And these princes, they mean well and they're lovely," he says, "but they're living in this alternate universe where there's no such thing as a market in health care and they don't understand why one might be remotely useful."
He pauses. "That's weird to me."
Mr. Bush is an outlier in the generally buttoned-down world of the health industry. He's exuberant, hyperactive, speaking in frenetic running monologues; it's not hard to see why the political class might be taken aback: "I still have to keep going to Washington and sucking up," he says, switching metaphors. "Because the problem is when you have a baby with an Uzi, right, they might accidentally mow you down. But here's the thing . . . they're brilliant people. It's just that the idea of a market in health care never occurred to them."
As Mr. Bush sees it, the profound problem with U.S. health care is that there's "no landscape of choices, or choosers." Due to the complexity of America's third-party laundromat for health dollars—your doctor's clerical staff bills your treatment to an insurance company picked by your employer, and it pays him with your money via premiums or foregone wages—"few doctors in America know the actual value of the services they render."
Athena's core business helps them manage their practices and get paid, but the larger purpose of the company, which he and board member Todd Park co-founded in 1997, is to try to shore up health care's resemblance to a normal market. It has grown into one of the country's most innovative health IT firms.
Athena began as a San Diego birthing clinic and floundered because it couldn't cope with back-office volatility. All transactions were conducted on paper. No one understood how to navigate the dense and bewildering coding rules for dozens of different insurers or the fee schedules for government payers like Medicaid. Claims were denied with no explanation or vaporized in purgatory. The clinic went bankrupt in 18 months.
With Mr. Park (who has joined the Obama administration), Athena designed a program to digitize records and automate billing. It now colonizes the wilderness of paperwork and habitual financial chaos that defines running a doctors office, and it is also moving into clinical record-keeping for individual patients. Some 15,000 physicians in 43 states use Athena as a virtual office, a number that is growing at an annual 30% clip.
It is a massive logistical undertaking. Athena's main facility is housed in a decommissioned World War II arsenal on the Charles, where 30,000 pounds of paper is processed every month, most of the tonnage being paper checks. Incredibly, doctors also receive on average 1,185 faxes each month—mostly lab results—and those are handled too.
State Medicaid programs, by the way, are easily the worst payers, according to Athena's annual ranking. In New York, for instance, claims must be tendered on a dead-tree form instead of electronically and in blue ink—black is grounds for rejection—and then go on to spend a full 161 days, or almost a half year, in accounts receivable.
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Zina Saunders
.While streamlining this disorder frees up time for the company's clients to treat patients, it also throws off vast data, which are fed in central servers, aggregated and analyzed. This "athenanet" system is among the few health-tech offerings based on "cloud computing"—in the sense that the applications are accessed on the Web, instead of a computer's hard drive, allowing constant updates and refinements. If a regulation changes or an insurer adjusts a payment policy, it is reflected on athenanet almost in real time; on the clinical side, the program can adapt at the same rapid pace as medicine itself.
Mr. Bush thinks the main benefit is the "collective intelligence" that he is starting to weave together from the 87% of American physicians who practice solo or in groups of five doctors or fewer. "We found one of the last few remaining crowds in health care, which are these independent practices. Now you can argue that this decentralization is not the best thing in the world," but what's most important, he argues, is that "they're still allowed to go and make their own decisions."
In effect, as the network gets bigger, it gets smarter, while opening the space for innovations to feed off one another and spread. There really can be "radical improvement" in health care, Mr. Bush says, but only if there are "radical improvers" able to set themselves apart and lead the forward advance. "No one ever says, 'Here's to the average,'" he declares pointedly.
The Athena model is superior to most electronic medical record systems, or EMRs, which are generally based on static software that are inflexible, can't link to other systems, and are sold by large corporate vendors like General Electric. One reason the digital revolution has so far passed over the health sector is sheer bad product. The adoption of EMR in health systems across the country has been dogged by cumbersome interfaces, error propagation and other drawbacks. In 2003, for instance, Cedars-Sinai in Los Angeles dumped a $34 million proprietary system after doctors staged a revolt.
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.Athena also stands in marked contrast to most of the wider health-care market, which Mr. Bush argues is homogenized and rigid, and getting more so. The problem is "easily fixed by releasing some power into the arms of consumers and cutting employers and certainly the government out of it," he says, turning to ObamaCare. "Certainly I'm not commenting on the amount of wealth redistribution that we should do as a society. Fundamentally I believe we need some, and whether the amount we're doing today is enough or too much or not enough, that's not my thing. If we feel like rich people should pay more for not-rich people's health insurance, that's fine.
"But just give them the money," he cries. "It's totally inefficient wealth redistribution because they can't get creative with it. They're not allowed by law to get creative with it."
What Mr. Bush means is that the government imposes standardized rules and mandates with no concern for how much they will cost or who will bear the burden. Given the choice, consumers might decide on cheaper policies that cover some services but not others, or decide to run more risk.
Yet for all the talk about expanding coverage, Mr. Bush says the real problem is that "You can't buy what you want." Another way of putting it is that "America will have one car. Everyone will have access to transportation, which means that everyone will have a black Escalade, with spinners. That's it. There's no Hyundais, no bicycles, no nothing."
And it's scandalously unfair. "These poor people who clip the things off the backs of cans to make the tomatoes cheaper are subsidizing the hypochondriac who gets his shoulder done with an arthroscope because it clicks when he serves at tennis."
Under ObamaCare, Mr. Bush says, "everyone is going to get health care according to the wise-men benefit panel, who will tell you exactly what it is, and then they'll run out of money, so every year the wise panel will just squish the benefit a little. People will start to say, well, that's not going to work for me." For this reason he doesn't think central health planning will have any longevity, and eventually people "will start leaking out into the [private] market once we run out of Obama energy."
His company, he thinks, will play an important role in such a world, where individuals would have more responsibility for weighing trade-offs—which, he believes, is the only lasting way to enforce discipline in health spending: "Today it's so complicated that the average consumer—and this is what the academics say—you can't put the average consumer in charge, it's too complicated. Yeah it's too complicated! So let's make it not complicated," he says. Athenanet generates "clean information," the basic price signals about health care that "a regular old consumer could look at and say, 'That's worth it' or 'I'd rather do this one on the other side of Route 128 that does it cheaper.'"
Mr. Bush is less sanguine about the White House cost-control approach of better living through technocracy and "Benthemite micromanagement." As an illustration he singles out the idea of dispensing bonus payments to hospitals that find ways to reduce Medicare spending. If the bonus is higher than what the hospital would have been paid under the status quo, then Medicare is worse off—but if the bonus is less than what the hospital would have earned otherwise, in what sense is it an incentive to change? In other words, "I'm going to give you a dollar bill for every 10-dollar bill you give me?" Mr. Bush asks incredulously.
The irony is that Athena will likely benefit from the Project Mayhem that is about to begin. "It's probably terrible that all this new bureaucracy is being created," Mr. Bush says. "But there's going to be 50 new Medicaid-type plans in these insurance exchanges, run by the same insurance commissioners, these same sort of glazed-over-looking state secretaries of health. You know, just not really the brightest bulbs in the chandeliers of the world. Medicaid, the worst payer in the country by a factor of four! Mother of pearl! So I feel a little bit like a robber baron. I am going to make oil money dealing with them."
The double irony is that Athena—while Mr. Bush might not put it in such an impolitic way, but then again, maybe he would—is also showing that the status quo for all its flaws is capable of organic change and real progress without the blunt-force trauma Congress is likely to inflict. Or in spite of it.
Take the nearly $47 billion in stimulus cash the White House has budgeted to prime the pump for health IT adoption. Mr. Bush says he's glad his industry is getting more attention from the bully pulpit, but that "It is kind of too bad that all these software companies that we're really close to putting out of business, these terrible legacy companies, with code that was written in the '70s, are going to get life support. That's why I call it the Sunny von Bülow bill. What it is, basically, is a federally sponsored sale on old-fashioned software."
"It's designed like a box-buying campaign," he continues. "You get this fixed chunk of money for a few years, you get to pay off your EMR, like its a thing. People in Washington think in terms of things that we'll buy and then they'll be there. Buildings. Roads. Tanks. What Lockheed Martin makes. Things.
"And this isn't that. This is a market: its a set of agreements, it's a language. What's needed is a way of exchanging value and making choices, that's ethical—and, you know, nobody, nobody, not nobody, has said a word about that.
Mr. Rago is a senior editorial page writer at the Journal.
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By SCOTT HARRINGTON
The public is growing wary of the cost of ObamaCare. Yet there is one budget-busting provision that hasn't received the attention it deserves: a new long-term care entitlement.
Known as the Community Living Assistance Services and Supports Act, or Class Act, this entitlement is in both the House and Senate bills and was a top priority of the late Sen. Ted Kennedy. It would provide at least $50 a day toward home or institutional care, equipment and supplies, or home improvements to assist the daily living of those who are enrolled. It is also a significant part of the reason that Democrats claim that ObamaCare is fiscally responsible, but this turns out to be a short-term budget ruse.
The Congressional Budget Office (CBO) projects that the House and Senate health-care bills will reduce federal deficits over the next 10 years by $138 billion and $130 billion, respectively. The lion's share of the savings, $101.6 billion and $72.5 billion, would be realized by the long-term care program.
How can a new entitlement reduce deficits? With budget accounting, the program will pile up more revenues than its costs. But only in the short run. In the long run, it will blow a hole in the federal budget.
Private long-term care insurance works like other insurance policies. Those who buy policies pay premiums over a prolonged period of time. The premiums pay for the benefits they may eventually receive and cover the benefits for those who need immediate care.
To make sure that a premium paid today can pay for a benefit promised for tomorrow, an insurer determines the amount it will need for future benefits, marks that amount as a liability, and puts aside funds to pay for it. An insurer also creates an additional pool of capital to act as a buffer, just in case.
That isn't how the Class Act would work. The House and Senate bills stipulate that premiums would be calculated to cover benefit payments over a 75-year horizon without federal subsidies. And the bills do authorize the secretary of Health and Human Services to adjust premiums and benefits to maintain solvency. But CBO and the Centers for Medicare & Medicaid Services (CMS) have identified parts of the program that will subject it to considerable financial risk.
First, those who enroll would likely be more apt to need care and will be more expensive to cover than those who buy private insurance. To cover its costs, the program would have to charge more than private insurers.
On Friday, CMS Chief Actuary Richard Foster said in a memo on the (less costly) Senate version of the program that premiums would be set so high they would discourage healthier people from buying in. As the healthy stayed on the sidelines, the program would have to charge more to those who did enroll. This in turn would price more people out of the program, risking what the memo called an "insurance death spiral."
Mr. Foster does project the program will lower the federal deficit in its first decade (by $39 billion and $38 billion for the House and Senate bills respectively, much less than the CBO estimates). But neither CMS nor the CBO include in their 10-year projections the program's future liabilities. Of course, that's exactly when the government will have to make good on its promises, putting pressure on the federal budget. Why? Because unlike private insurance, the program won't invest its early surpluses.
Instead the program will hand over its revenues to the feds, who will promptly spend it. In return, the program's administrators would receive federal IOUs, just as Medicare and Social Security do. But these are nothing more than liabilities that have to be repaid, either by taxes or borrowing.
Under the House bill, CBO projects that the entitlement would bring in $123 billion in premiums from 2010-2019 and pay out only $20 billion in benefits. CBO also projects that the Senate's version would generate $88 billion in premiums and $14 billion in benefits.
But in a letter late last month to Sen. Tom Harkin, CBO Director Douglas Elmendorf explained that while the Class Act would likely reduce federal budget deficits during 2020-2029, it would do so "by smaller amounts than in the initial decade."
By the third decade, CBO says the program would pay more in benefits than it received in premiums and what it saved Medicaid (which currently pays for long-term care for millions of elderly). Mr. Elmendorf concludes that "the programs would add to budget deficits in the third decade—and in succeeding decades—by amounts on the order of tens of billions of dollars for each 10-year period." These long-term demands on the Treasury would coincide with shortfalls in Medicare and Social Security projected to be in the hundreds of billions of dollars.
Sen. Kennedy notwithstanding, it is hard not to conclude that a major motivation for the Class Act is to make ObamaCare look fiscally better over CBO's official 10-year budget horizon. Without the new long-term care program, CBO's projected deficit reductions for the House and Senate bills would be $36 billion and $58 billion, respectively, rather than $138 billion and $130 billion. This makes the overall Democratic reform look fiscally more responsible than it really is. The real danger comes after 10 years, when the long-term care program will increase deficits and create even greater pressure for government rationing of medical care.
Mr. Harrington is professor of health-care management and insurance and risk management at the University of Pennsylvania's Wharton School and an adjunct scholar at the American Enterprise Institute.
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Second entry of the morning
WSJ
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ObamaCare's core promise—better quality care for everyone at lower costs—is being exposed as an illusion as it degenerates into the raw exercise of political power. Naturally, the White House and its media booster club are working furiously to prop up this fiasco, especially on cost control.
As Obama budget director Peter Orszag put it at a revealing media breakfast earlier this month, the Senate bill does everything the experts recommend to "get at the underlying drivers of health-care costs." While he admitted that "we don't know enough" to produce results right away, the key is to encourage "continuous improvement" through pilot programs and demonstration projects. Cost containment will actually take "years to decades," Mr. Orszag conceded.
The torch was then passed to Ron Brownstein of the Atlantic Monthly, David Leonhardt of the New York Times and editorial writers for the New England Journal of Medicine, among others. Last week the New Yorker ran a 5,000-word apologia from Atul Gawande, who likewise owned up to the fact that there is "no master plan for dealing with the problem of soaring medical costs," only "a battery of small scale experiments." Keep in mind, this is an argument in favor of ObamaCare.
They might have piped up earlier: What they're finally admitting is that all the grandiose talk about "bending the curve" used for months to sell ObamaCare really comes down to their hope that bureaucratic improvisation will make a difference over the long term. Yet the liabilities of the greatest social spending program in American history will be added to the budget almost immediately, and what happens if Mr. Orszag's technocratic revolution doesn't work as promised? Or rather, when it doesn't?
Forgotten in ObamaCare's march-to-the-sea campaign is that during the transition and early on, the White House was divided on whether to pursue health reform at all. Opponents included Larry Summers, worried about the economy and deficits, and David Axelrod, worried about the politics. Another faction led by Tom Daschle preached from the conventional social-equity church of liberalism.
Mr. Orszag proposed another option, citing academic research observing that as much as 30% of health spending is "waste" that doesn't affect outcomes. He argued the country could save $700 billion a year without harming quality—more than enough to pay for universal coverage.
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Associated Press
Peter Orszag.
.Thus cost control migrated from Orszag theory to free political lunch. Mr. Gawande wrote an influential New Yorker essay on the topic in June, and the theme shaped both the case for a new entitlement and especially the appeal to potential opponents in business.
But then Congressional Budget Office director Douglas Elmendorf testified in July that "the curve is being raised," given that ObamaCare lacks "the sort of fundamental changes" necessary to tamp down costs. Meanwhile, it became clear that Mr. Orszag's favored research was always more nuanced and qualified than his pose of papal infallibility. One of his main gurus, Jonathan Skinner, mused recently that "the key lesson" from a new study challenging some of his findings "is how little we know about the science of health-care delivery."
Well, sure. A field as dynamic and innovative as U.S. medicine, in which costs are largely driven by new technologies and better ways of caring for patients, is rife with complexities and uncertainties. But no one bothered to strike that note of caution when Washington was hopped up on a cost-control gambit that was too painless to be true.
The new cost-control apologists concede that there isn't any actual plan for controlling costs: Throw enough speculative policies against the wall, they say, and some breakthrough will stick. Yet Mr. Orszag's no-less-confident predecessors spent decades trying to pull down Medicare spending with little to no success. Technocracy rarely if ever works as intended. Mr. Gawande points to the case study of U.S. farm policy, and if politically sacrosanct agriculture subsidies and rural price-supports are the best to hope for, then what's the worst?
More relevant examples include Medicare's "relative value" payment scale, which was designed in 1985 by the Harvard economist William Hsiao to encourage more primary care. That's this year's rallying cry too. "Diagnosis-related groups" were introduced into Medicare in 1983 to alleviate hospital cost growth, and what a monumental success that turned out to be. With only brief periods of relatively slower growth, nominal Medicare spending has risen on average at an annual rate of 9.6% since 1980. Over the same period total Medicare spending has grown 13-fold, climbing from 1.2% of the economy to 3.2% today.
Congress lacks the stomach for serious cost control in any case. One policy Mr. Orszag favors—Medicare penalties for hospitals that re-admit certain patients—is limited to only three conditions in the Senate bill, and the penalties are trivial.
Another—a putatively independent commission that is supposed to enforce cost cutting—is barred from going after costs incurred by doctors and hospitals, which leaves out more than half of Medicare spending. Earlier this year Mr. Orszag got into a heated debate with Henry Waxman over such a commission at a dinner party hosted by Connecticut Rep. Rosa DeLauro, precisely because the House baron enjoys the political power that flows from controlling health spending.
Even if Mr. Orszag's Princeton and Yale Ph.D.s really do cook up some hope-and-a-prayer savings plan, it will invariably offend one constituency or another and Congress will block it. Thereupon the political class will do what it always does when costs run over: Tighten price controls across the board, before moving on to denying patient access to costly treatments that will be defined as "wasteful." That is, ration care.
"Basically everything that has been put forward in health policy discussions for a decade is in this bill," Mr. Orszag said on a conference call shortly before Thanksgiving. He then asked critics pointedly: "What specifically else would you do?"
Hmmm. One liberal sage noted in a 2007 paper that "four decades of empirical research" have shown that insulating people through third-party insurance coverage "from the full cost of health care has been responsible for anywhere from 10% to 50% of the large increase in health expenditures." Ultimately, he concluded, increasing cost-sharing would give individuals a direct stake in more prudent purchasing, as opposed to today's invisible health dollars that vanish as more expensive premiums, foregone wages and higher taxes.
Those are the words of Jason Furman, now the White House deputy economic director who seems to have been put into witness protection. Every serious health economist in the country recommends reforming the tax exclusion for employer-sponsored insurance, perhaps by converting it to a deduction or credit. Cost control will never stick unless it is extricated from politics and transferred to individuals to make their own trade-offs.
Such reforms were ruled out by union opposition, so the Senate gestures at them with a 40% excise tax on high-cost insurance plans, on the theory that two wrongs will make a right. But this untargeted tax will simply raise the cost of coverage for all workers in a given pool—it's too clever by 40%—while doing nothing to stem the distortions from first-dollar, third-party insurance.
No doubt there are efficiencies to be had in health care, and maybe Mr. Orszag has even identified some of them. But all of his bright ideas could be taken for a whirl without adding trillions of new liabilities to the federal balance sheet. And the bad faith of the White House and its acolytes is breathtaking.
The White House hawked a permanent entitlement expansion on flimsy and speculative theories that its own partisans now admit—albeit when it is nearly too late—aren't more substantive than the triumph of hope over experience, while simultaneously writing off the one policy that has been effective in the real world. The cost control mantra of ObamaCare was always a political bill of goods, and its result will be the opposite of its claims: poorer quality care at higher costs.
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"Mr. Orszag proposed another option, citing academic research observing that as much as 30% of health spending is "waste" that doesn't affect outcomes. He argued the country could save $700 billion a year without harming quality—more than enough to pay for universal coverage"
LOL if this wasn't such a ridiculous statement.
Just the definition of this word alone: "outcomes" could stimulate debates that could roar on forever.
Who decides what is the proper "outcome"?
Does he mean death or hospitalization?
Where is the *academic research* on the waste in government?
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Morning Bell: The Battle Over Obamacare’s Obituary Has Begun
Posted December 14th, 2009 at 9.31am in Health Care.
Last month, Speaker Nancy Pelosi (D-CA) rammed through her version of Obamacare almost a week before the agency in charge of running Medicare and Medicaid, the Centers for Medicare and Medicaid Services (CMMS), could issue its non-partisan and independent analysis of the legislation. And for supporters of the President’s plan, it’s a good thing she did. The CMMS report eviscerated almost every single promise the President has made about his health care plan.
According to that report, Obamacare: 1) raises health care costs; 2) causes millions of Americans to lose their current health care coverage; 3) forces millions of Americans to pay fines and still receive no health insurance; 4) causes millions of seniors to lose their Medicare Advantage plans; 4) places millions of Americans on welfare; 5) jeopardizes Medicare access for all seniors; 6) worsens health care access for the poor.
This past Friday, CMMS issued another report, this time on Majority Leader Harry Reid’s (D-NV) version of Obamacare and the verdict was in many ways worse: 1) health care costs would rise by $234 billion; 2) 17 million Americans would be forced out of their existing health insurance; 3) 19 million Americans would pay $29 billion in taxes/fines and receive no health care in return; 4) 33% of all Medicare Advantage customers would lose their health care plan; 5) 18 million Americans would be put on welfare; 6) the $493 billion in Medicare cuts would force 20% of Medicare providers to become unprofitable thus jeopardizing access to care for all seniors; and 7) the explosion in Medicaid recipients would exacerbate existing health care access problems for the poor.
The week before the Senate began debating Obamacare, CNN conducted a poll and found that Americans narrowly opposed the plan, 49% to 46%. Now that the Senate has been debating the plan for two weeks, and CMMS has issued two devastating reports on what the impacts of Obamacare would be, opposition to the plan has skyrocketed. This Friday’s latest CNN poll showed 61% of Americans now oppose Obamacare compared to just 36% who support it.
Liberals are is beginning to see the writing on the wall. They know that if Obamacare fails to pass the Senate this year, the battle will be on to explain its failure. For them, the story can not be that President Barack Obama tried to push too ambitious a government health plan. It must be that the President and Congress did not go far enough to the left to satisfy the supposedly government-hungry American people. Hence the left is now attacking the White House and Reid over the public option, the employer mandate, drug reimportation, abortion, and health insurance spending caps.
Obamacare is not dead yet. Speaker Pelosi has signaled that she will quickly pass anything that comes out of the Senate, so Reid could still cave on almost everything and get a terrible bill from everybody’s prospective on the President’s desk by New Years. But Senators thinking about moving quickly should remember that the public strongly opposes this bill, and that opposition is only rising.
http://blog.heritage.org/2009/12/14/morning-bell-the-battle-over-obamacares-obituary-has-begun/
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2nd post.
December 14, 2009
A Savings Mirage on Health Care
By Robert Samuelson
WASHINGTON -- We are now witnessing a determined counterattack by the Obama administration and its political allies on the matter of health care costs. Many critics (including me) have argued that President Obama's "reform" agenda wouldn't control rapidly rising health spending and might speed it up. The logic is simple. People with insurance use more health services than those without. If government insures 30 million or more Americans, health spending will rise. Greater demand will press on limited supply; prices will increase. The best policy: Control spending first; then expand coverage.
But the administration insists it can insure most of the uninsured and tackle runaway health spending simultaneously. There's so much waste in today's health care system that both goals can be pursued together, Peter Orszag, head of the Office of Management and Budget, has said.
Two new reports by liberal advocacy groups echo that claim. The first, from the Center on Budget and Policy Priorities, contends that lower Medicare reimbursement rates to hospitals and other providers can pay for about half of the $900 billion or so government cost over a decade of expanded health benefits. Critics (again, including me) have said that Congress would put the Medicare cuts in today and might repeal some or all of them in the future. Nonsense, says the study. Congress has allowed many past reductions in Medicare reimbursements to take effect.
Even more upbeat is a joint report from the Center for American Progress Action Fund (CAP) and the Commonwealth Fund arguing that savings from the bills' cost-cutting provisions have been underestimated. One measure would push hospitals to reduce readmission rates; some "bundled payments" between doctors and hospitals would encourage coordinated care; taxes on gold-plated insurance plans would deter overspending. Health costs would be lower than expected: Medicare "savings" would total $576 billion over a decade (about $200 billion more than estimated by the Congressional Budget Office, which mostly counted lower reimbursement rates); the federal deficit would drop up to $459 billion over a decade; and health care "savings" for typical families would total about $2,500 by 2019.
Who's right? Let's start with the numbers. Unfortunately, the word "savings" is used misleadingly. It doesn't mean (as is usual) actual reductions; it signifies smaller future increases. There's a big difference.
In 2009, national health spending will total an estimated $2.5 trillion, or 17.7 percent of gross domestic product. By 2019, it's projected to rise to $4.67 trillion under present policies, or 22.1 percent of GDP. With CAP's "savings," it rises a little less sharply to $4.49 trillion, or 21.3 percent of GDP, according to Harvard economist David Cutler, the study's co-author who provided these figures. Similarly, family health insurance premiums rise from 19 percent of median family income in 2009 to 25 percent in 2019 under present policies and 23 percent with CAP's "savings."
The point is simple: Even with highly optimistic assumptions, health spending remains out of control. It absorbs more of government, business and family budgets. Higher health spending would put pressure on future budget deficits, already projected to total about $9 trillion over the next decade. If new taxes and Medicare "savings" are real, they could be used exclusively to pay down deficits, not finance new spending.
But many may not be real. Writing in The Wall Street Journal, Dr. Jeffrey Flier, dean of the Harvard Medical School, gave the various health bills a "failing grade" and said they wouldn't "control the growth of costs or raise the quality of care." Quoted in Newsweek, Dr. Delos Cosgrove, head of the Cleveland Clinic, said much the same. Richard Foster, the chief actuary of the federal Centers for Medicare & Medicaid Services, doubts the cost-saving provisions touted by CAP would save much money. He's also skeptical that Congress, facing complaints from hospitals and a squeeze on services, would allow all the Medicare reimbursement cuts to take effect. True, Congress has permitted some reimbursement reductions to occur but has repeatedly blocked the Sustainable Growth Rate adjustment for doctors, which most resembles the new proposals.
Health cost increases might spontaneously recede, but history suggests skepticism. The relentless advances reflect an open-ended insurance and delivery system that gives neither patients nor providers any reason to restrain spending. To attack costs first would be politically challenging. It would require admitting that all good things are not possible simultaneously and that the uninsured already receive much medical care. It would require genuine bipartisanship, not just a scramble for a few Republican votes. And it would require stronger measures to dismantle a fee-for-service delivery system that now rewards more, not better, care. That's a demanding and realistic approach; Obama's is wishful thinking.
Page Printed from: http://www.realclearpolitics.com/articles/2009/12/14/get_real_about_health_costs_99526.html at December 14, 2009 - 04:11:21 PM CST
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Why Democrats push health care, even if it kills them
By: Byron York
Chief Political Correspondent
December 15, 2009
To some observers, the Democrats' race to pass national health care seems irrational -- even suicidal. Don't party leaders understand how much the public opposes the bills currently on the table? Don't they know that voters are likely to take their revenge at the polls next year? Given that, why do they keep rushing ahead?
Just look at the RealClearPolitics average of polls, which shows that Americans oppose the national health care bills currently on the table by a margin of 53 percent to 38 percent. That's not just one poll that might tilt right or left, it's an average of several polls by several pollsters. And the margin of opposition seems to be growing, not diminishing. And yet Democrats seem determined to defy public opinion. Why?
I put the question to a Democratic strategist who asked to remain anonymous. Yes, Democrats certainly understand that voters don't like the current bills, he told me, and they are fully aware they will probably pay a price next year. But they have found a way to view going ahead anyway as the logical thing to do, at least in their eyes.
You have to look at the issue from three different Democratic perspectives: the House of Representatives, the White House and the Senate.
"In the House, the view of [California Rep. Henry] Waxman and [House Speaker Nancy] Pelosi is that we've waited two generations to get health care passed, and the 20 or 40 members of Congress who are going to lose their seats as a result are transitional players at best," he said. "This is something the party has wanted since Franklin Roosevelt." In this view, losses are just the price of doing something great and historic. (The strategist also noted that it's easy for Waxman and Pelosi to say that, since they come from safely liberal districts.)
"At the White House, the picture is slightly different," he continued. "Their view is, 'We're all in on this, totally committed, and we don't have to run for re-election next year. There will never be a better time to do it than now.'"
"And in the Senate, they look at the most vulnerable Democrats -- like [Christopher] Dodd and [Majority Leader Harry] Reid -- and say those vulnerabilities will probably not change whether health care reform passes or fails. So in that view, if they pass reform, Democrats will lose the same number of seats they were going to lose before."
All those scenarios have a certain logic (even if the Senate calculation undercounts the number of potentially vulnerable Democrats). But each scenario is premised on passing an unpopular bill that hurts the party. Even if there's a strategic rationale for doing it, why are Democrats dead-set on hurting themselves?
"Because they think they know what's best for the public," the strategist said. "They think the facts are being distorted and the public's being told a story that is not entirely true, and that they are in Congress to be leaders. And they are going to make the decision because Goddammit, it's good for the public."
Of course, going forward has turned out to be harder than many Democrats thought. And now, with various proposals lying wrecked along the road, the true believers are practicing what the strategist calls "principled damage control."
But still, does it make sense? In the end, perhaps the most compelling explanation for Democratic behavior is that they are simply in too deep to do anything else. "Once you've gone this far, what is the cost of failure?" asks the strategist.
At that point -- Republicans will love this -- he compared congressional Democrats with robbers who have passed the point of no return in deciding to hold up a bank. Whatever they do, they're guilty of something. "They're in the bank, they've got their guns out. They can run outside with no money, or they can stick it out, go through the gunfight, and get away with the money."
That's it. Democrats are all in. They're going through with it. Even if it kills them.
Byron York, The Examiner's chief political correspondent, can be contacted at byork@washingtonexaminer.com. His column appears on Tuesday and Friday, and his stories and blog posts appears on ExaminerPolitics.com.
Find this article at:
http://www.washingtonexaminer.com/politics/Why-Dems-push-health-care_-even-if-it-kills-them-8658408-79264542.html
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Bland CBO Memo, or Smoking Gun?
Posted by Michael F. Cannon
This weekend, the Congressional Budget Office released “a very strange memo” titled, “Budgetary Treatment of Proposals to Regulate Medical Loss Ratios.” You wouldn’t know it from the title, but that little memo is the smoking gun that shows how congressional Democrats have very carefully hidden more than half the cost of their health care bills.
First, a little history. Like both the House and Senate bills, the Clinton health plan would have mandated that individuals and employers purchase private insurance. In its 1994 score of the Clinton plan, Bob Reischauer’s CBO included those mandated “private” payments in the federal budget –- i.e., as federal revenues and federal expenditures.
And yet, none of the CBO scores of this year’s bills include the costs of similar individual/employer mandates as federal revenues or federal spending.
My read of the CBO’s score of the Clinton health plan is that the private-sector mandates accounted for around 60 percent of the Clinton health plan’s total cost, the remainder being (traditional) government spending. So how is it that the CBO made the full cost of the Clinton health plan apparent to the public in 1994, but may now be revealing only 40 percent of the cost of the Obama health plan?
For some time, I’ve suspected the answer is that congressional Democrats have very carefully tailored their individual and employer mandates to avoid CBO’s definition of what shall be counted in the federal budget. Democrats are still smarting over the CBO’s decision in 1994. By revealing the full cost of the Clinton plan, the CBO helped to kill the bill.
Since then, keeping the cost of their private-sector mandates out of the federal budget has been Job One for Democratic health wonks. While head of the CBO, Obama’s budget director Peter Orszag altered the CBO’s orientation to make it more open and collaborative. One of the things about which the CBO has been more open is the criteria it uses to determine whether to include mandated private-sector spending in the federal budget. The CBO even published a paper on the topic. Read this profile of Orszag by Ezra Klein, and you’ll see that those criteria were also a likely area of collaboration with lawmakers.
The Medical Loss Ratios memo is the smoking gun. It shows that indeed, Democrats have been submitting proposals to the CBO behind closed doors and tailoring their private-sector mandates to avoid having those costs appear in the federal budget. Proposals that would result in a complete cost estimate — such as the proposal by Sen. Rockefeller discussed in the Medical Loss Ratios memo — are dropped. Because we can’t let the public see how much this thing really costs.
Crafting the private-sector mandates such that they fall just a hair short of CBO’s criteria for inclusion in the federal budget does not reduce their cost, nor does it make those mandates any less binding. But it dramatically reduces the apparent cost of the legislation. It is the reason we’re all talking about an $848 billion Reid bill, rather than a $2.1 trillion Reid bill.
If someone sold you a house, or a car, or a mutual fund this way, we would put them in jail.
http://www.cato-at-liberty.org/2009/12/16/bland-cbo-memo-or-smoking-gun/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+Cato-at-liberty+%28Cato+at+Liberty%29
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It was inevitable with 60 crats. My Federal tax dollars are going to fund medicaid programs in states like Louisianna, Nebraska and who knows where else.
Why try to pay one's own bills or be a success when it is easier just to get on line and have others pay for all your bills, health care, employment, retirement, diasabilities, food stamps and eveything else?
And what is worse it is not even for Americans. It is for illegals and for all those who were born here from illegals. This has to be at least 20 if not more like 30 million people.
I have pts who cannot speak one word of English who could not have been in the US for even a few years and they walk into my office with Medicare cards. Why? Because there must be some loop hole that extends to them from their relatives who are citizens.
And we wonder why we are going broke? It ain't the bankers you Democrat f**ks!
***Sen. Ben Nelson to announce support for health-care bill
By Shailagh Murray and Lori Montgomery
Washington Post Staff Writer
Saturday, December 19, 2009; 10:55 AM
Sen. Ben Nelson (Neb.), the final Democratic holdout on health care, announced to his caucus Saturday morning that he would support the Senate reform bill, clearing the way for final passage by Christmas.
"We're there," said Sen. Kent Conrad (D-N.D.), as he headed into a special meeting to outline the deal.
Democratic leaders spent days trying to hammer out a deal with Nelson, and worked late Friday night with him on abortion coverage language that had proved the major stumbling block. Nelson also secured other favors for his home state.
Under the new abortion provisions, states can opt out of allowing plans to cover abortion in insurance exchanges the bill would set up to serve individuals who don't have employer coverage. Plus, enrollees in plans that do cover abortion procedures would pay for the coverage with separate checks - one for abortion, one for rest of health-care services.
Nelson secured full federal funding for his state to expand Medicaid coverage to all individuals below 133 percent of the federal poverty level. Other states must pay a small portion of the additional cost. He won concessions for qualifying nonprofit insurers and for Medigap providers from a new insurance tax. He also was able to roll back cuts to health savings accounts.
"I know this is hard for some of my colleagues to accept and I appreciate their right to disagree," Nelson told reporters at the Capitol, of the many changes made at his behest. "But I would not have voted for this bill without these provisions."
With Nelson on board, Senate Majority Leader Harry M. Reid unveiled the final version of a sweeping overhaul of the nation's health insurance system that would expand coverage to an additional 31 million Americans, coming closer to attaining the Democrats' long sought goal of universal medical coverage.
The package closely tracks the $848 billion measure Reid (D-Nev.) drafted this month, before he entered into negotiations aimed at winning the 60 votes he needs to avert a GOP filibuster, aides said. Since then, Reid has made numerous concessions to moderate Democrats, scrapping an effort to create a government-run insurance plan and beefing up prohibitions on spending federal funds for abortion coverage, a change demanded by the final holdout, Sen. Ben Nelson of Nebraska.
Instead of a public option, the final product would allow private firms for the first time to offer national insurance policies to all Americans, outside the jurisdiction of state regulations. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress.
Starting immediately, insurers would be prohibited from denying children coverage for pre-existing conditions. A complete ban on the practice would take effect in 2014, when the legislation seeks to create a network of state-based insurance exchanges, or marketplaces, where people who lack access to affordable coverage through an insurer can purchase policies.
Insurers competing in the exchanges would be required to justify rate increases, and those who jacked up prices unduly could be barred from the exchange. Reid's package also would give patients the right to appeal to an independent board if an insurer denies a medical claim. And all insurance companies would be required to spend at least 80 cents of every dollary they collect in premiums on delivering care to their customers.
Every American would be required to obtain coverage under the proposal, and employers would be required to pay a fine if they failed to offer affordable coverage and their workers sought federal subsidies to purchase insurance in the exchanges. Reid's package would offer additional assistance to the smallest businesses, however, increasing tax credits to purchase coverage by $12 billion over previous versions.
The overall cost of the package was not immediately available, but aides said it would be more than covered by cutting future Medicare spending and raising taxes in the health sector, including a 40 percent excise on the most expensive insurance policies. The package would reduce budget deficits by $130 billion by 2019, aides said, and by as much as $650 billion in the decade thereafter.
Reid officially filed the package early Saturday with plans to hold a first critical vote after midnight Sunday. Barring unexpected delays, Democrats were still hoping to push the package to final passage by Christmas Eve.****
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"And what is worse it is not even for Americans"
I meant to say it is not even *only* for Americans. Plenty of Americans certainly have their hands outstrected.
The *roles of people on the doles* is expanding exponentially thanks to the ONE and his merry widely spending clowns in the Congress and Senate.
Cicero's words, as posted by Crafty circa 50 BC certainly ring true today here in the US. Rome last over another 400 years. But will we?
I don't know. Trememdous damage has been done by the liberals. It may not be too late. Our multiple enemies overseas are laughing their brains out at what fools we are.
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I fear even with a major Tea Party type of a groundswell in the coming elections, deep lasting damage has been done. Without such a groundswell, I fear we ARE done.
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An e-conversation amongst some friends:
Crocodile Tears For Primary Care
The Top 10 Most Overblown Health Stories of the Past Decade
By Richard N. Fogoros, M.D., About.com Guide
Updated December 08, 2009
About.com Health's Disease and Condition content is reviewed by our Medical Review Board
We are in the midst of a contentious debate over the future of our healthcare system, in which the opposing parties find almost nothing in common. But there is one thing everybody agrees upon - Republicans and Democrats, Keynsians and Reaganites, Buckeyes and Wolverines alike. Namely, robust primary care medicine is the backbone of healthcare, and whatever else we may end up doing, we need to re-invigorate primary care and restore it to the position of central importance it deserves.
To the notion that primary care medicine is vitally important to American patients, DrRich says hooray. To the notion that anyone with authority in our healthcare system actually wants to fix primary care, however, DrRich says hooey.
The fact of the matter is that in recent years, our healthcare system has taken exquisite pains to make primary care a completely untenable proposition for American doctors. Consider the plight of the modern primary care physician (PCP):
Their pay is determined arbitrarily by Acts of Congress, not by what they’re worth to their patients or to the market, and indeed in this way PCPs have a lot in common with workers in the old Soviet collectives.
They are directed to “practice medicine” by guidelines handed down from on high; guidelines which, being forcibly based on what is called “evidence-based medicine,” necessarily address the average response of some large group of patients to the treatment being considered and do not allow much if any latitude for an individual patient’s needs; and which are often promulgated less to assure the excellent care of patients than to further the agenda of various interest groups, professional, governmental and otherwise.
They are limited to 7.5 minutes per "patient encounter," and the content of those 7.5 minutes is scripted in advance by Pay for Performance checklists, strictly limiting any exchanges between doctor and patient that do not meet the approved agenda.
Their every move must be carefully documented according to incomprehensible rules, on innumerable forms and documents, that confound patient care but that greatly further the convenience of healthcare accountants and other stone-witted bureaucrats.
They are expected to operate flawlessly under a system of federal rules, regulations and guidelines that cover hundreds of thousands of pages distributed in countless volumes that are never available in any readily accessible form, and if they fail to do so, they are guilty of the federal crime of healthcare fraud. Furthermore, the specific meanings of these rules, regulations and guidelines are not merely opaque and difficult to ascertain, but indeed they are fundamentally indeterminate. So, PCPs operate under a massive quantum cloud of rules as best they can, but their actual status (regarding healthcare fraud) is, like Schrodinger’s cat, fundamentally unknowable - until the “box is opened” (typically through criminal prosecution), whereupon the meaning of the rules is finally crystallized in a court of law, and doctors who had been practicing in good faith find that they have at least a 50- 50 chance (like the cat) of learning that they are actually professionally dead.
Worst of all, PCPs have been charged with the duty of covertly rationing their patients’ healthcare at the bedside, and they have been pressed to nullify the classic doctor-patient relationship, by the healthcare bureaucracy that determines their professional viability, by the United States Supreme Court, and by the bankrupt, new-age ethical precepts of their own profession.
The healthcare system has (intentionally, DrRich argues) rendered primary care medicine such a soul-wrenching, personally and professionally demeaning endeavor that it has pushed most PCPs beyond mere anger, frustration, or resignation. Most American PCPs over the age of 50 with any measurable degree of self-respect are desperately looking for a way to retire early, and the ones under 50 are looking for some feasible way to change careers. Current medical trainees have learned to avoid primary care in droves.
The idea that the central authorities of healthcare are going to cede back to PCPs any degree of professionalism or independent thought - when strictly controlling the behavior of PCPs is Job One in their effort to reduce costs, and when they've worked so hard to put the PCPs where they've now got them - is laughable.
The plan, DrRich believes, is to give PCPs a few perks - a small increase in their paltry pay, for instance - to entice them to not to quit just yet, while they "train up" a new class of professionals who eventually will take over the job of primary care from the physicians, and who (they think) will be more malleable and controllable than physicians ever could be. At the moment, nurse practitioners have been identified as a likely PCP replacement.
Indeed, the House healthcare reform bill (HR 3692, Section 1303) specifically enumerates nurse practitioners as members of the category "PCPs" (a term now defined as "primary care practitioner," and not "primary care physician"). So soon, nurses will be, by law, functionally equivalent to doctors practicing primary care.
DrRich happens to greatly admire nurses, counts some of them among the finest healthcare professionals he has known, and believes that nurses' commitment to doing what's best for patients is at least equivalent to physicians'. Furthermore, he is convinced that nurses can function just fine as primary care practitioners, as the central authorities have now fashioned that profession. To the degree that nurses will chafe less than doctors at the forced restrictions, they may even function better.
Indeed, DrRich's respect for nurses is so great that he predicts most of them will forego the opportunity to become PCPs for the same reason doctors are - doing this job as it is now laid out, they will find, is an insult to their professional integrity.
But whether the central planners' vision comes to pass or not, DrRich finds their current lamentations for the plight of PCPs (a plight they engineered) to be just a tad disingenuous, and certainly overblown.
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I was talking to a urologist from an academic center in St. Louis whose wife is an internist. He stated that his wife made $90000 and his wife's NP made $95000 and that the only way that most of the primary care physicians get by in the academic centers is by being the spouse of the specialty physicians. One of the many problems with our system is that instead of insuring that everyone has access to a minimum level of care, at least for the Medicare population, the make sure that no one has access to the maximum level of care. For a physician to accept Medicare payments as a non-participating physician, they are limited to billing 115% of the Medicare fee schedule, which makes it hardly worth the trouble and added financial risk that the payment from Medicare which will go to the patient in that situation doesn't get passed back to the physician but covers some other essential needs for the patient like cigarettes and cellphone service. In order to completely break from the Medicare system and work on a cash basis, a physician cannot even see Medicare patients for 2 years. The bar is set so high for withdrawal that it is difficult to make a living while you are waiting for the 2 years to pass. You also have to have a fairly well to do clientele to make that scheme work. The free market has been stripped from the healthcare system. You can be the very best of your specialty but get paid no more than some slub who barely made it out of training.
John
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"""The free market has been stripped from the healthcare system"""
Healthcare has been surviving - for decades - under a price control regime. Government pricing of medical services is hiding under the pretense of being based on a "scientific" approach, but that's bullsh*t. In reality it's arbitrary, decided by a few bureaucrats sitting on a committee. Over time this, of course, resulted in huge dislocations.
Real reform would be a combination of tort reform (which would be a good first step in a fight against the culture of defensive medicine), AND massive deregulation. Instead, we are due for even more pervasive regulation.
As far as Primary Care is concerned, I think that over the next few years we will experience a shortage which will be severe beyond anyone's expectations. Think about it -- Traditionally, aging Docs would continue working in their practice well into their 60's, 70's and even 80's. They would slow down, work part time, fewer hours, BUT - they would continue working. The way things stand today, it is hard to make a living in private practice even when one works full blast. Forget about part time low volume work. All those older baby boomer docs will have no choice but to retire - in large numbers.
The way things are going, I wouldn't be surprised if the government will use the shortages as an exuse for a total takeover. Collectivist solutions appear to be shockingly acceptable and even popular... these days.
Ol' Fred Hayek must be turning in his grave.
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"The free market has been stripped from the healthcare system."
I am sure there exist individual exceptions, many here included, but doctors have no one to blame but themselves for this turn of affairs. Really, if true, it could not happen to a more deserving profession. Their greed, insensitivity, and rude and imperious treatment of their patients (read: customers) begged to be countered.
And now it has, or is. Good.
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The Anti Nationalized Health Care Resource
The problem with the U.S. Health Care system is a combination of third party payments, government regulations and an artificial limited supply of doctors. Since the average person does not directly pay for their health care they do not care about the costs. Medical insurance encourages unnecessary procedures and waste due to the illusion of it being "free" via a co-pay. In a true free market, direct price competition would drive down prices and encourage others to enter the market, further reducing costs. The problem is government regulation and organizations such as the AMA (American Medical Association) have created an artificial scarcity of doctors, limiting the supply. This is done by limiting the number of medical schools, medical licenses and increasing requirements. Thus the excessive demand cannot be met by normal market forces. Most people are well aware that a limited supply of a good or service increases it's value (cost). Few are aware that attempting to restrict a good or service's price (price controls) limits it's supply causing shortages. It is thus impossible for government controls to either increase the supply of medical care or lower it's price. Government can only "fix" the U.S. health care system by getting out of the way.
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D.
If that is truly the way you feel then you must have had some bad doctors, but one of the reasons that physicians are in the place they are in is because they generally are not greedy and are sensitive to their patient's needs. We have been more interested in our patient's welfare than the economics of medicine. One of the dilemma's in my practice is whether to continue seeing Medicaid and Indigent patients in our office. We have always done so because there was enough fat in the system to soften the blow even though we knew we were taking a loss, but if the Medicare cuts come through then we will probably have to stop seeing those patients. We are the only game in town and they will have to travel 50 miles to the state hospital for care even though they as a group are the least likely to be able to afford transportation. In my experience, at least in my town, the rude, greedy, insensitive physician is the exception as opposed to the rule. I am sorry that you have become so jaded against my profession.
J.
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Dr. Rich is dead on.
Primary care physicians will die out and be replaced completely by nurses in a decade.
Already we are hearing not "consult your doctor" but consult your "health care provider".
What you will see is specialists using their extra dollars hiring nurse practitioners and physician assistents and taking all the primary care under their wing because they can make dollars off it. Esp. so when their own reimbursements go down.
Patients will not see doctors for basic care - they will be treated by nurses.
Clayton Christensian pointed this out ten years ago with his disruption theories. Of course he is from Harvard where all this is stuff is being seeded from anyway.
Primary care will not be strengthened but will be "dumbed down". They will give prmary doctors a laughable 1-2% raise like that is going to do anything and all the while increase taxes from some other end to get the money and back at an even higher rate.
PCPs and doctors in general are already controlled and are de facto government employees - just with NO benefits. Only edicts.
That said I am not sure why anyone would want to become a doctor at all and not just a primary care doctor.
Specialists will tell you medicine is not a pleasure anymore.
As for "even with a major Tea Party type of a groundswell".
I fear this will not happen. I am not sure Obama is going down in polls so much because of his socialist agenda. I think some of his drop in the polls is due to liberals who are annoyed he is NOT socialist enough.
It was a pleasure to have a woman who was born in Chechnia in the office the other day giving me cookies made there.
She said this is still the greatest country in the world. I feel many of the Eastern Europeans do feel this way. It seemed when I was growing up this is what I would usually hear. How could one not feel proud of one's country? Now we have a President and government in general that has an intense visceral dislike of this country.
I am not sure about the Asians and certainly I question many of the Latinos who come here and vote for handouts in droves. OTOH there are many Latinos in the military which make me proud and grateful of them. Some of the Africans I have as patients are hard working. If I see one more unmarried young mother who states everyone should get health care in this country.....the government should be providing it!!!!
The bottom line I guess is if they can come here and play a system that will give them handouts and benefits paid for by taxpayers they figure why not.
Only Eastern Europeans who were previously under totaltarism (sp?) seem to have the work ethic without the outstretched hand. The Indians and Chinese have work ethic but also learn to play the system.
Just my anecdotal take.
Of course some would immediately claim I am a bigot and pig for even stating such observations.
How dare I state what I see?
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Politics: I am amazed that not one democrat senator from any of the other 49 states has enough backbone to stand up to the special rewards offered to Nebraska to purchase Ben Nelson's vote, to Louisiana to purchase Mary Landeau's vote or to the mystery state that will receive a free hospital on the federal taxpayers' dime.
Legal issue: I will also be amazed if a court can twist original meaning of the constitution far enough to uphold special treatment of states in the legislation to buy votes can somehow be considered to be 'equal treatment under the law'.
Voter fraud: The ACORN takeover of Mn Secretary of State and Minneapolis vote count control provided the 60th vote with uneven counting standards applied to heavily liberal voting precincts. Who says crime doesn't pay?
Even if there is a major political shift and Dems lose both the house and senate, almost impossible, it is still impossible to repeal legislation without a veto-proof majority.
Whatever happened to the concept in law that one congress should not have the power to bind future congresses. We deserve these liberal policies, marxism, socialism, statism, released terrorists, you name it for these 2 years. Then a new congress should come in and pass news laws, funding etc. based on THE WILL OF THE PEOPLE.
60% oppose this legislation. 60 senators voted for it. I have not seen numbers like that since Chavez exit polls showed him losing 40-60 and sure enough he 'won' by 60-40.
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"Voter fraud: The ACORN takeover of Mn Secretary of State and Minneapolis vote count control provided the 60th vote with uneven counting standards applied to heavily liberal voting precincts."
Doug, not that it matters at this point but do you think Coleman was robbed of the election?
The msm of course is dead silent on this issue.
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I certainly suspect so, but if anyone wants to continue the conversation, please take it over to the relevant thread.
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Change Nobody Believes In
A bill so reckless that it has to be rammed through on a partisan vote on Christmas eve.
And tidings of comfort and joy from Harry Reid too. The Senate Majority Leader has decided that the last few days before Christmas are the opportune moment for a narrow majority of Democrats to stuff ObamaCare through the Senate to meet an arbitrary White House deadline. Barring some extraordinary reversal, it now seems as if they have the 60 votes they need to jump off this cliff, with one-seventh of the economy in tow.
Mr. Obama promised a new era of transparent good government, yet on Saturday morning Mr. Reid threw out the 2,100-page bill that the world's greatest deliberative body spent just 17 days debating and replaced it with a new "manager's amendment" that was stapled together in covert partisan negotiations. Democrats are barely even bothering to pretend to care what's in it, not that any Senator had the chance to digest it in the 38 hours before the first cloture vote at 1 a.m. this morning. After procedural motions that allow for no amendments, the final vote could come at 9 p.m. on December 24.
Even in World War I there was a Christmas truce.
The rushed, secretive way that a bill this destructive and unpopular is being forced on the country shows that "reform" has devolved into the raw exercise of political power for the single purpose of permanently expanding the American entitlement state. An increasing roll of leaders in health care and business are looking on aghast at a bill that is so large and convoluted that no one can truly understand it, as Finance Chairman Max Baucus admitted on the floor last week. The only goal is to ram it into law while the political window is still open, and clean up the mess later.
***
• Health costs. From the outset, the White House's core claim was that reform would reduce health costs for individuals and businesses, and they're sticking to that story. "Anyone who says otherwise simply hasn't read the bills," Mr. Obama said over the weekend. This is so utterly disingenuous that we doubt the President really believes it.
The best and most rigorous cost analysis was recently released by the insurer WellPoint, which mined its actuarial data in various regional markets to model the Senate bill. WellPoint found that a healthy 25-year-old in Milwaukee buying coverage on the individual market will see his costs rise by 178%. A small business based in Richmond with eight employees in average health will see a 23% increase. Insurance costs for a 40-year-old family with two kids living in Indianapolis will pay 106% more. And on and on.
These increases are solely the result of ObamaCare—above and far beyond the status quo—because its strict restrictions on underwriting and risk-pooling would distort insurance markets. All but a handful of states have rejected regulations like "community rating" because they encourage younger and healthier buyers to wait until they need expensive care, increasing costs for everyone. Benefits and pricing will now be determined by politics.
As for the White House's line about cutting costs by eliminating supposed "waste," even Victor Fuchs, an eminent economist generally supportive of ObamaCare, warned last week that these political theories are overly simplistic. "The oft-heard promise 'we will find out what works and what does not' scarcely does justice to the complexity of medical practice," the Stanford professor wrote.
• Steep declines in choice and quality. This is all of a piece with the hubris of an Administration that thinks it can substitute government planning for market forces in determining where the $33 trillion the U.S. will spend on medicine over the next decade should go.
This centralized system means above all fewer choices; what works for the political class must work for everyone. With formerly private insurers converted into public utilities, for instance, they'll inevitably be banned from selling products like health savings accounts that encourage more cost-conscious decisions.
Unnoticed by the press corps, the Congressional Budget Office argued recently that the Senate bill would so "substantially reduce flexibility in terms of the types, prices, and number of private sellers of health insurance" that companies like WellPoint might need to "be considered part of the federal budget."
With so large a chunk of the economy and medical practice itself in Washington's hands, quality will decline. Ultimately, "our capacity to innovate and develop new therapies would suffer most of all," as Harvard Medical School Dean Jeffrey Flier recently wrote in our pages. Take the $2 billion annual tax—rising to $3 billion in 2018—that will be leveled against medical device makers, among the most innovative U.S. industries. Democrats believe that more advanced health technologies like MRI machines and drug-coated stents are driving costs too high, though patients and their physicians might disagree.
"The Senate isn't hearing those of us who are closest to the patient and work in the system every day," Brent Eastman, the chairman of the American College of Surgeons, said in a statement for his organization and 18 other speciality societies opposing ObamaCare. For no other reason than ideological animus, doctor-owned hospitals will face harsh new limits on their growth and who they're allowed to treat. Physician Hospitals of America says that ObamaCare will "destroy over 200 of America's best and safest hospitals."
• Blowing up the federal fisc. Even though Medicare's unfunded liabilities are already about 2.6 times larger than the entire U.S. economy in 2008, Democrats are crowing that ObamaCare will cost "only" $871 billion over the next decade while fantastically reducing the deficit by $132 billion, according to CBO.
Yet some 98% of the total cost comes after 2014—remind us why there must absolutely be a vote this week—and most of the taxes start in 2010. That includes the payroll tax increase for individuals earning more than $200,000 that rose to 0.9 from 0.5 percentage points in Mr. Reid's final machinations. Job creation, here we come.
Other deceptions include a new entitlement for long-term care that starts collecting premiums tomorrow but doesn't start paying benefits until late in the decade. But the worst is not accounting for a formula that automatically slashes Medicare payments to doctors by 21.5% next year and deeper after that. Everyone knows the payment cuts won't happen but they remain in the bill to make the cost look lower. The American Medical Association's priority was eliminating this "sustainable growth rate" but all they got in return for their year of ObamaCare cheerleading was a two-month patch snuck into the defense bill that passed over the weekend.
The truth is that no one really knows how much ObamaCare will cost because its assumptions on paper are so unrealistic. To hide the cost increases created by other parts of the bill and transfer them onto the federal balance sheet, the Senate sets up government-run "exchanges" that will subsidize insurance for those earning up to 400% of the poverty level, or $96,000 for a family of four in 2016. Supposedly they would only be offered to those whose employers don't provide insurance or work for small businesses.
As Eugene Steuerle of the left-leaning Urban Institute points out, this system would treat two workers with the same total compensation—whatever the mix of cash wages and benefits—very differently. Under the Senate bill, someone who earned $42,000 would get $5,749 from the current tax exclusion for employer-sponsored coverage but $12,750 in the exchange. A worker making $60,000 would get $8,310 in the exchanges but only $3,758 in the current system.
For this reason Mr. Steuerle concludes that the Senate bill is not just a new health system but also "a new welfare and tax system" that will warp the labor market. Given the incentives of these two-tier subsidies, employers with large numbers of lower-wage workers like Wal-Mart may well convert them into "contractors" or do more outsourcing. As more and more people flood into "free" health care, taxpayer costs will explode.
• Political intimidation. The experts who have pointed out such complications have been ignored or dismissed as "ideologues" by the White House. Those parts of the health-care industry that couldn't be bribed outright, like Big Pharma, were coerced into acceding to this agenda. The White House was able to, er, persuade the likes of the AMA and the hospital lobbies because the federal government will control 55% of total U.S. health spending under ObamaCare, according to the Administration's own Medicare actuaries.
Others got hush money, namely Nebraska's Ben Nelson. Even liberal Governors have been howling for months about ObamaCare's unfunded spending mandates: Other budget priorities like education will be crowded out when about 21% of the U.S. population is on Medicaid, the joint state-federal program intended for the poor. Nebraska Governor Dave Heineman calculates that ObamaCare will result in $2.5 billion in new costs for his state that "will be passed on to citizens through direct or indirect taxes and fees," as he put it in a letter to his state's junior Senator.
So in addition to abortion restrictions, Mr. Nelson won the concession that Congress will pay for 100% of Nebraska Medicaid expansions into perpetuity. His capitulation ought to cost him his political career, but more to the point, what about the other states that don't have a Senator who's the 60th vote for ObamaCare?
***
"After a nearly century-long struggle we are on the cusp of making health-care reform a reality in the United States of America," Mr. Obama said on Saturday. He's forced to claim the mandate of "history" because he can't claim the mandate of voters. Some 51% of the public is now opposed, according to National Journal's composite of all health polling. The more people know about ObamaCare, the more unpopular it becomes.
The tragedy is that Mr. Obama inherited a consensus that the health-care status quo needs serious reform, and a popular President might have crafted a durable compromise that blended the best ideas from both parties. A more honest and more thoughtful approach might have even done some good. But as Mr. Obama suggested, the Democratic old guard sees this plan as the culmination of 20th-century liberalism.
So instead we have this vast expansion of federal control. Never in our memory has so unpopular a bill been on the verge of passing Congress, never has social and economic legislation of this magnitude been forced through on a purely partisan vote, and never has a party exhibited more sheer political willfulness that is reckless even for Washington or had more warning about the consequences of its actions.
These 60 Democrats are creating a future of epic increases in spending, taxes and command-and-control regulation, in which bureaucracy trumps innovation and transfer payments are more important than private investment and individual decisions. In short, the Obama Democrats have chosen change nobody believes in—outside of themselves—and when it passes America will be paying for it for decades to come.
http://online.wsj.com/article/SB10001424052748704398304574598130440164954.html
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How does one handle this debating method?
http://www.youtube.com/watch?v=gNfG8gwamKM&feature=player_embedded
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"How does one handle this debating method?"
Admit it. They are better at getting their message out. Think what they could do with a better message.
Did I really hear them all say at the end that they pledge allegiance to the government??
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Upon reflection, I am going to take this over to "The Way Forward" thread.
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http://money.cnn.com/2009/12/23/news/economy/healthcare_doctors_in_prison/index.htm
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By BOB HERBERT
Published: December 28, 2009
There is a middle-class tax time bomb ticking in the Senate’s version of President Obama’s effort to reform health care.
Recent developments on the struggle over health care with background, analysis, timelines and earlier events from NYTimes.com and Google.
The bill that passed the Senate with such fanfare on Christmas Eve would impose a confiscatory 40 percent excise tax on so-called Cadillac health plans, which are popularly viewed as over-the-top plans held only by the very wealthy. In fact, it’s a tax that in a few years will hammer millions of middle-class policyholders, forcing them to scale back their access to medical care.
Which is exactly what the tax is designed to do.
The tax would kick in on plans exceeding $23,000 annually for family coverage and $8,500 for individuals, starting in 2013. In the first year it would affect relatively few people in the middle class. But because of the steadily rising costs of health care in the U.S., more and more plans would reach the taxation threshold each year.
Within three years of its implementation, according to the Congressional Budget Office, the tax would apply to nearly 20 percent of all workers with employer-provided health coverage in the country, affecting some 31 million people. Within six years, according to Congress’s Joint Committee on Taxation, the tax would reach a fifth of all households earning between $50,000 and $75,000 annually. Those families can hardly be considered very wealthy.
Proponents say the tax will raise nearly $150 billion over 10 years, but there’s a catch. It’s not expected to raise this money directly. The dirty little secret behind this onerous tax is that no one expects very many people to pay it. The idea is that rather than fork over 40 percent in taxes on the amount by which policies exceed the threshold, employers (and individuals who purchase health insurance on their own) will have little choice but to ratchet down the quality of their health plans.
These lower-value plans would have higher out-of-pocket costs, thus increasing the very things that are so maddening to so many policyholders right now: higher and higher co-payments, soaring deductibles and so forth. Some of the benefits of higher-end policies can be expected in many cases to go by the boards: dental and vision care, for example, and expensive mental health coverage.
Proponents say this is a terrific way to hold down health care costs. If policyholders have to pay more out of their own pockets, they will be more careful — that is to say, more reluctant — to access health services. On the other hand, people with very serious illnesses will be saddled with much higher out-of-pocket costs. And a reluctance to seek treatment for something that might seem relatively minor at first could well have terrible (and terribly expensive) consequences in the long run.
If even the plan’s proponents do not expect policyholders to pay the tax, how will it raise $150 billion in a decade? Great question.
We all remember learning in school about the suspension of disbelief. This part of the Senate’s health benefits taxation scheme requires a monumental suspension of disbelief. According to the Joint Committee on Taxation, less than 18 percent of the revenue will come from the tax itself. The rest of the $150 billion, more than 82 percent of it, will come from the income taxes paid by workers who have been given pay raises by employers who will have voluntarily handed over the money they saved by offering their employees less valuable health insurance plans.
Can you believe it?
I asked Richard Trumka, president of the A.F.L.-C.I.O., about this. (Labor unions are outraged at the very thought of a health benefits tax.) I had to wait for him to stop laughing to get his answer. “If you believe that,” he said, “I have some oceanfront property in southwestern Pennsylvania that I will sell you at a great price.”
A survey of business executives by Mercer, a human resources consulting firm, found that only 16 percent of respondents said they would convert the savings from a reduction in health benefits into higher wages for employees. Yet proponents of the tax are holding steadfast to the belief that nearly all would do so.
“In the real world, companies cut costs and they pocket the money,” said Larry Cohen, president of the Communications Workers of America and a leader of the opposition to the tax. “Executives tell the shareholders: ‘Hey, higher profits without any revenue growth. Great!’ ”
The tax on health benefits is being sold to the public dishonestly as something that will affect only the rich, and it makes a mockery of President Obama’s repeated pledge that if you like the health coverage you have now, you can keep it.
Those who believe this is a good idea should at least have the courage to be straight about it with the American people.
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Acouple of asides: Despite the deafening silence here at my attempt to get at the right and wrong of abortion, it may be the (side) issue that brings down this horrendous, limited government ending legislation.
Only 17% of Nebraskans support the special deal to buy Ben Nelson's vote. That question should push-polled to death across the rest of the states and publicized nationally: Do you know of the special deal where 49 states pay expenses for one state too buy their spineless Democrat's vote on health care and do you favor or oppose this form of legislated unequal protection under the law??
Now the (un)constitutionality of the individual mandate: Obviously there are liberal scholars who will say it is fine or they wouldn't be able to write and support any of these liberal policies that violate the founding tenets of our republic. They can make lame and pretend arguments such as that we already require auto insurance, but how do they hold water compared to these:
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http://www.heritage.org/Research/LegalIssues/lm0049.cfm
(This piece is long so I will just quote one section. Please follow link to read in its entirety!)
Personal Health Insurance v. Drivers' Auto Liability Insurance
Some have argued that a federal mandate requiring all citizens to obtain health insurance is no different than state laws that require licensed drivers to carry proof of auto insurance when driving on the public roads.[37] But there are several important constitutional differences that render the comparison decidedly inapposite.
First, there is a fundamental constitutional difference between the inherent police powers of the states and the enumerated powers of the national government. A bedrock principal of the American republic is that, whereas states enjoy plenary police powers (albeit subject to various constitutional limits), the national government is limited to the enumerated powers "herein granted" to it by the Constitution. Thus, states may craft numerous regulations for the protection of their citizens which are beyond Congress's power. In striking down the federal Gun-Free School Zones Act, the Lopez Court acknowledged that the states already enforced similar criminal laws even though Congress could not. Likewise, when it struck down the federal tort action for rape in Morrison,the Court did not question state laws allowing similar causes of action. State laws regulating the level of insurance that licensed state drivers must have to operate on state roads stem from a completely different source of constitutional authority--a state's police power--than Congress can invoke. Congress has never been thought to have such power, and the Supreme Court has always denied that such plenary federal power exists.
Second, automobile insurance requirements impose a condition on the voluntary activity of driving; a health insurance mandate imposes a condition on life itself. States do not require non-drivers, including passengers in cars with potentially bad drivers, to buy auto insurance liability policies--even though such a requirement undoubtedly would lower the auto insurance premiums for those who do drive. The auto insurance requirement is linked to driving and to the possibility that bad driving may cause injuries to others, including passengers in the driver's car, not to those who benefit from roads generally.
Third, state auto insurance requirements are limited to those who drive on public roads. The public roads are mostly constructed, owned, and maintained by the government, or in some other cases, are built on public rights of way or through the use of eminent domain. What a state (or private citizen) may require of someone using its property is wholly different than what it may do to control their purely private behavior. Driving on government roads is a privilege--one easily distinguished from merely living. For those who choose to drive on public roads, the state can establish terms and conditions reasonably related to preventing injury to others. States may issue drivers licenses, establish and enforce traffic laws, and may require that all those driving on their roads be adequately insured to compensate others for their injuries. These same rules do not extend to driving on private roads or property. Indeed, one may drive vehicles on private property without ever obtaining a state driver's license.
Finally, states require drivers to maintain auto insurance only to cover injuries to others.[38] The mandate does not require drivers to insure themselves or their property against injury or damage. Thus, the auto insurance requirement covers the dangers and liabilities posed by drivers to third parties only, even though many of those same risks apply to the driver himself. The auto insurance mandate seeks to avoid the all-too-common problem of an uninsured and insolvent motorist severely injuring a third party on a public road, leaving the injured party to cover her own medical expenses. But the driver remains free to assume the risk that she will injure herself, even if she is insolvent to pay for her own expenses. Thus, states only seek to ensure that drivers can pay the equivalent of tort judgments for their wrongful conduct to others on state roads; they do not tell drivers how to take care of themselves.
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ObamaCare: 'New frontier in pork barrel politics'
by Rowan Scarborough (more by this author)
Posted 12/30/2009 ET
What was championed by Democrats a year ago as a high-minded endeavor to reform health care has instead descended into a grotesque piece of legislation larded with pork, payoffs, back room deals and huge tax increases, say Republicans and experts on Congress.
"We have former members of Congress in jail and a lobbyist in jail for this sort of behavior," said David Williams, who has been tracking pork-barrel spending for 15 years for Citizens Against Government Waste. "People are really fed up with it."
The close-door deal making is just getting revved up. House and Senate leaders will hold private negotiations next month to reconcile their bills. Envious of the deals Democratic senators extracted from Senate Majority Leader Harry Reid, House members are sure to demand their share of pork favors in exchange for floor votes.
"The wonderful conference committee where a lot of bad things happen," is how Williams described the upcoming process to HUMAN EVENTS. "We never see any good things happen in a conference committee. It's always bad things. We're just putting up the wood paneling getting ready for the January hurricane that is the conference committee because we just suspect it's going to be a doozy."
Reid, the bill's behind-the-scenes architect, used Medicare and Medicaid payments like just another round of pork projects, called earmarks. He handed out a hundred million dollars here and a few hundred million dollars there to secure 60 votes needed for cloture to vote on his bill.
"It's hard to ignore the billions of dollars this is a giveaway for," Williams said. "On one hand, even a $100,000 earmark to get reelected has a huge corrupting influence on the process. But, oh my goodness, here are billions of dollars that were traded like monopoly money is just mind boggling."
The Senate version, and its more than 2,000 pages, is so studded in special favors to various states that Washington watchdogs groups, such as Williams' pork fighters, are still mining new gems a weeks after Reid wrote the $400 billion in tax increases and $2.5 trillion in spending over 10 years.
"Unfortunately, Congress is getting smarter," Williams said. "It's like when a cock roach builds up an immunity to bug spray. It figures out how to survive when it gets sprayed with that stuff. What congressmen do now is they will change a formula now for a state. So, it's not the teapot museum. It's not the 'bridge to no where.' But it's still these spending issues that are driving people in this country insane. They are getting away from the traditional silly projects. There's still pork in the appropriations bill. Don't get me wrong. But this is kind of the new frontier in pork barrel politics."
The magnitude of Reid's wheeling-dealing became so immense as his bill passed Christmas Eve on a party-line vote that some senators abandoned polite debate.
“Democrats have truly hit the bottom on their reckless pursuit of a government takeover of health care," said Sen. Jim DeMint, South Carolina Republican. "The Democrat majority just voted to retain the culture of corruption in Congress. Just two years ago, Democrats bragged about draining the swamp, but now they’re endorsing political bribery. This is Washington at its worst.”
Over in the House, GOP leader John Boehner declared, “Senate Democrats have sunk to plenty of new lows to jam through this government takeover of health care, but putting their votes on the auction block tops them all.”
The Democrats' legislative horse-trades are in addition to a whole pot of goodies President Obama handed out to doctors, hospitals, advocacy groups and drug makers to ensure they worked on behalf of a totally partisan bill.
Reid's plan provides money to the uninsured many of whom do not want health coverage by raiding Medicare. It cuts a half-trillion dollars in payments to certain providers.
You would think the most prominent voice for seniors in Washington The Association for the Advancement of Retired Persons would be up in arms. But it is silent. Moreover, it actually supports Obama-care.
Why? Republicans say it's because the bill will force more seniors to buy supplemental insurance. And AARP is a big provider of so-called "Medigap" plans, pulling in more than a half-billion dollars in 2008.
"Shame on AARP," Sen. John McCain, Arizona Republican, said on the Senate floor. "Take your AARP card, cut it in half and send it back. They've betrayed you."
Among the Reid handouts, the most infamous are hundreds of millions of dollars on Medicaid payments for the votes of Sen. Mary Landrieu of Louisiana and Ben Nelson of Nebraska. The payments cover the state cost of Medicaid, which will go up under HarryCare. Other states will likely be forced to raise taxes to meet new enrollee demands.
Then we learned that Sen. Chris Dodd, who is in a tough reelection battle in Connecticut, received another big Reid favor: $100 million for a new hospital.
The deals have become known as the "Louisiana Purchase" and "Cornhusker Kickback." To lump the vote-buying process under one banner, someone coined, "Cash for Cloture," a reference to the Obama subsidy for car buyers.
Now, more deals are surfacing. Williams said his group will likely issue a report once it finishes combing through over 2,000 pages of taxes, mandates, government panels, earmarked projects and federal aid.
Other Reid deals:
• A tax break for Mutual of Omaha Insurance Company (Nelson).
• Federal money for ACORN, the left-wing activist group connected to phony voter registration lists (Sen. Roland Burris of Illinois).
• Medicaid payments of $600 million for Vermont. (Patrick Leahy).
• More than $10 billion for government health centers (Bernie Sanders of Vermont).
• Florida seniors get to keep extra Medicare benefits that the elderly in other states will lose (Bill Nelson).
• Higher Medicare payments for hospitals in North Dakota (Byron Dorgan and Kent Conrad).
• Extend Medicare benefits to a small group of miners in Montana sickened by asbestos (Max Baucus).
AARP is not the only organization who stands to reap more revenue under ObamaCare. The White House enticed drug companies (Big Pharma) with all sorts of favors. In fact, the industry is go gaga over the House and Senate bills it is spending well over $100 million on media ads.
(Some of that money has flowed to two Chicago political/media companies founded by David Axelrod, Obama's closest White House adviser. Axelrod sold his interest to partners, and continues to receive the $2 million buyout in yearly installments. He has an interest in his former firm staying afloat.)
John Berlau of the Competitive Enterprise Institute is writing about one of the many favors the legislation gives drug firms. It has do with Flexible Spending Accounts (FSA) and Health Savings Accounts (FSA). People can contribute pre-tax dollars to both and use the money to buy drugs. But under the pending bills, only prescription drugs not over-the-counter medicines, as is the case now can be bought with FSA or FSA money, Berlau told Human Events.
"I think this provision itself, in addition to the harm it does to consumers, is an example of egregious pork for Big Pharma," Berlau said. "By taking away the tax advantages for over-the-counter drugs in FSAs and HSAs, but leaving them in there for prescription medicine, this law encourages folks to go to prescription drugs when they're sick even if OCT drugs will do the trick -- a huge gift to pharmaceutical firms that make expensive prescription drug that will raise health care cost by the billions over time."
And for those who say HarryCare is simply good old fashion horse-trading, critics say the sheer magnitude of the voting buying for what was supposed to be largely a policy bill puts it in class by itself. Berlau said, for example, that Congress has never agreed to pay a state's Medicaid bill in perpetuity, as it did for Sen. Ben Nelson.
Robert E. Moffit, a health care analyst at the Heritage Foundation, said there is an overriding issue that makes HarryCare pork unique.
Reid is handing out money and projects in a bill that affects 300 million Americans, as opposed to a yearly appropriations bill that hands out local bridge and highway projects. Thus, giving various states a special break on paying for Medicaid, means taxpayers elsewhere will have to make up the difference.
"I cannot recall a time where we had anything like this ever happen," said Moffit, a longtime Washington hand. "This transaction is being done to affected 300 million Americans. In other words, the project back home just doesn't affect the people back home. It's to further an agenda that affects every body in every state of the union."
To lawmakers, he said, "what's happening back home, I really don't care that they don't like what I'm doing. I'm going to do it anyway. And in order to get it done, they are doing this horse-trading, trading away literally hundreds of millions of dollars in taxpayer dollars in these payoffs to Louisiana and Nebraska and other states in broad day light. It's never been so blatant before for a lot of people and that's why people are referring to this as legalized corruption and bribery in daylight."
Moffit said the dealing may produce a backlash. Nelson's poll numbers have plummeted in Nebraska, according to a Rasmussen survey.
"The sense of fair play and the sensibilities of ordinary Americans are deeply offended by all this," he said.
Mr. Scarborough is a national security writer who has written books on Donald Rumsfeld and the CIA, including the New York Times bestseller Rumsfeld's War.
http://www.humanevents.com/article.php?id=35027
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Doug,
A topic close to your heart.
I think you can see in full bloom the liberal bias of a frequent contributer to NEJM.
Notice he cannot just give us the legal perspective but he has to shove at the end his true political bias.
Many of the public health people from the giant liberal "think tanks" of liberal academia are the true architects of this huge health care legislation that began 16 years ago and lied dorment while awaiting the right political moment to re-emerge its cancerous (IMHO) metastesis. Liberals just cannot help themselves, they seem to have some disease that drives them to tell the rest of us what we ought to do.
Notice, not one comment about poor women should not be getting pregnant to start with just that it is their right to have taxpayers pay for their abortions.
Anyway it is people like this, behind the scenes who crafted the legislation. I wonder how much this "humanitarian" makes?
***from the publishers of
the New England
Journal of Medicine
Abortion Politics and Health Insurance Reform
Posted by NEJM • December 2nd, 2009 • Printer-friendly
George J. Annas, J.D., M.P.H.
President Barack Obama has made it clear that he does not want abortion politics to sabotage health care reform. In his September 10 speech about health care to a joint session of Congress, he said, “Under our plan, no federal dollars will be used to fund abortions.” Nonetheless, the centrality of abortion in U.S. politics makes it likely that abortion funding will play a major role in determining whether there is any health care reform law at all. The current abortion controversy concerns the Stupak amendment, whose presence or absence from the final bill may determine the votes of enough members of Congress to determine the outcome. This makes it critical to understand both this amendment and the current state of the law on federal funding for abortion.
The Stupak amendment provides that “No funds authorized or appropriated by this Act . . . may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself, or unless the pregnancy is the result of rape or incest” (italics added).
The House passed this amendment by a vote of 240 to 194, with 64 Democrats voting in favor (the House health care bill itself passed 220 to 215). Many have blamed the Catholic bishops who lobbied fervently for passage of the Stupak amendment. More influential, however, has been the previously secret fundamentalist Christian political leadership group known variously as the Family or the Fellowship, which includes among its members both of the amendment’s main sponsors, Bart Stupak (D-MI) and Joe Pitts (R-PA).1
The Stupak amendment has been defended as merely continuing the practice created by the Hyde amendment. That amendment, named after the late Congressman Henry Hyde (R-IL), which has been attached to every Health and Human Services Appropriations Act passed since 1976 (and has been added to appropriations legislation for the Defense Department, the Indian Health Service, and federal employees’ health insurance plans) prohibits the use of federal funding for “any abortion” or for any “health benefits coverage that includes abortion,” unless the pregnancy is the result of “rape or incest” or “would, as certified by a physician, place the woman in danger of death unless an abortion is performed.” Under the Hyde amendment, states may use their own funds to finance abortion services through their Medicaid programs, and 17 states currently do so.
The U.S. Supreme Court has ruled on the government funding question twice. The first case, in 1977, involved a Connecticut regulation that limited state Medicaid funding to “medically necessary” abortions, thus excluding those not necessary to preserve a woman’s life or health. The Court ruled that women have a constitutional right to choose to have an abortion, but the state has no obligation to pay for the exercise of this right and may constitutionally encourage women to continue their pregnancies to term by providing funding for childbirth and not abortion. The state may not constitutionally create obstacles to abortion, but it has no obligation to remove obstacles, such as poverty, that are not of its own making.2
Three years after the Connecticut decision, the Court upheld the Hyde amendment, which prohibited federal funding for medically necessary abortions.3 Under this ruling, even low-income women who would have devastating health outcomes if they continued a pregnancy could not have an abortion paid for by Medicaid. In both cases, the Court ruled that the government could make “a value judgment favoring childbirth over abortion and [implement] that judgment by the allocation of public funds.” There is no constitutional requirement for the federal government to fund any abortion. Federal funding is a political question to be addressed by Congress.
The current version of the U.S. Senate bill on health care reform, which Majority Leader Harry Reid (D-NV) created by blending bills from two committees, does not contain the Stupak amendment but specifically excludes federal funding for abortions as prohibited by any federal law (including the Hyde amendment) that was in effect “6 months before the beginning of the plan year involved.” States must also ensure that “no federal funds pay or defray the cost” of abortion services in new health plans that cover abortion. Moreover, states are required to offer at least two plans in the proposed health insurance exchanges (where most people who currently lack coverage will purchase insurance): one that covers abortion services and one that does not. Nonfederal funds for abortion coverage in any plan must be segregated, and payment must be made separately, in an amount estimated by the secretary of health and human services, to cover this benefit.
The primary promoters of the Stupak amendment in the Senate, Orrin Hatch (R-UT) and Sam Brownback (R-KS), who is also a member of the Family,1 would not vote for a health care reform bill even if it outlawed federal payments for all abortions because both men object to more government involvement in health care. Since 51 votes would be required for the Senate to adopt the amendment, it seems unlikely that it will be added to the Senate bill.
Three major questions have been raised about the House and Senate approaches: Do they fulfill Obama’s no-federal-funding promise? Do they follow the Hyde amendment “tradition”? And do they represent good health insurance policy?
As for the first question, the Senate version fulfills the President’s promise by requiring abortion funding to come from sources other than federal tax dollars. This aspect of the provision has been denigrated as a “bookkeeping trick,” but all payments involve bookkeeping. Even federal employees who pay for abortions with their government salaries are using funds that came from federal tax dollars. As for the second question, the Stupak amendment goes far beyond the Hyde amendment by prohibiting the use of federal tax dollars not only for abortion itself but also for any health plan available on the proposed exchanges that covers abortion. The goal is to limit access to abortion, even when no federal funds are being used for it.
The third question relates to public health policy. The Hyde amendment institutionalizes the moral view of some members of Congress that even medically necessary abortions should not be considered health care. This view, for example, led Congress to criminalize an abortion procedure without an exception for the health of the pregnant woman.4 These are the types of federal government intrusions into health care that opponents of public insurance plans usually decry.
President Obama is nonetheless on solid political ground in leaving for another day the toxic issue of federal funding for abortions. Should the current Senate bill get to conference committee, the Senate conferees should insist that their abortion-funding–neutral language be adopted in the final bill. The House conferees are unlikely to object. The Stupak amendment cannot be fairly termed a health care bill because it further restricts funding, and voting against it seems to me a reasonable response from senators and representatives who support social justice and equality between the sexes.***
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Thanks CCP, If I read through their spin correctly they are saying don't let abortion details kill the bill. Set it aside, get it passed and add it back later. In 99+% of the cases, the issue has nothing to do with health care, except to keep women from harming themselves, assuming (falsely) that they would get pregnant and terminate at the same rate if medical services, free ones in particular, were not readily available. Funding solution could be simple, just dedicate all the dollars spent on marketing, legal and political for the abortion industry and the terminations would be fully funded. But then the liberal law firms and lobbyists would be defunded.
The ending description for abortion just can't be ignored: "...social justice and equality between the sexes", just as provocative as my description of it as slaughtering your young.
China is different, but as far as I know we terminate equally between the genders. The social justice elephant in the room they won't say isn't free terminations, it is that we terminate black babies at 3.1 times the rate of white babies and that rate is even higher for taxpayer funded abortions. Assuming abortion on demand is a good thing for women, it looks like white women are being treated unfairly. The unspoken racist argument implied is that these unwanted, mostly inner city babies would live miserable lives and be a net drain on our society anyway. That's quite a judgment! If true that issue should be aimed back at those 'parents' not the innocent unborns who have yet do anything wrong IMHO.
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On the health care Issue. Who is going to be in charge of operating this new beast. I would suggest giving the AMA something to do aside from running lobbyists. Postmen run the post office. Bankers run the FED. :evil:
Just trying to provoke some discussion that would maybe be constructive, and get me some more info on the issue?
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http://www.foxnews.com/politics/2010/01/02/senate-dem-asks-south-carolinas-attorney-dogs/?test=latestnews
Updated January 02, 2010
Senate Dem Asks South Carolina's Top Attorney to 'Call Off the Dogs'
FOXNews.com
A Democratic senator from Nebraska who played a crucial role in getting health care legislation passed in the Senate last month has asked South Carolina's top attorney to "call off the dogs" -- a reference to the state official's threat to challenge the constitutionality of the bill.
In a phone call Thursday, Sen. Ben Nelson, D-Neb., urged South Carolina Attorney General Henry McMaster to reconsider, Politico reported. McMaster is the head of a group of 13 GOP state attorneys general who are threatening to file a lawsuit against the Senate health care bill.
Nelson asked McMaster to "call off the dogs," according to a copy of the memo sent by McMaster's chief of staff to other GOP state attorneys general detailing the call and obtained by Politico.
The attorneys general are challenging the constitutionality of a Medicaid provision in the bill that they say benefits Nebraska at the expense of other states.
The deal Nelson cut with Senate Democratic leaders to gain his critical vote would exempt Nebraska from having to pay for the coverage of new enrollees into its Medicaid program and leave the tab with the federal government -- a move expected to cost Uncle Sam $100 million over the next 10 years.
But Nelson told McMaster that the deal wasn't his idea and that the same Medicaid exemption would be offered to every state, according to the memo.
McMaster told Nelson that the state attorneys were seeking to remove the Nebraska Medicaid provision from the bill and that "he saw no way that he -- nor any of the state attorneys general " will support extending the provision to every state, the memo said.
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A private sector IPO with numbers like this would get people sent to jail.
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http://www.cato.org/pubs/tbb/tbb-58.pdf
No. 58 • November 2009
Will Federal Health Legislation Cause the Deficit to Soar?
by Daniel J. Mitchell, Senior Fellow, Cato Institute
The health care plan approved by the Senate Finance Committee is supposed to reduce budget deficits over 10 years by $81 billion, according to the Congressional Budget Office.1 Similarly, the House version of health legislation would reduce 10-year deficits by $104 billion, according to the CBO.2 Supporters of these health care proposals thus argue that the plans are fiscally responsible.
However, enacting a $1 trillion entitlement program would greatly increase the burden of government spending. In addition, promises of lower deficits are a triumph of hope over experience. Government forecasters have a very poor track record of predicting costs. More realistic assumptions suggest that health legislation could easily push up 10-year deficits by $600 billion.
Government-run health care will cost more than the politicians are telling us. The tax increases will not collect as much money as the politicians think. And, to put it mildly, promises of future spending restraint are naïve. The following are some of the reasons why current federal health proposals will mean not just more spending and higher taxes, but also larger deficits and added debt.
1. The Senate plan would increase federal spending by nearly $900 billion, while the House plan would increase spending by more than $1.2 trillion, according to the CBO. These estimates are far too low because they do not properly measure how people and businesses change their behavior in response to government handouts.
1. Errors in forecasts by the Congressional Budget Office and Joint Committee on Taxation could have large fiscal implications. If revenues and offsets are 25 percent below the forecast and spending is 50 percent higher than estimated, the 10-year deficits will be $602 billion to $860 billion higher.
1. There are incentives for companies to dump their health plans since workers will then get more take-home pay and be able to obtain health insurance using subsides and handouts from the government. This will dramatically increase budgetary costs.
1. The spending estimates are far too low because they do not recognize that politicians in the future will be tempted to expand subsidies as part of routine vote-buying behavior, similar to what happened with Medicare and Medicaid.
1. Future savings in the Senate plan are based on unrealistic gimmicks such as a “Medicare Commission” and a “Failsafe Budgeting Mechanism.” These absurd ploys share one thing in common—a hollow commitment to be frugal in the future while spending more today.
1. Even the savings that might be real—such as reductions in Medicare payment rates for physicians’ services in the Senate plan—are pushed off into the future, where they can be cancelled by politicians seeking to curry favor with key constituencies.
1. Much of the new spending is “backloaded,” meaning that it does not take effect for several years. This makes the long-run costs appear deceptively low. More than 90 percent of the spending in the Senate plan takes place in the second five years of the 10-year projection, and more than 84 percent of the spending in the House plan is also in the last five years.
1. Outlays in both plans will be climbing by about 8 percent annually toward the end of the 10-year period, much faster than growth in the overall economy.3
1. The federal government’s ability to predict healthcare spending leaves much to be desired. When Medicare was created in the 1960s, the long-range forecasts estimated that the program would cost about $12 billion by 1990. It ended up actually costing $110 billion that year, or nine times more than expected.4
Source: Joint Economic Committee.Medicare Spending in 1990,Estimated and Actual$12$110$0$40$80$1201967 Estimate for 1990Actual Spending in 1990Billions of Dollars
1. When Medicaid was created in 1965, it was supposed to be a very small program with annual expenditures of about $1 billion.5 It has now become a huge $280 billion per year burden for federal taxpayers.
1. Medicaid’s disproportionate share hospital (DSH) program is a sobering example. Created in 1987 to subsidize hospitals with large numbers of uninsured patients, the program was supposed to cost $1 billion in 1992, but actually cost a staggering $17 billion.6
Source: Joint Economic Committee.Medicaid DSH Spending in 1992,Estimated and Actual$1$17$0$5$10$15$201987 Estimate for 1992Actual Spending in 1992Billions of Dollars
1. The Medicare Catastrophic Coverage of 1988 was repealed after less than two years, in part because some provisions were already projected to cost six times more than originally forecast. 7
2. The tax provisions in the health proposals will impose considerable damage while raising less revenue than expected. The House legislation will supposedly raise more than $460 billion from higher income tax rates, but actual collections would likely be far smaller because of reduced incentives to earn income and increased incentives to avoid and evade taxes.
1. The Senate plan has big tax increases on high-cost insurance policies, medical devices, and health insurance providers. However, a substantial share of those projected revenues would evaporate as businesses and consumers alter their behavior to protect themselves from the taxes.
1. With the phase-out of insurance subsidies in some plans, taxpayers with modest incomes will face marginal tax rates of nearly 70 percent, a staggering penalty on upward mobility that will hinder overall economic performance.8
1. To add insult to injury, the Internal Revenue Service would get new enforcement powers to determine if people have acceptable (in the eyes of politicians and bureaucrats) health insurance.
Deficits and debt will skyrocket if government-run healthcare is expanded. This will happen if either the House or Senate plan becomes law. Big increases in federal spending and higher taxes are a bleak combination that would substantially slow U.S. economic growth.
1 Congressional Budget Office, letter to Senator Max Baucus (D-MT), October 7, 2009.
2 Congressional Budget Office, letter to Representative Charles Rangel (D-NY), October 29, 2009.
3 Congressional Budget Office, letter to Senator Max Baucus (D-MT), October 7, 2009.
4 Joint Economic Committee, “Are Health Care Reform Cost Estimates Reliable?” July 31, 2009. The JEC cites 1967 testimony by Robert J. Myers.
5 Clay Chandler, “Health Care Costs a Long-Term Headache,” Washington Post, October 17, 1993.
6 Joint Economic Committee, “Are Health Care Reform Cost Estimates Reliable?” July 31, 2009.
7 Marilyn Moon, “The Rise and Fall of the Medicare Catastrophic Coverage Act,” National Tax Journal 43, no. 3 (September 1990).
8 Greg Mankiw, “Marginal Tax Rates from Health Reform,” October 10, 2009
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Coakley's Saviors
The health-care industry rides to the Democratic rescue.
We've argued that the leading health industry CEOs will one day be exposed as the most short-sighted business leaders in history, but how to explain the gala fundraiser that their top lobbyists hosted for Martha Coakley last night?
Amid a Beltway panic, the health lobby is riding to the rescue of the Massachusetts liberal, whose defeat in the special Senate race next Tuesday could deny Democrats the 60th vote for ObamaCare and thus maybe spare the U.S. health system from the coming damage.
As first reported by Timothy Carney of the Washington Examiner, the host committee for the fundraiser at Pennsylvania Avenue's Sonoma Restaurant includes lobbyists for Pfizer, Merck, Eli Lilly, Novartis and sundry other drug companies that have been among the biggest of ObamaCare's corporate sponsors. Other hosts—who have raised at least $10,000 for Ms. Coakley—include representatives from UnitedHealthcare, Blue Cross Blue Shield, Humana and other insurers. As far as we can tell, the insurance industry claims to oppose ObamaCare's current incarnation.
Naturally, lobbyists from America's Health Insurance Plans and Pharmaceutical Research and Manufacturers of America, the major trade groups, were on hand too. Money follows power in Washington, obviously, though this example seems especially inexplicable given that Ms. Coakley's GOP opponent, state senator Scott Brown, may be the last chance to defuse the health-care doomsday machine. But maybe someone in the press corps will bother to mention this episode the next time President Obama takes aim at the "special interests" he claims are opposing his agenda.
Against overwhelming public opposition, the only things keeping ObamaCare alive at this point are power politics and the misguided corporate cease-fire that Democrats have either coerced or bought—or is homegrown at companies like Pfizer that are deeply invested in more government control of the economy. Ms. Coakley's election would make that outcome a certainty.
http://online.wsj.com/article/SB10001424052748704586504574654704100186542.html?mod=WSJ_Opinion_AboveLEFTTop
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Business is often the enemy of free enterprise and the friend of fascism.
==================
In a different vein , , ,
http://www.daybydaycartoon.com/2010/01/07/
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Pelosi says House cannot pass Senate's health-care bill without changes
By Shailagh Murray and Paul Kane
Washington Post Staff Writer
Thursday, January 21, 2010; 11:43 AM
House Speaker Nancy Pelosi said Thursday that the Senate will have to amend its version of a health-care reform bill before her chamber can pass it.
"I don't think it's possible to pass the Senate bill in the House," Pelosi told reporters after a morning meeting with her caucus. "I don't see the votes for it at this time."
Pelosi has been struggling for days to sell the Senate legislation to reluctant Democrats in order to get a health-care bill to the president's desk quickly. But moderates in her caucus have raised doubts about forging ahead without bipartisan support -- a challenge as the midterm election approaches -- while liberals rejected the Senate bill as not going far enough.
Most problematic for many House Democrats was how the Senate bill handled federal subsidies to buy health insurance, and the Senate's new excise tax on high-value policies, which could hit union households.
Republican Scott Brown's victory Tuesday in a Senate special election in Massachusetts blindsided Obama and Democratic leaders, who had nearly reached the finish line on an ambitious overhaul of the nation's health-care system and were beginning to turn their attention to other challenges, namely creating jobs and lowering the deficit.
The loss of their Senate supermajority has required a frantic reassessment of their strategy. Pelosi (D-Calif.) and Senate Majority Leader Harry M. Reid (D-Nev.) have pledged to complete work on the massive bill they started nearly a year ago, but they have yet to identify a clear way forward that will appeal broadly to their rank-and-file.
Obama added to the confusion Wednesday when he seemed to endorse one option: having both the House and the Senate start from scratch, by voting on a scaled-back package of popular provisions that would crack down on insurance companies but provide health coverage to far fewer additional people.
"We know that we need insurance reform, that the health insurance companies are taking advantage of people," Obama told ABC News in an interview. "We know that we have to have some form of cost containment because, if we don't, then our budgets are going to blow up. And we know that small businesses are going to need help."
But the White House quickly moved to clarify that the president still wants comprehensive reform.
"Right now there are a lot of discussions going on about the best path forward," spokesman Reid Cherlin said in a statement. "But let's be clear that the president's preference is to pass a bill that meets the principles he laid out months ago: more stability and security for those who have insurance, affordable coverage options for those who don't, and lower costs for families, businesses, and governments."
reiterated Wednesday her resolve to send a health-care bill to Obama's desk. "We heard the people, and hopefully we will move forward with their considerations in mind. But we will move forward in the process," Pelosi told the U.S. Conference of Mayors in a speech.
Reid, meanwhile, struck a more cautious note. "We're not going to rush into anything," he told reporters after a Senate Democratic lunch. "Remember, the bill we passed in the Senate is good for a year. There are many different things that we can do to move forward on health care, but we're not making any of those decisions now."
Caution from moderates
Moderate members of Reid's caucus also urged restraint, interpreting the Massachusetts outcome as a clear signal against advancing such a huge bill along party lines.
"I felt from the beginning that the best way to adopt anything as major as health-care reform was to do it in a bipartisan way," said Sen. Joseph I. Lieberman (I-Conn.). "You've got to listen to the message from Massachusetts, and I think it was all about, they want us to work together, they don't want us to do too much at once, and they want to feel that we're listening to them."
The health-care legislation is only one of several major bills on which Reid now needs, in the wake of the Massachusetts result, to win Republican votes.
The Senate on Wednesday took up a proposal to increase the nation's debt ceiling, but it is not clear whether, even before Brown is sworn in, enough Democrats are willing to vote for the measure to overcome GOP objections. Bills to change immigration laws and curtail greenhouse-gas emissions, two other Obama priorities, will not even come to the Senate floor without Republican support.
Tuesday's election also deepened the uncertainty surrounding another top administration goal -- overhauling the nation's financial regulatory system. A version of the legislation passed the House last month, but it has met stiff resistance from Republicans on the Senate banking committee, primarily over the creation of a Consumer Financial Protection Agency.
Brown on health care
Brown was elected to replace the late Edward M. Kennedy (D), the Senate's longtime champion of universal health care. He struck a conciliatory note during a Wednesday news conference in Boston, telling reporters that he supports expanding health-care coverage.
"I think it's important for everyone to get some form of health care," Brown said. "So to offer a basic plan for everybody, I think, is important. It's just a question of whether we're going to raise taxes, we're going to cut half a trillion from Medicare, we're going to affect veterans' care. I think we can do it better."
But if the senator-elect was willing to consider a health-care bill, most Republicans voiced relief that they may have dodged the current Democratic effort. Asked Wednesday whether the bill is dead, Senate Minority Leader Mitch McConnell (R-Ky.) responded, "I sure hope so."
Sen. Susan Collins (Maine) is one of a handful of Republican moderates whose votes are certain to be sought by Obama and Reid in the months ahead on various bills. She said she remains open to a health-care compromise, but she worried that economic issues are more pressing.
"Many of us have heard from our constituents that, in addition to their overall concern about health care, they would like to see the administration and Congress focus on economic issues," Collins said. "That's the message from back home."
Staff writers Lori Montgomery and Perry Bacon Jr. contributed to this report.
http://www.washingtonpost.com/wp-dyn/content/article/2010/01/21/AR2010012101604.html
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I felt like we were going to the gallows and at one minute before the switch was to be pulled the governor calls and grants a pardon. I was even wondering what GS level I would start at.
The only pity is we still have three years left for JC 2.
A culture of government doles won't get this country back on its feet.
*****Jewish World Review January 21, 2010
Democrats on the precipice of failure
By George Will
http://www.JewishWorldReview.com |
"We are on the precipice of an achievement that's eluded Congresses and presidents for generations."
-- President Barack Obama, Dec. 15, on health-care legislation
Precipice, 1. a headlong fall or descent, esp. to a great depth -- Oxford English Dictionary
Trying to guarantee Americans the thrill of the precipice, the president dashed to Massachusetts on Sunday, thereby conceding that he had already lost Tuesday's Senate election, which had become a referendum on his signature program. By promising to cast the decisive 41st vote against the president's health-care legislation, the Republican candidate forced all congressional Democrats to contemplate this: Not even frenzied national mobilization of Democratic manpower and millions of dollars could rescue one of the safest Democratic seats in the national legislature from national dismay about the incontinent government expansion, of which that legislation is symptomatic.
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Because the legislation is frightening and unpopular, Democrats have had to resort to serial bribery to advance it. Massachusetts voted immediately after the corruption of exempting, until 2018, union members from the tax on high-value health insurance plans. This tax was supposedly the crucial component of what supposedly was reform's primary goal: reducing costs.
The late Sen. Daniel Patrick Moynihan (D-N.Y.) thought Bill Clinton's presidency was crippled by the 1993 decision to pursue health-care reform rather than welfare reform. So slight was public enthusiasm for the former that Clinton's program never even came to a vote in the House or Senate, both controlled by Democrats. There was such fervor for welfare reform that in 1996, after two Clinton vetoes, he finally signed the decade's most important legislation.
In their joyless, tawdry slog toward passage of their increasingly ludicrous bill, Democrats now cling grimly to Robert Frost's axiom that "the best way out is always through." Their sole remaining reason for completing the damn thing is that they started it. The Democrats seem to have convinced themselves that they lost control of Congress in 1994 because they did not pass an unpopular health bill in 1993. Actually, their 1994 debacle had more to do with the arrogance and malfeasance arising from 40 years of control of the House of Representatives (e.g., the House banking scandal), a provocative crime bill (gun control, federal subsidies for midnight basketball) and other matters.
With one piece of legislation, President Obama and his congressional allies have done in one year what it took President Lyndon Johnson and his allies two years to do in 1965 and 1966 -- revive conservatism. Today, conservatism is rising on the steppingstones of liberal excesses.
Between FDR's reprimand by voters in the 1938 midterm congressional elections (partly because of his anti-constitutional plan to enlarge and pack the Supreme Court) and LBJ's 1964 trouncing of Barry Goldwater, there was no liberal legislating majority in Congress: Republicans and conservative Democrats combined to temper liberalism's itch to overreach. In 1965 and 1966, however, liberalism was rampant. Today, Democrats worrying about a reprise of 1994 should worry more about a rerun of the 1966 midterm elections, which began a Republican resurgence that presaged victories in seven of the next 10 presidential elections.
The 2008 elections gave liberals the curse of opportunity, and they have used it to reveal themselves ruinously. The protracted health-care debacle has highlighted this fact: Some liberals consider the legislation's unpopularity a reason to redouble their efforts to inflict it on Americans who, such liberals think, are too benighted to understand that their betters know best. The essence of contemporary liberalism is the illiberal conviction that Americans, in their comprehensive incompetence, need minute supervision by government, which liberals believe exists to spare citizens the torture of thinking and choosing.
Last week, trying to buttress the bovine obedience of most House Democrats, Obama assured them that if the bill becomes law, "the American people will suddenly learn that this bill does things they like." Suddenly?
If the Democrats' congressional leaders are determined to continue their kamikaze flight to incineration, they will ignore Massachusetts's redundant evidence of public disgust. They will leaven their strategy of briberies with procedural cynicism -- delaying certification of Massachusetts's Senate choice, or misusing "reconciliation" to evade Senate rules, or forcing the House to swallow its last shred of pride in order to rush the Senate bill to the president's desk. Surely any such trickery would be one brick over a load for some hitherto servile members of the Democratic House and Senate caucuses, giving them an excuse to halt their party's Gadarene rush toward the precipice.*****
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Woof,
One might ask, what is so damn important about the Healthcare Bill that the Dem's and President Obama would risk losing power in both the House and Senate, tarnishing the Presidency of the first African American President, basically making him a lame duck with three years to go, and handing 2012 to the Republicans, if they don't throw up on themselves before then?
Was it a matter of moral principle that demanded the uninsured be covered after all these years without universal healthcare? Was it about lowering healthcare cost? Improving care? Just plain Ole' doing what's right for America? Does anyone think they really cared that much about any of those things that they used to justify what they were doing? I don't. So what is it? It's because the healthcare system could provide a government controlled framework that could be changed, added on to, and morphed into a socialistic system that could operate outside our current governmental framework of a constitutional republic. In other words it could easily be used as a shadow government to control the behavior of citizens and erode personal independence from government, freedom of choice, and individual rights. It's the Holy Grail of Socialism. That is why these Liberal, ideologically driven politicians were willing to go so far, even to the point of self destruction to grab the brass ring of healthcare reform. And I've got news for you, they are not giving it up yet, not if Obama and the Left is sticking to their playbook written by their hero Saul Alinsky.
www.americanthinker.com/2008/10/obamas_radical_revolutionits_a.html
P.C.
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It ain't over, what other elections are out there?
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Well, there is that little matter of the entire House of Representatives and one third of the US Senate being up for election in ten months , , ,
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EXactly.........
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Woof,
You don't understand; they are not going to let elections or any form of the will of the people like the tea parties or townhall revolts, get in their way and they havn't been kicked out yet.
http://news.yahoo.com/s/ap/us_health_care_overhaul
P.C.
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The triumvarite's efforts continue:
***IN THE COFFINPELOSI AND REID PLOT SECRET PLAN FOR OBAMACARE
By Dick Morris And Eileen McGann 01.25.2010 Highly informed sources on Capitol Hill have revealed to me details of the Democratic plan to sneak Obamacare through Congress, despite collapsing public approval for healthcare “reform” and disintegrating congressional support in the wake of Republican Scott Brown’s victory in Massachusetts.
President Obama, House Speaker Nancy Pelosi, and Senate Majority Leader Harry Reid all have agreed to the basic framework of the plan.
Their plan is clever but can be stopped if opponents of radical healthcare reform act quickly and focus on a core group of 23 Democratic Congressman. If just a few of these 23 Democrats are “flipped” and decide to oppose the bill, the whole Obama-Pelosi-Reid stratagem falls apart.
Here’s what I learned top Democrats are planning to implement.
Senate Democrats will go to the House with a two-part deal.
First, the House will pass the Senate’s Obamacare bill that passed the Senate in December. The House leadership will vote on the Senate bill, and Pelosi will allow no amendments or modifications to the Senate bill.
How will Pelosi’s deal fly with rambunctious liberal members of her majority who don’t like the Senate bill, especially its failure to include a public option, put heavy fines on those who don’t get insurance, and offering no income tax surcharge on the “rich”?
That’s where the second part of the Pelosi-deal comes in.
Behind closed doors, Reid and Pelosi have agreed in principle that changes to the Senate bill will be made to satisfy liberal House members — but only after the Senate bill is passed and signed into law by Obama.
This deal will be secured by a pledge from Reid and the Senate’s Democratic caucus that they will make “fixes” to the Senate bill after it becomes law with Obama’s John Hancock.
But you may ask what about the fact that, without Republican Scott Brown and independent Democrats such as Joe Lieberman, Reid simply doesn’t have the 60 votes in the Senate to overcome a Republican filibuster that typically can stop major legislation?
According to my source, Reid will provide to Pelosi a letter signed by 52 Democratic senators indicating they will pass the major changes, or “fixes,” the House Democrats are demanding. Again, these fixes will be approved by the Senate only after Obama signs the Senate bill into law.
Reid also has agreed to bypass Senate cloture and filibuster rules and claim that these modifications fall under “reconciliation” and don’t require 60 Senate votes.
To pass the fixes, he won’t need one Republican; he won’t even need Joe Lieberman or wavering Democrats such as Jim Webb of Virginia.
His 52 pledged senators give him a simple majority to pass any changes they want, which will later be rubberstamped by Pelosi’s House and signed by Obama.
This plan, of course, is a total subversion of the legislative process.
Typically, the Senate and House pass their own unique legislation and then both bills go to a conference committee. In conference, the leadership of both Democrat-dominated houses wheels and deals and irons out differences.
The final compromise bill is then sent back to the full Senate and full House for a vote and has to pass both to go to the president.
In the House, a simple majority passes the legislation. But under Senate rules, major legislation requires 60 votes to end a filibuster.
As it stands, the House bill and Senate bill have major discrepancies. Reid does not have 60 votes to pass a compromise bill that would no doubt include some of the radical provisions House members have been demanding.
But if the House passes the exact Senate bill that passed by a 60-39 Senate vote last month, there is no need for a conference on the bill. It will go directly to the president’s desk.
There is a rub to all of this.
This secret plan being hatched by Pelosi and Reid requires not only a pledge by 52 Democratic senators to vote later for the House modifications. House liberals must actually believe these Senators will live up to their pledge and pass the fixes at some future date.
A Senate source cautions: “Senators more than House members and both more than ordinary people, lie.”
Still, my Senate source and others in Washington believe that the liberals in the House, grasping at straws after the stunning Massachusetts defeat, will go along with the Reid-Pelosi plan to bypass a conference bill and ultimately will vote for the Senate version without changes.
Among the key “fixes” House liberals are demanding the Senate pass in reconciliation at some later date include a “carve out” for unions from the “Cadillac policy” insurance tax. The Senate plan funds their healthcare plan by heavy taxes on so-called “Cadillac” insurance plans that provide those insured with exceptionally good coverage including almost unlimited health access with little or no co-payments. The Senate’s view was that rich people have such plans and should be taxed for them to pay the less fortunate.
But many unions have Cadillac plans for their members, and they are furious their members will be hit with the Senate tax. The unions have told their minions in the House to oppose the Senate Cadillac plan tax.
House liberals also are requiring a fix that increases fines for those who flout the law and don’t buy health insurance (the Pelosi-passed plan includes criminal penalties, including possible jail time if a person doesn’t purchase insurance). Another fix will raise subsidies for low-income families seeking to buy insurance.
In the original House bill that passed, healthcare expansion costs would have been paid for by an income tax surcharge on the “rich.” House liberals are pushing for that fix as well.
So what is the counter-move? How do opponents of Obamacare stop this?
Opponents cannot rely on liberal Democrats in the House who might balk at passing the Senate bill with just a “pledge” from 52 senators. I have no doubt House liberals, despite their skepticism, will fade under pressure from Pelosi and Obama. They will do their duty and pass the Senate bill, whatever their current posturing.
Instead, the key to stopping the Pelosi-Reid plan lies with conservative or “moderate” Democrats who voted for the healthcare bill the first time.
There are 23 of these conservative-leaning Democratic House members who voted for Pelosi’s Obamacare back in November, which passed by just five votes, with 39 Democrats defecting to vote against the bill.
All 23 of these congressmen who did vote for the Pelosi bill are extremely vulnerable.
Opponents of Obamacare need to climb all over these 23 congressmen with TV ads and advocacy campaigns in their districts to get them to change their vote this time, to vote “no” to the Senate bill when it comes before the House.
Voters need to say, “You voted for Obamacare the first time. But your district opposes it by 2 to 1. Now it is coming up for a vote again. Listen to your constituents and vote no. We don’t want Medicare cuts or premium increases or rationing of medical care. Don’t monkey with our healthcare. Vote no this time.”
Since the House healthcare bill passed by five votes, much has happened and the political landscape has changed dramatically.
The Massachusetts election of a Republican to Ted Kennedy’s Senate seat has sent shock waves through Washington. Every one of these 23 Democrats knows they will face an angry backlash in their districts if they vote for the Senate bill and go along with Pelosi-Reid plan to ram through Obamacare.
I believe now is the time for opponents to act. The truth is that Obamacare is hanging by a thread.
Opponents, if they move now, can drive a stake through its heart.
Once these congressmen hear from their aroused constituents, they won’t be able to back Obamacare.
As I mentioned, the Pelosi health bill passed the House by only 220-215. Nancy Pelosi knows she has no margin for error.
If only a handful of these 23 congressmen change their vote under public pressure, the Pelosi-Reid plan is stopped and Obamacare is dead.
Click here to help fund ads in the districts of these swing Congressmen.
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Jan 25 2010 | Category: Dick's Articles | 10 Comments
Copyright © 2010 DickMorris.com*****
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Health Care: Who Knows 'Best'?
By Jerome Groopman
One of the principal aims of the current health care legislation is to improve the quality of care. According to the President and his advisers, this should be done through science. The administration's stimulus package already devoted more than a billion dollars to "comparative effectiveness research," meaning, in the President's words, evaluating "what works and what doesn't" in the diagnosis and treatment of patients.
But comparative research on effectiveness is only part of the strategy to improve care. A second science has captured the imagination of policymakers in the White House: behavioral economics. This field attempts to explain pitfalls in reasoning and judgment that cause people to make apparently wrong decisions; its adherents believe in policies that protect against unsound clinical choices. But there is a schism between presidential advisers in their thinking over whether legislation should be coercive, aggressively pushing doctors and patients to do what the government defines as best, or whether it should be respectful of their own autonomy in making decisions. The President and Congress appear to be of two minds. How this difference is resolved will profoundly shape the culture of health care in America.
The field of behavioral economics is rooted in the seminal work of Amos Tversky and Daniel Kahneman begun some three decades ago. Drawing on data from their experiments on how people process information, particularly numerical data, these psychologists challenged the prevailing notion that the economic decisions we make are rational. We are, they wrote, prone to incorrectly weigh initial numbers, draw conclusions from single cases rather than a wide range of data, and integrate irrelevant information into our analysis. Such biases can lead us astray.
The infusion of behavioral economics into public policy is championed by Cass Sunstein, a respected professor of law and longtime friend of President Obama; he is now in the White House, overseeing regulatory affairs, and will have an important voice in codifying the details of any bill that is passed. In Nudge: Improving Decisions About Health, Wealth, and Happiness, Sunstein and Richard Thaler, a professor of behavioral science and economics at the University of Chicago, propose that people called "choice architects" should redesign our social structures to protect against the incompetencies of the human mind.[1] Those who understand thinking better can make life better for us all.
Thaler and Sunstein build on behavioral economic research that reveals inertia to be a powerful element in how we act. Most people, they argue, will choose the "default option"—i.e., they will follow a particular course of action that is presented to them instead of making an effort to find an alternative or opt out. Further, they write,
These behavioral tendencies toward doing nothing will be re- inforced if the default option comes with some implicit or explicit suggestion that it represents the normal or even the recommended course of action.
Sunstein and Thaler propose to use default options as "nudges" in the service of "libertarian paternalism." For example, to promote a healthy diet among teenagers, broccoli and carrots would be presented at eye level in the cafeteria and would be easily available, while it would take considerable effort for students to locate junk food, thereby nudging them into accepting a healthier diet. But all choices should be "libertarian"—people should be free to opt out of "undesirable arrangements if they want to do so." The soft paternalistic nudge Sunstein and Thaler envisage should try "to influence choices in a way that will make choosers better off, as judged by themselves." They are very clear that nudges are not mandates, and that behavior should not be forcefully directed by changing economic incentives. Your doctor should not be paid less if she follows a course of treatment that she can defend as reasonable, even if she deviates from officially issued guidelines. To prevent policy planners from going down the slippery slope of coercion, there should, in Sunstein's view, be safety rails. Whatever the proposal put forward, he has written, people must retain "freedom of choice" and be able to oppose the more objectionable kinds of government intervention.
uch freedom of choice, however, is not supported by a second key Obama adviser, Peter Orszag, director of the Office of Management and Budget. In June 2008, testifying before Max Baucus's Senate Finance Committee, Orszag—at the time director of the Congressional Budget Office—expressed his belief that behavioral economics should seriously guide the delivery of health care. In subsequent testimony, he made it clear that he does not trust doctors and health administrators to do what is "best" if they do no more than consider treatment guidelines as the "default setting," the procedure that would generally be followed, but with freedom to opt out. Rather, he said,
To alter providers' behavior, it is probably necessary to combine comparative effectiveness research with aggressive promulgation of standards and changes in financial and other incentives. [Emphasis added.]
The word "probably" is gone in the Senate health care bill. Doctors and hospitals that follow "best practices," as defined by government-approved standards, are to receive more money and favorable public assessments. Those who deviate from federal standards would suffer financial loss and would be designated as providers of poor care. In contrast, the House bill has explicit language repudiating such coercive measures and protecting the autonomy of the decisions of doctors and patients.[2]
On June 24, 2009, when President Obama convened a meeting on health care at the White House, Diane Sawyer of ABC News asked him whether federally designated "best practices" would be mandated or simply suggested. That is, would he recommend Orszag's shove or Sunstein's nudge?
Obama: ...Let's study and figure out what works and what doesn't. And let's encourage doctors and patients to get what works. Let's discourage what doesn't. Let's make sure that our payment incentives allow doctors to do the right thing. Because sometimes our payment incentives don't allow them to do the right things. And if we do that, then I'm confident that we can drive down costs significantly.
Sawyer: Will it just be encouragement? Or will there be a board making Solomonic decisions... about best practices?
Obama: What I've suggested is that we have a commission... made up of doctors, made up of experts, that helps set best practices.
Sawyer: By law?
Obama: ...If we know what those best practices are, then I'm confident that doctors are going to want to engage in best practices. But I'm also confident patients are going insist on it.... In some cases, people just don't know what the best practices are. And certain cultures build up. And we can change those cultures, but it's going to require some work.
Sawyer: But a lot of people... say..."I'm very concerned that there's going be a reduction in treatment someplace in all of this." And the question is if there is a board that is recommending, that's one thing. If there is a board that is dictating through cost or through some other instruction, that's another thing. Will it have the weight of law? Will it have the weight of regulations?
Obama: ...I don't think that there's anybody who would argue for us continuing to pay for things that don't make us feel better. That doesn't make any sense. [Yet] that's the reason why, in America, we typically pay 50 percent more for our health care than other advanced countries that actually have better health care outcomes.
Still, the President appears not to be entirely in Orszag's camp. He has repeatedly deflected accusations of a "government takeover of health care" by asserting that no federal bureaucrat will come between the doctor and patient in clinical decision-making. The President has also repeatedly told physicians that reform would sustain them as healers, not make them into bean counters and paper pushers. In an interview on NPR two days before passage of the Senate bill, the President said that changes in how doctors and patients think about health care should come from giving them the "best information possible" and did not invoke the coercive measures favored by Orszag.
ow do we reconcile this apparent difference between Sunstein and Orszag? The President contends that sound policies are built on data, but which data? Here the evidence is strongly in favor of Sunstein and his insistence on the need for freedom of choice and retaining the ability to oppose objectionable forms of government intervention. Over the past decade, federal "choice architects"—i.e., doctors and other experts acting for the government and making use of research on comparative effectiveness—have repeatedly identified "best practices," only to have them shown to be ineffective or even deleterious.
For example, Medicare specified that it was a "best practice" to tightly control blood sugar levels in critically ill patients in intensive care. That measure of quality was not only shown to be wrong but resulted in a higher likelihood of death when compared to measures allowing a more flexible treatment and higher blood sugar. Similarly, government officials directed that normal blood sugar levels should be maintained in ambulatory diabetics with cardiovascular disease. Studies in Canada and the United States showed that this "best practice" was misconceived. There were more deaths when doctors obeyed this rule than when patients received what the government had designated as subpar treatment (in which sugar levels were allowed to vary).
There are many other such failures of allegedly "best" practices. An analysis of Medicare's recommendations for hip and knee replacement by orthopedic surgeons revealed that conforming to, or deviating from, the "quality metrics"—i.e., the supposedly superior procedure—had no effect on the rate of complications from the operation or on the clinical outcomes of cases treated. A study of patients with congestive heart failure concluded that most of the measures prescribed by federal authorities for "quality" treatment had no major impact on the disorder. In another example, government standards required that patients with renal failure who were on dialysis had to receive statin drugs to prevent stroke and heart attack; a major study published last year disproved the value of this treatment.
Other "quality measures" recommended by the government were carried out in community health centers to improve the condition of patients with asthma, diabetes, and hypertension. The conclusion of subsequent research was that there was, as a result, no change in outcome for any of these three disorders. Finally, Medicare, following the recommendations of an expert panel, specified that all patients with pneumonia must receive antibiotics within four hours of arrival at the emergency room. Many doctors strongly disagreed with such a rigid rule, pointing out that an accurate diagnosis cannot be made so quickly, and the requirement to treat within four hours was not based on convincing evidence. But the government went ahead, and the behavior of physicians was altered by the new default setting—for the worse. Many cases of heart failure or asthma, where the chest X-ray can resemble a pulmonary infection, were wrongly diagnosed as pneumonia; the misdiagnosed patients were given high doses of antibiotics, resulting in some cases of antibiotic-induced colitis. The "quality measure" was ultimately rescinded.[3]
hat may account for the repeated failures of expert panels to identify and validate "best practices"? In large part, the panels made a conceptual error. They did not distinguish between medical practices that can be standardized and not significantly altered by the condition of the individual patient, and those that must be adapted to a particular person. For instance, inserting an intravenous catheter into a blood vessel involves essentially the same set of procedures for everyone in order to assure that the catheter does not cause infection. Here is an example of how studies of comparative effectiveness can readily prove the value of an approach by which "one size fits all." Moreover, there is no violation of autonomy in adopting "aggressive" measures of this kind to assure patient safety.
But once we depart from such mechanical procedures and impose a single "best practice" on a complex malady, our treatment is too often inadequate. Ironically, the failure of experts to recognize when they overreach can be explained by insights from behavioral economics. I know, because I contributed to a misconceived "best practice."
My early research involved so-called growth factors: proteins that stimulate the bone marrow to produce blood cells. I participated in the development of erythropoietin, the red cell growth factor, as a treatment for anemic cancer patients. Erythropoietin appeared to reduce the anemia, lessening the frequency of transfusion. With other experts, I performed a "meta-analysis," i.e., a study bringing together data from multiple clinical trials. We concluded that erythropoietin significantly improved the health of cancer patients and we recommended it to them as their default option. But our analysis and guidelines were wrong. The benefits ultimately were shown to be minor and the risks of treatment sometimes severe, including stroke and heart attack.[4]
After this failure, I came to realize that I had suffered from a "Pygmalion complex." I had fallen in love with my own work and analytical skills. In behavioral economics, this is called "overconfidence bias," by which we overestimate our ability to analyze information, make accurate estimates, and project outcomes. Experts become intoxicated with their past success and fail to be sufficiently self-critical.
A second flaw in formulating "best practices" is also explained by behavioral economics—"confirmation bias." This is the tendency to discount contradictory data, staying wed to assumptions despite conflicting evidence. Inconsistent findings are rationalized as being "outliers." There were, indeed, other experts who questioned our anemia analysis, arguing that we had hastily come to a conclusion, neglecting findings that conflicted with our position. Those skeptics were right.[5]
Yet a third powerful bias identified in behavioral economics can plague expert panels: this is the "focusing illusion," which occurs when, basing our predictions on a single change in the status quo, we mistakenly forecast dramatic effects on an overall condition. "If only I moved from the Midwest to sunny California, I would be so much happier" is a classical statement of a focusing illusion, proven to be such by studies of people who have actually moved across the country. Another such illusion was the prescription of estrogen as the single remedy to restore feminine youth and prevent heart disease, dementia, and other complications of the complex biology of aging.[6] Such claims turned out to be seriously flawed.
here is a growing awareness among researchers, including advocates of quality measures, that past efforts to standardize and broadly mandate "best practices" were scientifically misconceived. Dr. Carolyn Clancy of the Agency for Healthcare Research and Quality, the federal body that establishes quality measures, acknowledged that clinical trials yield averages that often do not reflect the "real world" of individual patients, particularly those with multiple medical conditions. Nor do current findings on best practices take into account changes in an illness as it evolves over time. Tight control of blood sugar may help some diabetics, but not others. Such control may be prudent at one stage of the malady and not at a later stage. For years, the standards for treatment of the disease were blind to this clinical reality.[7]
Orszag's mandates not only ignore such conceptual concerns but also raise ethical dilemmas. Should physicians and hospitals receive refunds after they have suffered financial penalties for deviating from mistaken quality measures? Should public apologies be made for incorrect reports from government sources informing the public that certain doctors or hospitals were not providing "quality care" when they actually were? Should a physician who is skeptical about a mandated "best practice" inform the patient of his opinion? To aggressively implement a presumed but still unproven "best practice" is essentially a clinical experiment. Should the patient sign an informed consent document before he receives the treatment? Should every patient who is treated by a questionable "best practice" be told that there are credible experts who disagree with the guideline?
But even when there are no coercive measures, revising or reversing the default option requires a more complicated procedure than the one described by the President at the White House meeting. In November, the United States Preventive Services Task Force, reversing a long-standing guideline, recommended that women between the ages of forty and forty-nine do not need to have routine mammograms. To arrive at this conclusion, researchers made both a meta-analysis and computer models of data from seven clinical trials. The task force found that routine mammograms result in a 15 percent reduction in the relative risk of death from breast cancer for women in the forty to forty-nine age group, a similar level of benefit as in earlier analyses. For women in their forties, this means one life is saved for every 1,904 women screened. For older women in their fifties, one life is saved for every 1,359 women screened.[8]
If these estimates are correct, then how many lives might be saved in the United States for each age group if every woman received a mammogram? The 2008 US Census estimates the number of women between forty and forty-nine at 22.3 million. So if mammography were available to all these women, nearly 12,000 deaths could be potentially averted during these ten years in their lives. As for the 20.5 million women in their fifties, some 15,000 deaths could potentially be averted.
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What are the risks of mammography for women in their forties? The task force estimated a higher rate of false positive findings in mammograms in women in their forties compared to older women. This translates into increased anxiety when women are told that there may be a cancer and there is not. A false positive reading may also result in a woman having a biopsy. For every case of invasive breast cancer in a young woman diagnosed by mammography, five women with benign findings will have biopsies. In addition, there are potential risks of radiation from the mammogram itself, although no one really knows how significant these are. Then there is an unanswered question in the biology of breast cancer: Which tumors are indolent and which are aggressive? We lack the molecular tools to distinguish between slow- and fast-growing cancers. Some slow-growing ones detected in young women might be treated later in life without any disadvantage in the rate of survival. But aggressive breast cancers in young women are notoriously difficult to treat and frequently result in death. And as with essentially all screening tests in a population, the majority of women receiving mammograms do not have any disorder.
hese, roughly, are the statistics and state of the science with regard to breast cancer. How do we weigh the evidence and apply it to individuals and to society at large? Setting the default option that doctors will present to patients requires us to make value judgments. Dr. Otis Brawley of the American Cancer Society, an oncologist who worked for decades at the National Cancer Institute, is well versed in preventive care; he disagrees with the new default setting, based on findings that mammograms save lives. (Brawley also happens to be an African-American and has long been concerned about the meager access among minority and poor groups to potentially lifesaving screenings.)
Dr. Diana Petitti, a professor of bioinformatics at Arizona State University and vice-chair of the task force, appeared with Brawley on November 17, 2009, on the PBS NewsHour. She had no disagreement with him about what the studies show, and emphasized that the task force did not say that women in their forties should not get mammograms, only that they were no longer routinely recommended since the benefit to patients did not clearly outweigh the risks. Cost considerations were not part of the task force's deliberations.
Other supporters of the new recommendations took a less temperate view. A statistician who developed computer models for the task force told The New York Times that "this decision is a no-brainer."[9] It did not appear to be so clear to Melissa Block of NPR when she interviewed an internist who agreed with the task force. The doctor said that stopping routine mammography for young women would spare them anxiety, distress, and unnecessary biopsies. Block replied, "I've heard this before.... When people say, you know, there's unnecessary anxiety and false positives and fear and worry." That, she said, is "a very patronizing approach to take toward women's health.... Women may very well be willing to assume those harms if it means that they may be diagnosed earlier." The internist replied that each woman should talk with her doctor and figure out what is best.[10] Sunstein's Nudge coauthor, the behavioral economist Richard Thaler, wrote a thoughtful analysis of the pros and cons of mammography in The New York Times and concluded that "one can make a good case that we don't want the government making these choices" for us.[11]
Two days after the task force recommendations were released, Health and Human Services Secretary Kathleen Sebelius put some distance between the Obama administration and the task force's conclusions, saying:
My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years....
Dr. Petitti later appeared before Congress to apologize for any "confusion" caused by the task force report. Petitti was not recanting a scientific truth. She correctly described the new recommendations as "qualitative." That is, they were offered as value judgments that could be modified or revised; and the political process offers one way of doing so. As Sunstein has written, if default options embody standards that many people judge as not better for themselves, those standards can be changed.
Shortly after the new mammography guidelines were announced, an expert panel of obstetricians and gynecologists recommended that teenage girls no longer have routine pap smears for cervical cancer.[12] The incidence of deadly cervical cancer among teens is at most one in a million and screening does not appear to save that one life. When false positive results from screenings are followed by cervical surgery, the risk may be injury that can predispose a young woman to later premature labor. There was no public uproar following this changed default setting for many women. It was consistent with how most people value the benefit of lives saved versus risks incurred. This is the reality of "comparative effectiveness" research. It is not simply a matter of "what works and what doesn't." Nor will patients always "insist" on being treated according to what experts define as "best practice." They should be aware that there are numerous companies, some of them "not for profit," issuing standards for treatment that are congenial to the insurance industry but are often open to the kinds of counterevidence I have described here.
hat of the President's statement that doctors will want to engage in federally approved "best practices"? The American College of Physicians, composed of internists, agreed with the task force conclusions about mammography. The American Society of Clinical Oncology, representing oncologists, did not. I am a member of both professional organizations. What do I do? As a physician who has cared for numerous young women with breast cancer, many dying an untimely death, my bias was that the dangers of mammograms do not outweigh the reduction in mortality. Notably, the oncologists who head the breast cancer programs at Minnesota's Mayo Clinic and Utah's Intermountain Health—described by President Obama as pinnacles of quality care using guidelines—also disagreed with the task force.
Such challenges to "best practice" do not imply that doctors should stand alone against received opinion. Most physicians seek data and views on treatments from peers and, as needed, specialists, and then present information and opinion to patients who ultimately decide.
While costs were not part of the task force calculations, they prominently entered the national debate on them. Dr. Robert Truog of Boston Children's Hospital allowed that mammography saves lives, but asked if it is "cost effective."[13] That is, should policy planners set a price on saving those young women?
Cost-effectiveness is going to be a hard sell to the American public, not only because of the great value placed on each life in the Judeo-Christian tradition, but because the federal government has devoted many hundreds of billions of dollars to bail out Wall Street. To perform mammograms for all American women in their forties costs some $3 billion a year, a pittance compared to the money put into the bank rescue. The Wall Street debacle also made many Americans suspicious of "quants," the math whizzes who developed computer models that in theory accurately assessed value in complex monetary instruments but in fact nearly brought down the worldwide financial system. When a medical statistician says that imposing a limit on mammography is a "no-brainer," people may recall George Tenet's claim that the case for invading Iraq was a "slam-dunk."
At the White House gathering, the President portrayed comparative effectiveness as equivalent to cost- effectiveness, noting that other countries spend half of what we do by only paying for "what works." This contention is not supported by evidence. Theodore Marmor, a professor of health care policy at Yale, writes in Fads, Fallacies and Foolishness in Medical Care Management and Policy that movements for "quality improvement" in Britain have failed to reduce expenditures.[14] Marmor, with Jonathan Oberlander, a professor at the University of North Carolina, has written in these pages that the President has offered up rosy scenarios to avoid the harsh truth that there is no "painless cost control."[15] Lower spending in countries like France and Germany is accounted for not by comparative effectiveness studies but by lower costs of treatment attained through their systems of medical care and by reduced medical budgets. In Europe, prescription drugs cost between 50 and 60 percent of what they do in the US, and doctor's salaries are lower. (Insurance premiums also are tightly constrained.) France and Germany have good records in health care, but in Great Britain, where costs are strictly controlled by the National Health Service, with rationing of expensive treatments, outcomes for many cancers are among the worst in Europe.[16]
The care of patients is complex, and choices about treatments involve difficult tradeoffs. That the uncertainties can be erased by mandates from experts is a misconceived panacea, a "focusing illusion." If a bill passes, Cass Sunstein will be central in drawing up the regulations that carry out its principles. Let's hope his thinking prevails.
—January 14, 2010
Notes
[1]Yale University Press, 2008; See the review in these pages by John Cassidy, "Economics: Which Way for Obama?," June 12, 2008.
[2]On June 16, 2008, at the Health Reform Summit of the Senate Finance Committee, Orszag explicitly invoked behavioral economics to explain some of the deficiencies in American health care and as the basis for legislative interventions that would remedy rapidly escalating costs and gaps in quality.
On August 7, 2008, addressing the Retirement Research Consortium in Washington, D.C., Orszag presented "Behavioral Economics: Lessons from Retirement Research for Health Care and Beyond." Here, he states the likely need for aggressive measures. The Senate Finance Committee, under Max Baucus, was widely reported to have worked closely with the White House, and many of Orszag's proposals are prominent in the bill that Majority Leader Harry Reid brought to the floor. See Senate Bill HR 3590, Title III—Improving the Quality and Efficiency of Health Care.
The House rejected many of the ideas from the President's advisers in favor of safeguards on patient–physician autonomy, causing Rahm Emanuel, the White House chief of staff, to quip that politics trumps "ideal" plans made in the shade of the "Aspen Institute." See Sheryl Gay Stolberg, "Democrats Raise Alarms over Health Bill Costs," The New York Times, November 9, 2009. Explicit language in the House bill is intended to safeguard patient–physician autonomy. See House Bill HR 3962, Title IV—Quality; Subtitle A—Comparative Effectiveness Research.
[3]These results, respectively, come from the NICE-SUGAR Study Investigators, "Intensive versus Conventional Glucose Control in Critically Ill Patients," The New England Journal of Medicine, March 26, 2009; Silvio E. Inzucchi and Mark D. Siegel, "Glucose Control in the ICU—How Tight Is Too Tight?," The New England Journal of Medicine, March 26, 2009; the Action to Control Cardiovascular Risk in Diabetes Study Group, "Effects of Intensive Glucose Lowering in Type 2 Diabetes," The New England Journal of Medicine, June 12, 2008; the ADVANCE Collaborative Group, "Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 Diabetes," The New England Journal of Medicine, June 12, 2008; Robert G. Dluhy and Graham T. McMahon, "Intensive Glycemic Control in the ACCORD and ADVANCE Trials," The New England Journal of Medicine, June 12, 2008; Gregg C. Fonarow et al., "Association Between Performance Measures and Clinical Outcomes for Patients Hospitalized with Heart Failure," The Journal of the American Medical Association, January 3, 2007; Bengt C. Fellström et al., for the AURORA Study Group, "Rosuvastatin and Cardiovascular Events in Patients Undergoing Hemodialysis," The New England Journal of Medicine, April 2, 2009; Bruce E. Landon et al., "Improving the Management of Chronic Disease at Community Health Center," The New England Journal of Medicine, March 1, 2007; Rodney A. Hayward, "Performance Measurement in Search of a Path," The New England Journal of Medicine, March 1, 2007; Robert M. Wachter et al., "Public Reporting of Antibiotic Timing in Patients with Pneumonia: Lessons from a Flawed Performance Measures," Annals of Internal Medicine, July 1, 2008.
[4]The clinical development of other growth factors, like G-CSF for a low white blood cell count, fared better. G-CSF is a valuable treatment for many cancer patients, but, of course, not all.
[5]Contradictory evidence reverses "best practices" so frequently that within one year 15 percent must be changed, within two years, 23 percent are reversed, and at 5.5 years, half are incorrect. See Kaveh G. Shojania et al., "How Quickly Do Systematic Reviews Go Out of Date? A Survival Analysis," Annals of Internal Medicine, August 21, 2007.
[6]Focusing illusions are wonderfully illuminated by Daniel Gilbert, Stumbling on Happiness (Knopf, 2006). Also see the role of marketing in fostering the illusion: Natasha Singer and Duff Wilson, "Menopause, as Brought to You by Big Pharma," The New York Times, December 13, 2009. See also David A. Schkade and Daniel Kahneman, "Does Living in California Make People Happy? A Focusing Illusion in Judgments of Life Satisfaction," Psychological Science, September 1998.
[7]Dr. Clancy seeks new statistical methods to analyze heterogeneous groups of "real world" patients, so treatment guidelines become "personalized," delivering "the right treatment to the right patient at the right time." (See Patrick H. Conway and Carolyn Clancy, "Comparative-Effectiveness Research —Implications of the Federal Coordinating Council's Report," The New England Journal of Medicine, July 23, 2009; Harold C. Sox and Sheldon Greenfield, "Comparative Effectiveness Research: A Report From the Institute of Medicine," Annals of Internal Medicine, August 4, 2009.) This is a laudable goal and deeply attractive. It is more likely to come from basic science that classifies patients based on their genetic characteristics rather than statistics. Past attempts at observing groups of "real world" patients have often generated conclusions that were flawed, mistaking correlation for causation. A valiant attempt to apply research on comparative effectiveness to prostate cancer treatment options came up against similar hurdles. See Jenny Marder, "A User's Guide to Cancer Treatment," Science, November 27, 2009.
[8]US Preventive Services Task Force, "Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement," Annals of Internal Medicine, November 17, 2009; Heidi D. Nelson et al., "Screening for Breast Cancer: An Update for the US Preventive Services Task Force," Annals of Internal Medicine, November 17, 2009; Jeanne S. Mandelblatt et al. for the Breast Cancer Working Group of the Cancer Intervention and Surveillance Modeling Network (CISNET), "Effects of Mammography Screening Under Different Screening Schedules: Model Estimates of Potential Benefits and Harms, Annals of Internal Medicine, November 17, 2009.
[9]Gina Kolata, "In Reversal, Panel Urges Mammograms at 50, not 40," The New York Times, November 17, 2009. A detailed summation of the controversy is found in The Cancer Letter, November 20 and December 4, 2009.
[10]National Public Radio, All Things Considered, November 16, 2009.
[11]Richard H. Thaler, "Gauging the Odds (and the Costs) in Health Screening," The New York Times, December 20, 2009.
[12]acog Practice Bulletin, "Clinical Management Guidelines for Obstetrician-Gynecologists," Number 109, Obstetrics & Gynecology, December 2009; Denise Grady, "Guidelines Push Back Age for Cervical Cancer Tests," The New York Times, November 20, 2009.
[13]Robert D. Truog, "Screening Mammography and the 'R' Word," The New England Journal of Medicine, December 24, 2009.
[14]World Scientific, 2007.
[15]"Health Reform: The Fateful Moment," The New York Review, August 13, 2009.
[16]Theodore Marmor, Jonathan Oberlander, and Joseph White, "The Obama Administration's Options for Health Care Cost Control: Hope versus Reality," Annals of Internal Medicine, April 7, 2009; Donald M. Berwick, "Measuring Physicians' Quality and Performance, The Journal of the American Medical Association, December 9, 2009. A layman's journey seeking care abroad is described in the lively book by T.R. Reid. The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care (Penguin, 2009). Concerning the uproar in Britain about poor cancer outcomes, see Nick Triggle, "NHS Must Get Better at Early Cancer Diagnosis," BBC News, November 30, 2009; Rebecca Smith, "Cancer Care on the NHS Falls Behind the Rest of Europe," The Daily Telegraph, November 30, 2009; NHS Department of Health, "Cancer Reform Strategy: Achieving Local Implementation—Second Annual Report," December 1, 2009.
http://www.nybooks.com/articles/23590
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http://news.yahoo.com/s/ap/20100204/ap_on_he_me/us_health_care_government_role_1;_ylt=AmE.saQYdwidM0OYXkG9N9.yQLN_;_ylu=X3oDMTE2Z2Zxc242BHBvcwMxBHNlYwN5bi1yLWItbGVmdARzbGsDZXYtZ292J3R0b3Bh
We often see criticisms that Obamacare will mean the govt is taking over 16% of GDP. Actually this is rather misleading-- even without BO Care, the govt will shortly be paying over 50% of health care-- and the Medicaid and Medicare disasters are still coming down the rails. We are in denial. We consume more than we produce. Entitlements already in the pipeline are accelerating the speed and momentum of the impending disaster. We are lemmings headed for a cliff.
Prepare to have your assumptions shattered.
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I got a request recently for a prescription for a hospital bed. Of course it would be billed to Medicare.
Pt. walks with a cane and does have medical problems but a hosp. bed?
Someone probably told her to request it as she is entitled to it.
There is simply no end.
OTOH I've read some pieces that come to the conclusion that technological advances on the horizon appear to be slowing and there might be some sloping down to the increases from more technology.
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The cans must *refuse* to participate.
They must negotiate on their terms - not those of the partisan ideologue misleader in chief.
There is not way they will look good, there is no way Bama will allow them to look good, it is at it always is about Bama.
They should have their own meeting have a few of them stand on podiums and have bama sit on a small chair down in the pit and manipulate and paraphrase, and distort everything he says to fit their own narrative.
They must NOT be stupid again and do this. Let the crats claim they are calling them on being obstructionist. They cna easily argue this away. They will not win otherwise in such a staged crafted planned trick meeting:
***President Barack Obama is planning to host a televised meeting with Republican and Democratic congressional leaders on health care reform.
The Feb. 25 meeting is an attempt to reach across the aisle but not a signal that the president plans to start over, as Republicans have demanded, a White House official said.
“I want to come back [after the Presidents Day congressional recess] and have a large meeting — Republicans and Democrats — to go through, systematically, all the best ideas that are out there and move it forward,” Obama said in an interview with Katie Couric during CBS’s Super Bowl pre-game show Sunday.
Obama said he wants to “look at the Republican ideas that are out there.”
“If we can go, step by step, through a series of these issues and arrive at some agreements, then, procedurally, there’s no reason why we can’t do it a lot faster the process took last year,” he said.
In a statement, the official said, “What the president will not do is let this moment slip away. He hopes to have Republican support in doing so — but he is going to move forward on health reform.”
Obama first suggested reopening talks with Republicans during his State of the Union address last month, and reiterated the call at a Democratic fundraiser Thursday, but the White House had kept details of his plan under wraps until Sunday.
The idea has been met previously with skepticism by the congressional leaders of both parties. Republicans say they see little room for compromise because the bill should be scrapped, while Democrats argue they have already tried a bipartisan approach, but failed.
But since the Democratic loss in the Massachusetts Senate race, Obama has been forced to rework his legislative strategy – both by striking a more bipartisan tone, and returning to his campaign pledge of providing more transparency. He’s been dogged by questions about why he failed to live up to his campaign promise of televising the health care negotiations on C-SPAN.
The half-day meeting will take place at Blair House, and be broadcast live, presumably by C-SPAN, making it the first televised White House meeting involving the president since a forum last March.
There were 11 other roundtable discussions, usually led by White House health care reform director Nancy-Ann DeParle, that were webstreamed and, in some cases, carried live by C-Span.
“While he’s been very clear that he supports the House and Senate bills, if Republicans or anyone else has a plan for protecting Americans from insurance company abuses, lowering costs, reducing prescription drug prices for seniors, making coverage more secure, and offering affordable options to those without coverage, he’s anxious to see it and debate the merits of it,” the White House official said.
Legislators from both parties applauded the meeting, while holding to their positions on the health care legislation.
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The opposers of the policy can send a thundering message. Do not attend..........then do their own program.
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In my opinion.
Well I like and usually agree with Dick Morris but I don't agree that his GOP proposals for containing the cost of health care is even remotely enough. Of course as a doctor I like the idea of tort reform. And contrary to Bama's contention there is no evidence it would reduce costs, anyone with half a brain knows it would. But how much it would do so I admit I don't know. I don't know it would be gigantic, but it certainly could be substantial/significant.
What about the opening of insurance markets across state lines? (One of the favorite memorized and for lack of anything else to offer lines from the car salesman Hannity.) In addressing that idea I have included a bloggers (JIMH) rebuttel (see after Dick's piece) and tend to agree with him. I really don't see how this would work at all. It makes no sense. Why is my being able to buy insurance from say a company in Idaho going to bring down my costs here in NJ without simply increasing that company's premiums.
While Dick sounds off against rationed care there is simply no other way to reign in costs without someone rationing care.
Even now private insurers try to do it and cannot control costs.
As for doctor pay what can I say?
My colleague cardiologists are whining (and understandably so) about a 36 to 40% pay cut from Medicare. They say I should be happy with a 1% pay raise! Of course they could care less I've already had my pay cut for years and they tend to make anywhere from 200 to 1000 % more than me at this time and even after their pay cuts will do multiple times more than me.
Recently I reviewed a case for an administrative position. I ten year old congenitally disabled and deformed child. He is less than four feet tall and weighs 40 odd pounds. He lives at home on a breathing machine and a feeding tube. He has and requires 24 X 7 care. One hears the ethicists and religious types emphatically pointing out this child's, this human beings Right to whatever care is available to stay alive. One can feel the pain the parents feel when one reviews his medical bills - over 1.25 milliion over five years. Yet there is an opposite ethical argument that can be made. It may and would sound monstrous to some. Yet think of the care that is not afforded to others because of the cost of this one child who is so mentally as well as physiccally deformed he must have no clue what is even going on - and that is 166,666 people could have a $70 yearly annual preventative physical exam paid for for that sum of money.
Before we grandstand about how much we are against rationing care lets pause and think about what we are saying and doing.
GOP’S HEALTHCARE MOMENT
By Dick Morris 02.10.2010 Published on TheHill.com February 9,2009
President Barack Obama has so lowered expectations for the Republican Party that if they come to the healthcare summit he has called at the White House with concrete and well-articulated proposals, it will blow the country away. Repeatedly, the president has fashioned the GOP as the party of “no,” goading them by saying, “If you have any ideas, bring them on.”
Well, let them do it.
Republicans need to be on their toes and aggressive in the meeting and not let it devolve into a question-and-answer session with the president hogging the mike. He asked for a meeting, not a lecture or a media conference, and Republicans need to demand equal time to present their ideas.
Start with tort reform. The Republicans need to explain how much of the unnecessary medical costs are being driven by useless tort litigation. In Mississippi, where they acted to preclude much of it, malpractice premiums have declined by 50 percent.
The GOP needs to explain to the nation that when the president says he is going to cut costs by eliminating tests that aren’t necessary, he is catching doctors in a vise. On the one side, they have the government prohibiting or discouraging them from tests, and on the other, the trial-lawyer bar waiting to pounce on them for failing to administer the proper tests if their care has a bad outcome.
The Republicans need to make the cost-cutting part of the healthcare summit about tort reform, constantly raising the subject as the counter to the president’s proposed $500 billion cut in Medicare.
Then Republicans need to discuss other cost-saving measures such as allowing health insurance to be sold across state lines and other measures to encourage competition.
Republicans should also zero in on the need for more doctors if we are to expand the number of patients covered. They must articulate the conclusion so much of the nation has come to (but official Washington has never embraced): that you cannot have more patients without more doctors unless you want to impose rationing. They should make the case that you need to phase in coverage for those who are not now covered so that you can increase the supply of doctors and nurses at the same time. Supply must keep pace with demand so that artificial scarcity does not leave the nation short of doctors.
The Republicans need to point out that in Massachusetts, where Romney inflicted a version of ObamaCare on the state, the waiting time to see a doctor in Boston is now 63 days. They need to stress that any rationing will be felt primarily by the elderly and will lead to premature deaths.
Finally, Republicans need to explain their own proposals for reforming healthcare — including Medical Savings Accounts and expansions of current tax breaks to encourage people and small businesses to purchase insurance.
Then, Republicans need to keep up a steady drumfire of criticism of the president’s proposals. They need to:
• Attack the proposed cuts in Medicare.
• Criticize the individual mandate as unconstitutional and paint a vivid picture of how much it will cost young families.
• Demand that young people be permitted to purchase catastrophic coverage to satisfy any mandate, rather than full coverage they don’t need.
• Spell out, in detail, how the tax on medical devices will raise the cost of pacemakers, automated wheelchairs, arterial stints, prosthetic limbs and all manner of necessary medical equipment.
• Attack the proposal to make a taxpayer spend 10 percent of his income — as opposed to 7.5 percent at present — on medical expenses in order to deduct them. Expose this tax as a tax on the sick.
• Criticize the idea that people could be imprisoned for failing to have health insurance or paying the fine the legislation imposes. There is a big difference between tax evasion and failing to have health insurance.
With proper preparation, the Republicans can turn this healthcare summit into a nationally televised town meeting such as those that frustrated Democratic congressmen last August.
JimH on February 10, 2010 12:03 pm
Selling insurance across state lines will not work. The majority of insurance policies sold today are sold with a preferred provider network, aka PPO. What good does a policy I can purchase in Maine do me if I live outside the geographical service area of the network? I’ll be covered but out-of-network, with a higher deductible and out-of-pocket expense. Also, by living in an area where medical costs are higher than in Maine, what claims I do have will eventually have an effect on the the premium structure of the company. The insurer will have to raise premiums to account for the increased cost of my claims. Health insurance needs to be deregulated and we have to get back to the old indemnity style plans where there is no first dollar coverage. That will bring costs down because it will make people more cautious with their money and less likely to abuse the medical system for things such as colds and flu.
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"What good does a policy I can purchase in Maine do me if I live outside the geographical service area of the network?"
What good would it do the insurance company to have a network outside the State in which it is allowed to operate?
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being free has a price, that price is dying free. I have lived most of my life without coverage, I see no need to worry if I do or don't have coverage. If I am in an accident, I will probably get life saving treatment at one of the teaching hospitals, but that will be way better than 99% of humanity that has lived before me. If I want coverage, I find a job that gives it to me, or make arrangements thru the many plans that are out there. To be blunt, I would rather die than allow the government that degree of control of my life. Your average High School graduate with a full bag of science electives can give better health care than any doctor who gained his credentials prior to the Civil War.
This health care thing is just a boogey man that both sides of the political issue are raising to distract everyone from the real issues.
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[youtube]http://www.youtube.com/watch?v=0PqfXc4XtXM&feature=player_embedded#[/youtube]
What if you were injured and developed severe pain that wouldn't go away? Would your government let you take the kind of pain medication you need? If federal officials follow the recommendation of a Food and Drug Administration panel, many of the most effective prescription painkillers—including Vicodin, Percocet, and countless generics—would be banned.
Scott Gardner says that kind of a move would be "intensely cruel."
"I took Vicodin for three years," says Gardner. "I needed it. It got me through a very tough period of my life." The tough period began after a cycling accident shattered the left side of his body. After eight surgeries and countless hours of physical therapy, Gardner's once active life is now filled with limitations. He suffers from chronic pain that prevents him from sleeping more than a few hours at a time, and yet his pain today is nothing compared to the agonizing days and months following his accident.
"When there's nothing but pain, there's no reason to live," says Gardner. "There were times where the only way I could stay sane and civil was because I could take painkillers."
The fear of addiction and abuse already makes many suspicious of pain medication. Media reports about celebrities like Rush Limbaugh or Matthew Perry suggest that it's common for people to become addicted to medications they once took for legitimate medical conditions. And countless public service announcements remind us of the dangers of prescription drug abuse.
Now the old fear of prescription drug abuse takes a new twist. The FDA panel is targeting drugs like Vicodin and Percocet because they contain acetaminophen, a popular painkiller also found in many over-the-counter drugs. Panel members warn that some Americans ingest too much acetaminophen, and overdoses can lead to liver damage, even death.
But maybe the FDA panel isn't putting this threat into context. After all, mundane threats like falling down stairs claim more lives than acetaminophen overdoses. And it turns out the more common fear—that patients will become addicted to prescription drugs—is also overblown. In fact, the barrage of warnings we hear about prescription drugs obscures an important point—people saddled with severe chronic pain need these painkillers.
Says Gardner, "I think people who haven't dealt with pain don't really know what it's like."
"Don't Get Hurt" is written and produced by Ted Balaker, who also hosts. The director of photography is Alex Manning, the field producer is Paul Detrick and the animation in the piece is from Hawk Jensen.
Approximately five minutes.
For iPod, HD, and audio versions of this and other videos, go to Reason.tv.
To watch this video on Reason.tv's YouTube channel, go here. If you subscribe to the channel, you can also get automatic notifications when new videos go live.
Related video: When Cops Play Doctor: How the Drug War Punishes Pain Patients.
For Reason.com's coverage of "opiophobia," or overblown fears by the government about prescription painkillers, go here.
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Editorial Exegesis
"Those unversed in the arcana of Congressional procedure should familiarize themselves with 'reconciliation.' It's just another word for nothing left to lose -- that is, it's the tactic Democrats seem increasingly likely to use to bypass the ordinary legislative rules and railroad ObamaCare into law with a bare partisan majority of 50 Senators, plus Vice President Joe Biden. Speaker Nancy Pelosi announced ... that Democrats 'have set the stage' for reconciliation. 'It's up to us to make sure the public knows that this is not extraordinary,' she said. 'It would be a reflection on us if we could not convince people that this is not an unusual place to go.' Yet the reconciliation gambit really would be unprecedented for social legislation of this cost and scale. And as a matter of procedure, it would also be unusual, to say the least. As Mrs. Pelosi's senior health adviser, Wendell Primus, explained ... House Democrats would pass a series of 'fixes' to the Senate bill. The Senate would then pass the House reconciliation bill, sending amendments to President Obama to a bill that -- strictly speaking -- didn't exist, because it hadn't yet emerged from the House. The House would then retroactively pass the Senate bill as is. Democrats say this will all be kosher as long as Mr. Obama signs the Senate bill before he signs the reconciliation bill. 'There's a certain skill, there's a trick,' Mr. Primus conceded, 'but I think we'll get it done.' So even as Democrats themselves acknowledge that one reason the public hates ObamaCare so much is the corrupt tactics they have used to advance it through Congress, they still plan to try to land this Pelosian triple-handspring-quadruple pole vault to passage." --The Wall Street Journal
Upright
"Obamacare flunks the first test of any potential federal law: It is not constitutional." --National Review's Deroy Murdock
"It's not a good idea for Republicans to accept President Barack Obama's invitation to a 'bipartisan' health care summit, because it would not advance acceptable health care reform. The only thing it likely would advance would be Obama's propaganda message -- and, thus, his socialist agenda." --columnist David Limbaugh
"It isn't to evil dictators with a lust for power that Americans have been slowly surrendering their autonomy. It is to well-intentioned authorities who believe sincerely that our freedoms must be circumscribed for our own good. ... First Lady Michelle Obama announced what The New York Times called 'a sweeping initiative ... aimed at revamping the way American children eat and play -- reshaping school lunches, playgrounds, and even medical checkups -- with the goal of eliminating childhood obesity.' Nothing in the Constitution authorizes the federal government to take charge of 'revamping the way American children eat and play.' It is only our passivity that makes such an encroachment possible. This used to be the land of the free. Is it still?" --columnist Jeff Jacoby
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A good comeback to 'So what's YOUR health care reform plan?'
Cory Genelin
I've noticed a common rhetorical ploy being used at every echelon of the health care debate, from the President on down to the local coffee shop loudmouth: the assumption of common goals. I hear "Okay, if you don't like our plan to insure the 40 million uninsured Americans, what's your plan (or the Tea Partiers' plan, or the Republicans' plan, or the Libertarians' plan)?"
Sadly, what usually follows is the conservative debater's attempt to (at best) avoid the question or (at worst) justify conservative solutions by the standards of the liberals. "Well, you see, our plan would eventually cut cost which would then encourage . . . ." Instead, the conservative debater would do well to square off against that opening ploy and deal with it directly before moving on.
That question "If you don't like our plan to insure the uninsured, what's your plan?" is as logical as Scipio saying to the Carthaginians: "If you don't like my plan to destroy your city, I'd be happy to hear your ideas on how to destroy your city. See, I'm willing to listen and compromise! "
Here's a response I've found both persuasive and illustrative:
"I have no plan to order the lives of the 40 million uninsured. I have no plans for how you should run your life, what insurance you should have, or where you should spend you money; and frankly I find it a little creepy that you have a plan for ordering my private life. And let's face it, you don't plan to insure 40 million Americans, you plan to force the other 250 million Americans to do it."
Happy Hunting.
Cory Genelin
Page Printed from: http://www.americanthinker.com/blog/2010/02/a_good_comeback_to_so_whats_yo.html at February 27, 2010 - 08:48:41 AM CST
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Second Post.
Myth Diagnosis
EVERYONE KNOWS THAT PEOPLE WITHOUT HEALTH INSURANCE ARE MORE LIKELY TO DIE. BUT ARE THEY?
By Megan McArdle
See web-only content:
http://www.theatlantic.com/magazine/archive/2010/03/myth-diagnosis/7905/
IMAGE CREDIT: EDEL RODRIGUEZ
OUTSIDE OF THE few states where it is illegal to deny coverage based on medical history, I am probably uninsurable. Though I’m in pretty good health, I have several latent conditions, including an autoimmune disease. If I lost the generous insurance that I have through The Atlantic, even the most charitable insurer might hesitate to take me on.
So I took a keen interest when, at the fervid climax of the health-care debate in mid-December, a Washington Post blogger, Ezra Klein, declared that Senator Joseph Lieberman, by refusing to vote for a bill with a public option, was apparently “willing to cause the deaths of hundreds of thousands” of uninsured people in order to punish the progressives who had opposed his reelection in 2006. In the ensuing blogstorm, conservatives condemned Klein’s “venomous smear,” while liberals solemnly debated the circumstances under which one may properly accuse one’s opponents of mass murder.
But aside from an exchange between Matthew Yglesias of the Center for American Progress and Michael Cannon of the Cato Institute, few people addressed the question that mattered most to those of us who cannot buy an individual insurance policy at any price—the question that was arguably the health-care debate’s most important: Was Klein (not to mention other like-minded editorialists who cited similar numbers) right? If we lost our insurance, would this gargantuan new entitlement really be the only thing standing between us and an early grave?
Perhaps few people were asking, because the question sounds so stupid. Health insurance buys you health care. Health care is supposed to save your life. So if you don’t have someone buying you health care well, you can complete the syllogism.
Last year’s national debate on health-care legislation tended to dwell on either heart-wrenching anecdotes about costly, unattainable medical treatments, or arcane battles over how many people in the United States lacked insurance. Republicans rarely plumbed the connection between insurance and mortality, presumably because they would look foolish and heartless if they expressed any doubt about health insurance’s benefits. It was politically safer to harp on the potential problems of government interventions—or, in extremis, to point out that more than half the uninsured were either affluent, lacking citizenship, or already eligible for government programs in which they hadn’t bothered to enroll.
Even Democratic politicians made curiously little of the plight of the uninsured. Instead, they focused on cost control, so much so that you might have thought that covering the uninsured was a happy side effect of really throttling back the rate of growth in Medicare spending. When progressive politicians or journalists did address the disadvantages of being uninsured, they often fell back on the same data Klein had used: a 2008 report from the Urban Institute that estimated that about 20,000 people were dying every year for lack of health insurance.
But when you probe that claim, its accuracy is open to question. Even a rough approximation of how many people die because of lack of health insurance is hard to reach. Quite possibly, lack of health insurance has no more impact on your health than lack of flood insurance.
Part of the trouble with reports like the one from the Urban Institute is that they cannot do the kind of thing we do to test drugs or medical procedures: divide people randomly into groups that do and don’t have health insurance, and see which group fares better. Experimental studies like this would be tremendously expensive, and it’s hard to imagine that they’d attract sufficient volunteers. Moreover, they might well violate the ethical standards of doctors who believed they were condemning the uninsured patients to a life nasty, brutish, and short.
So instead, researchers usually do what are called “observational studies”: they take data sets that include both insured and uninsured people, and compare their health outcomes—usually mortality rates, because these are unequivocal and easy to measure. For a long time, two of the best studies were Sorlie et al. (1994), which used a large sample of census data from 1982 to 1985; and Franks, Clancy, and Gold (1993), which examined a smaller but richer data set from the National Health and Nutrition Examination Survey, and its follow-up studies, between 1971 and 1987. The Institute of Medicine used the math behind these two studies to produce a 2002 report on an increase in illness and death from lack of insurance; the Urban Institute, in turn, updated those numbers to produce the figure that became the gold standard during the debate over health-care reform.
The first thing one notices is that the original studies are a trifle elderly. Medicine has changed since 1987; presumably, so has the riskiness of going without health insurance. Moreover, the question of who had insurance is particularly dodgy: the studies counted as “uninsured” anyone who lacked insurance in the initial interview. But of course, not all of those people would have stayed uninsured—a separate study suggests that only about a third of those who reported being uninsured over a two-year time frame lacked coverage for the entire period. Most of the “uninsured” people probably got insurance relatively quickly, while some of the “insured” probably lost theirs. The effect of this churn could bias your results either way; the inability to control for it makes the statistics less accurate.
The bigger problem is that the uninsured generally have more health risks than the rest of the population. They are poorer, more likely to smoke, less educated, more likely to be unemployed, more likely to be obese, and so forth. All these things are known to increase your risk of dying, independent of your insurance status.
There are also factors we can’t analyze. It’s widely believed that health improves with social status, a quality that’s hard to measure. Risk-seekers are probably more likely to end up uninsured, and also to end up dying in a car crash—but their predilection for thrills will not end up in our statistics. People who are suspicious of doctors probably don’t pursue either generous health insurance or early treatment. Those who score low on measures of conscientiousness often have trouble keeping jobs with good health insurance—or following complicated treatment protocols. And so on.
The studies relied upon by the Institute of Medicine and the Urban Institute tried to control for some of these factors. But Sorlie et al.—the larger study—lacked data on things like smoking habits and could control for only a few factors, while Franks, Clancy, and Gold, which had better controls but a smaller sample, could not, as an observational study, categorically exclude the possibility that lack of insurance has no effect on mortality at all.
The possibility that no one risks death by going without health insurance may be startling, but some research supports it. Richard Kronick of the University of California at San Diego’s Department of Family and Preventive Medicine, an adviser to the Clinton administration, recently published the results of what may be the largest and most comprehensive analysis yet done of the effect of insurance on mortality. He used a sample of more than 600,000, and controlled not only for the standard factors, but for how long the subjects went without insurance, whether their disease was particularly amenable to early intervention, and even whether they lived in a mobile home. In test after test, he found no significantly elevated risk of death among the uninsured.
This result is not, perhaps, as shocking as it seems. Health care heals, but it also kills. Someone who lacked insurance over the past few decades might have missed taking their Lipitor, but also their Vioxx or Fen-Phen. According to one estimate, 80,000 people a year are killed just by “nosocomial infections”—infections that arise as a result of medical treatment. The only truly experimental study on health insurance, a randomized study of almost 4,000 subjects done by Rand and concluded in 1982, found that increasing the generosity of people’s health insurance caused them to use more health care, but made almost no difference in their health status.
If gaining insurance has a large effect on people’s health, we should see outcomes improve dramatically between one’s early and late 60s. Yet like the Kronick and Rand studies, analyses of the effect of Medicare, which becomes available to virtually everyone in America at the age of 65, show little benefit. In a recent review of the literature, Helen Levy of the University of Michigan and David Meltzer of the University of Chicago noted that the latest studies of this question “paint a surprisingly consistent picture: Medicare increases consumption of medical care and may modestly improve self-reported health but has no effect on mortality, at least in the short run.”
Of course, that might be an indictment of programs like Medicare and Medicaid. Indeed, given the uncertainties about their impact on mortality rates—uncertainties that the results from Sorlie et al. don’t resolve—it’s possible that, by blocking the proposed expansion of health care through Medicare, Senator Lieberman, rather than committing the industrial-scale slaughter Klein fears, might not have harmed anyone at all. We cannot use one study to “prove” that having government insurance is riskier than having none. But we also cannot use a flawed and conflicting literature to “prove” that Lieberman was willing to risk the deaths of hundreds of thousands. Government insurance should have some effect, but if that effect is not large enough to be unequivocally evident in the data we have, it must be small.
Even if we did agree that insurance rarely confers significant health benefits, that would not necessarily undermine the case for a national health-care program. The academics who question the mass benefits of expanding coverage still think that doing so improves outcomes among certain vulnerable subgroups, like infants and patients with HIV. Besides, a national health program has nonmedical benefits. Leaving tens of millions of Americans without health insurance violates our sense of equity—and leaves those millions exposed to the risk of mind-boggling medical bills.
But we should have had a better handle on the case for expanded coverage—and, more important, the evidence behind it—before we embarked on a year-long debate that divided our house against itself. Certainly, we should have had it before Congress voted on the largest entitlement expansion in 40 years. Unfortunately, most of us forgot to ask a fundamental question, because we were certain we already knew the answer. By the time we got around to challenging our assumptions, it was too late to do anything except scream at each other from the sidelines.
This article available online at:
http://www.theatlantic.com/magazine/archive/2010/03/myth-diagnosis/7905/
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"I have no plan to order the lives of the 40 million uninsured. I have no plans for how you should run your life, what insurance you should have, or where you should spend you money; and frankly I find it a little creepy that you have a plan for ordering my private life. And let's face it, you don't plan to insure 40 million Americans, you plan to force the other 250 million Americans to do it."
That is a brilliant way to put the conservative postion. I have found myself in this spot a couple of times. I wish I had thought of this...I will use it!
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The Right Prescription
Obamacare: Still a Threat to Your Life
By Peter Ferrara on 3.3.10 @ 6:08AM
The true reality of last week's health care summit, what was really going on between the lines, was ugly and scary. I have been deeply involved in these health care debates for almost 30 years, ever since I co-authored the first paper published on Health Savings Accounts (HSAs) with John Goodman in 1981. What the health summit made clear to me is that the Democrats do not understand what the Republicans are talking about on health care. Indeed, they have no idea what the American people are talking about either, or why growing majorities of us oppose what they are trying to do.
But it gets even worse. The health summit made clear that the Democrats do not understand what they themselves are doing on health care. They have been misled and manipulated by left-wing ideologues.
Why Your Life Is At Risk
Let me reveal my personal stake in this health care debate. My life is at risk. So is yours, as well as the lives of our children, our parents, and everyone else in our families. For the thorough government takeover of health care in America the Democrats are feverishly pursuing, and the outdated socialized medicine policies from other countries they are so religiously committed to adopting, would trash the very ability of the system to provide the health care many of us are likely to need in coming years to extend our lives, and to maintain our basic quality of life.
The decimation of our health care system under Obamacare begins with government mandates, regulations, bureaucracies, and controls. The House and Senate health care bills that President Obama and the Democrats refuse to take off the table create close to 100 new health care bureaucracies, boards, commissions and programs. This is the government takeover of health care.
These new authorities arrogate to the government the power to decide "what works" in health care, and what doesn't. The code words they use include "best practices" -- a government bureaucracy in Washington is going to decide what are the "best practices" in providing health care for you and your children, not you and your doctor. Another code phrase is "reward doctors for quality not quantity." Government bureaucracies in Washington do not know how to do this. But they will make a huge mess out of your health care in trying to.
These government bureaucracies will also have the power to cut off your health care when they decide it is no longer worth the money. We have already seen a glimpse of this in the declaration by a bureaucracy, to be expanded with more powers under Obamacare, that women over 72 should not have mammograms. What they are saying here is that if you are over 72 and get breast cancer, they don't want to know about it. Just take the painkiller and go home, to paraphrase President Obama. They believe they can buy more votes taking the money for your care and spending it somewhere else. This is called "cost effectiveness."
The destruction of the health care system is then expanded through the payment system. Among the code words here are "pay for performance" and "accountable care." This is how the bureaucracy will enforce its dictates concerning what works and what doesn't, best practices, cost effectiveness, and termination of health care no longer deemed worthy. Doctors and hospitals will be rewarded through payments if they follow the centralized bureaucracy's dictates; they will be penalized with reduced payments if they don't. You will never know what happened to you. The doctor is not going to tell you, "I could have saved your daughter's life with this new treatment, but that is not yet a best practice according to the government."
Health care obliteration then continues by constricting the payments overall to doctors, hospitals, specialists, surgeons, health care innovators, and other health providers. This is where the $500 billion in Medicare cuts come in, which is $800 billion in the first 10 years of full implementation under Obamacare. Seniors will soon find out that constricted payments mean constricted services, because President Obama has already begun cutting payments under Medicare, particularly for cancer and heart specialists, treatments, and diagnostics. But this is just part of the constricted payments to the entire health system under Obamacare, which is how President Obama thinks he will bring the cost curve down. The sad truth is that the only cost control in Obamacare involves health care rationing, which means denying you health care. Those union orchestrated sad sacks marching in the streets chanting for "health care" are suckers.
The final component ultimately leaving us with Potemkin Village health care is the effect of all of this on investment incentives. Nobody is going to invest the capital necessary to develop the new, life-saving health care treatments and technologies and miracle cure drugs, and build the new facilities and purchase the new equipment to provide them, with the constricted payments of Obamacare as their reward. That money will instead join the capital fleeing to build new factories providing good jobs in the increasingly booming economies of Brazil, India, and China.
We can begin to see these effects of Obamacare in Massachusetts, which adopted some of the Obamacare policies a few years ago. As John Goodman writes in his Health Alert ("Scaling the Summit") for February 26, "As a result, the waiting times to see a new doctor in Boston are twice as long as in any other U.S. city. And there are still as many people going to emergency rooms for care in Massachusetts today as there were before the Massachusetts health plan was adopted."
But none of the supporters of Obamacare -- the bloggers, the talk show hosts, the literal clowns like Bill Maher, Jon Stewart and Wanda Sykes that now get media coverage to lecture us on public policy -- understand any of this. They have their heads firmly and deeply stuck in the sand, and insist it is all made up. And as for Democrat members of Congress, they don't have a clue.
Fighting for Their Lives
But when their own lives are at risk, suddenly they can understand it quite well. Consider the case of Danny Williams, age 60, Premier of Newfoundland, Canada, who secretly snuck into the U.S. for his own heart surgery. After his surgery at Mount Sinai Medical Center in Miami, Williams told reporters, "This was my heart, my choice, and my health. I did not sign away my right to get the best possible health care for myself when I entered politics."
Why Williams felt he had to come to America was further illuminated by the recent heart surgery of former President Bill Clinton. As Dr. Marc Siegel explained in the New York Post,
Clinton, of course, got the best of care -- a cardiac stent (a tiny metal cylinder) coated with a drug to help keep his artery open. Recent studies in the New England Journal of Medicine and elsewhere have shown that these drug-eluting stents are more effective than bare metal ones. But they cost two-to-four times more -- and the technology is relatively new. That combination has left government run health-care systems slow to adopt them….Per capita, our neighbors to the north receive only half as many coronary [operations]. And only 30% of the stents placed in Canada are drug-eluting, compared to a whopping 80% in the United States. So a Canadian cardiac patient is less than a quarter as likely as an American to be outfitted with the kind of state-of-the-art stent that Clinton had. In Canada, land of single payer health insurance, you're also less likely to get the stent as soon as the need is clear.
Wanda Sykes owes Sarah Palin an apology.
Why Your Country Is at Risk
The Health Care Summit highlighted another issue that too many of us too easily conceded. House Republican Budget Chief Paul Ryan articulately exposed Obamacare as increasing the deficit by $460 billion over the first 10 years, and $1.4 trillion over the second 10 years. That is with half a trillion in tax increases, and half a trillion in Medicare cuts, over the first 10 years alone.
One of the chief tricks to hide these deficits is to provide for reversing some of the draconian cuts for doctors and hospitals in a separate bill scored as increasing the deficit by $371 billion. The Obamacare legislation also counts on raiding $52 billion in Social Security revenues. Still another trick to claim deficit neutrality is to count the 10 years of tax increases and Medicare cuts against only 6 years of increased Obamacare spending.
While we can't pay for all the entitlement programs we already have, Obamacare adds a new entitlement providing handouts to help pay for health insurance for families with incomes as high as $88,000 a year. That is why the true 10 year cost for Obamacare is really $2.3 trillion, as Ryan explained.
Filibuster Falsehoods
The ugly in the health care summit was the transparent trap President Obama and the Democrats laid for the Republicans. Obama was not the least bit interested in anything the Republicans had to say. He filibustered for 119 minutes of the summit, talking more than all the rest of the Democrats combined at 114 minutes. The Republicans were allowed only 110 minutes to speak altogether.
And as we have seen over and over on health care, much if not most of what President Obama had to say during his filibuster was just not true. The most embarrassing was the exchange with Sen. Lamar Alexander over whether Obamacare would cause health insurance premiums to rise. After Alexander cited CBO as saying they would, Obama imperiously disputed him as "not factually accurate," and then launched into a confused and convoluted argument as to why CBO had really said health insurance premiums would be going down. "But they didn't say that the actual premiums would be going up," Obama insisted. "What they said was they'd be going down by 14 percent to 20 percent." He insisted that he was sure he was right, and that he had gone over and over this with CBO, challenging Alexander to resolve the issue publicly "before we leave today" because "this is an example of where we've got to get our facts straight."
And so it was resolved before they left that day when Sen. Jon Kyl read from the CBO report saying that premiums would indeed rise under Obamacare, and Rep. Eric Cantor tried to explain to President Obama, "We just can't afford this. This government can't afford it, businesses can't afford it." Obama then retreated to saying, well, the premiums would be higher because his plan mandated richer benefits. But that is a concession that premiums would, in fact, be rising, not a demonstration that they would be falling. In fact, premiums will soar by much more than CBO admits, as much as 100% to 200% for young workers, as mathematically demonstrated in studies by WellPoint and others, which Obama and the Democrats have refused to even consider. Yes, the whole point is that premiums would be rising because of the benefits that the Democrats would mandate. And what the public and the critics have been telling them is that we can't afford those increases, and that in many cases the same can be achieved by different means.
President Obama and HHS Secretary Kathleen Sebelius perpetrated another falsehood in criticizing high risk pools, which, when done right, provide a safety net for the uninsured who have become too sick to buy insurance anywhere else. When you concentrate all the high cost risks in one pool, Sebelius insisted, then costs in that pool become very high, and it becomes too expensive for people. But the risk pools are all subsidized by tax funds precisely because those covered by the pool can't be expected to pay all the costs themselves. The point many conservatives and Republicans have been trying to make is that rather than trying to force these high cost uninsured onto the same insurance as everyone else, and massively increasing everyone's premiums as a result, provide them their own risk pool charging no more than they can afford, and subsidize remaining costs so that the pool is a real safety net ensuring that no one need lack essential health coverage and care. Experience shows this can be done at modest cost.
But the greatest ignorance of the day was reflected when President Obama said that a "high deductible plan" is "basically not health insurance." High deductible health plans are the only real insurance, spreading the risk of the high costs affecting only a few in any one year among the entire pool. It is the retro low deductible plans, covering routine yearly expenses that most incur, that are not health insurance, but prepaid health care involving enormously counterproductive incentives and unnecessary costs. Understanding this is essential to solving the health cost problem, but, again, Obama and the Democrats have no clue.
Instead, they repeated the canard that Health Savings Accounts are not workable for the poor, when the truth is they benefit the poor the most. An HSA includes a savings account that can be used to pay for expenses below the deductible. The poor are most in need of the savings they can keep if they don't waste money unnecessarily on health care. What Democrats don't like about HSAs is that they put the patient rather than the government in charge.
Those Who Live by the Reconciliation, Die by the Reconciliation
What was really going on at the summit was reflected in the persistent, obviously pre-arranged, transparently false theme among the Democrats that, hey, you know, we are not really that far apart, there is really a lot of agreement. That was meant to set the Republicans up so the Democrats could say afterward that the Republicans refused to support Obamacare simply for partisan, political reasons, or because they really were in the pocket of industry, and so the Democrats are justified in ramming it through without them, through reconciliation. That was the real point and goal of the summit.
That didn't work because the Republicans were surprisingly good in articulating their reasons for opposing the legislation, and those reasons resonated strongly with the American people. By giving the Republicans such a high profile forum to express these reasons and their far more common sense alternatives, the summit backfired into yet another disastrous loss for Obamacare.
Reconciliation is a process solely for enacting budgetary measures to reduce the deficit, not sweeping, historic reforms involving adoption of the costliest new entitlement in history. Proceeding with President Obama's health care overhaul through reconciliation would flout Congressional rules way beyond any historical precedent.
But what is adopted by reconciliation can and will be repealed by reconciliation, setting a precedent for future entitlement reforms using the same process.
Letter to the Editor
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Peter Ferrara is director of entitlement and budget policy at the Institute for Policy Innovation, a policy advisor to the Heartland Institute, and general counsel of the American Civil Rights Union. He served in the White House Office of Policy Development under President Reagan, and as Associate Deputy Attorney General of the United States under the first President Bush. He is a graduate of Harvard College and Harvard Law School.
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"And so it was resolved before they left that day when Sen. Jon Kyl read from the CBO report saying that premiums would indeed rise under Obamacare, and Rep. Eric Cantor tried to explain to President Obama, "We just can't afford this. This government can't afford it, businesses can't afford it." Obama then retreated to saying, well, the premiums would be higher because his plan mandated richer benefits."
That's interesting! Not one peep of this in the main stream propaganda machine.
Their pundits, and "news" anchors all came out in a chorus and said Obama stood his ground. One even said something to the effect that the chosen one shot down all of the Republican attempts to "rattle him".
From now on when anyone disagrees with the One they need to tell *him* he needs to get the facts right.
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Reconciliation is still the buzzword on Capitol Hill as Democrat "leaders" Harry Reid and Nancy Pelosi try to figure out how to ram ObamaCare down our throats. Not that they see it that way; as House Majority Leader Steny Hoyer put it, "That's not ramming something through with a majority. It is doing what democracy calls for." Well, this isn't a democracy, it's a republic: and the Founders set it up that way for a reason.
Accompanied by his teleprompter, Barack Obama began a renewed push for a vote on the health care bill by Easter when he met a group of people wearing lab coats in the Rose Garden on Wednesday (and he accused Rep. Eric Cantor of using a "prop" by bringing the 2,400-page bill itself to last week's health care summit). Obama claimed that "new and improved" legislation "incorporates the best ideas from Democrats and Republicans." As we said Tuesday, however, the problem isn't whether the bill is "bipartisan." A few Republican ideas sprinkled in won't fix it. The problem, at its core, is that a plan for Congress to take over one-sixth of the U.S. economy is unconstitutional.
In the face of all evidence, the teleprompter continued, "I don't believe we should give government bureaucrats or insurance company bureaucrats more control over health care in America." Huh? Giving government bureaucrats control over health care in America is precisely what Obama is proposing to do.
For all the talk about reconciliation in the Senate, the House vote may be the more important one. The Associated Press reports, "The House passed health overhaul legislation by a narrow 220-215 vote in November, but since then several Democrats have defected or left the House. To avoid a filibuster in the Senate that Democrats can't defeat, Obama is now pushing the House to approve the Senate's version of the bill, along with a package of changes to fix elements of the Senate bill that House Democrats don't like, including a special Medicaid deal for Nebraska and a tax on high-value insurance plans that is opposed by organized labor."
If Pelosi is able to strong-arm the Senate bill through the House with a bare majority, Senate reconciliation becomes moot. With three vacancies, Democrats need just 217 votes for passage, and there are a handful of Democrats who voted "no" in November who now say they're undecided. On the other hand, 12 pro-life Democrats, led by Bart Stupak of Michigan, say they're prepared to switch sides and scuttle ObamaCare if sufficient protections against abortion funding aren't put in place. The Senate bill doesn't meet their benchmark.
Never underestimate this president's lack of shame, though -- or his penchant for Chicago-style politics. For example, Rep. Jim Matheson (D-UT) voted against ObamaCare in November, but he is now "undecided." So on Wednesday, Obama nominated Jim's brother Scott to the 10th Circuit Court of Appeals. Offering jobs for playing the White House way is nothing new, and Scott Matheson is, to be fair, a well-credentialed nominee. However, even the appearance of selling judgeships for health care votes would give pause to a more honorable president.
As for leftist sentiment, perhaps MSNBC host Ed Schultz best summed it up this week, saying, "mall government has never gotten anybody any health care."
"The Republicans have a choice," Schultz declared. "Lead, follow or get the hell out of the way. ... We have people in need and they need to be helped."
Memo to Ed: If government would get out of the way, those people might be able to help themselves, as our Founders intended. Democrats aren't about to let that happen because it really isn't about helping those in need.
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One Giant Government Leap Backwards
With Obamacare, the government is selling a product that the rest of the country doesn’t want.
Rather than a post-partisan olive branch to congressional Republicans and the American public, President Obama’s latest health-care speech was a declaration of war. He’s more than willing to use a 51-vote reconciliation majority to jam through a roughly $2 trillion health-care plan that amounts to a government takeover of nearly one-fifth of the economy. He’s prepared to stick Uncle Sam right in the middle of the age-old relationship between patients and doctors, and doctors and hospitals, all while subjugating the private health-care insurance system to the status of a government-run utility — without bending the cost curve downward.
More spending. More tax hikes on investors, businesses, and individuals. New government boards to control prices, ration care, and redistribute income. The Obama administration is basically taking a giant government leap backwards that the country doesn’t want to take.
One of the most galling features of this plan is a taxpayer-subsidized government-insurance entitlement for people earning up to 400 percent above the poverty line, or nearly $100,000 for a family of four. In other words, a middle-class health-care entitlement that will add millions of people to the federal dole. It’s all too reminiscent of the political dictum of the old New Dealer Harry Hopkins: tax and tax, spend and spend, elect and elect.
The spending has been well chronicled by congressman Paul Ryan, who baffled President Obama at the so-called health-care summit with his cogent analysis of a ten-year cost of $2.3 trillion that sets a floor, rather than ceiling, for the likely expense of this entitlement package. Obama had no rebuttal.
On taxing, let’s not forget that the current health-care payroll tax of 2.9 percent will be expanded to cover all forms of investment and capital formation, on top of the repeal of the Bush tax cuts. The anti-growth consequences are incalculable. As the late Jack Kemp used to say, you can’t have capitalism without capital.
The White House says job creation is priority number one. But you can’t have new jobs without healthy businesses. And healthy businesses require investment. However, by taxing investment more we’ll get fewer jobs, reduced real wages, and slower economic growth.
And how stupid is it for the president to support a six-month payroll-tax cut for small businesses in the name of job creation while imposing a 1 percent permanent increase in that very same tax to fund the massive new health-care entitlement. Talk about self-defeating.
Oh, by the way, a government takeover of health care will cripple one of our most productive job-creating sectors. Over the deep two-year recession, while overall corporate payrolls fell by about 7.5 million, private health-care firms created almost 700,000 new jobs.
And the health-care industry is one of our fastest-growing, most technologically advanced areas. With constant breakthroughs in biotech, pharmaceuticals, medical equipment, and diagnostics, the growing demand for more health care could elevate this prosperous job-creating sector to a third of the economy in the decades ahead. What’s wrong with that? Why crush it?
Health-care reform was supposed to be about getting 10 million low-income, chronically uninsured people some health insurance. But that can be solved by playing small ball. Health-care reform also was supposed to slow down cost increases. But that will never happen until the third-party payment system, run by Big Government and Big Business, is replaced by true consumer choice and market competition.
Just give consumers the tax break, and let them shop across state lines to find the right insurance plan. And young people who are already paying taxes into Medicare should not be mandated to pay more taxes into this entitlement plan. The young will pay for health insurance when they’re ready to pay for it.
Clearly this new New Deal, or new Great Society, or whatever it is, is the government selling a product that the rest of the country doesn’t want. Ironically, polls show that roughly 80 percent of voters believe their health insurance is satisfactory, good, or excellent. Polls even show that the public knows that a simple majority vote on reconciliation is an insufficient check on runaway government.
The Byrd rule says that reconciliation is for budget control and deficit reduction. But the Obama Democrats think they can use reconciliation to install a massive new social policy that would emulate the socialist-labor entitlement state now prevalent in Western Europe. As the Greece crisis amply shows, that entitlement state is on the verge of bankruptcy.
Perhaps Obama’s throwing down the gauntlet on nationalized health care will be the political gift that keeps on giving, in terms of political regime change come November. But if Obamacare does pass, a future rollback will be very difficult, and American health care and economic prosperity will be put in grave jeopardy.
— Larry Kudlow, NRO’s Economics Editor, is host of CNBC’s The Kudlow Report and author of the daily web blog, Kudlow’s Money Politic$.
http://article.nationalreview.com/427062/one-giant-government-leap-backwards/larry-kudlow
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Entitlement state
I psoek with one of my patients who lived through the 30's. I said I thought times must have been terrible with bread lines etc.
I asked him though if times were in some ways worse now or worse then.
Many people now really question the future viability of the US. Did people think that then?
He thought about it while answering. He didn't say yes or no. Just that it was really a "different" world back then.
People didn't expect what they expect now. They were [hardier]. they learned to go through garbage dumps. They grew their own food in gardens.
No one expected unemployment, pensions, free health care, medicare, social security.
So I guess they didn't look at the future of the US as being in jeopardy as we do today.
I guess we didn't have the foreign threats we have now as well.
I asked him which is worse:
People on bread lines or a government that keeps expanding doles?
He didn't answer. I think he just didn't have a chance to think it over.
To me this is the prime question facing us today (at least on the domestic front).
I
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Myths about Reconciliation
Using reconciliation to pass Obamacare would be inappropriate and unprecedented. Here’s why.
How could you tell when the Democrats had finally settled on the reconciliation route? It was at some point between the time Harry Reid told Republicans at the health-care summit that “nobody has talked about reconciliation” and the time the White House stopped uttering the word altogether.
But though their diction has changed, the Left continues to perpetuate a number of myths about reconciliation that should be dispelled before Democrats in Washington use the procedure to force-feed the American people this $2.3 trillion behemoth.
Myth: Reconciliation is simply “majority rule.”
Democrats have referred to the maneuver that dare not speak its name as simple “majority rule.” In his March 3 speech, President Obama called for an “up-or-down vote” on health-care reform requiring “nothing more than a simple majority.” White House Press Secretary Robert Gibbs told MSNBC the next day that in most American households, “51 percent represents a majority viewpoint. I don’t think that’s a crazy concept.” Ezra Klein claimed that “a simple majority process” has been “key to getting anything done” in the Senate since the 90s.
But this isn’t about lowering the thresholds for passage, as most reconciliation measures initially pass the Senate with sizeable majorities — sometimes even by voice vote or unanimous consent. Rather, the process is explicitly about bypassing the Senate’s usual order of business — an open debate and amendment process with an emphasis on consent and consensus and robust protections for minority rights — to ensure the speedy passage of budget-balancing legislation. As a result, reconciliation measures are “privileged,” meaning that the Senate must consider them when they come to the floor. Likewise, debate on their substance is strictly limited to 20 hours and amendments are allowed only insofar as they address the contents of the measure itself (though, as author Foster notes here, there is nothing to stop a determined minority from gumming up the works indefinitely by forcing votes on the germaneness of extraneous amendments).
There is nothing wrong with the principled use of this “front-of-the-line” treatment for measures meant to bring budgetary outlays in line with revenues, but in a Congress that demonstrably no longer takes its duty to balance budgets seriously, reconciliation is once again being abused as a matter of political convenience.
The truth is that every single piece of successful legislation to emerge from the Senate — via reconciliation or otherwise — has done so via a final, up-or-down vote with a 50-plus-one threshold. The debate about reconciliation is a debate about the path to that vote. It’s about whether the Senate is and ought to be something more than a slightly smaller, slightly crustier House of Representatives.
When Harry Reid took over the majority leadership of the Senate, he vowed that “as our founding fathers intended, the Senate will perform its role as the ‘cooling saucer’ where debate and amendments play a role in forging consensus and compromise.”
Would that he lived up to those words.
Myth: Obamacare is in the main about cutting deficits, and therefore justifiably considered under reconciliation.
First, it’s important to understand why reconciliation might be necessary. The Senate bill includes an excise tax on high-cost employer-provided health-insurance plans — the kind that unions have acquired for their members through years of collective bargaining. The inclusion of this tax was almost an accident. Like many Democratic ideas, it started as a way to demagogue against the rich. Only later, after unions started voicing objections, did the Democrats realize what they had done, but by then it was too late. Health-care economists liked the idea of an excise tax on high-cost employer-provided plans, because the fact that these plans are otherwise untaxed is one of the great distortions in our health-care system that drive up the cost of insurance. Plus, the tax provided a real source of revenue to pay for new spending in the bill, thus improving its CBO score. The excise tax — dubbed the “Cadillac tax” by some — proved impossible to remove from the Senate bill without rocking the boat that was moving the bill toward passage.
But in the House, where union-backing progressives are stronger, objection to the tax made rubber-stamping the Senate bill impossible for Nancy Pelosi. Democratic leaders met with President Obama to devise a carve-out to protect the unions from the tax, and they had almost achieved a deal when a certain truck-driving Republican from Massachusetts won an election and upset the balance. Things fell apart for a while. The Democrats panicked. Health-care reform looked dead. Then Obama put forward a plan that would allow the Democrats to scrap the Cadillac tax through reconciliation. That’s where things stand.
As we’ve said, reconciliation is a process devised to ensure an easier process for shrinking budget deficits. Liberals have argued that according to the CBO, Obamacare would reduce the deficit, so amending it through the reconciliation process is appropriate. There are two problems with this argument. First, even taking the administration’s numbers at face value, its reconciliation plan would amend the legislation so that it reduces the deficit by less than the original bill. The CBO has not had time to score the president’s proposal, but the administration says that combined with the original legislation, the president’s plan would reduce the deficit by $100 billion. The CBO scored the Senate bill as reducing the deficit by $131 billion. Neither is a significant sum, but the point is that reconciliation in this case would actually move us backwards in terms of deficit reduction.
Second, the president’s plan replaces new revenue (the Cadillac tax) with revenue that is double-counted and, according to the CBO, cannot be used to offset new spending. Instead of the Cadillac tax, the president’s plan would raise revenue through a 2.9 percent Medicare excise tax on the investment income of people making more than $200,000. But as the CBO noted in objecting to a previous attempt to do this, that money must go into the Medicare trust fund, and the government must use it to pay out future Medicare benefits. It cannot simultaneously count that money as savings to be spent on a new health-insurance entitlement for the uninsured. So the president’s numbers are not to be taken at face value — by replacing Cadillac-tax revenue with double-counted revenue, his reconciliation plan would likely increase the bill’s cost by much more than $30 billion, increasing deficits in a manner contrary to the spirit of reconciliation.
Myth: We already passed health care with 60 votes in the Senate. Reconciliation is just for a few “fixes.”
In his March 3 speech, President Obama said that “reform has already passed the House with a majority. It has already passed the Senate with a supermajority.” Robert Gibbs has said “we got health-care done not with 51 but with 60 votes” in the Senate. By contrast, the Democrats argue, reconciliation will only be used to pass a small package of “fixes” introduced by the president to resolve the House and Senate versions of the bill. Ezra Klein and others have adopted the term “micro-reconciliation” to describe this strategy.
But to say that both chambers have already passed “reform” is deeply misleading, considering that reconciliation is necessary precisely because neither body’s bill is acceptable to the other. Indeed, the greatest impediment to the Democrats’ reconciliation strategy is not the Republicans, but the House’s mistrust of the Senate. Since the Senate acting first to “reconcile” a bill that has yet to become law would create a sort of legislative paradox, the White House and Senate Democrats have spent weeks trying to assure their colleagues in the lower chamber that they won’t be hung out to dry if they act first and pass the Senate bill before the reconciliation measure.
We’ve already noted the excise tax as a major source of tension between the chambers, but the Senate’s more permissive language on the federal funding of abortion is also a non-starter in the House, with Rep. Bart Stupak (D., Mich.) promising that a dozen or more pro-life House Democrats who voted yes on the House bill would balk at the Senate language. Since it will be nearly impossible to shoehorn a compromise into a reconciliation measure, the abortion issue could well doom Obamacare.
In short, the House and Senate are as far away from each other on reform as they were before Massachusetts, only now they’ve lost the supermajority that gave them the luxury of working out their differences in a conference report. So as it stands, there is not one health-care reform bill but two, and neither is in any shape to make it to the president’s desk without reconciliation.
Myth: This is just like when the GOP used reconciliation for the Bush tax cuts.
As we have noted, reconciliation would likely worsen the bill’s impact on the deficit, but the president’s supporters might say, “So what? The Bush tax cuts added to the deficit, and the GOP used reconciliation for those.” Here they have a point. But there are two reasons why health care is different. One, perhaps semantic, is that the Bush tax cuts were temporary — their impact on deficits was limited to the ten-year window specified by the Byrd Rule, which states that reconciliation bills cannot add to the deficit beyond the period covered by the budget resolution. Obamacare is designed to be a permanent new health-insurance entitlement. Second, and more important, is that the Bush tax cuts in addition to being temporary were strictly limited to fiscal policy — the kind of thing reconciliation was designed to handle — and therefore easy to score. As mentioned above, it is hard to know the true budgetary cost of Obamacare, because it is a tangled nest of tax hikes, regulations, twice-counted revenues, and unknowable costs tied to hard-to-predict factors such as health-care cost inflation.
Will Obamacare increase the deficit in a fiscal year after the ten-year period covered by the Byrd Rule? The answer is almost certainly yes. But unlike the Bush tax cuts, Obamacare will not sunset. Unless Republicans are able to repeal it — a difficult task, to put it mildly — its costs will be with us for good.
Myth: This is no different than what the Republicans did on Medicare Part D.
Again, charges of hypocrisy leveled at Republicans who object to using reconciliation to pass health-care measures have some force. It is true that reconciliation has been used more often by Republicans than Democrats since its adoption. And it is true that reconciliation has been used to pass big-ticket health-care measures such as COBRA and CHIP.
But most of the health-care measures passed via reconciliation did so with broad, bipartisan support. And as mentioned above, virtually all of the votes that were tight and/or partisan dealt with straightforward fiscal policy, without the massive unintended consequences that attend to a measure of the size and scope of Obamacare.
Perhaps the closest parallel to the Democrats’ current effort — and the one most often carted out in service of the hypocrisy charge — is Medicare Part D, which passed with 54 votes in a Republican-controlled Senate. But in fact it isn’t much of a parallel at all. For one thing, Medicare Part D wasn’t passed via reconciliation. Rather, Democrats could not or would not sustain a filibuster, and cloture on the conference report was secured 70–29 via the usual order of business. And when then-senator Tom Daschle (D., S.D.) tried to raise a point of order under the Congressional Budget Act — from which reconciliation rules stem — he was overruled with 61 votes.
Moreover, though the Republicans only had 54 votes, eleven Democrats (plus one Independent) voted with the majority, including the likes of Max Baucus, Kent Conrad, Mary Landrieu, Blanche Lincoln, and Ben Nelson.
During the floor debate, then-senator Pete Domenici (R., N.M.) raised the possibility of pursuing the bill under reconciliation, and rejected it:
Let me just tell you, without trying to take much time, that our distinguished leader had an opportunity to move this bill under what is called a reconciliation bill. Do you know what that would have done, Mr. President? That would have limited debate, and it would have made the bill almost not amendable and, indeed, besides that, there would be no points of order. He chose, as the bill progressed through, to do otherwise.
Medicare Part D is hardly a shining example of good legislation, but it passed under the standing rules of the Senate, under which the minority was afforded an open and extended debate. And it passed with significant support from that minority. Neither will be said of Obamacare if it is pushed through via reconciliation.
— Daniel Foster is National Review Online’s news editor. Stephen Spruiell is an NRO staff reporter.
http://article.nationalreview.com/print/?q=YWM3NzZlNWNiODUzOWQ3ZDI3MmE0NDE3YWFjNTM1NTI=
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Very good to see reconciliation broken down like that 8-)
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'Every argument has been made. Everything that there is to say about health care has been said, and just about everybody has said it," President Obama declared yesterday as he urged Democrats to steamroll his plan through Congress. What hasn't been heard, however, is even a shred of White House honesty about the true costs of ObamaCare, or its fiscal consequences.
Nearby, we reprint Wisconsin Republican Paul Ryan's remarks at the health summit last week, which methodically dismantle the falsehoods—there is no other way of putting it—that Mr. Obama has used to sell "reform" and repeated again yesterday. No one in the political class has even tried to refute Mr. Ryan's arguments, though he made them directly to the President and his allies, no doubt because they are irrefutable. If Democrats are willing to ignore overwhelming public opposition to ObamaCare and pass it anyway, then what's a trifling dispute over a couple of trillion dollars?
At his press conference yesterday, Mr. Obama claimed that "my proposal would bring down the cost of health care for millions—families, businesses and the federal government." He said it is "fully paid for" and "brings down our deficit by up to $1 trillion over the next two decades." Never before has a vast new entitlement been sold on the basis of fiscal responsibility, and one reason ObamaCare is so unpopular is that Americans understand the contradiction between untold new government subsidies and claims of spending restraint. They know a Big Con when they hear one.
Mr. Obama's fiscal assertions are possible only because of the fraudulent accounting and budget gimmicks that Democrats spent months calibrating. Readers can find the gory details in Mr. Ryan's pre-emptive rebuttal nearby, though one of the most egregious deceptions is that the bill counts 10 years of taxes but only six years of spending.
The real cost over a decade is about $2.3 trillion on paper, Mr. Ryan estimates, and even that is a lowball estimate considering how many people will flood to "free" health care and how many businesses will be induced to drop coverage. Mr. Obama claimed yesterday that the plan will cost "about $100 billion per year," but in fact the costs ramp up each year the program exists. The far more likely deficits are $460 billion over the first 10 years, and $1.4 trillion over the next 10.
What Mr. Ryan calls "probably the most cynical gimmick" deserves special attention, which is known in Washington as the "doc fix." Next month Medicare physician payments are scheduled to be cut by 22% and deeper thereafter, though Congress is sure to postpone the reductions as it always does. Failing to account for this inevitability takes nearly a quarter-trillion dollars off the ObamaCare books and by itself wipes out the "savings" that the White House continues to take credit for.
Some in the liberal cheering section now claim that this Medicare ruse isn't Mr. Obama's problem because it was first promised by Republicans and Bill Clinton in 1997. But then why did Democrats include the "doc fix" in all early versions of the bill to buy the support of the American Medical Association, only to dump this pricey item later when hiding it would make it easier to fake-reduce the deficit?
The President was (miraculously) struck dumb by Mr. Ryan's critique, and in his response drifted off into an irrelevant tangent about Medicare Advantage, while California Democrat Xavier Becerra claimed "you essentially said you can't trust the Congressional Budget Office." But Mr. Ryan was careful to note that he didn't doubt the professionalism of CBO, only the truthfulness of the Democratic gimmicks that the budget gnomes are asked to score.
Yesterday Mr. Obama again invoked the "nonpartisan, independent" authority of CBO, which misses the reality that if you feed the agency phony premises, you are going to get phony results at the other end.
The President also claimed the reason his plan is in trouble, and the reason Democrats must abuse the Senate's rules to ram this plan into law, is that "many Republicans in Congress just have a fundamental disagreement over whether we should have more or less oversight of insurance companies." So most of Mr. Obama's first year in office has been paralyzed over nothing more than minor regulatory hair-splitting. This is so preposterous that the President can't possibly believe it.
Congress's spring break begins on March 29, and Democratic leaders plan on jamming this monster through Congress before then. Americans have to hope that enough rank-and-file Democrats aren't as deaf to fiscal honesty as this President.
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I remember sick call in the service. I eneded up waiting in line with Wives and Kids who need a splinter removed, but I was running a fever of 104 when I finally got to the "vitals" they immediately jumped me into a room. I was complaining of Itching and these new bumps........ End story I ended up being "Patient 0" for an outbreak of Chicken Pox.
Think about it....................
DMV, Soc. Sec ofice, unemployment, everywhere in government you line up before getting anything. They do not care about a whole bunch of practical details.
The single sick call was broken down into a "More Distributed system for better service" so that the problem I accidentally discovered did not happen again.
The other aspect of this, is the "splinter removal" crowd. Free means there is no cost/benefit analysis on the part of the person who has the Boo-Boo (this isn't bad and it costs too much to see a doctor I will see if it clears up in a couple days) Vs. the Broken and need fixed (whoa that hurt, my arm looks weird, time to go to the doctor). Both these people end up waiting in a "Triage line" which has a majority of splinters, which means the real issues are delayed-maybe for too long........
I have had experince with Health Care done Government style, Like I said earlier..........
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While teaching at Fort Polk I received a nasty cut on my finger tip that needed four stitches. I went to the hospital on base. Things were not busy at all, but it took six hours to get it taken care of.
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Romney interview by Chris Wallace this AM. In general, I like his message about promoting the greatness of America not talking it down like the present guy at the top.
With regard to the topic of health care,
His responses to the charge that the health plan he signed in Mass makes him the wrong guy to be a spokesperson for the Repubs on the issue were totally unconvincing. He danced around the charge that Mass health premiums are 27% higher than anywhere else in the nation. He claimed that the cahrge there is a multimillion dollar cost *overshoot* in the allowed annual budget for health care was wrong and it was the opposite.
He keeps saying that 98% of the people in Mass are insured and he brings up again the person with brain cancer who, if resided in another state would have died for lack of insurance. Here in NJ there are poeple without insurance who undoubtedly cannot get decent routine care for chronic conditions but I know of no person with cancer that cannot somehow get coverage, charity care, medicaid, or help from the community, churches, Jewish charity organizations, etc.
He also claims that there is no free lunch. Everyone pays into the system. Yet he failed to explain that or go into any detail.
In conclusion - I agree with critics on the health care debate - he is absolutely the wrong guy to be a spokesperson for it on a national level.
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which puts Romney with a second strike (religion+health care) as far as a replacement for Obama.
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That he was born into a patrician family doesn' t help either.
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Health Care Is Heavily Taxed Now
By John Donaldson, MD
Congressional plans for financing the proposed health care legislation include provisions to tax health insurance of non-union citizens and medical devices vital to the delivery of medicines. We never hear that health care is already heavily taxed, but that these taxes are hidden from the consumer and have the greatest impact on the sick.
What we do hear is that costs are skyrocketing and insurance companies are gouging the public, in spite of actual data that indicate the profit for health insurance companies has lingered under 3.5% year after year. It should be obvious that those profits are not the source of significant increases in cost. Insurance companies rank 88th in profitability and hospitals 77th in U.S. corporate profitability.
Annually, we do the "Medicare Dance," whereby Congress waits until the last minute to overturn its mandate that payment to physicians and other providers will remain within a constant dollar amount. The fact that the nation has needs for increasing services to an aging and expanding population of seniors matters not. This year, a reduction of 21% has just been delayed until April Fool's Day after Senator Bunning's courageous and appropriate blocking of a temporary measure. Essentially, the government plays the doctors for suckers each year, satisfying them with no increases in payment in the face of cost increases to practice. This actually represents a decrease in payment. This year, the doctors were suckered even more: The last date to opt out of Medicare is March 17th.
I contend that almost the entire increase in the cost of care is related to hidden "taxes" -- costs imposed by government -- and not "waste, fraud, and abuse" as the politicians say in their glib lectures. Here are just a few of them:
Medicare, Medicaid Underfunding "Tax"
Each year, the government "adjusts" reimbursement to providers, including hospitals, doctors, home health, and a long list of individuals contracted for service. Hospitals are required to accept fixed payment based on diagnosis, irrespective of the acuity of the patient's illness. Currently, hospitals lose between 15% and 20% of the actual cost of providing care, justified in part by a declaration that a penalty is imposed on the assumption that they are gaming the system.
The providers are then required to recover their costs by essentially adding an additional surcharge to the rates charged other payers -- that is, the insured and the uninsured who pay their own medical bills. Managed care companies will negotiate bulk contracts that limit the amount a provider can charge them. Usually, for the provider, this is enough to cover cost plus an amount needed to cover the cost shift. As this pool shrinks, so too does the financial well-being of the provider. They must limit capital investment and eventually restrict service. Essentially, we have a crisis at this time because of government underfunding. If the federal government were to pay their bills for services received by their enrollees, some markets such as Florida would experience as much as a 30% drop in cost of care to the payers using insurance or paying cash.
Lawyer Full Employment "Tax"
This tax is seen every day of the week, but the notion that it is confined to medical malpractice is entirely fallacious. Every aspect of the provision of service has a hidden tax to cover the cost of the legal and victim industries. Product liability on medical devices, drugs, vaccines, and supplies adds substantially to the cost of care. Every aspect of health care is penalized at the courthouse. The Congressional Budget Office estimates that $54 billion can be saved over ten years with reform of medical malpractice alone.
The most annoying part of this is that it is such an easy fix that really costs us almost nothing. If we had "loser pays with guarantee," whereby the loser is responsible for the winner's costs, and if the loser is unable to pay, the liability shifts to the lawyer, the frivolous suits would dry up overnight. This does not restrict access to the legitimate victim, but certainly will remove the "roll the dice" filings.
Regulatory "Tax"
Every level of government gets involved in regulation of health care. It has become a collection of industries that all purport to contribute to the collective well-being. Frankly, much of it is no better than picking a provider from the Yellow Pages or from a sign on a bus. Government requires accreditation and until recently, JCAHO was the established religion. To keep Medicare funding, institutional providers were required by CMS to hold accreditation by this body. Huge sums of money were spent to meet ever-changing requirements, many of which were no more logical than the requirement to have Braille on drive-through ATMs.
EMTALA is another perfect example. Many states require a hospital to have an emergency room, and in order to retain federal and state funding, the hospital must provide access to virtually anyone who walks through the door -- legals, illegals, payers, and non-payers. Many use this as their primary care and have no intention of paying even if they can afford it. All of these costs get shifted to the payers as a hidden tax.
Special Interest Insurance "Tax"
It is almost impossible to buy health insurance without paying for the baggage programs inserted by politicians onto health insurance in each state. Many of these programs and providers are of marginal medical benefit at best and have only a very small constituency, which would be minute or entirely absent without the mandate of inclusion imposed on insurance companies. Why would everyone have to buy coverage for hair replacement or in vitro fertilization just to satisfy the senator whose wife practices it? Some states have over thirty insurance mandates.
Again, this is an easy fix costing nothing. The federal government outlines the requirements for a number of basic national plans and accredits companies to provide them. Providers will be required to deal with the plans in order to manage Medicare/Medicaid patients, effectively cutting out the state's special interest mandates, which can still be sold if anyone is foolish enough to buy them.
Implosion
If $500 billion is to be removed from the system from the providers of Medicare and Medicaid, then a deliberately engineered financial implosion for hospitals and physicians will take less than two years, thereby generating another "crisis" which will be managed again by the people that brought us this first crisis.
The next step will be complete absorption of the providers into global budgeting, mandated participation, and salaried positions. With this will come rationing and waiting lists. Even Obama cannot break the symbolic medical bread and wine to save the health care system on his current course.
With no more greedy insurance companies, mandated provision of care, and state-budgeted hospitals with salaried providers, whom are we to blame then?
Dr. Donaldson is a Pediatric Otolaryngologist in Fort Myers, Florida. He is the immediate past Chairman of the Board of Directors of Lee Memorial Health System, the seventh-largest public system in the USA.
Page Printed from: http://www.americanthinker.com/2010/03/healthcare_is_heavily_taxed_no.html at March 08, 2010 - 12:01:25 PM CST
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"Dr. Donaldson is a Pediatric Otolaryngologist in Fort Myers, Florida. He is the immediate past Chairman of the Board of Directors of Lee Memorial Health System"
Interesting. I may have met this guy. Years back I interviewed for a position with the Lee Mem. system in Ft. Myers.
I can't recall for sure the name but I remember some administrator there who interviewed me and he was a pediatrician. If you like hot weather and to fish, the Ft. Myers area is nice.
"The next step will be complete absorption of the providers into global budgeting, mandated participation, and salaried positions. With this will come rationing and waiting lists. Even Obama cannot break the symbolic medical bread and wine to save the health care system on his current course."
Well yes, THIS IS the goal of the academic elites with the Phoney One leading the charge. The present bill is just the next of many steps towards that end.
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If Democrats ignore health-care polls, midterms will be costly
By Patrick H. Caddell and Douglas E. Schoen
Friday, March 12, 2010; A17
In "The March of Folly," Barbara Tuchman asked, "Why do holders of high office so often act contrary to the way reason points and enlightened self-interest suggests?" Her assessment of self-deception -- "acting according to wish while not allowing oneself to be deflected by the facts" -- captures the conditions that are gripping President Obama and the Democratic Party leadership as they renew their efforts to enact health-care reform.
Their blind persistence in the face of reality threatens to turn this political march of folly into an electoral rout in November. In the wake of the stinging loss in Massachusetts, there was a moment when the president and the Democratic leadership seemed to realize the reality of the health-care situation. Yet like some seductive siren of Greek mythology, the lure of health-care reform has arisen again.
As pollsters to the past two Democratic presidents, Jimmy Carter and Bill Clinton, respectively, we feel compelled to challenge the myths that seem to be prevailing in the political discourse and to once again urge a change in course before it is too late. At stake is the kind of mainstream, common-sense Democratic Party that we believe is crucial to the success of the American enterprise.
Bluntly put, this is the political reality:
First, the battle for public opinion has been lost. Comprehensive health care has been lost. If it fails, as appears possible, Democrats will face the brunt of the electorate's reaction. If it passes, however, Democrats will face a far greater calamitous reaction at the polls. Wishing, praying or pretending will not change these outcomes.
Nothing has been more disconcerting than to watch Democratic politicians and their media supporters deceive themselves into believing that the public favors the Democrats' current health-care plan. Yes, most Americans believe, as we do, that real health-care reform is needed. And yes, certain proposals in the plan are supported by the public.
However, a solid majority of Americans opposes the massive health-reform plan. Four-fifths of those who oppose the plan strongly oppose it, according to Rasmussen polling this week, while only half of those who support the plan do so strongly. Many more Americans believe the legislation will worsen their health care, cost them more personally and add significantly to the national deficit. Never in our experience as pollsters can we recall such self-deluding misconstruction of survey data.
The White House document released Thursday arguing that reform is becoming more popular is in large part fighting the last war. This isn't 1994; it's 2010. And the bottom line is that the American public is overwhelmingly against this bill in its totality even if they like some of its parts.
The notion that once enactment is forced, the public will suddenly embrace health-care reform could not be further from the truth -- and is likely to become a rallying cry for disaffected Republicans, independents and, yes, Democrats.
Second, the country is moving away from big government, with distrust growing more generally toward the role of government in our lives. Scott Rasmussen asked last month whose decisions people feared more in health care: that of the federal government or of insurance companies. By 51 percent to 39 percent, respondents feared the decisions of federal government more. This is astounding given the generally negative perception of insurance companies.
CNN found last month that 56 percent of Americans believe that the government has become so powerful it constitutes an immediate threat to the freedom and rights of citizens. When only 21 percent of Americans say that Washington operates with the consent of the governed, as was also reported last month, we face an alarming crisis.
Health care is no longer a debate about the merits of specific initiatives. Since the spectacle of Christmas dealmaking to ensure passage of the Senate bill, the issue, in voters' minds, has become less about health care than about the government and a political majority that will neither hear nor heed the will of the people.
Voters are hardly enthralled with the GOP, but the Democrats are pursuing policies that are out of step with the way ordinary Americans think and feel about politics and government. Barring some change of approach, they will be punished severely at the polls.
Now, we vigorously opposed Republican efforts in the Bush administration to employ the "nuclear option" in judicial confirmations. We are similarly concerned by Democrats' efforts to manipulate passage of a health-care bill. Doing so in the face of constant majority opposition invites a backlash against the party at every level -- and at a time when it already faces the prospect of losing 30 or more House seats and eight or more Senate seats.
For Democrats to begin turning around their political fortunes there has to be a frank acknowledgement that the comprehensive health-care initiative is a failure, regardless of whether it passes. There are enough Republican and Democratic proposals -- such as purchasing insurance across state lines, malpractice reform, incrementally increasing coverage, initiatives to hold down costs, covering preexisting conditions and ensuring portability -- that can win bipartisan support. It is not a question of starting over but of taking the best of both parties and presenting that as representative of what we need to do to achieve meaningful reform. Such a proposal could even become a template for the central agenda items for the American people: jobs and economic development.
Unless the Democrats fundamentally change their approach, they will produce not just a march of folly but also run the risk of unmitigated disaster in November.
Patrick H. Caddell is a political commentator and former pollster. Douglas E. Schoen, a pollster, is the author of "The Political Fix."
http://www.washingtonpost.com/wp-dyn/content/article/2010/03/11/AR2010031102904.html?hpid=opinionsbox1
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Good summary of right vs service/commodity by Walter E. Williams.
A MINORITY VIEW
BY WALTER WILLIAMS
RELEASE: WEDNESDAY, MARCH 10, 2010
Is Health Care a Right?
Most politicians, and probably most Americans, see health care as a right. Thus, whether a person has the means to pay for medical services or not, he is nonetheless entitled to them. Let's ask ourselves a few questions about this vision.
Say a person, let's call him Harry, suffers from diabetes and he has no means to pay a laboratory for blood work, a doctor for treatment and a pharmacy for medication. Does Harry have a right to XYZ lab's and Dr. Jones' services and a prescription from a pharmacist? And, if those services are not provided without charge, should Harry be able to call for criminal sanctions against those persons for violating his rights to health care?
You say, "Williams, that would come very close to slavery if one person had the right to force someone to serve him without pay." You're right. Suppose instead of Harry being able to force a lab, doctor and pharmacy to provide services without pay, Congress uses its taxing power to take a couple of hundred dollars out of the paycheck of some American to give to Harry so that he could pay the lab, doctor and pharmacist. Would there be any difference in principle, namely forcibly using one person to serve the purposes of another? There would be one important strategic difference, that of concealment. Most Americans, I would hope, would be offended by the notion of directly and visibly forcing one person to serve the purposes of another. Congress' use of the tax system to invisibly accomplish the same end is more palatable to the average American.
True rights, such as those in our Constitution, or those considered to be natural or human rights, exist simultaneously among people. That means exercise of a right by one person does not diminish those held by another. In other words, my rights to speech or travel impose no obligations on another except those of non-interference. If we apply ideas behind rights to health care to my rights to speech or travel, my free speech rights would require government-imposed obligations on others to provide me with an auditorium, television studio or radio station. My right to travel freely would require government-imposed obligations on others to provide me with airfare and hotel accommodations.
For Congress to guarantee a right to health care, or any other good or service, whether a person can afford it or not, it must diminish someone else's rights, namely their rights to their earnings. The reason is that Congress has no resources of its very own. Moreover, there is no Santa Claus, Easter Bunny or Tooth Fairy giving them those resources. The fact that government has no resources of its very own forces one to recognize that in order for government to give one American citizen a dollar, it must first, through intimidation, threats and coercion, confiscate that dollar from some other American. If one person has a right to something he did not earn, of necessity it requires that another person not have a right to something that he did earn.
To argue that people have a right that imposes obligations on another is an absurd concept. A better term for new-fangled rights to health care, decent housing and food is wishes. If we called them wishes, I would be in agreement with most other Americans for I, too, wish that everyone had adequate health care, decent housing and nutritious meals. However, if we called them human wishes, instead of human rights, there would be confusion and cognitive dissonance. The average American would cringe at the thought of government punishing one person because he refused to be pressed into making someone else's wish come true.
None of my argument is to argue against charity. Reaching into one's own pockets to assist his fellow man in need is praiseworthy and laudable. Reaching into someone else's pockets to do so is despicable and deserves condemnation.
Walter E. Williams is a professor of economics at George Mason University. To find out more about Walter E. Williams and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com.
COPYRIGHT 2010 CREATORS.COM
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I agree. Good argument. It sums up the idea of taxation to pay for "entitlement" programs to a tee.
Of course the counter argument would be that all of us could some day be in a position of "needing" some form of assistance.
Or that we are only forced to pay what we "can".
The final fall back position of course the moral arugment that we need to help those in "need".
But as you point out WW turns the moral argument (and in my opinion rightly so) inside out by concluding it is immoral to force many to work as virtual slaves for the rest.
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"It's all supposed to be voluntary, those 'home visits' that are tucked into the mammoth Obamacare bill. If you have a strong stomach, and a stronger bottom, you can find home visitation on pages 568-595. That's Section 2951 of H.R. 3590, the Senate [health care] bill.... The bill provides for federal funding and supervision for this vast expansion of government intrusion into family life. This is the Nanny State on steroids. Is your family being 'targeted' for such home visitations? Let's see if you fit into one of these very broad categories: Families where Mom is not yet 21. (No mention here whether she is married or not.) Families where someone is a tobacco user. (Does this include the White House? Watch out, Sasha and Malia! Does Grandpa, whom you love and have taken in, enjoy his after-dinner pipe?) Families where children have low student achievement, developmental delays, or disabilities. As if that list were not wide-ranging enough, here's the net that can encompass tens of millions: Families with individuals who are serving or formerly served in the armed forces, including such families that have members of the armed forces who have had multiple deployments outside the United States. [Emphasis added.] ... Do you spank your children? You should know that HHS bureaucrats think you are an abuser. Do you support the Second Amendment? How would you like HHS bureaucrats asking your children if you maintain firearms in the home for family protection? Do you home-school your kids? Take care. Members of Congress who have tried to abolish home-schooling are big backers of this health care bill. Do you wonder why? ... One thing is clear: For life and liberty, we must defeat ObamaCare." --columnist Ken Blackwell
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David GoldhillPresident and CEO of GSN
Posted: March 17, 2010 09:37 AM
A Democrat's Case For "No"
The President: "Would you feel the same way if you were making $40,000...? Because that's the reality for a lot of folks. I mean, it is very important for us ... to listen to the folks that we get letters from -- because the truth of the matter, John, is they're not premiers of anyplace, they're not sultans from wherever. They don't fly into Mayo and suddenly decide they're going to spend a couple million dollars on the absolute, best health care. They're folks who are left out." (President Obama at the recent health care summit)
President Obama's statement perfectly encapsulates why I and many others are Democrats - our commitment to our fellow citizens who lack the resources to protect their families from misfortune. Sadly, I believe if we apply that standard to the proposed health care legislation, a Democrat should oppose this bill. Though superficially attractive, the bill's benefits to the uninsured are likely to be temporary, while its costs - even to its beneficiaries - will be large and lasting.
We Democrats have been swept up in a straightforward narrative of health care reform. For almost seventy years, we've been fighting entrenched industry interests to provide universal access to care - a benefit enjoyed by the citizens of all other developed countries. In the Administration's formulation, we're -- finally -- on the brink of a historic victory.
However, as with many long wars, we the combatants have ignored the transformation of the landscape - a transformation that has rendered our initial goals and our methods for achieving them hopelessly outdated.
First, over those 70 years health care has evolved from a rarely utilized service to the largest industry in our economy, as our physical and emotional well-being has become increasingly medicalized. The share of resources now devoted to care has impeded growth in our standard of living, especially for our middle class. Everyone knows that the US spends an astounding 17% of our GDP on care; but how many realize that over the past five years, we've spent 28 cents of every dollar of income growth? Our government's existing health care obligations account for much of America's deteriorating fiscal prospects, with all its negative implications for our future well-being.
Second, there is extensive evidence that the poorly structured incentives of our insurance-based system are themselves the cause of our health care inflation. Yet, continuing our Party's almost unquestioned conflation of health insurance with health care, the central feature of the proposed "reform" is further extension of our flawed insurance-based system.
Third, every other developed country is struggling with the cost of its universal health care system to such a degree that fundamental reform will almost certainly prove necessary to insure long-term sustainability. It is true that the US spends far more on health care than the universal care countries today; but it is absurd for us to ignore the lessons of the high rate of cost growth in these countries - growth that in some cases exceeds our own.
Fourth, despite the Administration's recent heated rhetoric, most of the entrenched health industry interests are quietly or openly in favor of this bill. Should the bill become law, I suspect we will look back at it as an industry bailout. Why? For the health insurance industry, the legislation not only guarantees tens of millions more customers, but also requires participation by the low-risk young and healthy. For hospitals, the legislation will reduce the cost of providing low-compensated care, by turning currently uninsured customers into full-paying private insurance ones.
But even if the health care landscape has shifted, doesn't the promise of adding 30 million uninsureds to the insurance safety net make the bill worthy of Democratic support? Only if we insist on looking at health care as an island, separate from everything else affecting American families. How else can Democrats in the depths of a recession support a massive tax increase on middle-class job creation (which is the effect of a corporate mandate)? How else could we justify diverting even more of middle class income to support our broken system of care, further starving families of funds for all their other needs? Most uninsured Americans lack insurance only temporarily; how many of them would trade lesser lifetime job prospects and lower disposable income for the short-term retention of health insurance?
Despite the bill's new subsidies to those who can' t afford whatever health insurance Congress deems to be adequate, the additional health spending in this bill heavily rests on private money - specifically the money of the currently uninsured who will be required to buy insurance. With health care now so expensive, the Government can't afford to fund the premiums for the ever-growing number of the uninsured. So it's requiring them - those $40,000 a year families - to share the costs.
The bill's subsidies may well provide some affordability benefit - but without meaningful reductions in the price of care, these are likely to be only temporary salve. How? Look at Medicare's history; its lack of real financial discipline has helped drive up care costs, leading to ever-greater premiums and out-of-pocket paid by its beneficiaries. So even with the government paying almost all of their bills, today's seniors pay a higher share of their income for health care than seniors did before Medicare.
Our current system of financing health care is also extraordinarily regressive - and the bill's mandate will make it even more regressive. Surprised? Consider corporate funded health insurance; the $15,000 annual premium for family coverage is a small share of the cost of compensation for the CEO, but a massive share of the compensation cost for the $40,000 a year employee. The Administration's own economists admit the obvious: regardless of who writes the premium check, it's the employee who's really funding the entire cost. Tack on Medicare taxes and out-of-pocket expenses, and the $40,000 a year employee is bearing health costs equal to 30% of his true cost to his employer; does this seem like a progressive system of funding worthy of extension?
For all the traditional liberal support for Medicare, even this cornerstone of government health care financing has a regressive effect, transferring resources from younger, poorer Americans to older, more financially secure ones. And the odds of the implicit "generational pact" ever being made good for today's younger people recedes daily; Medicare now has $74 trillion of unfunded liabilities, which this "reform" does nothing to fix.
And for the least well-off Americans? Expanding the eligibility for Medicaid may make legislators feel better, but with doctors abandoning the program, does this approach seem like a sustainable solution for their care needs?
The President is right that reform is urgent, but it must be real fundamental reform that alters the underlying structural incentives driving excessive health spending and prices. The true emergency is the growth of health care spending, which last year alone rose at a rate 6% above the rate of general inflation. Trying to control the cost of health insurance without meaningfully changing the incentives in health care is like trying to control gas prices by focusing on gas stations instead of oil markets. Yet without effective action against galloping care price increases, it will prove impossible for our nation to sustain real health security to our citizens.
For all its hat-tipping to cost control ideas, the legislation does little to curb health inflation. Its most important source of savings is $500 billion of unspecified Medicare cuts. If these savings should somehow be realized, shouldn't they be used to prop up this functionally insolvent program, rather than "fund" a new subsidy? Of course, does anyone expect these savings to be realized, when the same Congress debating their inclusion was also debating how - not whether - to repeal $250 billion of previously legislated Medicare cuts? If the legislation had any real prospect of controlling health care spending, would the pharmaceutical industry be funding the "yes" campaign?
We Democrats should not be requiring the middle class to spend ever more of their declining wealth on health care until we address the issue of why the $2.5 trillion we're already spending isn't sufficient. Does anyone doubt that the excess care, administrative waste, and undisciplined pricing in our current spending alone could fund all needed care for those now without it?
And while the anecdotes of Americans suffering without access to essential care tug at our heart-strings, remember that the accounting trick at the core of this legislation ("balancing" ten years of revenue and six years of benefits to produce "deficit neutral" results) means it will be four years before any additional Americans would be added to the insurance rolls. We have time to get this right.
What about the argument that Democrats should take what we can get now, in the knowledge that the bill's many failings can be fixed later? As the above makes clear, I'm not certain that what we are "getting now" is actually a positive for many uninsured Americans. Further, the bill will cement the inefficiencies and unaccountable practices in the health industries through yet more health spending; so it will be even politically harder later to get agreement on fixes, much less real reform.
The Republican Party's approach to health reform has been so hypocritical and obstructionist that it borders on the unpatriotic; all Democrats would like to see our well-meaning Administration have a political boost at the expense of a cynical opposition. But that win is likely to be achieved at real cost to many Americans - including many families getting by on $40,000 a year. We need to take the President at his word: this should be about doing what's right not what's political. With a very heavy heart, this Democrat suggests a "no" vote.
http://www.huffingtonpost.com/david-goldhill/a-democrats-case-for-no_b_502229.html
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http://reason.com/blog/2010/03/18/gimme-gimmicks-getting-giddy-o
Reason Magazine
Gimme Gimmicks: Getting Giddy Over the CBO's Latest Health Care Score
Peter Suderman | March 18, 2010
The latest—though likely not the last—Congressional Budget Office score for the Democrats health care overhaul is in, and after a harried week, it's making Rep. James Clyburn, the House Democrats' whip, "giddy." What's worth squealing about? The score, which estimates the budgetary effects of the Senate health care bill in the context of the reconciliation changes proposed by House Democrats, officially projects that the bill will cost $940 billion and reduce the deficit by $130 billion over ten years. In the following decade, the CBO's crystal ball says the package conjures up $1.2 trillion in deficit reduction (maybe), a number which it also warns should be viewed as about as accurate as the predictions from most crystal balls.
Fans of budgeting gimmicks are in for a treat, as the document reads like a sort Greatest Hits of Budgeting BS. Jacob Sullum has already noted some of its many balance-sheet deceptions, including double counting Medicare savings and the inclusion of $19.4 billion in scored deficit reduction from a totally unrelated student-loan program, but here's a few more:
The score for the Senate bill includes $72 billion in revenues generated by the CLASS act, a federally-backed disability insurance program. But that $72 billion is just premium revenue that will eventually have to be used to pay out benefits. The score counts that revenue anyway, despite the fact that, according to the CBO, it would probably add to the deficit in the long term.
Even if you buy the projected deficit reductions—I'm skeptical—the bill achieves them at the cost of raising the national debt. At Fortune, Shawn Tully explains:
That forecast, however, doesn't mean that what the CBO counts as lower deficits will lead to less debt, as taxpayers might expect. In fact, it appears that it would require the Treasury to borrow almost 40 cents of every dollar in new spending the bill requires.
It's not an easy trick to reduce deficits and yet borrow more money. CBO does it because it has to. By law, the CBO is required to use "cash" or "unified budget" accounting. Under that system, the CBO projects all the new revenues and new expenses from the legislation it's requested to "score." If the extra revenues exceed the additional outlays, the bill is deemed to reduce deficits. That's the case with the health-care bill. The rub is that the measure gets a large portion of its revenues from new Social Security and Medicare taxes—plus levies it collects upfront to pay for a long-term care entitlement program.
Counting those taxes as deficit reducers presents two problems. First, the extra revenues are mainly needed to pay for higher benefits in the future. Second, they cannot be used to fund the lavish subsidies, tax credits for small employers, and other spending the bill mandates. "The law is clear," says Donald Moran, a former Reagan Administration budget official who runs a Washington, DC-based health-care consulting and research firm. "Revenues from those entitlement taxes must go into their trust funds. That money is not available to pay for the spending commitments of the health-care bill."
Indeed, as anyone who bothers to read the first paragraph of the CBO's letter will see, the entire report is arguably something of a cheat. See, House Speaker Nancy Pelosi promised that the CBO score for the reconciliation bill would be available 72 hours before taking a vote. She's also been pushing hard to get a vote by this weekend. And, sure enough, just in time, here's the score—in preliminary, subject-to-change, implicitly rushed-to-early-release form. Or, as the CBO says in its careful bureaucratese:
Although CBO completed a preliminary review of legislative language prior to its release, the agency has not thoroughly examined the reconciliation proposal to verify its consistency with the previous draft. This estimate is therefore preliminary, pending a review of the language of the reconciliation proposal, as well as further review and refinement of the budgetary projections.
Translation: We weren't really done yet, but House leadership wanted to vote this weekend, so we rushed this sucker out early. Granted, at this point the Democrats have so thoroughly gamed mastered the scoring process that the end result would likely be similar no matter when it came out. This is why leadership has been so confident that it could pick up the votes needed for passage: Many of those wavering votes, it now seems, were probably dependent on the deficit reduction figures in the CBO score—a score that leadership achieved by spending all week tweaking and resubmitting the legislative language in order to produce the desired result. Not surprisingly, the vote count now seems to be moving in their direction. If I were the Democrats' official vote-getter today, I suppose I'd be giddy too.
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OPINION: DECLARATIONS MARCH 18, 2010, 6:58 P.M. ET Now for the Slaughter On the road to Demon Pass, our leader encounters a Baier.By PEGGY NOONAN
Excuse me, but it is embarrassing—really, embarrassing to our country—that the president of the United States has again put off a state visit to Australia and Indonesia because he's having trouble passing a piece of domestic legislation he's been promising for a year will be passed next week. What an air of chaos this signals to the world. And to do this to Australia of all countries, a nation that has always had America's back and been America's friend.
How bush league, how undisciplined, how kid's stuff.
You could see the startled looks on the faces of reporters as Press Secretary Robert Gibbs, who had the grace to look embarrassed, made the announcement on Thursday afternoon. The president "regrets the delay"—the trip is rescheduled for June—but "passage of the health insurance reform is of paramount importance." Indonesia must be glad to know it's not.
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Fox News Channel
The reporters didn't even provoke or needle in their questions. They seemed hushed. They looked like people who were absorbing the information that we all seem to be absorbing, which is that the wheels seem to be coming off this thing, the administration is wobbling—so early, so painfully and dangerously soon.
Thursday's decision followed the most revealing and important broadcast interview of Barack Obama ever. It revealed his primary weakness in speaking of health care, which is a tendency to dodge, obfuscate and mislead. He grows testy when challenged. It revealed what the president doesn't want revealed, which is that he doesn't want to reveal much about his plan. This furtiveness is not helpful in a time of high public anxiety. At any rate, the interview was what such interviews rarely are, a public service. That it occurred at a high-stakes time, with so much on the line, only made it more electric.
More Peggy Noonan
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I'm speaking of the interview Wednesday on Fox News Channel's "Special Report With Bret Baier." Fox is owned by News Corp., which also owns this newspaper, so one should probably take pains to demonstrate that one is attempting to speak with disinterest and impartiality, in pursuit of which let me note that Glenn Beck has long appeared to be insane.
That having been said, the Baier interview was something, and right from the beginning. Mr. Baier's first question was whether the president supports the so-called Slaughter rule, alternatively known as "deem and pass," which would avoid a straight up-or-down House vote on the Senate bill. (Tunku Varadarajan in the Daily Beast cleverly notes that it sounds like "demon pass," which it does. Maybe that's the juncture we're at.) Mr. Obama, in his response, made the usual case for ObamaCare. Mr. Baier pressed him. The president said, "The vote that's taken in the House will be a vote for health-care reform." We shouldn't, he added, concern ourselves with "the procedural issues."
Further in, Mr. Baier: "So you support the deem-and-pass rule?" From the president, obfuscation. But he did mention something new: "They may have to sequence the votes." The bill's opponents would be well advised to look into that one.
Mr. Baier again: So you'll go deem-and-pass and you don't know exactly what will be in the bill?
Mr. Obama's response: "By the time the vote has taken place, not only will I know what's in it, you'll know what's in it, because it's going to be posted and everybody's going to be able to evaluate it on the merits."
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Fox News Channel
That's news in two ways. That it will be posted—one assumes the president means on the Internet and not nailed to a telephone pole—should suggest it will be posted for a while, more than a few hours or days. So American will finally get a look at it. And the president was conceding that no, he doesn't know what's in the bill right now. It is still amazing that one year into the debate this could be true.
Mr. Baier pressed on the public's right to know what is in the bill. We have been debating the bill for a year, the president responded: "The notion that this has been not transparent, that people don't know what's in the bill, everybody knows what's in the bill. I sat for seven hours with—."
Mr. Baier interrupts: "Mr. President, you couldn't tell me what the special deals are that are in or not today."
Mr. Obama: "I just told you what was in and what was not in."
Mr. Baier: "Is Connecticut in?" He was referring to the blandishments—polite word—meant to buy the votes of particular senators.
Mr. Obama: "Connecticut—what are you specifically referring to?"
Mr. Baier: "The $100 million for the hospital? Is Montana in for the asbestos program? Is—you know, listen, there are people—this is real money, people are worried about this stuff."
Mr. Obama: "And as I said before, this—the final provisions are going to be posted for many days before this thing passes."
Mr. Baier pressed the president on his statement as a candidate for the presidency that a 50-plus-one governing mentality is inherently divisive. "You can't govern" that way, Sen. Obama had said. Is the president governing that way now? Mr. Obama did not really answer.
Throughout, Mr. Baier pressed the president. Some thought this bordered on impertinence. I did not. Mr. Obama now routinely filibusters in interviews. He has his message, and he presses it forward smoothly, adroitly. He buries you in words. Are you worried what failure of the bill will do to you? I'm worried about what the status quo will do to the families that are uninsured . . .
Mr. Baier forced him off his well-worn grooves. He did it by stopping long answers with short questions, by cutting off and redirecting. In this he was like a low-speed bumper car. In the end the interview seemed to me a public service because everyone in America right now wants to see the president forced off his grooves and into candor on an issue that involves 17% of the economy. Again, the stakes are high. So Mr. Baier's style seemed—this is admittedly subjective—not rude but within the bounds, and not driven by the antic spirit that sometimes overtakes reporters. He seemed to be trying to get new information. He seemed to be attempting to better inform the public.
Presidents have a right to certain prerogatives, including the expectation of a certain deference. He's the president, this is history. But we seem to have come a long way since Ronald Reagan was regularly barked at by Sam Donaldson, almost literally, and the president shrugged it off. The president—every president—works for us. We don't work for him. We sometimes lose track of this, or rather get the balance wrong. Respect is due and must be palpable, but now and then you have to press, to either force them to be forthcoming or force them to reveal that they won't be. Either way it's revealing.
And so it ends, with a health-care vote expected this weekend. I wonder at what point the administration will realize it wasn't worth it—worth the discord, worth the diminution in popularity and prestige, worth the deepening of the great divide. What has been lost is so vivid, what has been gained so amorphous, blurry and likely illusory. Memo to future presidents: Never stake your entire survival on the painful passing of a bad bill. Never take the country down the road to Demon Pass.
Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved
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Obamacare’s Imaginary Savings
President Obama and Democratic leaders in Congress touted the latest cost projections from the Congressional Budget Office (CBO) as evidence that the bill they are attempting to ram through Congress this weekend is fiscally responsible. Some Blue Dog Democrats may try to use the latest projections as an excuse to switch their votes from opposition to support of Obamacare.
But if they do so, the only people they will be fooling are themselves — the public long ago saw through the gimmicks and sleight-of-hand behind the Democratic deficit-cutting claims. Voters know a runaway entitlement program when they see one, and in this case they got some crucial help from Rep. Paul Ryan and others. The bill the Democrats want to pass is a massive federal spending spree, and the claims that it will reduce the deficit do not stand up to scrutiny.
According to CBO, Obamacare’s new subsidies for health insurance would cost $216 billion by 2019 — an expense that would increase another 8 percent every year thereafter. In addition, the plan includes $130 billion in other entitlement spending, plus another $70 billion for the bureaucracy needed to implement it. All totaled, the bill would cost at least $1.2 trillion through 2019, not the $940 billion advertised by the White House.
And even that $1.2 trillion is a low-ball estimate, because the Democratic plan would do almost nothing of real consequence until 2014. But when the program’s spending measures did finally kick in, costs would soar. Over the first ten years of full implementation, the bill’s cost would grow to at least $2.5 trillion, and perhaps much more. Today, Medicare and Medicaid spend far more money — about ten times as much — as the original government estimates predicted.
Most of the offsets the Democrats are pushing to “pay for” the bill are smoke and mirrors — cuts that won’t be made, taxes that won’t be collected. But there are some measures that, if enacted, promise to inflict real damage on the American economy and on America’s seniors. Among the plan’s $560 billion in tax hikes over the next ten years is a new Medicare tax on non-wage income, a penalty on investment that would undermine business growth and job creation. And there’s the Medicare Advantage cut, more than $200 billion over ten years. This reduction would force millions of Medicare beneficiaries out of their health-insurance plans, in direct contradiction of Obama’s promise. In total, the Medicare cuts in the president’s plan now exceed $520 billion over ten years.
But most of the offsets are window dressing, helpful in making the sale but unlikely to amount to much in the end. The president wants us to believe we can count on a massive revenue surge from the “Cadillac tax” after 2020, but the unions hate the tax, and the fact that the president’s plan puts off collecting it until he is safely in retirement suggests that Democrats are not serious about enforcing the measure when the time comes.
The Democrats’ plan assumes permanent, across-the-board cuts in Medicare hospital and nursing-home payments — cuts that that would go so deep that the chief actuary of the program expects that one in five facilities would have to stop taking Medicare patients to avoid insolvency. Which means those cuts probably aren’t going to happen. We have seen this before: Even as Democrats claim these new Medicare savings can be taken to the bank, they are working to undo a similarly clumsy and ill-advised cut in Medicare physicians’ fees — at a cost of $371 billion over ten years, another massive pile of money not accounted for in the Democrats’ “savings” projections.
While much of the spending isn’t counted, a big piece of the revenue is double-counted: The Democrats’ numbers show premiums from the new long-term care insurance program, along with Social Security and Medicare surpluses, being used both to pay for the insurance subsidies and to strengthen the ailing entitlement programs. But you can’t spend the same dollar in two different places. Which means that the Democrats are trying to finance another expensive entitlement program with funds that are needed to pay for entitlement programs already on the books.
When that double-counting is omitted and the real cost of physicians’ fees is included, all of the claimed deficit-reduction from the health bill vanishes.
The recklessness of the Democratic majority is remarkable. The federal budget is already suffocating under unaffordable entitlement commitments. We can’t pay for the ones we have, and they want to create a bunch of new ones. CBO finds no “bending of the cost curve” in the president’s plan. It is nothing but high-speed spending that is almost certain to grow even more expensive than advertised. It will be financed in part with job-killing tax hikes and ideologically driven cuts to Medicare Advantage — but mainly it’s going to be papered over with accounting gimmicks and “savings” that will never materialize.
The United States is already rushing headlong toward a debt crisis, in part because of the massive spending President Obama has already pushed through the Congress. Contrary to his claims, his health plan would not reduce the deficit, in the short term or in the long term. If enacted, it would only accelerate our descent into debt, and hasten the day of reckoning.
http://article.nationalreview.com/428569/obamacares-imaginary-savings/the-editors
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Michael Cannon: Innovation best alternative to Obamacare
By MICHAEL F. CANNON
2010-03-19 14:45:50
There is an alternative to the Obama health plan. It's called innovation.
Economist Glen Whitman and physician Raymond Raad found that, when it comes to basic medical sciences, diagnostics (e.g., MRIs and CT scanners), and therapeutics (e.g., ACE inhibitors and statins), the United States often produces more medical innovations than all other nations combined.
America's health insurance markets are not following suit, despite the ready availability of innovations that can improve the delivery of care, insure the "young invincibles," and provide secure coverage for the sick. Bringing those innovations to consumers requires tearing down regulatory barriers to competition – the very barriers that the Obama plan would stack higher.
Health researchers have long complained of the need for comparative-effectiveness research, health information technologies, coordinated care, and payment systems that better reward quality care.
Innovations that meet those needs are already at hand. Health plans like Kaiser Permanente and Group Health Cooperative are leaders in effectiveness research and health information technologies. Both emphasize cost-effective preventive care, and compete based on the convenience offered by their electronic medical records.
Those successes are the offspring of earlier innovations. Kaiser and Group Health use a payment system called "prepayment," combined with an integrated delivery system, which both enable and reward comparative-effectiveness research, electronic medical records, coordinated care, and prevention.
Yet these innovations lie beyond the reach of most consumers, Stanford health economist Alain Enthoven explains, because our employment-based health insurance system – a creature of the federal tax code – blocks entry by integrated, prepaid health plans.
Reformers also seek to cover millions of "young invincibles" – twentysomethings who decline health insurance because, reformers believe, they think they will never get sick.
While the Obama plan would force young invincibles to purchase health insurance, markets have developed insurance policies that can achieve the same result without coercion. Such policies pay a deferred dividend to customers who end up not filing any claims. The same miscalculation that causes young invincibles to underestimate their need for insurance also causes them to overestimate the probability that they will receive a dividend. Therefore, they insure.
Law professors Tom Baker of the University of Pennsylvania and Peter Siegelman of the University of Connecticut report these innovations are currently available in China, and were quite popular in life-insurance markets in the United States until they were demonized as a form of gambling. Lower barriers to market entry, including clear regulatory guidance about these products' legality, would cover many young invincibles without the need for more government.
Providing secure coverage to patients with high-cost illnesses may be our toughest challenge. The Obama plan tries to address this problem with price controls – i.e., by forcing insurers to charge all applicants of a given age the same premium, regardless of health status.
Markets long ago responded to consumer demand for protection against premium spikes, explains University of Pennsylvania health economist Mark Pauly, with an innovation that guarantees that those who develop a costly illness can renew their policy at the same premium as the rest of the group.
Many believe such renewal guarantees still leave insurers with incentives to mistreat their sick customers. Competition would solve that problem, too, University of Chicago finance economist John Cochrane explains, by pushing insurers to offer a total-satisfaction guarantee: "If at any time you are dissatisfied with your coverage, we will pay for you to switch to another insurance company at no additional cost to you." (Think about it: wouldn't you buy a health plan that offered that guarantee?)
Guaranteed renewability is a large step toward a total-satisfaction guarantee, and the market is busy making additional strides. Last year, UnitedHealth launched a new product that guarantees customers the option to buy coverage in the future at standard rates, no matter how sick they get in the meantime.
Expanding that guarantee so that customers could choose policies sold by another other insurance company, Cochrane explains, requires reducing barriers to competition – in particular, the very price controls that Democrats hope to expand.
Congress could jump-start these innovations with two reforms: letting individual consumers – elderly and nonelderly – control their health care dollars; and letting them purchase a health insurance plan regulated by the state of their choice.
Piling the regulations higher is a sure-fire way to block these innovations, and even more dramatic innovations that we cannot foresee.
http://www.ocregister.com/opinion/health-240160-innovations-insurance.html
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The Real Arithmetic of Health Care Reform
By DOUGLAS HOLTZ-EAKIN
Arlington, Va.
ON Thursday, the Congressional Budget Office reported that, if enacted, the latest health care reform legislation would, over the next 10 years, cost about $950 billion, but because it would raise some revenues and lower some costs, it would also lower federal deficits by $138 billion. In other words, a bill that would set up two new entitlement spending programs — health insurance subsidies and long-term health care benefits — would actually improve the nation’s bottom line.
Could this really be true? How can the budget office give a green light to a bill that commits the federal government to spending nearly $1 trillion more over the next 10 years?
The answer, unfortunately, is that the budget office is required to take written legislation at face value and not second-guess the plausibility of what it is handed. So fantasy in, fantasy out.
In reality, if you strip out all the gimmicks and budgetary games and rework the calculus, a wholly different picture emerges: The health care reform legislation would raise, not lower, federal deficits, by $562 billion.
Gimmick No. 1 is the way the bill front-loads revenues and backloads spending. That is, the taxes and fees it calls for are set to begin immediately, but its new subsidies would be deferred so that the first 10 years of revenue would be used to pay for only 6 years of spending.
Even worse, some costs are left out entirely. To operate the new programs over the first 10 years, future Congresses would need to vote for $114 billion in additional annual spending. But this so-called discretionary spending is excluded from the Congressional Budget Office’s tabulation.
Consider, too, the fate of the $70 billion in premiums expected to be raised in the first 10 years for the legislation’s new long-term health care insurance program. This money is counted as deficit reduction, but the benefits it is intended to finance are assumed not to materialize in the first 10 years, so they appear nowhere in the cost of the legislation.
Another vivid example of how the legislation manipulates revenues is the provision to have corporations deposit $8 billion in higher estimated tax payments in 2014, thereby meeting fiscal targets for the first five years. But since the corporations’ actual taxes would be unchanged, the money would need to be refunded the next year. The net effect is simply to shift dollars from 2015 to 2014.
In addition to this accounting sleight of hand, the legislation would blithely rob Peter to pay Paul. For example, it would use $53 billion in anticipated higher Social Security taxes to offset health care spending. Social Security revenues are expected to rise as employers shift from paying for health insurance to paying higher wages. But if workers have higher wages, they will also qualify for increased Social Security benefits when they retire. So the extra money raised from payroll taxes is already spoken for. (Indeed, it is unlikely to be enough to keep Social Security solvent.) It cannot be used for lowering the deficit.
A government takeover of all federally financed student loans — which obviously has nothing to do with health care — is rolled into the bill because it is expected to generate $19 billion in deficit reduction.
Finally, in perhaps the most amazing bit of unrealistic accounting, the legislation proposes to trim $463 billion from Medicare spending and use it to finance insurance subsidies. But Medicare is already bleeding red ink, and the health care bill has no reforms that would enable the program to operate more cheaply in the future. Instead, Congress is likely to continue to regularly override scheduled cuts in payments to Medicare doctors and other providers.
Removing the unrealistic annual Medicare savings ($463 billion) and the stolen annual revenues from Social Security and long-term care insurance ($123 billion), and adding in the annual spending that so far is not accounted for ($114 billion) quickly generates additional deficits of $562 billion in the first 10 years. And the nation would be on the hook for two more entitlement programs rapidly expanding as far as the eye can see.
The bottom line is that Congress would spend a lot more; steal funds from education, Social Security and long-term care to cover the gap; and promise that future Congresses will make up for it by taxing more and spending less.
The stakes could not be higher. As documented in another recent budget office analysis, the federal deficit is already expected to exceed at least $700 billion every year over the next decade, doubling the national debt to more than $20 trillion. By 2020, the federal deficit — the amount the government must borrow to meet its expenses — is projected to be $1.2 trillion, $900 billion of which represents interest on previous debt.
The health care legislation would only increase this crushing debt. It is a clear indication that Congress does not realize the urgency of putting America’s fiscal house in order.
Douglas Holtz-Eakin, who was the director of the Congressional Budget Office from 2003 to 2005, is the president of the American Action Forum, a policy institute.
http://www.nytimes.com/2010/03/21/opinion/21holtz-eakin.html
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What is the Bill# on this. It passed congress on sunday on the way to the senate.
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Woof,
No, the bill passed went to the President to be signed into law; the bill the Senate will take up will make changes to that law, comrad.
P.C.
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welcome to untied socialist amerika then........ :evil:
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Woof,
Yes, but it's a small price to pay so our nation's crack whores can get a "FREE" pap smear twice a year. :-P
P.C.
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"If you think health care is expensive now, just wait until the government makes it free."
PJ O'Rourke
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Some of these are petty, but plenty are not.
From IBD
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20 Ways ObamaCare Will Take Away Our Freedoms
By David Hogberg Posted 03/21/2010 03:24 PM ET
If some reports are to be believed, the Democrats will pass the Senate health care bill with some reconciliation changes later today. Thus, it is worthwhile to take a comprehensive look at the freedoms we will lose.
Of course, the bill is supposed to provide us with security. But it will result in skyrocketing insurance costs and physicians leaving the field in droves, making it harder to afford and find medical care. We may be about to live Benjamin Franklin’s adage, “People willing to trade their freedom for temporary security deserve neither and will lose both.”
The sections described below are taken from HR 3590 as agreed to by the Senate and from the reconciliation bill as displayed by the Rules Committee.
1. You are young and don’t want health insurance? You are starting up a small business and need to minimize expenses, and one way to do that is to forego health insurance? Tough. You have to pay $750 annually for the “privilege.” (Section 1501)
2. You are young and healthy and want to pay for insurance that reflects that status? Tough. You’ll have to pay for premiums that cover not only you, but also the guy who smokes three packs a day, drink a gallon of whiskey and eats chicken fat off the floor. That’s because insurance companies will no longer be able to underwrite on the basis of a person’s health status. (Section 2701).
3. You would like to pay less in premiums by buying insurance with lifetime or annual limits on coverage? Tough. Health insurers will no longer be able to offer such policies, even if that is what customers prefer. (Section 2711).
4. Think you’d like a policy that is cheaper because it doesn’t cover preventive care or requires cost-sharing for such care? Tough. Health insurers will no longer be able to offer policies that do not cover preventive services or offer them with cost-sharing, even if that’s what the customer wants. (Section 2712).
5. You are an employer and you would like to offer coverage that doesn’t allow your employers’ slacker children to stay on the policy until age 26? Tough. (Section 2714).
6. You must buy a policy that covers ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services; chronic disease management; and pediatric services, including oral and vision care.
You’re a single guy without children? Tough, your policy must cover pediatric services. You’re a woman who can’t have children? Tough, your policy must cover maternity services. You’re a teetotaler? Tough, your policy must cover substance abuse treatment. (Add your own violation of personal freedom here.) (Section 1302).
7. Do you want a plan with lots of cost-sharing and low premiums? Well, the best you can do is a “Bronze plan,” which has benefits that provide benefits that are actuarially equivalent to 60% of the full actuarial value of the benefits provided under the plan. Anything lower than that, tough. (Section 1302 (d)(1)(A))
8. You are an employer in the small-group insurance market and you’d like to offer policies with deductibles higher than $2,000 for individuals and $4,000 for families? Tough. (Section 1302 (c) (2) (A).
9. If you are a large employer (defined as at least 101 employees) and you do not want to provide health insurance to your employee, then you will pay a $750 fine per employee (It could be $2,000 to $3,000 under the reconciliation changes). Think you know how to better spend that money? Tough. (Section 1513).
10. You are an employer who offers health flexible spending arrangements and your employees want to deduct more than $2,500 from their salaries for it? Sorry, can’t do that. (Section 9005 (i)).
11. If you are a physician and you don’t want the government looking over your shoulder? Tough. The Secretary of Health and Human Services is authorized to use your claims data to issue you reports that measure the resources you use, provide information on the quality of care you provide, and compare the resources you use to those used by other physicians. Of course, this will all be just for informational purposes. It’s not like the government will ever use it to intervene in your practice and patients’ care. Of course not. (Section 3003 (i))
12. If you are a physician and you want to own your own hospital, you must be an owner and have a “Medicare provider agreement” by Feb. 1, 2010. (Dec. 31, 2010 in the reconciliation changes.) If you didn’t have those by then, you are out of luck. (Section 6001 (i) (1) (A)).
13. If you are a physician owner and you want to expand your hospital? Well, you can’t (Section 6001 (i) (1) (B). Unless, it is located in a country where, over the last five years, population growth has been 150% of what it has been in the state (Section 6601 (i) (3) ( E)). And then you cannot increase your capacity by more than 200% (Section 6001 (i) (3) (C)).
14. You are a health insurer and you want to raise premiums to meet costs? Well, if that increase is deemed “unreasonable” by the Secretary of Health and Human Services it will be subject to review and can be denied. (Section 1003)
15. The government will extract a fee of $2.3 billion annually from the pharmaceutical industry. If you are a pharmaceutical company what you will pay depends on the ratio of the number of brand-name drugs you sell to the total number of brand-name drugs sold in the U.S. So, if you sell 10% of the brand-name drugs in the U.S., what you pay will be 10% multiplied by $2.3 billion, or $230,000,000. (Under reconciliation, it starts at $2.55 billion, jumps to $3 billion in 2012, then to $3.5 billion in 2017 and $4.2 billion in 2018, before settling at $2.8 billion in 2019 (Section 1404)). Think you, as a pharmaceutical executive, know how to better use that money, say for research and development? Tough. (Section 9008 (b)).
16. The government will extract a fee of $2 billion annually from medical device makers. If you are a medical device maker what you will pay depends on your share of medical device sales in the U.S. So, if you sell 10% of the medical devices in the U.S., what you pay will be 10% multiplied by $2 billion, or $200,000,000. Think you, as a medical device maker, know how to better use that money, say for R&D? Tough. (Section 9009 (b)).
The reconciliation package turns that into a 2.9% excise tax for medical device makers. Think you, as a medical device maker, know how to better use that money, say for research and development? Tough. (Section 1405).
17. The government will extract a fee of $6.7 billion annually from insurance companies. If you are an insurer, what you will pay depends on your share of net premiums plus 200% of your administrative costs. So, if your net premiums and administrative costs are equal to 10% of the total, you will pay 10% of $6.7 billion, or $670,000,000. In the reconciliation bill, the fee will start at $8 billion in 2014, $11.3 billion in 2015, $1.9 billion in 2017, and $14.3 billion in 2018 (Section 1406).Think you, as an insurance executive, know how to better spend that money? Tough.(Section 9010 (b) (1) (A and B).)
18. If an insurance company board or its stockholders think the CEO is worth more than $500,000 in deferred compensation? Tough.(Section 9014).
19. You will have to pay an additional 0.5% payroll tax on any dollar you make over $250,000 if you file a joint return and $200,000 if you file an individual return. What? You think you know how to spend the money you earned better than the government? Tough. (Section 9015).
That amount will rise to a 3.8% tax if reconciliation passes. It will also apply to investment income, estates, and trusts. You think you know how to spend the money you earned better than the government? Like you need to ask. (Section 1402).
20. If you go for cosmetic surgery, you will pay an additional 5% tax on the cost of the procedure. Think you know how to spend that money you earned better than the government? Tough. (Section 9017).
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THEODORE DALRYMPLE
The Fix Is In
Why Britain’s National Health Service spends so much and does so little
22 March 2010
Americans would do well to ponder a recent admission by a former British minister in the Blair government. On March 2, the Guardianreported that the ex-minister, now Lord Warner, said that while spending on Britain’s National Health Service had increased by 60 percent under the Labour government, its output had decreased by 4 percent. No doubt the spending of a Soviet-style organization like the NHS is more easily measurable than its output, but the former minister’s remark certainly accords with the experiences of many citizens, who see no dramatic improvement in the service as a result of such vastly increased outlays. On the contrary, while the service has taken on 400,000 new staff members—that is to say, one-fifth of all new jobs created in Britain during the period—continuity of medical care has been all but extinguished. Nobody now expects to see the same doctor on successive occasions, in the hospital or anywhere else.
The ex-minister admitted that most of the extra money—which by now must equal a decent proportion of the total national debt—had been simply wasted. (The same might be said, of course, of the increased outlays put toward state education.) But his explanation for this state of affairs was superficial and self-exculpating, to say the least: he said that the NHS received more money than it knew what to do with because of managerial inexperience. “It was like giving a starving man foie gras and caviar,” he said.
As it happens, the NHS knew exactly what to do with the money: give it to its staff, new and old. British doctors, for example, are now the second-highest-paid in the world, though not necessarily the happiest. They have accepted the money on condition that they also accept—as quietly as mice—increasing government interference in their work. When you go to a family doctor in Britain, he is more likely to do what the government thinks he ought to do and will pay him a bonus for doing than what he thinks is right. This is sinister, even when what the government thinks is right happens to be right.
There is a possible explanation other than managerial inexperience for the waste, namely that the waste was intended and desired: indeed, that it was the principal object of the spending. Experience has long shown that further spending by state-monopoly suppliers of services (if services is quite the word I seek) benefits not the consumers but the providers. And they—ever more numerous—naturally vote for their own providers, the politicians. Thus the NHS has become an enormously expensive method of ballot-stuffing. Personally, I would rather have outright electoral fraud. It would be less expensive and slightly more honest.
Just before the last election, the chief executive of one of the hospitals in which I once worked was overheard saying, “My job is to make sure that the government is reelected.” (The government’s job, in turn, was to make sure that she remained chief executive.) She also explained that the hospital could expect no increase in its government funding, unlike other hospitals—because it was located in an area in which most people voted for the government anyway.
Theodore Dalrymple's most recent book is The New Vichy Syndrome.
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Interesting article. The British doctors are the second highest paid in the world? I didn't know that. Well like I have said money can buy anyone.
I can tell you that the model, getting doctors to do what the gov. tells them to do is EXACTLY what is going to happen here.
There is no question those who are driving the changes (the IVY leaGUE phDs and other statisticians) are going to pay physicians and hospital based on their "performance" and not fee for service. Performance is going to be based on "cost effective" outcomes and will include rationing. Everyone of any means will get the same (not initially) but ultimately because of the liberal notion it is NOT FAIR that some can pay for better and more care than others.
Bama IS not telling the truth when he says we are not transforming 1/6th of the economy. Yes the present bill only does this to a degree but there is no doubt the ultimate goal is more like Britain. He know this you know this and I know this. The MSM of course lets him off the hook and smirk at those who point this out and help to marginalize them as "far" right. MSNBC of course throws in the adjective "loons".
Unfortunately the truth is also that a large proportion of the population do want government sponsered care.
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Found a link to the text of the bill:
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3590eas.txt.pdf (http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3590eas.txt.pdf)
If you look around page 1290-1320, you can see where a new "Public health service" has just been created as a parallel to the uniformed services! The bill is not just to fix some systemic problems, it is a direct bid of the goverment for control of our health and our body- A direct attack on self ownership in my opinion.............
I was hoping I would not find something like this in the bill............
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Waxman’s Vendetta
If the liberal lion is genuinely surprised at the real world departing from CBO projections, he should brace himself for more shocks.
Henry Waxman is peeved. He expects corporate America to swallow health-care reform without a peep of protest — and, apparently, without revealing new costs to shareholders or the Securities and Exchange Commission.
Last week, AT&T announced it will take an immediate $1 billion write-down thanks to a new tax in the health bill that will cause Caterpillar ($100 million) and Deere & Co. ($150 million), among other large employers, to do the same. The benefits consultancy Towers Watson estimates that the change may reduce corporate profits by as much as $14 billion over time.
That’s real money. For comparison: It’s enough to bribe Sen. Ben Nelson of the Cornhusker Kickback 140 times over; it’s three times the amount Democrats poured into a (failing) weatherization program that once was a highlight of the stimulus bill; it represents 10 percent of the supposed deficit reduction of health-care reform over ten years. It may be that the health bill’s most immediate, high-profile effect is the destruction of shareholder wealth.
Not to fear. Waxman, the liberal lion who chairs the House Energy and Commerce Committee, is on the case. He doesn’t want to change the tax provision; he wants to browbeat the affected corporations. He has called the CEOs of AT&T, Caterpillar, and Deere to testify before his committee, accompanying his summons with a far-reaching document request lest the corporations miss the point: This is naked political harassment.
Citing the Congressional Budget Office, Waxman says his concern is that the write-downs appear “to conflict with independent analyses.” If he’s genuinely surprised at the real world departing from CBO projections, he should brace himself for more shocks. Is he going to demand OMB director Peter Orszag testify when the projected deficit reduction doesn’t materialize? Waxman maintains his interest is ensuring the bill “does not have unintended consequences.”
Because an immensely complex bill of more than 2,000 pages would never have any of those, right? But Waxman’s vendetta and the offending write-downs are hardly unintended or unforeseen.
Democrats clearly plan to blame the private sector for all the downsides of their health plan. Pres. Barack Obama told liberal lawmakers in a private lobbying session that the bill is only “a beginning.” Any increase in costs and premiums — both of which are inevitable — will be attributed to corporate malfeasance requiring yet more government intervention.
Democrats can’t say they weren’t warned about the coming write-downs. Companies began to receive a tax-free, deductible subsidy in 2003 to continue prescription-drug coverage for their retirees, a ploy to keep the firms from dumping retirees into the new government prescription-drug program. Outside experts and big employers counseled against ending the deductibility, pointing out that it would adversely affect the companies’ financial statements immediately (accounting rules require that corporations note the long-term effect of the new liability right away).
These warnings got shelved under a category ensuring their brusque dismissal: Information Inconvenient to the Passage of Health-Care Reform. Now that the prediction has come to pass, it’s all AT&T’s fault.
The companies will reconsider providing prescription-drug coverage for their retirees at all. The Employee Benefit Research Institute calculates that companies could now save $1,000 per beneficiary by handing them off to the government. As many as 2 million more retirees could end up on the government program, according to James Klein of the American Benefits Council. These retirees might wonder about the truthfulness of Obama’s constant promise that everyone can keep his current insurance.
The CBO estimated that the new treatment of the subsidy would generate roughly $5 billion in revenue. If companies stop taking the subsidy, that revenue disappears, while the costs of the drug program increase. A Towers Watson study stipulates that “employer plans generally provide much better protection than the standard Medicare benefit.” And subsidizing those employer plans is cheaper to the government than providing the coverage itself.
In short, a lose-lose-lose proposition — no doubt, the first of many. Henry Waxman will be a busy man.
— Rich Lowry is editor of National Review. © 2010 by King Features Syndicate.
http://article.nationalreview.com/429748/waxmans-vendetta/rich-lowry
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Rarick:
That comes up blank for me.
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How about this link: http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590ENR/pdf/BILLS-111hr3590ENR.pdf (http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590ENR/pdf/BILLS-111hr3590ENR.pdf)
It is a PDF file, those sometimes take a while
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Bluegrass Bummer
Does Kentucky’s experience with health-insurance overregulation hold lessons for repealing Obamacare?
In the mid-1990s, Kentucky was one of eight state governments that boldly went where the rest of the country refused to go: The commonwealth imposed Clintoncare’s restrictions on its insurance companies, even though Clintoncare had been vanquished from the national stage. In Kentucky and the other seven states, insurance premiums skyrocketed, healthy people stopped buying insurance, and insurance companies exited the market in droves. Only three of the eight were able to untangle themselves from the harmful provisions; only one, Kentucky, was able to pull off a full repeal.
Trey Grayson was elected Kentucky secretary of state in 2003, the year before Gov. Ernie Fletcher was able to finalize the repeal — you’ll note it took ten years to accomplish. Grayson, who is currently running for the Republican nomination to replace Jim Bunning in the U.S. Senate, says that those pushing to repeal Obamacare can take a few lessons from the Kentucky experience. “On the one hand it gives you some hope, because in Kentucky we were able to gradually repeal the elements that were driving up the number of uninsured, that were increasing premiums at a rate higher than the national average, that were driving insurance companies out of the state,” Grayson says. “But unfortunately it took ten years, caused rates to be higher, hurt our economy and hurt our state government from a revenue standpoint. So a lot of damage was done.”
In 1994, Democratic governor Brereton Jones strong-armed a version of Clintoncare through the Democratic-controlled state legislature over the reservations of Republicans and some conservative Democrats. Much like Obamacare, Kentucky’s House Bill 250 forbade insurance companies to deny coverage or charge higher rates based on pre-existing conditions, thus negating the point of insurance — which, properly understood, involves paying premiums to hedge against risk. Under Kentucky’s laws, as under Obamacare, you could wait until you got sick to buy coverage and still obtain it at the same rates as everyone else. (Obamacare includes a requirement that healthy people have insurance, which its proponents say will prevent the premium hikes and insurance-company flight that Kentucky experienced. But the penalty for evading this requirement is relatively small; its constitutionality is suspect; and it might not even be enforceable.)
The problem with such regulations is that healthy people make the rational decision to drop their coverage and wait until they get sick to renew it. As healthy people stop paying into the risk pool, premiums for those who remain skyrocket. If insurance companies are forbidden from increasing premiums to keep up with costs, they leave town or close down. Unsurprisingly, average premiums in Kentucky increased between 36 and 165 percent in the wake of the reforms. Within four years, over 40 insurance companies had stopped offering individual insurance coverage. The two remaining providers, Anthem Blue Cross/Blue Shield and a state-run plan called Kentucky Kare, teetered on the brink of insolvency (Kentucky Kare went under in 1999).
By the late 1990s, Grayson says, “If you said House Bill 250, it was a four-letter word.”
In 1998, the Kentucky legislature, still controlled by Democrats, started repairing the damage by passing a reform package that modified the insurance requirements but didn’t repeal them. In 1999, party switches gave Republicans control of the state senate, and the legislature repealed most of the harmful provisions. Finally, in 2003, Kentucky elected a Republican governor for the first time since 1967, and one of his first acts was to sign a moratorium on new insurance mandates. These reforms slowed the rise of premiums and started bringing insurance companies back to the state.
“What was interesting,” Grayson notes, “is that the repeals were done in a bipartisan manner. Democrats, many of whom voted for House Bill 250, saw the negative impact.” Rising premiums and fleeing insurance companies gave opponents of the bill a compelling story to tell. “When we had evidence, we used it,” Grayson says. “That was what convinced Kentucky voters.” The bill’s opponents armed themselves with facts, and the case against House Bill 250 grew too overwhelming to resist.
This is the first lesson proponents of repeal should take from Kentucky: Construct a narrative around all of the bill’s negative consequences. “So, for example, we’ve already had John Deere and Verizon and some other companies take charges for the next quarter,” Grayson says. “As we learn about businesses choosing to drop insurance or delay expansion plans or whatever they have to do to avoid this, I think we have to take those real-life consequences and tell the public.”
The second lesson, he says, “is that you don’t have to do a full repeal right off the bat. If you can start getting rid of some of the bad elements, try that.” Repealing the most unpopular parts of the bill — new taxes on investment, on income, on medical devices — can pave the way for repealing the spending provisions: “If those taxes have to be repealed or phased out,” Grayson says, “then you start to have a financial concern: How you are going to pay for all this stuff as the subsidies are phased in?”
Liberals are much more influential in Washington than in Kentucky’s statehouse in Frankfort: When the big problems with Obamacare start surfacing, they will push, not for repealing the bill, but for nationalizing even more of the health-care industry. They will call for a stronger penalty for not purchasing insurance or, if the Supreme Court invalidates that provision, they might push for a “public option” to offer a taxpayer-subsidized alternative to the private insurance companies they have broken. When the public option doesn’t work (and we know it won’t, thanks to another failed state experiment in Maine), liberals will argue that the only way to fix the broken system is to make the government the “single payer” for all medical costs.
Opponents of Obamacare must be prepared to make the opposite case, starting with this election cycle. The strongest lesson from Kentucky is that the longer Obamacare stays on the books, the more damage it will inflict on the economy. Conservative candidates such as Grayson can and should run on this issue. Health-care reform “is clearly on the minds of voters,” he says — it’s the second thing people want to talk to him about, after the University of Kentucky’s performance in the NCAA tournament — “and most folks I talk to are not real pleased. I think voters want us to do something about it — hopefully before the damage gets done.”
— Stephen Spruiell is an NRO staff reporter.
http://article.nationalreview.com/430274/bluegrass-bummer/stephen-spruiell
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Interesting.
Two questions for everyone here:
1) What should be the rules concerning someone with a pre-existing condition? What is the conceptual basis for your opinion?
2) What should be the rules for insurance companies when someone develops a serious condition? Should the insurance company be allowed to drop them? Raise their rates until they drop out? Or? What is the conceptual basis for you opinion?
I think answering these two questions important. IMHO it is fear of these two issues that drives much of the support for the HC Law.
I look forward to everyone's answers.
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First, remember poor people have free coverage, elderly have coverage, the rich have coverage (even if it is self insured) and the employees of most medium and large firms have plans, so we are filling a gap mostly where the cost doesn't show value to the person declining coverage.
I'll go with the easy one first: "2) What should be the rules for insurance companies when someone develops a serious condition? Should the insurance company be allowed to drop them?"
No. That is what you are carrying healthy insurance for, IMO, so it will be in place when you are not healthy or eligible for affordable coverage. The policy pays up to the policy lifetime limits if the premiums are maintained. Otherwise, who would ever insure while they are healthy?
1) What should be the rules concerning someone with a pre-existing condition? What is the conceptual basis for your opinion?
Conceptually, there is no easy answer. We can deny coverage but we don't deny treatment. This current law will requires 'repeal and REPLACE'. You can't politically just repeal and this is the heart of it.
Generally when I see a 3-way financial dispute, in this case the taxpayer, the insurance company and the patient, I say split it 3 ways in compromise. There should be a one-time settlement to allow all people with pre-conditions now to get in.
Going forward without an individual mandate, the incentive needs to be to take coverage now while you're healthy and a strong disincentive to wait. All you can really do is require a spend down of people's future assets and income if they wait. Isn't this done with nursing home costs now?
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Thank you.
Please allow me to add a third question for everyone:
3)
a) Should Medicare and Medicaid exist? If yes, what is the conceptual basis? If not, what should be done?
b) If they should exist/can't be terminated, are they solvent? If not, what should be done?
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Crafty,
We've visited these questions before; is there a specific response you are seeking?
Think of much of what would follow depends on the market philosophy one initially embraces. Free market purism invokes specific and predictable parameters; a private/public solution does the same, as does a public only. Unfortunately the tangled mess we are currently encumbered with upon which the new 2000 page mess is overlaid does not lend itself to clean cleavages or quick answers so I'm loathe to start deconstructing as only "yes buts," will follow. Will say that the current amalgamated mess has me thinking along lines applied when someone bites you: the best strategy is to jam the affected body part deeper into the gullet and wait for the gag reflex to do the work for you. Confess currently waiting for this mess to collapse under it's own weight and then being poised to deal with the pieces strikes me as the only foreseeable path.
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Fair enough.
I guess what I am looking for here is the ability to concisely state what we believe and why. If we can't do that, then we are not poised to do anything.
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Interesting.
Two questions for everyone here:
1) What should be the rules concerning someone with a pre-existing condition? What is the conceptual basis for your opinion?
2) What should be the rules for insurance companies when someone develops a serious condition? Should the insurance company be allowed to drop them? Raise their rates until they drop out? Or? What is the conceptual basis for you opinion?
I think answering these two questions important. IMHO it is fear of these two issues that drives much of the support for the HC Law.
I look forward to everyone's answers.
3)
a) Should Medicare and Medicaid exist? If yes, what is the conceptual basis? If not, what should be done?
b) If they should exist/can't be terminated, are they solvent? If not, what should be done?
1) Is the Preexisting condition and "acquired condition"? Lung cancer from smoking, High Blood pressure from overweight/flabby body for example. In which case I would say "conditional coverage" lose the weight/quit smoking/ etc. in a certain amount of time to gain coverage.
Is it a regular disease- cancer, polio, or other type of condition that happens despite what would be a normally healthy life style? In which case my question would be who dropped coverage? That insurer would then be responsible for meeting his contract. If there has not been any previous coverage, then coverage at an increased premium would be the option.
People are responsible for keeping themselves healthy- they are the owner of their life and body, if they are failing in this responsibility another should not be held accountable. The Insurer has the right to set conditions on what they will cover and how given their assumption of risk. Individuals who do not care enough to take care of themselves can hardly expect anyone else to care. If they choose a high risk uninsurable life style- then they have to assume the responsibility all the way. Ther are instances where a healthy and responsibly acting individual just gets sick thru no fault of his own, the premiums he has been pating should cover this, and the insurance company should not be able to "minimize losses" by suspending coverage when a person has been paying in. If a person is trying to be a leech by insuring themselves only when they think they might have a major risk, then they should be charged somwething more as part of paying their fair share.
2) The Insurance companies have a responsibility to charge a fair rate for their coverage, if they are cutting their premiums so much that they cannot sustain the losses on the other end of the policy (ie, I have been paying for 20years to cover myself now, but the company dropped me) then they are not doing their job. If companies are undercutting then it is lawsuit time? I do not know what laws would apply but there are several under restraint of trade of business practices?
3) Medicare and Medicaid probably would be unnecessary if the insurance companies were doing their job. If you are an individual that did not plan properly, then you are free to pay the consequences as far as I am concerned.
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I think free market purism is the avenue that will return the greatest number of positive results for the greatest number of people, while providing disposable income enough for those inclined to do so to donate to assist hard luck cases. I think the current political climate, however, leaves one side of the aisle dependent on a permanent underclass demanding that basic services be inefficiently distributed by the federal government, which in turn creates an ever expanding redistributive bureaucracy. I don't see much being done to address this status quo until it collapses under its own weight, expect instead that band-aids will keep getting slapped on to the current structure to keep it barely afloat, though hope at some point Americans wake up and realize the current special interest hodgepodge does not serve our interests and so vote out the the non-managerial non-mathematicians that brought us this current mess. Alas, this subject is all too easy to demagogue, so I don't hold out much hope for rational progress.
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Can we do without Medicare?
I don't know.
Is there any realistic chance this can be abolished.
I really don't see how.
The most important thing to a senior is their medical care. I remember when I lived in Florida and every single time I sat somewhere, say a restaurant (including toojays) and I was near a table of seniors 100% of the time the topic of their conversation would turn to medical issues. Whose your doctor, their medicines, their insurance, their HMO, their medical problems. Every single time. NO exceptions.
Some seniors seem happy with their care. Others complain about the costs of their meds, they say the "donut" hole helps but some still complain about having to pay almost anything for medicines.
I guess my point is it is political suicide to even suggest eliminating Medicare. IMHO forget about it. Your like tearing their hearts out. In their minds it IS a fight to the death.
As for cigarettes I agree. I used to be against the cigarette tax as I am with most taxes. Yet when I watch people continue to smoke despite their knowing better, despite for some of them incurring huge life and limb threatening medical problems as a result I find it hard to have sympathy. I had a patient recently tell me she did not want to quit now. Her father was sick. I asked if she wanted to quit. She said yes. So I asked what was the reason you didn't quit before he was sick. I got no answer. I pointed out there is always some excuse in the "rat race" of life to have a reason not to quit.
Therefore I urged he to stop making excused and to please get serious about thinking about a strategy that will work for her.
Frankly it is exasperating. While I hate to see people suffer, see people get medical problems I find it hard to feel sorry for people who won't quit. They are doing it to themselves. I am glad they are paying tax. They who smoke are costing this country a gigantic bundle in medical care.
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I agree that advocating abolishing Medicare would be political suicide. So do we simply say that, or is there a principled reason which reaches the same conclusion?
Am I also correct in thinking it already or about to be bankrupt? If so, what, if any, principles apply?
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"or is there a principled reason which reaches the same conclusion?"
I just did a search on this and cannot find much though it may be the search words I use.
I guess some would claim Medicare is not an entitlement per se since we pay into it.
We will eventually wind up with rationing of some sort. Look at all the other countries that have gone this path and they all ration.
And they are going broke anyway.
The wheels are in motion. As this bill leads us to have gigantic cost overuns (and it certainly will) the powers to be will continue to implement fixes that eventually will lead to rationing. I have not heard anything that convinces me there is any other alternative. Certainly not from the repubs.
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I wish that congress and the IRS did not have control over this program. I wish they had chosen to do something like make a deal with the AMA and a large non-traditional medical organization. If those 2 mereged and ran "basic" medical and life saving like the post office runs "basic" mail and package? Base the costs of this basic care off of the "medcal expense account" that everyone has access to. (The one limited by the current bill to 2.500/yr) Use the revenue from the "dissappearing" savings account to go to Basic Care? (people could use it as a chritable tax shelter while using some of it for themselves?)
As it is I see no real way out aside from full repeal and rework from the start.
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Rarick,
I agree with you.
But doctors are far from organized and a large heterogenous group of different specialties, ages, men vs women, ethinic groups, foreign born vs American born, and philosophies.
There are many articles in the med journals making "calls to action". Like, "we doctors must take action now or we never will, etc, etc, yadda, yadda, etc".
"We are the buyers in health care not the patients(since we are the ones ordering tests, etc)". Blah blah blah blah blah.
I can go on ad nauseum. Usually a few people will write letters to the editor in response to these articles some agreeing some the other way. The medical organizations have different stances too. The American College of Physicians has already accepted for *many* years now the fait accompli (sp?) of government takeover of health care and sucks up to the government agreeing to nearly every concept they come up with in hopes we can salvage at least a minimal say in what happens. For example if we can at least get some tort reform. Or some payment reform to salvage primary care from the ruins it is in. Of course the Feds take payments away from specialists to give us a few bones fragmenting the medical community more. The Cardiologists who for all intents and purposes have done everything they can to soak the system for every dime have attempted to sue the Feds for payment cuts. Of course that didn't work. I have no sympathy for what one primary doc rightly called the "priviledged class" when referring to cardiologists.
Of course the dishonest Phoney One goes around claiming that illegals are not covered now suggesting no one need worry about that. Of course he fails to say that all their American born children are. And what a joke this will turn out to be the true minute they grant amnesty cloaked as some sort of program that requires them to pay fines, learn some English, pay back taxes etc.
There is NO escaping the conclusion that any rational person can come to that the policy makers that come up with these gov. health care plans and the politicians that push for them including the great liar in chief, do not know the sytem WILL go broke when millions more are added onto the rolls requiring the government to step in and save it from itself with single payer. (Keeping these people out of ERs won't do it. In fact I predict it will just make costs go up even more.)
THE REAL TRUTH IS THAT THIS IS THE STRATEGY.
Pelosi/Bela Lugosi has already basically said as much when she claims this bill is just the start. "Kicking in the door" and more bills to fix the system towards their ultimate goal. Bama has said as much too.
I am sure that Bama told this to Kusinich on that air force one plane ride. He must have told him not to worry. That the present bill is the only one politically viable enough to get passed, but not to worry as it is only the start of a process to get "our" ultimate goal passed which is single payer government run rationed care where everyone is treated exactly like everyone else.
I am sure he told him he agrees with Kusinich in principle and probably promised him that they will together succeed but it takes time. "Pretend to be one of them if you want to change them".
There is no question we will have debt skyrocket as a result. Don't think for even a second, or a pause that all this talk of bundling payments, research into cost effective care, getting rid of the middle men insurers, single payer, preventative care, etc, will be enough. It problably will help but as soon as millions more are on the rolls for free to them - the game is up. Look at Massachussets. Romney is the poster boy for this.
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From the New England Journal of liberalism, woops I mean Medicine. Notice PhDs are getting this political piece published in the NEJM that purports to be non partisan.
Look at this line carefully:
***On the political front, Republicans unanimously opposed the final bill in both the House and the Senate. They have expressed outrage at the Democratic leadership’s decision to “ram through” reform using budget reconciliation to modify the Senate-passed bill sufficiently to make it acceptable to the House. The outrage is baseless***
Oh really, the outrage is "baseless". Says who? These policy liberals are the ones who are going to decide all health care in this nation. Make no mistake about it. They are drooling at the prospect of getting the power to say yes or no to our health care. I wonder what they make. FOX news should do some research on these people and their financial interests. Notice they all seem to fall behind the scenes. Yet they are making policy the Dems are shoving down our throats - I know this claim is "baseless". Where is the journalism that should be looking into these progressives?
****from the publishers of
the New England
Journal of Medicine
The War Isn’t Over
Posted by NEJM • March 24th, 2010 • Printer-friendly
Henry J. Aaron, Ph.D., and Robert D. Reischauer, Ph.D.
Health care reform advocates will and should celebrate their history-making legislative success. For many, the past year has been all health care all the time. Celebration should be limited, however. Major challenges lie ahead, and hard work remains to be done. Opponents will continue, and probably intensify, their opposition. They have promised legal challenges and are likely to seek repeal of all or part of the legislation. Moreover, formidable implementation hurdles must be surmounted if health care reform is to achieve its goals.
On the political front, Republicans unanimously opposed the final bill in both the House and the Senate. They have expressed outrage at the Democratic leadership’s decision to “ram through” reform using budget reconciliation to modify the Senate-passed bill sufficiently to make it acceptable to the House. The outrage is baseless, but the fury is real and will poison future debate.
The first political testing ground will be the November 2010 midterm elections. Republicans have pledged to make the substance of the reform and the procedures used to enact it central to these elections. The Democratic majorities in both chambers of Congress are likely to be reduced, probably by even more than is usual for an off-year election. With 2010 gains under their belts, opponents will almost certainly continue and intensify attacks on the reform legislation during the 2012 presidential and congressional campaigns; they may well regain control of the Senate — 21 Democrats and 2 independents who vote with them, but only 10 Republicans, will be up for reelection — and could win the White House.
The reform legislation’s implementation schedule gives these political possibilities particular salience. Although many provisions of the bill will take effect immediately or soon after enactment, implementation of the big-ticket items is deferred. The individual and employer mandates, the subsidies to make insurance affordable, the Medicaid expansion, and major insurance-market reforms will all start in 2014. And the tax on high-cost insurance plans goes into effect in 2018. Given the intensity of Republicans’ opposition to the substance and manner of passage of this reform, if the GOP regains the presidency and control of Congress in 2012, implementation could be substantially delayed or the law could be significantly modified or even repealed before its major elements have been implemented.
Making the legislation a success requires not only that it survive but also that it be effectively implemented. Although the bill runs to more than 2000 pages, much remains to be decided. The legislation tasks federal or state officials with writing regulations, making appointments, and giving precise meaning to many terms. Many of these actions will provoke controversy. Performing them will take staff, money, and time. Given the current federal deficit and beleaguered state treasuries, needed staff and funding will be hard to come by.
Even with adequate resources, implementing health care reform will be complex and difficult. Much of this challenge is inherent in the complicated and diverse ways in which health care is delivered and paid for in the United States. Part of the challenge arises from the likelihood that as implementation proceeds, unforeseen challenges will emerge.
To get some flavor of what lies ahead, consider the following. The law provides for income-based credits payable by the federal Internal Revenue Service (IRS) to insurers on behalf of households that apply for coverage through state-managed health insurance exchanges. IRS filing units (whether individuals, couples, or families) are not always the same as the units covered by a health insurance policy. Eligibility for health insurance subsidies should be based on current income, but the IRS has income information only for past years. Mechanisms for exchanging income information between the IRS and the state insurance exchanges will need to be developed, as will ways of handling subsidies when definitions of a family unit vary and when family composition or income changes significantly between the time that taxes are filed and the time when insurance subsidies are to be delivered.
Other issues arise because the legislation asks state officials, some of whom oppose the reform, to play a large part in its implementation. The bill calls on each state to set up its own health insurance exchange and permits the exchanges to operate under widely varying rules. For example, states may establish separate exchanges for individuals and for small groups and may create a basic plan for individuals and families with incomes between 133 and 200% of the federal poverty level. Insurers need not offer the same plans in the exchanges as they do outside them. Averting insurance-company competition that is based on risk selection will require aggressive state oversight, which some states may be unwilling or unable to provide.
These responsibilities will be terra incognita for many state administrators. Even when goodwill prevails, administrators will find implementation very difficult. However, the experience of the Commonwealth Connector, the exchange though which Massachusetts residents without employer-provided insurance obtain affordable coverage, offers encouragement that these difficulties can be overcome.
Furthermore, parts of the reform are bound not to work as expected. For example, the legislation calls for extending Medicaid to everyone with an income below 133% of the federal poverty level. Medicaid rolls in some states will expand by 50% or more. It is unclear whether these states will be able to find enough providers who are willing to accept the anticipated payment rates to serve this expanded population, even as the demand from better-paying patients for services is growing. If they don’t, will they raise provider payment rates, curtail Medicaid benefits (as states are legally authorized to do), or simply let patients fail to find doctors who are willing to provide them with care?
To further complicate matters, some families may be able to buy insurance in several distinct ways, depending on their income, family composition, and state policy. Different family members may be eligible under Medicaid, under the Children’s Health Insurance Program (CHIP), through the exchanges with subsidies, through the exchanges without subsidies, or through a yet-to-be-created state basic health insurance plan. If employers offer plans that meet federal standards and cost households no more than stipulated fractions of the worker’s income, employees will not be eligible for insurance through exchanges, but if employment-based insurance does not meet federal standards or is too costly, employees will have the option of buying insurance through the exchanges — with or without subsidies, depending on income. Small changes in income can push some, but not all, family members from one form of coverage to another — for example, from Medicaid or CHIP to the basic plan to the exchanges. Negotiating this maze will be a challenge for many health care seekers, particularly low- and moderate-income families. Providing ample counseling will be essential. These and myriad other implementation difficulties will fuel continued political controversy.
Passage of health care reform legislation is a cause for celebration. But supporters must not relax. They should prepare to meet the serious challenges that remain. If those challenges are not recognized and surmounted, health care reform could go the way of the Medicare Catastrophic Coverage Act of 1988. That bill, enacted with almost self-congratulatory enthusiasm, provoked vociferous resistance from some observers and was repealed 16 months later. If supporters of the current reform meet the remaining challenges, its course could instead resemble that of the Medicare drug bill, which was widely regarded as a case study in efficient and effective implementation.
Far from having ended, the war to make health care reform an enduring success has just begun. Winning that war will require administrative determination and imagination and as much political resolve as was needed to pass the legislation.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
Source Information
From the Brookings Institution (H.J.A.) and the Urban Institute (R.D.R.) — both in Washington, DC.
This article (10.1056/NEJMp1003394) was published on March 24, 2010, at NEJM.org.
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Read this article at NEJM.org
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It looks like we just got notified by our provider, Anthem Blue Cross, (yes those folks) that our rates are going up 100%. :x :-o :x
Our agent had told us we were guaranteed the rate we had for many more months. He is out of town until Monday, at which point we will seek clarification.
If this turns out to be what it appears to be, it is a real hard hit for our family.
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Crafty,
That is terrible.
I sympathize.
There is no doubt this is due to the health care bill.
The insurers are going to have to come up with money somewhere to pay for all the new people with medical conditions and the rest.
They started jacking up the rates this past year in anticipation of the health care bill.
My rates up 21%. I am sure they will skyrocket even more now.
An MBA administrator I work with who works closely with some of the big insurers in NJ said that the health care companies aniticipated the health care bill passing and would have been in total disaray if it *didn't* pass.
The health care policy makers and ALL the politicians behind the bill including of course Bama *know* this will happen. They know rates will skyrocket, they know people will be screaming for government to step in, they will be out their populist hay out of the insurers "ripping us off" and eventually will slowly but surely have government step in and take control and dictate the rationing of health care to all of us. He/they are lying to us when they pretend otherwise. Talk radio is correct on calling them on this and the disingenious jerks who publish in the NEJM who claim that those who opposed the bill were doing so on "baseless" or bogus "claims" are boldfaced ideologues - no less no more. Now if I send in a letter to the NEJM editor calling them on this the journal will simply not publish my letter.
Thus they forced down the throats of 90% of the US population their will forcing us to pay for the 10% who will get the free benefits. And yes the benefits will be free.
Do not think for one second they don't KNOW this. Of course they do.
And getting back to your question as to whether Medicare can be replaced by anything else - I don't know the answer and I have not seen anyone even consider this or entertain that idea - though it is a good one.
Unfortunately, as you can see by my post of the NEW ENGLAND JOURNAL OF MEDICINE article which is the medical version of the NYT, the policy people behind the wheels and gears of health care policy want to *expand* and not do away with Medicare/caid. They want to expand it to all Americans with *them at the helm*.
I keep thinking I must cancel my subscription to the NEJM but I keep talking myself out of it because they are the premier journal in the US and I do like to read their occasional important medical publications. That said I can tell you without quivication that most doctors are outraged by their politics and that journal does NOT speak to most of our views on the health care debate. The journal stifles any real disagreement or letters of correspondence that hold opposing views to their liberal clones that get their articles and opinions published as though it is gospel and make it appear they speak for us.
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yeah, a 0 deductible to a 500$ deductible........... I'm going to have to start playing a game I have been putting off, Tax Shelter and I am only average income :(
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Well, good news-- it looks like for some reason we were billed for two months, which included a slight increase due to a , , , particular birthday of my wife.
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http://hotair.com/archives/2010/04/12/nyt-obamacare-may-have-accidentally-stripped-congress-of-health-coverage/
BwahahahaHAHAHAHAHAhahahahaha!!!
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The new doctors will come from overseas. As is already the case in NJ.
I was shocked when an *Indian* colleague of mine complained about the doctor competition in NJ by saying the "damn Indians, they just keep coming". I don't balme them if they want a better life here. But when does it end or even slow?
By SUZANNE SATALINE And SHIRLEY S. WANG
Getty Images
First-year resident Dr. Rachel Seay, third from left, circumcises a newborn in George Washington University Hospital's delivery wing on March 12.
The new federal health-care law has raised the stakes for hospitals and schools already scrambling to train more doctors.
Experts warn there won't be enough doctors to treat the millions of people newly insured under the law. At current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges.
That shortfall is predicted despite a push by teaching hospitals and medical schools to boost the number of U.S. doctors, which now totals about 954,000.
The greatest demand will be for primary-care physicians. These general practitioners, internists, family physicians and pediatricians will have a larger role under the new law, coordinating care for each patient.
The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007.
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Medical Training in Second Life (04/12/10)Getting Doctors, Hospitals to Use Electronic Medical Records (01/26/09)Faces of Health Care: A Doctor is in the House (12/22/09)A shortage of primary-care and other physicians could mean more-limited access to health care and longer wait times for patients.
Proponents of the new health-care law say it does attempt to address the physician shortage. The law offers sweeteners to encourage more people to enter medical professions, and a 10% Medicare pay boost for primary-care doctors.
Meanwhile, a number of new medical schools have opened around the country recently. As of last October, four new medical schools enrolled a total of about 190 students, and 12 medical schools raised the enrollment of first-year students by a total of 150 slots, according to the AAMC. Some 18,000 students entered U.S. medical schools in the fall of 2009, the AAMC says.
But medical colleges and hospitals warn that these efforts will hit a big bottleneck: There is a shortage of medical resident positions. The residency is the minimum three-year period when medical-school graduates train in hospitals and clinics.
There are about 110,000 resident positions in the U.S., according to the AAMC. Teaching hospitals rely heavily on Medicare funding to pay for these slots. In 1997, Congress imposed a cap on funding for medical residencies, which hospitals say has increasingly hurt their ability to expand the number of positions.
Medicare pays $9.1 billion a year to teaching hospitals, which goes toward resident salaries and direct teaching costs, as well as the higher operating costs associated with teaching hospitals, which tend to see the sickest and most costly patients.
Doctors' groups and medical schools had hoped that the new health-care law, passed in March, would increase the number of funded residency slots, but such a provision didn't make it into the final bill.
"It will probably take 10 years to even make a dent into the number of doctors that we need out there," said Atul Grover, the AAMC's chief advocacy officer.
While doctors trained in other countries could theoretically help the primary-care shortage, they hit the same bottleneck with resident slots, because they must still complete a U.S. residency in order to get a license to practice medicine independently in the U.S. In the 2010 class of residents, some 13% of slots are filled by non-U.S. citizens who completed medical school outside the U.S.
One provision in the law attempts to address residencies. Since some residency slots go unfilled each year, the law will pool the funding for unused slots and redistribute it to other institutions, with the majority of these slots going to primary-care or general-surgery residencies. The slot redistribution, in effect, will create additional residencies, because previously unfilled positions will now be used, according to the Centers for Medicare and Medicaid Services.
From the Archive
Opinion: How to Fix the Doctor Shortage (01/04/10)Health Blog: Would Adding Residency Slots Solve the Primary-Care Shortage? (11/27/09)Opinion: The Coming Shortage of Doctors (11/06/09)Health Blog: Obama: 'Severe Shortage' of Primary Care Doctors (08/11/09)Some efforts by educators are focused on boosting the number of primary-care doctors. The University of Arkansas for Medical Sciences anticipates the state will need 350 more primary-care doctors in the next five years. So it raised its class size by 24 students last year, beyond the 150 previous annual admissions.
In addition, the university opened a satellite medical campus in Fayetteville to give six third-year students additional clinical-training opportunities, said Richard Wheeler, executive associate dean for academic affairs. The school asks students to commit to entering rural medicine, and the school has 73 people in the program.
Journal Communitydiscuss“ As a specialist physician I will suggest that until primary care physicians can earn 70-80% of what most specialists make without killing themselves, there will be no incentive for the best and the brightest to go into primary care. ”
—Michael Brennan "We've tried to make sure the attitude of students going into primary care has changed," said Dr. Wheeler. "To make sure primary care is a respected specialty to go into."
Montefiore Medical Center, the university hospital for Albert Einstein College of Medicine in New York, has 1,220 residency slots. Since the 1970s, Montefiore has encouraged residents to work a few days a week in community clinics in New York's Bronx borough, where about 64 Montefiore residents a year care for pregnant women, deliver children and provide vaccines. There has been a slight increase in the number of residents who ask to join the program, said Peter Selwyn, chairman of Montefiore's department of family and social medicine.
One is Justin Sanders, a 2007 graduate of the University of Vermont College of Medicine who is a second-year resident at Montefiore. In recent weeks, he has been caring for children he helped deliver. He said more doctors are needed in his area, but acknowledged that "primary-care residencies are not in the sexier end. A lot of these [specialty] fields are a lot sexier to students with high debt burdens."
Write to Suzanne Sataline at suzanne.sataline@wsj.com and Shirley S. Wang at shirley.wang@wsj.com
Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved
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I forgot to note that the doctor "shortage" will be also addresed by having nurse practitioners and physician assistants do what we do.
In a way, if control of health care goes the way the elites want this may not be unreasonable. Indeed we won't need doctors at all except to do the most complex tasks or the very sickest intensive care. Every aspect of medical care will be cook book and anyone can follow down the path of computer programs that spit out what to do in any given moment.
There will be all sorts of statician studies "proving" that care will be just as good, that "outcomes" for large populations will be the same.
As a primary care physician I am used to being devalued. So I am neither shocked or even care at this point.
It would be like replacing trained experienced police officers with auxillary police, or attorneys with paralegals and giving them cook books to follow.
Then pointing out how violent crime is not up, just as many traffick tickets are given out and that civil legal situation is just as dandy as before.
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"having nurse practitioners and physician assistants do what [doctors] do"
Except that with public unionization and lack of market discipline on costs and efficiencies, we will be paying the less qualified as much as we would or could have been paying the MD's IMO.
As far as I know the physician shortage is matched with a system of keeping good people out. The extreme salaries needed to pay doctors (in the eyes of others) comes from the limits on supply and the artificially high cost of higher eduction. Medical schools have no constraints on costs either until people quit applying and entering at those prices.
I'm waiting for my libertarian friends to call for legalization of private, unlicensed health care if we are moving toward less trained and less qualified practitioners anyway.
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Well there is a lot of fear amongst doctors of "going out of business" and having to lay people off. I am surprised at what I am hearing. Of course not all areas of the country are like the NYC metropolitan area which has had plenty of doctors.
A cardiologist today told of taking a pay cut from his group and of another one being let go.
I am a bit surpirsed in view of how much they have made for years.
As for me I have gotten nothing for years and expect nothing. I am not holding my breath for "saving primary care".
In fact the plan as I see it is simply to replace us with nurses though few are coming out and saying that now till after as many elections as they can put this off for.
All I can say for certain if seniors want to bitch about the cost of their medicines prior to W's part D plan that went into effect, and then complain still about thier Rx costs that fall into the "donut holes", then just wait till Bama and his ideological policy makers (who are drooling at the thought of getting control, power and making plenty of dough) get done with them.
The "greatest" generation that now expects to sit back and let us pay may be the biggest bunch of crab apples pretty soon.
Then comes the "boomers" getting into the Medicare slots (which I guess I am one) and need I say more?
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The Insurance Mandate in Peril
First Congress said it was a regulation of commerce. Now it's supposed to be a tax. Neither claim will survive Supreme Court scrutiny.
By RANDY E. BARNETT
A"tell" in poker is a subtle but detectable change in a player's behavior or demeanor that reveals clues about the player's assessment of his hand. Something similar has happened with regard to the insurance mandate at the core of last month's health reform legislation. Congress justified its authority to enact the mandate on the grounds that it is a regulation of commerce. But as this justification came under heavy constitutional fire, the mandate's defenders changed the argument—now claiming constitutional authority under Congress's power to tax.
This switch in constitutional theories is a tell: Defenders of the bill lack confidence in their commerce power theory. The switch also comes too late. When the mandate's constitutionality comes up for review as part of the state attorneys general lawsuit, the Supreme Court will not consider the penalty enforcing the mandate to be a tax because, in the provision that actually defines and imposes the mandate and penalty, Congress did not call it a tax and did not treat it as a tax.
The Patient Protection and Affordable Care Act (aka ObamaCare) includes what it calls an "individual responsibility requirement" that all persons buy health insurance from a private company. Congress justified this mandate under its power to regulate commerce among the several states: "The individual responsibility requirement provided for in this section," the law says, ". . . is commercial and economic in nature, and substantially affects interstate commerce, as a result of the effects described in paragraph (2)." Paragraph (2) then begins: "The requirement regulates activity that is commercial and economic in nature: economic and financial decisions about how and when health care is paid for, and when health insurance is purchased."
In this way, the statute speciously tries to convert inactivity into the "activity" of making a "decision." By this reasoning, your "decision" not to take a job, not to sell your house, or not to buy a Chevrolet is an "activity that is commercial and economic in nature" that can be mandated by Congress.
It is true that the Supreme Court has interpreted the Commerce Clause broadly enough to reach wholly intrastate economic "activity" that substantially affects interstate commerce. But the Court has never upheld a requirement that individuals who are doing nothing must engage in economic activity by entering into a contractual relationship with a private company. Such a claim of power is literally unprecedented.
Since this Commerce Clause language was first proposed in the Senate last December, Democratic legislators and law professors alike breezily dismissed any constitutional objections as preposterous. After the bill was enacted, critics branded lawsuits by state attorneys general challenging the insurance mandate as frivolous. Yet, unable to produce a single example of Congress using its commerce power this way, the defenders of the personal mandate began to shift grounds.
On March 21, the same day the House approved the Senate version of the legislation, the staff of the Joint Committee on Taxation released a 157-page "technical explanation" of the bill. The word "commerce" appeared nowhere. Instead, the personal mandate is dubbed an "Excise Tax on Individuals Without Essential Health Benefits Coverage." But while the enacted bill does impose excise taxes on "high cost," employer-sponsored insurance plans and "indoor tanning services," the statute never describes the regulatory "penalty" it imposes for violating the mandate as an "excise tax." It is expressly called a "penalty."
This shift won't work. The Supreme Court will not allow staffers and lawyers to change the statutory cards that Congress already dealt when it adopted the Senate language.
In the 1920s, when Congress wanted to prohibit activity that was then deemed to be solely within the police power of states, it tried to penalize the activity using its tax power. In Bailey v. Drexel Furniture (1922) the Supreme Court struck down such a penalty saying, "there comes a time in the extension of the penalizing features of the so-called tax when it loses its character as such and becomes a mere penalty with the characteristics of regulation and punishment."
Although the Court has never repudiated this principle, the Court now interprets the commerce power far more broadly. Thus Congress may regulate or prohibit intrastate economic activity directly without invoking its taxation power. Yet precisely because a mandate to engage in economic activity has never been upheld by the Court, the tax power is once again being used to escape constitutional limits on Congress's regulatory power.
Supporters of the mandate cite U.S. v. Kahriger (1953), where the Court upheld a punitive tax on gambling by saying that "nless there are provisions extraneous to any tax need, courts are without authority to limit the exercise of the taxing power." Yet the Court in Kahriger also cited Bailey with approval. The key to understanding Kahriger is the proposition the Court there rejected: "it is said that Congress, under the pretense of exercising its power to tax has attempted to penalize illegal intrastate gambling through the regulatory features of the Act" (emphasis added).
In other words, the Court in Kahriger declined to look behind Congress's assertion that it was exercising its tax power to see whether a measure was really a regulatory penalty. As the Court said in Sonzinsky v. U.S. (1937), "nquiry into the hidden motives which may move Congress to exercise a power constitutionally conferred upon it is beyond the competency of courts." But this principle cuts both ways. Neither will the Court look behind Congress's inadequate assertion of its commerce power to speculate as to whether a measure was "really" a tax. The Court will read the cards as Congress dealt them.
Congress simply did not enact the personal insurance mandate pursuant to its tax powers. To the contrary, the statute expressly says the mandate "regulates activity that is commercial and economic in nature." It never mentions the tax power and none of its eight findings mention raising any revenue with the penalty.
Moreover, while inserting the mandate into the Internal Revenue Code, Congress then expressly severed the penalty from the normal enforcement mechanisms of the tax code. The failure to pay the penalty "shall not be subject to any criminal prosecution or penalty with respect to such failure." Nor shall the IRS "file notice of lien with respect to any property of a taxpayer by reason of any failure to pay the penalty imposed by this section," or "levy on any such property with respect to such failure."
In short, the "penalty" is explicitly justified as a penalty to enforce a regulation of economic activity and not as a tax. There is no authority for the Court to recharacterize a regulation as a tax when doing so is contrary to the express and actual regulatory purpose of Congress.
So defenders of the mandate are making yet another unprecedented claim. Never before has the Court looked behind Congress's unconstitutional assertion of its commerce power to see if a measure could have been justified as a tax. For that matter, never before has a "tax" penalty been used to mandate, rather than discourage or prohibit, economic activity.
Are there now five justices willing to expand the commerce and tax powers of Congress where they have never gone before? Will the Court empower Congress to mandate any activity on the theory that a "decision" not to act somehow affects interstate commerce? Will the Court accept that Congress has the power to mandate any activity so long as it is included in the Internal Revenue Code and the IRS does the enforcing?
Yes, the smart money is always on the Court upholding an act of Congress. But given the hand Congress is now holding, I would not bet the farm.
Mr. Barnett is a professor of constitutional law at Georgetown and the author of "Restoring the Lost Constitution: The Presumption of Liberty" (Princeton, 2005).
http://online.wsj.com/article/SB10001424052748704446704575206502199257916.html
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End to Rescission, and More Good News Recommend
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LinkedinDiggFacebookMixxMySpaceYahoo! BuzzPermalink Published: May 2, 2010
Americans are already starting to see the benefits of health care reform. The new law requires health insurance companies — starting in September — to end their most indefensible practice: rescinding coverage after a policyholder gets sick. In recent days insurers and their trade association have rushed to announce that they will end rescissions immediately.
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That is very good news for the thousands of people who each year pay their premiums but lose their coverage just when they are likely to run up big medical bills.
The insurers decided to act quickly after they were whacked by some very bad publicity. An investigative report by Reuters said that one of the nation’s biggest insurers, WellPoint, was targeting women with breast cancer for fraud investigations that could lead to rescissions.
Although WellPoint fiercely denied singling out breast cancer patients for scrutiny, it acknowledged using computer algorithms to search for a range of conditions that applicants would likely have known about at the time they applied. That seemed like a backhanded admission that it was indeed searching for excuses — the company would say legitimate reasons — to cancel coverage. The Obama administration and Congressional Democrats urged insurers to end rescissions at once.
Insurers claim policies are rescinded only when people have misrepresented or lied about their health status or other important factors at the time of application. Insurers do rescissions only on individual policies, not employer-based coverage. They argued that to keep down rates for the rest of their customers they needed the ability to exclude people who failed to report pre-existing conditions.
An investigation and hearings last year by the House Committee on Energy and Commerce challenged those claims. They found many troubling cases where the pre-existing conditions were trivial, unrelated to the claim, or not known to the patient.
Some companies issued policies quickly to start collecting premiums and only later, if a policyholder filed expensive claims, performed a detailed examination of medical records. If they found any discrepancies or omissions, they would retroactively cancel the policy, refund the premiums paid, and refuse to pay for further medical services. At that point, of course, the applicant would be unable to get coverage from any other insurer.
The House investigation found that three big insurers rescinded some 20,000 policies over a five-year period, and a survey by the National Association of Insurance Commissioners found more than 27,000 rescissions in an overlapping five-year period. That’s a small percentage of the millions of policies issued or in force in any given year, but a disaster for the thousands of people who lost their insurance.
The insurers were wise to short-circuit the criticisms and end rescissions now. This follows a recent agreement by many companies to start letting dependents stay on their parents’ policies until age 26, which isn’t required until September. Under pressure from the White House, the industry has also agreed to cover children with pre-existing medical conditions as soon as new rules are issued.
Many of the other major provisions of reform don’t kick in until 2014, but it is already changing the behavior of insurers. That means more security for many Americans who might otherwise find insurance unaffordable or unavailable
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The good parts of healthcare could have been done with bipartisanmaybe unanimous majority. It makes a lie (IMO)of the promise to unite, not divide. I can't imagine a Republican opposing this. I can't imagine an informed consumer paying for a policy while healthy that does not continue to cover you later when you are not.
The leftists in charge would not give us basic, obvious protections that people wanted without mixing them with the unpopular provisions of socialism, mandates, and new taxes in order to get the end result that they wanted.
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Amen!!!
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Source: Indy Star http://www.indystar.com/article/20100430/OPINION12/4300313/1002/OPINION/Obamacare-poised-to-crash
NEW ORLEANS -- Just five weeks since the president of the United States signed Obamacare into law, it already resembles an overweight airplane lumbering down the tarmac, poised to crash and burn soon after takeoff. Obamacare's excess cargo of broken promises threatens such a catastrophe.
"The plan I'm announcing tonight," President Barack Obama promised a joint session of Congress last Sept. 9, "will slow the growth of health-care costs for our families, our businesses, and our government."
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Not so fast, warns Medicare's Office of the Actuary. In a devastating, independent, 38-page analysis released on April 22, Chief Actuary Richard Foster forecast, "The growth rate reductions from productivity adjustments are unlikely to be sustainable on a permanent annual basis . . . We show a negligible financial impact over the next 10 years for the other provisions intended to help control future health-care cost growth."
"This is an objective report by administration actuaries that shows this sweeping legislation has serious, serious problems," says health-policy analyst Grace-Marie Turner of the Galen Institute. Foster's study delineates the canyon between Obama's warm words and the chilly disappointment that awaits those who expect Obamacare to do good.
"We will have a health-care plan that actually works for you, reduces spending and costs over the long term," Obama promised at the Oct. 7, 2008 presidential debate, among other appearances.
In fact, Foster calculates, the plan will boost U.S. health spending by $311 billion through 2019, while federal medical outlays will grow "by a net total of $251 billion."
"If you like your health-care plan, you will be able to keep your health-care plan. Period. No one will take it away. No matter what," Obama promised the American Medical Association last June 15, and on numerous other occasions.
This guarantee will turn to dust, Foster predicts. "Some smaller employers would be inclined to terminate their existing coverage," he explains. Elsewhere, "the penalties would not be a substantial deterrent to dropping or foregoing coverage." Thanks to these and similar factors, "We estimate that such actions would collectively reduce the number of people with employer-sponsored health coverage by about 14 million," Foster writes.
NEW ORLEANS -- Just five weeks since the president of the United States signed Obamacare into law, it already resembles an overweight airplane lumbering down the tarmac, poised to crash and burn soon after takeoff. Obamacare's excess cargo of broken promises threatens such a catastrophe.
"The plan I'm announcing tonight," President Barack Obama promised a joint session of Congress last Sept. 9, "will slow the growth of health-care costs for our families, our businesses, and our government."
Advertisement
Not so fast, warns Medicare's Office of the Actuary. In a devastating, independent, 38-page analysis released on April 22, Chief Actuary Richard Foster forecast, "The growth rate reductions from productivity adjustments are unlikely to be sustainable on a permanent annual basis . . . We show a negligible financial impact over the next 10 years for the other provisions intended to help control future health-care cost growth."
"This is an objective report by administration actuaries that shows this sweeping legislation has serious, serious problems," says health-policy analyst Grace-Marie Turner of the Galen Institute. Foster's study delineates the canyon between Obama's warm words and the chilly disappointment that awaits those who expect Obamacare to do good.
"We will have a health-care plan that actually works for you, reduces spending and costs over the long term," Obama promised at the Oct. 7, 2008 presidential debate, among other appearances.
In fact, Foster calculates, the plan will boost U.S. health spending by $311 billion through 2019, while federal medical outlays will grow "by a net total of $251 billion."
"If you like your health-care plan, you will be able to keep your health-care plan. Period. No one will take it away. No matter what," Obama promised the American Medical Association last June 15, and on numerous other occasions.
This guarantee will turn to dust, Foster predicts. "Some smaller employers would be inclined to terminate their existing coverage," he explains. Elsewhere, "the penalties would not be a substantial deterrent to dropping or foregoing coverage." Thanks to these and similar factors, "We estimate that such actions would collectively reduce the number of people with employer-sponsored health coverage by about 14 million," Foster writes.
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"I can make a firm pledge," Obama told Dover, New Hampshire voters on Sept. 12, 2008. "Under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes."
Obamacare's first 10 years of operations would cost $2.5 trillion. This massive new expenditure, plus Washington's other spendaholic commitments, explains Obama's eagerness to jettison his oft-repeated commitment not to raise taxes on Americans who earn less than $250,000 annually.
To finance Obamacare and their other pricey projects, many Washington Democrats crave a national sales tax. Obamacare already features $569 billion in new taxes on -- among other things -- prescription drugs, medical devices, health insurance plans, and even tanning salons. These levies will trickle down to couples with annual incomes below $250,000, and individuals under $200,000. Rather than keep his promise, Obama triumphantly signed these health-related tax hikes.
Regarding a national sales levy -- atop the income tax and countless tributes that tread on Americans as if with cleated boots -- Obama refuses to reject it. In fact, Americans for Tax Reform noted Obama's remarks as he introduced his deficit commission on Tuesday: "It's important that we not restrict the review or the recommendations that this commission comes up with in any way. Everything has to be on the table."
Unveiled in 2008, "Barack Obama's Plan for a Healthy America" was designed for "Making health insurance universal."
After all this hassle and expense, Richard Foster concludes, "an estimated 23 million people{$326} would remain uninsured in 2019."
Before Obamacare gets airborne, only to plow swiftly into a nearby cornfield, this Congress -- or a clean one elected next November -- urgently must cancel this flight, disembark its enraged passengers and replace this rusty bucket with a viable aircraft.
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Finally we are beginning the hear in the media what the academics at Harvard and a few other liberal ivory towers have in store for us as they have planned for decades. Please recall how I have said these are the handful of people who are pushing for government controlled socialized medicine. Now that this guy is pushed out there as the new leader of the radical overhaul of our health care system in the US we are finally seeing him scrutinized. The goal certainly is single payer, no choice, government controlled and dictated care to all of us. No execptions. Is it finally clear to the nay sayers yet or not?
****Donald Berwick’s Radical Agendaby Ben Domenech
President Obama’s nomination of Donald Berwick as the head of the Centers for Medicare and Medicaid Services (CMS) is a gathering far less attention than a certain other nominee — but it will be getting more attention in the weeks to come, given his particularly radical agenda when it comes to health policy.
Berwick is a leading Ivy League academic and technocrat – he’s graduated from Harvard not once, but three times – and is the founder of a Cambridge-based think-tank, the Institute for Health Care Improvement. Yet the job of running CMS is hardly the same as running a small think tank or talking in broad terms about the nature of health care – CMS is essentially the world’s second largest insurance company after the United Kingdom’s NHS, covering over 98 million people and overseeing roughly $800 billion annually in taxpayer-funded health care expenditures.
Berwick is a great fan of the NHS, and worked as a consultant on the project under Tony Blair. Berwick will have the opportunity to apply the ideas he gained through that experience with the power of the CMS position, which means that his nomination holds massive ramifications for Medicare and Medicaid recipients, hospitals and doctors and, under Obama’s law, all Americans.
Berwick: Health Care Must Redistribute Wealth
Key to understanding Berwick’s views on the NHS is a speech he gave as part of a presentation offered two years ago, in which he shared his thoughts on the NHS and health care generally. You can watch the full speech here, which is excerpted above. The full video shows several lines from Berwick that are notable. He decries private sector solutions to health care problems, dismissing the “invisible hand of the market” as an “unaccountable system.” He also states:
“I am romantic about the NHS; I love it. All I need to do to rediscover the romance is to look at health care in my own country.”
And more disturbingly, in the clip above:
“Any health care funding plan that is just equitable civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional.”
Berwick’s Views on Why the US Should Be More Like the UK
Robert Goldberg, vice president of the Center for Medicine in the Public Interest, writes on Berwick’s views expressed in 2008 at length in this piece at the American Spectator:
“Berwick complained the American health system runs in the ‘darkness of private enterprise,’ unlike Britain’s ‘politically accountable system.’ The NHS is ‘universal, accessible, excellent, and free at the point of care – a health system that is, at its core, like the world we wish we had: generous, hopeful, confident, joyous, and just’; America’s health system is ‘toxic,’ ‘fragmented,’ because of its dependence on consumer choice. He told his UK audience: ‘I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.’”
But as Goldberg points out:
“It may not be joyous or just or configured correctly, but for nearly every disease, particularly cancer, stroke, and heart attacks, Americans live longer and healthier than the English because of better care.”
Indeed, the UK has a terrible record on heart attacks, cancer, and more. A recent piece in the Telegraph runs down the OECD numbers concerning Britain’s actual outcomes from the system Berwick supports so much:
“Britain also languishes near the bottom of the breast cancer league table, with a survival rate of 78.5 per cent. The OECD-wide average is 81.2 per cent. Heart attack victims in Britain are also more likely to die after entering hospital than in most other developed nations. Around 6.3 per cent of patients who have suffered a heart attack have passed away within 30 days of entering a British hospital – significantly higher than the 4.3 per cent average. The figures also show that British life expectancy is much lower than our nearest neighbours. Men in this country can expect to live to 79 years and six months, against 81 years in France. While the report’s authors identified some successes in British healthcare – we have among the best records in Europe for screening women for breast and cervical cancer – the survey indicates that Labour’s much-trumpeted NHS investment has failed to raise standards in key areas.”
The fact is that the UK system is designed for a very different population than ours, with a very different culture — one with far fewer guns, auto accidents, better diets, and fewer young people doing dangerous things. Yet America still has advantages in dealing with these key diseases. While there are many statistics to trumpet on this point, perhaps the best example is that American life expectancy at age 65 is actually higher than Britain.
Berwick: Best System is Ration-Based Single Payer
Berwick is not so much an ideologue as a true believer in governmental efficiency over the ability of the marketplace and the consumer to direct their health care. In a recent piece in Health Affairs, written along with two colleagues, Berwick details his position on the ideal nature of health care:
“If we could ever find the political nerve, we strongly suspect that financing and competitive dynamics such as the following, purveyed by governments and payers, would accelerate interest in [our policy ideal] and progress toward it: (1) global budget caps on total health care spending for designated populations, (2) measurement of and fixed accountability for the health status and health needs of designated populations, (3) improved standardized measures of care and per capita costs across sites and through time that are transparent, (4) changes in payment such that the financial gains from reduction of per capita costs are shared among those who pay for care and those who can and should invest in further improvements, and (5) changes in professional education accreditation to ensure that clinicians are capable of changing and improving their processes of care. With some risk, we note that the simplest way to establish many of these environmental conditions is a single-payer system, hiring integrators with prospective, global budgets to take care of the health needs of a defined population, without permission to exclude any member of the population.”
As the eloquent Avik Roy wrote recently, there are serious flaws in Berwick’s approach (emphasis mine):
“First off, as William Schambra observed in National Affairs, it assumes that politicians — and politics — play no role in forming health-care policy. Even if you believe that technocrats could better organize our health-care system, Berwick’s approach only works if the narrow interests of Congressmen, labor unions, general hospitals, the AARP, etc., have no influence on the writing of law. No one who watched Democrats make the Obamacare sausage can harbor any illusions on this score.
“Secondly, as Friedrich Hayek pointed out back in 1945, the command approach is doomed to fail because its commanders do not gain accurate information about what is happening on the ground. Technocrats may believe they can marshal statistics and analysis to optimize the health-care system, but they are not omniscient. Their analyses rely on too many assumptions and on unreliable data. This is why government programs always result in colossal amounts of waste, fraud, and abuse. On the other hand, a truly free market for health insurance could efficiently allocate health-care resources to those therapies and tests that patients and doctors most need.”
Yet Berwick is not particularly ideological in his endorsement: he simply believes that the single payer model is the most efficient, and the most easily managed, approach to health care. In large part, this is because he believes in government-directed rationing of care.
In an interview on Comparative Effectiveness Research, Berwick supported an agency which would rationing health care. He particularly focused on what he perceives as the benefits of the UK’s National Institute for Clinical Health and Excellence: As Dr. Berwick said:
“NICE is extremely effective and a conscientious, valuable, and — importantly — knowledge-building system [which has] developed very good and very disciplined, scientifically grounded, policy-connected models for the evaluation of medical treatments from which we ought to learn.”
The interviewer pointed out: “Critics of CER have said that it will lead to the rationing of health care.” To which Berwick replied: “The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open.”
Here are just some of the horror stories from NICE over the past several years. Under Donald Berwick’s authority as the head of CMS, get ready to see stories like these in the pages of American papers in the years to come.*****
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y SCOTT GOTTLIEB
President Obama guaranteed Americans that after health reform became law they could keep their insurance plans and their doctors. It's clear that this promise cannot be kept. Insurers and physicians are already reshaping their businesses as a result of Mr. Obama's plan.
The health-reform law caps how much insurers can spend on expenses and take for profits. Starting next year, health plans will have a regulated "floor" on their medical-loss ratios, which is the amount of revenue they spend on medical claims. Insurers can only spend 20% of their premiums on running their plans if they offer policies directly to consumers or to small employers. The spending cap is 15% for policies sold to large employers. This regulation is going to have its biggest impact on insurance sold directly to consumers—what's referred to as the "individual market." These policies cost more to market. They also have higher medical costs, owing partly to selection by less healthy consumers. Finally, individual policies have high start-up costs. If insurers cannot spend more of their revenue getting plans on track, fewer new policies will be offered.
This will hit Wellpoint, one of the biggest players in the individual market, particularly hard. The insurance company already has a strained relationship with the White House: Earlier this month Mr. Obama accused Wellpoint of systemically denying coverage to breast cancer patients, though the facts don't bear that out.
Restrictions on how insurers can spend money are compounded by simultaneous constraints on how they can manage their costs. Beginning in 2014, a new federal agency will standardize insurance benefits, placing minimum actuarial values on medical policies. There are also mandates forcing insurers to cover a lot of expensive primary-care services in full. At the same time, insurers are being blocked from raising premiums—for now by political jawboning, but the threat of legislative restrictions looms.
One of the few remaining ways to manage expenses is to reduce the actual cost of the products. In health care, this means pushing providers to accept lower fees and reduce their use of costly services like radiology or other diagnostic testing.
To implement this strategy, companies need to be able to exert more control over doctors. So insurers are trying to buy up medical clinics and doctor practices. Where they can't own providers outright, they'll maintain smaller "networks" of physicians that they will contract with so they can manage doctors more closely. That means even fewer choices for beneficiaries. Insurers hope that owning providers will enable health policies to offset the cost of the new regulations.
Doctors, meanwhile, are selling their practices to local hospitals. In 2005, doctors owned more than two-thirds of all medical practices. By next year, more than 60% of physicians will be salaried employees. About a third of those will be working for hospitals, according to the American Medical Association. A review of the open job searches held by one of the country's largest physician-recruiting firms shows that nearly 50% are for jobs in hospitals, up from about 25% five years ago.
Last month, a hospital I'm affiliated with outside of Manhattan sent a note to its physicians announcing a new subsidiary it's forming to buy up local medical practices. Nearby physicians are lining up to sell—and not just primary-care doctors, but highly paid specialists like orthopedic surgeons and neurologists. Similar developments are unfolding nationwide.
Consolidated practices and salaried doctors will leave fewer options for patients and longer waiting times for routine appointments. Like the insurers, physicians are responding to the economic burdens of the president's plan in one of the few ways they're permitted to.
For physicians, the strains include higher operating costs. The Obama health plan puts expensive new mandates on doctors, such as a requirement to purchase IT systems and keep more records. Overhead costs already consume more than 60% of the revenue generated by an average medical practice, according to a 2007 survey by the Medical Group Management Association. At the same time, reimbursement under Medicare is falling. Some specialists, such as radiologists and cardiologists, will see their Medicare payments fall by more than 10% next year. Then there's the fact that medical malpractice premiums have risen by 10%-20% annually for specialists like surgeons, particularly in states that haven't passed liability reform.
The bottom line: Defensive business arrangements designed to blunt ObamaCare's economic impacts will mean less patient choice.
Dr. Gottlieb, a former official at the Centers for Medicare and Medicaid Services, is a fellow at the American Enterprise Institute and a practicing internist. He's partner to a firm that invests in health-care companies.
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***The bottom line: Defensive business arrangements designed to blunt ObamaCare's economic impacts will mean less patient choice.***
This is an understatement. The goal is NO choice for us. The goal is Donald Berwick and his Harvard buddies and the Dem politicians will decide EVERYTHING.
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They will decide everything along ideological and politically expedient lines to the benefit of the "buddies" of whichever party. More yearly changes to the system in the interests of "fairness" which have made taxes such a snarl of loopholes, subsidies and favors. I was talking to a Brit on the strip the other day while waiting to see BlueMan. He was saying that people waiting for joint replacements were waiting upwards of 2 years if they were on the government insurance. The private insured option usually had them done in a month or less after pre-operation prep/precautions were tended to.
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A POTH Editorial
Few Americans know what a “medical loss ratio” is, but a fierce struggle over how to calculate it under the new health care reform law will determine how much insurers must spend on patient care and how much they can retain for administration and profits. This is but one of many battles that will emerge as federal and state regulators develop regulations to implement reform.
The new law requires health insurers, starting in 2011, to spend at least 80 to 85 percent of the premiums they collect on medical services or activities that improve the quality of care. (That percentage is the medical loss ratio.) The remainder can be allocated to profits or administrative activities that do not directly benefit patients, such as marketing, overhead and salaries.
The law leaves plenty of room for finagling over what can be counted as a quality improvement activity. The National Association of Insurance Commissioners, which is helping the administration develop standards, is being lobbied by insurers to adopt a broad definition and by consumer advocates to keep it narrow.
Some insurers are clearly overreaching. They argue that much of the cost of setting up networks of providers should count as quality improvement, because they check the credentials and disciplinary records of doctors. They want to include programs to root out fraud or overbilling because they probably weed out some bad doctors as well. And they would include the cost of programs, including precertification, that judge whether care is covered and appropriate. All these look like activities whose primary purpose is to reduce costs for the insurer with quality at best a secondary issue.
Senator Jay Rockefeller, chairman of the commerce committee, says his staff has found that insurers are already reclassifying many administrative costs as medical expenses to create the appearance of a higher medical loss ratio. He is rightly urging a rigorous standard.
Sensible boundaries can surely be drawn. Health information technology that improves patient care by preventing drug interactions should clearly count, but technology that primarily streamlines business operations should not. Programs that help manage and coordinate the care given chronically ill patients should count, but programs that review whether doctor-recommended services are covered should not.
Regulators will have to find an approach that prevents insurers from gaming the system while encouraging them to spend money on meaningful measures to improve quality — a major goal of the reform law.
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Rasmussen reports that "Sixty-three percent (63%) of voters nationwide favor repeal of the health care law. That’s the highest level of support for repeal yet measured."
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And Rusmussan reports Bamster's (Rush's nickname for the phoney ONE) approval at 44% though this low level was reported before. :-D :-) :wink:
If only the Cans can get their act together!?
Doug, I hope you are right and there is some sort of "Contract with America" again.
I am hoping they are saving coming out with a contract list till closer to crunch time rather than give away their eggs now. Yet in this day and age and as I have learned from the music business it is impossible to keep people for finding out one's ideas anyway.
That aside if the cans can come up with something a contract I think they can run away to *crushing* victory in Nov and not just win by default.
I believe A Lame Duck Bamster without his adoring majority in both houses will fold in the face of the opposition.
As for Contract with America, Newt appears to be planning a run. Can he overcome previously terrible ratings though? I dunno.
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"Doug, I hope you are right and there is some sort of "Contract with America" again. "
In 1994 that was done very late in the campaign and these were all very highly poll tested proposals. It stole the oxygen away from their opponents and it answered the main complaint of the opponents - we know what you are against, but you never tell us how you would govern. The Contract did that.
2006 was the opposite. As Democrats were coasting to a negative victory - people were going to elect Bush's opposition. Pelosi went into hiding, either to heal her plastic surgery or to keep her San Francisco Liberal mug out of the local news or the moderate Dems running contested races across the heartland. The strategy of 2008-2008 was to downplay the leftist agenda because it doesn't stand up to scrutiny.
I don't know if Republicans need a Contract with America to win this year, but they need the experience and discipline of hammering one out in order to govern and to set the table for 2012. For 2012 we will need leaders that will agree to the principles, not Pied Piper types that will make some other song sound appealing.
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Soaring costs force Canada to reassess health model - Yahoo! News
http://news.yahoo.com/s/nm/20100531/hl_nm/us_health
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Will the IRS Oversee Your Health Care?
The Patient Protection and Affordable Care Act, which was signed into law on March 23, 2010, mandates that every American, with few exceptions, have health coverage starting in 2014. Failure to obtain required coverage will result in a penalty. For those whose household income is below set limits, there are federal tax credits to help make coverage affordable.
It is not clear how involved the Internal Revenue Service will be in enforcing the mandate. IRS Commissioner Shulman has indicated that the definition of "adequate health coverage" as required by the new law will be determined by the Department of Health and Human Services (not by the IRS). However, the IRS will create 1099 forms that insurance companies will use to inform the IRS of those with adequate coverage.
If the IRS learns that an individual does not have adequate coverage (presumably because no 1099 was received for that person), a letter will be sent about the penalty. The penalty could be withheld from any tax refunds owed to an individual without adequate health coverage. There are no criminal sanctions for failure to obtain coverage or to pay the penalty for lack of coverage.
The IRS will also do outreach to inform eligible taxpayers about tax credits available to help pay for health coverage.
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An MD friend writes:
Good summary, As I understand it, the Insurance Company will send the original to the IRS then the individual receives two copies of the 1099. One goes with your return attached to W-2, the other for your records.
The reality is, Most people will pay the fine and since there is no preexisting exclusion capability for private, exchange or government insurance, people will buy or apply for the policy when they need their Gall bladder out, their hernia fixed etc then drop it after its preformed and paid for. This is an old trick, currently, women buy a Blue's policy, get pregnant, see an OB-GYN and get accepted as a patient then drop their BCBS policy and pick up Medicaid. The OB is then obligated to deliver the child at a much reduced reimbursement. Even with the new bill, just as today, If the uninsured experiences an emergency it will be the old story--go to the ER get treated and don't pay the bill. For those of us who are MDs they have seen and experienced this many times.
Sadly this healthcare bill now allows for a healthy, capable of hard work single fun loving 25 year old male to qualify for Medicaid. The only thing better is that when we legalize "medical marijuana" the tax payer can pay for both the healthcare and the "Medical Marijuana" to keep this 25 yo happy and healthy.
The fact is most working people may financially be better off to not carry insurance, pay the fine, invest the difference and follow the above. Since HSAs are legislated to disappear why not save the money after tax where the Feds can only tax it instead of confiscate it when they take over the 401-ks, pension plans etc as has been discussed up there.
Gamming the system is going to become an art form. For the rest of us who follow the law, healthcare will become more expensive.
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As for marijauna the only real reason to legalize it is to take the profit out of the business as a criminal enterprise.
Medically I am not convinced of any value. It is just a bunch of middle aged (my generation) pot head hippies who want to smoke dope.
Almost without exception.
I met an ophthamologist in Florida who was harrased by the DEA like Katherine and I are harrased by the organizewd crime that runs the music business. His life was ruined. They stalked him, would get into his safety deposit boxes, go through his mail, listen in at his home, go through all his accounts, watch his associates, friends, and family. I guess he was pushing for the vague and questionable medicinal use of pot for glaucoma. It does seem to reduce eye pressures but spordically and unpredictably and from what I read not at all in a way that is comparable to real medicinals that are not available. I suppose it may have some anti-emitic effects in cancer treatment or with advanced AIDS, but mostly it seems to me the people pushing it are th post heads from the 60's and 70s.
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http://www.csmonitor.com/Money/Mises...war-on-doctors
Justice Department declares war on doctors
In a landmark Idaho case, the Justice Department forced a group of doctors to accept government price controls.
By S.M. Oliva, Guest blogger / May 31, 2010
As I’ve long suspected, “health care reform” has emboldened the Justice Department to take a more active role in enforcing government price controls against physicians. Today the Antitrust Division, joined by Idaho Attorney General Lawrence Wasden, forced a a group of Boise orthopedists to accept price controls for worker’s compensation and HMO contracts as part of a settlement accusing the doctors of “price fixing”:
According to the complaint, the conspiring orthopedists engaged in two antitrust conspiracies, which took place from 2006 to 2008. In the first conspiracy, through a series of meetings and other communications, the orthopedists agreed not to treat most patients covered by workers’ compensation insurance.
They entered into a group boycott in order to force the Idaho Industrial Commission to increase the rates at which orthopedists were paid for treating injured workers. The Idaho Industrial Commission sets the fee schedule that determines the amount that orthopedists and other healthcare providers usually receive for treating patients covered by workers’ compensation insurance.
The boycott resulted in a shortage of orthopedists willing to treat workers’ compensation patients, causing higher rates for orthopedic services.
In the second conspiracy, all of the defendants, except [one], and other conspiring orthopedists agreed to threaten to terminate their contracts with Blue Cross of Idaho. They jointly threatened to terminate their contracts to force Blue Cross of Idaho to offer better contract terms to orthopedists.
The proposed settlement prevents the Idaho Orthopaedic Society and the named orthopedists from agreeing with their competitors on fees and contract terms.
The settlement also prohibits them from collectively denying medical care to patients, refusing to deal with any payer or threatening to terminate contracts with any payer.
This case is a watershed for two reasons:
First, until now the Federal Trade Commission, not the Justice Department, has taken the lead in prosecuting physicians. Since 2000, the FTC has brought about three dozen cases against physicians (all but one of which settled without any trial). But the FTC only has civil and administrative jurisdiction; the Antitrust Division has civil and criminal jurisdiction. The Sherman Act makes no distinction between civil and criminal “price fixing,” so in a case like this, it’s entirely a matter of prosecutorial discretion whether to charge the doctors with a civil or criminal offense.
Based on the descriptions in the Antitrust Division’s press release, there’s certainly no reason they couldn’t have prosecuted the doctors criminally and insisted upon prison sentences — and there’s little doubt such threats were made or implied to obtain the physicians’ agreement to the proposed “settlement.”
The second reason this is a landmark case is that the Justice Department has unambiguously stated that refusal to accept government price controls is a form of illegal “price fixing.”
The FTC has hinted at this when it’s said physicians must accept Medicare-based reimbursement schedules from insurance companies. But the DOJ has gone the final step and said, “Government prices are market prices,” in the form of the Idaho Industrial Commission’s fee schedule.
The IIC administers the state’s worker compensation system and is composed of three commissioners appointed by the governor. This isn’t a quasi-private or semi-private entity. It’s a purely government operation.
What’s more, the Antitrust Division has linked a refusal to accept government price controls with a refusal to accept a “private” insurance company’s contract offer. This leaves little doubt that antitrust regulators consider insurance party contracts the equivalent of government price controls — and physicians and patients have no choice but to accept them.
Despite this, Antitrust Division chief Christine Varney, an Obama political appointee, insists she’s trying to protect “competition”:
The orthopedists who participated in these group boycotts denied medical care to Idaho workers and caused higher prices for orthopedic services.
Today’s action seeks to prevent the recurrence of these illegal acts and protects Idaho consumers by promoting competition in the healthcare industry.”
The Idaho attorney general compounds the lie:
The free marketplace works best when there is fair competition. Anticompetitive activity harms the marketplace, businesses and consumers.
Enforcement of the antitrust laws restores competition to the marketplace to the benefit of businesses and consumers and the marketplace as a whole.
But what “competition” do they refer to? The IIC fee schedule is set by government fiat. There’s no “competition” among orthopedists — or any other physicians for that matter. Everyone gets paid exactly the same “acceptable charges” based on the schedule. Even in the case of the Blue Cross contract, the physicians weren’t “competing” on price; they were simply told to accept the reimbursement levels proposed by the insurer.
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And as much as the government would tout the “conspiracy” among physicians, as I said yesterday, we’re basically talking about people having conversations with one another. The truth is the antitrust regulators don’t need much to establish a Sherman Act “conspiracy.” Even if there’s no evidence of direct communication between physicians, if a large number of physicians in a given market individually reject a government price control scheme or insurance company contract, the Antitrust Division can simply “infer” the existence of a conspiracy.
This is another reason why the DOJ’s presence in a physician case is more disturbing than the normal FTC case. The DOJ has a number of “tools” the FTC does not, including the self-granted power to award amnesties from criminal prosecutions to the first “conspirator” to step forward and provide evidence against one’s competitors.
A doctor that feared prosecution could seek amnesty — and provide the Justice Department a blank check to rummage through his files and private communications. And if that doesn’t work, the DOJ can always seek wiretaps of physicians’ phones and computers, a power awarded the DOJ during a 2006 renewal of the PATRIOT Act.
The potential exposure of your physician’s confidential records — including your medical records — is limitless.
And while I usually caution against reading partisan political motives into an antitrust case — and I’d note the Idaho attorney general is a Republican — it’s hard to segregate today’s action from the larger political context of “Obamacare.”
Christine Varney is an Obama political appointee, and if the Idaho case is an indication her Division plans to take a more hands-on approach to dealing with local physician groups, this policy will quickly degenerate into political demagoguery. It’s just too easy to label physicians “price fixers” and scapegoat them for the failure of government planning of the healthcare industry.
UPDATE: The DOJ has released the proposed order and other documents. It’s a naked censorship order that restrains the physicians from
(A) encouraging, facilitating, entering into, participating in, or attempting to engage in any actual or potential agreement or understanding with, between, or among competing physicians about:
any fee, or other payer contract term or condition, with any payer or group of payers, including the acceptability or negotiation of any fee or other payer contract term with any payer or group of payers;
the manner in which the defendant or any competing physician will negotiate with, contract with, or otherwise deal with any payer or group of payers, including participating in or terminating any payer contract; or
any refusal to deal or threatened refusal to deal with any payer;
or
(B) communicating with any competing physician or facilitating the exchange of information between or among competing physicians about:
the actual or possible view, intention, or position of any defendant or his or her medical practice group, or any competing physician concerning the negotiation or acceptability of any proposed or existing payer contract or contract term, including the negotiating or contracting status of the defendant, his or her medical group, or any competing physician with any payer or group of payers, or
any proposed or existing term of any payer contract that affects:
the amount of fees or payment, however determined, that the defendant, his or her medical practice group, or any competing physician charges, contracts for, or accepts from or considers charging, contracting for, or accepting from any payer or group of payers for providing physician services;
the duration, amendment, or termination of any payer contract; or
the manner of resolving disputes between any parties to any payer contract.
The order also illegally legislates through the courts by requiring the physicians to adhere to the 1996 Department of Justice and Federal Trade Commission Statements of Antitrust Enforcement Policy in Health Care, which is not law but merely the subjective opinions of unelected government antitrust lawyers. The order also requires the physicians to make “all books, ledgers, accounts, records, data, and documents,” available for government inspection at any time in the next ten years.
Since this is an DOJ case, it is subject to final approval by a federal judge in Idaho. There’s a mandatory 60-day public comment period, after which the judge will almost certainly rubber stamp the order as being “in the public interest.” Still, there’s at least an opportunity to express some serious dissent to what’s transpired here.
2ND UPDATE: It turns out the Idaho physicians hired the guy who used to run the Antitrust Division’s litigation department — and developed the government’s anti-physician antitrust rules — to represent them. No wonder they settled without a fight.
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Beng a physician is no longer a "profession".
We are controlled, regulated, villified, debased, and guilty to we prove our innocence.
My accountant and of course my lawer makes twice what I make despite my having far more training, education, legal risk, regulation to deal with, and stress.
I have to fight to get paid, I have to go through a quagmire of regs, mazes, fee collectors, billers, chase after pateints for even a few dollars, pay all of these people a cut just to get paid. I have to pay my accountant a much higher hourly rate just to get my tax refund due me from the government even though all she does is sit on her ass and write a letter, add and subtract, and fill out a form.
I could go on.
There are some doctors who abuse the system and while I don't condone that at least some of them justify doing it because of all the suffering we are made to go through.
All the while I go through this I see Bamster protecting lawyers. Not a peep about their corruption. Not one peep.
Katherine and I have gone what I have ad nauseum noted hear. And of course I am still expected to be a saint who loves medicine and just lives to provide the most humane best medical care to my patients and all the while agree with another scumbag lawyer named Chuck Schumer state all doctors should make no more than 80K a year. If that is what he wants there will be no one left in medicine other than nurses and Asians and Middle Easterners dying to come here and work for 100 hrs a week for ten cents. Then they will smarten up, realize this is not what they came here for and stop coming and many will go back to where they are from because it aint' worth it here.
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Actually CCP being a physician IS still a profession. One that I admire greatly, much more than your accountant or lawyer.
You can walk into any room, any place and be very proud.
I've said prayers of gratitude, sent cards, and bought gifts for many years for my surgeon at my birth and my wife's relatively recent surgeon.
I merely "like" my lawyer and accountant. I like my plumber too.
I admit, life was easier years ago; my Grandfather was a successful surgeon; paperwork wasn't a big issue. Nor were rules and regulations.
However, don't despair, Physician income (see 2010 numbers below) is still up there. As a side note, and I would be curious about your
opinion, physician wages do not seem to be predicated on medical knowledge and talent. Merely having the license to practice is enough. You can attend Harvard
Medical School, or some Guadalajara Tech (I know doctors from both) and probably you will earn the same wage. In contrast to lawyers
who graduated near the top from Harvard Law and make big bucks, the guy who graduates from no name school will need to chase
a lot of ambulances to make a good living. Or, they are very talented and on their own rise to the top. It is more of a meritocracy.
The same applies to accounting. I know the trend is opposite of what I am suggesting, but I think doctors should be paid based on talent,
not merely because they have a degree and put in the time. I like classical music; my very favorite teacher (as a side note, her husband is a traditional Cantor; we've had
many wonderful "discussions" about Wagner and Van Karajan) has a Phd. from UCLA and has spent many years doing research. Yet she doesn't make close to $100K.
Years in school should not be the only deciding factor.
For example, if you graduate from any Medical School, here in LA, you (general practice) are automatically offered a $125K+ job to start plus significant benefits. Graduate at the top
of your class from one of 5-6 top Law Schools and you can start at over $200K. But, if you graduate from only an average Law School
and aren't at the top of your class, you are lucky to get a job. Of course, the cream rises, but among physicians, ability and education does not
necessarily translate into income. Graduate from Harvard Med. or Guadalajara Tech, your pay is near the same. Another words, you are guaranteed a good paying job even
in today's terrible economy.
2010 income physician numbers in dollars.
Specialty Average Lowest Highest
Family Practice 148,000 112,000 197,000
Internal Medicine 160,000 118,000 205,000
Dermatology 232,000 169,000 407,000
OB-GYN 248,000 184,000 350,000
Ophthalmology 257,000 162,000 417,000
Neurology 197,000 131,000 253,000
Oncology 269,000 155,000 473,000
Cardiology 318,000 205,000 451,000
Surgery
Cardio 559,000 351,000 853,000
Neuro 438,000 280,000 714,000
Urology 285,000 181,000 375,000
Vascular 359,000 238,000 637,000
I rounded numbers to the nearest $1000
Sorry for the poor graph; it looked fine before I copied and pasted.
Also, these numbers are low compared to some other surveys.
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http://reason.com/blog/2010/06/07/the-obama-administrations-geni
Reason Magazine
The Obama Administration's Genius New Plan For Keeping Health Insurance Premiums Down
Peter Suderman | June 7, 2010
The Wall Street Journal reports on the Obama administration's latest policy innovation:
On Monday, insurers that sell Medicare Advantage plans must submit their 2011 bids to the government. In a letter to four insurance-industry executives, Health and Human Services Secretary Kathleen Sebelius warned the companies not to increase premiums and co-payments for seniors.
"Focus on price and quality rather than asking seniors who need health care the most to pay more for it," Ms. Sebelius wrote in a letter sent Friday and reviewed by The Wall Street Journal. The letters went to WellPoint Inc., Cigna Corp., BlueCross BlueShield Association and Health Care Service Corp., according to a person familiar with the situation. Those executives met with Ms. Sebelius last month.
Many insurance companies are planning to increase costs for a range of services for seniors next year, according to consultants who have helped prepare their bids. Dozens of Medicare Advantage providers plan to cut back vision, dental and prescription benefits. Some plans are eliminating free teeth cleanings and gym memberships, and raising fees for hearing aides, eye glasses and emergency-room visits.
Consultants cite two reasons for the cuts. The rate the government will pay private insurers to run the plans is frozen for 2011 at 2010 levels, while medical costs are expected to increase an average of at least 6%. Such price increases and benefit cuts will help them recoup that difference, the consultants say.
Meanwhile, the health overhaul will impose drastic payment cuts to insurers that run the plans, and consultants say insurance companies need to begin adapting now. Starting in 2012, the law calls for a gradual reduction in government payments to insurers, totaling $136 billion before the end of the decade.
The Obama administration and Senate Democrats say that passing those costs on as early as next year is unfair. In her letter, Ms. Sebelius warned insurers that she will deny insurers bids if they include excessive price increases, using new powers under the health law.
Now why would Sebelius need to send a letter like this? Wasn't the Affordable Care Act supposed to, you know, make care more affordable? And didn't President Obama himself indicate that seniors needn't fear Medicare cuts? Or is this an admission that that, despite the administration's steady promises to the contrary, health insurance premiums are likely to go up in the wake of the new health care law?
Or maybe this letter is just a way of following through on those promises. The way the Obama administration will keep prices down and quality up is by...writing threatening letters to the health insurance industry warning them to keep service levels high and prices low.
If this is such a great idea, though, I wonder why we can try it for other industries? I propose we start with the video game console market: Let's make sure Microsoft puts out a next-generation Xbox pronto, and a stack of nifty new games to go with it. Obviously, though, I don't want to pay any more for it than a current console. Maybe the FTC and the FCC can take of this one with a joint-letter. And how about the wedding industry? Costs have gone up steadily over the years, and American families, already burdened by the effects of a sluggish economy, are suffering. If all it takes is a stern letter and a flash of some agency's regulatory weaponry to get more reasonable pricing and service out of the wedding planners and DJs and venue managers of the world, then surely this is a problem we can solve.
It's absurd, obviously, but hardly more so than what the Obama administration is doing here. Price controls on health insurance have already provoked a massive legal battle in Massachusetts, and the state's four biggest insurers are now all reporting operating losses—in large part, they claim, because of rate-hike rejections. Even Bill Clinton's economic advisers warned during the HillaryCare debates that imposing price controls would be difficult to implement and were likely to produce adverse effects. But those lessons appear not to have been passed on to the current administration, which seems determined to turn health insurance into an all-but government-run quasi-public utility.
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Dear Policy Patriots -
Major Campaign to Sell ObamaCare - to You! This week, Politico and The New York Times published two devastating revelations:
Multimillion Dollar Propaganda Campaign. According to Politico, White House allies, led by former Senate Majority Leader Tom Daschle and Victoria Kennedy, the widow of the late Senator Ted Kennedy, are set to unveil a $125 million public relations make-over for ObamaCare. This unprecedented propaganda campaign is designed to last until the law is fully in place in 2014 and to convince you and millions of your fellow countrymen that up is down, that black is white and that ObamaCare is good for you.
Advice to Candidates: Avoid Voters, Avoid Talking about Health Care. You're not likely to see TV images of candidates confronting angry voters at town hall meetings this summer. The reason? As The New York Times reports, members of Congress who voted for ObamaCare have "heeded the advice of party leaders and tried to avoid unscripted question and answer sessions." Among the recommendations to lawmakers: "Hold events in controlled settings...without the worry of being snared in an angry confrontation with seniors."
ObamaCare Propaganda Aimed at Seniors - Paid for with Your Tax Dollars! During the debate over ObamaCare, the Obama Administration threatened health insurance companies who informed seniors of the possibility that they could lose Medicare Advantage (MA) benefits. However, the health insurance companies were telling the truth. In fact, the information they used came from the Administration's Congressional Budget Office (CBO) and the Chief Actuary of Medicare. Medicare's Chief Actuary predicted that under ObamaCare as many as 7.4 million beneficiaries will lose their MA plan altogether and another 7.4 million will experience a loss of benefits. Incredibly, the forthcoming ObamaCare media blitz will target these seniors and claim that Medicare Advantage enrollees will be better off under ObamaCare.
Sebelius Threatens Insurers Publicly. ObamaCare stripped $200 billion from federal payments to Medicare Advantage plans. And no knowledgeable person is in doubt about the consequences of that. As one expert explained, "Washington can't slash $200 billion out of Medicare Advantage and then try to shift the blame...when those cuts inevitably result in higher premiums and benefit reductions for seniors." Nevertheless, on Monday Health and Human Services Secretary Kathleen Sebelius threatened health insurers, warning them not to increase premiums and co-payments when they submit their 2011 Medicare Advantage bids to the federal government. This is a clever ruse - getting ready to blame the victim for the results of a crime the administration has already committed.
The Vaunted Seniors' Rebate Check: Penny Wise... This week the Obama Administration will advertise its efforts to provide health care for seniors, citing a one-time, $250 health care rebate check that 80,000 seniors will receive this week and as many as four million may receive in the coming months. What the President won't mention is that the four million seniors who receive a check represents less than 10 percent of the Medicare population and that the seniors who benefit are among the nation's wealthiest Medicare beneficiaries. The check only goes to those not already receiving Medicare Extra Help. Finally, the rebate check comes in the midst of rising prescription drug costs for all seniors, not just 10 percent. As Senate Minority Leader Mitch McConnell explained earlier this week, "for every senior who receives a check, more than three other seniors will see an increase in their prescription drug insurance premiums."
...Pound Foolish. Not only will the President fail to distribute a check to 9 out of 10 seniors, but the one-time check pales in comparison to ObamaCare's pilfering of seniors' health care. According to the non-partisan Congressional Budget Office (CBO), ObamaCare cuts Medicare spending by $8,980 per senior over the next ten years. Consider also that:
The Chief Medicare Actuary Warns against Cuts in Senior Care. They urge that the Administration's planned $500 billion cuts in Medicare could jeopardize the access to care seniors receive.
The Chief Medicare Actuary Predicts Seniors Lose Coverage. They say that $206 billion in cuts to Medicare Advantage (MA) will result in 7.4 million beneficiaries who will lose their Medicare health plan.
The CBO Puts a Number on Lost Benefits. Seniors enrolled in Medicare Advantage (MA) will lose an average of $816 per patient in 2019.
Premiums Will Rise, Says CBO. The CBO estimates that Medicare prescription drug coverage premiums will increase by 9 percent as a result of the Democrats' health law.
The NCPA Needs Your Help! The National Center for Policy (NCPA) vigilance comes at a price. We need your support to continue the important policy work that we do. Please consider donating to the National Center for Policy Analysis. You can donate online or mail a check to:
National Center for Policy Analysis
P.O. Box 650098
Dallas, Texas 75265-0098
Thanks for your support!
Warm regards,
Jeanette Nordstrom
National Center for Policy Analysis
www.ncpa.org
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Repeal BO's hostile takeover of our health care!
http://heritageforamerica.org/support/donate-now-to-help-heritage-actions-fight-to-repeal-obamacare/
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Not surprising since they feel he will push for primary care physicians to once again have a more central role in "managing" care and thus increase their power. Folks don't be fooled. "Patient centered care" or "patient centered medical home" care are other code words for government run/controlled *rationed* care. It is Federal *HMO* care for all of us whether we like it or not. As a primary care provider I suppose I should be rejoicing. Truthfully I am near tears every day at watching Bamster taking our freedoms all away. Essentially all of us will eventually be forced on to a Federally run HMO medicaid program.
****AAFP Applauds Appointment of Donald Berwick as New CMS Administrator
Administration Declares Recess Appointment Necessary
By News Staff
7/7/2010
The AAFP has praised the appointment of Donald Berwick, M.D., as the new administrator of CMS, saying in a prepared statement that Berwick's medical expertise and commitment to ensuring high quality care for all will serve America well as CMS implements the reforms in the Patient Protection and Affordable Care Act.
"As a research professional, a clinician and a policy analyst, he brings an extensive background that’s crucial to ensuring that health care policy improves patient care and the practice of medicine," said AAFP President Lori Heim, M.D., of Vass, N.C., in the statement. "His leadership has helped ensure that best practices in medical care and groundbreaking medical research are brought to the physicians' offices, and his support for strengthening primary care in the Medicare and Medicaid systems will help set the path for building up the foundation of all high quality health care."
As CMS administrator, Berwick will serve as a key player in overhauling the nation's health care system by overseeing a variety of major tasks associated with the new health care reform law. Those tasks include expanding Medicaid coverage, writing new rules and regulations and establishing pilot projects to test different models of care and payment policies. Heim said the AAFP "looks forward to working with Dr. Berwick as the nation moves forward in ensuring that Americans have access to high quality, affordable health care."
President Obama used a recess appointment to make Berwick the new administrator of CMS on July 7, thereby circumventing a contentious confirmation process for the nomination in the Senate. Although Obama nominated Berwick for CMS administrator in April, Republicans were critical of the choice because they were concerned that Berwick could be a proponent of health care rationing. Republican opposition could have delayed the nomination indefinitely, prompting Obama to make a recess appointment while Congress is out of session.
The Senate had not scheduled hearings on Berwick's nomination, and White House Communications Director Dan Pfeiffer said in The White House blog on July 6 that "many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points."
In a prepared statement, Obama said, "It's unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purposes." The president said the appointment would allow Berwick to "get to work on behalf of the American people right away."
Senate Republican Leader Mitch McConnell, R-Ky., accused the Obama administration of sneaking Berwick through without public scrutiny, saying in a prepared statement that "the Obama administration intends to arrogantly circumvent the American people yet again by recess appointing one of the most prominent advocates of rationed health care to implement their national plan."
Sen. Max Baucus, D-Mont., chair of the Senate Finance Committee, also criticized the Obama administration for not going through the standard nomination process. In a prepared statement, Baucus said, "Senate confirmation of presidential appointees is an essential process prescribed by the constitution that serves as a check on executive power and protects ... all Americans by ensuring that crucial questions are asked of the nominee -- and answered."
Nevertheless, Baucus said, "I look forward to working with CMS as they implement health reform to deliver the better health care outcomes and lower costs for patients we fought to pass in the landmark health reform law."
The AAFP supported the Berwick nomination from the outset, saying in a prepared statement in April that Berwick has "demonstrated a long-standing commitment to building a patient-centered, quality focused and efficient health care system." The Academy also put its signature on two widely circulated sign-on letters to Senate leaders supporting the Berwick nomination.
Berwick is a Harvard University professor and the president and CEO of the Institute for Healthcare Improvement, or IHI, a nonprofit organization in Cambridge, Mass., that advances concepts to improve patient care. He is a strong believer that physicians and hospitals can improve care while reducing medical errors and saving money. The AAFP has a long-standing relationship with Berwick through advocacy efforts in the public and private sectors and through its work and involvement with IHI.
Copyright © 2010 American Academy of Family Physicians****
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Yeah, if you are not eating the goverment primary care giver's prescribed diet, of the properly prescribed foods, do not be surprised if you find yourself uncovered for failure to comply with prescripted health care.............. :evil:
There is SO MUCH that is basically WRONG with this, it turns us into animals in a zoo in a lot of ways. The best of care, but we are suddenly unable to act like what we are.........like a tiger, ape or other animal in the zoo with the best in care, a long life over what it would have in the wild, but somehow totally pitiful...........
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Good summary of what is in the plans for us with regards to Health care.
Take these for example from the new controller of one seventh of the economy, Berwick:
1) ***"One over-demanded service is prevention: annual physicals, screening tests, and other measures that supposedly help catch diseases early."***
Well if the issue is costs than this is probably true that these things are overrated. But this is my point. The concept of a medical home is not for prevention as much as it is a central point as a command center to manage care or ration care based on 'cost effective' formulas.
2) ****"Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy."***
This is key. I don't know if it is obvious to lay people if you will, perhaps it is. But what this means is that doctors (and there patients) will not be granted the freddom to practice as they see fit in a given situation or case. Doctors and nurses will need to be "taught", if you will, or better yet forced, to do what they are told with regards to how and what care they deliver. And that is the big goal of HIT in health care. All of the data that gets put in will travel to Dr. Berwick's and team's office where he and his friends at Harvard will be able to study endless reams of data, and take there analysis, do studies, design studies, then dictate back to health care providers what they MUST do in any given situation.
I don't necessarily object to this - it is managed care. What I object to is that all of us will be FORCED into this situation whether we like it or not, whether we are able and willing to pay more or not. Whether we have earned it, whether some abuse the system and the rest. IT is HMO medicaid care forced on every person in America whether a citizen, legal immigrant, or illegal immigrant. It is true communism of the health care system.
***Barack Obama's incredible "recess appointment" of Dr. Donald Berwick to head the Centers for Medicare and Medicaid Services (CMS) is probably the most significant domestic-policy personnel decision in a generation. It is more important to the direction of the country than Elena Kagan's nomination to the Supreme Court.
The court's decisions are subject to the tempering influence of nine competing minds. Dr. Berwick would direct an agency that has a budget bigger than the Pentagon. Decisions by the CMS shape American medicine.
Dr. Berwick's ideas on the design and purpose of the U.S. system of medicine aren't merely about "change." They would be revolutionary.
One may agree with these views or not, but for the president to tell the American people they have to simply accept this through anything so flaccid as a recess appointment is beyond outrageous. It isn't acceptable.
Daniel Henninger discusses President Obama's incredible "recess appointment" of Dr. Donald Berwick to head the Centers for Medicare and Medicaid Services (CMS).
Podcast: Listen to the audio of Wonder Land here. The Democratic chairman of the Senate Finance Committee, Max Baucus, was taken aback at the end-around: "Senate confirmation of presidential appointees is an essential process prescribed by the Constitution that serves as a check on executive power."
Let's look, then, at what President Obama won't let the American electorate hear Dr. Berwick say in front of a committee of Congress. These excerpts are from past speeches and articles by Dr. Berwick:
"I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do."
"You cap your health care budget, and you make the political and economic choices you need to make to keep affordability within reach."
"Please don't put your faith in market forces. It's a popular idea: that Adam Smith's invisible hand would do a better job of designing care than leaders with plans can."
"Indeed, the Holy Grail of universal coverage in the United States may remain out of reach unless, through rational collective action overriding some individual self-interest, we can reduce per capita costs."
"It may therefore be necessary to set a legislative target for the growth of spending at 1.5 percentage points below currently projected increases and to grant the federal government the authority to reduce updates in Medicare fees if the target is exceeded."
"About 8% of GDP is plenty for 'best known' care."
"A progressive policy regime will control and rationalize financing—control supply."
View Full Image
AP Photo/ Goodman Media International, Inc.
Donald Berwick
"The unaided human mind, and the acts of the individual, cannot assure excellence. Health care is a system, and its performance is a systemic property."
"Health care is a common good—single payer, speaking and buying for the common good."
"And it's important also to make health a human right because the main health determinants are not health care but sanitation, nutrition, housing, social justice, employment, and the like."
"Hence, those working in health care delivery may be faced with situations in which it seems that the best course is to manipulate the flawed system for the benefit of a specific patient or segment of the population, rather than to work to improve the delivery of care for all. Such manipulation produces more flaws, and the downward spiral continues."
"For-profit, entrepreneurial providers of medical imaging, renal dialysis, and outpatient surgery, for example, may find their business opportunities constrained."
"One over-demanded service is prevention: annual physicals, screening tests, and other measures that supposedly help catch diseases early."
"I would place a commitment to excellence—standardization to the best-known method—above clinician autonomy as a rule for care."
"Health care has taken a century to learn how badly we need the best of Frederick Taylor [the father of scientific management]. If we can't standardize appropriate parts of our processes to absolute reliability, we cannot approach perfection."
"Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy."
"Political leaders in the Labour Government have become more enamored of the use of market forces and choice as an engine for change, rather than planned, centrally coordinated technical support."
"The U.K has people in charge of its health care—people with the clear duty and much of the authority to take on the challenge of changing the system as a whole. The U.S. does not."
***
There is no need to rehearse the analogies in literature and social thought that Dr. Berwick's ideas summon. That the Obama White House would try to push this past public scrutiny with a recess appointment says more about Barack Obama than it does Dr. Berwick.
Vilifying Dr. Berwick alone for his views is in a way beside the point. Within Mr. Obama's circle they all think like this. Defeat Dr. Berwick, and they will send up 50 more who would pursue the same goals.
If the American people want the world Dr. Berwick wishes to give them, that's their choice. But they must be given that choice with full, televised confirmation hearings.
Barack Obama, Donald Berwick and the rest may fancy themselves philosopher kings who know what we need without the need to inform or persuade us first. That's not how it works here. That is Sen. Baucus's point.
It should be clear why Berwick is bigger than Kagan. We need a large public debate over these views, over what Mr. Obama has said his health plan would and would not do. We need to find out if every Democrat in Congress and every Democrat writing newspaper columns and blogs agrees with Dr. Berwick about clinical and individual autonomy and about leaders with plans.
Then we need to build an election around whether we want to go down the road Dr. Berwick has planned for us, or start dismantling the one that President Obama paved through Congress on a partisan vote.
Write to henninger@wsj.com
Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved***
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Health lobbyists focus on a once-obscure group
By Christopher Weaver
Thursday, July 15, 2010; A17
For years, an obscure federal task force sifted through medical literature on colonoscopies, prostate-cancer screening and fluoride treatments, ferreting out the best evidence for doctors to use in caring for their patients. But now its recommendations have financial implications, raising the stakes for patients, doctors and others in the health-care industry.
Under the new health-care overhaul law, health insurers will be required to pay fully for services that get an A or B recommendation from the U.S. Preventive Services Task Force, a volunteer group made up of primary care and public health experts.
That's good news for patients, who will no longer face cost sharing for these services, but it puts the group in the cross hairs of lobbyists and disease advocates eager to see their top priorities -- routine screening for Alzheimer's disease, diabetes or HIV, for example -- become covered services.
"It's a wide-open door for lobbying," says Robert Laszewski, a health insurance industry consultant.
On Wednesday, first lady Michelle Obama; Jill Biden, the wife of Vice President Biden; and Health and Human Services Secretary Kathleen Sebelius discussed the importance of preventive care at a news conference to unveil regulations for implementing the provisions, which include coverage of immunizations and additional services for women and children.
"Too many Americans don't get the preventive care they need to stay healthy and keep health-care costs down for all of us," Sebelius said. "Our challenge is to remove the barriers."
The preventive-services task force will guide that effort. Founded in 1984, it has 16 members -- many of whom are doctors. The group meets three times a year and is staffed by officials at the Agency for Healthcare Research and Quality.
Under the new law, the task force could become a political lightning rod. If it doesn't recommend a service, insurers might not pay for it, and advocates might argue the decision is a barrier to care. If the panel does back a service, it might increase patients' access, as well as create new business opportunities.
The requirement applies only to plans created after Sept. 23. The Obama administration estimates that 31 million people in new employer plans, and 10 million people in new individual plans, will benefit next year. By 2013 the number of people in employer plans who will benefit is projected to reach 78 million, for a total of 88 million. Health department officials expect the provision will boost insurance premiums by about 1.5 percent.
The increased interest of advocates may conflict with the task force's tradition of scholarly dedication to the science of randomized medical trials.
"If you want to be evidence-based, lobbying just doesn't fit," said Ned Calonge, the panel's chairman and the chief medical officer for the Colorado Department of Public Health and Environment. "My charge to members would be to stay true to the methods and the evidence."
But sticking to the science hasn't always been popular. The task force set off a firestorm in November 2009 when, seemingly oblivious to the politically charged health-care debate, it recommended that women begin getting routine mammograms at 50, rather than at 40.
Critics pounced on the proposal, saying the government would engage in health-care rationing. Breast cancer activists also protested. The result: Sen. Barbara A. Mikulski (D-Md.) inserted an amendment in the health-care law to explicitly cover regular mammograms for women between 40 and 50.
Groups including the American Diabetes Association and General Electric, which manufactures equipment for mammography, also lobbied Congress on task force issues. The diabetes group won a requirement that the task force include in its reviews of evidence the guidelines drafted by specialty groups -- language intended to help preserve diabetes coverage.
In response to the backlash over the mammography recommendation and other calls for transparency, the task force recently adopted a new policy of accepting public comment before finalizing its recommendations.
Calonge said the task force was "willing to take on such challenges as increased scrutiny may bring forward." He said that while the panel wouldn't change its recommendations just because of criticism, it also would not be "immune" to input that might add perspective." But, he added, "the science needs to come first."
In addition to the task force, other scientific bodies and government groups will also help determine the services that must be covered. For instance, plans must also cover a set of standard vaccines recommended by the Advisory Committee on Immunization Practices, as well as screening practices for children that have been developed by the Health Resources and Services Administration in conjunction the American Academy of Pediatrics. Health plans will also be required to cover additional preventative care for women recommended under new guidelines that the Department of Health and Human Services is expected to issue by August 2011.
Several disease groups are going directly to HHS to make their cases.
The diabetes association, for instance, is arguing to the department that the current task force guidelines, which call for screening for diabetes only when a patient has elevated blood pressure, could become a barrier to care and that insurers should be required to provide broader coverage.
Lobbyist Tekisha Everette called the guideline "a shark in the water" and said her group has pressed Sebelius to include a broader diabetes screening requirement in regulations.
The HIV Medicine Association is making a similar argument. A two-page memo it delivered to the staff of the preventive services task force explains that one reason 20 percent of people with HIV don't know they are infected is that testing isn't reimbursed by most insurers.
Calonge said his panel's recommendation would only be used to set minimum coverage requirements and that insurers are free to cover additional services. The panel revisits its recommendations every five years.
Many commercial insurers already cover preventive services without cost sharing, often based on the task force's advice, according to Robert Zirkelbach, a spokesman for America's Health Insurance Plans, a trade group based in Washington. "There's broad recognition that prevention is essential," he said.
Weaver is a reporter for KHN (www.kaiserhealthnews.org), an editorially independent news service and a program of the Kaiser Family Foundation, a nonpartisan health-care policy organization that is not affiliated with Kaiser Permanente. Washington Post staff writer N.C. Aizenman contributed to this report.
http://www.washingtonpost.com/wp-dyn/content/article/2010/07/14/AR2010071405995.html
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From Obama's director of Health,Human,Services:
"Too many Americans don't get the preventive care they need to stay healthy and keep health-care costs down for all of us," Sebelius said.
From Obama's new health czar or whatever he is called:
"One over-demanded service is prevention: annual physicals, screening tests, and other measures that supposedly help catch diseases early."
As for the U.S. Preventive Services Task Force this was the group that stopped recommending mammograms for women at average risk between ages 40 and 50 that just last year resulted in a gigantic uproar from other medical groups, babe organizations, political pundits, that gave the cable industry a nice chance to make a buck discussing ad nauseum for months.
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"One over-demanded service is prevention: annual physicals, screening tests, and other measures that supposedly help catch diseases early."
Can't we just call him the Death Panel Czar?
Speaking of tax consequences, soon we will see our czars proposing to ease the burdensome cost of healthcare by waiving the carbon tax on cremation for those who decline the surgery.
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"As for the U.S. Preventive Services Task Force this was the group that stopped recommending mammograms for women at average risk between ages 40 and 50 that just last year resulted in a gigantic uproar from other medical groups, babe organizations, political pundits, that gave the cable industry a nice chance to make a buck discussing ad nauseum for months."
Sorry already noted in the article posted by BBG.
And clarify:
" The concept of a medical home is not for prevention as much as it is a central point as a command center to manage care or ration care based on 'cost effective' formulas." Not my opinion. I meant that that is Berwick's opinion and overall goal.
I can't wait to see the elites and their families at Harvard and in Congress, and the Senate have to go on managed medicaid like the rest of us. I am not holding my breath.
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CCP; you of course are following the Health Care issues much closer than most here on this site.
I have a question.
I have a high deductible ($3500.00). Shit happens, but I can afford $3500. And my out of pocket
is $5000; again manageable in case of emergency. And I am blessed with good health.
Coming from a family of medical practitioners, I chose (self employed) such a plan and still pay through the nose because
I want to choose ANY doctor, any hospital, any procedure I may need or want without money being an issue.
Nor if I am in a weakened state (seriously ill) do I want to argue. HMO's are different. For example,
my naive, but loving wife, only 37 was diagnosed with Pancreatic Cancer. As you know, 95% die within 6 months. Without boring you
with the details, my wife has an HMO plan. I kept hearing "No", but as you and others on this site know I can
be obnoxious :-) I pushed, hard, and kept pushing (and I have a strong health/legal background) some more. The result is that she is
doing "fine" 3+ years later; she is back to work and we played golf together this last weekend. But after listening to "sorry",
"she will die" etc. I am happy to say I got the best health care available and God willing she is doing fine. But it was a lot of work.
Sorry for the long story, but my question is, is there any mention of people being able to buy a supplemental plan
to "move you you to the head of the list" or being able to use the "back door" so to speak? Or most important, being able
to pick and choose your doctor, tests, etc.? I have a friend in England, a GP Internist like you, who says that they have a system like that.
It supplements the National Health Care Plan. Is there any mention of that in the Obama Health Care Plan?
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JDN,
Thank you for sharing this story.
My grandfather died of pancreatic cancer before I was born. My middle name is after him.
I do believe that if Berwick has his way your wife would likely have been sent to hospice.
I don't think some sort of cost effective control is unreasonable when we are providing care free of charge courtesy of taxpayers to those who don't pay for whatever reason but I reject out of hand the notion that all of us must be forced into the same system and that is only FAIR as Berwick contends. I just cancelled my sbscription to the NEJM. I find THEM obnoxious!
Health care is not a right. Yet, I don't think we can't be a humane society and provide some care to those who can't pay, but health care is never free and for those of us who do pay or choose to pay we have a right too, to get the best and not simply the most cost effective care.
Berwick, the little Harvard data and bean counting weasel will throw all kinds of numbers at you stating more is not necessarily better, and infant mortality, and life span and all the rest of liberal ivy league garbage. But I guarantee you, when he, his family or members of our fearless progressive government get sick they will want and demand world class care.
BTW, I don't find you obnoxious. We agree on a lot and I like diversity of opinion.
I hope your wife continues to do well. Thanks to the US research complex there is always hope of new drugs coming out. Bamster should be going around the world (as well as this communist clown Berwick) praising US health care. It is broken but if one gets really sick I don't want to be anywhere else.
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Thank you for your kind thoughts. You are not farfetched; even my wife's HMO initially suggested Hospice!
I think there should be some organized system for those who truly cannot pay; a safety net if you will rather than everyone simply
clogging the emergency room. However as far as I am concerned, regarding illegal immigrants, after they are able to be safely transported,
send them back to their country of origin for further treatment.
But I also agree with choice and for those fortunate enough to have saved and pay their premiums,
I think they should be able to have a choice to demand and receive world class care.
Some people drive a simple car; some drive a luxury car. Both will get you there, albeit luxury is better.
I hope as matters settle down supplemental plans will be offered.
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Provided by the Tooth Fairy no doubt. Somehow, I think not.
JDN, so very glad you were able to help your wife. It looks like lots more of us are going to get the same opportunity to fight the powers that be. :cry:
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Posted in healthcare but also intended to reinforce points made in the way forward questioning the suitability of Romney to lead conservatives.
http://online.wsj.com/article/SB10001424052748704324304575306861120760580.html
By JOSEPH RAGO
President Obama said earlier this year that the health-care bill that Congress passed three months ago is "essentially identical" to the Massachusetts universal coverage plan that then-Gov. Mitt Romney signed into law in 2006. No one but Mr. Romney disagrees.
As events are now unfolding, the Massachusetts plan couldn't be a more damning indictment of ObamaCare. The state's universal health-care prototype is growing more dysfunctional by the day, which is the inevitable result of a health system dominated by politics.
In the first good news in months, a state appeals board has reversed some of the price controls on the insurance industry that Gov. Deval Patrick imposed earlier this year. Late last month, the panel ruled that the action had no legal basis and ignored "economic realties."
Senior Editorial Page Writer Joe Rago on why Obama is using a recess appointment to install the new head of Medicare and Medicaid.
In April, Mr. Patrick's insurance commissioner had rejected 235 of 274 premium increases state insurers had submitted for approval for individuals and small businesses. The carriers said these increases were necessary to cover their expected claims over the coming year, as underlying state health costs continue to rise at 8% annually. By inventing an arbitrary rate cap, the administration was in effect ordering the carriers to sell their products at a loss.
Mr. Patrick has promised to appeal the panel's decision and find some other reason to cap rates. Yet a raft of internal documents recently leaked to the press shows this squeeze play was opposed even within his own administration.
In an April message to his staff, Robert Dynan, a career insurance commissioner responsible for ensuring the solvency of state carriers, wrote that his superiors "implemented artificial price caps on HMO rates. The rates, by design, have no actuarial support. This action was taken against my objections and without including me in the conversation."
Mr. Dynan added that "The current course . . . has the potential for catastrophic consequences including irreversible damage to our non-profit health care system" and that "there most likely will be a train wreck (or perhaps several train wrecks)."
Sure enough, the five major state insurers have so far collectively lost $116 million due to the rate cap. Three of them are now under administrative oversight because of concerns about their financial viability. Perhaps Mr. Patrick felt he could be so reckless because health-care demagoguery is the strategy for his fall re-election bid against a former insurance CEO.
The deeper problem is that price controls seem to be the only way the political class can salvage a program that was supposed to reduce spending and manifestly has not. Massachusetts now has the highest average premiums in the nation.
In a new paper, Stanford economists John Cogan and Dan Kessler and Glenn Hubbard of Columbia find that the Massachusetts plan increased private employer-sponsored premiums by about 6%. Another study released last week by the state found that the number of people gaming the "individual mandate"—buying insurance only when they are about to incur major medical costs, then dumping coverage—has quadrupled since 2006. State regulators estimate that this amounts to a de facto 1% tax on insurance premiums for everyone else in the individual market and recommend a limited enrollment period to discourage such abuses. (This will be illegal under ObamaCare.)
Liberals write off such consequences as unimportant under the revisionist history that the plan was never meant to reduce costs but only to cover the uninsured. Yet Mr. Romney wrote in these pages shortly after his plan became law that every resident "will soon have affordable health insurance and the costs of health care will be reduced."
One junior senator from Illinois agreed. In a February 2006 interview on NBC, Mr. Obama praised the "bold initiative" in Massachusetts, arguing that it would "reduce costs and expand coverage." A Romney spokesman said at the time that "It's gratifying that national figures from both sides of the aisle recognize the potential of this plan to transform our health-care system."
An entitlement sold as a way to reduce costs was bound to fundamentally change the system. The larger question—for Massachusetts, and now for the nation—is whether that was really the plan all along.
"If you're going to do health-care cost containment, it has to be stealth," said Jon Kingsdale, speaking at a conference sponsored by the New Republic magazine last October. "It has to be unsuspected by any of the key players to actually have an effect." Mr. Kingsdale is the former director of the Massachusetts "connector," the beta version of ObamaCare's insurance "exchanges," and is now widely expected to serve as an ObamaCare regulator.
He went on to explain that universal coverage was "fundamentally a political strategy question"—a way of finding a "significant systematic way of pushing back on the health-care system and saying, 'No, you have to do with less.' And that's the challenge, how to do it. It's like we're waiting for a chain reaction but there's no catalyst, there's nothing to start it."
In other words, health reform was a classic bait and switch: Sell a virtually unrepealable entitlement on utterly unrealistic premises and then the political class will eventually be forced to control spending. The likes of Mr. Kingsdale would say cost control is only a matter of technocratic judgement, but the raw dirigisme of Mr. Patrick's price controls is a better indicator of what happens when health care is in the custody of elected officials rather than a market.
Naturally, Mr. Patrick wants to export the rate review beyond the insurers to hospitals, physician groups and specialty providers—presumably to set medical prices as well as insurance prices. Last month, his administration also announced it would use the existing state "determination of need" process to restrict the diffusion of expensive medical technologies like MRI machines and linear accelerator radiation therapy.
Meanwhile, Richard Moore, a state senator from Uxbridge and an architect of the 2006 plan, has introduced a new bill that will make physician participation in government health programs a condition of medical licensure. This would essentially convert all Massachusetts doctors into public employees.
All of this is merely a prelude to far more aggressive restructuring of the state's health-care markets—and a preview of what awaits the rest of the country.
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http://reason.com/blog/2010/07/19/i-guess-it-depends-on-the-mean
Reason Magazine
I Guess it Depends on the Meaning of "Absolutely not a tax increase"
Matt Welch | July 19, 2010
If you only glanced at Jesse Walker's one-sentence description this morning of the Obama administration stating that the health care mandate is indeed a tax, and did not click through to the New York Times article, you are missing out on some seriously stinky White House propaganda. Here is the core five-paragraph lie; seems that the mandate is "absolutely not a tax increase"...unless you have to defend it in a court of law:
In a brief defending the law, the Justice Department says the requirement for people to carry insurance or pay the penalty is "a valid exercise" of Congress's power to impose taxes.
Congress can use its taxing power "even for purposes that would exceed its powers under other provisions" of the Constitution, the department said. For more than a century, it added, the Supreme Court has held that Congress can tax activities that it could not reach by using its power to regulate commerce.
While Congress was working on the health care legislation, Mr. Obama refused to accept the argument that a mandate to buy insurance, enforced by financial penalties, was equivalent to a tax.
"For us to say that you've got to take a responsibility to get health insurance is absolutely not a tax increase," the president said last September, in a spirited exchange with George Stephanopoulos on the ABC News program "This Week."
When Mr. Stephanopoulos said the penalty appeared to fit the dictionary definition of a tax, Mr. Obama replied, "I absolutely reject that notion."
This bit of brazen bullshittery has retroactive implications on the 2008 presidential campaign. Back then, according to the political science thumbsucker The Obama Victory: How Media, Money, and Message Shaped the 2008 Election, John McCain–surprisingly–had some momentum in mid-October that threatened to put him within striking distance. The proximate cause? Obama's "share the wealth" comment to Joe the Plumber, and the resulting suspicion that the Democrat was a "tax-and-spend liberal." How did Obama rebut what turned out to be a prescient charge? The book identifies three ways:
1) By "consistently stat[ing] that only those couples and businesses making more than $250,000 would see a tax increase."
2) By "hammer[ing] home the misleading assertion...that, if elected, the Republican presidential contender would raise most people's taxes by making employer-provided health benefits taxable for the first time."
3) By leveraging Obama's massive fundraising advantage to broadcast a series of reassuring messages to the nation that made him look presidential and reiterated his many soon-to-be-broken economic policy promises. The two- and 30-minute spots were called "Defining Moment," and if you have a strong stomach, you can watch the shorter version below:
[youtube]http://www.youtube.com/watch?v=vJvkRFKGgGw&feature=player_embedded[/youtube]
The Obama campaign also was able to take advantage of what the book almost charitably describes as "McCain's uneven performance during the early days of the Wall Street meltdown."
So to sum up: McCain accurately dings Obama for being a tax-raiser. Obama responds by reiterating tax pledges he wouldn't keep, while specifically (and "misleadingly") attacking McCain for raising taxes with his health care plan. The ruse works–for most of the campaign, opinion polls showed that more people believed McCain was likely to raise taxes than Obama. Then, after the election, when Obama's successfully passed health care plan imposes a new tax, he denies this fact in literally absolutist terms, until his administration is challenged to defend it in court.
It's breathtaking. And not in the good way.
A final note about the book I'm taking this stuff from: The authors, Kate Kenski, Bruce W. Hardy and Kathleen Hall Jamieson, are altogether credulous when it comes to defending Obama against McCain's charges. For instance, they state that "McCain's messages magnified public belief in the false argument that the Democratic ticket would raise taxes on more than those specified in his plans." It is perhaps not surprising, then, that when Jamieson was invited by The New York Times to give the president some advice over the weekend, the title on her squib was "Explain Broken Promises."
Reason has been all over the mandate/tax propaganda; start here.
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I spoke to a young lady from England recently. She states anyone can go to a doctor in England and it is "free". Five minutes later she says they all put in 11% of their pay into the National Health Care system.
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Coincidentally, the woman from England who was touting the British system as being so good afterwards told of a new born nephew having mental status alterations.
To make a long story short it took days to finally have a cat scan of her brain approved wherein they found a fractured skull and a bleed that they think was probably due to forceps injury during child birth.
She later recanted and reportedly said that "maybe the British health care system is not so good".
If weasle Berwick has his way we will all have no choice. As far as progressives are concerned it is "inevitable". If not with this bill then the next one. Caveat emptor, Reid recently saying we will get a public option. [shoved down our throats]
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A true story can come from anywhere, but it seems when they brag about superior healthcare in other countries, they refer to coverage more than outcomes.
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http://www.latimes.com/news/health/healthcare/la-na-health-doctors-20100728,0,2722731.story
As Congress debated the healthcare bill, many critics lamented it would do little to transform a system in which doctors and hospitals bounce patients around in an uncoordinated, costly, sometimes tragic process.
But something unexpected has happened since President Obama signed the legislation in March. Spurred in part by the law, many independent providers across the country are racing to mold themselves into the kind of coordinated teams held up as models for improving care. In some places, the scramble is so intense that physician groups and hospitals are putting aside rivalries and signing new partnerships almost daily.
"It's kind of like the Oklahoma land rush right now," said Patrick Carrier, a veteran hospital administrator who heads Christus Santa Rosa, a group of Catholic hospitals in San Antonio. "Everyone has their wagons lined up and they're getting ready to go."
Three of San Antonio's hospital systems are competing to form alliances with local doctors who are giving up their private fee-for-service practices in exchange for paid positions on a hospital's team.
Healthcare experts have long argued that such a unified approach to medical care offers the best hope for improving quality and saving money. While a few institutions such as the Mayo Clinic and Kaiser Permanente have thrived doing this, the entrenched, competing interests of providers were widely seen as a barrier to nationwide change. It is possible the current rush will fail to reproduce the best models or their results. Further consolidation in the $2.5-trillion healthcare industry might drive up costs for everyone. It could also reprise problems from the 1990s, when HMOs were criticized for restricting patient choice and access to care. But some experts and providers see the new courtship dances as a surprisingly hopeful sign. The healthcare debate may have helped spark doctors, hospitals and others to rethink what they do, raising the prospect of better outcomes for millions of Americans.
"There are a lot of people who have reached the conclusion that they need to change the way they practice medicine," said Dr. Mark B. McClellan, a former Medicare and Medicaid chief in the George W. Bush administration and a leading advocate of more care coordination.
In San Antonio, the leaders of the Christus Santa Rosa hospital have made that very calculation. Over nearly a century and a half, Santa Rosa's onetime infirmary a few blocks from the Alamo stanched cholera outbreaks and saved polio victims in a ward filled with iron lungs. But it operated on a fairly standard business model.
"We looked at our daily census, and if our beds were filled, we'd say, 'We're doing our job,'" Carrier said. "The more people we have in our beds, the more money we earn."
In Santa Rosa's cardiac telemetry ward, that is still the way it works. Recent patients included a 48-year-old man and a 71-year-old woman with congestive heart failure, and a 76-year-old woman with high blood pressure. Such chronic conditions, if treated properly, need not lead to a hospital stay.
The new law directs Medicare to reward alliances of healthcare providers, known as Accountable Care Organizations, or ACOs, if they reduce the cost of caring for patients like these while improving quality. That would likely mean fewer hospitalizations — and less income for Santa Rosa.
"In the new world, we're going to have to manage patients' diseases to manage expenses," Carrier said.
The best way to do that, he and others at Santa Rosa have concluded, is to work more closely with doctors, who now largely determine whom to admit to the hospital.
"Some folks are beginning to say that if you're not an ACO, you may not get paid at all," said Peter Maddox, senior vice president for strategy at Christus Health, the Catholic healthcare system that owns Santa Rosa.
Half a dozen times a week, Carrier meets with independently practicing doctors, talking with them about ways to collaborate and even trade their independence for a good pay package from Santa Rosa. And he's not alone.
"Every group of doctors I talk to is also talking to someone else," Carrier said.
Ultimately, Carrier said, Santa Rosa would like to put 100 primary care doctors on the payroll or in some other arrangement so the hospital and the doctors could manage patients' care jointly and benefit from incentives that Medicare and other insurers may offer.
Not everyone is interested in these overtures. Dr. Manuel M. Quinones Jr., who dissolved a partnership with Santa Rosa several years ago, said physicians should be wary. "When a hospital controls the lion's share, it will always be first in line to get the money," he said.
But like Carrier, many doctors in San Antonio see a changing world in which it's increasingly difficult to practice on their own.
"It's scary," said Dr. A. Charles Rabinowitz, a cardiologist who has watched many colleagues sell their practices. "There is a lot of paranoia out there."
Dr. C. Scott Horn, a family physician in suburban San Antonio, is carefully weighing offers from two hospital systems.
"I don't want to be told that I can only see a patient for 15 minutes," said Horn, the great-grandson of a Texas family doctor. "If someone comes in with an earache and tells me they're getting divorced and their life is falling apart, I'm not going to say, 'Sorry, make another appointment.'"
But practicing independently, Horn wrestles with multiple insurers, uncertain Medicare payments and new requirements to start using electronic health records. Though he has not decided what to do, he is intrigued by a different kind of healthcare model.
"It leads to the best medicine if the people delivering care talk to one another," the 63-year-old physician said. "That may be hard to get going. But in the long run, it's going to be better for patients."
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Yes there is some shaking out going on. I understand that a lot of doctors are choosing early retirement too. Was it on this board where it was discovered that the healthcare bill was solving the GP crunch by doing a "government service period for payment of med school" sort of thing? When I was in the service there was a running joke that most of the active duty doctors had finished in the lower third of the med school classes........... I wonder if a similar situation would develop, "government" doctors would be insured federally, so they would be less diligent/competant?
Admitted market forces aren't doing a good job right now, but there is serious government meddling going on too, that has got to be diluting the mix........
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"Admitted market forces aren't doing a good job right now,"
I would quibble with this and say that the problem now is the severely legally diminished role of market forces.
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okay. :-D legal and government meddling are diluting the effect of market forces.
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Somehow last week I put this under Health Thread instead of Politics of Health Care. This is no joke; this is actual charting of the new system as researched and published at the Joint Economic Committee. Please click on the link and enlarge the pdf to see the details:
http://jec.senate.gov/republicans/public//index.cfm?a=Files.Serve&File_id=8e6dbf03-ca4a-44be-9de4-a100c43fb5c8
(http://i603.photobucket.com/albums/tt114/dougmacg/ObamacareChart.jpg)
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We are going to die! , , , sooner rather than later :cry:
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yep, an inch of paperwork to get that sore throat checked. Is it a cold, Strep, Mono......... Instead of making an appointment, gagging on a swab, paying your 150$ and getting an answer in 3-4 days, after filling out 2 pages of mainly medical info.
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Missouri voters on Tuesday overwhelmingly approved a measure aimed at nullifying the new federal health care law, becoming the first state in the nation where ordinary people made known their dismay over the issue at the ballot box.
The measure was intended to invalidate a crucial element of President Obama's health care law — namely, that most people be required to get health insurance or pay a tax penalty. Supporters of the measure said it would send a firm signal to Washington about how this state, often a bellwether in presidential elections, felt about such a law. The referendum drew support from 71 percent of nearly 939,000 voters. "My constituents told me they felt like their voices had been ignored and they wanted Washington to hear them," Jane Cunningham, a state senator and Republican who had pressed for a vote, said Tuesday night. "It looks to me like they just picked up a megaphone."
The referendum, known as Proposition C, was seen as a first look at efforts by conservatives to gather and rally their forces over the issue. Before the vote, the referendum had not appeared to to capture the general population's attention with any broad, statewide media campaign. Republican primary voters (who had the most competitive races on Tuesday) appeared to play a key role in the vote's fate; far more voters (577,612) cast ballots in the state's Republican primary for an open United States Senate seat as cast ballots for the Democratic candidates (315,787).
Practically speaking, it remains entirely uncertain what effect the vote will have. The insurance requirement of the federal health care law does not come into effect until 2014. By then, experts say, the courts are likely to weigh in on the provision requiring people to buy insurance.
"While we're disappointed that Missourians didn't vote against this, we think the courts will ultimately decide it," said David M. Dillon, a spokesman for the Missouri Hospital Association.
For some, the outcome was not merely about health care, but about the role of states in setting policy.
"This really wasn't an effort to poke the president in the eye," said State Senator Jim Lembke, a Republican. "First and foremost, this was about defining the role of state government and the role of federal government. Whether it's here in Missouri with health care or in Arizona with illegal immigration, the states are going to get together on this now."
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By GRACE-MARIE TURNER
If Republicans take control of one or both houses of Congress this fall, many will have been elected with a promise to "repeal and replace" ObamaCare. But what are their options, really? There likely will be an initial showdown, but President Obama will surely veto any challenge to the law, and it would be hard to imagine mustering the votes to overturn it.
Information is the key weapon. Republicans can use congressional hearings to explain what ObamaCare is doing to the economy and the health sector. Their strongest cases would be built around jobs, the cost of health care, and the rising deficit.
If evidence shows that looming mandates on employers are crippling job-creation, they should be repealed. If health costs are rising, as they inevitably will be, Congress needs to hold hearings to investigate the causes and explain why the offending taxes and regulations must be repealed.
View Full Image
Chad Crowe
.Here are six key strategies that a Republican Congress could employ to put on the brakes:
• Defund it. House Republican Leader John Boehner of Ohio has vowed to choke off funding for implementation of the legislation, starting with parts that are especially egregious such as the "army of new IRS agents" needed to police compliance.
While Republicans could target the most damaging provisions of the legislation and tie their defunding measures to appropriations legislation that the president wants and needs to sign, they'd better be ready for battles. When former House Speaker Newt Gingrich lost a stand-down with President Clinton over closing down the government in 1996, it was widely seen as a setback for GOP efforts to scale back big government.
• Dismantle it. To focus committee action and floor votes, Republicans can look for provisions in the law that Democrats are on record as opposing. For example, Senate Budget Committee Chairman Kent Conrad (D., N.D.) has said that the new federal program to fund long-term care—the Community Living Assistance Services and Supports Act, or CLASS Act—is "a Ponzi scheme of the first order, the kind of thing that Bernie Madoff would have been proud of." Mr. Conrad and five of his Democratic colleagues sent a letter to Senate Majority Leader Harry Reid (D., Nev.) before the legislation passed opposing the program and expressing "grave concerns" about its fiscal sustainability.
Other highly unpopular provisions include the requirement that all businesses must file 1099 forms with the IRS to report any purchases totaling more than $600 in a year. This is designed to raise about $17 billion over 10 years from tax cheats. Rep. Dan Lungren (R., Calif.) was the first to introduce legislation to repeal this gigantic paperwork burden. Many Democrats in vulnerable districts who voted for the health law are also anxious to repeal this provision, which the National Federation of Independent Business says will impact 40 million businesses.
• Delay it. Republicans can also vote to postpone cuts to the popular Medicare Advantage program, postpone mandates requiring that individuals and businesses purchase and provide health insurance, and delay imposition of the $500 billion in taxes required by the law. Mr. Obama wouldn't likely sign such legislation, but the debate would shine a light on problems that haven't received nearly enough attention.
• Disapprove regulations. The Congressional Review Act of 1996 (CRA) gives Congress the authority to overturn regulations issued by federal agencies if both houses approve, with a two-thirds majority needed to override a presidential veto. This would be difficult to pull off. But proposing a resolution of disapproval under the CRA gives Republicans a platform to express strong disagreement and bring attention to especially egregious rules.
The current congressional majority wants to gut the CRA, and the House passed a bill that would eliminate the requirement that federal agencies submit their rules to Congress before they can take effect. The Senate has not yet acted, but this measure should be on the Republicans' watch list for the rest of the year.
• Direct oversight and investigation. Other aspects of ObamaCare are ripe for public hearings. For example, rules dictating how much insurance companies must spend on direct medical benefits are already hugely controversial—even before they have been issued. Businesses are also aghast at the narrow openings they have to protect their current health plans from onerous federal regulation. Republicans could summon many witnesses to testify about the impact of this regulatory straightjacket.
Congress also must keep a careful eye on the evolving cost estimates and deficits. Former Congressional Budget Office Director Douglas Holtz-Eakin estimates that the cost of the subsidies for private insurance could rise to $1.4 trillion —triple the $450 billion assumed by the current CBO. This is because the legislation creates strong incentives for businesses to drop coverage and dump their employees into federally subsidized insurance. Congress has a responsibility to protect taxpayers from what surely will be exploding costs.
Republicans also will want to call Donald Berwick, head of the powerful Centers for Medicare and Medicaid Services, to testify before Congress and detail his regulatory agenda for implementing the health-care law. He escaped that duty earlier this year when the White House avoided his Senate confirmation by giving him a controversial recess appointment.
• Delegate to the states. Congress should encourage states to press forward with their own innovative programs. For example, Gov. Mitch Daniels's popular and fiscally responsible Healthy Indiana Plan expands coverage to the uninsured using a health savings account model. And the lightly regulated Utah Health Exchange provides a marketplace for individuals and small businesses to purchase affordable, portable health insurance. Both are threatened by ObamaCare. The more that states are marching forward with reform that suits the needs and pocketbooks of their citizens, the easier it will be for Congress to repeal ObamaCare and start over.
Americans intuitively understand that government can't pay for huge new entitlement programs and the expansion of Medicaid with imagined cuts to Medicare, while still improving Medicare's long-term solvency. They also know that job creation is flat and that employers' fear of ever-rising health benefit costs is part of the problem. They need to hear the evidence that their fears are valid.
The real wallop of ObamaCare will come in 2014, when most of the spending begins and businesses and individuals are hit with intrusive and expensive mandates. The main job of Republicans, should they capture Congress, will be to slow down implementation of the law and explain to the American people the damage it will do—and already is doing—to our economy. If the White House changes hands in 2012, they can be ready to start with a clean slate and begin a step-by-step approach to sensible reform.
Ms. Turner is president of the Galen Institute.
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There was an article in Journal of American Medical Assoc. which I receive for free thus I cannot copy it here.
The author stated it like this:
There are 3 choices:
1- We can have a doctor and their patient decide what care to give/receive.
2- We can take a government nanny approach like taxing fatty foods, tax breaks for excercise, regulate towards healthier foods, regualte cigarettes, alcohol as we etc.
Or the author's preferred approach;
3- Redistribute wealth and ration care.
We know which one is Obamacare.
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CCP, Choice "1- We can have a doctor and their patient decide what care to give/receive." - sounds kind of American to me, at least the America that I once knew.
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Crafty, Over in The Way Forward I agreed whole-heartedly with this piece (GRACE-MARIE TURNER) and wanted to add that here. She is right on the money. Obama will not see new light and sign anything to do with repeal. These are some practical steps a new congress can do for roughly the same affect. De-fund, dismantle, delay, direct oversight and delegate to the states. ObamaPelosiCare is a choice that should be rejected at the state level and never was a power of the federal government.
IIRC the neutral budget required collecting taxes 4 years before providing services so that the 10 year plan falsely breaks even saying 10 years pays for 6. Instead of repealing, the new congress should set forward with a clean budget to their own priorities and just omit BS like that. There will be a Newt-like showdown coming and I hope they are ready to hold ground win that war of opinion.
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By HAL SCHERZ
Facing a nationwide backlash, Democratic congressional candidates have a new message for voters: We know you don't like ObamaCare, so we'll fix it.
This was the line offered by Democrat Mark Critz, who won a special election in Pennsylvania's 12th congressional district after expressing opposition to the law and promising to mend it—but not to repeal it. As a doctor I know something about unexpected recoveries, and this latest attempt to rescue ObamaCare from repeal needs to be taken seriously.
For Democrats who voted for ObamaCare, this tactic is an escape route, a chance to distance themselves from the president with a vague promise to fix health-care reform in the next Congress.
To counter this election-year ruse, my colleagues and I at Docs4PatientCare are enlisting thousands of doctors in an unorthodox and unprecedented action. Our patients have always expected a certain standard of care from their doctors, which includes providing them with pertinent information that may affect their quality of life. Because the issue this election is so stark—literally life and death for millions of Americans in the years ahead—we are this week posting a "Dear Patient" letter in our waiting rooms.
Associated Press
Andy Griffith pitches President Barack Obama's health care law to seniors.
.The letter states in unambiguous language what the new law means:
"Dear Patient: Section 1311 of the new health care legislation gives the U.S. Secretary of Health and Human Services and her appointees the power to establish care guidelines that your doctor must abide by or face penalties and fines. In making doctors answerable in the federal bureaucracy this bill effectively makes them government employees and means that you and your doctor are no longer in charge of your health care decisions. This new law politicizes medicine and in my opinion destroys the sanctity of the doctor-patient relationship that makes the American health care system the best in the world."
Our doctor's letter points out that, in addition to "badly exacerbating the current doctor shortage," ObamaCare will bring "major cost increases, rising insurance premiums, higher taxes, a decline in new medical techniques, a fall-off in the development of miracle drugs as well as rationing by government panels and by bureaucrats like passionate rationing advocate Donald Berwick that will force delays of months or sometimes years for hospitalization or surgery."
We cite the brute facts of ObamaCare's passage:
"Despite countless protests by doctors and overwhelming public opposition—up to 60% of Americans opposed this bill—the current party in control of Congress pushed this bill through with legal bribes and Chicago style threats and is determined now to resist any 'repeal and replace' efforts. This doctor's office is non-partisan—always has been, always will be. But the fact is that every Republican voted against this bad bill while the Democratic Party leadership and the White House completely dismissed the will of the people in ruthlessly pushing through this legislation."
Then we address the Democrats' evasive campaign maneuver:
"In the face of voter anger some Democratic candidates are now trying to make a cosmetic retreat, calling for minor modifications or pretending they are opposed to government-run medicine. Once the election is over, however, they will vote with their party bosses against repealing this bill."
The letter's final lines are the most important:
"Please remember when you vote this November that unless the Democratic Party receives a strong negative message about this power grab our health care system will never be fixed and the doctor patient relationship will be ruined forever."
This message is going out to an electorate that is already frustrated over what they see happening to health care. Missouri voters rejected ObamaCare overwhelmingly in August, voting by a margin of 71%-29% to reject the federal requirement that all individuals purchase health insurance. Democratic pollster Douglas Schoen has assessed that ObamaCare is "a disaster" for Democrats. And around the country many little-noticed primaries have reflected voter rage—including the Republican primary victory of surgeon, political newcomer, and advocate of repeal Daniel Benishek in Michigan's first district.
Meanwhile, the Obama administration's damage-control efforts have fallen flat. The latest round of pro-ObamaCare television spots targeting the elderly and starring veteran actor Andy Griffith have not only failed to move the polling numbers. They have caused five U.S. Senators to ask for an investigation of the ads as a violation of federal laws barring the use of tax dollars ($750,000) for campaign purposes.
America's doctors have millions of personal interactions each week with patients. We have political power. And we intend to use it by working to defeat those who have disrupted and gravely endangered the best health-care system in the world.
Dr. Scherz, a pediatric urological surgeon at Georgia Urology and Children's Healthcare of Atlanta, serves on the faculty of Emory University Medical School and is president and cofounder of Docs4PatientCare.
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David Walter Banks for The New York Times
Displaced patients to be covered by a new agreement met at an Atlanta-area church.
By KEVIN SACK and CATRIN EINHORN
Published: August 31, 2010
ATLANTA — Thirty-eight end-stage renal patients, most of them illegal immigrants, would receive the dialysis they need to stay alive at no cost under a rough agreement brokered Tuesday among local dialysis providers and Atlanta’s safety-net hospital, Grady Memorial.
The deal will be too late for Fidelia Perez Garcia, left, who left for Mexico and died.
The deal, if completed, would end a yearlong impasse that has come to symbolize the health care plight of the country’s uninsured immigrants and the taxpayer-supported hospitals that end up caring for them. The problem remains unaddressed by the new health care law, which maintains the federal ban on government health insurance for illegal immigrants.
Grady, which receives direct appropriations from Fulton and DeKalb Counties, ultimately agreed on Tuesday to help pay for continuing dialysis for most of the immigrants. Others would be distributed among local dialysis providers as charity cases.
Last fall, Grady’s new management closed its money-losing outpatient dialysis clinic in a move intended to demonstrate fiscal toughness to the city’s philanthropic community. The closing displaced about 60 uninsured illegal immigrants who depended on free thrice-weekly treatments at the clinic to survive.
Illegal immigrants, and legal immigrants newly in the country, are not eligible for Medicare, the federal program that covers most dialysis costs for American citizens with end-stage renal disease.
Grady volunteered to transport the patients to other states or their home countries and pay for three months of treatment. Thirteen accepted the offer. But in response to a patient lawsuit and news media scrutiny, the hospital eventually contracted with a commercial dialysis provider to treat the others in Atlanta for one transitional year.
That contract, with Fresenius Medical Services, expired on Tuesday.
Vital details of the agreement remain to be negotiated, including precisely how the patients will be distributed, how much Grady will pay and whether the arrangement will extend for patients’ lifetimes. But all parties said after meeting Tuesday morning that they were optimistic that they would reach an understanding and that patients would see no lapse in treatment.
“That would make me feel real happy because continuing with my dialysis, I need it to live,” said Ignacio Godinez Lopez, 24, who crossed into the United States illegally as a teenager and has been treated at Grady’s expense for four years. “I’m young, and without dialysis it would be taking my life.”
The patients in Atlanta have gambled that American generosity, even at a time of hostility toward illegal immigrants, would prove a surer bet than uncertain care in their home countries. Several said that the fates of those who returned home had reinforced their fears about leaving Atlanta.
Five of the 13 patients who left for Mexico with assistance from Grady or the Mexican government have died, according to Matt Gove, a Grady senior vice president. Most died while still receiving dialysis, although not always as regularly as recommended.
One patient, Fidelia Perez Garcia, 32, apparently succumbed in April to complications from renal failure after running out of Grady-sponsored treatments in Mexico. Patients with end-stage renal disease can die in as little as two weeks without dialysis, which filters toxins from their blood.
Ms. Perez’s mother, Graciela Garcia Padilla, said by telephone that her family was able to raise money for three additional dialysis sessions, at a cost of about $100 each. Ms. Perez then went 12 days without dialysis and persuaded a hospital to treat her only when she was close to death, Ms. Garcia said.
“They sent her to me just to die,” Ms. Garcia said. “Here, they let people die.”
At the same time, regular treatment in Atlanta has not guaranteed survival. Four of the 45 patients who were receiving dialysis at Fresenius clinics have also died, Mr. Gove said.
Nationally, about one in five dialysis patients die within a year of starting treatment, and about two in three die within five years, according to government figures.
The hospital, which has recently begun a financial turnaround after years of multimillion-dollar losses, has spent more than $2 million on repatriation and dialysis since closing its clinic, Mr. Gove said. As the expiration of Grady’s contract with Fresenius loomed, each sought to shift responsibility to the other. Larry L. Johnson, a DeKalb County commissioner who prodded and mediated the negotiations, said there was movement only when Grady agreed to contribute financially to the patients’ care.
Under the broad outlines of the agreement provided by Mr. Johnson and other participants, Fresenius, DaVita Inc. and Emory University’s health system would each treat a small number of patients — most likely three to five — as charity cases. Fresenius would care for the rest with financial assistance from Grady.
Fresenius and DaVita are the country’s largest commercial dialysis providers, with combined net income of more than $1.3 billion last year.
The agreement would not address the broader concern of how to care for illegal immigrants in the region who have developed renal disease since the Grady clinic’s closing, or those who will do so in the future. At the moment, their only option may be to wait until they are in distress and then visit hospital emergency rooms, which are required by law to provide dialysis to patients who are deemed in serious jeopardy.
Kevin Sack reported from Atlanta, and Catrin Einhorn from New York.
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If you are an outlaw- you can expect a short life. Illegal Immigrants are just that, make the decision, live and die with the consequences. Free people have the same exact issues to deal with too, Citizenship is a happy accident that some free people enjoy and get some saftey nets. Citizenship comes with a price that illegals are refusing to pay- why should they enjoy the same services as a citizen? What protection under the law should they enjoy other than arrest and deportation?
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Even bank robbers receive medical attention...
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JDN,
Nothing stopping you from paying for illegal alien medical bill out of your own pocket.
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I offer the following concept for consideration:
It seems to me that much of the conversation/debate makes health care an all or nothing proposition. Why not have a certain base level that everyone gets whether they are covered or not (e.g. you are hit by a car and need emergency treatment) and other stuff (long, expensive treatment) that you don't, unless you provide for it yourself.
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I think that is what a majority were thinking of before Obama and company ramrodded thru their comprehensive package.......... Would be willing to support a "disaster/major medical" that covered immediate life threatening stuff. If your wanted more then you would need to get supplemental insurance. I do not believe I should be required to pay the medical expenses on a life time chain smoker, or an extreme sport bicyclist, or the 70 year old who is going in for a 3rd or fourth organ transplant.
Just the unpredictable "life happened" accident stuff. The bicyclist hit by the car making a left...... The bystander at a drive by shooting...... etc. All the rest of the stuff would be "old school" you gotta figure out how to make enough to survive, or use enough common sense to avoid the expense all together.......
All I would expect is that the person treated have a legal status as a citizen, and that it was a genuine accident/ non-chronic condition. Otherwise get whatever coverage you can afford through the current methods.
I would put this medical coverage in control of an entity separate from the government. Something like UL labs, NRA, Post Office. Maybe something like the ADA or AMA (Dental and Medical associations)? With some provisions to give citizens teeth in maintaining responsibility/accountability?
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http://reason.com/archives/2010/09/09/seven-empty-promises-about
Reason Magazine
Seven Empty Promises About ObamaCare
The president is still struggling to sell his plan.
Peter Suderman | September 9, 2010
Just weeks before the Patient Protection and Affordable Care Act (PPACA)—a.k.a ObamaCare—passed, President Barack Obama urged congressional Democrats to make a final push for the bill, and asked them to schedule a vote as quickly as they could. “From now until then, I will do everything in my power to make the case for reform,” he said.
The bill passed, but the case didn’t take. Since Obama signed the bill into law, its unpopularity has, according to Pollster.com’s multi-poll aggregate, held steady, with roughly 48 percent of the public opposed. Liberal health care activists trying to sell the law and help its supporters in Congress have been forced to backtrack on their messaging—and in some cases, have found that their best strategy is to avoid mentioning the law at all. Now, the Obama administration and its allies are launching a multimillion dollar ad campaign intended to sell the public on the law’s virtues.
The president and his administration, it seems, are still doing everything they can to make the case for reform. The problemn is that so much of that case isn’t likely to pay off. Here are seven empty promises made about ObamaCare:
1. If you like your plan, you can keep your plan.
In June of 2009, President Obama gave a press conference where he explained his frequent promise that those who like their health care plans can keep their health care plans. “What I’m saying is, the government is not going to make you change plans under health reform,” he said. So in order to ensure health plan continuity, the law included a “grandfathering” provision that allows employers and insurers to continue offering plans that already exist without subjecting them to new rules and regulations. But the requirements that plans must meet in order to keep their grandfathered status are particularly strict. And in a draft document laying out grandfathering rules, the administration admitted that “after some period of time, most plans will relinquish their grandfathered status.” Meanwhile, the new law may also force more than 3 million seniors to switch their Medicare drug plans, regardless of whether they like them or not.
2. It will put Medicare on better fiscal footing.
In August 2010, the Obama administration’s Department of Health and Human Services released a report claiming that the PPACA would “extend the life of the Medicare Trust Fund by 12 years.” Later, Obama’s Health and Human Services Secretary, Kathleen Sebelius, told ABC News that her view is “supported” by the Congressional Budget Office (CBO). It’s not. Instead, the CBO said that “to describe the full amount of HI trust fund savings as both improving the government’s ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings.” This view is backed up by Medicare’s top actuary as well, who has written that “in practice the improved (Medicare hospital insurance) financing cannot be simultaneously used to finance other Federal outlays (such as the coverage expansions) and to extend the trust fund.”
3. It will cost around $900 billion.
In September 2009, Obama told a joint session of Congress that his health care plan would cost “around $900 billion over ten years.” The CBO’s final cost estimate for the law came in at about $950 billion—close enough to the president’s figure for government work, perhaps—but a report from the CBO later estimated that the law will actually require about $115 billion in additional discretionary spending, putting the official price tag well over $1 trillion.
4. It won’t cut Medicare benefits.
At a 2009 AARP panel, President Obama brushed away the idea that his health care plan might cut Medicare benefits, telling the audience that “nobody’s talking about reducing Medicare benefits.” But according to the head of the Congressional Budget Office, thanks to $130 billion in planned cuts to companies that offer Medicare Advantage plans, the health care law will “reduce the extra benefits that would be made available to beneficiaries through Medicare Advantage plans.” Roughly 25 percent of Medicare recipients use Medicare Advantage plans. One can argue about whether or not the government should be reducing Medicare benefits, but it’s simply not true that no one in the program will lose the benefits they currently have.
5. It will be paid for “mostly” by shifting around money that we’re already spending.
One of the least popular aspects of the PPACA was its sky high cost. The president tried to combat this by saying that, although the bill would cost “about $100 billion per year,” most of that money would “come from the nearly $2 trillion a year that America already spends on health care.” Actually, the majority of the money from the bill’s official scored cost comes from new taxes. According to the CBO, “the two pieces of legislation [that make up the health care law] were estimated to increase mandatory outlays by $401 billion and raise revenues by $525 billion.”
6. It will give consumers more access and greater choice.
Organizing for America, the successor to Obama’s campaign organization, claims that the new health care law will result in “more choices...for millions of Americans.” But early signs indicate that, as a result of the law, patients and consumers will have fewer options for doctors and health insurance. Most experts, for example, expect that the health care overhaul will result in a serious doctor shortage, particularly amongst primary care phsyicians, meaning many individuals will have to wait longer for care, and may not get to see the doctor they want to see. Meanwhile, insurers in some states are already cutting back on insurance options.
7. It will bring down the price of insurance.
Just a few weeks before the final law passed, Obama said that “my proposal would bring down the cost of health care for millions.“ And health care affordability was so crucial to the president’s argument that the word made it into the title of the bill: the Patient Protection and Affordable Care Act. So will health care costs come down? Not likely. The CBO predicted that the law will cause average health insurance premium prices to rise by 10-13 percent. And a recent survey indicates that most businesses expect insurance prices to rise as a result of the PPACA. Perhaps Obama meant that the law would “bend the cost curve” and reduce the growing cost of health care? Even if he did, it wouldn’t matter; that’s not likely either. In June of 2009, CBO Director Douglas Elmendorf warned Congress that its proposals would bend the curve in the wrong direction. And in a May 2010 presentation at the Institute of Medicine, Elmendorf declared that in the CBO’s judgment, “the health legislation enacted earlier this year does not substantially diminish [the] pressure” of rising health costs.
Peter Suderman is an associate editor at Reason magazine.
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ObamaCare's Fatal Flaw?
By Louis Case
Scott Brown's election could be the most significant turning point in the whole ObamaCare fiasco. And not because it was an "expression of the will of the people," because, as we've learned, that doesn't matter to our Washington overlords. No, Brown's election has trapped Congress in its own sloppy arrogance.
In a September 8 appearance on Greta Van Sustern's "On The Record," Virginia's Attorney General, Ken Cuccinelli, explained the significance of the Brown victory in the context of Virginia's lawsuit to overturn ObamaCare.
In 2010, before ObamaCare was passed, the Commonwealth of Virginia passed its Health Care Freedom Act, which says, more or less, that Virginia residents cannot be required to buy health insurance. After ObamaCare passed, Virginia sued in federal court to have ObamaCare declared unconstitutional because it exceeded the scope of the Commerce Clause. The case already survived its first challenge by the federal government.
On September 3, both parties filed a Motion for Summary Judgment and a Memorandum in Support. To win such a motion, the movant must show that "there is no genuine issue as to any material fact and that the movant is entitled to judgment as a matter of law" (Fed. R. Civ. P. 56[c].) One section of Virginia's Memorandum in Support of the Motion focused on the issue of severance.
Virginia is asserting that certain portions (that is, the personal mandate) of ObamaCare are unconstitutional. If Virginia prevails, it leaves the question of what happens to the rest of the ObamaCare statute. This is where the concept of severance comes in. Normally, all comprehensive laws contain a boilerplate severance clause: it says that if any portion of the law is found to be unconstitutional, that portion is severed from the rest of the law -- that is, the rest of the law stands.
But ObamaCare contains no severance clause. Virginia is asserting that if it prevails on its substantive claims, the whole law is unconstitutional. (If Virginia does not prevail, any one of the twenty-plus legal challenges have the same severance argument available.)
If a severance clause is normal boilerplate, why does not ObamaCare contain one? This is where Scott Brown's election enters. Recall that the House passed its version of ObamaCare. On Christmas Eve, after much horsetrading and bribing, the Senate passed its version. The Senate version was not drafted to be in its final form; it was drafted to get 60 votes. Normally, these bills would be reconciled in a conference committee, and the final version would have to be voted on again with 60 votes in the Senate. However, before it could be sent to conference and reconciled, Scott Brown won in Massachusetts -- a reconciled bill could no longer get 60 votes! That is why the House had to vote up or down on the Senate bill, which was basically a draft without the normal boilerplate inserted.
As Virginia argued in its Memorandum (Pages 24 to 28), the presence of a severance clause raises a presumption that Congress did not intend the whole statute to depend on the constitutionality of any particular clause. But with no severance clause, they are not entitled to that presumption. A court cannot sever the offending clause on its own if the statute would not function as Congress intended.
Attorney General Cuccinelli took clear delight in the box the feds are in. On the one hand, to prevail on its claim that the personal mandate is a proper exercise of the Commerce Clause, the feds must argue that it is necessary and essential to ObamaCare. On the other hand, to get around the severance problem, the feds must argue that the personal mandate is not essential. In the severance portion of the Memorandum (Pages 24 to 28), Virginia cited and quoted the statute itself, the feds' pleadings, and the feds' oral arguments emphasizing the necessity and importance of the personal mandate. I'm sure that section could have been much, much longer, but courts put limits on the size of Memoranda.
Courts sometimes examine the legislative history to divine congressional intent. Cuccinelli cleverly addressed that in his "On The Record" interview. He said there were two possible reasons for the exclusion of a severance clause: 1) sloppiness, or 2) a sort of mutually assured destruction -- that is, these senators inserted their little pet projects, and if they couldn't have theirs, then nobody else could have their pet projects, either. This was clever because against the background of behind-the-scenes wheeling and dealing, it's plausible. So when the feds assert at oral argument that Congress intended severability and cite newspaper articles, congressional records, etc. to back it up, guess what they open the door to.
While it's foolish to hazard a prediction of what courts will do, there is reason for optimism. There are factors in addition to the solid legal arguments against ObamaCare that might influence the court. First, a majority of people hate the law. Second, there is much litigation over it. Third, it is a fundamental and permanent change from a free America to a Euro-America. A single judge can end all that strife. Moreover, if you were a judge, would you like to go down in history as the one who gave up on America?
Page Printed from: http://www.americanthinker.com/2010/09/obamacares_fatal_flaw_1.html at September 13, 2010 - 08:30:21 PM CDT
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:-o :-o :-o
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"Virginia is asserting that if it prevails on its substantive claims, the whole law is unconstitutional."
- I can't answer that technical point legally but I can address it logically. The votes for that package were carefully sought out and chosen based on the bill's entirety. Recall the cornhusker kickback, the hospital in Connecticut, 10 years of taxes to pay for 6 years of benefits because of such delicate budget issues etc. If the Court strikes down anything that changes the financial substance of the bill, and the purchase mandate is the largest piece of that puzzle, then you can not assume that all the pretend budget hawks in those narrow vote margins would have still voted 'yea' for the new court-broken, budget breaking package. It seems to me any Supreme Court decision that would hold up the remaining parts of a bill that obviously would not have passed without including the unconstiututional portions would be flawed logic and wrongly decided IMHO.
Maybe Bigdog wants to jump in on this.
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I too would like his take on this.
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Guro Crafty, DougMacG, et al,
The starting point of this article is sound, in that it is true that bills usually have separable ("severance") contents to them, in large part due to the understanding that bills can be overturned in part, but not necessarily in whole, by the federal courts. (Sidenote: the Supreme Court, of course, disallowed the president, via the line item veto to do the same due to a violation of the "Presentment Clause" found in Article I.) So, yes, in theory, the Supreme Court or lower federal court could, in fact, overturn the health care plan in whole, not just in part.
However, I am not sure that the author is thinking lucidly in much of the other portions of the article. For example, he plays very loosely with the language of the Constitution in the article. He says: "the feds must argue that it is necessary and essential to ObamaCare" and "the feds' oral arguments emphasizing the necessity and importance of the personal mandate" (emphasis mine). That is NOT what the Constitution says, however. The Constitution (Article I, section 8, clause 18) says "The Congress shall have power ... to make all Laws which shall be necessary and proper (emphasis mine). This distinction may be small, but it is important. "Proper" has historically been taken rather loosely, and expansively. There has been some change in recent years, but on average, the federal government, even with recent conservative courts (as compared to the Warren Court), has most often sided with the national government in Commerce Clause cases.
I also think that he misunderstands the power that courts have. Courts are weak, by design. Alexander Hamilton wrote famously that the federal judicial branch lacked "the purse and the sword," powers granted to Congress and the executive branch, respectively. There is no real enforcement mechanism that court's enjoy. President Jackson once noted that "John Marshall has made his decision, now let's see him enforce it." It is true that the federal bench has seen its powers increase in recent years, but that is a function of the powers of the federal government's increased powers, not really the bench vs. the elected branches (see for example Gerald Rosenberg's excellent book The Hollow Hope). For all the talk of the threat of the judiciary, the fact is that, in some very real ways (appointment by the president ad Senate, salary increases by Congress, control over types of cases the Supreme Court can hear, possibility of impeachment, etc. etc.), the judiciary is not the spectre that many on both sides of the ideological spectrum think that it is.
Moreover, it takes enforcement of judicial decisions to make a decision become policy. The executive branch is charged with that enforcement. There is an appeals system in place. The idea that a "single judge can end all that strife" is (very probably) false.
Furthermore, I have seen claims in recent news articles that the case discussed by the author and another filed by the Florida are "likely headed to the Supreme Court." (Remember that , as the article notes, the initial challenge upheld the law.) I would love to see the evidence for the claim rather than just it being asserted. The federal district (trial courts) hear more than 300,000 cases a year. About 60,000 of those cases are then appealled to the Circuit Courts. Of those, the Supreme Court hears about 80 a year. Statistically, that means that the case will likely NOT reach the Supreme Court, even it is appealled (the Supreme Court receives about 10,000 appeals a year). It only takes four justices to hear a case, in what is called the "Rule of Four," so it might seem likely that the Supreme Court would hear the case. However, assuming it came to Court having upheld the legislation, it seems unlikely that the liberal block would vote to take it. It also seems unlikely that the conservative block would vote to hear it because they aren't necessarily sure how Kennedy would vote. Many argue that he has moved "right" since O'Connor's retirement, but he also is a student of international law, much to the chagrin of many conservatives (see his death penalty jurisprudence, for example). Therefore, he is probably not as concerned as his conservative colleagues about a "European" model of health care. This means that the conservatives would fear the judicial "seal of approval" on the national health care legislation.
Finally, there is a very real question about whether the Supreme Court would find the case to justiciable. The Court has long held that cases which present a "political question," or one that is best decided by the elected branches, would not be heard by that court. The most famous example of this is the Vietnam war, which had several legal challenges, none of which were ever heard by the Supreme Court. It is very possible that even ideological sympathetic justices would not wish to hear the case due to the political nature of the question. (Again, remember that as of now the first legal challenge to the law upheld the law.) If the Supreme Court refuses to hear a case, the lower court decision would stand in that instance.
I liked the article because it is interesting and thought provoking, but I think there are holes in the overall assertions made by the author.
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http://hotair.com/archives/2010/09/14/wh-to-congress-lets-repeal-a-part-of-obamacare-mm-kay/
It looks like the white house wants a partial repeal of obamacare. Smells like desperation.
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BD:
Thank you for that thoughtful analysis.
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BD:
Thank you for that thoughtful analysis.
Thank you to you and DougMacG for the invitation, with apologies for my inability to be a consistent participant in this forum.
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Thank you Bigdog for a very helpful analysis. I think you have it right in the sense that this court will be unlikely to jump in as it sits and for the reasons you stated, mainly that the legislation can still be scrapped, rewritten, confirmed or expanded in the political process without court intervention.
I agree that since no judge or lower court has not struck down any part of it so far, it puts no real pressure on the Supreme Court to select the case.
There was a post by Marc from the WSJ further up this thread that I thought gave very reasonable advice to a potential new congress on what to do in terms of opposition to ObamaCare. In a nutshell, de-fund it, delay implementation, dismantle key portions and delegate powers to the states, etc. Options are still available for derailing this without a court intervention.
On the legal issue, Bigdog introduced Article I, section 8, clause 18 of the constitution. Let me please quote the clause here in its entirety for those of us not as recently familiar with it:
Article 1, Section 8, Clause 18
"To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Power, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof."
I take that to mean that the power of congress in the larger sense needs to be granted elsewhere in the constitution and then the laws necessary and proper to carry it out are granted here. So where in the constitution is the larger power of the congress granted to run the nation's and the individual's healthcare?
That power to regulate is arguably derived from the Commerce Clause, but the choice or fact alone of no insurance is a non-economic activity.
The Commerce Clause reads: [The Congress shall have Power]"To regulate Commerce ... among the several States..." - Article 1, Section 8, Clause 3
Healthcare I'm sure meets current standard for constituting interstate commerce. This legislation though goes further in my opinion than regulation of private companies providing services in the sense that it eliminates individual choices that millions choose today. A strong argument can be constructed either direction about whether this is not a necessary and proper way of regulating that commerce in a limited government context. As BD pointed out, neither side of this divided court should be confident enough that their side would prevail to unnecessarily risk establishing a new precedent against their own view.
For me, the Commerce Clause has already been used far too expansively. I can see a constitutional power for reasonable regulations of the firms who provide interstate healthcare, like requiring an MD for certain procedures or requiring surgeons to cut with clean knives, but I have no idea where they were given the power to even ask me about my non-coverage, health history or personal data beyond my name and address for census and income for taxes.
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Easy to find opinions on either side of this. Here's one by authors who worked in the Reagan and HW Bush Justice Departments, written before the final bill was negotiated, with key paragraphs excerpted: http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082103033.html
The otherwise uninsured would be required to buy coverage, not because they were even tangentially engaged in the "production, distribution or consumption of commodities," but for no other reason than that people without health insurance exist. The federal government does not have the power to regulate Americans simply because they are there. Significantly, in two key cases, United States v. Lopez (1995) and United States v. Morrison (2000), the Supreme Court specifically rejected the proposition that the commerce clause allowed Congress to regulate noneconomic activities merely because, through a chain of causal effects, they might have an economic impact. These decisions reflect judicial recognition that the commerce clause is not infinitely elastic and that, by enumerating its powers, the framers denied Congress the type of general police power that is freely exercised by the states. ...
The other obvious alternative is to use Congress's power to tax and spend. In an effort, perhaps, to anchor this mandate in that power, the Senate version of the individual mandate envisions that failure to comply would be met with a penalty, to be collected by the IRS. This arrangement, however, is not constitutional either.
Like the commerce power, the power to tax gives the federal government vast authority over the public, and it is well settled that Congress can impose a tax for regulatory rather than purely revenue-raising purposes. Yet Congress cannot use its power to tax solely as a means of controlling conduct that it could not otherwise reach through the commerce clause or any other constitutional provision. In the 1922 case Bailey v. Drexel Furniture, the Supreme Court ruled that Congress could not impose a "tax" to penalize conduct (the utilization of child labor) it could not also regulate under the commerce clause. Although the court's interpretation of the commerce power's breadth has changed since that time, it has not repudiated the fundamental principle that Congress cannot use a tax to regulate conduct that is otherwise indisputably beyond its regulatory power.
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=DougMacG link=topic=1411.msg40618#msg40618 date=1284567215]
On the legal issue, Bigdog introduced Article I, section 8, clause 18 of the constitution. Let me please quote the clause here in its entirety for those of us not as recently familiar with it:
Article 1, Section 8, Clause 18
"To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Power, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof."
I take that to mean that the power of congress in the larger sense needs to be granted elsewhere in the constitution and then the laws necessary and proper to carry it out are granted here. So where in the constitution is the larger power of the congress granted to run the nation's and the individual's healthcare?
That power to regulate is arguably derived from the Commerce Clause, but the choice or fact alone of no insurance is a non-economic activity.
The Commerce Clause reads: [The Congress shall have Power]"To regulate Commerce ... among the several States..." - Article 1, Section 8, Clause 3
Woof,
For one thing they seem to interpret the meaning of "all other powers vested by this constitution" as meaning the Constitution has all the power. I would refer them to the 10th Amendment: "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."
I would also point out that 'the power to regulate commerce' isn't the same as the government being given the power to participate in commerce. :wink:
P.C.
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Forgive the nitpick PC, but it is "interstate commerce", not "commerce".
I would also add a reminder of the 9th Amendment as well as the 10th.
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Woof Guro Craftydog,
:lol: And I will nitpick and say that the term commerce clause refers to the Foreign Commerce clause, Interstate Commerce clause, and Indian Commerce clause and each of those refers to their application under the same sentence in the Constitution that reads, The Congress shall have power to regulate commerce with foreign nations, and among the several states, and with the Indian tribes; and since I was using the term in context with how it is used in the Constitution, I didn't think that any distinction was necessary, as seeing the term "interstate commerce" isn't used in the Constitution to begin with, but you are certainly right that there is a significant distinction to be made between the limited power to regulate interstate commerce and regulating all commerce. You're also right about the 9th Amendment being applied to the issue of government healthcare as well, however the 9th more specifically addresses rights being denied or disparage by the government where the 10th addresses delegated powers, which is what the Commerce Clause does in giving the government power to regulate commerce... between the several states and so on and so forth, which was what I was addressing. My larger point was that the government was delegated the power to regulate but in the case of healthcare they are not only regulating, they are participating in commerce between the States by taking over healthcare to a large degree and that is not a power that is specifically given to them anywhere in the Constitution. Which was what Doug was alluding to in his post. Now of course that won't stop some lowlife, oath breaking, ideologically driven, Liberal Federal Judge from conjuring up from the ether and vapors of Liberal Constitutional law (which has nothing to do with the Constitution), and find that indeed that's what the Founders had in mind. :-P
P.C.
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"you are certainly right that there is a significant distinction to be made between the limited power to regulate interstate commerce and regulating all commerce"
Which was what I intended to say :-)
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Woof,
But there lies the "de facto but not de jure", "in fact but not necessarily within the law"; there is precedent (a word that now means amendment by judiciary), in Constitutional law that overides the 10th Amendment. Wickard v. Filburn (1948), this involved the 1938 Agricultural Adjustment Act. This act controlled how much wheat a farmer could grow according to acreage. A guy in Ohio named Roscoe Filburn, went over this amount by growing his allotment to sell and then growing enough over that to feed his own family and cattle. His lawyers made the case that since the extra wheat was not sold in interstate commerce, that Congress didn't have the power to regulate the overage under the Commerce Clause. The Supreme Court of the U.S. conceded that his actions were not "commerce" but ruled that it was immaterial and made a decision against him finding that Congress could regulate any activity that exerts a substantial economic effect on interstate commerce and his own contribution to the demand for wheat may be trivial by itself, is not enough to remove him from the scope of federal regulation, where as here his contribution, taken together with that of many others similarly situated is far from trivial. So within the law due to this precedent, the Commerce clause gives Congress the power to regulate almost anything. Of course this is unconstitutional but because of stare deisis, this has never been overturned. Which is why making a case against the government for actively engaging in commerce via the healthcare law should be pursued instead of their ability to regulate it. The Commerce Clause gives them power to regulate not participate.
P.C.
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The argument needs to be made that Wickbard should be reversed.
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Woof Guro Craftydog,
Absolutely, but not likely I'm afraid. The study of Constitutional law relies on precedents, not the Constitution; which means most judges are not educated on the intent of the Founders but only on the opinions and views of other judges.
P.C.
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Well, I know a little bit about this :wink: When I was in Ruth Bader Ginsburg's class on Constitutional Law even she recognized that sometimes cases were wrongly decided and should be reversed. Why, look at how she reversed her previous thinking on the matter of States' Rights in Bush vs. Gore! :evil:
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P.C.:"I would refer them to the 10th Amendment: "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."
Crafty: "I would also add a reminder of the 9th Amendment as well as the 10th."
9th Amendment: "The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people."
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Yes, the 10th would be the basis for the Massachusetts system and fewer people are being hurt by that and easier to dismantle than a federal program.
9th amendment is where they found the right to privacy (IIRC), an unenumerated right that the Roe v. Wade rests on. ObamaCare is an gigantic invasion of privacy. How can you participate in the system without the compulsory taking of very very personal information?
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Don't forget the 1st amendment and I believe there is a religious out-clause in Obama-Care. What I don't get in terms of a right of privacy and freedom of religion is why anyone would have to disclose their religion to qualify and then have the validity of the objection scrutinized by big government. That is not freedom of religion.
My religion, home churched, has opposition to big government and socialized medicine right in the core beliefs derived from the ancient biblical principles of thou shalt not steal and thou shalt not covet thy neighbor's health coverage (or his wife or his ass). God endowed and entrusted each one us with the capability to negotiate our own coverages and contracts in a free society and every infringement on that is a punishable sin.
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Crafty, Perhaps a constitutional amendment could be constructed to overturn Wickard v. Filburn, the case where growing 'wheat' on private property for personal consumption only was deemed to be a form of interstate congress. We shouldn't need one, but that could give the liberal justices something new to study rather than dream up new expansions to the commerce clause. Might get the support of another generation that wants to grow more than wheat.
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P.C.'s distinction between regulating and participating in commerce is brilliant! ... if not something that should be obvious to all of us. Without drifting subjects here but this is all tied to things like removing General Motors' CEO, restructuring Chrysler's debt, arbitrary market interventions like cash for clunkers, choosing which investment houses get merged and bailed and which get closed and sold, etc. The health care bill is all part of that runaway process of government meddling and participating, not regulating.
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Woof Doug,
This is the second time in my life that someone referred to something I did as being brilliant; my mom said "Brilliant!", when I dropped and broke her favorite coffee cup. I liked this time better. :lol:
P.C.
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Obama says he doesn't explain it well enough which means of course that you unwashed out there are too stupid to understand that rule by the elite and handing your private decisions is going to be good for you...
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http://www2.timesdispatch.com/news/editorials/2010/sep/27/ed-care27-ar-526411/
HEALTH CARE: 'You Dummies'
Several months ago President Obama promised that Democrats would be proud to campaign on the new health care overhaul. With campaigns now peaking, the only Democrats who mention the law these days are the ones who voted against it. So supporters have decided to try a new approach: calling voters dimwits.
That's not how they're putting it, of course. Obama, for instance, says he faults himself "for not being able to make the case "more clearly to the country." Maybe if he spoke louder and used small words . . . .
Funny thing, though: The president said precisely the same thing nine months ago, during his State of the Union address, when health-care reform was still being debated: "This is a complex issue . . . .I take my share of the blame for not explaining it more clearly to the American people."
Wait a second. Received wisdom tells us Obama is the greatest orator since Ronald Reagan, if not Cicero. He's so eloquent he could talk the ticks off a dog. He's known for nine months that he needs to do a better job of selling the health care overhaul -- and he hasn't been able to do it. Did he suddenly get tongue-tied? What's the real problem here?
The problem is not that people just don't understand a complex law, or even that -- as a recent AP story spun it -- Obama "has yet to find the right wavelength for communicating information that's relatively straightforward." After all, congressional Democrats conceded they didn't understand what was in the bill, either. But that didn't keep them from voting for it.
The problem is that the law stinks. The critics' predictions -- it's going to raise health care costs, the deficit, taxes, and insurance premiums, make getting medical care more complex, and help fewer people than advertised -- are coming true already. Members of the public understand this all too well.
When someone says, "I'm sorry you took it the wrong way," the listener knows the speaker is not really apologizing -- he's calling the listener oversensitive. And when a politician says, "I'm sorry I didn't explain things clearly enough," the voters know he's not really admitting a personal failure -- he's calling them stupid.
Democrats and an often sympathetic media are trying, once again, to tell voters they would like a lousy law if only they had enough brains. No wonder the Republicans are poised on the verge of an electoral sweep.
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Glenn Beck had an incredible clip of Sen Kerry yesterday wherein he rather directly accuses American voters of being clueless.
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Let's implement these ideas.
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If Obamacare Is Repealed, What Then?
By Deane Waldman October 03, 2010
(J. Deane Waldman MD MBA is the author of "Uproot U.S. Healthcare," Tenured Professor in both the Medical and Management Schools at University of New Mexico and Adjunct Scholar for the Rio Grande Foundation. Educated and trained at Yale, Chicago Medical, Mayo Clinic, Northwestern, Harvard, and Anderson Schools, he has authored over one hundred academic citations in medicine as well as healthcare strategy and management. He has been chief of pediatric cardiology at three major medical centers.)
Most opponents of Obamacare (HR 3590), including its Republican detractors, offer nothing substantive as an alternative. If healthcare is truly "broken" and if Obamacare is so wrong, what should we do instead?
The answer is surprisingly straightforward: practice good medicine, rather than smarmy politics, on sick healthcare. That is the thesis of my book "Uproot U.S. Healthcare."
There are five steps in good medical practice, whether on a sick person or a sick system.
* 1. Review all past and present evidence. Depending on logic alone is not acceptable.
* 2. Diagnose the reason(s) for illness -- do root cause analysis.
* 3. Treat cause(s), not the signs and symptoms. Avoid the ‘blame game.'
* 4. Partner with the patient. You cannot dictate to her, him, or it.
* 5. Adjust the treatment plan if outcomes are not those desired.
As is obvious, Congress did none of these. (In medical practice, this is called malpractice.) What would happen if the principles of good medical practice were applied to healthcare?
Evaluating past evidence proves the following.
* 1) When any system disconnects the consumers from control of their money, they cannot economize and have no reason to do so. Therefore, with limited ‘supply' and unlimited ‘demand' for health care services, the government must ration, as is done in every country with universal health care. Check out any recent British newspaper.
* 2) Every cost projection of every entitlement Program ever enacted by Congress has underestimated its true cost. In 1990, the GAO found that Medicare cost 854% more than Congress' original projection. Medicare is now projected to go broke by 2017. If ObamaCare is estimated to cost >$1 trillion, imagine what the actual price tag will be, that our children will have to pay.
* 3) When government manages anything, the bureaucratic cost explodes at the expense of the public. Before HR 3590, 40% of all healthcare dollars went to the bureaucracy. With the massive bureaucratic expansion enacted by ObamaCare, that number will approach 50%. When you are talking about trillions, Congress is creating an unsustainable waste of our tax dollars.
Root Cause Analysis shows 10 reasons for increased healthcare spending.
See details in "Uproot US Healthcare."
* 1. New value (care not possible in the past)
* 2. More people who live longer
* 3. Actions without evidence
* 4. Bureaucracy, Inefficiency, Reconciliation, and Regulatory Compliance. This is called the "waste of the middle."
* 5. Disconnecting consumers from control of their money
* 6. Rewarding outcomes that we don't want
* 7. Defensive medicine
* 8. Adverse outcomes and errors (medical)
* 9. Money taken out of healthcare legally
* 10. Fraud, abuse, errors (financial) and embezzlement.
Curative treatment
Clearly, we want to spend money on the first two above. To stop wasteful spending permanently or using medical terms to cure the patient, we need to fix #3 through #10. If action without evidence (#3) wastes money, we should require evidence before spending. Unless a regulation and its accompanying costly Federal bureaucracy are proven to be worth the expense, show them the sunset. If defensive medicine is due to the tort system, replace the tort system. If you want insurance companies to make less or no profit (#9), change how they do business.
Partnering
The American people hate (I do not use that word lightly) being dictated to by government. Our nation was founded on an act of rebellion against what we now have again: a government that ignores the wishes of the people.
The only way to develop a healthcare system that will be acceptable to the populace is by asking them what they want the system to do and what they are willing to do. If government tells people what the system will do for them and to them, Americans will rebel.
Do you want proof? First, note the lowest approval rating for Congress in the history of our country. Second, witness the success of the Tea Party, whose sole unifying concept is its opposition to excess government spending.
With Obamacare being clearly "wrong," what is "right?"
Until we practice good medicine on healthcare, it will continue to decline and we will keep paying with our money and our lives.
http://www.americanthinker.com/2010/10/if_obamacare_is_repealed_what.html
http://books.google.com/books?id=ikUnEJYEqvgC&pg=PA154&lpg=PA154&dq=google+books+Uproot+Healthcare&source=bl&ots=aPrsPPTNWG&sig=sG44A1WuyGaocjh3WCtQ6P8JOrM&hl=en&ei=6a-oTPbnKc-jnge9qMybDQ&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBUQ6AEwAA#v=onepage&q&f=false
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Doug:
Quite right.
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"quite right"
I look forward to CCP's comments as well.
The entire book is accessible at the google books link.
The Pledge to America I think compels a new R. House to revisit this issue and at least vote on repeal and replace with something consistent with limited government principles.
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You Can’t Keep the Plan You Have
Obamacare is coming to a doctor’s office near you.
Last year, I ordered a CT scan of the chest on a 63-year-old patient whose chest X-ray had revealed a lung nodule. I had no problem getting the test approved by his private insurance company. The radiologist suggested that I repeat the CT scan this year to make sure the nodule hasn’t turned into cancer.
But this year, the same insurance company is denying the test, having clamped down on several elective services while also raising its premiums. This company now has to cover children with pre-existing conditions and can place no lifetime limits on care. It is struggling to preserve its profits as Obamacare kicks in — profits that, to begin with, are only approximately 4 percent of its total revenue.
Next year, my patient will have Medicare. He can’t afford a secondary insurance plan (Medicare Part B covers only 80 percent of most charges), and he doesn’t qualify for Medicaid as his secondary, so he was hoping to join a Medicare Advantage plan — a private insurance plan that seniors can choose to receive, partly at government expense, instead of Medicare. But in 2011, Medicare Advantage is due to be cut $140 billion by the new law, and it is doubtful that the plan he wants will still be available. Harvard Pilgrim, the second-largest insurer in Massachusetts, has just dropped 22,000 patients from its Medicare Advantage plan in anticipation of these cuts. Soon seniors everywhere will have the same problem. In fact, the Medicare actuary estimates that 7 million out of the 11 million people with Medicare Advantage will be set adrift over the next seven years.
One of those patients will likely be my fellow with the lung nodule who needs a follow-up scan.
President Obama clearly hasn’t visited a real doctor’s office recently. If he sat on my office couch, he would immediately discover that real patients are terribly worried about how dysfunctional and expensive all health insurance, public and private, is becoming under the new law of the land. Of course, the problem of spiraling health-care costs and inadequate access to essential services was already happening before, but Obamacare is making it far worse.
My medical office is changing, and not for the better. As I write this, I have a patient waiting in the next room who has to pay cash to see me because his employer’s contribution to his plan has dropped this year, and his deductible has gone up. Many employers are getting ready to dump their employees on the state exchanges in 2014. They are adopting plans that won’t “grandfather in” under the draft regulations of the new law, which mandate low deductibles and low co-pays. I am treating my patient for high blood pressure, which may be due to his worrying over his medical bills. My bill is minor compared to the hundreds of dollars that the laboratory charges him for the routine blood tests his insurance no longer covers.
Next door to this man is a woman complaining about her premiums, which are up 20 percent from last year. She wants to add her 23-year-old son, who has diabetes, to the policy under the new law — but she can’t, because her son has a full-time job and is supposed to get it from his employer. But the employer isn’t offering it, and is prepared to ultimately pay the Obamacare penalty that is supposed to enforce the “mandate” that he provide insurance.
Under the “consumer protections” that just kicked in, private insurers are unable to charge co-pays for preventive services including mammograms, colonoscopies, and vaccines. This sounds good until you consider that when these services are “free,” demand for them will increase, and we doctors are ill equipped to handle such a demand surge. Further, it is unlikely that doctors will receive greater reimbursements to compensate for the lost co-pays — and so they will stop providing these services in droves. Your insurance may pay for your colonoscopy, but you may not be able to find a doctor to perform it.
And things are only going to get worse. Full-throttle Obamacare, which comes into effect in 2014, will promote insurance plans that require little payment from patients out-of-pocket — and thus are easy to overuse. This will remove the brakes from the system. In my doctor’s office of the near future, I expect the waiting room to be clogged with more and more patients even as the government and private insurers limit the tests and treatments I can offer.
Yesterday I saw a patient who just lost his job. He had no insurance, and I saw him for a very small fee. He expects to end up on Medicaid (it will be much easier to qualify under Obamacare), and since I don’t accept it — and more and more doctors are doing likewise — he will likely end up getting his care in the ER. But ERs are already overcrowded, and are not ready to handle more patients.
The president can keep telling Americans that their health care won’t change. But for my patients, it already has.
– Marc Siegel, M.D., is an associate professor of medicine at NYU and the medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News medical contributor.
http://www.nationalreview.com/articles/248520/you-can’t-keep-plan-you-have-marc-siegel
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I agree with all of it except this:
"President Obama clearly hasn’t visited a real doctor’s office recently."
Sure he has. But he (and his political buddies) doesn't have any denials like the rest of us.
I am also seeing companies starting to deny more and more and pts. benefits being stripped.
This is only the beginning. Berwick et al are just drooling getting their teeth into cutting what they deem statistically isn't cost effective.
It is all a numbers game.
America is not fooled that 50 million more can be covered and costs and deficits will go down. Even with the massive rationing they have in store for us.
Private insurers will eventually go under - as planned.
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"Private insurers will eventually go under - as planned"
This most certainly IS the plan-- and is why we must elect Congressmen and Senators who will defund, rollback, reverse and undo Obamacare and enable the return of the free market to the health sector.
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A slippery slope to forced euthanasia?
Pressure for legalising euthanasia has been stepped up in Australia by the pro-euthanasia Greens.
It appears that the party of death never sleeps. Already the Greens have introduced their pro-death bill into Australia’s Federal Parliament. The party's leader, Bob Brown, argued that most Australians support voluntary euthanasia. But I suspect most Australians in fact may not have a clear understanding of just what the euthanasia agenda is all about.
They are certainly not getting the full story from the pro-death lobby. There are many misconceptions and myths out there that need to be dispelled. One is that this will in fact be entirely voluntary, with no pressure or coercion. But this is just wishful thinking.
The truth is the right to die implies a duty to kill. Let me explain. We live in a rights-mad culture. Everyone is demanding a right for this or that. But there are no rights without corresponding duties. An officially sanctioned right must be backed up by the legally enforced means to ensure those rights can be carried out. Thus if society goes down the path of legalised euthanasia, this right to die will lead to its necessary corollary, the duty to kill.
Indeed, once a society has said that its citizens have the right to die, it will be forced to provide the means to do so. If a state says there is a legal right to die, logically, anyone can bring suit to ensure that governments comply. Just as today society tells us a woman has a right to abort her own child, so it provides, via medical aid and tax-payer funding, the means to carry out this activity.
In fact, once legalised, it is possible that doctors may one day face lawsuits if they violate someone’s rights by not killing them. As commentator John Leo puts it: “Imagine doctors purchasing malpractice insurance that covers ‘denial of death’ suits. That day may not be far away.”
And as ethicist Leon Kass reminds us, the “vast majority of candidates who merit mercy killing cannot request it for themselves.” But we can count on the fact that the “lawyers and the doctors (and the cost-containers) will soon rectify this injustice. . . Why, it will be argued, should the comatose or the demented be denied the right to such a ‘dignified death’ or such a ‘treatment’ just because they cannot claim it for themselves?”
For all the talk about choice, about freedom to choose, about giving people options, the legal and social legitimisation for assisted suicide will effectively eliminate one option, namely, staying alive without having to justify one’s existence. With legalised euthanasia, the burden will be upon people to justify being alive - we will have to prove that we ought to be allowed to live.
Lest that sound too far out, consider the words spoken in 1984 by the then Colorado Governor Richard Lamm who said, “Elderly people who are terminally ill have a duty to die and get out of the way.” Or recall the comments made in Australia by the country’s then Australian Governor-General Bill Hayden who, thinking of his own advancement in years, spoke of “unproductive burdens” which we need to be “disencumbered” of via euthanasia.
But as Simon Leys (Pierre Ryckmans) has noted, why is Bill Hayden as a senile, incoherent old man in a wheel chair (one day) any less of value and worth than Bill Hayden was as Governor-General? A society that allows such distinctions is one that has “simply forsaken the very principle of civilisation and crossed the threshold of barbarity”.
Moreover, would Hayden set up a test whereby we determine who is an unproductive burden? Will people be forced to give written evidence as to why they should be allowed to remain alive? After all, in a world of scarcity, such proposals are not all that far off. Indeed, some people are calling for such measures already.
Some people, concerned by what they see as a crisis in over-population, have called for a drastic reduction in population levels.
The tone of debate seems to be becoming increasingly shrill. Many formerly uncommitted public figures and organisations are now speaking out in favour of cutting population levels. In recent times, the Anglican Church of Australia has warned of “catastrophic” consequences of global overpopulation. Sir David Attenborough has pushed for lower population in his documentary: “How many people can live on planet Earth?”. And the previously non-aligned Australian businessman, Dick Smith, produced his own documentary, “Population Puzzle”. Smith commented “This is the most important issue I have ever undertaken in my life. I won’t rest until we have a proper plan in place that informs Australians just how many people we can sustainably support in this country.”
It is clear where such passionate “concern” can lead. In the past a number of Australian commentators have argued for draconian measures to cull population, with some claiming that Australia’s population it should be reduced to less than half its present level. Going back as far as the 1990s, the then Leader of the Australian Democrats John Coulter argued that no Australian family should have more than two children. One city councillor even argued that people who choose to have three children should be compulsorily sterilised and forced to pay the government $200 per fortnight.
It does not take much imagination to see that euthanasia will be enlisted to support such population-reduction goals.
Again, this is not far-fetched. In the past Australia’s Economic Planning Advisory Commission (EPAC) has discussed the rising costs of health care for the elderly and in one publication EPAC actually looked at the issue of euthanasia as one option in the whole discussion. There was no talk about alleviating suffering or being compassionate -- the whole proposal centered on cost-cutting measures.
Indeed, it is estimated that around half of all health care dollars are spent on people in their last six months of life. Thus cost considerations are increasingly becoming a major part of the decision-making process. In a recent case of a brain-dead man on life support, a Monash University medical ethicist said that there would be a high cost involved in maintaining the man, so the economic factor would have to be considered in deciding his fate.
American human rights lawyer Wesley J. Smith drives this point home: “If assisted suicide were ever permitted to become a legitimate and legal part of medical practice, in the end it would be less about ‘choice’ than about profits in the health care system and cutting the costs of health care to government and families. The drugs for assisted suicide only cost about $35 to $40, while it might cost $35,000 to $40,000 (or more) to treat the patient properly. The math is compelling, and contains a warning we dare not ignore.”
In a culture where worth and value tends to be measured by the bottom line, the call for legalised euthanasia will likely also be assessed in those terms. Financial considerations will tend to trump other concerns, including the right to life. All the more reason to never allow euthanasia to be legalized.
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How to Reform ObamaCare Starting Now - WSJ
http://online.wsj.com/article/SB10001424052748704116004575521770685906984.html
States should steer the mandated health-insurance exchanges in a pro-market direction and dare Washington to stop them.
By SCOTT GOTTLIEB AND TOM MILLER
The Republican rallying cry during this election season has been a promise to "repeal and replace" ObamaCare. The problem is that through at least 2012 President Obama would veto any law repealing his signature health-care legislation. What, then, can Republicans do in the next two years? Look to the states.
After November, more than 30 Republican governors (many newly elected) will have the opportunity to resist the legislation at the state level. They could refuse to implement the health-care exchanges that are the core of ObamaCare. Doing so would force the federal government to step in and run the exchanges for the states—a chore that would slow down federal implementation of ObamaCare but fail to provide any alternative solution to insurance coverage problems.
The more promising option is for governors to perform as much radical surgery as possible on the exchanges until a new Congress working with a different president can do something better. By offering their own market-friendly versions of exchanges, they will establish an alternative to ObamaCare and its one-size-fits-all health plans.
The feds may declare that these exchanges do not comply with federal rules and are not eligible for new federal subsidies beginning in 2014. But the Obama administration will be hard-pressed to find the resources to establish and run its own federal exchanges in time if enough states resist its dictates and appeal to their citizens with a better offer.
ObamaCare intends health-care exchanges to be a regulatory dragnet to trap insurers into offering a single government-prescribed set of health benefits. State-designed exchanges could, and should, do the opposite.
Any willing insurers already licensed to operate in a state should be able to offer plans. Their operating rules would focus on providing better information to consumers, rather than limiting the types of plans available. Exchanges should also enable easier allocation of private payments and public subsidies, simplify enrollment, and reduce transaction costs.
Once inside the exchange, consumers would be guaranteed the ability to renew their coverage without regard to changes in their health status, so long as they remain continuously insured. If individuals want to switch plans, they couldn't be hit with higher costs due to changes in health status as long as they stay within some baseline range of benefits that was largely equivalent to their previous plan. And a new Congress should make sure that consumers shopping in these market-based exchanges get the same tax advantages that employers do, eliminating the bias that now forces people to get coverage from their bosses.
Under this arrangement, there wouldn't be the incentive for gaming the system that exists under ObamaCare, which encourages forgoing coverage until one gets sick, or buying cheap policies and upgrading only after an illness strikes.
Of course, not everyone will be able to afford to purchase insurance in these exchanges. Poor people and those with major medical problems or chronic conditions that make them largely uninsurable would certainly need to be subsidized. But today we already subsidize many of these people through a patchwork of programs.
Taxpayers can provide targeted subsidies through expanded high-risk pools to cap out-of-pocket, risk-based premium costs for the most vulnerable. In the longer term, states could get waivers to "monetize" Medicaid medical benefits and allow these recipients to shop in the same exchanges. Recipients might well prefer a voucher option to Medicaid coverage that pays most providers half as much as private insurance and fails to deliver many of the benefits it promises. Subsidies should flow directly to consumers, rather than to the health plans as ObamaCare required.
The elements of these market-based exchanges are already buried deep inside ObamaCare. But they remain under a lethal dose of regulation that rules out every choice but those made by the bureaucrats working inside the president's "Office of Health Reform."
ObamaCare was not about fixing the insurance market. It was about seizing control of it. Thus it shouldn't be surprising that a new analysis by the Congressional Research Service says that states can use ObamaCare to erect a de facto single-payer system by simply excluding from their exchanges every plan but a state-run "public" plan. "There is no specific language in [the president's health plan] that would prohibit an exchange from denying certification to every private plan that applies," the analysis finds.
California is already headed down this road. Voters have opted for a "selective contracting" scheme in which a five-member board of unaccountable appointees will tightly control which insurers operate in the California exchange.
But other states, particularly Utah, are moving in the opposite direction with their own version of market-based exchanges before ObamaCare's regulations can catch up. The Utah Health Exchange is an Internet-based information portal that connects consumers to the information they need to make informed choices. In many cases, it allows them to buy insurance electronically.
Several other states are interested in establishing similar plans and daring the Obama administration to stop them. Replacing the command-and-control features of ObamaCare with a plan offering consumers a real marketplace is a change many people can start to believe in. And one Mr. Obama would be imprudent to oppose.
Messrs. Gottlieb and Miller are Resident Fellows at the American Enterprise Institute.
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Scott Grannis - The six fatal flaws of ObamaCare
(Go to the his blog to light up the links at the end: http://scottgrannis.blogspot.com/2010/11/six-fatal-flaws-of-obamacare.html )
In a series of posts earlier this year in which I discussed the growing list of fatal flaws in healthcare reform, I opined that "the defects of this legislation are so massive and pervasive that it will never see the light of day." Arguably, that's still true today, especially as we can now add one more fatal flaw to the list: you don't have to comply with the law because you can get a waiver! To date, 111 firms have been granted waivers by the Obama administration, and the list is sure to grow by leaps and bounds. The very fact that many firms need to apply for waivers is good evidence that ObamaCare is fatally flawed. To celebrate the increasing likelihood of ObamaCare's eventual demise, let me recap the fatal flaws as I see them:
Fatal flaw #1: The penalty imposed for not buying a policy is very likely to be less than the cost of insurance for a great many people. This, combined with the requirement that insurance companies may not deny coverage to anyone with a pre-existing condition, means that a large number of people will forgo signing up for a policy, knowing that they a) will save money and b) can always sign up for insurance if they turn out to develop a serious medical condition. Thus, the actual revenues will far way short of projections.
Fatal flaw #2: The government has no ability to enforce the penalty for noncompliance.
Fatal flaw #3: Mandating that people buy a health insurance policy simply because they are alive is arguably unconstitutional. It is also a way of hiding the fact that young people will effectively be paying a huge new tax in order to subsidize older people.
Fatal flaw #4: Regulating the price which insurance companies must charge for policies, coupled with a requirement that companies must rebate to their customers the amount by which their loss ratios fall below 90%, effectively turns these companies into government-run enterprises and would likely result in the effective nationalization of the healthcare industry. That is a violation of the Fifth Amendment, and of a Supreme Court requirement "that any firm in a regulated market be allowed to recover a risk-adjusted competitive rate of return on its accumulated capital investment."
Fatal flaw #5: A government-imposed restructuring of the healthcare industry can't possibly improve our healthcare system, and is extremely likely to make it worse. As Don Boudreaux has noted, "Trying to restructure an industry that constitutes one-sixth of the U.S. economy is ... so complicated that it's impossible to accomplish without risking catastrophic failure."
Fatal flaw #6: In cases wherein companies find that complying with the law would result in large increases in healthcare premiums that would threaten employees' access to a plan, the Dept. of Health and Human Services may grant a waiver to the company. As evidence of the first five fatal flaws accumulates, and as healthcare insurance companies continue to raise premiums to pay for the unintended consequences of government attempting to regulate an entire industry and hundreds of millions of people, more and more companies are likely to apply for waivers. At some point the whole edifice will come crashing down of its own weight.
I have a more detailed discussion of each of these flaws here, here, here, here, and here.
UPDATE: Lest I be accused of offering only non-constructive criticism, I refer readers to previous posts about the right way to reform healthcare, here, here, and here.
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Where’s My Obamacare Waiver?
Everyone should get the break that Big Labor is getting.
More than 1 million Americans have escaped the clutches of the Democrats’ destructive federal health-care law. Lucky them. Their employers and labor representatives wisely applied for Obamacare waivers earlier this fall and got out while the getting was good. Now, it’s time for Congress to create a permanent escape hatch for the rest of us. Repeal is the ultimate waiver.
As you’ll recall, President Obama promised repeatedly that if Americans liked their health-insurance plan, they could keep it. “Nobody is talking about taking that away from you,” the cajoler-in-chief assured. What he failed to communicate to low-wage and part-time workers across the country was that they could keep their plans only if their companies begged hard enough for exemptions from Obamacare’s private-insurance-killing regulations.
According to the U.S. Department of Health and Human Services website, at least 111 waivers have now been granted to companies, unions, and other organizations of all sizes that offer affordable health insurance or prescription-drug coverage with limited benefits. Obamacare architects sought to eliminate those low-cost plans under the guise of controlling insurer spending on executive salaries and marketing.
It’s all about control. If central planners can’t dictate what health benefits qualify as “good,” what plans qualify as “affordable,” and how health-care dollars are best spent, then nobody can. The ultimate goal, of course: precipitating a massive shift from private to government insurance.
McDonald’s, Olive Garden, Red Lobster, and Jack in the Box are among the large, headline-garnering employers who received the temporary waivers. But perhaps the most politically noteworthy beneficiary of the HHS waiver program: Big Labor.
The Service Employees Benefit Fund, which insures a total of 12,000 SEIU health-care workers in upstate New York, secured its Obamacare exemption in October. The Local 25 SEIU Welfare Fund in Chicago also nabbed a waiver for 31,000 of its enrollees. SEIU, of course, was one of Obamacare’s loudest and biggest spending proponents. The waivers come on top of the massive sweetheart deal that SEIU and other unions cut with the Obama administration to exempt them from the health-care mandate’s onerous “Cadillac tax” on high-cost plans until 2018.
Other unions that won protection from Obamacare:
United Food and Commercial Workers Allied Trade Health and Welfare Trust Fund
International Brotherhood of Electrical Workers Union No. 915
Asbestos Workers Local 53 Welfare Fund
Employees Security Fund
Plumbers and Pipefitters Local 123 Welfare Fund
United Food and Commercial Workers Local 227
United Food and Commercial Workers Local 455 (Maximus)
United Food and Commercial Workers Local 1262
Musicians Health Fund Local 802
Hospitality Benefit Fund Local 17
Transport Workers Union
United Federation of Teachers Welfare Fund
International Union of Painters and Allied Trades (AFL-CIO)
Two organizations that appear to be chapters of the International Longshoremen’s Association (ILA).
Several of these labor organizations did not respond to requests for comment about their waivers. But Jay Blumenthal, financial vice president of the Local 802 Musicians Health Fund in New York, did explain to me: “We got grandfathered in” (his description for getting a pass) because “things were moving so fast” and “we need time now to prepare for the law.” In other words: Policy cramdowns first, political fixes later. A supporter of Obamacare, Blumenthal told me he “see no irony, no,” in unions’ having supported the very health-care “reform” from which they are now seeking relief.
Chris Rodriguez, director of human resources at Fowler Packing Company in California’s San Joaquin Valley, sees things a little differently. Fowler pursued an HHS waiver because their low-wage agricultural workers would have lost the basic coverage his company has voluntarily offered for years. “We take care of our employees, and we warned [health-care officials that] if they imposed this, large numbers of workers would lose access to affordable coverage,” he told me. Rodriguez said he’s grateful the firm won a waiver, but he had not lost sight of the fact that the very policies passed to increase health-insurance access are having the opposite effect: “That’s our government at work.”
Indeed, some prominent government officials who lobbied hardest for Obamacare are now also joining waiver-mania — including liberal Democratic senator Ron Wyden, who has been pushing for an individual-mandate exemption for his state of Oregon, and Democratic senator Ben Nelson of Nebraska, who is pushing to waive Obamacare’s burdensome 1099 reporting requirements on small businesses.
Fearful of retribution by HHS secretary and chief inquisitor Kathleen Sebelius, who has threatened companies speaking out about Obamacare’s perverse consequences, many business owners who obtained waivers refused to talk to me on the record. One said tersely: “We did what we had to do to survive.”
A new House GOP majority now has the chance to protect the rest of America from this regulatory monstrosity. We want out.
— Michelle Malkin is the author of Culture of Corruption: Obama and His Team of Tax Cheats, Crooks & Cronies (Regnery, 2010)
http://www.nationalreview.com/articles/253427/where-s-my-obamacare-waiver-michelle-malkin#
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From today's POTH:
Arizona Cuts Financing for Transplant Patients
By MARC LACEY
Budget cuts ended payments for certain transplants, a decision that amounts to a death sentence for some patients.
No apologies to Sarah Palin were to be found in the article.
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Woof,
Here we go.
http://www.news.yahoo.com/s/ap/20101213/ap_on_bi_ge/us_health_care_overhaul_virginia
P.C.
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A copy of the memo opinion from Judge Hudson:
http://www.vaag.com/PRESS_RELEASES/Cuccinelli/Health%20Care%20Memorandum%20Opinion.pdf
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Woof bigdog, :-)
Good to hear from you, doing O.K.?
P.C.
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From today's POTH:
Arizona Cuts Financing for Transplant Patients
By MARC LACEY
Budget cuts ended payments for certain transplants, a decision that amounts to a death sentence for some patients.
No apologies to Sarah Palin were to be found in the article.
Effective at the beginning of October, Arizona stopped financing certain transplant operations under the state’s version of Medicaid.
Perhaps I missed something, but it seems this is just an example of Arizona trying to cut state (Medicaid) budget expenses i.e. focusing primarily on
poor people without private insurance. Why is an apology due Sarah Palin?
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Because she was mocked for saying that there would be panels deciding who lived and who died.
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But wasn't she referring to Obama's proposed Health Care plan? THIS decision is SOLELY Arizona's (Republican Majority Legislature)
decision to save money. Or do you think Arizona owes Palin an apology for some reason?
Actually, (not my intent here to argue the subject) if we had National Health care many of these poor
and/or uninsured people probably would still be covered. In this instance, Arizona is indirectly (withholding funds) deciding who can
live and die among those who are either poor and/or have no insurance. There does not seem to be any other criteria except
ability to pay. I guess if you can't pay for it, or if you don't have insurance, you are out of luck in Arizona and you will die. :-(
That being said, someday somebody needs to decide who gets what, many organs are in short supply,
but I question whether it should be decided upon solely by the ability to pay.
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Man's penis amputated following misdiagnosis
Published: 29 Dec 10 09:10 CET | Double click on a word to get a translation
Online: http://www.thelocal.se/31130/20101229/
Share1006
A Swedish man was forced to have his penis amputated after waiting more than a year to learn he had cancer.
The man, who is in his sixties, first visited a local clinic in Blekinge in southern Sweden in September 2009 for treatment of a urinary tract infection, the local Blekinge Läns Tidning (BLT) reported.
When he returned in March 2010 complaining of foreskin irritation, the doctor on duty at the time diagnosed the problem as a simple case of inflammation.
After three weeks passed without the prescribed treatment alleviating the man’s condition, he was instructed to seek further treatment at Blekinge Hospital.
But it took five months before he was able to schedule an appointment at the hospital.
When he finally met with doctors at the hospital, the man was informed he had cancer and his penis would have to be removed.
It remains unclear if the man would have been able to keep his penis had the cancer been detected sooner.
The matter has now been reported to the National Board of Health and Welfare (Socialstyrelsen) under Sweden’s Lex Maria laws, the informal name used to refer to regulations governing the reporting of injuries or incidents in the Swedish health care system.
The Local/dl (news@thelocal.se)
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By KARL ROVE
Aprimary task for the new Republican House majority is to undo as many of the pernicious effects of ObamaCare that it can. One of these effects is the spectacle of employers going hat-in-hand to the Department of Health and Human Services (HHS) for waivers from some of the law's more onerous provisions.
In September, HHS Secretary Kathleen Sebelius began granting waivers to companies that provided workers "mini-med" coverage—low-cost plans with low annual limits on what the insurance will pay out. This followed announcements by some employers that they would have to drop these plans because they did not meet the new health law's requirement that 85% of premium income be spent on medical expenses.
By early December, HHS had granted 222 such waivers to provide mini-med policies for companies including AMF Bowling and Universal Forest Product, as well as 43 union organizations. According to the department's website, the waivers cover 1,507,418 employees, of which more than a third (525,898) are union members. Yet unionized workers make up only 7% of the private work force. Whatever is going on here, a disproportionately high number of waivers are being granted to administration allies.
Then, on Dec. 21, Ms. Sebelius announced that insurance companies seeking rate increases of 10% or more in the individual or small group market must publicly justify the hikes under standards set by her department.
Insurance regulation has traditionally been a state responsibility, and 43 states must already approve proposed insurance-rate increases. ObamaCare does not authorize HHS to deny rate increases, but the agency said that if a state "lacks the resources or authority" to conduct the kind of review the agency wants, it will conduct its own.
This proposed regulation will erode the states' dominant role in insurance regulation, centralizing more power in Washington. The HHS announcement also mentioned that it will set different thresholds of what constitutes an "unreasonable" increase for every state by 2012.
The Obama administration's behavior to date suggests that it will not hesitate to take care of its friends. The Senate Republican Policy Committee's health policy analyst, Chris Jacobs, points out that the administration has already given an extravagant gift to the AARP (American Association of Retired Persons), a key player in passing the Patient Protection and Affordable Care Act.
The AARP provided a big chunk of the $121 million spent on ads supporting the bill's passage, as well as $21 million on lobbying in 2009, according to the Center for Responsive Politics. HHS's proposed regulations on Dec. 21 exempted the AARP's lucrative "Medigap" plans from the rate review and other mandates and requirements.
The AARP and other Medigap providers can require a waiting period before seniors with pre-existing conditions have to be covered. Insurers covering those under 65 cannot.
The AARP is also exempt from the new law's $500,000 cap on executive compensation for insurance executives. (The nonprofit's last CEO received over $1.5 million in compensation in his last full year, 2009.) It won't pay any of the estimated $14 billion in new taxes on insurance companies, though according to its 2008 consolidated financial statement, it gets more money from its insurance offerings than it does from dues, grants and private contributions combined. Nor will it have to spend at least 85% of its Medigap premium dollars on medical claims, as Medicare Advantage plans must do; the AARP will be held to a far less restrictive 65%.
It's not hard to connect the dots. The Obama administration is using waivers to reward friends. On the flip side, business executives will be discouraged from contributing to the president's opponents or from taking any other steps that might upset the White House or its political appointees at HHS.
This is not what people had in mind when candidate Obama promised in his acceptance speech in August 2008 to undo "the cynicism we all have about government."
In a speech at the University of Iowa last March, the president heralded health-care reform as "a new set of rules that treats everybody honestly and treats everybody fairly." Determining whether that is true will be another task for House Republicans. They have an obligation to look into this matter, and Mr. Obama can hardly object. It was former Supreme Court Justice Louis Brandeis, whom the president frequently quotes, who wrote in 1913 that sunlight "is the best of disinfectants."
Mr. Rove is the former senior adviser and deputy chief of staff to President George W. Bush.
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actually writes a rather coherent and honest piece :-o
Buckle Up for Round 2By DAVID BROOKS
Published: January 6, 2011
The health care reform law was signed 10 months ago, and what’s striking now is how vulnerable it looks. Several threats have emerged — some of them scarcely discussed before passage — that together or alone could seriously endanger the new system. These include:
The courts. So far, one judge has struck down the individual mandate, the plan’s centerpiece. Future decisions are likely to break down on partisan lines. Given the makeup of the Supreme Court, this should concern the law’s defenders.
False projections. The new system is based on a series of expert projections on how people will behave. In the first test case, these projections were absurdly off base. According to the Medicare actuary, 375,000 people should have already signed up for the new high-risk pools for the uninsured, but only 8,000 have.
More seriously, cost projections are way off. For example, New Hampshire’s plan has only about 80 members, but the state has already burned through nearly double the $650,000 that the federal government allotted to help run the program. If other projections are off by this much, the results will be disastrous.
Employee dumping. This is the most serious threat. Companies and unions across America are running the numbers and discovering they would be better off if, after 2014, they induced poorer and sicker employees to move to public insurance exchanges, where subsidies are much higher.
The number of people in those exchanges could thus skyrocket, especially as startup companies undermine their competitors with uninsured employees and lower costs. The Congressional Budget Office projects that 19 million people will move to the exchanges at a cost of $450 billion between 2014 and 2019. But according to the economists Douglas Holtz-Eakin and James C. Capretta, costs could soar to $1.4 trillion if those who would be better off in the exchanges actually moved to them. The price of the health care law could double. C. Eugene Steuerle of the Urban Institute, who has been among those raising the alarms about this, calls the law’s structure “unworkable and unfair.”
Health care oligarchy. Since the law passed, there has been a frenzy of mergers and acquisitions, as hospitals, clinics and doctor groups have joined together into bigger and bigger entities. The drafters encourage this, believing large outfits would be more efficient. The downside to this economic concentration is there could be less competition and cost control. In many places, the political power of these quasi-monopolies would be huge, with unforeseeable results. The law bans doctors from starting up hospitals to increase competition.
Public hostility. Right now about 53 percent of Americans oppose the health care law and 43 percent support it, according to an average of the recent polls. Complaints are especially high among doctors. According to a survey by the Physicians Foundation, 60 percent of private practice doctors say the law will force them to close their practices or to restrict them to certain categories of patients.
Given this level of unhappiness, people will blame the Obama law for everything they hate about the health care system. Political opposition was fierce last November, and it could easily shape the 2012 election and lead to changes or repeal.
Over all, there is a strong likelihood that the current health care law will face an existential threat over the next five years. Each party should be preparing contingency plans.
When the crisis comes, Democrats will face an interesting choice — to patch the Obama system or try to replace it with something bigger. The administration may want a patch, but by a ratio of nearly 2 to 1, according to a CNN poll, Democratic voters would prefer a more ambitious law. Liberals could logically say that the mistake was trying to create a hybrid system, rather than moving straight to a single-payer one.
Republicans are going to have to move beyond their current “Repeal!” posture and cohere behind a positive alternative. One approach, which Tyler Cowen of George Mason University has written about, is to allow more state experimentation. Another approach, championed by Capretta, Yuval Levin of National Affairs and Thomas P. Miller of the American Enterprise Institute, revolves around the words “defined contribution.”
Under this approach, Republicans would say that the federal government has a role in subsidizing health insurance — a generous role, but not unlimited. The government would provide needy citizens with a predefined amount of money to spend on insurance and allow them to shop in a transparent, regulated, but not micromanaged marketplace.
After the trauma of the last two years, many people wish the issue would go away. But it’s not going away, especially since costs will continue to rise.
Some Congresses achieve health care; members of this Congress or the next one will have health care thrust upon them.
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It is only common sense to think that adding 45 to 50 million people to the rolls will only drive down health care costs. :? I have not read it but the CBO estimate or whatever it is called has to based on multiple assumptions about "preventative" and "quality" care which are really code words for restricted controlled care. I can even in my armchair gaurantee that these assuptions are based on magical thinking and are not based in any reality. The CBO estimate is all based on pulling the rug out from the argument that providing health care to 50 million people (at the expense of all the rest of us) will not drive up costs or the deficit. That is like our government downplaying the Chinese military build up. I don't know. Did our leaders always lie like dogs to us?
There is just no end to the tales told in order to redistribute wealth from tax payers to tax benefit receivers. As long as 50% of the country pays no Federal tax this country is screwed. There is no end to those on the dole who are quite happy to vote themselves money from the treasury. Answer: all people have to pay income tax. I admit I am not holding my breath though.
****CBO Says Healthcare Law Repeal Will Increase Deficit.
The CBO analysis of the economic effects of repealing the healthcare law garnered much press coverage on Thursday. Many sources characterized the analysis as another bone of contention between Republicans and Democrats that will only intensify the debate over health reform.
The AP (1/7, Alonso-Zaldivar) reports, "Repealing President Barack Obama's landmark health care overhaul would add billions to government red ink and leave millions without coverage, Congress' nonpartisan budget referees said Thursday ahead of a politically charged vote in the House." The AP adds, "In a letter to [House Speaker John] Boehner, budget office director Douglas Elmendorf estimated repeal would increase the deficit by $230 billion from 2012 to 2021," and that "about 32 million more people would be uninsured in 2019 as a consequence." But, "Boehner brushed off the Congressional Budget Office analysis as emboldened Republicans, now in the majority in the House, issued their own report arguing that Obama's coverage expansion would cost jobs and increase budget deficits."
The Los Angeles Times (1/7, Levey) reports, "House Republican leaders quickly dismissed the new projection from the Congressional Budget Office...as unrealistic," and "some analysts have also questioned whether all the savings in the sweeping health overhaul will be realized." Boehner said in response to the analysis, "CBO is entitled to their opinion. ... I do not believe that repealing the job-killing healthcare law will increase the deficit." Nevertheless, "the closely watched CBO, an agency which lawmakers from both parties have historically relied on, is widely considered one of the most important independent sources for information about the impact of proposed legislation."
According to Politico (1/7, Kliff), "Michael Steel, spokesman for Speaker John Boehner, brushed off the estimate as faulty accounting," saying, "There is no one that believes the Washington Democrats' job-killing health care law will lower costs, because it won't. That's why we pledged to repeal it and replace it with common-sense reforms that will actually work."
The Washington Times (1/7, Dinan) reports that House Majority Leader Eric Cantor (R-VA) also weighed in on the CBO analysis, saying, "CBO did the job it was asked to do by then the Democrat majority. And it was really comparing apples to oranges, because it talked about 10 years' worth of tax hikes and 6 years' worth of benefits. ... Everyone knows, beyond the 10-year window, this bill has the potential to bankrupt the federal government as well as the states." Yet, "CBO officials, in the letter, challenged that argument, saying the health care law will reduce deficits over the longer term as well," which "means repeal would increase the deficit in the long-term, too."
The Washington Post (1/7, Goldstein) reports, "The CBO's assessment, arriving as Republicans have mobilized to make the law's repeal the first major House vote of the new Congress, touches on a sensitive area for the GOP." Notably, "Republicans are vowing to take tough measures to reduce the deficit, although they already have exempted the health care measure from rules requiring that any spending increases be accompanied by offsetting reductions so that the net effect on the deficit is null." The Post says, "The CBO's analysis provided an early glimpse of the brute force politics spreading across Capitol Hill and beyond in the new era of divided government."
The National Journal (1/7), the Wall Street Journal (1/7, Bendavid) "Washington Wire" blog, Reuters (1/7, Whitesides, Cowan), and another CQ Today (1/7, Ethridge) article also cover the story, as does The Hill (1/7, Kasperowicz) in its "Healthwatch" blog and Medscape (1/6, Lowes).
Obama Vows To Veto Any Repeal Attempts. The Hill (1/7, Youngman) reports, "President Obama officially drew a line in the sand Thursday evening, threatening to veto House Republicans' attempt to repeal Obama's landmark healthcare law." The Hill adds, "In a statement of administration policy released by the Office of Management and Budget (OMB), the administration said that repeal would 'would explode the deficit, raise costs for the American people and businesses, deny an estimated 32 million people health insurance, and take us back to the days when insurers could deny, limit or drop coverage for any American.'"
Health Policy and Legislation
House GOP Unveils Several Bills To Repeal, Defund Healthcare Law.
The Hill (1/7, Pecquet) reports in its "Healthwatch" blog, "Republicans have already introduced almost a dozen bills aimed at repealing, defunding and otherwise weakening Democrats' healthcare reform law since the new Congress opened for business Wednesday." Indeed, "in addition to House Majority Leader Eric Cantor's (R-Va.) bill to repeal the entire law, at least two Republicans -- Reps. Steve King (R-Iowa) and Connie Mack (R-Fla.) -- have introduced straight repeal bills."
Politico (1/7, Brown) reports, "Republicans reopened their battle against President Barack Obama's health care law, using the first committee meeting of the new Congress Thursday to eviscerate the overhaul as a 'job killer' and a 'malignant tumor.'" Politico adds, "The committee's formal mandate Thursday was to write the terms of the debate for the repeal vote Wednesday," although "the meeting quickly turned into a rerun of the past two years in both tone and substance, with Republicans blasting Democrats for their handling of the law and Democrats accusing Republicans of flouting their own party rules to rush the repeal bill to a vote."
Chicago Sun-Times (1/7, Carlman) reports, "Newly installed Republicans in the US House of Representatives plan to make good this week on their vow to roll back the Patient Protection and Affordable Care Act, the package of health reforms passed by Congress and signed by President Obama less than a year ago." But, HHS Secretary Kathleen Sebelius "called the repeal effort 'a huge step backwards' and said the act already has granted Americans freedoms they did not enjoy before it was passed, including coverage for pre-existing conditions, a reduction in employers' expenses and reduced prescription costs for seniors." Sebelius added, "Those are goals we've been talking about for years, and we're finally making some progress. ... We can't afford to take benefits away from families."
Senate Dems Seek To Counter Health Reform Repeal Efforts.
CQ HealthBeat (1/7, Norman) reports, "Senate Democrats are joining in an all-hands-on deck effort to defend their embattled health care law with a series of hearings on the measure's benefits announced Thursday for the Health, Education, Labor and Pensions committee." For instance, "Senate Democrats also launched their own hearings to counter the heat on the House side. HELP Committee Chairman Tom Harkin, D-Iowa, said he'll convene the sessions during the next several months to highlight how the law benefits Americans. They'll probably include testimony from people who live outside the Beltway," and "administration officials will be asked to discuss implementation and experts will testify."
The Hill (1/7, Millman) notes in its "Healthwatch" blog, "The first will examine how the law protects consumers against health insurers. The committee also will examine how the law requires insurers to be transparent about rates and spend at least 80 percent of premiums on healthcare services; benefits small business owners; reduces the deficit; increases quality of care; reduces waste, fraud and abuse; invests in prevention and wellness; provides portable insurance; and expands coverage."
Conservative Groups Urge Dems Who Voted "No" To Support Repeal.
The Hill (1/7, Millman) reports in its "Healthwatch" blog, "Groups opposing healthcare reform are urging 13 House Democrats who voted against the reform law to support the repeal bill next week." In a letter to the lawmakers, DeFundIt.org, Americans for Prosperity, Independent Women's Voice and the Association of American Physicians and Surgeons wrote, "If you are really against ObamaCare, then you will vote yea for repeal."
Physicians Group Asks GOP To Strengthen, Not Repeal Healthcare Law.
The Hill (1/7, Millman) reports in its "Healthwatch" blog, "A pro-reform physicians group is asking leading House Republicans to strengthen -- not repeal -- last year's healthcare overhaul." Notably, "Doctors for America on Thursday morning delivered a petition, signed by more than 2,000 physicians and medical students, to the offices of Speaker John Boehner (R-Ohio) and Majority Leader Eric Cantor (R-Va.) that urged the new House majority to improve the healthcare reform law." The physicians wrote, "We believe repealing or weakening the Affordable Care Act will move our healthcare system backward -- and we strongly urge against it." ****
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Yes, adding people to the roll can not lower costs. CBO estimates were based on known false assumptions run various ways (including gold sales tracking for tax collections) until they kept it for a minute under a trillion. Then they required the 'doctor fix' and other bills to continue. Eliminating choices and competition lowers quality, not cost. I would add in hypothetical numbers, if you tell everyone who makes between 25k to 35k that they have to make under 24k to get free health care, their share of national income is bound to decrease.
One of the socialistic theories is that if you eliminate a few percent of profit, costs drop by the same amount, hence all the non-profit hospitals. To me that is a lack of understanding of the role of an incentive system in economics and prevents resources from flowing to their most valuable use. The more crucial the industry, the less we utilize the strongest forces known to lower costs and increase quality and innovation. I don't know any examples of collective institutions out-performing for-profit industries.
A good friend is a cfo of a big hospital group here. State law requires hospitals to be non-profit. They pay themselves huge sums (IMO) to run a 'non-profit' building, then they own various 'for-profit' businesses inside the hospital such as the monopoly pharmacy on the first floor.
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Watch for the jornOlist talking points to include this Dem response to the REp efforts to repeal Health Care.
The Dems and their media minions will be all out claiming the Repubs are trying to take patients "rights" away:
***Greg Sargent writes in the Washington Post (1/14) The Plum Line, "At a House Dem leadership meeting last week, Dem leaders decided that" The Patient's Rights Repeal Act "is the phrase they will officially use to brand the House GOP's push to repeal health reform, aides tell me." Sergeant adds, "With House Republicans set to press forward with repeal next week, the idea behind the Dem talking point is to emphasize what repeal would take away from you -- and to position the plight of the patient in the center of this battle." Meanwhile, "Dems are gearing up for a major campaign against repeal, in hopes that it will give them another crack at selling the American public on the law by highlighting its most popular provisions and arguing that repeal would do away with them."
***
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There are a few people like Lincoln and Reagan that should post in with the founding fathers. The late Nobel winning economist Milton Friedman would fit well with that company. Here he speaks in 1978 at the Mayo Clinic in Rochester MN. You wouldn't know that he missed the debate of the last couple of years. Real Clear Politics posts a few videos each day of opinion maker highlights of the last day and sneaked this video in with them yesterday:
http://www.realclearpolitics.com/video/2011/01/16/milton_friedman_on_socialized_medicine.html
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Counterpoint: The NY Times writes their editorial Saturday as if we hadn't already had the debate and the groundshifting election on this issue in the past year with their warning of 'The Truth and Consequences of Repeal': http://www.nytimes.com/2011/01/16/opinion/16sun1.html
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Doug,
The NYT piece is the beginning of the jornolist/dem politician onslaught response to Repubs efforts at HC repeal.
I heard Bamster has said he would be willing to alter the HC bill. Again showing he is the great compromiser, the conciliator of our age. :roll:
Now he doesn't have free reign to ram it all down our throats so he is suddenly such a marvelous compromiser. :roll:
If I can see this coming a mile away so must our Republican leaders.
Unfortunately, we are also seeing signs they plan on dealing with it by also compromising. They may be afraid to risk being labeled the party of no and shutting down government which does not go well with the swingers based on history from the 90's.
Thus I think efforts to repeal/block HC will fold as the Republicans will try to meet or one up the Bamster with looking like they are working with the other side IMO.
A new MSM buzz word is "governing". The republicans can either fall into this trap or risk being tarnished as "shutting down" government.
The two parties *MUST* compromise to do the business of "governing" (Not my opnion but MSM). Obviously the MSM idea of governing is ramming endless thousand page bills down the throats of taxpayers.
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The Dem strategy among the entire political party and the complicit journolist MSM is now clear.
They will *fix* the non popular portions of Healthcare (thus appearing to be compromisers while at the same time they will mitigate any unpopularity of their party).
Also, the Dems are already playing the sympathy card (scrapping this bill will hurt so many people, 127 million poeple benefit from this yada yada yada) and the cans are essentially silent. Cans also have to meet head on the already multiple airway claims about why this bill will not help as many people as it will *hurt*.
The Republicans are already being outdone. They should be hitting airwaves incessantly as to why the whole bill has to be scrapped and started over and the Dems cannot pick and choose and make every single line of the 2000 page morrass into some sort of separate topic for "vigorous debate".
I think we've lost. I am not confident about our "leadership". Boehner looks like an idiot crying all the time. The first time was touching. The last several times are bizarre - like said, the "weeper of the House".
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I fear you may be right.
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Personally the HC bill is secondary. Actually as a primary care provider some actually think I should be grateful for the Democrat bill as it attempts to boost primary care.
But I am totally against it. I am totally against the entire liberal agenda which this is just a part. I agree with Morris. Now the Republicans and teaparties have to fight even harder. The bamster charm offensive is in full gear. Unfortunately Clinton showed him the way and it works. Already Bamster is doing better in the polls. Not a good sign. I just wish conservatives would just stop telling how smart Obama is. He is just reading scripts. He is nothing more then the front guy for what is really going on.
***DickMorris.com OBAMA’S CHOICETHE PERILS OF PALIN »RIGHT MUST FIGHT ROUND 2
By Dick Morris01.19.2011Share this article
Published on TheHill.com on January 18, 2011
Now for the counteroffensive. The House Republicans are pushing to repeal ObamaCare. While they will doubtless succeed in the House and either fail in the Senate or face an Obama veto, their decision to raise and debate the issue is a crucial one. As happened when it passed last year, ObamaCare will ignite a national controversy.
But are conservatives prepared to win the debate? When ObamaCare was being pushed through Congress by the likes of Pelosi, Reid, Obama and Emanuel, the right was galvanized. Rallies, demonstrations, town-hall forums, television ads, letters to the editor, television commentary — all bombarded the nation, emphasizing the faults of the bill. But now these voices are stilled, complacent, perhaps exhausted. Or are they intimidated by the liberal spin on the Gabrielle Giffords shooting that we all must lower our voices?
Already, liberal groups and unions are running ads calling on House Republicans not to repeal ObamaCare. One such spot, paid for by Americans United for Change, says:
“Members of Congress know that their health insurance plan can’t deny coverage for their kids. Congressmen can rest assured that their insurance plan won’t drop their families if they get sick. The Affordable Care Act gave your family the same protections that members of Congress get. But Republicans want to take that protection away from your family. They want to put insurance companies back in charge. Call Congress. Tell them you deserve the same health insurance protection they get. Tell them: Don’t repeal the Affordable Care Act. You deserve the same health insurance protections as Congress.”
Where is the conservative reply? Where are the conservative voices? Could the opportunity to repeal ObamaCare give the left a chance to make its case without an answer?
Voters still oppose ObamaCare. The Rasmussen Poll has them backing repeal by 55-40. But if opponents of the program remain complacent, those numbers could change quickly.
Republicans need to remind America that the huge increases they are now paying in their health insurance are concrete evidence of the impact of the mandates in ObamaCare. They need to point out that the $500 billion of Medicare cuts are coming and that, already, reductions in physician fees are driving thousands of doctors to close their doors to Medicare patients. The Republicans need to explain how ObamaCare creates an entirely new entitlement and will swell the deficit.
Voters don’t buy the argument that ObamaCare will cut the deficit. According to Rasmussen, 45 percent say that repealing the program is more likely to cut the deficit, while 33 percent say leaving it on the books will be a better way to reduce it. Republicans need to underscore this linkage.
The larger point is that the new Republican House gives conservatives a chance to re-litigate the battles they lost in Congress in 2009 and 2010. At each turn, they need to re-fight the battle for public opinion and carry it each time. A president usually sets the agenda. But conservatives can keep the focus on the unpopular spending and legislation Obama jammed through a Democratic Congress by pushing for de-funding and repeal.
Republicans won’t get repeal. But they will be able to de-fund the program. They can block the IRS from enforcing the individual and employer mandates and can stop the Department of Health and Human Services from slicing $500 billion from Medicare and implementing healthcare rationing. But it will be a long fight. Republicans will have to demand these concessions as a prerequisite for approving the budget and perhaps even a debt-limit increase. They will need to stand their ground in the face of the hue and cry that they are being irresponsible and holding the nation hostage.
And they’ll need public opinion on their side!
They will need the Tea Party to get loud and conservative groups to start advertising. It’s the second round. A round the opponents of ObamaCare can win. But they mustn’t go to sleep. They need to wake up!***
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Britain Plans to Decentralize Health Care
By SARAH LYALL
Published: July 24, 2010
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CloseLinkedinDiggMixxMySpaceYahoo! BuzzPermalink LONDON — Perhaps the only consistent thing about Britain’s socialized health care system is that it is in a perpetual state of flux, its structure constantly changing as governments search for the elusive formula that will deliver the best care for the cheapest price while costs and demand escalate.
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Andrew Testa for The New York Times
The new British government’s plan to drastically reshape the socialized health care system would put local physicians like Dr. Marita Koumettou in north London in control of much of the national health budget.
Even as the new coalition government said it would make enormous cuts in the public sector, it initially promised to leave health care alone. But in one of its most surprising moves so far, it has done the opposite, proposing what would be the most radical reorganization of the National Health Service, as the system is called, since its inception in 1948.
Practical details of the plan are still sketchy. But its aim is clear: to shift control of England’s $160 billion annual health budget from a centralized bureaucracy to doctors at the local level. Under the plan, $100 billion to $125 billion a year would be meted out to general practitioners, who would use the money to buy services from hospitals and other health care providers.
The plan would also shrink the bureaucratic apparatus, in keeping with the government’s goal to effect $30 billion in “efficiency savings” in the health budget by 2014 and to reduce administrative costs by 45 percent. Tens of thousands of jobs would be lost because layers of bureaucracy would be abolished.
In a document, or white paper, outlining the plan, the government admitted that the changes would “cause significant disruption and loss of jobs.” But it said: “The current architecture of the health system has developed piecemeal, involves duplication and is unwieldy. Liberating the N.H.S., and putting power in the hands of patients and clinicians, means we will be able to effect a radical simplification, and remove layers of management.”
The health secretary, Andrew Lansley, also promised to put more power in the hands of patients. Currently, how and where patients are treated, and by whom, is largely determined by decisions made by 150 entities known as primary care trusts — all of which would be abolished under the plan, with some of those choices going to patients. It would also abolish many current government-set targets, like limits on how long patients have to wait for treatment.
The plan, with many elements that need legislative approval to be enacted, applies only to England; other parts of Britain have separate systems.
The government announced the proposals this month. Reactions to them range from pleased to highly skeptical.
Many critics say that the plans are far too ambitious, particularly in the short period of time allotted, and they doubt that general practitioners are the right people to decide how the health care budget should be spent. Currently, the 150 primary care trusts make most of those decisions. Under the proposals, general practitioners would band together in regional consortia to buy services from hospitals and other providers.
It is likely that many such groups would have to spend money to hire outside managers to manage their budgets and negotiate with the providers, thus canceling out some of the savings.
David Furness, head of strategic development at the Social Market Foundation, a study group, said that under the plan, every general practitioner in London would, in effect, be responsible for a $3.4 million budget.
“It’s like getting your waiter to manage a restaurant,” Mr. Furness said. “The government is saying that G.P.’s know what the patient wants, just the way a waiter knows what you want to eat. But a waiter isn’t necessarily any good at ordering stock, managing the premises, talking to the chef — why would they be? They’re waiters.”
But advocacy groups for general practitioners welcomed the proposals.
“One of the great attractions of this is that it will be able to focus on what local people need,” said Prof. Steve Field, chairman of the Royal College of General Practitioners, which represents about 40,000 of the 50,000 general practitioners in the country. “This is about clinicians taking responsibility for making these decisions.”
Dr. Richard Vautrey, deputy chairman of the general practitioner committee at the British Medical Association, said general practitioners had long felt there were “far too many bureaucratic hurdles to leap” in the system, impeding communication. “In many places, the communication between G.P.’s and consultants in hospitals has become fragmented and distant,” he said.
The plan would also require all National Health Service hospitals to become “foundation trusts,” enterprises that are independent of health service control and accountable to an independent regulator (some hospitals currently operate in this fashion). This would result in a further loss of jobs, health care unions say, and also open the door to further privatization of the service.
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Britain Plans to Decentralize Health Care
Published: July 24, 2010
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The government has promised that the new plan will not affect patient care and that the health care budget will not be cut. But some experts say those assertions are misleading. The previous government, controlled by the Labour Party, poured money into the health service — the budget is now about three times what it was when Labour took over, in 1997 — but the increases have stopped. The government has said the budget will continue to rise in real terms for the next five years, but it is unlikely that the increases will keep up with the rising costs of care and the demands of an aging population.
“The real mistake that is being made by the health secretary is to drive through an ideologically determined program of reorganization which is motivated by the principle of efficiency savings,” said Robin Durie, a senior lecturer in politics at the University of Exeter. “History shows clearly that quality will suffer as a consequence.”
Dr. Durie added, “The gulf between the rhetoric of the white paper and the technicalities of what is involved in the various elements of the overall reorganization being proposed is just extraordinary.”
For example, he asked, how will the government make good on its promise to give patients more choice — a promise that seems to require a degree of administrative oversight — while cutting so many managers from the system?
“How will the delivery of all this choice be funded?” Dr. Durie asked. “And how will the management of the delivery of choice be funded?”
Dr. Vautrey said the country needed to have a “mature debate about what the N.H.S. can and cannot afford.”
He said: “It is a sign of the mixed messages that government sends out. They talk about choice and competition and increased patient expectations at the same time as they tell the service they need to cut costs and refer less and prescribe less. People need to understand that while the needs of everyone may be met, their wants will be limited.”
As they prepare for the change, many doctors are wondering whether it will be permanent this time around.
“Many of our colleagues have seen this cycle of change repeatedly,” Dr. Vautrey said. “Many would look at previous reorganizations and compare it to this one and wonder how long the current change will last before the next one comes along.”
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Interesting to note the gov is giving some control to primary care in Britain. Being the czar here Berwick seems to think British model is the model we should follow I don't know what to make of it. Other than it is obvious guaranteeing care to everyone and expecting to control costs with primary care is likely to fail.
If, as I am not clear from this article, that the government is giving up and saying to primary care doctors - here we give you X amount of money and you spend it however you think best and take the rest for your salaries - than - if that the case - expect a big problem. This formula has been used by mangaed care and is a recipee for cut throat health care. Imagine going to a doctor who you know will make more money denying care to you. His/her judgement on every single decision is now clouded by their knowing that. Is that what we want. I have seen that first hand. I wouldn't dream of going to any doctor with that in mind. The doctor will constantly balance what he can deny you with the risk of if it's wrong - getting his ass sued. To protect that he/she will document up the wazoo as much as possible.
That is how they sometimes get away with it.
The whole idea we will bend the cost curve down while providing care to 50 million more is aburd. And they are guaranteeing everyone get the same?
We will all pay more and get less. Not more.
Oh sure Gifford would get managed care. Yeah right.
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Everything starts with repeal
By Charles Krauthammer
Friday, January 21, 2011
Suppose someone - say, the president of United States - proposed the following: We are drowning in debt. More than $14 trillion right now. I've got a great idea for deficit reduction. It will yield a savings of $230 billion over the next 10 years: We increase spending by $540 billion while we increase taxes by $770 billion.
He'd be laughed out of town. And yet, this is precisely what the Democrats are claiming as a virtue of Obamacare. During the debate over Republican attempts to repeal it, one of the Democrats' major talking points has been that Obamacare reduces the deficit - and therefore repeal raises it - by $230 billion. Why, the Congressional Budget Office says exactly that.
Very true. And very convincing. Until you realize where that number comes from. Explains CBO Director Douglas Elmendorf in his "preliminary analysis of H.R. 2" (the Republican health-care repeal): "CBO anticipates that enacting H.R. 2 would probably yield, for the 2012-2021 period, a reduction in revenues in the neighborhood of $770 billion and a reduction in outlays in the vicinity of $540 billion."
As National Affairs editor Yuval Levin pointed out when mining this remarkable nugget, this is a hell of a way to do deficit reduction: a radical increase in spending, topped by an even more radical increase in taxes.
Of course, the very numbers that yield this $230 billion "deficit reduction" are phony to begin with. The CBO is required to accept every assumption, promise (of future spending cuts, for example) and chronological gimmick that Congress gives it. All the CBO then does is perform the calculation and spit out the result.
In fact, the whole Obamacare bill was gamed to produce a favorable CBO number. Most glaringly, the entitlement it creates - government-subsidized health insurance for 32 million Americans - doesn't kick in until 2014. That was deliberately designed so any projection for this decade would cover only six years of expenditures - while that same 10-year projection would capture 10 years of revenue. With 10 years of money inflow vs. six years of outflow, the result is a positive - i.e., deficit-reducing - number. Surprise.
If you think that's audacious, consider this: Obamacare does not create just one new entitlement (health insurance for everyone); it actually creates a second - long-term care insurance. With an aging population, and with long-term care becoming extraordinarily expensive, this promises to be the biggest budget buster in the history of the welfare state.
And yet, in the CBO calculation, this new entitlement to long-term care reduces the deficit over the next 10 years. By $70 billion, no less. How is this possible? By collecting premiums now, and paying out no benefits for the first 10 years. Presto: a (temporary) surplus. As former CBO director Douglas Holtz-Eakin and scholars Joseph Antos and James Capretta note, "Only in Washington could the creation of a reckless entitlement program be used as 'offset' to grease the way for another entitlement." I would note additionally that only in Washington could such a neat little swindle be titled the "CLASS Act" (for the Community Living Assistance Services and Supports Act).
That a health-care reform law of such enormous size and consequence, revolutionizing one-sixth of the U.S. economy, could be sold on such flimflammery is astonishing, even by Washington standards. What should Republicans do?
Make the case. Explain the phony numbers, boring as the exercise may be. Better still, hold hearings and let the CBO director, whose integrity is beyond reproach, explain the numbers himself.
To be sure, the effect on the deficit is not the only criterion by which to judge Obamacare. But the tossing around of such clearly misleading bumper-sticker numbers calls into question the trustworthiness of other happy claims about Obamacare. Such as the repeated promise that everyone who likes his current health insurance will be able to keep it. Sure, but only if your employer continues to offer it. In fact, millions of workers will find themselves adrift because their employers will have every incentive to dump them onto the public rolls.
This does not absolve the Republicans from producing a health-care replacement. They will and should be judged by how well their alternative addresses the needs of the uninsured and the anxieties of the currently insured. But amending an insanely complicated, contradictory, incoherent and arbitrary 2,000-page bill that will generate tens of thousands of pages of regulations is a complete non-starter. Everything begins with repeal.
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By KARL ROVE
ObamaCare has recently been dealt three body blows. Speaker John Boehner pushed a bill to repeal it through the House. GOP leader Mitch McConnell will get to put Senate Democrats on record with a vote on repeal as well. And this week, U.S. District Judge Roger Vinson declared the law unconstitutional.
The White House's reaction is dismissive. The nation doesn't want to "re-litigate" ObamaCare, we're told. So long as Mr. Obama sits in the Oval Office, repeal is going nowhere. The Supreme Court will uphold the law. And by 2012, health care will be a winning issue for Democrats.
I'm not so sure. Take the question of Granny. In a speech last Friday defending his health-care law's effect on seniors against GOP attacks, Mr. Obama said, "I can report that Granny is safe." She may not feel that way if she's one of the 700,000 seniors whose private Medicare Advantage insurance policy was not renewed last year because her insurance provider quit the business.
There will be more nonrenewals in 2011. This year's funding cuts to Medicare Advantage will be $2 billion; next year's will be $6 billion. The Centers for Medicare and Medicaid Services (CMS) estimate that half of those with Medicare Advantage policies—seven million seniors—will lose their coverage eventually. And 60% the doctors surveyed by the nonprofit Physicians Foundation said health-care reform would "compel them to close or significantly restrict" the number of patients in their practices, especially those on Medicare or Medicaid.
Granny's daughter, son and grandchildren are not all that safe, either. Providers such as Guardian Life and the Principal Financial Group are dropping their health-insurance businesses. And companies will be tempted to drop coverage for their employees and dump them onto the government's tab.
No taxpayer is safe, either. Last week Richard Foster, CMS's chief actuary, confirmed to Congress that ObamaCare's Medicare cuts couldn't be used to reduce both Medicare's unfunded liability and to pay for ObamaCare's expense. Since the Obama administration is relying on this double counting to rig the numbers, Mr. Foster's testimony was particularly damaging.
What the country most needs—and what the GOP must now advocate—is a fundamentally new approach to containing health-care costs.
The most promising model for Medicare comes from Clinton Budget Director Alice Rivlin and House Budget Committee Chairman Paul Ryan (R., Wis.). Under their plan, starting in 2021 those turning 65 and going on Medicare would get a fixed contribution to use to purchase insurance, allowing them in many instances to keep their existing coverage. Consumers will be in charge.
Annual support would grow at the same yearly rate as the economy plus 1%. Medicare payments would be adjusted by income, geography and health risk. Poor seniors would get extra help for out-of-pocket expenses.
This bipartisan model builds on the success of the Medicare prescription drug benefit passed in 2003. This market- and competition-oriented experiment gave seniors a fixed sum they could use to purchase drug insurance coverage. In response, drug companies and insurance providers flooded the market with options that drove prices for consumers down.
Though more seniors signed up for the benefit, signed up quicker and used it more than expected, the program costs much less than estimated (the original Congressional Budget Office estimate was $552 billion for the first 10 years, but the estimated cost is now $385 billion). Competition and consumer choice are far more effective in containing costs than is bureaucratic price-setting.
We're at an unprecedented moment. The huge historic advantage Democrats have enjoyed on the health-care issue has evaporated. ObamaCare is increasingly less popular. Its unpopularity is up nine points in the last month, to 50%, in a Kaiser/Harvard survey. The public is now taking a close look at what the Republican Party might have to offer.
The Rivlin-Ryan alternative plan is bold and not without risk. Past efforts at entitlement reform haven't been successful. Having worked in the Bush White House during the 2005 Social Security battle, I know of what I speak. Still, the Rivlin-Ryan plan is right on substance. And unlike 2005, it may also be the right moment.
Thanks in good measure to Mr. Obama's profligacy, the entitlement crisis is no longer a vague, abstract concern. More and more Americans understand the current course leads to a disaster for the nation's finances. And so the public may be willing to go places and do things that in the past it may not have.
This is an unusual and fluid moment. My hunch is voters are more inclined than ever to reward the political party that addresses entitlement reform—and more inclined than ever to punish the one that fiddles while America's fiscal house burns.
Mr. Rove is the former senior adviser and deputy chief of staff to President George W. Bush.
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This is an interesting discussion of the legality of the health care law, two Supreme Court justices, and the role of Congress to regulate interstate commerce.
http://www.nytimes.com/2011/02/08/opinion/08tribe.html?_r=2&hp=&adxnnl=1&adxnnlx=1297162948-Ry0HQx71YHQsncxJVfxlvw
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BD, Okay interesting. Surprisingly, I disagree with his reasoning and conclusion.
Usually I stop reading commentary when I reach the first falsehood:
"Individuals who don’t purchase insurance they can afford have made a choice to take a free ride on the health care system."
Bullsh*t.
There is also the possibility of fee for service, pay on the spot or mail me a bill, which has worked in almost every other industry since founding of the Republic, and then some. Fee for service worked fine in health care until government meddling (and other factors) drove costs beyond normal reach. Insurance does not bring down cost, it smooths out variable costs - at a higher level than they would otherwise be to pay for administration of the insurance and to pay for how the coverage increases usage. Under a nationwide program, more people, not fewer will be taking a free or subsidized ride on the health care system. Is there not any way to arrive at constitutionality without starting with a false premise??
"...confused assertion that what is at stake here is a matter of personal liberty — the right not to purchase what one wishes not to purchase... "
Is that not clearly spelled out in the 9th amendment, almost word for word? :-) ...competing with the unenumerated power of government to PARTICIPATE in interstate commerce.
Just as the Professor dismisses the view of two judges so far, he will disagree with the Court when this is decided. Delusional IMO to think this is a 9-0 uphold certainty because: "Since the New Deal, the court has consistently held that Congress has broad constitutional power to regulate interstate commerce."
There are plenty of people on and off the Court that think that power has already been read too broadly. Trivialize it as political or "a misunderstanding of the court and the Constitution" if that is expedient, better yet call it a fundamental disagreement in principles.
BD or LT, do you support the constitutionality of mandatory national food insurance, food crossed state lines, and then what is next after that?
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DougMacG: I think you misunderstood Tribe's intention in regard to Scalia and Kennedy. As you are no doubt aware, there is much made about the "political decisions" of the Court, and the view of a few justices in particular. I think what Tribe is trying to do, at least in part, is to take a pure legal view of the merits, and note that the justices in question have voted in a particular way in prior cases. This would suggest, Tribe asserts, that the justices will follow precedent rather than follow the politics that they are often accused of. (I would think that, on its face, this is something you would agree with.)
What may be less apparent from the article is the ongoing battle between legal scholars and political scientist who study Supreme Court decion making. Legal scholars opine, not surprisingly, that the law matters, and that the value of stare decisis helps to understand why cases are decided in a particular fashion. Some political scientists, with Jeffrey Segal and Harold Spaeth being the most cited examples, believe that we can predict how a Supreme Court justice will vote based on personal preferences. I suspect that much of Tribe's article was aimed at political scientists.
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Bigdog, Thank you and I respect that. I understand from a citizen and layman's point of view the importance of stare decisis, a higher standard required to overturn what was wrongly decided, and I believe this case gives ample wiggle room to each Justice to either say as Prof. Tribe did, that this is no different than what they have always done, as well as to very reasonably say this goes considerably further than we have ever read that ever-expanding power to go. (Same newspaper predicting precedents will fall unpredictably in this Court: http://www.nytimes.com/2007/06/21/washington/21memo.html)
Having read Prof. Tribe on many occasions, I find him to be more effective as an advocate for one side of interpretation than as a predictor of how others will reason and decide a case. You disagree? In this piece I read him to be taunting or leading the so-called other side to see this as a continuation of past decisions rather than a serious prediction that Scalia and Kennedy are "open and shut" with him because of the established power to regulate and that no rights of any value are violated in the process.
The Florida judge said (something like) if this power isn't limited, what power would be? I posted the food insurance question and Obama when opposing the mandate suggested facetiously that we could mandate home purchases to end homelessness. I can't say whether he thought that was unconstitutional or just a stupid idea, but unlimited power certainly was not the intent or language used to define central government power.
I agree Scalia (or any of those 5) would vote against his presumed political position to be consistent in his constitutional interpretation. I don't find Tribe persuasive though. As I pointed out, he started with a false premise (that is a big deal to me in logic) and then trivialized a right of private affairs to not have terms and choices of private contracts coerced and tracked by central authorities. Even auto insurance is a state mandate and avoidable by choosing other OR NO transportation. Kennedy I find unpredictable but people say he is strong on states' rights. Regulating commerce across state lines has not meant in most other industries that there can only be one set of rules. There were state based solutions available to address this issue that disappear with a federal mandate. Separate from merit, 26 states suing is a pretty strong indicator that states' interests are being tromped on, at least in their view.
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Prof. Tribe: "Since the New Deal, the court has consistently held that Congress has broad constitutional power to regulate interstate commerce." - True.
Synonyms of 'regulate' http://thesaurus.com/browse/regulate :
manage, organize
adapt, adjust, administer, allocate, arrange, balance, classify, conduct, control, coordinate, correct, determine, direct, dispose, fit, fix, govern, guide, handle, improve, legislate, measure, methodize, moderate, modulate, monitor, order, oversee, pull things together, put in order, readjust, reconcile, rectify, rule, run, set, settle, shape up, square, standardize, straighten up, superintend, supervise, systematize, temper, time, true, tune, tune up
* Thesaurus ran through the whole alphabet without hitting 'mandate', 'coerce', or 'participate'.
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Synonyms of verb 'mandate':
delegate, designate, depute, assign
order, prescribe, dictate
* Accepted interpretations of the English language include the root word of 'dictatorship' but not 'regulation'.
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http://althouse.blogspot.com/2011/02/professor-tribe-would-like-you-to-know.html
February 8, 2011
Professor Tribe would like you to know how nonpartisan the Supreme Court Justices are ... I mean, will be, when they decide the individual mandate question the way he would like.
The NYT has an op-ed by lawprof Larry Tribe that purports to demonstrate how obvious it supposedly is that the Supreme Court will find the health care law constitutional.
The justices aren’t likely to be misled by the reasoning that prompted two of the four federal courts that have ruled on this legislation to invalidate it on the theory that Congress is entitled to regulate only economic “activity,” not “inactivity,” like the decision not to purchase insurance. This distinction is illusory. Individuals who don’t purchase insurance they can afford have made a choice to take a free ride on the health care system. They know that if they need emergency-room care that they can’t pay for, the public will pick up the tab. This conscious choice carries serious economic consequences for the national health care market, which makes it a proper subject for federal regulation.
Of course, the argument Tribe likes was presented, considered, and rejected in the 2 federal court cases. It's a perfectly comprehensible argument, but that doesn't make its success in the Supreme Court a sure thing. Acting as if it does, Tribe says "it’s distressing that many assume its fate will be decided by a partisan, closely divided Supreme Court." Oh, you terrible people who fail to bow to the obviousness of one side of a constitutional argument! You compound your sins by falling prey to the upsetting belief that the Supreme Court Justices are politically partisan!
To imagine Justice Scalia would abandon that fundamental understanding of the Constitution’s necessary and proper clause because he was appointed by a Republican president is to insult both his intellect and his integrity.
That's not sarcasm. Read the whole thing. You'll see, it's not intentional sarcasm. It might be an attempt to sweet-talk Scalia into using the health-care litigation to score some political neutrality points, but it's not sarcasm. It's more: Ah! What a fine Justice, full of integrity and intellect, I will say Justice Scalia is if he decides this case my way!
Justice Anthony Kennedy, whom many unfairly caricature as the “swing vote,” deserves better as well.
Oh! People are sooooo unfair to Justice Kennedy. I, Larry Tribe, will protect him from the scurrilous "swing vote" remarks people make.... when he decides this case my way!
Yes, his opinion in the 5-4 decision invalidating the federal ban on possession of guns near schools is frequently cited by opponents of the health care law.
I hope they do a better job of pointing at the Lopez case than that NYT link does. Here's the right link, in case anyone cares.
But that decision in 1995 drew a bright line between commercial choices, all of which Congress has presumptive power to regulate, and conduct like gun possession that is not in itself “commercial” or “economic,” however likely it might be to set off a cascade of economic effects.
Drew a bright line, eh? But the line, if you can call it a line, isn't about "commercial choices." That's Tribe's phrase — as he assures us the line is bright! — and what the Court said was "commercial activity" — which is why the argument about the distinction between activity and inactivity has been so important in the health care litigation. Tribe declares lines to be bright precisely at the point when he is shedding darkness. (If you think you can't shed darkness, I agree. I'm just riffing on the linguistic oddity of the lawyer's expression "bright line." Aren't easy-to-see lines usually dark — like black ink on white paper?)
The decision about how to pay for health care is a quintessentially commercial choice in itself, not merely a decision that might have economic consequences.
"Quintessentially" is such a strong word that perhaps you will not notice that it's next to the phrase that is not "economic activity."
Only a crude prediction that justices will vote based on politics rather than principle would lead anybody to imagine that Chief Justice John Roberts or Justice Samuel Alito would agree with the judges in Florida and Virginia who have ruled against the health care law.
Oh, come on. Tribe's rhetorical move has become comical at this point. It reminds me of an old-fashioned mother exerting moral pressure on a child by telling him how sure she is that he is such a good little boy that he could never do whatever it is she doesn't want him to do. Put more directly, it's an assertion of authority: I'm telling you what's right and if you don't do it, you'll be wrong. Could the Justices possibly yield to pressure like that? It's crude to think that they would, isn't it? It's an insult both their intellect and their integrity.
And yet, Larry Tribe does think it, right? That's what's behind his rhetoric. I believe. Crudely.
UPDATE: I have 2 more posts about this op-ed, one dealing with Tribe's disapproval of people who fail to take responsibility and one dealing with the meaning of "choice."
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http://althouse.blogspot.com/2011/02/i-have-to-take-3rd-shot-at-larry-tribes.html#more
February 8, 2011
I have to take a 3rd shot at Larry Tribe's op-ed: That big word "choice."
Here's my first shot and here's my second shot at Larry Tribe's op-ed purporting to say why the Supreme Court will come down in favor of the constitutionality of the individual mandate to buy health insurance. I didn't set out to write one post after another about the op-ed, but I must go on to talk about his use of the word "choice" — which is monumentally important in the discussion of abortion rights. Tribe's op-ed has nothing to say about abortion. I wonder if he would have written it differently if abortion had crossed is mind, but I can't believe that a constitutional law professor would overlook the abortion-related significance of the word "choice."
Tribe's op-ed, as I wrote in the first post, rests very heavily on misrepresenting the Supreme Court's commerce power doctrine as referring to "commercial choices." In fact, the cases refer to "commercial activities," and a switch from "activity" to "choice" is immensely important in the health care litigation, in which opponents stress that the failure to buy insurance is inactivity, not activity, and therefore beyond even the broadest interpretations the Supreme Court has ever given to the Commerce Clause.
Tribe attempted to skew opinion by substituting "choice" for "activity," and I have called him on that. But I need to go further, because someone who uses words to get things done needs to be kept honest not only about shifting from one word to another, but also about changing the meaning of the same from case to case. Let's look at how Tribe talked about "choice" and health insurance and then see how that squares with what "choice" is supposed to mean in the abortion context.
In today's op-ed, Tribe wrote:
Individuals who don’t purchase insurance they can afford have made a choice to take a free ride on the health care system. They know that if they need emergency-room care that they can’t pay for, the public will pick up the tab. This conscious choice carries serious economic consequences for the national health care market, which makes it a proper subject for federal regulation.
You can see that Tribe has given a very broad definition to the notion of choice. People bumble along, doing what they want, aware of the chance of an undesirable outcome, vaguely expecting to take advantage of an out that isn't very nice. That's a choice. It is something real and specific that the individual has done. Society can, as a group, based on our idea of the good, say to that person: We are now going to require you to take responsibility at that early decision point of yours. So Tribe says.
Now, apply that to abortion. If we take a similarly broad view of choice, we could say — as anti-abortion advocates do — that women who know they may be fertile have a choice when they go ahead and have sexual intercourse with a man. They can refrain from having sex, but if they go forward, they know that if they need emergency-room care get that they can’t pay for get pregnant, the public will pick up the tab they can get an abortion.
Of course, the Supreme Court case law does not present the woman's right to choose in terms of taking responsibility at that early point. It says:
These matters, involving the most intimate and personal choices a person may make in a lifetime, choices central to personal dignity and autonomy, are central to the liberty protected by the Fourteenth Amendment. At the heart of liberty is the right to define one's own concept of existence, of meaning, of the universe, and of the mystery of human life. Beliefs about these matters could not define the attributes of personhood were they formed under compulsion of the State.
The choice that matters is an elaborate process of high-level reflection that occurs after the woman becomes pregnant — that is, when it's too late to take the precautions that the majority might have liked her to take so that she would not show up with the demand for something it wants to prevent.
I realize there are many distinctions that can be made between health insurance and abortion, but there is so much sophistry around the word "choice" that I think it's important to concentrate on what choice means and how it matters in the law. It seems to me that society, acting through a legislature, may have a preference about when an individual should be required to make a choice, and that the individual, valuing autonomy, may want a broader range of choice than the majority would like to permit. When we think about government power and individual autonomy, how consistent must we be about what "choice" means?
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No one should expect much real health-care progress for the next two years, but at least President Obama is now making concessions to the political mood, however minor. The White House is suddenly trying to pacify the critics it used to claim were partisans, or industry shills, or arguing in bad faith.
The latest penitent is Kathleen Sebelius, who has finally admitted that there are severe fiscal problems with a new entitlement for long-term care that was included in ObamaCare. Speaking Tuesday at the Kaiser Family Foundation, the Health and Human Services Secretary defended the new government insurance program, known by the acronym Class. But she also said that "The law, while the structure in the statute wasn't perfect, provided ample flexibility to make sure that Class is successful. . . . We at HHS are committed to using that authority to making sure that both the program meets people's needs while remaining fiscally sound."
In other words, Ms. Sebelius plans to use her administrative powers to rewrite the Class program so it doesn't follow Congressional orders and bankrupt itself by design. She even made a promise that her rewrite will be so complete that "no taxpayer dollars will be used to pay for Class benefits," period.
That would certainly be a first in entitlement history, which is why President Obama's own deficit commission recommended the "reform or repeal" of Class. It said the program will "require large general revenue transfers or else collapse under its own weight," while Senate Budget Chairman Kent Conrad has called Class "a Ponzi scheme of the first order, the kind of thing that Bernie Madoff would have been proud of."
The main reason Democratic liberals insisted on passing Class is because it will crowd out private insurance for long-term care like home health aides or nursing homes. But they also used it to rig the bill's budget math to make it appear to reduce the deficit.
The program will start collecting premiums up front in 2012 but won't pay out any cash benefits until five years later. The $70 billion or so accumulated during that lead time will finance other parts of ObamaCare, and then the Class program is scheduled to go broke sometime between 2020 and 2025 in part because the money can't be spent twice.
Ms. Sebelius promised to resolve problems that "threaten the financial stability long term of the plan," like eliminating "loopholes that could allow people to skip premium payments and then re-enroll in the program without paying any penalty." (Speaking of small favors.) She also noted that "as currently written," premiums are required to be flat but benefits are indexed to inflation.
One question is why Ms. Sebelius didn't speak about these defects before the bill passed. The answer, we'd guess, is that she and Mr. Obama like the Class program as written but now fear that House Republicans and even Senate Democrats could vote to repeal it wholesale unless the Administration pledges to reform it.
The reality is that as long as entitlements are on the books, they always expand. Ms. Sebelius may change the program now, but a future Congress will quietly restore the same ills. Republicans should fight to repeal Class in its entirety, and then let Mr. Obama defend a program that even his chief health deputy now admits is a disaster waiting to happen.
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By KARL ROVE
Senate Majority Whip Dick Durbin likes to taunt his Republican colleagues, arguing that ObamaCare can't be repealed because 60 votes are required to end debate in the Senate on any measure.
Though Republicans will likely win control of the Senate in 2012, Mr. Durbin is right that they probably won't get to 60 senators. That would require the GOP to win back more than half the Democratic seats up next year. Rep. Jim Moran (D., Va.) recently called GOP promises of repeal "a political scam on their base. . . . It can't happen."
Not so fast. Keith Hennessey, a former White House colleague of mine, says Democrats are wrong. He argues that Republicans can repeal health-care reform with a simple Senate majority.
Director of the National Economic Council under President George W. Bush, Mr. Hennessey now teaches at Stanford Business School and is a research fellow at the Hoover Institution. Last week on his website, KeithHennessey.com, he made the case that congressional Republicans could use the reconciliation process to kill ObamaCare with 51 votes in the Senate and a majority in the House of Representatives.
The Budget Act of 1974 established the reconciliation process. The House and Senate Budget Committees can direct other committees to make changes in mandatory spending (like ObamaCare's Medicaid expansion and insurance subsidies) and the tax code (such as ObamaCare's levies on insurance policies, hospitals and drug companies) to make spending and revenue conform with the goals set by the annual budget resolution.
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President Obama signing the health care bill last March.
.For example, under reconciliation the Senate Budget Committee could instruct the Senate Finance Committee to reduce mandatory spending on insurance subsidies and Medicaid expansion. These two items make up more than 90% of spending in ObamaCare. All the changes from all the committees are then bundled into one measure and voted upon. Because reconciliation is protected by the rules of the budget process, it doesn't take 60 votes to bring it up and it requires only a simple majority to pass.
Will this 51-vote strategy work? One long-time GOP budget whiz, embarrassed he hadn't thought of this, told me it would. Another Republican veteran of the budget wars agreed, though she had some concerns that certain elements of ObamaCare, such as some insurance provisions, might be beyond the reach of reconciliation. For example, would reconciliation allow Republicans to kill the requirement that younger, healthier workers pay higher premiums than they rightly should to keep premiums for older workers lower?
Mr. Hennessey believes that these are "strategically unimportant" items. He says the goal should be to repeal ObamaCare's big-cost drivers, and reconciliation provides the tool to do it.
Using reconciliation would require that Republicans pick up at least four seats in 2012, when 23 senators who caucus with the Democrats are up for re-election, many in red states. Already, vulnerable Democratic senators like Jon Tester of Montana, Claire McCaskill of Missouri and Joe Manchin of West Virginia are talking about how to get rid of some of ObamaCare's most objectionable parts, like the individual mandate. They'll only get more skittish as the election approaches. Democrats cannot complain if the GOP uses reconciliation after Democrats used it to pass ObamaCare through the Senate.
Congressional Republicans are getting crucial help in this battle from allies outside Washington. Republican governors know that ObamaCare's mandatory expansion of Medicaid rolls will collapse state budgets. Texas Gov. Rick Perry has called ObamaCare "unaffordable, unsustainable and unworkable," and many have criticized the law for shifting billions of dollars onto the states. GOP governors are in charge of at least 10 key battleground states and can continue to drill home this message in states such as Ohio and Florida that are vital to Mr. Obama's re-election.
Even Democratic governors in swing states are critical of ObamaCare's Medicaid expansion. "There is no hidden pool of money" to pay for expanding Medicaid, lamented Colorado Gov. John Hickenlooper. North Carolina Gov. Bev Perdue said she opposes health-care reform "that shifts costs to the states." States are "not going to be in a position to pick up the tab" of expanding Medicaid, warned Washington Gov. Christine Gregoire.
Democrats harp on the 60-vote threshold and ignore the reconciliation option because they want Americans to accept the inevitability of ObamaCare. But its roots are clearly in shallow soil.
Of course, a 51-vote Senate strategy would also require a Republican president who would sign a reconciliation bill. All of which means that ObamaCare will be a central issue in the 2012 election. The president may not want to "re-litigate" ObamaCare, but Republicans—and a majority of Americans—do.
Mr. Rove is the former senior adviser and deputy chief of staff to President George W. Bush.
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By LLOYD M. KRIEGER
The Republicans who now control the House of Representatives hope to repeal or defund ObamaCare, but the law has already yielded profound, destructive changes that will not be undone by repeal or defunding alone. Active steps and new laws will be needed to repair the damage.
The most significant change is a wave of frantic consolidation in the health industry. Because the law mandates that insurers accept all patients regardless of pre-existing conditions, insurers will not make money with their current premium and provider-payment structures. As a result, they have already started to raise premiums and cut payments to doctors and hospitals. Smaller and weaker insurers are being forced to sell themselves to larger entities.
Doctors and hospitals, meanwhile, have decided that they cannot survive unless they achieve massive size—and fast. Six years ago, doctors owned more than two-thirds of U.S. medical practices, according to the Medical Group Management Association. By next year, nearly two-thirds will be salaried employees of larger institutions.
Consolidation is not necessarily bad, as larger medical practices and hospital systems can create some efficiencies. But in the context of ObamaCare's spiderweb of rules and regulations, consolidation is more akin to collectivization. It means that government bureaucrats will be able to impose controls with much greater ease.
With far fewer and much larger entities to browbeat, all changes in Medicare and Medicaid policies will go through the entire system like a shock wave. There will be far fewer individual insurers, doctors, hospitals, device makers, drug manufacturers, nursing homes and other health-care players to resist.
There is little mystery how the government will exercise its power. Choices will be limited. Pathways to expensive specialist care such as advanced radiology and surgery will decline. Cutting-edge devices and medicines will come into the system much more slowly and be used much less frequently.
This is why simply defunding enforcement of the individual mandate and other upcoming directives will not be enough: Given all this consolidation, limits on treatment choices are already becoming hardwired into the system. Lawmakers must take concrete steps to stop and reverse this.
On the provider end, this means enacting tax and other economic shields for insurers and providers that choose not to succumb to the financial pressure encouraging consolidation. It means unwinding all of the rules—about data compilation, reporting and compliance requirements, and information technology—designed to increase overhead to the point that only massive and easily regulated provider organizations can survive.
Legislators will have to scrub the 2,700-page ObamaCare law line by line to remove all of the disincentives for medical practices, hospitals and others to remain smaller and independent.
On the consumer end, reform means re-establishing choice at all levels of the system. Lawmakers at a minimum should change the individual mandate so that people can choose what type of coverage they buy. To do this, legislation has to ensure that all consumers have access to a menu of options for varying types of coverage, and that they are free to purchase policies across state lines. There should also be tax breaks for people who purchase medical care not covered by their insurance, so there is reasonable chance of escaping government-imposed limits on treatment choices.
System-wide, collectivization will be dismantled only by limiting the power of government agencies to determine what care gets funded. That means new legislation to supersede Section 1311 of the Patient Protection and Affordable Care Act, which requires herding everyone into "qualified plans" and forcing doctors (via fines, penalties and nonpayment) to follow care guidelines determined by the secretary of Health and Human Services.
ObamaCare is already doing great damage, even years before its individual mandate and other controls kick in. Its systematic undoing is an urgent necessity.
Dr. Krieger, a plastic surgeon, invests in health-care companies.
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A NY TImes (Pravda on the Hudson) editorial today:
The number of kidneys available for transplants falls far short of the need, so there is no choice but to ration them. An emotionally difficult proposal to change the first-come-first-served transplant system makes good sense.
There are nearly 90,000 people on waiting lists to receive kidney transplants, and in 2009 there were only some 10,400 kidneys from dead donors to give them. And about 6,300 kidneys were transplanted from living people who donated one of their two kidneys and usually specified the recipient.
Currently the kidneys from dead donors are provided, through an organ procurement and transplantation network, to people who have been waiting the longest. That may seem fair since many transplant candidates wait for years, and some die while waiting.
But the system has serious shortcomings. Some elderly recipients get kidneys that could function far longer than they will live and that could have done more good for a younger recipient. Some younger recipients get kidneys that will fail and will need to be replaced, using up another scarce kidney.
These problems could be eased through a proposal under consideration at the transplant network to better match the likely longevity of the patient with the likely functional life of the kidney.
The patients and kidneys would each be graded separately. About 20 percent of the kidneys predicted to have the longest functional lives would be provided to the youngest and healthiest patients. The other 80 percent of kidneys would go to patients who are no more than 15 years older or younger than the donor.
The approach seems likely to make it harder for elderly people to get a kidney. But when kidneys are already scarce — and apt to get scarcer as much of the population ages and sickens — it is a rational choice.
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This is the most obvious mathematical question ever to NOT be asked aloud by so many people for so long. This question has gone through my mind every time I have heard the fact that Pelosi-Obama Care has to use 10 years of revenues to pay for 6 years of benefits in order to keep the 'cost' to the Treasury (almost) under a trillion dollars. Is there not one person trained in mathematical progressions bold enough and smart enough to ask the most obvious question on earth:
WHAT ABOUT THE ELEVENTH YEAR?!!!!
I don't believe I ever wrote it or asked or heard or read anyone else ask it until I heard this. I am not familiar with Sam Zell, but i nearly fell off my chair to hear him ask this.
http://finance.yahoo.com/video/cnbc-22844419/24401227#video=24399404
"What about the eleventh year? You guys have constructed this with ten year of revenues and six years of costs, what about the eleventh year?"
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Bachmann Calls on Congress to Block $105B in Health Law Money
Published March 08, 2011
FoxNews.com
Reuters
U.S. Rep. Michele Bachmann at the 38th annual CPAC meeting at the Marriott Wardman Park Hotel in Washington, Feb. 10, 2011.
Rep. Michele Bachmann is threatening to leverage a must-pass budget bill to ensure Congress strips billions of dollars from the federal health care overhaul -- money she says was unfairly baked into the law.
Though Democrats dispute her charges and it's unclear whether she could rally enough support in her party to force the rescission, Bachmann, R-Minn., told Fox News she wants to use the fiscal 2011 budget process to eliminate $105 billion in "buried" health law funding. That money was included as mandatory spending over the next eight years, meaning it's automatic and not subject to annual spending votes by Congress.
"This is a crime against democracy," Bachmann told Fox News on Tuesday. "No one knew that Harry Reid, Pelosi and Obama put $105 billion in spending in the bill. ... This is a bombshell."
The hefty down payment for the health law makes it more difficult for Republicans who want to de-fund the policy through the annual appropriations process. To remedy this, Bachmann said she wants to include language demanding the money back in the next short-term budget bill, which will probably be required to fund the government when the latest short-term bill expires March 18.
"You didn't tell the American people, you didn't tell the Senate, you didn't tell the House. Give the money back. And then we'll start talking about the budget. This is the first thing," Bachmann told Fox News Monday night.
But Democrats pushed back on Bachmann's claim, particularly an earlier remark she made about the funding being a "deceitful" trick hidden from public view. One Democratic aide said the $105 billion was calculated as part of the original "score" for the bill presented to Congress.
"The Congressional Budget Office had this included in their score. They scored the bill and found it (saved) $1.2 trillion over 20 years," the aide said. "What is deceitful is Bachmann voting to end patients' rights while keeping her taxpayer-funded health care."
Though Bachmann claims the authors of the health care law "buried" the money, the House had three months to find it before approving the final version last March. Bachmann's also not the first person to point this out. Rep. Steve King, R-Iowa, tried earlier this year, without success, to block the $105 billion. The mandatory money was the subject of a study by Heritage Foundation fellow and former congressman Ernest Istook in late January.
Istook got his figures in large part from a Congressional Research Service report dated Oct. 14 of last year.
Though the information has been floating around in various Washington studies, Istook wrote in January that the inclusion of the money was a major foul on Democrats' part. He accused the bill's authors of bypassing the normal appropriations process to block any future Congress from meddling with the money.
"Making years' worth of spending decisions in advance is an attempt to handcuff the current Congress and prevent it from determining current levels of spending," he wrote.
Among other provisions, about $40 billion would go to the Children's Health Insurance Program, $15 billion would go to a prevention and public health fund, $10 billion would go to Medicare and Medicaid innovation programs, and $9.5 billion would go to the Community Health Centers Fund.
Bachmann claims part of that spending would essentially give Health and Human Services Secretary Kathleen Sebelius a $16-billion "slush fund" that would allow her to do "whatever she wants with this money."
Bachmann called on the bill's supporters to give the money back, though Democrats who backed the health law, most notably President Obama, have argued that the law goes a long way toward insuring the uninsured and protecting health care consumers.
Read more: http://www.foxnews.com/politics/2011/03/08/bachmann-calls-congress-block-105-billion-health-law-money/#ixzz1G1aSPUbj
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By SCOTT GOTTLIEB
Across the country, cash-strapped states are leveling blanket cuts on Medicaid providers that are turning the health program into an increasingly hollow benefit. Governors that made politically expedient promises to expand coverage during flush times are being forced to renege given their imperiled budgets. In some states, they've cut the reimbursement to providers so low that beneficiaries can't find doctors willing to accept Medicaid.
Washington contributes to this mess by leaving states no option other than across-the-board cuts. Patients would be better off if states were able to tailor the benefits that Medicaid covers—targeting resources to sicker people and giving healthy adults cheaper, basic coverage. But federal rules say that everyone has to get the same package of benefits, regardless of health status, needs or personal desires.
These rules reflect the ambition of liberal lawmakers who cling to the dogma that Medicaid should be a "comprehensive" benefit. In their view, any tailoring is an affront to egalitarianism. Because states are forced to offer everyone everything, the actual payment rates are driven so low that beneficiaries often end up with nothing in practice.
Dozens of recent medical studies show that Medicaid patients suffer for it. In some cases, they'd do just as well without health insurance. Here's a sampling of that research:
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TWISTED PATIENT
.• Head and neck cancer: A 2010 study of 1,231 patients with cancer of the throat, published in the medical journal Cancer, found that Medicaid patients and people lacking any health insurance were both 50% more likely to die when compared with privately insured patients—even after adjusting for factors that influence cancer outcomes. Medicaid patients were 80% more likely than those with private insurance to have tumors that spread to at least one lymph node. Recent studies show similar outcomes for breast and colon cancer.
• Major surgical procedures: A 2010 study of 893,658 major surgical operations performed between 2003 to 2007, published in the Annals of Surgery, found that being on Medicaid was associated with the longest length of stay, the most total hospital costs, and the highest risk of death. Medicaid patients were almost twice as likely to die in the hospital than those with private insurance. By comparison, uninsured patients were about 25% less likely than those with Medicaid to have an "in-hospital death." Another recent study found similar outcomes for Medicaid patients undergoing trauma surgery.
• Poor outcomes after heart procedures: A 2011 study of 13,573 patients, published in the American Journal of Cardiology, found that people with Medicaid who underwent coronary angioplasty (a procedure to open clogged heart arteries) were 59% more likely to have "major adverse cardiac events," such as strokes and heart attacks, compared with privately insured patients. Medicaid patients were also more than twice as likely to have a major, subsequent heart attack after angioplasty as were patients who didn't have any health insurance at all.
• Lung transplants: A 2011 study of 11,385 patients undergoing lung transplants for pulmonary diseases, published in the Journal of Heart and Lung Transplantation, found that Medicaid patients were 8.1% less likely to survive 10 years after the surgery than their privately insured and uninsured counterparts. Medicaid insurance status was a significant, independent predictor of death after three years—even after controlling for other clinical factors that could increase someone's risk of poor outcomes.
In all of these studies, the researchers controlled for the socioeconomic and cultural factors that can negatively influence the health of poorer patients on Medicaid.
So why do Medicaid patients fare so badly? Payment to providers has been reduced to literally pennies on each dollar of customary charges because of sequential rounds of indiscriminate rate cuts, like those now being pursued in states like New York and Illinois. As a result, doctors often cap how many Medicaid patients they'll see in their practices. Meanwhile, patients can't get timely access to routine and specialized medical care.
The liberal solution to these woes has been to expand Medicaid. Advocacy groups like Families USA imagine that once Medicaid becomes a middle-class entitlement, political pressure from middle-class workers will force politicians to address these problems by funneling more taxpayer dollars into this flawed program.
President Barack Obama's health plan follows this logic. Half of those gaining health insurance under ObamaCare will get it through Medicaid; by 2006, one in four Americans will be covered by the program. A joint analysis from the Republican members of the Senate Finance and House Energy and Commerce Committees estimates that this will force an additional $118 billion in Medicaid costs onto the states.
We need an alternative model. One option is to run Medicaid like a health program—rather than an exercise in political morals—and let states tailor benefits to the individual needs of patients, even if that means abandoning the unworkable myth of "comprehensive" coverage.
Democratic and Republican governors are pleading with the president for flexibility to do just this. At least so far, this has been a nonstarter with an Obama health team so romanced by Medicaid's cozy fictions that it neglects the health coverage that Medicaid really offers, and the indecencies it visits on the poor.
Dr. Gottlieb is a clinical assistant professor at the New York University School of Medicine and a resident fellow at the American Enterprise Institute.
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WSJ:
The future tragedies of government health care will include today's many warnings about how it operates in practice. The subsidize-mandate-overregulate insurance model is imploding in Massachusetts. Then there's Washington state, where a government board may decide that modern medicine is too expensive for kids with diabetes.
Seriously. In 2006, Washington created a board to scrutinize the cost-effectiveness of various surgeries and treatments, known as the Health Technology Assessment program. At a hearing today, the panel will debate glucose monitoring for diabetic children under 18. In other words, the board is targeting the fundamental standard of diabetes care that has been the established medical consensus for at least three decades.
This state issue deserves far more scrutiny, if only because ObamaCare and the stimulus devoted billions of dollars to comparative effectiveness research. As President Obama has so often put it, the idea is to pit Treatment X against Treatment Y and find out "what works and what doesn't." In theory, it sounds great. But the Health Technology Assessment is an example of how comparative effectiveness will work in the real world, as the political system tries to find ways to restrict or limit treatment to control entitlement spending.
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.Diabetes affects the body's secretion of insulin, the hormone that metabolizes sugar, and most kids with type 1 diabetes take multiple daily insulin injections or use insulin pumps. The best way to manage this chronic disease is with frequent self-monitoring and then calibrating the insulin dose to current blood-sugar levels. Patients do so either with finger sticks that are read by an electronic meter or continuous glucose monitors that track blood sugar levels virtually in real time.
The Health Technology Assessment has homed in on both technologies, claiming that the "effectiveness and optimal frequency of self-monitoring of blood glucose in patients is controversial." Not among physicians. But in a recent report, the panel suggests that there isn't enough "evidence" to support monitoring among childhood and adolescent diabetics, and that the randomized controlled trials that have been conducted aren't high quality.
Such a trial would violate medical ethics: A group of children would essentially be required to not monitor glucose—putting them at risk for long-run complications from too high or low blood sugar, including seizures and even death. Following a landmark 1993 trial on tight glycemic control, and the vastly improved outcomes since, the clinical benefits of intensive management are irrefutable.
Except, apparently, to a government board looking to scrimp. Washington's Health Technology Assessment makes decisions for state-subsidized health care, including Medicaid beneficiaries, public employees and prisoners—about 750,000 people. If it bans continuous monitors or limits finger sticks to a certain daily number at today's hearing, pediatric patients and their parents will lose the tools—and the more and better information—they need to manage their disease.
The most compelling reason to be worried about comparative effectiveness research is simple. Randomized trials are designed to find average results over large groups of people, but doctors do not treat averages. They care for individuals, and what works for the typical patient may not work for you or your diabetic child.
More to the point, as shown by the arbitrary Washington state method, political comparative effectiveness isn't about informing choices. It's really about taking away options. Note that all of the largest U.S. health insurers that Democrats like to claim hate treating sick people—Aetna, Cigna, WellPoint, UnitedHealth—cover diabetes self-monitoring. So do the local plans Premera Blue Cross and Regence Blue Cross Blue Shield.
Which brings us from Washington state to Washington, D.C. The Health Technology Assessment program's director, Leah Hole-Curry, was appointed last year as a governor of the comparative effectiveness board established by ObamaCare. The national board is known as the Patient-Centered Outcomes Research Institute, yet at an early meeting in November, Ms. Hole-Curry and the other 14 governors debated whether or not patients were the institute's "primary constituents."
Now this agenda is on autopilot. The institute is built on self-executing funding—that is, not subject to annual appropriations like other federal programs—and dedicated taxes on insurers. At the very least Americans deserve some honesty about who these people are and what they favor.
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Patient, heal thyself
A bottom-up approach to the biggest problem in government
Mar 17th 2011 | from the print edition
IN ANY discussion about the role of the state, one subject soon dwarfs all others: health care. McKinsey points out that American spending on this has grown at an annual lick of 4.9% over the past 40 years, whereas GDP per person has grown by just 2.1%. Pessimists are convinced nothing can be done to restrain it. A refreshingly different perspective is provided by Sir John Oldham, a British doctor who is clinical lead for productivity in the National Health Service.
His view of what he calls the coming tsunami is as pessimistic as anybody’s. Health costs, he points out, are determined by long-term conditions—things like diabetes, heart disease, obesity and lung disease, which are usually linked to lifestyle and diet. Some 15m Britons suffer from such conditions, which take up 70% of “bed days” in hospitals.
The numbers of cases in other countries are equally worrying. They explain why America, which currently spends 16% of its GDP on health care (see chart 5), is theoretically on track to spend 100% of its GDP on health care by 2065, followed soon by Japan. China too has seen a huge rise in such conditions. They are no longer diseases of the old: in America, says Sir John, the Facebook generation is picking them up so rapidly that it might be the first not to live longer than its parents. But they are still mainly diseases of the poor, who live less healthy lives, smoking more, drinking more and consuming more salt and trans fats in processed food.
A hard-hearted economist might spot potential savings (especially on pensions) from people dying younger. But even he would be disappointed: any such savings would be wiped out by the adverse effect of such diseases on the productivity of the working-age population. One obvious way to alleviate this problem is to tax the things that are causing it: when governments are having to strengthen their ambulances to cope with heavier patients, it is time for a levy on cheeseburgers. But Sir John reckons that getting patients to help manage their illnesses might be even more promising.
Technology is starting to make this vastly easier. Futurists dream of small gadgets roaming people’s bodies and reporting their findings to computers, but lower-tech versions of this already exist. In one pilot scheme in Britain’s Stoke-on-Trent patients use fairly basic methods to record their own weight, cholesterol, blood pressure and so on every week and text the result to a computer, which tells them what to do about them.
This can be economically attractive, because the most expensive things in health care tend to be unscheduled visits to hospital. But it also improves people’s health. A patient is always around to monitor himself, and he will be highly motivated. A big study by the Cochrane Institute showed that among people who managed their own anticoagulant treatment, repeat blood clots declined by half; deaths from clots also fell.
Sir John suggests that the NHS should set up an incentive scheme for its workers to lead healthier lives that would create rewards (or, as he likes to call them, “care miles”). That would set a good example. But for the biggest employer in the country it could also save a lot of money.
The Economist welcomes your views.
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Health care mandates for everyone - except Bamster's friends:
****Michelle Malkin • March 25, 2011 10:39 AM
The Weiner Waiver Wormhole
by Michelle Malkin
Creators Syndicate
Copyright 2011
New York Democratic Rep. Anthony Weiner toasted the one-year anniversary of Obamacare this week — and accidentally spilled his champagne glass all over the disastrous, one-size-fits-all mandate. Ostensibly one of the federal health care law’s staunchest defenders, Weiner exposed its ultimate folly by pushing for a special cost-saving regulatory exemption for New York City.
If it’s good for the city Weiner wants to be mayor of, why not for each and every individual American and American business that wants to be free of Obamacare’s shackles?
Weiner joins a bevy of the “Patient Protection and Affordable Care Act’s” loudest cheerleaders — unions, foundations and left-leaning corporations — in clamoring for more waivers for favors. (The list of federal waiver recipients now tops 1,000, covering more than 2.6 million workers.) And he follows a gaggle of health care takeover-promoting Democrats maneuvering on Capitol Hill for get-out-of-Obamacare loopholes.
At a speech before the George Soros-supported Center for American Progress, as reported by Politico.com, Weiner revealed that he’s “in the process now of trying to see if we can take (President Barack Obama) up on” a favor waiver and is “taking a look at all of the money we spend in Medicaid and Medicare and maybe New York City can come up with a better plan.” Echoing all the Republican critics of Obamacare who objected to top-down rules that override local variations in health care expenditures, Weiner explained: “I’m just looking internally to whether the city can save money and have more control over its own destiny.”
More local control over taxpayers’ destiny, eh? Give that man a “Hands Off My Health Care” sign, a Gadsden flag and a tea party membership card ASAP!
I kid, of course. The ultimate agenda of many waiver-seekers is to create a wormhole path to even more radical restructuring of the health system. Weiner has brazenly called for a single-payer “public option” to replace Obamacare should it be repealed. Democratic Sen. Ron Wyden of Oregon has also crusaded for more Kabuki “flexibility” in the law through a bipartisan state waiver proposal.
But as The Heritage Foundation noted, the plan “simply changes a date on an existing ‘state innovation’ provision of Obamacare from 2017 to 2014 — still well after the federal Obamacare infrastructure has been cemented in place.” And it is essentially “a back-door vehicle for progressive states to enact the ‘public option’ and speed up the establishment of a single-payer system for health care.” White House health care advisers Nancy-Ann DeParle and Stephanie Cutter further reinforced in a conference call to liberal advocates that the bill would help states implement single-payer health care plans, such as those tested in Connecticut and Vermont.
Weiner argues that the waiver process dispels “this notion that the government is shoving the bill down people’s throats.” But only the politically connected, deep-pocketed, lawyered-up and Beltway-savvy can apply. And the White House refuses to shed more light on its decision-making process. Obama’s selective favor waivers simply underscore the notion that unaccountable regulatory bureaucrats are presiding over government by the cronies, for the cronies and of the cronies.
Real control over our destinies means flexibility and choice for all. Repeal is the ultimate democratic waiver.****
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Replace ObamaCare With Health Savings Accounts
Mar. 26 2011 - 1:12 pm | 5,209 views | 0 recommendations | 13 comments
As we pass the one year anniversary of the passage of the Patient Protection and Affordable Care Act, lovingly known to most as ObamaCare, and with a repeal movement trying to get into full swing, it’s worth revisiting what could have been, and what could still be. Simply repealing ObamaCare might save the country from the certain financial and health care disasters it would bring, but repeal alone doesn’t address the noble goal of ensuring as many people as possible, and the necessary goal of curbing runaway health care inflation. There is another way.
It’s vital to understand that the twin problems of uninsured Americans and exploding costs were not caused by the lack of a federal solution to health care. Quite to the contrary, it is precisely the government’s involvement in this sector of the economy that has caused these problems. Numbers released by the U.S. Centers for Medicare & Medicaid Services back in January place the government’s share at a little over 43% of 2009’s total health care spending, although Cato Institute’s Michael Cannon wonders if the numbers should be closer to 50%. Consider this contrast: Senator Jim De Mint has proposed a balanced budget amendment that would limit government spending to 20% of GDP, and that has many on the left (and the right, but for different reasons) completely apoplectic. Apparently 20% of the entire economy is too little for the left but nearly half of a huge sector of our economy is just fine. But more on government’s meddling later.
The root causes by example
For almost anyone having health insurance, the exact cost of services delivered is rarely questioned. When your doctor says, “We’re going to order some tests…”, or, “I’d like you to get an MRI…”, you probably reply “OK, sure.”. Let’s assume that these tests and scans are unquestionably required. There may be several labs in the area that could do those tests, or a few different facilities with MRI equipment, but more than likely, you’ll take your doctor’s recommendation (“we have a lab right down the hall”) and go through the motions.
With almost any other purchasing decision, it would not be uncommon to shop around for your personally desired mix of quality versus price versus service versus location versus whatever.
However, for some reason, we’ve allowed our medical care transactions to be treated differently. With a lot of insurance plans, the aforementioned tests and MRI’s probably won’t even be billed to you. You’ll never know what they really cost.
But what of the situation that precipitated those tests? Perhaps it was a physical, which being a responsible person you’ve had annually for as long as you remember. Similarly, you probably change the oil in your car on a regular basis.
Do you file a claim with your auto insurance company to change your oil?
And there you have two of the major reasons health care is so expensive, and why health insurance, which isn’t the same as health care, is equally so.
Now few people would suggest that you should question your doctor’s every recommendation. You’d find your customer or boss questioning your every action equally irritating and disrespectful. And few people would argue for skipping annual physicals on a regular basis as a cost-saving measure.
But in health care have we somehow reached a place where we use insurance to pay for things that have very high probabilities of occurring. Insurance was invented to protect against calamities that hopefully never happen. Companies that sell insurance employ armies of people who try to predict the likelihood of these calamities. Given a probability, pricing the insurance is then pretty straightforward, and given an accurate probability, the product can be offered at a consistent level of profit, one that allows the insurance company to be there when you need it.
Here’s where things go awry.
If an insurance company is certain that they’re going to pay, say, $2,500 in claims on a policy each year, then they need to collect at least $2,500 just to have a prayer of staying in business. In fact, with their own costs of salaries, taxes, rents, records-keeping, their own employee benefits and so on, they might need to collect $5,000 just to have anything left over after paying out that $2,500.
“Well that sounds kind of stupid, having to send the insurance company $5,000 just so they can send $2,500 of it back.”
Hold that thought. Enter, Health Savings Accounts.
Separating Health Care from Health Insurance
Only Health Savings Accounts distinguish the “care” from the “insurance”. They are different issues, and they require different solutions.
To demonstrate the difference, say you currently have a traditional “family plan” through your employer that costs the employer $12,000 a year. Your employer is very generous, and pays for all of it. You see whatever doctors you want, and make “co-payments” of $25 per doctor visit. Beyond that, it’s basically all you can eat — the buffet line starts to your left.
With a Health Savings Account, your employer still spends $12,000 a year (in actuality, probably less). But they take $5,000 of the $12,000 and put it into an account with your name on it. The money is now legally yours. It’s a form of compensation. With the remaining $7,000, they buy a “High Deductible Health Plan“, whose deductible just happens to be $5,000. The HDHP covers you in full for any unlikely tragedy that should it occur, would be financially devastating.
When you go for your physical, since it’s a non-risk, near-certain probability event, you pay for the physical with a plastic card linked to your HSA. Here’s the kicker: since that $5,000 is your money, whatever balance you have at the end of the year is yours to keep. Note that this is distinctly different from “Flexible Spending Accounts” that many people have, which have a “use it or lose it” aspect to them (thus making them the local eyeglass store’s best friend in December).
Next year, your employer deposits another $5,000 into the account and the process repeats. Over time, the balance in the HSA account can grow, and it’s yours to keep if you change employers. And hopefully, the health tragedy that your high-deductible plan would cover in full, never happens.
Now you’re in a whole new world.
Suddenly you’ll pocket the difference in price between one provider of lab work, and a cheaper but totally acceptable alternative. Under a system of widespread HSA’s, labs would start advertising their services and prices to the retail customer. MRI service providers would do the same, as would doctors’ offices.
Can’t evaluate one lab versus another? A lot of people might be in that category, so a new company would pop up that would do that for you — the “Consumer Reports” of lab comparisons, if you will. You might even pay more for a lab that had a certain level of certification that you trusted. Think the certifying company might be corruptible? Any more so than your local government agency that might otherwise be mandated to do the same thing, paid for by additional tax dollars from you?
Of course, many different types of High Deductible Plans would be offered to cover the catastrophic events, some of which might have their own additional limitations or costs, in return for an even lower annual rate. Just as the labs and MRI providers would undoubtedly compete for business, the insurance companies, returning largely to the business of pricing risk, not certainty, would have every incentive to compete as well. We want to allow the insurance companies to beat each other up in the marketplace, rather than beat us up.
“But wait a minute.” you say. “In your example, I might have to spend $300 on the physical, where right now I only make a $25 co-payment”. True, but where did the $300, or the $25, come from in the first place? In both cases, your employer is the originator of the money, as they are funding the full $12,000. But with the HSA, you have an incentive to retain as much of the $5,000 each year as you can. With the traditional plan and the $25 co-payments, you don’t. The concept is the same even if you have to pay a portion of your health insurance costs from each paycheck, as is the more typical case.
Some history, and the future
Remember, our current system of indirect payments for medical care came about as a result of World War II wage controls, under which employers realized they could raise an employee’s “compensation” by paying for their medical insurance. Since then, endless additions of regulations and stipulations on what must be covered, and how insurance can be sold, have straitjacketed the free market’s ability to work its wonders in the health care sector of our economy. Nowadays, the often “gold-plated” medical benefits given to some unions in lieu of higher wages are killing state budgets. ObamaCare, at its core, just enlarges the very system we already have, the system that is both fundamentally broken and bankrupting us. It can not work.
By contrast, in places where HSA’s are being offered, people are voluntarily flocking to them. For example, in the state of Indiana, 70% of state employees have switched into HSA’s. The state is projected to save over $20 million in 2010 because of this, and the employees have accumulated over $30 million in their HSA’s since the plan’s inception. Ironically, using HSA’s can achieve what was originally intended after the WW II wage controls: they can increase an employee’s total compensation, but in an actuarially sound way.
That’s not to say that we should force all Americans into HSA’s. For certain people, they may not make sense. All that says is that any employer should simply offer HSA’s as an option to their existing health care choices, and allow the employees to decide for themselves.
“Well it all sounds intriguing Zarras, but what’s the catch behind all this?” The catch is that suddenly you and your doctor are in much greater control of your health care. Since most of your spending is going to be on non-catastrophic events, your insurance company rarely enters into the picture. Also absent are many of the rules and restrictions the government would want to put on your insurance plans and the way you go about purchasing and using them.
And there you have the reason why big-government politicians loathe these plans: their role in your health care is dramatically reduced.
http://blogs.forbes.com/deanzarras/2011/03/26/replace-obamacare-with-health-savings-accounts/
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Second post.
Bwahaha:
White House Hit with FOIA Lawsuit Over Obamacare Waivers
11:30 AM, MAR 23, 2011 • BY MARK HEMINGWAY
Crossroads GPS, the policy arm of Karl Rove's American Crossroads PAC, just dropped a lawsuit on the Obama administration:
Today, a law firm representing Crossroads Grassroots Policy Strategies (GPS), a nonprofit conservative issue advocacy organization, filed a lawsuit against the U.S. Department of Health and Human Services (HHS) in the United States District Court for the District of Columbia, over the department’s repeated failure to comply with the Freedom of Information Act by providing information about the department’s granting of waivers from the Patient Protection and Affordable Health Act, also known as Obamacare.
The lawsuit seeks judicial enforcement of a FOIA request for “any and all memoranda, guidance, directives, instructions and other documents … relating to the criteria to be applied by HHS in deciding whether to grant or deny applications for waiver of the annual limit requirements” ordered by the Obamacare law.
“The Obamacare waiver program has all the same flaws as the underlying law: unfettered government power, federal bureaucrats picking winners and losers, and the appearance, if not the reality, of favoritism to political cronies,” said Steven Law, president of Crossroads GPS. “Until President Obama is willing to grant the entire country a waiver from Obamacare, his Administration needs to come clean on how they decide who wins and losers in the waiver lottery.”
Crossroads GPS submitted its FOIA request to HHS on January 7, 2011, and HHS acknowledged its receipt of the request on January 11, 2011. After repeated attempts by letter, phone, email and fax to generate action on the request, no action has been taken, despite the 20 day statutory limit on fulfilling FOIA requests.
So far the administration has issued over a thousand waivers, with no clear guidance as to who's elligible to duck the law. This lawsuit could result in a treasure trove of politically embarassing information.
http://www.weeklystandard.com/blogs/white-house-hit-foia-lawsuit-over-obamacare-waivers_555381.html
Suit PDF here:
http://crossroadsgps.org/sites/default/files/HHS%20FOIA%20Complaint.pdf
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Third post.
Obamacare's small business impact:
[youtube]http://www.youtube.com/watch?v=cUQHS6t89fM&feature=player_embedded[/youtube]
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http://reason.com/blog/2011/03/29/fixing-the-doc-fox
Reason Magazine
Fixing the Doc Fix
Peter Suderman | March 29, 2011
At the end of this year, Medicare’s physician reimbursement formula calls for doctors to face a 29.5 percent fee cut. Needless to say, it’s a near certainty that this won’t happen. Since 2003, Congress has consistently passed overrides to the cuts dictated by the formula, known as the Sustainable Growth Rate. Last year alone, Congress passed five short-term extensions, including a 13-month extension that keeps rates from dropping until 2012.
This problem has become known as the “doc fix,” and in his most recent budget proposal, President Obama called for a permanent fix. But his ten-year proposal only pays to keep physician’s rates from dropping for two years (and it does so with cuts that are spread out over a complete decade, meaning we'll have spent the money before the cuts pay off).
Neither Democrats nor Republicans are terribly interested in letting doctors’ Medicare payment rates fall, hence the regular overrides. Doing so would anger two powerful interest groups: physicians and seniors. Given that the president and both parties want to ensure that the fees don’t drop, one has to operate under the assumption that they won’t. Somehow, reimbursement rates will be kept at (or at least near) current levels.
But that means coming up with money to pay for those higher fees. How much money? According to the Congressional Budget Office, the cost, which continues to grow the longer Congress delays a fix, is now about $380 billion. The problem is that these days, pay-fors—revenue raisers or spending offsets that could be used to fund the fix—are hard to come by. That’s why the president proposed a decade-long series of snips in order to pay for extending current rates by just two years. And why are pay-fors so hard to come by? Because the biggest, most obvious Medicare cuts—about $500 billion worth—were used to fund last year’s health care overhaul. (And it should be noted that even those cuts are far from certain to go through and actually pay off as projected.)
If you presume that the doc fix will be funded somehow—even if it means more short-term extensions and deficit spending—then you have to think of this as irresponsible on the part of President Obama and the Democratic members of Congress who voted for the health care overhaul. They had a $380 billion problem to fix within Medicare, their existing system. But after coming up with changes that they believed would reduce the cost of that system by about $500 billion, they ignored the problem they already had and spent the money on a new entitlement instead.
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2nd post:
Hamburger on Waivers — Part III
Jonathan H. Adler • March 20, 2011 3:42 pm
Columbia Law’s Philip Hamburger has a third essay on the constitutional problems with the issuance of waivers under the health care reform law. (Here are my posts on I and II.) The Department of Health and Human Services has given out over 1,000 waivers of various requirements thus far, and more are surely on the way. Setting aside the general constitutional objections to waivers of regulatory requirements, Hamburger argues that if, as I would argue, waiver authority must be delegated by Congress, some of the waivers issued thus far remain legally problematic.
The constitutional defense of the health-care waivers has thus far been a defense of waivers in general, without attention to the realities of the health-care statute. As a result, the defense of the waivers not only is wrong on the Constitution but also is irrelevant to the statutory realities. . . .
the health-care statute says nothing about granting HHS a power to waive the restricted annual limits. As reported by David J. Shestokas, congressman Cliff Stearns of Florida — chairman of the House Energy and Commerce subcommittee on oversight and investigations — complained, “The word ‘waiver’ is not in there. We can’t find it anywhere.”
Of course, Congress could have granted the power to waive the restrictions in a more subtle manner — for example, as part of the substantive authority granted to the secretary of HHS to determine the restricted annual limits. But statutory provisions must be understood in their statutory context, and this context shows that when Congress sought to give the secretary a waiver power, it had no difficulty doing so expressly. For example, in its provision on state innovation, the statute specifies that “The Secretary may grant a request for a waiver . . . ” In contrast, in its provision on restricted annual limits, the statute does not say anything of the sort. Evidently, Congress did not delegate a waiver power for the restricted annual limits.
I find Prof. Hamburger’s statutory arguments more compelling than the blanket constitutional argument against waiver authority. Agency authority to waive statutory or regulatory requirements should come from Congress. If, as Hamburger claims, HHS has granted waivers where it lacked clear statutory authority to do so, this would be problematic, but it is not clear who, if anyone, would have standing to challenge the waiver.
UPDATE: The NYT has more on the waiver debate:
Obama administration officials say they were expecting praise from critics of the new health care law when they offered to exempt selected employers and labor unions from a requirement to provide at least $750,000 in coverage to each person in their health insurance plans this year.Instead, Republicans have seized on the waivers as just more evidence that the law is fundamentally flawed because, they say, it requires so many exceptions. To date, for example, the administration has relaxed the $750,000 standard for more than 1,000 health plans covering 2.6 million people. . . .
Waivers are usually seen as a way to deal with exceptional circumstances in which the enforcement of a law or policy might cause hardship. But with the new health care law, exceptions like these have become increasingly common. They provide wiggle room in a law originally thought to be strict and demanding.
http://volokh.com/2011/03/20/hamburger-on-waivers-part-iii/
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http://reason.com/blog/2011/03/03/whoops-medicare-makes-48-billi
Reason Magazine
Whoops! Medicare Makes $48 Billion in "Improper" Payments
Peter Suderman | March 3, 2011
Your waste, fraud, and abuse factoid of the day: The federal government spent just a hair over $500 billion on Medicare payments in 2010—and nearly 10 percent of that spending was improper for some reason, including fraud, according to a new report by the Government Accountability Office.
Medicare, which the GAO notes is already on an “unsustainable” long-run path, shelled out an estimated $48 billion in "improper payments" last year—and, the report says, those in charge of the program aren’t doing nearly enough to avoid making similar payment mistakes in the future. In fact, the $48 billion figure is probably low, because it doesn’t include any improper payments from the Medicare Part D prescription drug benefit.
Even still, it’s enough for the government watchdog to warn that Medicare suffers from “pervasive internal control deficiencies.” Consequently, the GAO has dubbed Medicare a “high risk” program “because its complexity and susceptibility to improper payments, combined with its size, have led to serious management challenges.”
It’s not clear how much of the problem is related to fraud and how much is related to internal factors, and some Republicans seem upset about the lack of clarity on that front. The inability to tell which is which is a sign of how little oversight there is in the program’s payment system, but I’m not sure there’s much comfort to be had here either way: A system that loses tens of billions of dollars each year to sloppy, incompetent management is arguably even worse than one that’s been willfully defrauded by clever schemers. It’s one thing to lose a truckload of taxpayer money when someone is making a concerted effort to bilk you out of it. It’s another thing entirely to lose it because you were so inept that you couldn’t keep track of it.
This is the sort of thing to remember when single-payer supporters talk up Medicare-For-All. Yes, Medicare remains popular, but it’s incredibly wasteful and has severe, ongoing management problems. As GAO notes, this isn’t the first time tens of billions in waste has been found in the system; when the program was examined in 2007, GAO found similarly problematic spending patterns, and recommended changes accordingly. But Medicare’s administrators have failed to effectively follow up on the bulk of the oversight office’s suggestions since then. Expand Medicare, especially to the point where it has a monopoly or near-monopoly, and you’re only going to expand this sort of waste and mismanagement.
That’s obviously not to say that private insurers have no waste, no mismanagement. But they differ from Medicare in two important ways: First, they can go out of business. If they consistently lose money due to incompetence, it won’t take long before they shut down. Second, those dealing with private insurers can leave for competitors if poor management forces prices up too high. Now, competition in the health insurance is far from perfect, and occurs mostly at the employer level. But as anyone who’s ever had to switch plans after their employer went to a new insurance provider knows, it does exist, and employers do make changes when they think they can get a better deal from another provider. But Medicare doesn’t have that sort of competition, and and it continues to run on the taxpayer’s dime regardless of how poorly managed it is—all of which helps explain why it wastes so much money on mismanagement and how it ended up on the unsustainable, fiscally ruinous course it’s on now.
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Remember those rotten, profit driven insurance companies driving up health care costs? Their profit is one quarter of what the GAO says Medicare misallocates.
Medicare Loses Nearly Four Times as Much Money as Health Insurers Make
3:48 PM, MAR 3, 2011 • BY JEFFREY H. ANDERSONSingle PagePrintLarger TextSmaller Text
In a newly released report, the Government Accountability Office (GAO) estimates that, in fiscal year 2010, $48 billion in taxpayer money was squandered on fraudulent or improper Medicare claims. Meanwhile, the nation’s ten largest health insurance companies made combined profits of $12.7 billion in 2010 (according to Fortune 500). In other words, for every $1 made by the nation’s ten largest insurers, Medicare lost nearly $4.
This is sobering news for the minority of Americans who (for some reason) continue to think that government-run health care is a model of efficiency and cost-effectiveness. Last year, total outlays for Medicare were $509 billion; therefore, Medicare spent nearly 10 percent of its outlays on fraudulent or improper claims. Actually, it may have been even worse than that: The GAO writes that this $48 billion in taxpayer money that went down the drain doesn’t even represent Medicare’s full tally of lost revenue, since it “did not include improper payments in its Part D prescription drug benefit, for which the agency has not yet estimated a total amount.”
The combined profits of the nation’s ten largest health insurers are down 2 percent from 2008. In fact, the nation's ten largest health insurers’ combined profits last year were less than the profits that Walmart — a supporter of Obamacare — made all by itself. Walmart made $14.3 billion last year, up 12 percent from 2008. (On the Fortune 500 list, Walmart’s profits also dwarf the profits of all but one oil company.)
True, private insurers may never manage to make nearly as much money as government-run heath care programs manage to lose. Still, there is good news on the horizon for insurers: If Obamacare isn’t repealed, then, as of 2014, every American will be required to buy their product (or a federally mandated version of it) under penalty of law. Moreover, the Congressional Budget Office estimates that $1 trillion would be funneled from taxpayers, through Washington, to those same insurers, from 2014 to 2025. Ever wonder why insurers didn’t oppose Obamacare?
http://www.weeklystandard.com/blogs/medicare-loses-nearly-four-times-much-money-health-insurers-make_552860.html
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How ObamaCare Strokes the Fat Cats by Michael D. Tanner
from Cato Recent Op-eds
When government says it's set to do something for the little guy, hang on to your wallet.
The latest evidence for this came in a congressional report released last week, showing that the seniors lobby (and insurance giant) AARP stands to make more than $1 billion as a result of ObamaCare.
The game works this way: The new health-care law contains more than $136 billion in cuts to the Medicare Advantage program, which now covers one in five seniors. As a result, according to Medicare's chief actuary, at least 7 million seniors will be forced out of their Medicare Advantage plan and back into traditional Medicare.
But since traditional Medicare lacks several Medicare Advantage benefits, many will have to buy so-called "Medigap" policies to make up the difference. And who's the nation's largest marketer of Medigap plans? The AARP.
An 18-month congressional probe found that the AARP stands to make $55 million to $166 million in one year alone from seniors switching from Medicare Advantage to AARP Medigap plans. Over the next 10 years, it would earn more than $1 billion from new customers. Business is good if you can get the government to put your competitors out of business.
The AARP isn't the only big ObamaCare winner to come to light in the last few days. A hearing by the House Energy and Commerce's Subcommittee on Oversight and Investigations disclosed that labor unions and big businesses — including General Electric, Verizon, AT&T and IBM — have received nearly $1.9 billion in payments under the new health-care law to help offset health-insurance costs for early retirees.
The biggest single recipient: the United Auto Workers, which got nearly $207 million in taxpayer money. By the time the feds finish handing out funds to well-connected companies and unions, it's expected to have cost taxpayers $5 billion.
The program doesn't even require companies or unions to demonstrate any "financial need" for the subsidy. As a result, it enables companies to incentivize early retirement for older employees, saving the companies money and improving their balance sheets — with taxpayers footing the bill.
This is nothing new, of course. ObamaCare has benefited special interests and big businesses from the start. The major pharmaceutical firms got a requirement that all insurers must cover their products. That's one reason why Big Pharma spent more than $150 million on ads in favor of the bill.
Other provider groups and beneficiary constituencies are pursuing a similar strategy. They've been lobbying a government panel that will determine the benefits that must be included in every insurance plan. At recent hearings, interests ranging from the in-vitro-fertilization industry to autism groups showed up to demand their share of the spoils.
Even large insurers played the game: They got a mandate requiring everyone to buy their product. Sure, they'll have to adjust to some costly new regulations, and those added benefits will be expensive, but they can simply pass the costs on to consumers via higher premiums. After all, what can consumers do? If they decide not to buy insurance, the government will punish them.
Nor should we forget that politically connected firms and unions have regularly received waivers from ObamaCare's worst provisions.
So one year in, ObamaCare's big winners are becoming clear: Big Business, Big Labor and special-interest lobbies. The only losers are the American people.
Michael Tanner, a Cato Institute senior fellow, is co-author of Healthy Competition: What's Holding Back Health Care and How To Free It.
http://www.cato.org/pub_display.php?pub_id=12951
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Wash. Post, CBS, NBC Should Disclose Receipt of ObamaCare Subsidies
from Cato @ Liberty by Michael F. Cannon
1 person liked this
By Michael F. Cannon
It's not an easy period for major media organizations, what with all this creative destruction revamping that sector of the economy. So the Washington Post Co. couldn't help but be pleased when it received a $570,000 bailout from ObamaCare's Early Retiree Reinsurance Program. That program allows the Obama administration to run up the national debt another $5 billion by doling out cash to corporations that provide retiree health benefits. The CBS Corporation received more than $720,000. General Electric, a part owner of NBC Universal, Inc., cleared nearly $37 million.
Since The Washington Post, CBS News, NBC News, and MSNBC have now received subsidies (the latter two indirectly) from this very controversial law, their reporters should disclose that fact to their audiences when reporting on ObamaCare. A disclaimer like this should suffice: "The Washington Post Corporation has received subsidies under the health care law." That would be consistent with how NBC discloses its relationship with General Electric:
http://www.thedailyshow.com/watch/thu-march-24-2011/family-matters
Oh, and kudos to the marketing whiz who decided to call all these ObamaCare spending programs "slush funds."
http://www.cato-at-liberty.org/wash-post-cbs-nbc-should-disclose-receipt-of-obamacare-subsidies/
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WHAT does Medicaid have in common with “I Dream of Jeannie,” “Lost in Space” and “Get Smart”? They all made their debut in 1965. Although we enjoy watching reruns of these classics, the television networks have updated their programming. The federal government should do the same.
In recent years Washington has taken an obsolete program, which covers health care for low-income Americans, and made it worse through restrictive rule-making that defies common sense. It is biased toward caring for people in nursing homes rather than in their own homes and neighborhoods. It lacks the flexibility to help patients who require some nursing services, but not round-the-clock care.
If we were designing a health insurance program for low-income families today, we would use a much different model to drive efficiency and innovation — one that recognizes that the delivery of health care is fundamentally personal and local.
Time and again states like Wisconsin have blazed the path in Medicaid — from giving individuals greater control over their care to expanding the use of electronic medical records — while the federal bureaucracy has lagged behind. Just now Washington is discovering accountable care organizations (networks of doctors and hospitals that share responsibility for caring for patients and receive incentives to keep costs down) and “medical homes” (a model in which one primary-care doctor takes the main responsibility for a patient).
Wisconsin has created a database of claims and payments that gathers information from all insurers, including private companies and the state Medicaid program. It allows people to compare cost and quality across providers. We have asked Washington to add its data to our database, but it has not done so.
We need to modernize not only Medicaid’s benefits and service delivery, but also its financing. In good times, the open-ended federal Medicaid match encourages states to overspend. Amazingly, the program is now viewed by some states as a form of economic development because each state can at least double its money for each dollar spent. That matching feature penalizes efficiency and thrift, since a reduction of $1 in state spending also means forfeiting at least one federal dollar, often more.
Medicaid in its present, outdated form is unsustainable. Without serious reform, it is unthinkable to add 16 million more people, as President Obama’s health care legislation would do. The White House budget would temporarily pay 100 percent of the costs of new Medicaid enrollees. As a result, many states would expand enrollment, deferring the hard decisions until the federal money goes away.
An alternative approach is to offer block grants for Medicaid, as my fellow Wisconsinite, Representative Paul D. Ryan, the chairman of the House Budget Committee, has urged. Why now support a block grant for Medicaid when similar proposals have failed?
First, we know from more than a decade of experience with welfare reform that switching from open-ended entitlements to block grants pushes both individuals and states to behave more responsibly.
Second, more than a decade of experience with the State Children’s Health Insurance Program, which has vastly expanded coverage for children while being more flexible than Medicaid, shows the success of the block-grant model.
Third, there are already caps within Medicaid through so-called Section 1115 demonstration projects. It is through such projects, known as waivers, that innovative programs like BadgerCare in Wisconsin and MassHealth in Massachusetts (which President Obama says was his model for reform) were built. States from Arizona to Washington have also had waivers that capped federal liability for Medicaid. Their success shows that we can move beyond demonstration projects and let the federal government relinquish control over Medicaid.
Finally, some state officials oppose block grants because capped financing would bring the fiscal discipline they try desperately to avoid. But this discipline is precisely what is necessary to slow the rate of growth in health care costs. It is unlikely that doctors and hospitals will support authentic cost-saving measures as long as they believe there is more money coming from somewhere.
States are not merely “laboratories of democracy,” but also sovereign governments under our system of federalism. Unfortunately, the encroachment of the federal government in Medicaid threatens to reduce states to mere agents.
Block grants would bring a truce to the tug-of-wars between Washington and the states. This is the best option for Medicaid, facing a midlife crisis, to survive.
Scott Walker, a Republican, is the governor of Wisconsin.
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I posted on Media Issues that WSJ editorial writer Joseph Rago won the 2011 Pulitzer Prize for Editorial Writing today. Here are the stories for which he won the award: Hot links for all at the link: http://online.wsj.com/article/SB10001424052748703916004576271222668393848.html
1) Back to the ObamaCare Future, March 1, 2010
2) The ObamaCare Crossroads, March 20, 2010
3) ObamaCare and the Constitution, April 2, 2010
4) Farewell, Medicare Advantage, June 11, 2010
5) The Avastin Mugging, August 18, 2010
6) ObamaCare 'Amnesia,' Sept. 10, 2010
7) Big Insurance, Big Medicine, Oct. 26, 2010
8.) Breast Cancer and the FDA, Dec. 17, 2010
9) Sebelius's Price Controls, Dec. 22, 2010
10) PolitiFiction, Dec. 23, 2010
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http://reason.com/blog/2011/04/25/obamacares-cutthroat-corporati
ObamaCare's Cutthroat Corporatism
Peter Suderman | April 25, 2011
Prior to the passage of the Patient Protection and Affordable Care Act, many of the big players in the health care industry met with the White House in order to cut deals that would result in industry support. The logic, at the time, was that a health care overhaul was inevitable, and therefore it was more advantageous for industry groups to be seen as friendly towards the legislation than as oppositional. The White House, for its part, was at least somewhat anxious about the prospect of fighting a big-dollar industry campaign to kill the law (like the one that helped defeat HillaryCare), and so had an incentive to bring industry groups to the bargaining table.
We're still waiting for information on many of the negotiations that took place between the White House and various outside corporate and union groups. But it's fairly well established that the drug industry, through PhRMA, cut a deal to support the overhaul. In exchange, the White House promised to limit industry concessions to about $80 billion, and agreed that Medicare would not use its bargaining power as a pharmaceutical megapurchaser to negotiate cheaper prices on prescription drugs.
PhRMA saw the health care overhaul as a chance to advance its long-term interests and played along. But funny enough, it now seems that the White House is not all that interested in holding up its end of the bargain. President Obama's recent speech on the debt included proposals that would violate the agreement.
Drug industry sources tell FOX Business the Administration is backtracking on what is called the “PhRMA deal” in health reform, a deal that was struck behind closed doors in late 2009 and early 2010 in order to get the industry to support and endorse health-care reform.
In the “PhRMA” deal, drug companies would fork over $80 billion in fees as well as give drug discounts to seniors in Medicare over 10 years, among other things.
In exchange, the White House agreed, among other items, to not force the drug industry to accept rebates on drugs sold through Medicare Part D, a program launched under President George W. Bush to subsidize prescription drugs for seniors.
But President Barack Obama's new deficit push calls for those Medicare rebates, via the Simpson-Bowles plan.
The deficit plan "has blown the deal to smithereens," says William S. Smith, managing director of Healthcare National Strategies, a D.C.-based government affairs consulting firm. “The Obama Administration has repudiated the PhRMA deal,” says Smith, a former vice president for US public affairs and policy at Pfizer.
The Obama debt plan may not become law. But the fact that the president is willing to propose these deal-breaking measures at all suggests that the White House feels no obligation to honor the agreement. And why should the White House stick to its word? The incentive to play along disappeared the day the law passed. At this point, you have to wonder why PhRMA and other groups agreed to these non-enforceable deals in the first place. Either way it tells you a lot about the mangled state of America's quasi-government-run health care system: Industry makes a backroom deal to buy into new federal regulations out of self-interest, then, after the regulations pass, finds out that the government has no plans to stick by the agreement. It's cutthroat corporatism at its finest.
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Doc Holiday
by Michael D. Tanner
This article appeared in The New York Post on May 1, 2011.
The United States already faces a growing physician shortage. As our population ages, we require more and more intensive health care. At the same time, enrollment in medical schools has been essentially flat, meaning we are not producing new physicians at anywhere near the rate we need to. In fact, according to the American Association of Medical Colleges, we face a shortfall of more than 150,000 doctors over the next 15 years.
And it could get a whole lot worse.
The health reform bill signed into law last year is expected to significantly increase the number of Americans with health insurance or participating in the Medicaid program. Meanwhile, an aging population will increase participation in Medicare. This means a greater demand for physician services.
romising universal health coverage is easy. But what does universal coverage mean if you can't actually see a doctor?
But at the same, the bill may drive physicians out of practice.
Existing government programs already reimburse physicians at rates that are often less than the actual cost of treating a patient. Estimates suggest that on average physicians are reimbursed at roughly 78% of costs under Medicare, and just 70% of costs under Medicaid. Physicians must either make up for this shortfall by shifting costs to those patients with insurance — meaning those of us with insurance pay more — or treat patients at a loss.
As a result, more and more physicians are choosing to opt-out of the system altogether. Roughly 13% of physicians will not accept Medicare patients today. Another 17% limit the number of Medicare patients they will see, a figure that rises to 31% among primary care physicians. The story is even worse in Medicaid, where as many as a third of doctors will not participate in the program.
Traditionally, most doctors have been willing to take some Medicare patients either out of altruism or as a "loss leader," to reach other family members outside the Medicare program. Others try to get around Medicare's low reimbursement rates by unbundling services or providing care not covered through the program. (Nearly 85% of seniors carry supplemental policies to cover these additional services). With many office and equipment costs fixed, even a low reimbursement patient may be better than no patient at all for some doctors. This is even more true for hospitals where Medicare patients may account for the majority of people they serve. And doctors can take some comfort in the fact that Medicare is pretty much guaranteed to pay and pay promptly. The same is not always true of private insurance.
But if reimbursements fall much more, the balance could be tipped.
The government's own chief actuary says that reimbursement cuts could mean "reductions in access to care and/or the quality of care." Once the cuts hit hospitals, they too will be in trouble. Medicare's actuaries estimate that 15% of hospitals could close. Inner-city and rural hospitals would be hardest hit.
Nor is the pressure on reimbursement rates likely to be felt solely in government programs. The health care law contains a number of new regulations that are already driving up insurance premiums. The government is responding by cajoling and threatening insurers. If insurers find their ability to pass on cost increases limited, they too may begin to cut costs by cutting reimbursements.
For a lot of older physicians, retirement in Florida may begin to look like a very good option. Roughly 40% of doctors are age 55 or over. Are they really going to want to stick it out for a few more years if all they have to look forward to is more red tape (both government and insurance company) for less money? Those that remain are increasingly likely to join "concierge practices," limiting the number of patients they see and refusing both government and private insurance.
And, at the same time, fewer young people are likely to decide that medicine is a good career. Remember, the average medical school graduate begins their career with more than $295,000 in debt.
A 2010 IBD/TPP Poll found that 45% of doctors would at least consider leaving their practices or taking early retirement as a result of the new health care law. And, an online survey by Sermo.com, a sort of Facebook for physicians, found that 26% of physicians in solo practices were considering closing. Of course, not every doctor who told these polls that he or she would consider leaving the field will actually do so. But if even a small portion depart, our access to medical care will suffer.
In fact, we have already seen the start of this process in Massachusetts, where Mitt Romney's health care reforms were nearly identical to President Obama's. Romney's reforms increased the demand for health care but did nothing to expand the supply of physicians. In fact, by cracking down on insurance premiums, Massachusetts pushed insurers to reduce their payments to providers, making it less worthwhile for doctors to expand their practices. As a result, the average wait to get an appointment with a doctor grew from 33 days to over 55 days.
Promising universal health coverage is easy. But what does universal coverage mean if you can't actually see a doctor?
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Woof,
This brought to you by the same government that will be running your healthcare:
http://news.yahoo.com/s/ap/20110510/ap_on_re_us/us_postal_problems (http://news.yahoo.com/s/ap/20110510/ap_on_re_us/us_postal_problems)
P.C.
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By LAURA MECKLER
White House hopeful Newt Gingrich called the House Republican plan for Medicare "right-wing social engineering," injecting a discordant GOP voice into the party's efforts to reshape both entitlements and the broader budget debate.
More on Politics from WSJ
The New Speed of Politics in 2012 Fiscal Health Hinges on Containing Costs of Care Huckabee Declines to Endorse Anyone Rep. Ryan Weighs Run for the Senate Kyl May Be Open to Revenue Increases Medicare Stirs Fray Over Debt Full coverage at Washington Wire blog In the same interview Sunday, on NBC's "Meet the Press," Mr. Gingrich backed a requirement that all Americans buy health insurance, complicating a Republican line of attack on President Barack Obama's health law.
The former House speaker's decision to stick with his previous support for an individual mandate comes days after former Massachusetts Gov. Mitt Romney defended the health revamp he championed as governor, which includes a mandate.
The moves suggest the Republican primary contest, which will include both men, could feature a robust debate on health care, with GOP candidates challenging the Democratic law while defending their own variations.
On the List for 2012?
Read about the potential Republican presidential contenders.
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More photos and interactive graphics Later Sunday, in an interview with the Wall Street Journal, he also acknowledged that many Republicans are uncomfortable with requiring insurance coverage but challenged them to offer an alternative solution. "Most Republican voters agree with the principle that people have some responsibility to pay for their costs," he said.
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NBC / Associated Press
As Mike Huckabee exits, Newt Gingrich takes a shot at Paul Ryan's plan, and like Mitt Romney, supports the concept of a mandate to buy insurance.
Mr. Gingrich also said he would like to see the mandate implemented at the state level, with states experimenting with alternative approaches. But he said he should apply to all Americans.
The Republican presidential field is beginning to take shape after an unusually long delay, with former Arkansas Gov. Mike Huckabee saying he would skip the 2012 race and the other candidates beginning to engage in substantive policy debates.
Mr. Huckabee declined to endorse any of the remaining candidates. His decision opens the door for other Republicans to court the Christian conservatives who fueled the former Baptist minister's 2008 campaign.
Mr. Gingrich, who has fashioned himself as a policy wonk in recent years, instantly roiled an already controversial debate over the U.S.'s long-term budget picture. He said on NBC's "Meet the Press" that seniors should not be required to use a new Medicare program, as envisioned by the House GOP, but should be persuaded to voluntarily migrate to a better system.
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Associated Press
Paul Ryan
"I don't think right-wing social engineering is any more desirable than left-wing social engineering," he said when asked about a Medicare plan championed by House Budget Chairman Paul Ryan (R., Wis.) as an element of the party's 2012 budget proposal. He said he was against "radical change" on the right and the left.
The House GOP budget would privatize Medicare for Americans under age 55. When they reach retirement age, they would receive a government subsidy to buy a private insurance policy instead of participating in the existing government-run system. The subsidies' value likely would not rise as quickly as health care costs are expected to rise.
Ryan spokesman Conor Sweeney said in response to Mr. Gingrich that Mr. Ryan's plan is the only serious proposal for Medicare, which faces long-term financial crisis as health costs rise and Baby Boomers join the program's ranks. "The most 'radical' course of action on Medicare is to continue to cling to the unsustainable status quo," he said.
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Associated Press
Mike Huckabee
The GOP budget cleared the House as part of a budget outline without a single Democratic vote, and Democrats have sought to use the policy as a line of political attack with voters.
Republican leaders have said they do not plan to write legislation that would flesh out details of the concept. But they also say the Ryan plan remains their position in budget talks with the White House and the Senate.
Other Republican candidates for president, including Mr. Romney and former Minnesota Gov. Tim Pawlenty, have applauded Mr. Ryan for showing leadership in putting together a budget plan, but have declined to endorse its elements.
In the interview with the Journal, Mr. Gingrich also said that in advocating for big changes to Medicare, House Republicans have failed to both come up with the right policy, and to properly sell it to the country. He said bad salesmanship was part of President Obama's problem in pushing his own health care plan. "Republicans should learn. There's a big lesson there," he told the Journal.
Mr. Gingrich also stuck with his past support for the central plank of the Obama health plan—the mandate to buy insurance.
In 1993, Mr. Gingrich said Americans should be required to have health insurance just as they are required to have automobile insurance. Back then, he endorsed the use of vouchers to help everyone buy insurance. He also endorsed the use of income-based vouchers to help everyone buy insurance.
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Nearly 20 percent of new Obamacare waivers are gourmet restaurants, nightclubs, fancy hotels in Nancy Pelosi’s district
By Matthew Boyle - The Daily Caller 12:07 AM 05/17/2011
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Of the 204 new Obamacare waivers President Barack Obama’s administration approved in April, 38 are for fancy eateries, hip nightclubs and decadent hotels in House Minority Leader Nancy Pelosi’s Northern California district.
That’s in addition to the 27 new waivers for health care or drug companies and the 31 new union waivers Obama’s Department of Health and Human Services approved.
Pelosi’s district secured almost 20 percent of the latest issuance of waivers nationwide, and the companies that won them didn’t have much in common with companies throughout the rest of the country that have received Obamacare waivers.
Other common waiver recipients were labor union chapters, large corporations, financial firms and local governments. But Pelosi’s district’s waivers are the first major examples of luxurious, gourmet restaurants and hotels getting a year-long pass from Obamacare.
For instance, Boboquivari’s restaurant in Pelosi’s district in San Francisco got a waiver from Obamacare. Boboquivari’s advertises $59 porterhouse steaks, $39 filet mignons and $35 crab dinners.
Then, there’s Café des Amis, which describes its eating experience as “a timeless Parisian style brasserie” which is “located on one of San Francisco’s premier shopping and strolling boulevards, Union Street,” according to the restaurant’s Web site.
“Bacchus Management Group, in partnership with Perry Butler, is bringing you that same warm, inviting feeling, with a distinctive San Francisco spin,” the Web site reads. Somehow, though, the San Francisco upper class eatery earned itself a waiver from Obamacare because it apparently cost them too much to meet the law’s first year requirements.
The reason the Obama administration says it has given out waivers is to exempt certain companies or policyholders from “annual limit requirements.” The applications for the waivers are “reviewed on a case by case basis by department officials who look at a series of factors including whether or not a premium increase is large or if a significant number of enrollees would lose access to their current plan because the coverage would not be offered in the absence of a waiver.” The waivers don’t allow a company to permanently refrain from implementing Obamacare’s stipulations, but companies can reapply for waivers annually through 2014.
Café Mason, a diner near San Francisco’s Union Square, got a waiver too. When The Daily Caller asked the manager about the waiver and how the president’s new sweeping federal health care law was affecting his restaurant, he hung up the phone. The Franciscan Crab restaurant on Fisherman’s Wharf in San Francisco got a waiver. Its menu features entrees ranging from about $15 to $60. The Franciscan’s general manager didn’t return TheDC’s requests for comment.
Four-star hotel Campton Place got one too, as did Hotel Nikko San Francisco, which describes itself as “four-diamond luxury in the heart of the city.” Tru Spa, which Allure Magazine rated the “best day spa in San Francisco,” received an Obamacare waiver as well.
Before hanging up on TheDC, Tru Spa’s owner said new government health care regulations, both the federal-level Obamacare and new local laws in Northern California, have “devastated” the business. “It’s been bad for us,” he said, without divulging his name, referring to the new health care restrictions.
But, the spa owner wouldn’t talk about it or the reason his company sought a waiver. He hung up after saying, “I’ve got clients on the other line, good-bye.”
San Francisco Honda, which has two of its three locations in Pelosi’s district, and San Francisco’s Royal Motors Group both got waivers too. Neither called TheDC back.
Blue & Gold Fleet, which describes itself as “the Bay Area’s premier provider of Bay Cruise, Ferry Service and Motorcoach Tours,” got an Obamacare waiver approved in April. The tour service company didn’t return TheDC’s requests for comment.
Nightclub Infusion Lounge got an Obamacare waiver approved in April too. Infusion Lounge calls itself a “sophisticated nightlife destination” with “Asian inspired sub-rosa lounge, fashioned by Hong Kong’s hottest designer, Kinney Chan,” which makes for a “true ultra lounge catering to both dancing hipsters and young professionals looking to relax in style.” Infusion Lounge’s owners didn’t return TheDC’s requests for comment either.
Simco Restaurants and several other affiliated chains based in the area got waivers for their businesses as well. For example, Gordon Yoshida, the manager of memorabilia store Only in San Francisco, told TheDC that Sandra Fletcher of Simco walked him through the process of getting an Obamacare waiver. Fletcher did not return TheDC’s requests for comment.
Pelosi’s office did not respond to TheDC’s requests for comment either.
http://dailycaller.com/2011/05/17/nearly-20-percent-of-new-obamacare-waivers-are-gourmet-restaurants-nightclubs-fancy-hotels-in-nancy-pelosi’s-district/
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I can pose this under constitutional questions as well, but in terms of health care policy, given the equal protection clause of the 14th amendment, why isn't a waiver for one - automatically a waiver for all?
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The Equal Protection Clause, part of the Fourteenth Amendment to the United States Constitution, provides that "no state shall ... deny to any person within its jurisdiction the equal protection of the laws".[1] The Equal Protection Clause can be seen as an attempt to secure the promise of the United States' professed commitment to the proposition that "all men are created equal"[2] by empowering the judiciary to enforce that principle against the states.[3] As written it applied only to state governments, but it has since been interpreted to apply to the Federal Government of the United States as well.
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This seems to me to be a very pertinent and troubling question.
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Volokh is aslo nibbling at this, asking if the waivers count as political favors:
Are Health Care Waivers Political Favors?
Jonathan H. Adler • May 18, 2011 10:38 am
The Daily Caller reports that a substantial percentage of recent health care waivers issued by the Department for Health and Human Services have gone to businesses in Rep. Nancy Pelosi’s San Francisco district — and not just any businesses, but swanky spas, restaurants and nightclubs.
Does this story mean that health care waivers are being used for political purposes? We don’t know. The issuance of 1,000-plus waivers is a relatively short period has raised lots of questions. The problem is that HHS has not been sufficiently clear about the criteria it is using in its waiver decisions. As a consequence, it is difficult to know whether waivers are being used improperly. As I’ve written before (see, e.g., here, here, and here), I think waivers can be a valuable policy tool, so long as their use is guided by a clear, ascertainable standard for their use. Thus far, I don’t think that has been the case with waivers issued under the PPACA.
UPDATE: As a commenter notes below, one explanation for the large number of waiver applications for San Francisco businesses is “Healthy San Francisco”. As this story from the San Francisco Business Times explains:
Under Healthy San Francisco, all San Francisco businesses with over 20 employees must provide health care coverage or access to health care for its employees. Many employers opt to open a Health Reimbursement Account or HRA for its employees; those accounts are then used to reimburse employers for some health care costs.
The waivers that are granted for one-year periods are intended to protect employees from suffering any reduction in coverage because of suddenly increased premiums, and to limit how much employers need to pay in a given year for coverage. The federal Department of Health and Human Services has approved 1,372 waivers so far — almost 90 percent of the waiver requests it has received.
“We have mandatory health care expenditures. We are the only place I know of in the country that has that,” said Rob Black, executive director of the Golden Gate Restaurant Association. “Because we have a 100 percent expenditure rate, we are going to have a much higher take-up rate (of waivers) than the country as a whole. That is what is driving that.”
As for the standards upon which waivers are granted, I do not believe the two guidance documents linked in the comments (here and here) concerning the waiver program HHS created with interim final regulations last year provide much in the way of clear criteria. Further, as Columbia’s Professor Joseph Hamburger has argued, it is not clear the PPACA authorizes a wavier authority as wide-ranging as that which HHS has exercised.
Meanwhile, on Friday Nevada became the third state to receive a waiver for the PPACA’s requirements that insurers spend a minimum of 80 percent of premiums on care, following New Hampshire and Maine. Five more state waiver requests are pending.
http://volokh.com/2011/05/18/are-health-care-waivers-political-favors/
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From the Newt discussion, thanks CCP, this is worth pursuing here:
Newt:"Citizens should not be able to cheat their neighbors by not buying insurance, particularly when they can afford it, and expect others to pay for their care when they need it"
CCP: Good point. There is no easy answer to this.
...
CCP: People don't get insurance because they can't pay for it, can't get it (preexisting condition), or take a chance.
But all these groups know they can show up in an ER and they will get treated.
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Above on this thread page, Lawrence Tribe put it this way (in a BD post): "Individuals who don’t purchase insurance they can afford have made a choice to take a free ride on the health care system."
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I feel bad about posting my honest and accurate reaction to Tribe/BD: ("Bullsh*t") because that seemed to end the discussion, but as one healthy self-employed person with enough assets to be disqualified from state plans who now has lapse in coverage, I can say that none of the above is the reason. In fact, the Republican counter-proposal to Obamacare of last year would have solved my problem, but Dems are not going to allow any partial fixes to pass while Utopia is pending in court.
I paid almost 20 years of major medical coverage when I went self-employed without receiving an insurance dime paid out toward my health care. Now I desperately want to be covered again but can't find any plan to fit my need. My illiquid assets are my coverage. Yes I will be treated in any emergency room or any other medical facility and it will be FEE FOR SERVICE just like it was when I was covered and just like it is for ever other product or service I procure in the economy almost anywhere in the world. That does not make me a leach on society. I will be paying the bill. Not Prof. Tribe or anyone else.
I am victim of the 12 cent rule. My experience is that every dollar 100% of every healthcare product and service I have procured was paid by me out of my pocket and watched like a hawk, in addition to the tens of thousands I paid in premiums. But I pay 100% in a world where everyone else is paying only 0.12 of every dollar of service and don't give a rip what it costs.
Third party pay is the problem, not the solution. I would LOVE to pay fair market value for medical services I can afford and medical coverage beyond what I can afford, but that would be beyond the value of any bond that Newt would require.
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When mandatory car insurance started, we also had the option of posting 'bond' up to minimum coverage in lieu of sharing risk with worse drivers. That alternative should have been 'post assets of your choosing' - in a free society - and furthermore that partial freedom provision quietly went away once people became acclimated with mandatory insurance.
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We could have gov't get the hell out of healthcare and let the free market price it. I know, just crazy talk..... :roll:
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We could have gov't get the hell out of healthcare and let the free market price it. I know, just crazy talk..... :roll:
That would solve it, but for some reason we can't.
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http://danieljmitchell.wordpress.com/2011/04/21/would-you-prefer-privatization-or-a-death-panel/
Choose wisely.
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Underneath Newt Gingrich's rhetoric last week about Paul Ryan's "right-wing social engineering" was a common anxiety about the politics of Medicare: Is this the right moment for entitlement reform? Did the GOP endanger its House majority by giving Democrats a campaign strategy for 2012, and is Mr. Ryan's proposal really too "radical" after all?
Entitlement reform is the hardest challenge in politics, which is one reason we oppose all new entitlements. But Republicans now tempted to retreat at the first smell of cordite need to understand that they are taking even larger political and policy risks than Mr. Ryan is. The Medicare status quo of even two years ago, much less 20, is irretrievably gone, and anyone pining for its return is merely making President Obama's vision of government-run health care inevitable.
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This reality is underscored in the just-released annual report of the Medicare trustees. Democrats sold ObamaCare as a way to slow the growth of costs, but the report shows that the program's finances have deteriorated even since last year. Medicare is carrying $24.6 trillion in unfunded liabilities through 2085, and chief actuary Richard Foster says even that does "not represent a reasonable expectation for actual program operations."
As a matter of simple arithmetic, this problem can't be solved with tax increases, because health costs and thus government spending on health care are rising so much faster than the economy as a whole is growing. The U.S. capacity to pay for Medicare on present trend diminishes every year.
With ObamaCare, Democrats offered their vision for Medicare cost control: A 15-member unelected board with vast powers to set prices for doctors, hospitals and other providers, and to regulate how they should be organized and what government will pay for. The liberal conceit is that their technocratic wizardry will make health care more rational, but this is faith-based government. The liberal fallback is political rationing of care, which is why Mr. Obama made it so difficult for Congress to change that 15-member board's decisions.
Republicans have staunchly opposed this agenda, but until Mr. Ryan's budget they hadn't answered the White House with a competing idea. Mr. Ryan's proposal is the most important free-market reform in years because it expands the policy options for rethinking the entitlement state.
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Associated Press
House Budget Committee Chairman Paul Ryan
."Premium support" is not a new idea, but it has long been dormant, and Republicans will need to continue their effort to reintroduce it to voters. Seniors would receive a fixed-dollar subsidy from the government to choose from private insurance options, with higher payments for the poor and sick. Consumers would make cost-conscious choices at the margin, and insurers and providers would compete on health-care value and quality.
Mr. Gingrich is right that reforms of this magnitude need to be grounded in a social consensus built over time. But that means the task for Republicans is to educate the public about market principles and more consumer choice. Mr. Ryan's model is flexible enough to adjust the level and rate of growth of the premium-support subsidy. The Ryan Medicare plan was never going to be adopted this year, but it is the first credible, detailed alternative to Mr. Obama's approach.
Some GOP critics, like Mr. Gingrich, claim that it would be politically safer to introduce premium support but give seniors a chance to keep traditional Medicare. The problem is that this leaves all of Medicare's distortions in place and does little to stop its explosive costs. As long as the major incentive in health care is Medicare's fee formula, very little will improve.
Republicans have been passing such reform quarter-measures for 20 years, with little to show for it. Medicare Advantage already offers private insurance options to one in four seniors, but this camel's nose hasn't led to a reconstruction of the larger Medicare tent. The same is true of health savings accounts in the 2003 prescription drug benefit, or the current Republican talking point that medical malpractice reform will somehow solve every problem in health care.
All of these are important but don't reach Medicare's core problem of government-controlled prices and regulation, and in any case Democrats always gut the reforms once they return to power. In retrospect, this play-it-safe strategy paved the way for ObamaCare.
The political forces unleashed by ObamaCare will grow unimpeded if Republicans now retreat from offering an alternative. Once the White House's efforts to limit costs by fiat fail—as they inevitably will—liberals will turn to even harsher controls. This future is already emerging in post-Mitt Romney Massachusetts, and also in Vermont, which wants to move to single government payer.
***
We wrote earlier this year that Republicans would get no objection from us if they postponed Medicare reform until they had a GOP President, but the House went ahead anyway. Far be it from us to criticize politicians for having too much courage. But having committed themselves, Republicans will appear (and will be) feckless if they abandon reform only weeks after voting for it. Trying to change entitlements can be agony, but it is fatal to try and fail. The voters will conclude the critics were right.
Mr. Gingrich has done great harm to his party and the cause of reform with his reckless criticism of Mr. Ryan, forfeiting any serious claim to be the GOP nominee. But equally as culpable are the self-styled conservative pundits who derided Republicans for dropping the reform mantle during the Bush years but now tremble that Mr. Ryan has gone too far.
The reality is that Medicare "as we know it" will change because it must. The issue is how it will change, and, leaving aside this or that detail, the only alternatives are Mr. Ryan's proposal to introduce market competition or Mr. Obama's plan for ever-tightening government controls on prices and care. Republicans who think they can dodge this choice are only guaranteeing that Mr. Obama will prevail.
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http://patriotpost.us/perspective/2011/05/25/paul-ryan-on-medicare/
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By KARL ROVE
A kerfuffle was stirred up last week by a devastating McKinsey & Company study that concluded up to 78 million Americans would lose their current health coverage as employers stopped offering insurance because of President Obama's Patient Protection and Affordable Care Act.
The report contradicted Mr. Obama's frequent pledge that under his reform, "if you like your health-care plan, you can keep your health-care plan." And McKinsey's was at least the fourth such analysis calling the president's promise into question.
Pulitzer Prize-winner Joseph Rago tracks the White House effort to prevent the impact of its policies.
.In May 2010, former Congressional Budget Office (CBO) Director Douglas Holtz-Eakin concluded that employers would drop coverage for about 35 million Americans because of ObamaCare. A month later, in June 2010, the National Center for Policy Analysis (NCPA) pegged the number between 87 million to 117 million. And last November, Allisa Meade, a McKinsey analyst, told health-insurance company executives that 80 million to 100 million people might lose their employer-provided health insurance.
Simple economics is the reason. According to the Kaiser Family Foundation's Employer Health Benefits 2010 Annual Survey, the annual premium for an average policy last year was $5,049 for a single worker, with the company picking up roughly $4,150 and the employee the rest. For a family of four, the total cost was $13,770, with the company picking up $9,773.
Yet under ObamaCare, businesses can stop providing health-care coverage, paying a $2,000 per-worker fine instead. For small businesses, the trade-off is even more attractive: They are given a pass on the first 50 workers.
Workers losing coverage will be moved into the "exchange," a government-run marketplace to buy health plans. Those whose insurance costs were more than a specified share of their income (9.5% in 2014) could get subsidies. The exchange starts in 2014 and is fully operational by 2016.
Perversely, ObamaCare both drives up the cost of insurance with mandates and rules while making it attractive for companies to dump the increasingly more expensive coverage and pay a lesser fine. There will be huge ramifications for the country's finances if more workers lose coverage than was estimated.
When Mr. Obama's health-care bill passed in March 2010, the CBO and the congressional Joint Committee on Taxation predicted that 24 million workers would be covered by the exchange. Of these, nine million to 11 million would lose their employer-provided coverage, offset by six million to seven million who would be getting employer-provided insurance, for a net of three million workers losing company-sponsored coverage. The CBO said the exchanges would cost $511 billion over ObamaCare's first decade.
But what if more people are dumped into the exchange than originally estimated? Costs from the increased subsidies will explode.
If Mr. Holtz-Eakin is correct that there will be 11 million more people in the exchange, then costs could be nearly 40% higher than the $511 billion price tag. If between 78 million and 87 million people are moved into the exchange, the tab could more than triple. And if NCPA's upper-range estimate is right and 117 million people were dumped into the exchange, ObamaCare would cost nearly $2 trillion more than expected in the first decade alone. Much of this extra expense would come from workers losing their employer-sponsored insurance.
Mr. Obama's health-care law has already put the country in bad financial shape. He claimed it reduced the deficit by $143 billion—but that was before the CBO added $115 billion to administer the legislation, including the hiring of bureaucrats and thousands of IRS agents to enforce the new mandates. This reduced Mr. Obama's claimed savings to $28 billion.
The deficit-reduction claim also came before House Budget Committee Chairman Paul Ryan drew attention to the law's Ponzi scheme. It's funded by borrowing $521 billion from the Social Security Trust Fund, Medicare, and new long-term care insurance premiums, and by ignoring the $300 billion cost over 10 years of the annual inflation increases in reimbursements to hospitals and doctors. These gimmicks hide the fact that ObamaCare is really $701 billion in the red in its first decade.
ObamaCare's deficits in its second decade (2020 to 2029) will be even more horrendous as it continues borrowing from Social Security, Medicare and the long-term care insurance program to meet its much larger than anticipated expenses, including a much higher number of people who end up in the exchange.
On March 9, 2010, then-Speaker of the House Nancy Pelosi famously told a meeting of county officials that "we have to pass the bill so that you can find out what is in it, away from the fog of the controversy."
We are now, to our horror, finding out how harmful this measure is. More Americans are realizing that unless repealed, ObamaCare will sink America in a sea of red ink. This helps explain why the nation has turned so hard against it—and against its author whose slippery pledges so misled us.
Mr. Rove is the former senior adviser and deputy chief of staff to President George W. Bush.
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"devastating McKinsey & Company study that concluded up to 78 million Americans would lose their current health coverage as employers stopped offering insurance because of President Obama's Patient Protection and Affordable Care Act. The report contradicted Mr. Obama's frequent pledge that under his reform, "if you like your health-care plan, you can keep your health-care plan." "
They lie with such ease, it used to be said of the Clintons. My health plan is gone and the reasons people like Lawrence Tribe have ascribed to my lack of coverage are false. Massive over-regulation doesn't lower costs and massive new regulations don't leave existing plans unchanged. It's not rocket science.
Why was it all or none? Why did they not implement immediately the important reforms Republicans would agree to while we wait for the monstrosity - if the good of the country was the goal.
Why was it delayed implementation? A taste of delayed care? Why was it 10 years to pay for 6, and then find out it doesn't.
"The deficit-reduction claim also came before House Budget Committee Chairman Paul Ryan drew attention to the law's Ponzi scheme. It's funded by borrowing $521 billion from the Social Security Trust Fund, Medicare, and new long-term care insurance premiums, and by ignoring the $300 billion cost over 10 years of the annual inflation increases in reimbursements to hospitals and doctors. These gimmicks hide the fact that ObamaCare is really $701 billion in the red in its first decade."
Are Ponzi schemes legal in all 50 states? Would someone please release Bernie Madoff.
I don't get the whole waiver thing. What basis does the selective waiver process have in equal protection under the law? What other laws allow for politically-based waivers? My tax return mandate? Please grant me a waiver.
The damage done to our economy before its implementation is immeasurable and largely unreported. See Ryan piece on regulatory uncertainty.
One reason people buy gold and other non-productive assets is that it is one last places you can put investment money that does not insert yourself into the vicious, highly regulated, ever-changing battle lines of state and federal legislatures and regulators for the crime of ... hiring people.
Some people want to build a better mousetrap. Other people want to read and study compliance opinions nearly everyday regarding all the changes and administrative ruling updates of highly restraining employment law, payroll law, layoff law, unemployment compensation law, workman comp law, healthcare law... If you don't want to do all of it, you won't be building a better mousetrap - not in this country.
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The smartest guy by far in my school district growing up went on to become a lawyer by way of a top Ivy league law school and made his career in the employee benefits section of a major local utility. That, unfortunately, not inventing amazing new energy sources or curing deadly diseases, is where the action is.
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The Obama Administration is handing out waivers far and wide for its health-care bill, but behind the scenes the bureaucracy is grinding ahead writing new regulations. The latest example is the rule for Accountable Care Organizations that are supposed to be the crown jewel of cost-saving reform. One problem: The draft rule is so awful that even the models for it say they won't participate.
***
The theory for ACOs, as they're known, is that hospitals, primary-care doctors and specialists will work more efficiently in teams, like at the Mayo Clinic and other top U.S. hospitals. ACOs are meant to fix health care's too-many-cooks predicament. The average senior on Medicare sees two physicians and five specialists, 13 on average for those with chronic illnesses. Most likely, those doctors aren't coordinating patient care.
This fragmentation is largely an artifact of Medicare's price control regime: The classic case study is Duke University Hospital, which cut the costs of treating congestive heart failure by 40% but then dumped the integration program because it lost money under Medicare's fee schedule.
View Full Image
Associated Press
A patient and doctor at Geisinger Medical Center, one of the physician groups that the ACO rule is based on.
Intelligent liberals now concede this reality but claim that the government merely needs to devise better price controls. By changing the way it pays, Medicare under the ACO rule is effectively mandating a new business model for practicing medicine. The vague cost-control hope is that ACOs will run pilot programs like Duke's and the successful ones will become best practices. While the program is voluntary for now, the government's intention is to make it mandatory in the coming years.
But what if they had an ACO revolution and no one showed up? The American Medical Group Association, a trade association of multispeciality practice groups and other integrated providers, calls the rule recently drafted by the Department of Health and Human Services "overly prescriptive, operationally burdensome, and the incentives are too difficult to achieve." In a survey of its members, 93% said they won't enroll.
The Administration wrote its rule based on an ACO pilot program that started in 2005 among 10 high-performing physician groups, including Geisinger Health System and Dartmouth-Hitchcock. All 10 say they have "serious reservations" about the new rule and that without major revisions "we will be unable to participate." In other words, the providers that are already closest to being an ACO have rejected the Administration's handiwork.
And no wonder, since the 429-page rule is a classic of top-down micromanagement. ACOs will need to comply with a kitchen sink of 65 clinical measures that are meant to produce efficiencies, like reducing infections or ensuring that patients take their medications after hospital discharge. If care at an ACO costs less than Medicare predicts it will cost under the status quo, then the ACO will receive a share of the savings as a bonus payment. The rule also includes financial penalties if an ACO misses its targets.
Incredibly, the ACO teams won't know in advance which patients they're supposed to manage. Seniors will be "retrospectively assigned" to an ACO at the end of every year, based on an arbitrary algorithm, for the purposes of calculating costs.
Think about that one: The Geisinger model works because Geisinger patients are treated by Geisinger physicians. Yet this rule is written to ensure that seniors can take "advantage of the full range of benefits to which they are entitled under the Medicare FFS program, including the right to choose between healthcare providers and care settings." So ACOs are going to transform health care, but individual patients don't need to be part of the transformation if they don't feel like it.
Oh, and HHS reserves the right to conduct site visits and audits and "to inspect all books, contracts, records, documents, and other evidence" to ensure that health systems are complying with the ACO rule. The mystery is why even 7% say they'll participate.
The irony, and maybe the tragedy, is that Paul Ryan's Medicare reform plan is far more likely to drive more accountable care. Under his proposed premium support payments, seniors would be responsible for the marginal costs of their care, and we suspect most will choose more efficient providers. As these incentives start to change patient behavior and spread throughout the delivery system, the doctors and hospitals that offer a better value for the health dollar will succeed.
This market approach respects the complexity and uncertainty of modern medicine, allowing for local flexibility and gradual change. Government doesn't know "what works and what doesn't," and it can't. What works will be different for different people and places.
***
The Obama Administration's attempt at omniscience delayed the ACO rule for months amid bitter interagency combat. The White House budget office favored more flexibility, but the HHS bureaucracy prevailed in its belief that it can run this brave new world via the Federal Register. ACOs are gaining traction among private health plans in concert with providers, but the regulatory uncertainty is inhibiting the investments and long-term practice decisions required to bring off an ACO—in effect, a Gresham's regulatory law that is crowding out innovation.
The ACO concept is well-meaning, and we hope it works, but we suspect it will go the way of diagnostic-related groups, HMOs, the sustainable growth rate, and every other top-down government plan to cut health spending since the 1970s. We also hope ACOs work because if they don't, the liberal fallback to cut costs are harsher price controls and the political rationing of care. Seniors will wish they had Paul Ryan's choices.
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If you think health care is expensive now, wait until you see what it costs when it's free. – P.J. O'Rourke
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A Hospital Drug Shortage Made In Washington
Posted by Walter Olson
As readers may know, I’ve been beating the drum for a while on the increasingly dangerous shortages that doctors are encountering in the availability of common, off-patent drugs used in hospital and clinical settings, including drugs that are important in chemotherapy, anesthesia, and infection control. Among the reasons for the shortages: the Food and Drug Administration has toughened its regulation of pharmaceutical makers in ways that lead to manufacturing line shutdowns and withdrawals from production.
John Goodman has a must-read blog post at Health Affairs Blog on the mounting crisis, amplified by a post by George Mason economist Alex Tabarrok at Marginal Revolution, getting into further specifics. In particular:
• 246 drugs are now considered to be in shortage, a record high, and the number has been rising for years. Rationing of scarce chemotherapy drugs is now making a difference in which patients have a chance at survival. In the absence of familiar compounds, doctors are falling back on inexact substitutes, sometimes more dangerous and less effective.
• After “tainted drugs” scares a few years ago, the FDA stepped up its Good Manufacturing Practice regulations, which control the production of pharmaceuticals. In particular, it now proclaims zero tolerance, barbed by tough fines, for many technical infractions whose actual impact on patient risk is at best doubtful, and it is unafraid of shutting down production lines again and again for retooling until its regulations are satisfied to the letter. It also changes its formulation and manufacturing requirements often, with scant forgiveness for makers who have trouble retooling to the new specifications quickly.
• Remarkably, the feds have inserted themselves into the role of central planners of drug output. Goodman:
For example, a drug manufacturer must get approval for how much of a drug it plans to produce, as well as the timeframe. If a shortage develops (because, say, the FDA shuts down a competitor’s plant), a drug manufacturer cannot increase its output of that drug without another round of approvals. Nor can it alter its timetable production (producing a shortage drug earlier than planned) without FDA approval.
That the results might include many unpleasant surprises will surprise only those unfamiliar with the record of a century of central planning failure.
• Pre-1938 drugs are suffering particular disruptions because of a separate FDA program, long demanded by consumer groups, to subject these “grandfathered” compounds to regulatory oversight just as tough as newer drugs. The dictates of the Drug Enforcement Administration also contribute to problems with some controlled substances.
• Several leading professional organizations, including the American Society of Anesthesiologists and the American Society of Clinical Oncology, collaborated on a meeting last November to raise the visibility of the issue and seek possible solutions. You can read its summary report here. Objectively, it’s a damning indictment, but be warned that — rather typically in a field where many key players live in fear of offending the FDA — the report refrains from outspoken criticism of the agency and in fact proposes widening the agency’s funding and powers.
Wouldn’t this make a good subject for hearings at the newly Waxman-liberated House Commerce Committee?
http://www.cato-at-liberty.org/a-hospital-drug-shortage-made-in-washington/
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2nd post:
http://reason.com/blog/2011/06/15/gao-report-obamacare-waivers-i
Reason Magazine
GAO Report: ObamaCare Waivers Issued to Prevent Premium Increases Caused By Health Law’s Mandates
Peter Suderman | June 15, 2011
For months, it’s been unclear how the Obama administration’s Center for Consumer Information and Insurance Oversight (CCIIO)—the new bureaucracy set up to regulate health insurance under ObamaCare—was deciding whether to hand out waivers to businesses and unions seeking exemptions from some of the law’s requirements. Now, thanks to a new report from the Government Accountability Office (GAO), we have a somewhat better idea: The administration was handing out waivers in order to prevent large health insurance premium hikes that last year’s health care would have otherwise caused.
According to the GAO, which prepared its report with the help and guidance of CCIIO, the Obama administration’s new insurance regulators “granted waivers on the basis of an application’s projected significant increase in premiums or significant reduction in access to health care benefits.” It’s not a bright-line test, however; there’s still a discretionary element. As the report’s authors explain, “officials told us that they could not exclusively rely on specific numerical criteria to define a significant increase in premiums or a significant decrease in access to benefits, because applicant characteristics and circumstances varied widely.” So the process is still not fully transparent.
But what’s most important about the report is how it reveals, yet again, that the folks running the ObamaCare show are aware of the effects the law will have on the price of insurance. Like the Obama administration’s decision to grant the state of Maine a waiver from ObamaCare’s medical loss ratio requirement, the GAO’s description of the waiver process is about as straightforward an admission as anyone is likely to get fulfilling ObamaCare’s new insurance requirements does indeed drive up premium prices and/or reduce health insurance benefits.
Now, the administration would likely contest that argument as unfair. After all, they did issue waivers to businesses and union groups where the premium hikes or benefit losses were expected to be largest. But if anything, the waiver process simply shows that the Obama administration knows that, despite all of the president’s claims about bringing down the cost of both care and insurance premiums, the legislation, as passed, will make health insurance more expensive for a very large number of individuals—hence the issuance of 1,347 waivers covering more than 3 million people.
The result is an inherently unfair system in which some businesses and unions have to obey the rules and some don't, and the regulators get to decide who falls into which category. I've said it before, and I'll probably say it again: If it's so clear that the provisions in question aren't working for so many people, why not just grant everyone waivers by ditching those requirements entirely?
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The point seems simple and obvious to me: How can this be Constitutional under the Equal Protection clause?
Even worse, if I have my facts correct here, my understanding is that there is no provision for waivers in the statute; the waivers are a bureaucratic creation :-o
Baraq's America is a Kafkaesque nightmare.
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http://news.yahoo.com/s/ap/20110621/ap_on_go_ca_st_pe/us_health_overhaul_glitch
Hooray! Other people's money!
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Apparantly the AMA is more interested their members get paid then in individual freedom. It is almost always about the money.
I got this in my email. I am not and never have been an AMA member but I got this from the ACP American College of Physicians who are generally rather liberal but to some degree follow the trends in a politically realistic fashion. Unlike years ago where medical groups had enormous political sway in Washington they hold almost NO sway now. So they just jump on board and play both sides as best they can and go with the political winds. Right or wrong that is the way it is. Not like the legal lobby which controls the country like a vice.
***Welcome to The ACP Advocate.
I’m pleased to start off this issue by reporting to you the news in our first story. At its June meeting, the American Medical Association's House of Delegates passed a resolution to reaffirm the necessity of a personal responsibility requirement (the individual mandate) as part of health reform. Continuing to emphasize the importance of the requirement is crucial. Without requiring everyone (including the young and healthy among us) to have health insurance, the system simply won’t be able to provide coverage to all at rates that are affordable. This sort of requirement is necessary in order to continue to have a viable private payer system.
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Apparantly the AMA is more interested their members get paid then in individual freedom. It is almost always about the money.
I got this in my email. I am not and never have been an AMA member but I got this from the ACP American College of Physicians who are generally rather liberal but to some degree follow the trends in a politically realistic fashion. Unlike years ago where medical groups had enormous political sway in Washington they hold almost NO sway now. So they just jump on board and play both sides as best they can and go with the political winds. Right or wrong that is the way it is. Not like the legal lobby which controls the country like a vice.
***Welcome to The ACP Advocate.
I’m pleased to start off this issue by reporting to you the news in our first story. At its June meeting, the American Medical Association's House of Delegates passed a resolution to reaffirm the necessity of a personal responsibility requirement (the individual mandate) as part of health reform. Continuing to emphasize the importance of the requirement is crucial. Without requiring everyone (including the young and healthy among us) to have health insurance, the system simply won’t be able to provide coverage to all at rates that are affordable. This sort of requirement is necessary in order to continue to have a viable private payer system.
How Orwellian! I hope it's starting to sink in to all the young and stupid Obama voters how they've suckered. You've got crushing student loans, no jobs and you must buy health insurance to subsidize everyone else. Tweet that!
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"You've got crushing student loans, no jobs and you must buy health insurance to subsidize everyone else."
Don't forget we ought to pay for the education of illegals too.
If one is born here to a family that works to pay for their children's education good.
If your illegal and cannot afford an education the above group will be forced to subsidize you out of the good heartedness of the ruling Democrat party itching for a vote.
For a long time people have clamored that health care is a "right".
When did retirement often before 60 and even 50 become a "right"?
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A friend writes:
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Dhimmitude -- What does it mean?
Obama used it in the health care bill.
Now isn't this interesting? It is used in the health care law.
Dhimmitude -- I had never heard the word until now. Type it into Google
and start reading. Pretty interesting. It's on page 107 of the healthcare
bill. I looked this up on Google and yep, it exists.. It is a REAL word.
Word of the Day: Dhimmitude
Dhimmitude is the Muslim system of controlling non-Muslim populations
conquered through jihad. Specifically, it is the TAXING of non-Muslims in
exchange for tolerating their presence AND as a coercive means of converting
conquered remnants to Islam.
ObamaCare allows the establishment of Dhimmitude and Sharia Muslim diktat
in the United States . Muslims are specifically exempted from the
government mandate to purchase insurance, and also from the penalty tax for being
uninsured. Islam considers insurance to be "gambling", "risk-taking", and
"usury" and is thus banned. Muslims are specifically granted exemption
based on this.
How convenient. So I, as a Christian, will have crippling IRS liens
placed against all of my assets, including real estate, cattle, and even
accounts receivables, and will face hard prison time because I refuse to buy
insurance or pay the penalty tax. Meanwhile, Louis Farrakhan will have no such
penalty and will have 100% of his health needs paid for by the de facto
government insurance. Non-Muslims will be paying a tax to subsidize Muslims.
This is Dhimmitude.
I recommend sending this onto your contacts. American citizens need to
know about it --
=====
Another friend replies:
Click here to see what Snopes says.......it appears that there is a
"general exemption" for religious groups, but actual specifics have not
yet been determined.
http://www.snopes.com/politics/medical/exemptions.asp
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Better to be Amish. :-D
Reading the article, no offense, I question your "friend".
So he is really worried about "crippling IRS liens
placed against all of my assets, including real estate, cattle, and even
accounts receivables, and will face hard prison time" Wow!
Even cattle huh? :-o
It seems Muslims get blames for anything and everything. Or Obama.
Yet these or similar laws have been in place for years....
Kudo's to you for also referencing Snopes.com which makes mockery of the previous friend.
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"It seems Muslims get blames for anything and everything."
I know, wage jihad against the rest of humanity for centuries and it's funny how you develop a bad reputation.
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JDN:
I take my friend's meaning to be that the exemption was written with Islam in mind. Thus the issue presented is not really Muslims or Islam, but the pre-emptive dhimmitude of the authors of the bill (including Baraq as intellectual author?).
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Let me tell you a long personal story; don't worry there is a Health Cost Care point at the end. :-D
This last week I was riding my motorcycle up Angeles Crest in Angeles National Forest; for those of you who don't know the area,
it's a beautiful long mountain ride full of twists and turns in my hometown just above LA. A biker's heaven,
if you like going fast in canyons. My brother hates the ride on his Harley. :-)
Anyway, I was going fast, too fast; on a narrow straightaway I blew by a Forest Ranger Truck. Two turns later, deep in the turn I hit gravel.
Oh oh. Tried to straighten up, did ok, then hit one of those new stupid deep reflector holes and lost it (pilot error). Flipped, hit my head and slid,
according to the CHP who investigated the scene, over 120 yards over rocks, pavement, etc. I then sat up and said Whew, that was close. (3 have died on bikes on this road in the last 3 weeks). But everything on my body seemed to move and I could focus.
The Forest Ranger truck stopped; two very polite and gorgeous girls got out who are Botanists from Boston. Not bad for a rescue
team. :-) Cell phones don't work up Angeles Crest, but they had radios. While I admit I felt like I had gone too many rounds with a heavyweight,
I basically checked myself; everything moved, albeit slowly. So I said could they please call my Father or Wife
to come get me. I'll have AAA tow the bike.
For Health Insurance I have a great plan, but it's a $5000.00 Deductible. I'm usually healthy. Still, it's expensive. The theory of high
deductible plans is that you avoid going to the doctor unless it's really necessary. I decided to save money.
But, then the fire trucks showed up; 5 of them. I guess it was a boring day. The paramedic checked me out; found
"nothing" seriously wrong, but... Then they said they are taking me to ER down the hill. I saw dollar signs going
off and said pass. Time will heal everything.
They said just lay down on this gurney. I did. They strapped me in 10 different ways. I rested. Then the Fire Captain
said they are taking me to ER. I said "No Thanks". Didn't matter, literally he got in my face and said I'm going.
They put me in the Ambulance took me to the ER.
I'm blessed living near an excellent Hospital. The ER doc was great; he checked me out, mumbled about how lucky
i was and how truly sore I will be (I am), but nothing permanent/serious seems to be going on. He gave me some good drugs,
the nurse patched up areas that were bleeding, and my wife picked me up. I had good equipment; good leathers (top only).
So my knees are messed up, my back is really sore, and I have bruises all over, but in the end, I will be fine.
Now here is the question, for all you anti national health insurance plan people. I can afford, although times aren't great,
the $5000.00 deductible. And the 20% co-pay thereafter. I'm sure the bill will be close to 10K. It could have been much much worse.
I know the Fire Captain had my best interest at heart. Also, that is just how he does it and I don't think he's used to hearing
"No" very often, although I didn't like being kidnapped.
But he is not going to pay the bill. Easy for him to say go to the ER.
If I didn't have the 5K who would? Well first they come after me. Take my house, garnish my wages, etc. If the well
is dry, they send it to a collection agency. If all else fails the government (that's you all) will pay.
Why not have a base government plan covering everyone like Medicare and then supplemental private plans for the bells
and whistles? My father has Medicare; he loves it. He also has a great, albeit expensive supplemental plan ($800.00 month) that covers
everything else in the world that Medicare doesn't that Dad pays for himself. He's happy. I just want the same choice.
I think that makes sense for everyone.
As a side note, as I have mentioned, my wife was quite sick, but miraculously is doing much better. Still, no guarantees.
She has kept her job and her insurance (great boss) but now they are thinking of laying her off as well as other employees. It's the times.
I don't care about her earnings so much, but we need the insurance. No job, no insurance. Sure, you can have COBRA.
But that runs out fast. Then what? With her pre-existing condition no one will offer coverage at any price. I understand
the actuarial math, but.... So what's a person to do? Go without coverage? Again, a base national health plan might be the answer.
Just a thought.
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"Why not have a base government plan covering everyone like Medicare and then supplemental private plans for the bells
and whistles?"
One problem is the government is already broke and with the population getting older we cannot afford it as it is.
(In case you haven't noticed?)
Perhaps we could cover you but then tax you for riding your motorcylce which is a very high risk endeavor.
We tax cigarettes, Michelle wants a calorie tax, so why not cylces?
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IMHO the matter of people getting kicked out of their insurance due e.g. to a job loss and while having what then becomes a pre-existing condition is a genuine problem.
If we could REPLACE what we have now with a simple base plan that would then put this whole matter to rest, off the top of my head that would be a reasonable compromise. The problem is that with progressives if you give an inch they come back looking for a mile see e.g. "Don't ask, don't tell" or "civil unions".
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"The problem is that with progressives if you give an inch they come back looking for a mile see e.g. "Don't ask, don't tell" or "civil unions".
Exactly. We cannot compromise any more because there is no compromise.
They never stop demanding for more. Goal:
One world government that controls and monitors everything around the world.
Government distribution of all wealth and conjointly all poverty.
Everything we do or not do is monitored. For example one eats a french fry you get taxed. You flush one too many times it is recorded and automatically deducted from one's account as is every other tax, fee, fine, and charge.
You don't exericse you are taxed.
The Ivy league universities guide everything - they kind of already do.
and on and on.
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"She has kept her job and her insurance (great boss) but now they are thinking of laying her off as well as other employees. It's the times."
She has coverage because she of the job (private sector inferred). They are laying off employees because of the economy. Number one cause of the continued bad economy with almost no new hiring: healthcare reform with non-existent cost savings, along with two dozen new tax increases, new regulations, penalties and heavy burdens on employers.
JDN: "With her pre-existing condition no one will offer coverage at any price."
Crafty: "IMHO the matter of people getting kicked out of their insurance due e.g. to a job loss and while having what then becomes a pre-existing condition is a genuine problem."
Pre-existing condition - instantly - was one of the planks offered in the Republican alternatives and turned down by the ObamaPelosi-ites. It is a feature of Obamacare but implementation was delayed I believe to 2014. IT DID NOT HAVE TO BE THAT WAY. That was solvable in 2009 but they wanted the whole enchilada, not compromise or even a single Republican vote. If Obamacare did not utilize financial deception to pass, the good features would be law now.
JDN, I'm glad you are okay. That said...
By your own description, you were a) on a motorcycle, and b) going too fast. (Did I read that right?) Those are two risks that someone else might not want to pay for, and will be likely be freedoms you would lose as we shift the financial consequences to others... or it could void your warranty.
You were burning fossil fuels for the enjoyment. (?) I'm surprised that freedom wasn't already taken the day Al Franken took the 60th vote in the Senate. So many potential prohibitions. So little time.
'Base plan' means disparity and arguing the unfairness to eternity. Probably a better way than Obamacare to get to full coverage, single payer.
Base plan will however include everything controversial, abortion, birth control, sex change operations, smoker, motorcycle, sky dive coverage. Anything less will be unfair. French fries and stick fighting might be the only exclusions?
We already, at least in our state, have full coverage for the financially challenged. We are talking about a middle class entitlement. Paid for by whom?
You were going to be treated, like it or not, in this case. We are only talking about who pays for it.
"My father has Medicare; he loves it. He also has a great, albeit expensive supplemental plan ($800.00 month) that covers everything else in the world that Medicare doesn't that Dad pays for himself. He's happy. I just want the same choice."
a) You will be there soon. :-)
b) Medicare is bankrupt. Let's expand it. :-(
"Why not have a base government plan covering everyone"
Third party pay for millions is already the reason why costs for the rest of us are OUTRAGEOUS.
Healthcare was mostly affordable back when most service was fee for service. That was when prices had to match affordability.
"then the fire trucks showed up; 5 of them. I guess it was a boring day."
Would that happen in the private sector?
"Flipped, hit my head and slid"
Hope you mean - hit my helmet.
"3 have died on bikes on this road in the last 3 weeks"
Sounds like fun ... :?
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We drifted to govt healthcare on libertarian issues http://dogbrothers.com/phpBB2/index.php?topic=1565.msg52640#msg52640 where it also belongs and I wanted to answer part of it here.
GM wrote: Yeah, it's funny how a free market can make products and services cheaper for everyone to access but somehow that can't be used for healthcare.
Yes, that was a point a tried to make with a highly educated liberal relative recently. She was arguing that single payer is the most efficient system and I kept answering with the question: "for everything?" No, only healthcare because that was all she had looked into, but has someone looked into the most efficient and effective ways to allocate scarce resources if they look at one failed example. What about housing? I see areas here where the average price has adjusted from $3 million to $2 million. At either level, the price is astronomical and the product exceedingly complex and extravagant because that is exactly what people are wanting and able to afford. Those prices in a free market continuously adjust so that is true under changing cicumstances and the product built adjusts too - if left alone to adjust. In healthcare, not so.
JDN wrote: "Do you know what cancer costs? Or a heart attack? Even just a "routine" visit to the emergency room is $1000's of dollars, Etc.
Yes. Do you know why??
I put it in a previous reply: "If we paid our own medical bills (for the most part), the cost levels set by providers would be limited to what people could generally afford and were willing to pay (imagine that!), not what an entity with the power to print money could possibly spend."
That does not mean there won't be a safety net for the needy, there already is. It means as you expand that to include routine care for ordinary income Americans, the entire system with the only known, effective force for cost control is gone. That can't happen! Look at Europe! Yeah, look at Europe.
The welfare state like Scandinavia or even Japan relied on a culture of homogeneous people all possessing an unending work ethic and not interested in taking advantage of the system, where the safety net goes only to the truly needy no matter what are the rules. Hardly a description of Europe today, or the US.
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"Yes, that was a point a tried to make with a highly educated liberal relative recently. She was arguing that single payer is the most efficient system and I kept answering with the question: "for everything?" No, only healthcare because that was all she had looked into, but has someone looked into the most efficient and effective ways to allocate scarce resources if they look at one failed example. What about housing? I see areas here where the average price has adjusted from $3 million to $2 million. At either level, the price is astronomical and the product exceedingly complex and extravagant because that is exactly what people are wanting and able to afford. Those prices in a free market continuously adjust so that is true under changing cicumstances and the product built adjusts too - if left alone to adjust"
Single payer for food? Who needs supermarkets and restaurants? We could have "nutrition panels" to decide give you the food you need. It would be amazingly efficient!
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If this doesn't beat it all - now politicallyt correct health care in our medical journals.
I get this journal for free in the mail and it often has some good medical reviews. This month it comes out with articles on global warming for doctors and patients. I have a feeling this is a sign of what is to come. Quality measurements of primary care will include politically correct indoctrination orders from the Federal payer - Department of Health and Human Services - Medicare.
For goodness sakes now it is my job to discuss the health ramifications of "global warming" with patients? And how we can all help to work towards fixing this? Can we ever stop being told what to do? :x
****Slowing Global Warming: Benefits for Patients and the Planet
Parker C L
August 1 2011 Vol. 84 No. 3
View Abstract
Global warming will cause significant harm to the health of persons and their communities by compromising food and water supplies; increasing risks of morbidity and mortality from infectious diseases and heat stress; changing social determinants of health resulting from extreme weather events, rising sea levels, and expanding flood plains; and worsening air quality, resulting in additional morbidity and mortality from respiratory and cardiovascular diseases. Vulnerable populations such as children, older persons, persons living at or below the poverty level, and minorities will be affected earliest and greatest, but everyone likely will be affected at some point. Family physicians can help reduce greenhouse gas emissions, stabilize the climate, and reduce the risks of climate change while also directly improving the health of their patients. Health interventions that have a beneficial effect on climate change include encouraging patients to reduce the amount of red meat in their diets and to replace some vehicular transportation with walking or bicycling. Patients are more likely to make such lifestyle changes if their physician asks them to and leads by example. Medical offices and hospitals can become more energy efficient by recycling, purchasing wind-generated electricity, and turning off appliances, computers, and lights when not in use. Moreover, physicians can play an important role in improving air quality and reducing greenhouse gas emissions by advocating for enforcement of existing air quality regulations and working with local and national policy makers to further improve air quality standards, thereby improving the health of their patients and slowing global climate change.
Full Article - Access restricted to AAFP members and AFP paid subscribers.
Please log-in below to view.
If you are looking for patient information, you may also wish to visit the AAFP patient information Web site, www.familydoctor.org.
Here is a handout we can give to patients:
http://www.aafp.org/afp/2011/0801/p282.html
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CCP - I think you should have put this in the Humor section! :-D
This is a joke, right?
I have cracked ribs from my accident; I don't won't to hear about "global warming". Just Vicadin. :-)
As a side note, the head of ER that I went to is Jewish. What a fabulous Doctor. I got lucky; he was on duty. VERY knowledgeable, (I know, my ex wife is a Board Certified Neurologist) he was professionally caring, efficient, practical about my dollars, I was in love with him. I find it interesting that Jews in general are brilliant. My compliments!
Interesting different discussion, but why?
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JDN: Search on the SCH forum for an interesting and controversial article by Charles Murray on that very question.
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"CCP - I think you should have put this in the Humor section!
This is a joke, right?"
JDN, no I am afraid it is not a joke.
Just more "progressism creep" in our society.
It really is a cancer.
"I find it interesting that Jews in general are brilliant. My compliments!"
Thank you I will include myself in that group! :-D
Unfortunately some Jews (liberals) are misguided and have used their brains inadvertantly to destroy the United States as they think they are making the world a better place. There appears some signs at least a few of them are learning the foolishness of there ways. The rest are stubborn to the death and will narcissitically think they know better then the rest of us.
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WASHINGTON (Reuters) - An appeals court ruled Friday that President Barack Obama's healthcare law requiring Americans to buy healthcare insurance or face a penalty was unconstitutional, a blow to the White House.
The Appeals Court for the 11th Circuit, based in Atlanta, found that Congress exceeded its authority by requiring Americans to buy coverage, but also ruled that the rest of the wide-ranging law could remain in effect.
The legality of the so-called individual mandate, a cornerstone of the 2010 healthcare law, is widely expected to be decided by the Supreme Court. The Obama administration has defended the provision as constitutional.
The case stems from a challenge by 26 U.S. states which had argued the individual mandate, set to go into effect in 2014, was unconstitutional because Congress could not force Americans to buy health insurance or face the prospect of a penalty.
"This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them re-purchase that insurance product every month for their entire lives," a divided three-judge panel said.
Obama and his administration had pressed for the law to help halt the steep increases in healthcare costs and expand insurance coverage to the more than 30 million Americans who are without it.
It argued that the requirement was legal under the Commerce Clause of the Constitution. One of the three judges of the appeals court panel, Stanley Marcus, agreed with the administration in dissenting from the majority opinion.
The majority "has ignored the undeniable fact that Congress' commerce power has grown exponentially over the past two centuries and is now generally accepted as having afforded Congress the authority to create rules regulating large areas of our national economy," Marcus wrote.
Many other provisions of the healthcare law are already being implemented.
The decision contrasts with one by the U.S. Appeals Court for the 6th Circuit, based in Cincinnati, which had upheld the individual mandate as constitutional. That case has already been appealed to the Supreme Court.
The Court of Appeals for the 4th Circuit, based in Richmond, has yet to rule on a separate challenge by the state of Virginia.
(Reporting by Jeremy Pelofsky and James Vicini; Editing by Eric Beech)
http://news.yahoo.com/appeals-court-rules-against-obama-healthcare-law-171829777.html (http://news.yahoo.com/appeals-court-rules-against-obama-healthcare-law-171829777.html)
P.C.
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"The case stems from a challenge by 26 U.S. states which had argued the individual mandate, set to go into effect in 2014, was unconstitutional..."
Just the fact that 26 states oppose it should be enough to get what's left of the Obamacare coalition to BACK OFF. We shouldn't need the court system to know that the constitution never authorized this kind of power.
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By no means am I a constitutional scholar, but what is the difference between the established constitutionality of an individual mandate to participate in Social Security and Medicare, and a mandate to participate in a National Health Care system?
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Woof,
Who said it has been established?
P.C.
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Woof,
Who said it has been established?
P.C.
The Supreme Court.
On May 24, 1937 the Supreme Court handed down its decision in the three cases. Justice Cardozo wrote the majority opinion in the first two cases and he announced them on what was, coincidentally, his 67th birthday. (See sidebar on Justice Cardozo.)
Mirroring the situation in Congress when the legislation was considered, the old-age insurance program met relatively little disagreement. The Court ruled 7 to 2 in support of the old-age insurance program. And even though two Justices disagreed with the decision, no separate dissents were authored. The unemployment compensation provisions, by contrast, were hotly disputed within the Court, just as they had been the focus of most of the debate in Congress. The Court ruled 5 to 4 in support of the unemployment compensation provisions, and three of the Justices felt compelled to author separate dissents in the Steward Machine case and one Justice did so in the Southern Coal & Coke case.
Justice Cardozo wrote the opinions in Helvering vs. Davis and Steward Machine. After giving the 1788 dictionary the consideration he thought it deserved, he made clear the Court's view on the scope of the government's spending authority: "There have been statesman in our history who have stood for other views. . .We will not resurrect the contest. It is now settled by decision. The conception of the spending power advocated by Hamilton . . .has prevailed over that of Madison. . ." Arguing that the unemployment compensation program provided for the general welfare, Cardozo observed: ". . .there is need to remind ourselves of facts as to the problem of unemployment that are now matters of common knowledge. . .the roll of the unemployed, itself formidable enough, was only a partial roll of the destitute or needy. The fact developed quickly that the states were unable to give the requisite relief. The problem had become national in area and dimensions. There was need of help from the nation if the people were not to starve. It is too late today for the argument to be heard with tolerance that in a crisis so extreme the use of the moneys of the nation to relieve the unemployed and their dependents is a use for any purpose [other] than the promotion of the general welfare."
And finally, he extended the reasoning to the old-age insurance program: "The purge of nation-wide calamity that began in 1929 has taught us many lessons. . . Spreading from state to state, unemployment is an ill not particular but general, which may be checked, if Congress so determines, by the resources of the nation. . . But the ill is all one or at least not greatly different whether men are thrown out of work because there is no longer work to do or because the disabilities of age make them incapable of doing it. Rescue becomes necessary irrespective of the cause. The hope behind this statute is to save men and women from the rigors of the poor house as well as from the haunting fear that such a lot awaits them when journey's end is near."
With these cases decided, Justice Stone could then dispose of the third case in short order. "Together the two statutes now before us embody a cooperative legislative effort by state and national governments, for carrying out a public purpose common to both, which neither could fully achieve without the cooperation of the other. The Constitution does not prohibit such cooperation." 6
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(I disagree with that ruling.)
The Court, in the past, reaffirming the power of congresses of the past to go far beyond any concept of limited government laid out in the constitution, even if it happened more than a thousand times, is not precedent to go miles further.
Where is the individual mandate in social security or Medicare except to be taxed on income, which was a power previously lacking but specifically added to the constitution.
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IIRC, Obamacare was allowed to be deemed passed as a reconciliation item because it was at zero net cost as a budget item.
Besides funny math, 10 years of taxes matched against 6 years for benefits and plenty of other tricks, the reason it was rated at zero net cost was because of the individual mandate.
The individual mandate was struck down.
The deemed passed procedure is now null and void.
Obamacare is thus repealed effective August 12, 2011. (?)
- Doug
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The individual mandate was struck down.
The deemed passed procedure is now null and void.
Obamacare is thus repealed effective August 12, 2011. (?)
- Doug
Until the next court ruling. :-D
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The individual mandate was struck down.
The deemed passed procedure is now null and void.
Obamacare is thus repealed effective August 12, 2011. (?)
- Doug
Until the next court ruling. :-D
Or the economy crashes from our massive debt. One way or another, it's doomed.
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I had a very short conversation yesterday with an old friend who runs a very large healthcare organization, and what he said startled me. In reply to 'how's work going' he said we're busy implementing Obamacare. I said I thought it was getting repealed. His politics isn't any different than mine, but they believe with certainty that some version of Obamacare is coming.
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When Obamacare was passed (deemed), Republicans were open to many reforms to avoid national care: end pre-conditions, open up competition across state lines, limit liability, etc. After passage the conversation turned to repeal AND replace, pretending the opposition R's will have their own healthcare proposal by election time. Now the candidates all just (naively) say repeal and go on to the next topic.
All that ignores the fact the it took the perfect storm of winning 59 senate seats plus stealing the 60th, deeming passed what wasn't, budget tricks like taxing gold, lying about costs and using 10 years of revenues to pay for 6 years of costs to get it passed. Now Republican candidates think they can just promise repeal and if they win election it all goes away?
The perfect storm for Republicans in 2012 does not include either taking 60 senate seats or having the Democratic party apologize and fold. With the worst economy in memory we only have about a 50-50 chance right now of even beating Obama and the anti-incumbent mood could actually hurt Republicans in the House. The Senate seats Dems will lose (best case) are the moderate ones, not the furthest left from blue states. Even in the storm of 2010 people like Barbara Boxer and Harry Reid held their seats.
The Supreme Court will likely do something to the individual mandate similar to what the Appeals court just did. Best case, Republicans may take the Presidency, House and a 53-54 vote majority, but not close to 60. This legislation already doesn't stand on its own but will be left largely in place, lacking the votes to repeal. The deadlock will make the debt ceiling stalemate look like a walk in the park. Any deadlock is victory for national healthcare advocates. Getting repeal votes or even cloture votes from the remaining liberals is a hell freezing over scenario. No Republican candidate or anyone else is talking at all about how to solve and settle this either politically or operationally. Meanwhile we will be 3 years into its implementation.
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I gotta say my initial impression here is that conceptually that this is not much different from requiring companes to say what is in the box and how much there is of it.
===========================================
Anyone who has ever tried to read a health insurance policy knows how hard it is to find out what the plan actually covers and how much it will cost. The Obama administration proposed welcome new rules this month that would make it a lot easier for consumers to compare one policy with another — on cost and coverage — before signing up.
Health policies are notorious for their confusing legalese. When confronted with a big medical bill, enrollees are often shocked to find that there are limits or exclusions they never heard of, leaving them owing a lot more than they can afford to pay.
The new rules, which carry out provisions of the health care reform law, would require insurers and employers, starting next year, to provide a brief summary in plain English listing such items as premiums, deductibles, services not covered, and the costs of using a provider in the network as compared with one outside the network.
There will also be “coverage examples” showing how much the insurer would pay and what a typical enrollee would pay for three common types of health expenses: having a baby, treating breast cancer and managing diabetes. The summaries would be provided in a document or, if consumer safeguards are met, on the insurer’s Web site, on a government site or by e-mail.
Each insurer would have to display the information in the same format and the same order, making it easy to compare policies side by side before buying. Although some private and government sites already offer some of the same information, the new formats are expected to provide the most comprehensive, unbiased information available.
Insurers are complaining that compiling and disseminating the benefits information will drive up their costs. That is a ridiculous objection. The administration estimates that the proposal would cost some $50 million a year to carry out. That seems a small burden on a multibillion-dollar industry. The investment would provide a huge benefit to confused consumers and help spur competition to bring down health insurance costs.
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But a difficult choice......
http://www.latimes.com/business/la-fi-lazarus-20110902,0,2080851.column
"Every day was a good day," Karen said. "We were a family, and the kids got to be with their father. You can't put a price on that."
Well, you can, obviously. And it can be argued that you should. The United States already spends about twice per person on healthcare compared with most other developed nations — $7,538 a year on average, according to the Organization for Economic Cooperation and Development.
That translates to healthcare accounting for about 16% of the overall U.S. economy. That compares with 11.2% in France, 10.5% in Germany, 9.4% in Sweden and 8.7% in Britain.
In the harsh light of pure statistics, it's clear that we have to do more to bring down healthcare costs and expenditures. One way to do that would be through the efficiencies of extending Medicare to all Americans and more strictly regulating how much can be charged for medical procedures and insurance.
Another would be to limit how much of our healthcare resources should be devoted to, for lack of a more artful term, lost causes.
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From a public health point of view it is clear this vaccine should be given to all. Yet I tend to agree with Bachmann that people should have choice. That said I doubt this is a big issue in the race for the President and was over dramatic on Bachmann's part - with we are attacking little girls and risking them for drug company profit logic:
****Michele Bachmann attacks Rick Perry on HPV
210 Email Print
By ALEXANDER BURNS | 9/12/11 9:16 PM EDT Updated: 9/12/11 10:05 PM EDT
Michele Bachmann accused Rick Perry of using sixth-grade girls as profit engines for a drug company at the CNN/Tea Party Express debate, lacing into the Texas governor for having attempted to mandate the HPV vaccine for young teenagers.
“To have innocent little 12-year-old girls be forced to have a government injection through an executive order is just wrong,” Bachmann said. “Little girls who have a negative reaction to this potentially dangerous drug don’t get a mulligan.”
Continue Reading
The Minnesota congresswoman went even further, accusing Perry of handing out favors to a company, Merck, represented by his former top aide, Mike Toomey.
“There was a big drug company that made millions of dollars because of this mandate,” Bachmann said. “The governor’s former chief of staff was the chief lobbyist for this drug company.”
Perry pushed back hard against Bachmann, but seemed flustered as the attacks on HPV intensified.
“At the end of the day, this was about trying to stop a cancer,” Perry said. “At the end of the day, I am always going to err on the side of life.”
When Bachmann suggested he mandated the vaccine as a favor to a campaign contributor, Perry responded: “I raised $30 million and if you’re saying I can be bought for $5,000, I’m offended”
Bachmann shot back: “I’m offended for all the little girls and parents who didn’t have a choice.”****
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Thank you CCP for weighing in on this: "From a public health point of view it is clear this vaccine should be given to all."
I thought Perry already admitting his mistake. It was a freedom-based error made in the interest of saving lives. It is too late to wait and see if you need a vaccine. If he had a friend tied closely to the vaccine, then he had someone he trusted telling him what you just said (repeating): "From a public health point of view it is clear this vaccine should be given to all."
When it is not a mandate, it is thrust strongly on you from what perhaps should be your most trusted person, your Pediatrician. That happened to me with my daughter. I had very strong reservations about it and said yes. To say no meant to research it endlessly to know enough to prove him and the whole profession wrong. Based on my comments on other subjects, in the back of my mind that is possible. It feels much better to have you agree with Perry adviser and our doctor and the association of pediatricians etc. because I know that in this forum you would freely speak up against them if you felt that way. :-)
It's far more invasive than seat belts, booster seats, motorcycle helmets, smoke and CO detectors, and all the other things we do in the name of public health. We deserve the freedom to make our own decisions. Parents deserve that when the subject is their kids. But it is common place in America to be legislating public health mandates from government. Those of us who assume people will make the responsible decision on their own will be offended, but most people accept most of this, especially if they are getting the science right.
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Sounds like Bachmann's comment of it causing mental retardation in a specific family she spoke to is another glimpse at over the top leaps that she is willing to make. Another example of shooting (without looking) in the wrong direction. Her political causes I think would do very well with Perry as President; the person she should be trying to defeat is in the White House.
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Doug,
I agree with your thoughts but also sympathize understand the rights of parents to have a say.
So much of communicable disease is political. Look at the Aids epidemic. The pols protected the gay community more than the health of the general public.
I don't want to bash the legal profession but clearly the class action law suit industry also helps drive this. Blame anything and everything one can when going after deep pockets.
There are clearly some ethical attorneys like their are unethical physicians yet the legal system is in view out of control.
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While Prof. (emeritus in her own mind) Ann Coulter, Phd, MD. MSc was on Hannity radio yesterday "teaching" us cervical cancer is a rare disease she neglected to note the vector that causes it is truly epidemic:
http://www.cdc.gov/std/stats09/figures/48.htm
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I don't have any children but if I did I would resoundingly encourage him and her to get vaccinated. I strongly recommend it to all adult women I see under age 26. Most are sexually active. Asking them to use condoms is nice but not effective. They all have boyfriends and are convinced their boyfriends have or would never cheat. I had one girl age 17 who admitted to being sexually active with her "boyfriend" get totally indignant when I strongly suggested she get vaccinated and read up about gardisal on the net. She glared at me knowing full well her boyfriend was, is, and always will be her only love - forever! :wink:
Doug, without a doubt you did the exact right thing in portecting your children. I do agree with Bachman that parents and young adults should have a choice but otherwise she is nuts to put it bluntly.
http://www.ottawacitizen.com/health/Half+have+infections+Study/4365276/story.html
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I think this was a "not ready for prime time" moment for Bachmann. Most likely a campaign killing move. It just demonstrates how they have so little to go after Perry with.
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By SALLY C. PIPES
The U.S. Census Bureau has released its latest estimates on poverty, income and health-insurance coverage. Strikingly, the official poverty rate is the highest it's been in 50 years.
As one might expect, the number of Americans without health insurance also rose—to 49.9 million, an increase of 919,000 since 2009.
But that large number hides more than it reveals. And diving into it shows that the uninsured rate won't fall unless the economy starts humming again. Unfortunately, ObamaCare's billions of dollars in new taxes and regulations won't allow that to happen.
Let's take a closer look at the 49.9 million uninsured. The Census reports that 9.5 million of them, about 19%, have household incomes over $75,000. In other words, a fifth of the uninsured make at least 50% more than the median American. They can afford to purchase a plan but have chosen not to.
Another 8.8 million uninsured make between $50,000 and $75,000. Paying for coverage might be more of a stretch for these folks, but they still have incomes higher than the majority of Americans.
For these two subsets of the uninsured population, an insurance plan might not be worth the money, particularly if they're young and healthy. And with ObamaCare set to drive up the cost of a basic individual insurance plan by 10% to 13%, according to the Congressional Budget Office, the number of voluntarily uninsured is certain to grow.
Another 9.7 million of the uninsured are noncitizens, both legal and illegal immigrants. Illegal immigrants will not be able to participate in ObamaCare's exchanges, so they'll continue to seek care in expensive emergency rooms and community hospitals, thereby adding to the cost of care for everyone else. Add these three groups up, and more than half of the people the Census Bureau counts as uninsured could be considered questionably so.
The uninsured truly in need of help are those with household incomes below $25,000. They represent roughly a third of the uninsured, or 16.1 million.
Now, 16 million uninsured is nothing to sneeze at. But they represent only 5% of the American population. Finding coverage for them doesn't require remaking one-sixth of the U.S. economy, as ObamaCare does. Many of these 16 million people are already eligible for public insurance, chiefly Medicaid and the State Children's Health Insurance Program. They just haven't signed up.
The Census figures also show that the number of people with private insurance dropped by 300,000 last year. About 1.5 million people lost their employer-sponsored insurance, most likely because of the economic downturn. But that loss in coverage was partially offset by the fact that over a million people bought coverage for themselves or their families on the private market.
What are we to make of all these numbers? For starters, increasing the employment rate offers the fastest way to reduce the number of uninsured.
The Census pegs the uninsured rate at 16.3%. Not-so-coincidentally, the percentage of the population that is unemployed, has temporarily given up searching for a job, or is working part-time but would like full-time employment is 16.2%.
In America's employer-dominated insurance system, those two figures are closely linked. Without job growth, the percentage of Americans without insurance will stagnate or increase.
The president and his team have cited the Census figures as proof of the need for ObamaCare. But any coverage gains delivered by the law will undoubtedly be undermined by the law's $800 billion in tax increases, which will further slow economic growth and prevent employers from hiring, and thus from furnishing the previously unemployed with coverage.
Because of ObamaCare's mandates and regulations, many employers are also set to drop the coverage they offer and let their employees buy insurance in the exchanges. In June, a study by the consulting firm McKinsey & Co. estimated that about a third of employers will do so. In a report last year published by his American Action Forum, former Congressional Budget Office Director Douglas Holtz-Eakin estimated that 35 million of the 160 million people who currently have employer-based coverage will lose it.
The Census Bureau's latest report confirms that insurance coverage can be hard to come by. But there's more to the Census figures than meets the eye. Until the American economy resumes growing, the uninsured rate will stay right where it is.
Ms. Pipes is president and CEO of the Pacific Research Institute in San Francisco. Her latest book is "The Truth About Obamacare" (Regnery 2010).
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The Obama health-care plan passed 18 months ago, and its cynicism still manages to astonish. Witness the spectacle surrounding one of its flagship new entitlements, which is eliciting some remarkable concessions from its drafters.
The Health and Human Services Department recently shut down a government insurance program for long-term care, known by the acronym Class. HHS also released a statement claiming that reports that HHS is shutting down Class are "not accurate." All HHS did was suspend Class policy planning, told Senate Democrats to zero out Class funding for 2012, reassigned Class's career staffers to other projects and pink-slipped the program's chief actuary. Other than that, it's full-speed ahead.
HHS is denying what everyone knows to be true because everyone also knows that the Class entitlement was not merely created to crowd out private insurance for home health aides and the like. Class was added to the bill because it was among the budget gimmicks that Democrats needed to create the illusion that trillions of dollars of new spending would somehow reduce the deficit.
Benefits in the Class program, which was supposed to start up next year, are rigged by an unusual five-year vesting period. So the people who sign up begin paying premiums immediately—money that Democrats planned to spend immediately on other things, as if the back-loaded payments to Class beneficiaries would never come due. The $86 billion or so that would have built up between 2012 and 2021 with the five-year lead is supposed to help finance the rest of ObamaCare. The Class program would go broke sometime in the next decade, but that would be somebody else's problem.
Corbis
.Opponents warned about this during the reform debate, and people on HHS's lower rungs were telling their political superiors the same thing as early as mid-2009, according to emails that a joint House-Senate Republican investigation uncovered.
In one 2009 note, chief Medicare actuary Richard Foster—a martyr to fiscal honesty in the health-care debate—wrote that "Thirty-six years of actuarial experience lead me to believe that this program would collapse in short order and require significant Federal subsidies to continue." He suggested that Class would end in an "insurance death spiral" because the coverage would only be attractive to sicker people who will need costly services. It could only be solvent if 230 million Americans enrolled, which is more than the current U.S. workforce.
An HHS Office of Health Reform official, Meena Seshamani, rejected Mr. Foster's critique because "per CBO it is actuarially sound." But of course CBO only scores what is presented to it, no matter how unrealistic. Despite this false reassurance, later even one HHS political appointee took up Mr. Foster's alarms, writing that Class "seems like a recipe for disaster to me."
In February of this year, Health and Human Services Secretary Kathleen Sebelius finally admitted the obvious, testifying at a Congressional hearing that, gee whiz, Class is "totally unsustainable" as written. By then Class had become a political target of vulnerable Senate Democrats looking to shore up their fiscal bona fides, despite voting for it when they voted for ObamaCare.
Bowing to this political need, Mrs. Sebelius has repeatedly promised to use her administrative discretion to massage Class's finances until it is solvent. But given that the office doing that work has now been disbanded, this evidently proved impossible, as the critics claimed all along.
***
All of this would seem to make repealing Class an easy vote for Congress, but, this being Washington, it isn't. Since the CBO says Class's front-loaded collections cut the deficit to the tune of that $86 billion, HHS has to pretend that the program is still alive to preserve these phantom savings.
Some Republicans are also nervous about repealing Class because, under CBO's perverse scoring, they'll be adding $86 billion to the deficit. Others would prefer not to repeal any of ObamaCare until they repeal all of it, on grounds that some of it might survive if the worst parts go first.
So an unaffordable entitlement that will be a perpetual drain on taxpayers may continue to exist because of a make-believe budget gimmick that everyone now admits is bogus. Congress can't reduce real future liabilities because it would mean reducing fake current savings.
This is literally insane. It's rare to get a political opening to dismantle any entitlement, much less one as large as Class. House Republicans ought to vote to repeal it as soon as possible as an act of fiscal hygiene, forcing Senate Democrats to vote on it and President Obama to confront (even if he won't acknowledge) the fraud he signed into law.
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http://www.nytimes.com/2011/10/18/us/massachusetts-tries-to-rein-in-its-health-care-cost.html?_r=1&nl=todaysheadlines&emc=tha2
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By LOUISE RADNOFSKY
Every Republican presidential candidate has promised to repeal the Obama administration's health-care overhaul. But despite full-throated criticism, it's going to be hard for any of them to fulfill that pledge if elected.
Despite their full-throated pledges to repeal the health overhaul law, no Republican presidential candidate is likely to fulfill that pledge entirely if elected in 2012. Louise Radnofsky has details on The News Hub.
.Standing in the way of that seemingly simple campaign promise—an article of faith among GOP voters—is a welter of practical and political obstacles. They include immovable limits on what elements the Senate can tackle, in the likely event Republicans don't have a 60-seat majority after the 2012 election, and the party's need to come up with spending cuts to replace savings promised by "ObamaCare," as it's dubbed by critics.
These and other hurdles have sparked a lively debate among the candidates over whose approach is best, with former Massachusetts Gov. Mitt Romney battling rivals who say his two-step plan is unrealistic. For now, GOP lawmakers and conservative strategists are pushing separate, piecemeal approaches.
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Close.The conundrum is in part a direct consequence of the law's complexity, something Democrats now consider an asset. In the House, some Republicans have been studying ways to choke off funds for the law while working toward repeal, while in the Senate Republicans are pushing bills to knock out specific pieces of the law.
The complications are evident in Mr. Romney's two-step plan.
Mr. Romney has proposed signing an executive order on "day one" offering waivers to any governor who wants his or her state to opt out of the law. His rivals note that by law, such waivers can't take effect before 2017. The move would also leave untouched the focus of conservative opposition: the requirement that individuals carry insurance or pay a fee.
Mr. Romney said he would follow this on "day two" with legislation to repeal the law, using a Senate tactic called budget reconciliation. That would require only 51 votes to succeed, a total the GOP might reach after next year's election.
But under the rules, such a bill would tackle only parts of the legislation that relate directly to the budget. Anything else would require 60 votes to overcome a Democratic filibuster, and few see Republicans notching that number.
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WashWire: Poll: Most Don't Like Health-Care Law
.Presidential contenders Rick Perry and Jon Huntsman have attacked Mr. Romney's approach, particularly the first step of his plan.
"Ultimately there are no administrative silver bullets that can roll back the core provisions," said Tim Miller, a spokesman for Mr. Huntsman. Mark Miner, a spokesman for Mr. Perry, said the candidate would do "as much as is possible through executive order, but will focus on leading Congress to pass a full repeal."
In addition, some provisions of the law are linked with others and would cause problems for health insurers if dismantled. Moreover, while polls show a plurality of the public backs repeal, people also favor certain pieces of the bill.
In a March 2011 survey by the non-partisan Kaiser Family Foundation, 74% said they thought lawmakers should keep provisions that prohibited insurance companies from denying coverage because of a person's medical history. But a new poll just released by the foundation found that 51% of respondents have an unfavorable opinion of the law, up from 46% in the March survey.
In the coming election campaign, Democrats are expected to highlight such provisions, including a mandate that insurance companies issue coverage for children even if they have pre-existing medical conditions.
"The few policies that aren't loved, such as the individual requirement to purchase insurance, make the overwhelmingly desirable provisions, such as the insurance-reform protections, workable and affordable," said Chris Jennings, a former senior health adviser to President Bill Clinton.
Another potential problem: The Congressional Budget Office initially found that the law narrowed the deficit, thanks to its tax increases and Medicare cuts. Opponents say such savings are illusory because they expect Congress to put off those provisions. Even so, reconciliation rules require Republicans to provide offsetting cuts.
When the health care overhaul passed in 2010, CBO calculated it would reduce the deficit by $124 billion over 10 years. Since then, the Obama administration has shelved the law's long-term-care insurance program, which CBO originally estimated would save $70 billion over that time period.
CBO declined to comment on future projections.
Proponents of repeal point out that the law's deficit-reduction projections are likely to diminish substantially by 2013.
Conor Sweeney, a spokesman for House Budget Chairman Paul Ryan (R., Wis.), said analysts used gimmicks to arrive at their original estimates for the overhaul's deficit reduction, and that the demise of the long-term-care program leaves a more manageable budget gap to fill.
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Republican presidential hopeful Mitt Romney
.In the Republican-controlled House, Mr. Ryan has led efforts to repeal the legislation in its entirety. He has said he believes it can be replaced with other measures that would contain the cost of health care, such as changes to the structures of Medicare and Medicaid. He also wants to keep insurance companies from being able to deny coverage based on a person's medical history.
Choking off the law's funds, which some Republicans recommend, could help thwart the overhaul in 2013. But it would leave the law on the books for Democrats to revive funding for it in the future.
In the Senate, where the procedural problems are most acute, Sen. Orrin Hatch of Utah, the top Republican on the Senate Finance Committee, is pushing smaller bills to address specific pieces of the law, including requirements for individuals and employers to purchase insurance or pay a fine, and a tax on medical devices, according to spokeswoman Julia Lawless.
James Capretta, a top budget official in the administration of George W. Bush, said if drafters were "creative" and went after every provision that had spending implications, they could remove most of the law or make it irrelevant using the budget reconciliation process. "It would take a fair amount of work, but it's definitely doable," he said.
Senior GOP leadership aides said it was too early to know for sure how they would go about using the reconciliation process, and neither they nor the presidential candidates have specified how they would plug the budget gap.
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GOP Wastes Obamacare Opportunity by Michael D. Tanner
from Cato Recent Op-eds
A new poll released last week shows that support for Obamacare has reached an all-time low. According to the poll by the Kaiser Family Foundation, which has traditionally found more support for the health-care law than other groups, just 34 percent of Americans now support the law. In fact, barely half of Democrats support the signature achievement of a Democratic president.
It's not hard to see why. Among the revelations in recent weeks:
Insurance premiums are rising. President Obama once promised that the health-care bill would save each of us as much as $2,500 annually on our premiums. But a recent survey by the Kaiser Family Foundation shows family premiums increasing by a whopping 9 percent this year, three times more than the previous year's increase. The average family policy now costs more than $15,000 per year. Not only has Obamacare failed to slow premium growth, but at least two percentage points of that increase is directly attributable to the health-care law's provisions.
Consumers have fewer choices. Obamacare is driving insurance companies out of the market, meaning there will be less competition and fewer choices. Just last month, two health-insurance companies announced that they were leaving Florida's individual-insurance market because of provisions in the law, most notably the medical-loss-ratio requirement that insurers must spend at least 80 percent of premiums on medical care or give customers rebates. And in Iowa, Des Moines–based American Enterprise Group announced last week that it will also pull out of the individual major-medical-insurance market, making it the 13th company to pull out of some portion of Iowa's health-insurance business since June 2010.
More debt, fewer taxpayers. A new study from the Congressional Budget Office concluded that the subsidies in the bill will add $1.36 trillion to the national debt over the first seven years after the bill is fully implemented. And at a time when 47 percent of Americans already pay no income tax, the bill's tax credits will remove as many as 8.1 million more Americans from the tax rolls.
CLASS Act dies (sort of). And how can we forget that the administration itself had to announce it was pulling the plug on the CLASS Act, the bill's Ponzi-like long-term-care program? At the same time, however, the administration came out against any effort to actually repeal the program that they believe is actuarially unsound.
Yet Republicans have seemed strangely quiet about the issue of late. So much so, in fact, that the Washington Times was led to wonder if Republicans have "given up" on repeal. There certainly does not appear to be much evidence that Republicans are still making repeal a top priority. The House hasn't taken a vote on Obamacare since trying to change the bill's graduate-medical-education funding back in May. There isn't even an all-out effort to get behind a repeal of the CLASS Act, despite Democratic defections on the issue.
And the Republican presidential candidates have relatively little to say as well. This seems especially odd, given that any Republican not named Mitt Romney should be hammering on the issue almost daily. But lately there seems to be more attention paid to the nationality of Romney's gardener than to his continued defense of Romneycare.
As for Romney himself, if he hopes to persuade Republican voters that there is a difference between Obamacare and the Massachusetts health plan — and, more important, that he can be trusted to repeal Obamacare — he should be saying so very frequently and very loudly.
This is one of those times when good policy makes good politics. But Republicans seem content to blow this golden opportunity.
Michael Tanner is a senior fellow at the Cato Institute and coauthor of Leviathan on the Right: How Big-Government Conservatism Brought Down the Republican Revolution.
http://www.cato.org/pub_display.php?pub_id=13819
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Republican's ability to snatch defeat from victory can be frightening indeed.
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This week President Obama finally confronted a major U.S. health-care disgrace—the growing shortages of lifesaving drugs, especially anticancer therapies. For some reason the White House lumped its executive order with its "we can't wait" campaign against House Republicans, but the pity is that we will have to wait, because the only genuine fix is a liberal anathema: market prices.
Shortages have more than tripled since 2005, according to the University of Utah's Drug Information Service, and by the end of the year more than 300 products are likely to be back-ordered, in short supply or totally unavailable. Some are anesthetics and pain therapies, others emergency room "crash cart" drugs. But most—about 70% in 2010—belong to the class of drugs known as "sterile injectables" that are mainstays of the chemotherapy arsenal, such as paclitaxel or cytarabine.
The result is that more and more patients are receiving substandard care—relying on less effective or more expensive substitutes or else forced to postpone treatment. In oncology, delays of weeks or even days can be fatal.
Most sterile injectables have been off-patent for decades, but unlike other cheap generic drugs with low profit margins, production is complex and requires special facilities. Nonetheless, George W. Bush and the Republican majority decided that Medicare was "overpaying" for these cancer drugs and included a 6% cap on price increases every six months in the 2003 prescription drug bill. These new price controls (which apply to the providers that purchase the drugs) took effect in 2005, when the shortages began.
In a rational market, sterile injectable prices would now be rising to encourage more supply, since the demand for cancer drugs is inelastic. The old reimbursement system, called "buy and bill," was imperfect, but at least it allowed prices to float and wasn't producing the scarcity that central planning always does. The sterile injectables that are in short supply currently sell for $37.88 a dose on average, and modest price increases could make the market economic.
The problem is compounded because Food and Drug Administration rules cause pointless delays. It takes as long as two and a half years to receive FDA manufacturing approval for a generic, so other drug makers can't ramp up production if a company cancels a product line due to these disincentives or even if the fragile supply chain for sterile injectables is contaminated and manufacture is delayed.
Mr. Obama's executive order will do little if any good since it doesn't address or even mention this underlying distortion that Medicare has created. Instead, it merely expands the FDA reporting requirements about production interruptions or terminations. This is supposed to be an early warning system, but the scandal is that the availability of basic medicines could be allowed to become an emergency.
The order also tells the Justice Department to crack down on the "grey markets" that have sprung up to deliver supplies to doctors and hospitals, albeit with the inevitable markups. So rather than allow price signals to govern supply and demand, Mr. Obama wants to suppress them further.
The larger danger apart from the risks to the patients forced to receive compromised treatment is to the future of cancer progress. The common chemotherapy drugs are critical in clinical trials as the standard regimen or in combination with new options, and the Coalition of Cancer Cooperative Groups reports that as many as half of all ongoing trials require the drugs that are vanishing. This is a delay that really is killing people.
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http://www.glennbeck.com/2011/11/15/judge-elena-kagan-wont-recuse/
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http://www.glennbeck.com/2011/11/15/judge-elena-kagan-wont-recuse/
Of course not. Anyone shocked at hearing this?
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It will be interesting to see what Bigdog says. The facts are different but my understanding was that Clarence Thomas was not unduly influenced by people he knows including his wife, nor would he recuse himself. Kagan I think was personally involved with this legislation, but I believe they are their own judge of conflict of interest and the decision to recuse. These questions remind us of why Presidential and Senatorial elections matter greatly.
Clearly the constitution authorizes all power with no limits (sarc.), it will be argued. They never really meant that 'the powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people', did they?
It will be argued in court that the mandate is really a tax even though it was argued explicitly on the congressional floor of debate and to the people that it is NOT a tax. I'm wondering if anyone who makes that duplicitous argument in front of the Supreme Court will be charged with Contempt, handcuffed and hauled out of there.
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Can someone please explain why Social Security is mandatory, acceptable and constitutional, Medicare (seems to me like a national health care plan for seniors) is mandatory, acceptable and constitutional,
but constitutional/legal questions still exist concerning a National Health Care plan?
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Soc. security is a tax made legal by the 16th. The 'contract' to pay you later is non-binding on the goverment. Your s.s. statement always says estimate with an asterisk. It is not a mandate. I don't pay any. Just choose no income. What in that did you think in that is comparable to mandating that every citizen purchase of a private product from a private company?
Constitution haters today should do what income tax advocates did back then - pass a new amendment if you want to authorize a new power previously left to the states or to the people.
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No SS tax on cap gains, on dividends, not sure what requirements are concerning the self-employed. Anyone?
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Doug - you ignored Medicare. Isn't that basically a National Health Care Plan? And a pretty good one; at least my father is happy.
Frankly, I wish I had his plan.
I'll let Doug also answer Crafty's question since Doug replied he doesn't pay any Social Security taxes.
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**It's always nice to have someone else pay for your healthcare, until the money runs out.
http://www.cbsnews.com/8301-505144_162-36940290/could-you-die-faster-medicares-broke/
May 15, 2009 7:54 PM
Could You Die Faster? Medicare's Broke.
ByKathy Kristof (MoneyWatch)
The wolf really is at the door.
For years Social Security and Medicare have been saying that they're running out of money. But, until now, the date of insolvency was years away.
The just-released Social Security trustees report says that Medicare will be spending more than it brings in this year. In less than a decade, the system will have run through all of its savings and be incapable of paying bills.
Social Security is slightly better off. By 2037--about the same time as GenX and GenY will want to punch out of the working world--Social Security won't have the money to pay full benefits.
When the systems stop running surpluses -- that's now -- it's also bad for taxpayers because the government has borrowed all the money out of the so-called "trust fund" to finance current operations. When those I.O.U. have to be repaid, there is less money for roads, parks, the military and every other service the government provides.
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First, if we are going to get along how about a little forum etiquette. To whoever wrote: "Doug - you ignored [my second point]..." after I answered your first point while you answered none of my points in two substantive posts on the subject... don't write things like that. You don't know if I was done writing or had other matters to attend to.
There is a logic string that I call 'and another thing', where the implication is made that a second point builds on the strength of the first point before establishing any validity in the first point. If you want your second point considered first, put it first. I deny the charge that I don't answer enough points made on this forum.
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I know less about Medicare than social security (one reason to wait until I got home to look things up and post) but it looks to me like it operates EXACTLY the same way as the Social Security Tax. If you think it is a "contribution" or an insurance policy and not a tax, try declaring income and not paying it! Had you answered points already made we would have a starting point to discuss that. Medicare is another component of the payroll tax package we used to call FICA. Medicare is a 2.9% tax on income/wages and it brings no direct benefit to the one paying it. It pays out to people 65 and older in the form of health care benefits. They don't ask the recipient how much they paid in, and if you are under 65 they don't give you Medicare health care benefits, except for the exceptions. The 'promise' that it will be there when you are 65 or older is non-binding on the government, just like Social Security. As with social security, that is because each new congress elected every two years has the power to end or change every program. If they did not have that power, it fails a test we used to call 'consent of the governed'.
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Schedule SE calculates the self employment tax which includes the Social Security and Medicare tax. http://www.irs.gov/pub/irs-pdf/f1040sse.pdf It is based on Schedule C - Business Income: http://www.irs.gov/pub/irs-pdf/f1040sc.pdf. Also Schedule F - Farm Income. The tax is .9235 x 15.3%, temporarily reduced to 13.3%. In other words the self employed pay double - BOTH the employee and employer halves of FICA tax. There is no FICA / SE tax on schedule B income (dividends), Schedule D income (Capital Gains) or Schedule E income (rental real estate).
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I did not say I never paid S.S. taxes, just that I don't currently receive wages or business income that applies to Schedules 'C' or 'SE'. Take my situation as hypothetical, it is not a mandate on all citizens so it is not at all the same as the health care mandate. (Repeating what was ignored) Medicare just like Social Security is a direct tax on income that is specifically authorized in the 16th amendment to the constitution: "Congress shall have power to lay and collect taxes on incomes". Where (repeating the ignored question) does the constitution expressly authorize the power of congress to impose in ObamaCare a mandate to buy a private product?? If it is "not delegated to the United States by the Constitution" then it is "reserved to the states and to the people" - meaning it is NOT A FEDERAL POWER.
A better analogy would have been auto liability insurance except that it is not imposed on everyone and this has been extensively argued in courts. It is a choice to drive, and that mandate for drivers on public streets is a power reserved to the states and to the people. In the Obamacare case, it is 26 states suing the federal government for usurping their power. The majority of states say it is a power reserved to states, yet you deny there is a question, not just disagree with the answer. :-(
Repeating my other question, when did we quit acknowledging the need to AMEND the constitution in order to create a new federal power. If you can't point to the authority for a power granted in the constitution, then just tell us you no longer live in a constitutionally based, limited government Republic. Maybe you are right.
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Hoping the testiness can , , , move forward now.
On the merits, Doug's analysis seem well reasoned to me.
=======================
By JONATHAN H. ADLER AND MICHAEL F. CANNON
Even if ObamaCare survives Supreme Court scrutiny next spring, its trials will be far from over. That's because the law has a major glitch that threatens its basic functioning. It's so problematic, in fact, that the Obama administration is now brazenly trying to rewrite the law without involving Congress.
The Patient Protection and Affordable Care Act offers "premium assistance"—tax credits and subsidies—to households purchasing coverage through new health-insurance exchanges. This assistance was designed to hide a portion of the law's cost to individuals by reducing the premium hikes that individuals will face after ObamaCare goes into effect in 2014. (If consumers face the law's full cost, support for repeal will grow.)
The law encourages states to create health-insurance exchanges, but it permits Washington to create them if states decline. So far, only 17 states have passed legislation to create an exchange.
This is where the glitch comes in: ObamaCare authorizes premium assistance in state-run exchanges (Section 1311) but not federal ones (Section 1321). In other words, states that refuse to create an exchange can block much of ObamaCare's spending and practically force Congress to reopen the law for revisions.
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.The Obama administration wants to avoid that legislative debacle, so this summer it proposed an IRS rule to offer premium assistance in all exchanges "whether established under section 1311 or 1321." On Nov. 17 the IRS will hold a public hearing on that proposal. According to a Treasury Department spokeswoman, the administration is "confident" that offering premium assistance where Congress has not authorized it "is consistent with the intent of the law and our ability to interpret and implement it."
Such confidence is misplaced. The text of the law is perfectly clear. And without congressional authorization, the IRS lacks the power to dispense tax credits or spend money.
What about congressional intent? Law professor Timothy Jost suggests that since ObamaCare requires all exchanges to report information about premium assistance, and it would be silly to impose that requirement on federal exchanges if their enrollees were not eligible, that shows Congress could not have intended anything but to provide assistance in federal exchanges. At least, he argues, there's enough ambiguity here about Congress's intent that federal courts will permit the administration to resolve it.
Not so fast. The Supreme Court has increasingly limited such deference to cases where the text of the law—rather than Congress's intent—is ambiguous. In this case the language of the law is clear, as even Mr. Jost admits.
The health law's authors in Congress deliberately chose to pass the bill with known imperfections and to use the reconciliation process to make only limited amendments. Writing a perfect bill would have required too many votes and risked failure. If what they passed was an imperfect bill with no premium assistance in federal exchanges, then that is what Congress intended.
And there are plausible reasons why Congress may have wanted to limit assistance to state-run exchanges—including encouraging states to create exchanges so that the federal government doesn't have the burden.
Supporters of ObamaCare, including George Washington University's Sarah Rosenbaum, have argued that nobody will have standing to challenge the IRS rule in court. That's not the case.
Under the law, employers must pay penalties when their employees receive premium assistance—a measure designed to encourage employers to keep offering coverage. Any employer whose employees receive premium assistance through a federal exchange would therefore suffer harm from the IRS rule and would have standing to challenge these illegal tax credits and outlays.
Public-interest lawyers could file suit as soon as the IRS rule becomes final and they find an employer that will be harmed. Any firm that doesn't offer health benefits and that employs lots of full-time, low-skilled, young workers in a state that fails to create an exchange should suffice. A successful challenge would block the law's employer mandate in that state.
In addition, under the Congressional Review Act, a simple (filibuster-proof) majority vote in each chamber of Congress could send to President Obama's desk a resolution blocking this IRS rule. Even if Mr. Obama vetoed the resolution (taking personal responsibility for this assault on the rule of law), a future president could still rescind the rule. Quite a perilous situation in which to leave the president's signature accomplishment.
Like the rest of the nation, the Obama administration wants a different health-care law than the one we got. But that doesn't give it the authority to rewrite the law by fiat.
Mr. Adler is professor of law and director of the Center for Business Law and Regulation at Case Western Reserve University. Mr. Cannon is director of health policy studies at the Cato Institute.
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Yes, rather testy.... And....
Doug did give you Crafty, per your request, a good explanation of the individual tax ramifications.
I never said Doug "never" paid S.S. taxes. However, Doug did say, "I don't pay any (S.S. taxes)."
As for Social Security and Medicare being only a "promise" not an obligation, perhaps, but I have no doubt it is a promise the country will keep with
certain necessary modifications. If that were to change, there would definitely be a "new Congress". :-o
As for it's constitutionality, quite a few courts have said that it it; I suppose we will see, but the odds are in it's favor.
I think many of the rulings and logic have been posted on this forum.
However for Doug to attack Obama Care because it allows private choice seems rather ingenious. Using Doug's logic, if Obama had
simply proposed covering all American's through Medicare and taxed then accordingly that would be constitutionally ok,
but mandating and giving them a choice of private products is not. :?
Well, maybe as I said, that is what he should have done. Most people are happy with Medicare. So let's just forget
the private insurance choices. :-D Think of all the lobbyists who would be out of a job.
From an actuarial standpoint (as I have previously mentioned, I spent years in the Health Industry) the more individual "choice"
you have, the more adverse selection comes into play. That is one main reason group plans are able to offer favorable rates and benefits
versus individual plans. Worse, actuarially speaking, if someone can opt out, but later if they become sick or injured we still have a moral obligation
to care for them. Unlike driving a car (you can walk, take the bus or metro) often times you have no choice when it comes to Medical Care.
So we pay one way or another.
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"As the Supreme Court has previously decided, Congress can intervene in local, individual decisions when necessary to support a legitimate regulatory regime for interstate commerce."
I think there are valid points on both sides of the argument.
http://www.latimes.com/news/opinion/opinionla/la-ed-health-20111116,0,4240404.story
http://www.latimes.com/news/opinion/commentary/la-oe-chermerinsky-healthcare-20111115,0,4312764.story
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The point of 'Social Security and Medicare being only a "promise" not an obligation' had to do with the constitutionality question relating to the health care issue not the desirability of social security or a prediction of what future congresses might do. It is constitutional because in law it is merely another tax and another social spending program as legal as all the others. The 'social contract' is like the lockbox. It doesn't exist in law.
"...attack Obama Care because it allows private choice..." It restricts private choice. My previous coverage is already gone. In the name of reducing costs it makes it unlawful to simply choose fee for service, the way we pay for almost everything else and the best way known to control costs. Central to economics, supply and demand, is that suppliers can only charge what the consumers can afford and choose to pay. Turn over the payment system to an apparatus willing to spend without limit a trillion a year more than they take in eliminates all freedom based forms of price constraint.
"if Obama had simply proposed covering all American's through Medicare and taxed then accordingly that would be constitutionally ok"
Pres. Obama already said he preferred that and considered this a step along the way to getting there. But if he stuck to that in his campaign he would not have been elected by his own calculation. He also needed the votes in congress; even among Democrats the votes were not there. Constitutionally based on precedent, you are on the right track. Taxes to no end, unevenly applied, and government not regulating but participating in the health care services industry follows the precedent of what some consider to be wrongly decided cases.
"From an actuarial standpoint...the more individual "choice" you have, the more adverse selection comes into play. "
There were some far reaching Republican proposals on the table addressing pre-existing conditions etc. when Obamacare was passed. Water over the dam now, unless we get to start this debate again. These might have been considered regulating interstate commerce.
"I think there are valid points on both sides of the argument."
Thank you, that is quite a step forward from denying that a constitutional question even exists.
Case law has set the precedent implying that incremental increases in federal government power can expand forever without limit because of pronouncements like you quoted: "Congress can intervene in local, individual decisions when necessary to support a legitimate regulatory regime for interstate commerce". That thinking will win at least 4 votes from this court. Some of the others I expect will recognize this as a new power and they will have to decide what to do about that. What govt powers don't somehow relate to regulating interstate commerce in a global economy?
Pretty obvious to me though that it is not a "legitimate regulatory regime" to make it unlawful for an individual to choose fee for service over insurance products in a free society. It is a wholly different question from whether they can tax and/or provide social services. As I wrote 2 years ago, the vote will be 4-4 and the future direction of our republic will come down to the mood of one Justice Kennedy.
As we await the decision, one question remains for the power already exists crowd, what power then would NOT be legitimate for the federal government in your view? My view is that this if found to be constitutional, this could be their final case. We will no longer need to review federal powers.
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We all agree that the costs of health care going up around 10% is unsustainable. We will all go bankrupt. Berwick "sells" (using his own term) his vision for the rest of using catch phrases like "quality", "human right" etc.
He does admit in a disingenius way that of course we are going to ration but we should do it with our eyes open. He is covering up the fact that extending care to 40 million people will not lower costs and that the rest of us will in some way pikc up that tab and get less. My opinion is that he is trying to get us to socialized medicine with arguments that he can improve quality of care, save costs on needless tests, health IT, performance measures, reducing side effects, infection rates.
The most telling part of the interview is an example he uses of a test his own daughter's insurance refused to pay for. He says he is a pediatrician and he can assure us she "needed" this test. What he doesn't tell us is that insurers do not refuse tests out of the blue and not without their own data that is EXACTLY the kind of stuff CMS is planning for us. His excuse is when the private insurers refuses payment they do not say why. I can tell you they do have appeals processes and the processes do include the option of a review by another doctor. Additionally everyone knows they go by actuarial data to determine what to pay for or not. That is exactly what he is planning. In any case health care in the US is broken. But I don't want single payer we are all forced to be in Harvard policy makers control health care.
http://www.bing.com/videos/watch/video/dr-donald-berwick-on-up-w-chris-hayes/6n2a2p5
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Some women who had cancer that was not well seen on mammogram has lobbied politicians to require that doctors inform them of their "dense" breasts which might lead to a missed early cancer because of the density obscuring the spot.
So without any medical evaluation of whether lierally chasing down every dense breast in the US leading to more expensive imaging tests and more procedures mostly false postives we have a political activist going straight to the poliiticians for more gigantic spending. Oh "but it will save lives and how much is a life worth" is the retort?
Folks there is no end in sight to do gooders. We are so F...!
****Dense Breast Bill Veto in Calif - Lets get on Jerry Brown's case!
Jennifer1961
Posts: 130
Joined: May 2010
October 13, 2011 - 11:22pm
Hey ladies! I'm so upset about this veto. OUr legislature passed the bill which would require that women be informed of dense breast and that mammogram may not show malignant growths. I never thought this would happen or I would have put pressure on Jerry Brown. From what I understand he bowed to the Calif. Medical Assoc. which is a very powerful lobby here. I personally could have been spared a lot of grief if I had been told I had dense breasts. I had my mammogram faithfully every year, but no one thought to mention it to me. Perhaps it could have been caught sooner and I wouldn't of had to have chemo and 6 surgeries. But I'm lucky. My tumor was close to the surface so I was able to feel it pretty easily. I know a lot of ladies aren't so lucky and they end up with a dire prognosis. This is about $$$$ nothing else. Let's give Gov. Brown a piece of our minds. Let him know we're more powerful than the Calif. Medical Assoc.
Jennifer
‹ do not want to take anastrozole? CT scan, no changes, but 10th infection since April and this time in the kidneys ›
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kchaffee
Posts: 4
Joined: Oct 2011
October 20, 2011 - 12:45am
HENDA LAW
Henda Law. All women should be informed about their breast density and
the need for additional testing. Jerry Brown is allowing women to die,
because he vetoed the law on this very issue, he has blood on his hands.
Lets start a Occupy Protest on this very important issue.............
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New Flower
Posts: 2583
Joined: Aug 2009
October 21, 2011 - 10:07pm
yes it is very important to be aware
I wish I knew, probably could catch mine much earlier
New Flower
VickiSam
Posts: 5179
Joined: Aug 2009
October 24, 2011 - 10:37am
Okay California Gals .. I am in the processing of
gathering email addresses .. telephone numbers .. and other means of contacting .. our YAHOO IDIOT -- Governor -- Jackasss Brown!
Vicki Sam
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New Flower
Posts: 2583
Joined: Aug 2009
October 24, 2011 - 8:50pm
Good Thank you
I still cannot understand the gov. He is proposing many other spending initiatives, while young women are suffering from misdiagnosis and likely to get treatment at the very late stage. Vicki, I am glad that you have been
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How Doctors Die
It’s Not Like the Rest of Us, But It Should Be
by Ken Murray
Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.
It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.
Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).
Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.
To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent. “How can anyone do that to their family members?” they’ll ask. I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.
How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.
To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not.
The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.
But of course it’s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.
Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman’s terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.
Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.
It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.
Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack’s worst nightmare. When I arrived at the hospital and took over Jack’s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.
Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of overtreatment.
But doctors still don’t over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.
Several years ago, my older cousin Torch (born at home by the light of a flashlight—or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.
We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.
Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.
Ken Murray, MD, is Clinical Assistant Professor of Family Medicine at USC.
http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/
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BBG:
That was a very good read.
Marc
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Democrats are running on Mediscare in 2012 and President Obama has all but called the "premium support" reform un-American, if not the decline and fall of Western civilization. That would seem to put the issue in Newt Gingrich's wheelhouse, but the GOP candidate also claimed in a recent interview that the Paul Ryan reform model is "politically impossible" and "suicide." Well, not so fast.
Today Senator Ron Wyden and Mr. Ryan are releasing a bipartisan defined-contribution health-care plan, as the Oregon Democrat and Wisconsin Republican explain nearby. This is an important moment because it shows that the serious entitlement debate is taking place within the camp of choice and incentives, not the Obama status quo.
Wyden-Ryan shares the same architecture as the House budget. It would replace today's open-ended Medicare with a fixed-dollar subsidy for seniors to choose from a menu of private plans. Costs would fall as insurers and providers innovate to compete for patient market share, rather than responding to fee-for-service price controls.
But there are several key changes. Most of the substantive argument turns on how the premium supports should grow over time. Wyden-Ryan would dispose of a predetermined rate—GDP plus 1%, medical inflation, etc.—and instead use competitive bidding. Insurers and traditional Medicare, which would remain intact, would essentially participate in a reverse auction and the second lowest bid would set the benchmark for a given region. Seniors would pay at the margin for more expensive options.
As a practical matter, competitive bidding may be an improvement over a set formula because it relies on local information and adjusts with the behavioral and organizational responses that will vary from region to region. Medicare as centrally planned from Washington will never be able to keep pace with the market if subject to the same defined payments. In any case, the growth rate to-and-fro is largely an artifact of the Congressional Budget Office, which has admitted there is a "gap in the toolkit" when predicting market-based savings. It knows this first hand from having grossly overestimated the costs of the 2003 prescription drug benefit.
Messrs. Wyden and Ryan also sneak in a reform of the larger employer market, which would allow businesses with fewer than 100 workers to move to a defined-contribution model without tax penalties. Mr. Wyden has been campaigning for such a reform for years from the Democratic backbenches.
The Oregonian voted for the Affordable Care Act, though his decision to join Mr. Ryan is another signal that the entitlement debate is moving in a more promising direction. Variations on defined contribution were also mulled by the "super committee," only to end up on the horns of liberal intransigence.
The brutal math is that Medicare spending has been growing about three percentage points faster every year than the overall economy for the last quarter-century and is now the main driver of the fiscal crisis. Mr. Obama has ruled out any structural reforms and his only fallback is the command-and-control technocracy that continues to fail and will ultimately harm patient care. The Wyden-Ryan deal shows that smart liberals prefer a different future.
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By LOUISE RADNOFSKY
The Obama administration said Friday it would shift to states the decision about what treatments many insurance plans must cover under the health-care overhaul, sidestepping contentious fights with Republican state officials and patient-advocacy groups.
The move—a departure from the way the administration had been expected to implement the provision—disappointed some disease-advocacy groups that had hoped federal regulators would spell out exactly what services insurance policies for millions of Americans will have to cover to be sold in state-run insurance exchanges that open in 2014.
Instead, the administration said states could use what is now offered in their local markets as the basis to determine what benefits must be included in new plans sold to individuals and small groups.
The move represents an attempt by the administration to defuse Republican criticism that the law gives the federal government too much control over Americans' medical care. But some small-business employers immediately raised concerns that the change would make plans more expensive for them.
States will be able to set their coverage standards to align with either those of the most popular federal-employee plans in the state; the most popular state-government employee plans; the largest plans offered to consumers who buy coverage in small groups, or the largest HMO in a state's market.
"As we've acknowledged many times, coverage that works in Florida may not work in Nebraska," said Health and Human Services Secretary Kathleen Sebelius.
Republicans and employer groups warned the approach could allow states to mandate a rich benefit package, particularly because the federal employees' health-benefits plan is among the country's more generous packages. The most popular national federal-employee plan offered by Blue Cross and Blue Shield typically covers some therapies for a person with autism, chiropractic services and infertility drugs, among other things.
Neil Trautwein, employee-benefits policy counsel at the National Retail Federation, said he was concerned the cost of a federal-employee plan could be beyond the reach of an individual purchaser or a small employer.
The approach also made some disease groups wary that their ailment could get left out of the final benefits requirements.
"It's not what we were asking for," said Carl Schmid, deputy executive director of the AIDS Institute. "I think it's very clever what they did, but I think that what patient groups were looking for was a list of mandated services. This is still going to allow a patchwork of care and that's what I thought we were going to try to get beyond."
Some larger patient-advocacy groups said they were optimistic that if states opt for the standards of the federal plan, it would be helpful for their members, though they were less sure about the impact of states picking the other benchmarks.
"People with cancer and their families have fared well under the largest federal employees' health-benefits plan," said Stephen Finan, senior director of policy at the American Cancer Society Cancer Action Network. "The quality of coverage patients receive under the three other options…is less certain."
Federal health officials said Friday they expected most of the options offered in the state exchanges to meet the wider coverage requirements outlined in the law. In some instances, they said, states might have to ensure their standards included rehabilitative and pediatric dental and vision services to comply with the measure.
The implementation plans also raise questions of possible disparity, with people in some states having better plans than others. And depending how substantive the coverage differences are among states, it could lead some people to move in an attempt to get better coverage elsewhere.
The move came in a "bulletin," which isn't binding but indicates the regulations the federal government is going to issue in the future.
Steve Larsen, a top HHS official in charge of enacting the overhaul law's insurance changes, said the bulletin was intended to help states plan ahead as they start new legislative sessions in January.
If a state refuses to set up an exchange, the federal government will run it for them. If this happens, the government will use one of the largest local small-group plans operating in the state to set standards for its exchange, officials said, an effort to be seen as committed to a market-based approach.
Many state governments are hostile to the overhaul law, and 26 have brought a case challenging its constitutionality, which will be decided by the Supreme Court next year.
Some of those states are simultaneously taking steps to implement the law locally, including setting up exchanges. Many governors in those places argue that it is preferable to retain as much state control over how the law is operating in their state if it is upheld.
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http://www.powerlineblog.com/archives/2011/12/hayek-vindicated-again.php
Posted on December 19, 2011 by Steven Hayward in Economy, Health Care
Hayek Vindicated Again
Way back on the Federal Page of today’s Washington Post is an article that ought to be on the front page above the fold, and its deep placement on the boutique page of the bureaucracy shows how the Post, like most everyone else, doesn’t understand what a big story it is. And it is clinical study of Hayek’s “knowledge problem”—the impossibility of centralizing fundamentally dispersed knowledge in a timely and accurate way—that we’ve discussed at various times here over the past few months.
The headline is “Concern growing over deadlines for health care exchanges,” and it discusses the difficulties of one of the main pillars of Obamacare—the mandate that the states set up insurance “exchanges” where people and businesses can do one-stop shopping for their mandated health insurance policies. But this is no simple exchange; because of the mix of federal programs such as Medicaid and Medicare, and the various regulations pertaining to eligibility, guaranteed issue, and other features of Obamacare, the states are having a hard time figuring out how they are going to do it. And time is running out. As the Post explains, “the exchanges will need to incorporate state and federal data on income, employment and residency. Enrollment through the state and federal exchanges is scheduled to begin in the fall of 2013.”
Obamacare has a fallback position: if states can’t (or won’t) make the deadline, the federal government will step in and run the exchange out of Washington. I’ve heard rumors for months now that the Dept. of Health and Human Services is terrified of having to do this, and doubts it can be done by the deadline. The Post story would seem to lend some credence to these rumors:
It’s hard to know how far along the federal government is because the Obama administration has “been very reluctant to provide any updates on progress,” said Dan Schuyler, a director at the consulting firm Leavitt Partners in Salt Lake City, which is advising states on the exchanges.
The Department of Health and Human Services did not respond to requests for comment. Those designing a federal exchange face enormous technical, political and financial challenges.
Technically, data from a host of federal agencies need to be collected into one system, which then must be linked with computer systems in 50 states and the District of Columbia.
Matt Salo, executive director of the National Association of State Medicaid Directors, said computer systems in some states are old and may need substantial upgrading. There is some doubt, he said, about whether there is enough “physical capacity in the IT systems world” to get it all done in time.
Another Obama high-speed train wreck to nowhere.
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Yes. I posted IT in health care is not ready for prime time but it is being shoved upon us.
There is a whole industry just drooling to get/stay in on it.
Yet this is not just Obamacare stuff. Gingrich and other Republicans have also been pushing this for a long time.
Government cannot even get their own systems to work well.
Make no mistake about it. Health care is driven by the money - the constant fight between payers and the providers and the developers of drugs and technology and associated research.
Those who have a vested stake in making the money off the evolution of it all talk about how *exciting* this all is.
Otherwise it is all very much a mess indeed.
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All the extremely private health care individual information in the nation integrated into one easily accessed system. What could possibly go wrong?
A trick question from my early career in bank information systems: what is the objective of the bank's computer system? It is a rookie mistake is to think the system should make all information available to all users. The answer is the opposite. The system needs to hold and process all the data with people's very private information but only make very limited information available to any user - just enough to do their job with proper security clearance. The larger the institution, the larger the opportunity for security breaches. Has anyone ever heard of wikileaks?
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http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3&hpt=hp_c1
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"Spending on Medicaid, a theoretically cooperative federal-state program, is
approximately 40 percent of all federal funds given to states and 7 percent of all
federal spending. Enacted in 1965 as a program for the poor, it has exploded. The
increase in its costs by the end of this decade is expected to be $434 billion. ...
Obamacare requires states to cover all persons with incomes up to, effectively, 138
percent of the poverty level. The federal government will pay all increased costs
(other than administrative costs) until 2016; by 2020 states will pay 10 percent of
the expansion. But even with the federal government paying most of the costs, in
many states their portion of Medicaid costs is the largest item in their budgets,
even exceeding education. And Obamacare, which forbids states to make more
restrictive the eligibility criteria it adopted before this new burden, would deny
all Medicaid funds to noncompliant states. This would cost most states billions of
dollars. ... In theory, state participation in Medicaid is voluntary; practically,
no state can leave Medicaid because ... [it] leaves states this agonizing choice:
Allow expanded Medicaid to devastate your budgets, or abandon the poor." --columnist
George Will
(http://patriotpost.us/opinion/george-will/2012/01/22/something-to-argue-about/ )
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Our Sick State
by Mark Steyn
National Review's Happy Warrior
January 25, 2012
http://www.steynonline.com/4783/our-sick-state
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A couple of months back, I was with a friend of mine when she suddenly collapsed and I found myself having to run her to the emergency room. After a fairly harrowing 14 hours, the hospital released her, the doctor writing her a prescription for the still-very-intense pain she was in. So we stopped at her local Kinney Drugs in Vermont.
Despite having been called in by the doc, the prescription wasn't ready. Come back in an hour. Heigh-ho. So we left it an hour and a half, and then, not wishing to make another pointless trip, called the pharmacy just to make sure. No, sorry, the druggist said. They ran the insurance number and it was denied. So they canceled the prescription. Without calling the patient to tell her they'd canceled it. I passed the phone to my friend, lying on the couch like a tubercular Victorian heroine, and she explained that her employer had recently switched plans from Blue Cross/Blue Shield to Cigna and, midst groans, gave them the new policy number. She waited another hour in pain and we then returned to Kinney Drugs, using the convenient drive-thru lane.
This time, they had the drugs. My pal handed over her new insurance card. After some 15 minutes, the clerk returned and said the insurer had declined it. There were two cars backed up behind us. My friend said that couldn't be right, the number was valid, could they please run the number again. They did. Same result. There were now four cars behind us. The clerk suggested we drive around the building, join the back of the drive-thru line, and maybe when she'd taken care of the four cars behind things would have quietened down sufficiently for her to call someone and try to find out what the problem was.
Never mind my friend's crippling pain, spare a thought for me: I'd had to spend untold hours being kindly and supportive and sympathetic, which is not a role to which I'm naturally suited, and the strain was beginning to tell. In that useful Americanism, I didn't need this in my life right now. So I enquired of Kinney Drugs whether it would be possible for us just to pay for the prescription — you know, with money — and then bugger off to resume our lives. She went off to see whether that was still possible. Upon her return, I grabbed my wallet and pulled out a credit card.
"That will be eighteen dollars and 79 cents," she said.
Oh. For whatever reason — perhaps the sheer dogged determination required to negotiate this time-consuming transaction to a successful conclusion — I had assumed this would be one of those expensive pills about which one hears so much and I'd be ponying up 500 bucks. Instead, I put away the credit card and fished out a $20 bill.
And then I thought of the opportunity cost not only to me but to the four cars behind. It seemed a very expensive way to buy 18 bucks' worth of pills.
It turned out my friend's prescription was denied because someone at the pharmacy had transposed two numbers. Oh, well. Could happen to anyone. And, in fact, it does. Speaking as an unassimilated foreigner, I notice when you're standing in line that the big difference between a trip to the pharmacy in the U.S. and one in the rest of the developed world is that in America the druggists spend virtually their entire time talking about not the medicine but the "customer"'s degree of access to it. For example, while guest-hosting for Fox News just after Christmas, I was taken ill while in New York. Saw a doc, got a prescription, this time went to a Duane Reade pharmacy on Sixth Avenue. The lady ahead of me was going away for New Year's. Too bad. Her health-care provider declined to provide her with a renewal of her prescriptions before the 31st. The stylishly accoutered lady ahead of her had a better strike rate. After some delay, the pharmacist returned. She informed her (and the rest of us) that the good news was that her insurer had approved her Ortho, but the bad news was that they'd denied her Valtrex. Ortho is a birth-control pill. Valtrex is a herpes medication. Had her dinner date been a couple of places behind me in line, the news might have cast a bit of a damper on his evening. As it was, it occasioned general amusement among the women present.
I don't quite know what you'd call these rituals, but the term "private health-care system" doesn't seem the most obvious fit. Indeed, as in so many other areas of American life — the Fannie-Freddied mortgage market, the six-figure college education — the main purpose of these dysfunctional labyrinths ever more disconnected from any genuinely free market seems to be to discredit the very concept of a "private" system and thus soften up the electorate for statist fixes. I've argued for years in these pages that governmentalized health care fundamentally transforms the relationship between citizen and state in ways that make it all but impossible to have genuinely conservative government ever again. But at least the Canadian and British systems have the saving grace of an equality of awfulness. Both Obamacare and, alas, Romneycare seem designed to combine the worst aspects of the Scottish NHS and America's present third-party pseudo-market — and thus a scale of bloated, bureaucratic, inflationary capriciousness unknown to human history.
In free, functioning societies, it ought to be easy to buy a bottle of pills. The fact that it isn't is one reason why America has a real bad headache.
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The Foundation
"Tyranny, like hell, is not easily conquered; yet we have this consolation with us, that the harder the conflict, the more glorious the triumph." --Thomas Paine
Government & Politics
ObamaCare's Continued Chaos
To no thinking person's surprise, the Obama administration admitted this week that another element of ObamaCare is going to cost more than originally expected. This isn't really news so much as it is yet another confirmation that the president's takeover of health care will be an absolute disaster.
The latest program to exceed expectations is the Pre-Existing Condition Insurance Plan, which provides health insurance for people who can't obtain coverage through private carriers. The PCIP was meant to be an interim program phasing out in 2014, at which point all insurers will be required to accept all comers who want coverage. In November 2010, the federal government estimated an annual cost of $13,000 per enrollee. Since the program's launch last year, some 50,000 people have signed up, and now the expected cost is around $29,000 per enrollee.
While we're on the subject, the outrageous contraception mandate remains yet another tarnished gem in the ObamaCare crown. Health and Human Services Secretary Kathleen Sebelius announced this week that the administration has begun "outreach" to officials in the Catholic Church, insurers and groups that run self-insured insurance plans. However, Sebelius' "outreach" isn't in search of a compromise with faith-based groups whose rights are being trampled for the sake of free contraception. The administration hasn't backed down from its non-compromise offer that the cost for free contraception be shifted from faith-based employers to private insurance companies. The mandate is here to stay, and faith-based employers have 18 months to comply.
One of the free contraception mandate's more vocal supporters testified this week before the House Democratic Steering and Policy Committee about how tough life can be without free birth control. The hearing was nothing more than a showpiece for the issue with a single witness, Sandra Fluke (is there a pun here?), a Georgetown law student and self-professed "reproductive rights activist." Fluke made the absurd claim that free contraception is a necessity at her school, which currently doesn't provide it. "Forty percent of the female students at Georgetown Law reported to us that they struggled financially as a result of this policy," she complained. Of course, the HHS mandate has nothing to do with university students, but that's beside her point.
Fluke asserted that contraception could cost $3,000 through three years of law school. That's a lot of money to spend on protected sex over that time frame. In fact, humorist Frank J. Fleming quipped, "Anyone buying that much contraception should probably be writing it off on her taxes as a business expense." Fluke's assertion that she and other women have an absolute right to contraception at someone else's expense is disturbing. There is no right to sex free of consequences. Fluke also implies that the women of Georgetown law have no control over their urges or actions, all the while thinking she's standing up for women's rights. When did "get your laws off my body" become "you have to pay for the stuff that goes into my body"?
The most important question, of course, is just where within the Constitution is the government granted the power to mandate this sort of thing for private or religious organizations? This was asked of Rep. Kathy Hochul (D-NY) by one of her constituents at a recent town hall. She replied, "Well, basically, we're not looking to the Constitution on that aspect of it." We suppose Hochul's candor is refreshing, but it didn't sit well with the crowd -- nor should it. Hochul attempted to defend ObamaCare by stating that Congress determined that citizens are entitled to health care. "So why don't we provide free access to Band-Aids and cancer screenings?" the constituent followed up. "Aren't those more important to health care than contraception?" Hochul could only say, "Well, clearly more work needs to be done." Nice understatement.
In the Senate, an amendment to impose a religious-conscience exemption to ObamaCare was rejected Thursday. Proposed by Sen. Roy Blunt (R-MO), the Respect for Rights of Conscience Act was attached to an upcoming transportation bill. Democrats were nearly united in opposition, and retiring Maine "Republican" Olympia Snowe was the only GOP member to oppose it. Obama, adamantly pushing "free" contraception, would have been forced to veto the whole transportation bill in order to prevent the conscience exemption from again being the law. His other option would have been to let the amendment pass and hope it takes some of the heat off as the presidential election moves forward.
The one bit of good news is that a House committee voted to throw out the "death panel" provision of ObamaCare. The Independent Payment Advisory Board was supposed to help with cost control, but has been accurately tagged as a "death panel" because of its rationing of care. All things considered, however, a new administration and a more Liberty-friendly Congress must be installed in January to repeal this monstrosity.
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From an actuarial standpoint, paying for contraceptives is far more cost effective than pregnancy. It's cost effective; consider it preventative medicine. Or are you suggesting that pregnancy, a voluntary optional procedure not be covered like it wasn't under many plans years ago?
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http://www.sickandsickermovie.com/
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From an actuarial standpoint, paying for contraceptives is far more cost effective than pregnancy. It's cost effective; consider it preventative medicine. Or are you suggesting that pregnancy, a voluntary optional procedure not be covered like it wasn't under many plans years ago?
This is the role of government? How about we just sterilize those who can't afford birth control? That's even more cost effective, right?
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:? :? :?
Good grief GM; do you know anything about actuarial science or employee benefit plan design? Incentives?
All those tests you get for free in your health care plan, your physical, immunizations, etc. Do you think they do that because they are nice? Of course not,
routine care, preventative care is cheaper than expensive procedures. I don't know if it's the role of government or not, but if you want to have
a cost effective plan you need to provide carrots and sticks. Or just pay and pay and pay.
It's your choice; no one is making you do anything. But they offer an incentive, i.e. free for contraceptives. That is a whole lot cheaper than pregnancy.
But it's your choice.
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Was your response to Crafty's post on the disaster that is Obozocare?
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I didn't watch much of it; I'm not a big fan of amateur propaganda youtube videos.
However, I do know personally quite a few Canadians who are very happy with their plan.
And I know there are 50 million Americans who don't even have a health insurance plan.
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I didn't watch much of it; I'm not a big fan of amateur propaganda youtube videos.
**You prefer the LeftAngeles Slimes professional propaganda. We know, you parrot it unthinkingly without end.
However, I do know personally quite a few Canadians who are very happy with their plan.
**Ah, were they down here seeking medical care like every Canadian who needs to and can afford it?
And I know there are 50 million Americans who don't even have a health insurance plan.
**Another bogus DNC talking point that is untrue as everything else you parrot.
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http://nrinstitute.org/mediamalpractice/?p=134
Why That 48 Million Uninsured Number is Wrong
A March 31 AP article entitled “Sebelius calls for action now on health care” repeats the claim, pushed by proponents of government run health care, that there are “48 million uninsured Americans”.
Numbers in the 40-million range regularly used by proponents of health care “reform” are based on reports from the Census Bureau which show, for example, over 45 million people “not covered” in 2007. However, these numbers are extremely misleading for several reasons, and the difference is critical not simply as a debating point but as a context for appropriate government policy changes.
■The Census Bureau itself says that “Health insurance coverage is likely to be underreported…” (See Appendix C of THIS report) For example, “16.9 percent of people with an MSIS record indicating Medicaid coverage reported…that they were uninsured.”
■According to Sally Pipes of the Pacific Research Institute, “as many as 12 million uninsured Americans are eligible for Medicaid and the State Children’s Health Insurance Program–but they haven’t signed up.”
■More than half of the uninsured are between 18 and 34 years of age, a group which has relatively few expensive health issues and for whom self-insuring (paying their own medical bills) makes sense. Only 14% of people over the age of 55% are uninsured.
■Over 9 million of the “uninsured” have household incomes over $75,000.
■Roughly 30% of the uninsured are without insurance for less than 6 months (though this statistic will likely worsen during the current recession).
■And finally, estimates are that between 7.5 million to over 10 million of the uninsured (15% of them or more) are illegal immigrants.
The number of chronically uninsured people who would prefer to have insurance but can’t afford it is likely 10-12 million people, or one quarter of the number often repeated by the media. Reporters who cite the 48 million number without providing a full context do their readers a great disservice.
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"The number of chronically uninsured people who would prefer to have insurance but can’t afford it is likely 10-12 million people"
Yes, out of 310 million people. Other proposals on the table as alternatives to Obamacare including end of pre-existing conditions clauses, tort reform and allowing cross state line competition would have shrunk the 10 million figure significantly.
'Can't afford it' is a function of two variables: income and cost of health care. One party's policies have the effect of lowering national income or at least stopping its growth, while implementing hundreds and huindreds of programs that drive up the cost of health care. The other party is struggling within itself to decide how large the (negative0 role of government should be.
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http://www.freep.com/article/20090820/BUSINESS06/908200420/1319/
Canada eyed in the health care debate
Dany Mercado, a leukemia patient from Kitchener, Ontario, is cancer-free after getting a bone marrow transplant at the Barbara Ann Karmanos Cancer Institute in Detroit.
Told by Canadian doctors in 2007 he couldn't have the procedure there, Mercado's family and doctor appealed to Ontario health officials, who agreed to let him have the transplant in Detroit in January 2008.
The Karmanos Institute is one of several Detroit health facilities that care for Canadians needing services not widely available in Canada.
Canada, for example, has waiting times for bariatric procedures to combat obesity that can stretch to more than five years, according to a June report in the Canadian Journal of Surgery.
As a result, the Ontario Ministry of Health and Long-Term Care in April designated 13 U.S. hospitals, including five in Michigan and one more with a tentative designation, to perform bariatric surgery for Canadians.
The agreements provide "more immediate services for patients whose health is at risk," Jensen said.
Three Windsor-area hospitals have arrangements with Henry Ford Hospital, Detroit, to provide backup, after-hours angioplasty. Authorities will clear Detroit-Windsor Tunnel traffic for ambulances, if necessary. The Detroit Medical Center also provides Canadians complex trauma, cancer, neonatal and other care.
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Yes, Canada and Rest of the World benefited from the advances and care available that came out of what freedoms we had left in our healthcare system.
Rule One in economics: tax something and you will get less of it.
Rule One in Obamanomics: New excise tax on medical devices.
I had a discussion last week with a person who is head of strategy for a major medical device manufacturer. I did not know the person's politics but asked if the new tax on their product would be helpful to them. The answer was No.
Killing off the medical device industry here hurts people everywhere.
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http://blog.heritage.org/2012/02/14/side-effects-obamacare-tax-will-kill-jobs-strangle-medical-device-industry/
Side Effects: Obamacare Tax Will Kill Jobs, Strangle Medical Device Industry
Alyene Senger and Brett Ryan, February 14, 2012
Last week, the IRS released its proposed plan to implement the 2.3 percent excise tax on medical devices designed to help foot the bill for Obamacare.
Harmful effects of the health law’s new taxes and requirements on business continue to emerge as its implementation continues. As Heritage’s Curtis Dubay explains, “All tax increases have negative economic effects because higher taxes take resources from the productive hands of the private sector and transfer them to the wasteful hands of politicians.”
As the National Center for Policy Analysis shows, the medical device manufacturer tax is already hurting Americans by reducing employment:
In November 2011, device maker Stryker Corporation announced its intention to layoff 1,000 workers in order to cut costs in advance of the tax.
Another firm, Covidien Plc, announced the layoff of 200 U.S. workers and plans to offshore production to Mexico and Costa Rica.
Congress can legislate who collects a tax, but it cannot legislate who actually bears the tax’s economic burden. So it is surprising only to Congress that American workers have to bear the brunt of a tax that Congress assumed device manufacturers would pay.
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Proliferation of unneeded and redundant Medical Devices on every corner is just one of the reasons our Healthcare system is out of control.......
latimes.com
Worldwide price survey puts U.S. medical, hospital costs at top
By Patrick McMahon
4:50 PM PST, March 6, 2012
A study comparing prices for hospital stays, physician office visits, drugs and other medical procedures in developed countries shows U.S. prices among the most expensive.
The International Federation of Health Plans, a London-based network of 100 insurance companies in 30 developed nations, annually looks at prices, and last week published its 2011 Comparative Price Report on medical and hospital fees by country.
Among the results: Cost per day for hospital charges averaged $3,949 in the U.S., followed by Chile at $1,552. The average hospital cost for a U.S. patient’s total stay was $15,734; Germany was next at $5,004.
For appendectomies, the total facility and physician costs averaged $13,003 in the U.S., followed by Switzerland at $5,840.
A physician fee for a routine office visit averaged $89 in the U.S., also followed by Switzerland, at $64.
U.S. was second on the list for total facility and physician costs for cataract surgery, averaging $3,748. Switzerland led the list at $5,310; Australia was No. 3 at $3,591.
Scott Hauge, president of the San Francisco-based Small Business Coalition, told coalition members this week that the survey and other indicators of growing medical costs are "not good news for small businesses that are struggling to continue to provide health insurance and why health insurance access and cost is the number one issue again for small businesses in our survey."
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"Proliferation of unneeded and redundant Medical Devices on every corner is just one of the reasons our Healthcare system is out of control......."
Good grief, what does that mean? Will the new medical device excise tax help us to quash these cures gone wild?
"Cost per day for hospital charges averaged $3,949 in the U.S."
Costs are higher than people can afford because of THIRD PARTY PAY.
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"Proliferation of unneeded and redundant Medical Devices on every corner is just one of the reasons our Healthcare system is out of control......."
Good grief, what does that mean? Will the new medical device excise tax help us to quash these cures gone wild?
I wasn't clear; I have no idea why they were implemented, nor do I support any new tax on medical devices.
"Cost per day for hospital charges averaged $3,949 in the U.S."
Costs are higher than people can afford because of THIRD PARTY PAY.
That's not quite true. You posted on another thread, "There is something about the concept of insurance the activists don't understand. You insure against expenses uncertain or unforeseen, the regular bills you simply pay. " I agree; I am not rich, but i have a $5K deductible insurance plan. As you said, I can budget for the routine, but not the unexpected. It's like my car insurance; again I have a high deductible.
That said, I've used my car insurance carrier before. I've also used, even recently my health insurance. And many people's financial pain threshold is less than $5K. Third Party Pay is here to stay. But that's good; they act as a funnel, a filter actually in many instances reducing costs.
Necessary medical care is almost unique. If I'm in a motorcycle accident, I break my ribs, injure my knee, and have a concussion, when the ambulance arrives, I'm not going to ask the price. Nor would I ask the price at the ER room since I'm in pain. I have no choice. Almost any other product or service I can think of allows me to shop and price compare. Or simply not buy, like not buying a car and choosing alternatives. So that makes medicine unique.
My point about medical devices is given our free enterprise system, every tiny hospital, every tiny clinic seems to want the latest and best. But they don't need it; there is an MRI down the street; why does each town need a surplus of them time whatever multiplier? Because of Medical Device salesmen (no fault of theirs; that's their job) and the keeping up with the Jones attitude. It's cheaper to have big brother say you only need 5 MRI's not 15 for example. if you look at studies of procedures, doctors aren't stupid, they do the procedures that pay the most, not the ones that are the most cost effective. You need a third party, who is there to rein in greed because people will pay anything, do anything, because they are in pain or are dying. If you doctor says you need an MRI, are you going to say "No" or even get a second opinion? Of course not. The physician is "god" and you don't question "God". And so you go get an MRI at the facility in which the doctor has a financial interest. Or a friend. But definitely not the one that is the most cost effective.
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You should be insuring only for the unexpected that you can't afford. That shares the cost with all the people taking the same or similar risks. We already have free health care for the poor, that is an old and tired argument.
"...But they don't need it; there is an MRI down the street; why does each town need a surplus of them time whatever multiplier? Because of Medical Device salesmen (no fault of theirs; that's their job) and the keeping up with the Jones attitude. It's cheaper to have big brother say you only need 5 MRI's not 15 for example."
Really? The only successful form of cost constraint is a free market loaded with competition. Granted healthcare will never be a free market, but that does not justify a full abandon all of what works for tyranny.
I don't know what it is you don't know about medical device sales, but it isn't that easy. The way you don't take unnecessary MRIs is to PAY FOR THEM. Do you leave the gas pump on when you leave or fill up on someone else's card, do you buy steaks at the grocery and leave them on the counter and not go back to get them, do you leave your credit card at the golf clubhouse after you charge your green fees and say charge the next several groups too or expect that someone did that for you. No. We tie usage to payment; it is quite simple. We watch our expenses like hawks when it is our money.
With a federal government running 40% of its expenses unpaid for before Obamacare, it is all a bunch of b*llsh*t to even think taxing the rich or the medical device company is paying for it. They won't and they don't. You should be criticizing the political salesmen who say someone else should pay for it when they know no one else is.
"I have no idea why they were implemented, nor do I support any new tax on medical devices."
They were pretending to pay for free health care, BCP for the sexually active, etc.
"If I'm in a motorcycle accident, I break my ribs, injure my knee, and have a concussion, when the ambulance arrives, I'm not going to ask the price. Nor would I ask the price at the ER room since I'm in pain. I have no choice...."
You are talking to the wrong guy. I've been hit by a car (hit and run) and when they finally came they asked me which hospital I wanted to be taken to. If there was one that had a reputation for higher quality or lower cost, I could have chosen.
Prices are high because of government mandates and third party pay more than any or all other reasons. Every other industry where these factors are smaller has the natural forces of cost control that are removed from healthcare. Please point out where this is not true.
The result that will come out of this is losing the right to ride the motorcycle. Why don't you see that? You have the freedom to ride and you have the freedom to insure your risk. Why do you need government to step in - in any way - and limit your choices?
"Third Party Pay is ... a filter actually in many instances reducing costs. "
Good grief. Payments funneled through insurance companies to chosen suppliers with bureaucratic decision makers... that is better than free people making free choices? Why not for all industries instead of just the most crucial ones? FYI, self insured, I was the only one out fixing houses the day after the tornado, half the rest the fully insured were in meetings and negotiations and half with their government mortgages and zero equity never did repair. God bless your right to vote and post anyway. I hope the viewpoint expressed is soundly defeated in November.
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I don't know what it is you don't know about medical device sales, but it isn't that easy. The way you don't take unnecessary MRIs is to PAY FOR THEM. Do you leave the gas pump on when you leave or fill up on someone else's card, do you buy steaks at the grocery and leave them on the counter and not go back to get them, do you leave your credit card at the golf clubhouse after you charge your green fees and say charge the next several groups too or expect that someone did that for you. No. We tie usage to payment; it is quite simple. We watch our expenses like hawks when it is our money.
Maybe somehow I wasn't clear, but there is a huge difference (I don't have a choice; I must have treatment) between steaks and golf. That's the key; medical is not optional. Further, it's a mystery, i.e. we trust our doctor's opinion. I may respect your opinion on which steak to buy, or which club to use, but the repercussions of my ignoring your advice aren't fatal. It may well be with a medical decision.
"If I'm in a motorcycle accident, I break my ribs, injure my knee, and have a concussion, when the ambulance arrives, I'm not going to ask the price. Nor would I ask the price at the ER room since I'm in pain. I have no choice...."
You are talking to the wrong guy. I've been hit by a car (hit and run) and when they finally came they asked me which hospital I wanted to be taken to. If there was one that had a reputation for higher quality or lower cost, I could have chosen.
I did have a choice, although it wasn't put to me that way. I knew which hospital was better so I went there (they will take you to the closest one unless you insist). But again, medicine is different. I don't mind driving a low end car (5 year old Subaru), it get's me to and from just as good as my friend's Jag. But if I broke my leg, do I want the lowest cost, poorly trained doctor to set it? I mean I might be cripple for the rest of my life. Not to mention if my condition was life threatening. There is a huge difference needing, wanting, and a product that is an absolute necessity....
Prices are high because of government mandates and third party pay more than any or all other reasons. Every other industry where these factors are smaller has the natural forces of cost control that are removed from healthcare. Please point out where this is not true.
No you are right, 99% of the time, I would agree with your argument, but I repeat myself; Medical Care is unique. Please point out any other product with similar ramifications and pricing that will affect my life so dramatically.
The result that will come out of this is losing the right to ride the motorcycle. Why don't you see that? You have the freedom to ride and you have the freedom to insure your risk. Why do you need government to step in - in any way - and limit your choices?
No, that's not true. I don't care about the motorcycle. It's trash. I can buy another one (I've given up and gone to bicycles). Your theory only pertains to vehicle insurance. I again agree with you, if you can't afford the insurance and/or self insurance cost, don't drive; take the bus or walk. However, MEDICAL IS DIFFERENT. If I break both legs, I get cancer, etc. I can't choose to ignore the problem or choose an alternative or choose to do without, I MUST do whatever's necessary to solve the problem. And as a society, we IMHO cannot let anyone go without basic medical care. I don't want cripples on the street because they couldn't afford to have their leg set.
"Third Party Pay is ... a filter actually in many instances reducing costs. "
Good grief. Payments funneled through insurance companies to chosen suppliers with bureaucratic decision makers... that is better than free people making free choices? Why not for all industries instead of just the most crucial ones? FYI, self insured, I was the only one out fixing houses the day after the tornado, half the rest the fully insured were in meetings and negotiations and half with their government mortgages and zero equity never did repair. God bless your right to vote and post anyway. I hope the viewpoint expressed is soundly defeated in November.
Again, I too think people should only insure what they cannot afford to do themselves. They make free choices. But medical is different. If I have a heart attack, I don't have a "choice".
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As usual, our points miss each other. There are many many many many many many choices made in health care, most with which I disagree.
People inform themselves and get a second opinion in medicine all the time. You have never second guessed a doctor?
"do I want the lowest cost, poorly trained doctor to set it?"
There isn't a poorly trained or low cost doctor in this country, but it is under central control where you will lose the power to make that choice. You don't see that?
"I don't care about the motorcycle. It's trash. I can buy another one (I've given up and gone to bicycles). Your theory only pertains to vehicle insurance. "
No! Tedious comes to mind. We were discussing healthcare insurance. Please focus. You can buy a policy to cover the ambulance and all the emergency care, bone setting heart transplant, anything, what on earth is the problem? In a free market, you might be able to buy a policy to cover only that and not all the procedures that you consider non-essential but others demand. Still you miss the point and call me wrong. You WILL lose the right to ride the motorcycle - symbolic for all those types of choices that someone else paying your bills determines to be too risky.
Why don't you push to have government regulate commerce like requiring complete disclosures of prices instead of having government participate in the commerce.
Why don't consumers organize and take over negotiations with the providers if they don't like the way they are treated. I know someone who did - a major labor union - and they self-insure. Government isn't the only lever. Were you going to get me an example of where a free market could not contain costs better than central control?
Rationing who gets what service is not lowering costs.
Why did healthcare go okay the first 200 years of so?
If we want to change the role of the federal government, why not go through the old fashioned process of AMENDING THE CONSTITUTION first, if it is such a good idea?
What other rights involve mandating someone else supply the product or perform the service for you?
Why no comment on GM's analogy? No one offers to pay for the right to bear arms but BCP at no additional charge is a right higher than self defense?
"I don't want cripples on the street because they couldn't afford to have their leg set."
Yeah, America was so cruel before Pelosi-Obamacare. Cripples on the street, that is why we chose tyranny over freedom. Who was denied that type of service, where, when? Nothing sells liberalism like lying.
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Were you going to get me an example of where a free market could not contain costs better than central control?
Life expectancy at birth in the USA is 50th in the world, below most developed nations and some developing nations. It is below the average life expectancy for the European Union. The World Health Organization (WHO), in 2000, ranked the U.S. health care system as the highest in cost, first in responsiveness, 37th in overall performance, and 72nd by overall level of health (among 191 member nations included in the study). The Commonwealth Fund ranked the United States last in the quality of health care among similar countries,and notes U.S. care costs the most.
We spend and spend, but we don't deliver. Almost all major countries have a national health care plan (central control); one that cost's less than ours and delivers more.
http://www.creditloan.com/blog/2010/03/01/healthcare-costs-around-the-world/
Bottom line, if you are rich and/or have great insurance you get great care in America; if not, you get marginal care at best in the United States.
If we want to change the role of the federal government, why not go through the old fashioned process of AMENDING THE CONSTITUTION first, if it is such a good idea?
I don't think there is a need to amend the constitution; we will see how the Court rules...
"I don't want cripples on the street because they couldn't afford to have their leg set."
Yeah, America was so cruel before Pelosi-Obamacare. Cripples on the street, that is why we chose tyranny over freedom. Who was denied that type of service, where, when? Nothing sells liberalism like lying.
Study after study will show that the quality of medical care provided indigent patients is far lower than rich or fully insured patients. And that's a fact; no one is lying.
Then again, you might argue, if they can't pay for it, they don't deserve treatment, right? Let the free market (those who have money) dictate who gets medical care and the quality thereof.
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I don't understand thd format where you quote me and then makde unrelated points, but God Bless your right to do that.
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It's a pity you are not in LA or I'm not in MN. I honestly think we would agree on most points, but somehow we seem to miscommunicate. A game of golf, a sail, or a beer might mend fences.
I tried to point out to answer your question that most of the free world has a national health care plan (central control) AND better results than our free market plan.
I tried to indirectly point out, without going through the legal arguments again (see forum for a detailed analysis) as to why a national health care plan is constitutional. I mean good grief,
my Dad is covered by Medicare; what is that other than a national health care plan? And Social Security?
And I tried to point out that we have a two tiered health care system; one for the haves and one for the have nots. The quality of care is dramatically different. I can give you personal examples;
when they thought I didn't have insurance (I was semi conscious) after being hit by a car AND when they mixed up the paperwork and said I was "fine" but actually I had acute meningitis. After they figured out
I had good insurance and some money, I got first class treatment. But is that right? IMHO the answer is a resounding NO.
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I tried to point out to answer your question that most of the free world has a
national health care plan (central control) horrific wait times, horric service and crushing debt AND better results than glides on the innovation and progress of our free market plan.
Fixed it for you!
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my Dad is covered by Medicare; what is that other than a national health care plan? And Social Security?
They are broke. We can't afford them, much less a new "entitlement". Wishing and pretending won't make this truth go away.
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http://blogs.the-american-interest.com/wrm/2012/03/10/50-of-uk-nursing-home-patients-abused-by-government-health-care/
50% of UK Nursing Home Patients Abused By Government Health Care
Fans of government health care keep telling us that government can do the job, and they point to countries like the UK as examples where single payer, government run health care systems deliver high quality, compassionate care.
They are either grossly ignorant or they are lying through their teeth.
A recent study by a British healthcare regulator finds that half of all elderly people in Britain’s nursing homes are being denied basic health services.
Half.
Some older people were forced to wait months for a doctor or nurse to treat simple health problems. No doubt they were waiting for the Bureau of Bedsore Management to review the proper procedures before issuing a bandage-changing permit.
Over the polite grumbling of many advocacy groups, the British Parliament can be faintly heard tinkering away at some far overdue legislation. No doubt the grannies will get some relief just as soon as the House of Commons passes some new laws, the House of Lords (whoever they have there now that they have chased the actual, you know, Lords out of it) sagaciously tinkers with it, the Queen signs it, the bureaucrats get all the regulations nicely written, and the memos and administrative procedures get delivered to the proper offices.
Of course, the National Health Care service has been around since the 1940s and somehow these lingering little problems haven’t quite been cleared up yet. It’s obviously just a question of getting the right regulations in place and any century now the system will by running like a fine tuned machine and there won’t be any problems at all.
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"jornolister":
Here is what I mean about Fareed Zakaria who meets with Obama regularly to coordinate the framework of his shows with the agenda of the WH. If I hear him ask one more guest, "don't you think Obama is right?", or exclaim "you know it is true [what the wh says], give another lecture about the glories of whatever the WH policy is on whatever the topic du jour is:
http://www.forbes.com/sites/aroy/2012/03/19/fareed-zakarias-puzzling-take-on-health-care-in-britain-taiwan-and-switzerland/
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By RON JOHNSON
One year after the passage of ObamaCare, this paper published an op-ed I wrote ("ObamaCare and Carey's Heart") about how America's health-care system saved my daughter's life, and describing how implementing this law will limit innovation, lead to rationing, and lower the quality of care. Now, two years out, I would like to focus on the budgetary disaster.
As a candidate, Barack Obama repeatedly claimed that his health-care plan would lower annual family health-insurance premiums by $2,500 before the end of his first term as president. But the Kaiser Family Foundation recently reported that the average family premium has increased $2,200 since the start of this administration.
Then there is the higher cost to taxpayers. The CBO's initial estimate in March 2010 of ObamaCare's budget impact showed it saving money, reducing the federal deficit by $143 billion in the first 10 years. But that positive estimate was largely the product of gimmicks inserted into the bill by Democratic leaders to hide the law's true cost.
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.Sure enough, the administration last October announced it would not implement one of those gimmicks, a long-term care program called the Class Act, because it was financially unworkable. The loss of the premiums that would be collected to finance the Class Act wiped out $70 billion of the supposed deficit reduction projected by CBO. And last month the administration's proposed fiscal 2013 budget included $111 billion in additional spending for the premium subsidies in the health law's insurance exchanges—further eroding any confidence in the original ObamaCare projections.
This would not be the first time a government program exceeded its projected cost. When Medicare was passed in 1965, for example, the federal government estimated it would cost $12 billion in 1990. Medicare actually cost $110 billion in 1990.
In the case of ObamaCare, one of the principal sources of the lowball estimate used to justify the law is related to the insurance exchanges. The CBO originally estimated that one million Americans would lose their employer-sponsored care and be forced into the exchanges.
But a McKinsey & Co. study in June 2011 showed that 30%-50% of employers plan to stop offering health insurance to their employees once the health law is implemented in 2014. Last week the CBO breezily dismissed this and other studies on the ground that "it is doubtful that any survey conducted today could provide very accurate predictions of employers' future decisions."
As someone who purchased group health insurance for over 31 years, I fully understand why the McKinsey study is more credible than the CBO.
Why? Because the decision employers face under ObamaCare is straightforward: Do they pay $20,000 per year for family coverage, or do they pay the $2,000 penalty to the government?
It is not as if dropping health coverage will expose their employees to financial risk. They will thereby make employees eligible for huge subsidies in the health-care exchanges—$10,000 if their household income is $64,000 per year. In a competitive environment, ObamaCare provides the incentive for employers to drop coverage.
According to the CBO, 154 million Americans are covered under employer-sponsored plans. What would be the cost to taxpayers if 50% of those individuals lost their coverage and became eligible for subsidies? The answer is difficult to calculate, but CBO's answer is basically: Don't worry, revenues will increase automatically to cover those costs (for example, employees' taxable incomes will increase when they lose employer-provided coverage).
In reality, as government assumes a greater share of health-care costs, pressure to cut payments to providers will be enormous. Reduced government reimbursements to providers will cause massive cost-shifting to those remaining in the private health-insurance market. More employees will lose coverage. Before long, we will have what the left has long sought—a single payer health-care system modeled after Medicaid.
In recent testimony before the Senate Appropriations Committee, Health and Human Services Secretary Kathleen Sebelius told me that America's health insurance system is in a "death spiral." She failed to acknowledge that implementation of ObamaCare will be the cause of that death spiral, and American taxpayers will be left to pick up the tab.
In a June 2009 speech to the American Medical Association, Mr. Obama promised: "If you like your health-care plan, you'll be able to keep your health-care plan. Period. No one will take it away, no matter what." I'm not sure what you would call that statement, but whatever you call it, it was a doozy.
Mr. Johnson, a Republican, is a senator from Wisconsin.
A version of this article appeared Mar. 20, 2012, on page A11 in some U.S. editions of The Wall Street Journal, with the headline: ObamaCare's Costs Are Soaring.
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Well, this sounds pretty inconvenient for the unconstitutional argument , , ,
http://www.forbes.com/sites/rickungar/2011/01/17/congress-passes-socialized-medicine-and-mandates-health-insurance-in-1798/
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Well, this sounds pretty inconvenient for the unconstitutional argument , , ,
http://www.forbes.com/sites/rickungar/2011/01/17/congress-passes-socialized-medicine-and-mandates-health-insurance-in-1798/
Obviously it's constitutional to make everyone in America work as a sailor. :roll:
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Yes, an interesting mandate. Seems to me the distinction GM points out is noteworthy. There is no mandate to participate in that kind of commerce, but if you do you must participate in the cost.
Obama-care mandates that if you exist, you must purchase this product. The income tax code comes close except that a constitutional amendment specifically authorizing it was required. Certainly without the amendment our tax code is unconstitutional.
The Obama administration argued in it's passage that Obamacare is not a tax and argued in its constitutionality that it is.
The closest precedent for the individual mandate was the internment mandate of Japanese-American imposed by the FDR administration. http://www.u-s-history.com/pages/h1662.html By merely existing a mandate was placed on you. As is the case now, it was really in their own best interest: http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=US&vol=323&invol=214
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By DAVID B. RIVKIN JR. AND LEE A. CASEY
On Monday, the Supreme Court will begin an extraordinary three-day hearing on the constitutionality of ObamaCare. At stake are the Constitution's structural guarantees of individual liberty, which limit governmental power and ensure political accountability by dividing that power between federal and state authorities. Upholding ObamaCare would destroy this dual-sovereignty system, the most distinctive feature of American constitutionalism.
ObamaCare mandates that every American, with a few narrow exceptions, have a congressionally defined minimum level of health-insurance coverage. Noncompliance brings a substantial monetary penalty. The ultimate purpose of this "individual mandate" is to force young and healthy middle-class workers to subsidize those who need more coverage.
Congress could have achieved this wealth transfer in perfectly constitutional ways. It could simply have imposed new taxes to pay for a national health system. But that would have come with a huge political price tag that neither Congress nor the president was prepared to pay.
Instead, Congress adopted the individual mandate, invoking its power to regulate interstate commerce. The uninsured, it reasoned, still use health services (for which some do not pay) and therefore have an impact on commerce, which Congress can regulate.
Congress's reliance on the Commerce Clause to support the individual mandate was politically expedient but constitutionally deficient. Congress's power to regulate interstate commerce is broad but not limitless.
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.First among the limits is the very nature of congressional authority, which is based on specifically enumerated powers. As the Supreme Court has consistently acknowledged, the Constitution denies the federal government the type of broad public health and welfare regulatory authority known as a "general police power," which is reserved exclusively to the states. The court has also repeatedly held that preservation of this division between federal and state authority is a matter for supervision by the courts, and its precedents make clear that congressional Commerce Clause regulation must be subject to some judicially enforceable limiting principle.
The defining characteristic of a general police power is the states' ability to regulate people simply as people, regardless of an individual's activities or interaction with goods or services that might themselves be subject to regulation. Thus, the Supreme Court has ruled that states, exercising their general police power, can require all resident adults to obtain a smallpox vaccination. Only this type of authority could support ObamaCare's individual mandate, which applies to all Americans as such, regardless of any goods they may buy or own, or any activities in which they might choose to engage.
Congress has crossed a fundamental constitutional line. Neither the fact that every individual has some discernible impact on the economy, nor that virtually everyone will at some point in time use health-care services, is a sufficient basis for federal regulation. Both of these arguments, advanced by ObamaCare's defenders, are flawed because they admit no judicially enforceable limiting principle marking the outer bounds of federal authority.
On the left and right, legal thinkers too often forget that Congress has no constitutional power simply to regulate the economy. Rather, that power comes from a series of discrete authorities—to regulate interstate and foreign commerce, to tax, spend and borrow, to coin money and fix its value and so forth—that together allow it broad control over the nation's economic affairs. As a result, congressional efforts to address national problems may well be less economically efficient than would a more straightforward exercise of police power. The Constitution subordinates efficiency to guarantee liberty.
The Constitution divides governmental power between federal and state governments so that one may check the other. This requires that the electorate be able to tell, especially on Election Day, which government is responsible for which policies and regulations with which we live.
As Justice Anthony Kennedy explained in one leading Commerce Clause case, United States v. Lopez (1995): "The theory that two governments accord more liberty than one [emphasis added] requires for its realization two distinct and discernible lines of political accountability: one between the citizens and the Federal Government; the second between the citizens and the States." Congress's use of its commerce power in passing ObamaCare eradicates those "discernible lines of political accountability."
Even so, Congress's enumerated powers support a vast and ever growing regulatory state, much of it based upon the Commerce Clause. Neither that Leviathan, nor the Supreme Court's precedents upholding it, is now at issue.
Justice Antonin Scalia explained in another of the Supreme Court's recent Commerce Clause cases, Gonzales v. Raich (2005), that the power to regulate interstate commerce, especially in conjunction with the power "to make all laws which shall be necessary and proper [emphasis added] for carrying into execution" its enumerated powers, gives Congress broad authority to reach even local and non-commercial activities when necessary to make legitimate regulatory schemes effective. Raich upheld federal control of purely local cultivation, sale and use of marijuana, and it is often incorrectly cited as support for the individual mandate.
Related Video
Wisconsin Senator Ron Johnson on how ObamaCare will ratchet up health-care costs.
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.But the Necessary and Proper Clause does not guarantee Congress whatever power it would like to reach its policy goals. That provision supports only otherwise legitimate exercises of Congress's enumerated powers. So under the Commerce Clause, Congress can try to achieve universal coverage through regulating the interstate health-care insurance market, as ObamaCare does, by requiring insurance companies operating in that market to cover pre-existing conditions. Then under the Necessary and Proper clause, Congress could also require employers to collect data on pre-existing conditions from new hires so insurers can better plan.
Requiring all Americans to have health insurance may well create a new revenue stream for insurance companies so as to lessen these new burdens on them, but it does nothing to make these new coverage requirements effective regulations of interstate commerce as the Supreme Court uses that term. In particular, the individual mandate does not prevent avoidance or evasion of these new insurance regulations. Nor does it make compliance easier to police, as was the case in Raich. There, the ability to regulate local marijuana production and use was necessary to make its interstate regulation effective because, as Justice Scalia noted, the homegrown variety "is never more than an instant from the interstate market."
Unlike the regulations at issue in Raich, the individual mandate applies regardless of anyone's interaction with a commodity, service or other activity, like the interstate sale or transport of marijuana, that Congress can legitimately regulate. Put another way, the Controlled Substances Act is about the regulation of drugs, not people. It affects individuals only to the extent that they interact with the substances it proscribes, and it can be avoided by simply avoiding those substances.
Americans cannot escape the individual mandate by any means because it regulates them as people, simply because they are alive and here. That requires police power authority. Permitting Congress to exercise that authority—however important its ultimate goal—is not constitutionally proper and would forever warp the federal-state division of authority.
Messrs. Rivkin and Casey are lawyers who served in the Justice Department during the Reagan and George H. W. Bush administrations. They represented the 26 states in their challenge to ObamaCare before the trial and appellate courts.
A version of this article appeared Mar. 22, 2012, on page A15 in some U.S. editions of The Wall Street Journal, with the headline: The Supreme Court Weighs ObamaCare.
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"The individual mandate is incompatible with centuries of contract law. This is so because a compulsory contract is an oxymoron."
http://www.washingtonpost.com/opinions/obamacares-rewriting-of-contract-law/2012/03/23/gIQAVuFmWS_story.html
George F. Will
Opinion Writer
Obamacare’s contract problem
View Photo Gallery — Both supporters and opponents of the Affordable Care Act are organizing efforts to raise support for their respective sides when the Supreme Court hears oral arguments on the health-care law in late March.
By George F. Will,
On Monday the Supreme Court begins three days of oral arguments concerning possible — actually, probable and various — constitutional infirmities in Obamacare. The justices have received many amicus briefs, one of which merits special attention because of the elegant scholarship and logic with which it addresses an issue that has not been as central to the debate as it should be.
Hitherto, most attention has been given to whether Congress, under its constitutional power to regulate interstate commerce, may coerce individuals into engaging in commerce by buying health insurance. Now the Institute for Justice (IJ), a libertarian public interest law firm, has focused on this fact: The individual mandate is incompatible with centuries of contract law. This is so because a compulsory contract is an oxymoron.
The brief, the primary authors of which are the IJ’s Elizabeth Price Foley and Steve Simpson, says that Obamacare is the first time Congress has used its power to regulate commerce to produce a law “from which there is no escape.” And “coercing commercial transactions” — compelling individuals to sign contracts with insurance companies — “is antithetical to the foundational principle of mutual assent that permeated the common law of contracts at the time of the founding and continues to do so today.”
In 1799, South Carolina’s highest court held: “So cautiously does the law watch over all contracts, that it will not permit any to be binding but such as are made by persons perfectly free, and at full liberty to make or refuse such contracts. . . . Contracts to be binding must not be made under any restraint or fear of their persons, otherwise they are void.” Throughout the life of this nation it has been understood that for a contract to be valid, the parties to it must mutually assent to its terms — without duress.
In addition to duress, contracts are voidable for reasons of fraud upon, or the mistake or incapacity of, a party to the contract. This underscores the centrality of the concept of meaningful consent in contract law. To be meaningful, consent must be informed and must not be coerced. Under Obamacare, the government will compel individuals to enter into contractual relations with insurance companies under threat of penalty.
Also, the Supreme Court in Commerce Clause cases has repeatedly recognized, and Congress has never before ignored, the difference between the regulation and the coercion of commerce. And in its 10th Amendment cases (“The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people”), the court has specifically forbidden government to compel contracts.
In 1992, the court held unconstitutional a law compelling states to “take title to” radioactive waste. The court said this would be indistinguishable from “a congressionally compelled subsidy from state governments” to those who produced the radioactive waste. Such commandeering of states is, the court held, incompatible with federalism.
The IJ argues: The 10th Amendment forbids Congress from exercising its commerce power to compel states to enter into contractual relations by effectively forcing states to “buy” radioactive waste. Hence “the power to regulate commerce does not include the power to compel a party to take title to goods or services against its will.” And if it is beyond Congress’s power to commandeer the states by compelling them to enter into contracts, it must likewise be beyond Congress’s power to commandeer individuals by requiring them to purchase insurance. Again, the 10th Amendment declares that any powers not given to the federal government are reserved to the states or to the people.
Furthermore, although the Constitution permits Congress to make laws “necessary and proper” for executing its enumerated powers, such as the power to regulate interstate commerce, it cannot, IJ argues, be proper to exercise that regulatory power in ways that eviscerate “the very essence of legally binding contracts.”
More at the link.
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I had not seen this point articulated previously. It seems to me quite sound and I will be adding it to my repertoire.
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Conservatives hijack #ILikeObamacare hashtag on Twitter
Published: 7:37 PM 03/23/2012
By Paul Conner
Speaker Nancy Pelosi of California holding the gavel used to pass Medicare Reform, laughs as she walks across the street and into the U.S. Capitol as the House prepares to vote on health care reform in the U.S. Capitol in Washington, Sunday, March 21, 2010. Walking with Speaker Pelosi are from left, Rep. Steny Hoyer, D-Md., Rep. John Lewis, D-Ga., and Rep. John Larson, D-Conn. (AP Photo/Charles Dharapak)
Conservatives on Twitter today quickly hijacked the #ILikeObamacare hashtag, which had been launched by President Barack Obama’s campaign to highlight supporters of the Democrats’ signature health care reform law.
The Twitter hashtag was the most popular in the world Friday afternoon, but not for reasons the Obama campaign wanted. (RELATED: Full coverage of the health care law)
For every tweet saying, “My son is now covered, despite his pre-existing condition,” ten tweets were dripping with sarcasm about the health care law. The Daily Caller rounded up ten funniest tweets that came across our screen.
10.) @jimmiebjr: #ILikeObamacare because I trust the same people who wrote the tax code to keep things simple, understandable, and transparent for me.
9.) @EWErickson: #ILikeObamacare because I think responsibility is giving free condoms to our kids while we bankrupt their future.
8.) @brostap: #ilikeobamacare because…oh wait it’s terrible…
7.) @joshgreenman: #ILikeObamacare because “love” is too strong a word.
6.) @IamJackBlack: #ILikeObamacare because anything we do to be more like Canadians is only a good thing.
5.) @anthropocon: #ILikeObamacare because I hate the government listening to my phone calls, but I want them to decide if I get a pacemaker.
4.) @iowahawkblog: #IlikeObamacare because the best things in life are free. Give or take $2 trillion.
3.) @karr_pe: #ilikeobamacare because my senior citizen mother is really getting on my nerves.
2.) @gman949: #ILikeObamacare because now my prostate exam won’t hurt as much as the higher taxes I have to pay for it.
1.) @voteforcantwell: #ILikeObamacare Because I’m too poor to pay for insurance – Sent from my iPad 3”
Read more: http://dailycaller.com/2012/03/23/conservatives-hijack-ilikeobamacare-hashtag-on-twitter/
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Followup on contract law which is taught both in business school as well as legal training: The elements of a valid contract always first require competent parties which I would presume to be someone capable of freely choosing whether to enter or not enter the contract. Also required is 'consideration'. Googling around I found this description of the validity of consideration: "The payment doesn't need to be a fair payment. The courts will not intervene where one party has made a hard bargain unless fraud, duress or unconscionable conduct is involved."
Whoops, that link came from Australia. http://www.smallbusiness.wa.gov.au/four-essential-elements-of-a-contract/ They aren't allowed to look at foreign law for guidance, right?
Here's another take on it: "The vitiating factors or elements are misrepresentation, duress, undue influence and certain forms of mistake." http://wiki.answers.com/Q/What_are_the_vitiating_elements_of_valid_a_contract
There use to be an out-clause when our state auto insurance became 'mandatory' for motorists: you could post a bond or other assets as another way to demonstrate financial responsibility up to the minimum requirements of the new law. Speaking of auto insurance, the closest I've come to empathizing with a rape victim was when I had to Geico that I needed to change the bank account of my auto-pay. They went through every imaginable personal question possible just short of asking me what I was wearing. What will be your right of privacy with your new, state run health insurance company (do they get to know your first elementry school attended and your mother's maiden name?), and who will be overseeing their ability to pay? Dodd Frank with a side payment to Newt to keep down the scrutiny?
In the case of financial responsibility pertaining to healthcare, I believe it is the loose freedom of personal bankruptcy that allows young, healthy, financially able people to avoid the risk that they may have to pay for large unforeseen healthcare costs for the rest of their lives if the don't freely choose to procure insurance. People wipe out these debts in amounts that are only a fraction of a year's income in our court system. Funny that many other debts cannot be wiped out in bankruptcy: tax debt, child support, and student loans are examples. It is quite a strange web that we weave to convince ourselves that the most egregious destruction ever of our most intimate privacy rights is given up in the name of 'necessary and proper'. What a bunch of bs.
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Lets put the Obamacare decision materials in this thread so as to leave room for other Constitutional issues in that thread.
www.landmarklegal.org/uploads/11-398bsacLandmarkLegalFoundation_FILED.pdf
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"Lets put the Obamacare decision materials in this thread so as to leave room for other Constitutional issues in that thread."
Tomorrow starts the oral arguments of the case. One of the strangest points in prognostication is that it is considered a mathematical certainty that all four so-called liberal justices will vote for this unprecedented, unauthorized, unconstitutional federal taking of personal privacy and liberty.
On the other side I recall that Republican appointees of intended conservative justices over the last several decades have not always turned out to be that predictable.
Assuming the universal prognostications are right, the only question in the case is what does Anthony Kennedy think and will Scalia or Roberts jump over with him.
As an optimist (and contrarian) on our constitutionally limited American government, I assume the vote will be 9-0 to strike this down. It isn't authorized. It isn't necessary. It isn't proper. It isn't even regulation of interstate commerce.
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Subscribe at the link for excellent economic analysis!
http://scottgrannis.blogspot.com/2012/03/seven-fatal-flaws-of-obamacare.html
Scott Grannis: The seven fatal flaws of ObamaCare March 1, 2012
Fatal flaw #1: The penalty imposed for not buying a policy is very likely to be less than the cost of insurance for a great many people. This, combined with the requirement that insurance companies may not deny coverage to anyone with a pre-existing condition, means that a large number of people will forgo signing up for a policy, knowing that they a) will save money and b) can always sign up for insurance if they turn out to develop a serious medical condition. Thus, the actual revenues will far way short of projections.
Fatal flaw #2: The government has no ability to enforce the penalty for noncompliance.
Fatal flaw #3: Mandating that people buy a health insurance policy simply because they are alive is arguably unconstitutional. The Supreme Court has already decided to take up this issue and will begin hearing oral arguments this month. I note that a recent USA/Gallup poll shows that an overwhelming 72% of Americans believe that the individual mandate is unconstitutional. The mandate is also a way of hiding the fact that young people will effectively be paying a huge new tax in order to subsidize older people.
Fatal flaw #4: Regulating the price which insurance companies must charge for policies, coupled with a requirement that companies must rebate to their customers the amount by which their loss ratios fall below 90%, effectively turns these companies into government-run enterprises and would likely result in the effective nationalization of the healthcare industry. That is a violation of the Fifth Amendment, and of a Supreme Court requirement "that any firm in a regulated market be allowed to recover a risk-adjusted competitive rate of return on its accumulated capital investment."
Fatal flaw #5: A government-imposed restructuring of the healthcare industry can't possibly improve our healthcare system, and is extremely likely to make it worse. As Don Boudreaux has noted, "Trying to restructure an industry that constitutes one-sixth of the U.S. economy is ... so complicated that it's impossible to accomplish without risking catastrophic failure." No collection of laws or government bureaucrats can achieve anything close to the efficiency that free markets can deliver; the demise of socialism is the most obvious proof of this. Government control of healthcare will inevitably result in higher prices and rationing, leaving everyone worse off. UPDATE: Acknowledging this reality, the CBO in March '12 calculated the cost of ObamaCare to be $1.76 trillion over a decade, almost double the $940 billion forecast when the bill was signed into law.
Fatal flaw #6: In cases wherein companies find that complying with the law would result in large increases in healthcare premiums that would threaten employees' access to a plan, the Dept. of Health and Human Services may grant a waiver to the company. As evidence of the first five fatal flaws accumulates, and as healthcare insurance companies continue to raise premiums to pay for the unintended consequences of government attempting to regulate an entire industry and hundreds of millions of people, more and more companies are likely to apply for waivers. To date, over 1200 companies have been granted waivers. At some point the whole edifice will come crashing down of its own weight.
Fatal flaw #7: The individual mandate violates centuries of contract law, since in order to be valid, contracts to purchase health insurance must be entered into freely.
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As a media issue aside, I have started to wonder if Newsweek (Wash Post co.) is turning conservative or if Samuelson is another token conservative like Geo. Will. This piece has excellent insight. Extrapolating the numbers cited for health improvements gained when the uninsured get insurance, this program should spark about a 0.14% improvement in health outcomes to the American public, not counting the overall detriment the system that it will certainly cause.
http://www.realclearpolitics.com/articles/2012/03/26/obamas_ego_trip_113601.html
March 26, 2012
Obama's Ego Trip
By Robert Samuelson
WASHINGTON - As the Supreme Court hears arguments on the constitutionality of the Affordable Care Act (ACA) -- Obamacare, as many call it -- the justices will probably share at least one assumption: that their decision will have a big effect on the health of Americans. Ideally, everyone ought to have insurance, and it's popular wisdom that this would significantly improve people's health. But it's not true. The ACA's fate will dramatically affect government and the health care system; the impact on Americans' health will be far more modest.
Rarely has a program with so little potential inspired so much contention. Although millions would benefit from health insurance, the overall relationship between people's insurance status and their self-reported health is underwhelming. Consider a study of Massachusetts' universal coverage program, enacted under former Gov. Mitt Romney, by economists Charles J. Courtemanche of the University of Louisville and Daniela Zapata of the University of North Carolina at Greensboro. It estimated that about 1.4 percent of the state's adult population moved into the "very good" or "excellent" health categories.
Another study by economist Daniel Polsky of the University of Pennsylvania examined what happened to uninsured Americans who went on Medicare at age 65. Polsky found "no significant health effect for the uninsured relative to the insured upon reaching Medicare eligibility." Although other studies report somewhat larger effects, most share a weakness. They rely on people's self-reported assessment of their health. Just receiving government-subsidized insurance, worth $8,000 to $12,000, may make people feel better. It shields them from financial setbacks.
On reflection, the loose relation between health and insurance is not puzzling. Many uninsured are young and healthy; in 2010, 40 percent were between the ages of 18 and 34. Others pay their own bills or receive "uncompensated" care. Still others are too sick to be cured by any means. Finally, having insurance may not change unhealthy lifestyles or how people use the medical system. Before receiving Medicare, the uninsured used emergency rooms more than the insured; once on Medicare, they still did.
So the laudable goal of universal coverage ought to be balanced against drawbacks. At the margin, the ACA will probably discourage job creation, because mandated insurance raises the cost of hiring and the complexity of the 2,700-page law will intimidate some employers. Requiring younger workers to have expensive, comprehensive insurance (as opposed to catastrophic coverage) expands the undesirable inter-generational transfer from them to their wealthier elders. Finally, the ACA worsens the budget outlook.
The Obama administration has obscured this by arguing the program reduces budget deficits. Though technically true, this is misleading.
From 2012 to 2021, the Congressional Budget Office estimates the ACA's insurance subsidies at $1.5 trillion. But the CBO reckons these costs will be offset by revenue increases (including: a higher Medicare payroll tax, higher taxes on unearned income, penalties for individuals without insurance, taxes on drug and insurance companies) plus assumed cuts in Medicare. Still, all these tax increases and savings might have been applied to the huge projected deficits that existed pre-ACA. The administration resembled a homeowner who couldn't afford the mortgage but scraped up money for an expensive renovation. And if the renovation's costs are underestimated -- or all the new money doesn't materialize -- the ACA will increase the deficit.
To these problems is now added a possible backlash from a Supreme Court ruling. The administration argues that the ACA falls within the government's authority to regulate interstate commerce. Opponents contend that the insurance "mandate" requiring coverage would give government unprecedented power to order Americans to buy almost anything. Unless there's a lopsided decision (7-2 or better), the court may deepen public polarization over the ACA.
If the court disallows the mandate, President Obama's liberal supporters will accuse it of partisan judicial activism by usurping the role of elected leaders. If it narrowly blesses the ACA, conservatives will say constitutional liberties were sacrificed on the altar of political expediency. Either way, the court risks withering criticism that it is meddling in the election.
Considering the ACA's glaring -- and predictable -- economic and political shortcomings, why did Obama make it his first-term centerpiece? The answer seems to be his obsession with securing his legacy as the president who achieved the liberal grail of universal coverage. In his book "The Escape Artists: How Obama's Team Fumbled the Recovery," Noam Scheiber recounts a telling incident. Obama's advisers tell him he can be known for preventing a second Great Depression. "That's not enough for me," Obama replies.
The ACA is Obama's ego trip, but as a path to presidential greatness, it may disappoint no matter how the court decides. Lyndon's Johnson's creation of Medicare and Medicaid was larger, and he isn't deemed great. And then, unlike now, government seemed capable of paying for bigger programs.
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"Can the Supreme Court Survive a Health-Care Decision?" (from constitutional issues)
Yes, if they get it right - one way or the other.
This is quite an odd situation - the will of the people and the action of their representatives are pulling in two different directions.
If the law is struck down, it means there are still limits on government. How well they define that will reflect on them and on the structuring of new programs far into the future.
Bush v. Gore stood the test of time (IMO) because it turned on a simple concept. the constitution gave an authority to the Florida legislature, not the Florida court, so the overturn of the will of the legislature by the state court was struck down.
In Roe v. Wade the right of privacy was judged paramount; the life of the unborn human being was not. That is obscenely immoral and illogical to many but no one questions that the life status of the unborn is not covered in the words of the constitution. All it takes is a new amendment to fix that.
What is the phrase or concept that will be paramount in the healthcare decision, in either direction?
Conservatives believe the healthcare case is symbolic of having no limits on government, but the justices would need to agree on what that limit is and how this program violates it.
I think it is as simple as this: the federal government does not have unenermerated powers. If the people want this new power in their federal government, they need (IMO) to go back and authorize it in an amendment like they did with the 16th amendment authorizing the power to levy a direct tax on income. The amendment process didn't change.
On the liberal side, they believe that requiring someone to perform healthcare services on you is already a right (unenumerated) in a civilized society and the provisions in the bill were all 'necessary and proper' to 'regulate' the interstate commerce market to guarantee those services are performed and paid for.
Seems to me that "necessary" is a much stronger test in this context than just politically necessary. There is no one in the Obama administration or Pelosi-Reid congress that did not know they had already authority to spend more on healthcare services and to raise conventional tax up to any rate they want. The far simpler and broader alternative of single payer with universal coverage was ruled out at the time for political, not constitutional reasons.
What is the evidence and unanswerable argument that this new power is necessary?
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Part one, part two transcripts. Historic stuff, might be interesting to go through. I imagine one could go wrong guessing their opinion by hearing their question.
http://www.politico.com/news/stories/0312/74537.html
http://www.politico.com/news/stories/0312/74543.html
Other accounts:
http://www.foxnews.com/politics/2012/03/27/swing-justice-poses-tough-questions-on-obamacare-at-supreme-court-hearing/
"Can you create commerce to regulate it?" Kennedy asked Solicitor General Don Verrilli.
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During the debate of the Obamacare mandate at the Supreme Court Justice Kennedy says that the mandate fundamentally changes the relationship of a citizen with the government. http://www.realclearpolitics.com/video/2012/03/27/kennedy_individual_mandate_fundamentally_changes_relationship_of_govt.html
CHIEF JUSTICE ROBERTS: The key in Lochner is that we were talking about regulation of the States, right, and the States are not limited to enumerated powers. The Federal Government is. And it seems to me it's an entirely different question when you ask yourself whether or not there are going to be limits in the Federal power, as opposed to limits on the States, which was the issue in Lochner.
SOLICITOR GENERAL VERRILLI: I agree, except, Mr. Chief Justice, that what the Court has said as I read the Court's cases is that the way in which you ensure that the Federal Government stays in its sphere and the sphere reserved for the States is protected is by policing the boundary: Is the national government regulating economic activity with a substantial effect on interstate commerce?
JUSTICE KENNEDY: But the reason, the reason this is concerning, is because it requires the individual to do an affirmative act. In the law of torts our tradition, our law, has been that you don't have the duty to rescue someone if that person is in danger. The blind man is walking in front of a car and you do not have a duty to stop him absent some relation between you. And there is some severe moral criticisms of that rule, but that's generally the rule.
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Doug writes,
"I imagine one could go wrong guessing their opinion by hearing their question."
Jeff Toobin whom we all know, and admits his forcast appears to have been dead wrong thinks the line of questioning by the Justices is quite telling:
http://www.cnn.com/video/?hpt=hp_c1#/video/crime/2012/03/27/nr-toobin-mandate.cnn
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Worrisome his comments about Roberts , , ,
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"not only that they're compelling us to enter into the marketplace, they're not — they're prohibiting us from buying the only economically sensible product that we would want. Catastrophic insurance." Carvin quote from the exchange below. [not exactly necessary, not exactly proper.]
For sure Roberts and Kennedy are trying to find the limits of both sides of the argument. I read through the day two transcripts, individual mandate day at the Court, a strange sort of 9 or 10 person highly interrupted discussion. (and now lost my post in a computer crash)
(Now they are on severability - if they strike down part, the justices are supposed to then read, judge and re-write 2700 pages - that the lawmakers never read??)
Each has their own points they are trying to get at. Ginsburg kept going back to how Social Security and other programs tie to this. Each new program expanding government and shrinking liberties is used as the lever to help enable the next expansion of government. Social security in is actual form is merely tax and spend. In its conceptual form as a forced savings, generational transfer and long term contract binding future congresses to continue it to for everyone's lifetime, it is a constitutional farce.
Verrilli was adamant to not call anything a mandate; it is merely the minimum coverage set by congress.
Many justices were lost to find a 'limiting principle'. If we allow this expansion, then what is the limit on government power over the individual?
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Sotomayer (wise Latina) showed a sign of noticing a problem: "...The government says, borrowing my colleague's example, you can't buy a car without emission control. I don't want a car with emission control. It's less efficient in terms of the horsepower. But I'm forced to do something I don't want to do by government regulation. [but you don't have to buy the car] You are not forced to buy a product you don't want. And I agree with you that since the government regulates all markets, there is no limiting principle on their compelled purchase. When they put these environmental controls on the...They forced me to buy, if I need...unpasteurized goods, goods that don't have certain pesticides but have others. There is government compulsion in almost every economic decision because the government regulates so much...."
CARVIN: The difference here is the government is trying to tell you to buy the car in the first place.
And as Justice Kennedy pointed out, that's a fundamental alteration of the relationship between the national government and its citizens. Never before in our history has the government presumed to tell us, Go ahead and buy products you don't want because it's going to help other people.
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Can they make you buy a cell phone, buy brocolli, buy burial insurance?
Health insurance is unique because you don't know when you will need it or what you will need. (?) Yet we have systems in place that work fine for police and fire emergency services. Opposing attorney ripped up the catastrophic argument because the bill is a far cry from just catastrophic coverage - that is what is prohibited by the bill. This is a brief excerpt of note, read it to the end, why framers were not afraid of 'regulating commerce':
Mr. Carvin: ...It would be perfectly fine if they
20 allowed — you do actuarial risk for young people on the
21 basis of their risk for disease, just like you judge
22 flood insurance on the homeowner's risk of flood. One
23 of the issues here is not only that they're compelling
24 us to enter into the marketplace, they're not — they're
25 prohibiting us from buying the only economically
103
1 sensible product that we would want. Catastrophic
2 insurance.
3 Everyone agrees the only potential problem
4 that a 30-year-old, as he goes from the healthy 70
5 percent of the population to the unhealthy 5 percent.
6 And yet Congress prohibits anyone over 30 from buying
7 any kind of catastrophic health insurance. And the
8 reason they do that is because they needed this massive
9 subsidy.
10 Justice Alito, it's not our numbers. CBO
11 said that injecting my clients into the risk pool lowers
12 premiums by 15 to 20 percent. So, Justice Kennedy, even
13 if we were going to create exceptions for people that
14 are outside of commerce and inside of commerce, surely
15 we'd make Congress do a closer nexus and say look, we're
16 really addressing this problem. We want these
17 30-year-olds to get catastrophic health insurance.
18 And not only did they — they deprived them
19 of that option. And I think that illustrates the
20 dangers of giving Congress these plenary powers, because
21 they can always leverage them. They can always come up
22 with some public policy rationale that converts the
23 power to regulate commerce into the power to promote
24 commerce, which, as I was saying before, is the one that
25 I think is plenary.
104
1 JUSTICE KAGAN: Mr. Carvin, a large part of
2 this argument has concerned the question of whether
3 certain kinds of people are active participants in a
4 market or not active participants in a market. In your
5 test, which is a test that focuses on this
6 activity/inactivity distinction, would force one to
7 confront that problem all the time.
8 Now, if you look over the history of the
9 Commerce Clause, what you see is that there were sort of
10 unhappy periods when the Court used tests like this -
11 direct versus indirect, commerce versus manufacturing.
12 I think most people would say that those things didn't
13 really work. And the question is, why should this test,
14 inactive versus active, work any better?
15 MR. CARVIN: The problem you identify is
16 exactly the problem you would create if you bought the
17 government's bogus limiting principles. You'd have to
18 draw distinctions between the insurance industry and the
19 car industry and all of that.
20 We turn you to the Commerce Clause
21 jurisprudence that bedeviled the Court before the 1930s,
22 where they were drawing all these kinds of distinctions
23 among industries; whereas our test is really very
24 simple. Are you buying the product or is Congress
25 compelling you to buy the product? I can't think of a
105
1 brighter line.
2 And again, if Congress has the power to
3 compel you to buy this product, then obviously, they
4 have got the power to provide you — to compel you to
5 buy any product, because any purchase is going to
6 benefit commerce, and this Court is never going to
7 second-guess Congress's policy judgments on how
8 important it is this product versus that product.
9 JUSTICE ALITO: Do you think they are
10 drawing a line between commerce and everything else that
11 is not commerce is drawing an artificial line, drawing a
12 line between Congress and manufacturing?
13 MR. CARVIN: The words "inactivity" and
14 "activity" are not in the Constitution. The words
15 "commerce" and "noncommerce" are. And again, it's a
16 distinction that comes, Justice Kagan, directly from the
17 text of the Constitution.
18 The Framers consciously gave Congress the
19 ability to regulate commerce, because that's not a
20 particularly threatening activity that deprives you of
21 individual freedom. If you were required, if you were
22 authorized to require A to transfer property to B, you
23 have, as the early cases put it, a monster in
24 legislation which is against all reason in justice,
25 because everyone intuitively understands that regulating
106
1 people who voluntarily enter into contracts in setting
2 changing conditions does not create the possibility of
3 Congress compelling wealth transfers among the
4 citizenry. And that is precisely why the Framers denied
5 them the power to compel commerce, and precisely why
6 they didn't give them plenary power.
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This is off the acponline.org first page without need for a password so I think it ok to print. I note Dr. Hood's Masters in public health is from (you guessed it) *Harvard*. I remember a few decades ago I once considered getting a degree in pulbic health to help shape the "future" of health care but the stuff was simply too boring. I don't agree with the College's position on this yet I believe part of it is due to a pragmatic political approach to inevitable changes that must take place or else this country will go bust.
****The Present and Future of the Affordable Care ActMarch 26, 2012tion:
Virginia L. Hood, MBBS, MPH, FACP
President, American College of Physicians
Washington — The American College of Physicians (ACP), representing 132,000 internal medicine specialists and medical student members, is pleased to report that the Affordable Care Act (ACA) has resulted in major improvements in access and coverage for tens of millions of Americans seen by internal medicine physicians. Considering that it is just a little over two years since the ACA was enacted into law, and many of its programs are not yet fully effective, the ACA has had notable success in improving health insurance coverage. Looking to the future, the ACA will ensure that nearly all legal residents in the United States will have access to affordable coverage beginning in 2014—if the law is allowed to be fully implemented.
Interestingly, the public policy discussion of the improvements made by the ACA on its two-year anniversary is taking place in a context when the Supreme Court is hearing oral arguments this week on lawsuits challenging the law’s constitutionality. ACP did not submit an amicus brief on the constitutional questions being considered by the Supreme Court because our expertise is in evidence-based assessment of the policies required to ensure that our patients have access to health insurance, not in constitutional law. But the evidence leads us to firmly believe that the ACA’s programs to expand health insurance coverage—including subsidies, health exchanges, essential benefits packages, an individual insurance requirement, and a single national eligibility standard for Medicaid—are necessary to help protect and ensure the health of the American people.
The ACA Already is Helping Millions of PeopleAs a direct result of the ACA:
2.5 million young adults kept their health insurance coverage because they were allowed to stay on their parents’ plans. The percentage of people between ages 19 and 25 being carried as a dependent on a parent’s employment-based coverage increased from 24.7 percent in 2009 to 27.7 percent in 2010. The number of young adults with employment-based coverage as a dependent increased from 7.3 million to 8.2 million.
Through the end of July 2011, 1.28 million Americans with Medicare received discounts on brand name drugs in the Medicare Part D coverage gap — up from 899,000 through the end of June and 478,000 through the end of May. These discounts have saved seniors and people with disabilities a total of $660 million. Figures released a week ago from the Department of Health and Human Services indicate 5.1 million seniors have saved more than $3.2 billion on prescription drugs because of the ACA.
More than 18.9 million Medicare beneficiaries, or 55.6 percent, have received one or more preventive services at no out-of-pocket cost to them.
The National Health Service Corps, which receives mandatory funding under the ACA, has awarded nearly $900 million in scholarships and loan repayment to health care professionals to help expand the country’s primary care workforce and meet the health care needs of communities across the country. There are nearly three times the number of NHSC clinicians working in communities across America than there were three years ago—increasing access to health care. In 2008, approximately 3.7 million patients were provided service by 3,600 NHSC clinicians. With field strength of more than 10,000 clinicians, NHSC now provides health care services to about 10.5 million patients.
The ACA will Help Many Millions More over the Next Two YearsMany patients seen by internal medicine specialists have multiple chronic diseases (often labeled as “pre-existing conditions” by health insurers), which makes it very difficult for them to find health insurance at a premium they can afford. Under the ACA, insurers won’t be allowed to exclude them from coverage, charge them an excessive premium, or refuse to renew their coverage. These protections, already in effect for children, will become effective for adults on January 1, 2014.
Studies suggest that an individual requirement is needed for such reforms to work. Without an individual insurance requirement, some people may wait to obtain insurance until they are sick, aware that insurers will not turn them down or charge them higher premiums (except for family size and tobacco use). This will drive up premiums for everyone else, causing more persons to drop coverage, and potentially, resulting in millions more uninsured persons.
ACP also strongly supports requiring Medicaid to cover all persons with incomes up to 133 percent of the Federal Poverty Level. This change, which initially will be paid for by the federal government, is the most effective way to ensure that low-income persons have access to coverage. Some 16 million vulnerable Americans will receive coverage from this change.
When these and other programs enacted by the ACA become fully implemented by 2014, it is estimated that 94 percent of legal residents in the United States will have access to affordable health insurance coverage, with 32 million persons who now have no health insurance being able to obtain coverage. This will be a historic achievement in improving the health of the American people. Studies show that people without health insurance live sicker and die younger than people with coverage.
ACP fervently hopes that the Supreme Court will chart a course that does not derail implementation of the ACA’s key programs to expand coverage, while responsibly carrying out the court’s constitutional obligation to clarify the constitutional questions. And we hope that a day will come when Congress will be able to move beyond a partisan debate over “repeal and replace” of the ACA to discussion of bipartisan improvements that could be made in the law, without sacrificing the commitment it made to helping nearly all Americans obtain affordable health insurance coverage.
***
The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 132,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults. Follow ACP on Twitter and Facebook.
Contact:
David Kinsman, (202) 261-4554
dkinsman@acponline.org
Jacquelyn Blase
2010-2011 Annual Report of the Executive Vice President
LeadershipPresident
Chair, Board of Regents
Executive VP
Immediate Past President
President-elect
Jobs at ACP ·Contact Us ·Privacy ·Site Map ·For Advertisers ·For Media ·For Governors ·For Regents © Copyright 2012 American College of Physicians. All Rights Reserved.
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By LAMAR ALEXANDER, MIKE JOHANNS, JOHN HOEVEN AND JIM RISCH
Two years after ObamaCare was signed into law the American people are more opposed to it than ever. It is now clear that the law will impose heavy burdens on state and family budgets and increasingly possible that its mandate that all Americans purchase health insurance or face penalties will be ruled unconstitutional. As lawmakers, we need to repeal the law and do what we should have done in the first place: go step by step to reduce costs so that more people can afford insurance.
When the Senate was voting on the health-care bill in 2010, we suggested anyone who voted for it ought to serve as a governor and actually try to implement its new mandates and costs. That's the real trick—implementing a more than $2.5 trillion bill that increases costs in a health-care system that is already too expensive, and doing so when state budgets have been roiled by recession.
The National Governors Association (NGA) reports states are facing a collective $95 billion budget shortfall this year alone. But ObamaCare's expansion of Medicaid will force an additional $118 billion in unfunded mandates onto the states through 2023.
The National Association of State Budget Officers says Medicaid now comprises nearly one quarter of states' entire budgets. Each one of us has served as governor in our state and knows that increased costs in one area means less money in another. America's families know this as well since they can't just print and borrow money when their spending goes up like the federal government does.
Yet, astonishingly, more than half of ObamaCare's newly promised health-insurance coverage was accomplished by assigning nearly 26 million more people to an already broken Medicaid program and telling governors, "Now, you find a way to help pay for it."
This will leave states with two choices, or a combination of both: either cut funding in areas such as K-12 education, public universities and colleges, veterans affairs programs, and other much-needed services; or raise sales, income or property taxes.
As Nebraska Gov. and NGA Chairman Dave Heineman said in February, "The overall fiscal condition of states has improved, but governors are very concerned about the growth of Medicaid as it consumes an increasing share of state budgets. Medicaid's rapid growth could result in less funding for education, transportation, or public safety." Indeed, in just three years the annual budget shortfall created by the new Medicaid mandate will already be greater than the entire Nebraska State Patrol's approximately $50 million budget.
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.Tennessee's previous governor, Democrat Gov. Phil Bredesen, has called ObamaCare "the mother of all unfunded mandates," estimating that it would cost Tennessee an additional $1.1 billion from 2014 to 2019, even with the federal government covering the Medicaid expansion for the first three years.
The North Dakota Department of Human Services reported that the expansion will increase the number of beneficiaries on the state's Medicaid rolls by 50%, and is expected to cause serious access-to-care dilemmas because there aren't enough health-care providers in the state who take Medicaid to absorb the new patient load.
The same is true in Idaho, where Medicaid rolls would nearly double to include more than a quarter of the state's population. The additional enrollees would add more than $240 million in costs between 2014 and 2020. Gov. Butch Otter has repeatedly stated "big federal programs aren't the answer" and that ObamaCare "keeps states and the marketplace from making health care more affordable."
College students in nearly all states will be hit with a triple whammy. First of all, tuitions are increasing at public universities and colleges in large part because ObamaCare restricts governors from making changes to Medicaid eligibility that would reduce their state's health-care costs. Consequently, higher education is one of the first places they can cut.
College students are being hit again because the federal government took over the student-loan business in 2010, eliminating the competition. This allows the Education Department to borrow money from Treasury at an interest rate of 2.8% and lend it to college students at a rate of 6.8%. A portion of the profits from overcharging students will be used to help pay for ObamaCare.
And the third blow comes as college students graduate and enter a depressed job market where employers are creating fewer jobs as a result of the high costs associated with ObamaCare. Analysts at UBS have suggested as much when they stated in a September 2011 report that the health-care law is "arguably the biggest impediment to hiring, particularly hiring of less skilled workers."
As this week's historic debate in the Supreme Court clearly shows, the fight over ObamaCare is far from over. We and our Republican colleagues voted against the law two years ago and will continue to work toward a smarter, step-by-step solution that will make health care available to more Americans at a lower cost to the federal government, the states, and individuals seeking care.
Messrs. Alexander, Johanns, Hoeven and Risch are U.S. senators from Tennessee, Nebraska, North Dakota and Idaho, respectively. Each previously served as his state's governor.
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The pathetic Republican leadership ought to have a Specific Plan by now for implementing this that they can promote as the alternative to Obamacare. Why don't they?!? Boehner and McConnell need to go.
What to do on the Day After Obamacare
By JOHN H. COCHRANE
Last week, the Supreme Court heard arguments on the constitutionality of the administration's health law, aka ObamaCare. Opponents are giddy with the possibility that the law might be struck down.
But what then? Millions of uninsured, both those who choose not to purchase coverage and those who can't due to pre-existing conditions, will still be with us. The rising costs and inefficient delivery of health care will still be with us.
The country can have a vibrant market for individual health insurance. Insurance proper is what pays for unplanned large expenses, not for regular, predictable expenses. Insurance policies should be "guaranteed renewable": The policy should include a right to purchase insurance in the future, no matter if you get sick. And insurance should follow you from job to job, and if you move across state lines.
Why don't we have such markets? Because the government has regulated them out of existence.
Most pathologies in the current system are creatures of previous laws and regulations. Solicitor General Donald Verrilli explained as much in his opening statement to the Supreme Court: "The individual market does not provide affordable health insurance," he noted, "because the multibillion dollar subsidies that are available" for the "employer market are not available in the individual market."
Start with the tax deduction employers can take for their contributions to group health-insurance policies—but which they cannot take for making contributions to employees for individual, portable insurance policies. This is why you have insurance only so long as you stay with one employer, and why you face pre-existing conditions exclusions if you change jobs.
Continue with the endless mandates (both state and federal) on insurance companies to provide all sorts of benefits people would otherwise not choose to buy. It sounds great to "make insurance companies pay" for acupuncture. But that raises the premiums, and then people choose not to buy the insurance. Instead of these mandates, at least allow people to buy insurance that only covers the big expenses.
What about Medicare and Medicaid? Two words: premium support. The underlying point of premium support is simple. If insurance costs $5,000 and the government gives an individual a $4,500 voucher, that individual will still feel the correct economic signal to shop for cost-efficient health insurance and health care.
The main argument for a mandate before the Supreme Court was that people of modest means can fail to buy insurance, and then rely on charity care in emergency rooms, shifting the cost to the rest of us. But the expenses of emergency room treatment for indigent uninsured people are not health-care's central cost problem. Costs are rising because people who do have insurance, and their doctors, overuse health services and don't shop on price, and because regulations have salted insurance with ever more coverage for them to overuse.
If we had a deregulated, competitive market in individual catastrophic insurance, that market would be so much cheaper than what's offered today that we would likely not even need the mandate.
Meanwhile, staggeringly inefficient markets for health care itself need a thorough, competition-focused deregulation. Americans will know there's a healthy market when hospitals post prices on their websites, and when new hospital and health-care businesses routinely enter to challenge the old ones. Here too regulations keep competition at bay.
The number of new doctors is still restricted, thanks to Congress and the American Medical Association. Congress caps the number of residencies, the AMA has fought the expansion of medical schools, state tests make it difficult for foreign doctors to work here, and on and on.
There are hundreds of government impediments to competition. New hospitals? In my home state of Illinois, every new hospital, expansion of an existing facility or major equipment purchase must obtain a "certificate of need" from the Illinois Health Facilities Planning Board. The board does a great job of insulating existing hospitals from competition if they are well connected politically. Imagine the joy United Airlines would feel if Southwest had to get a "certificate of need" before moving in to a new city—or the pleasure Sears would have if Wal-Mart had to do so—and all it took was a small contribution to a well-connected official.
The result is a monstrous system in which insurance patients are gouged to subsidize Medicare, and cash patients are gouged most of all. Here's Mr. Verrilli again: "Insurance has become the predominant means of paying for health care in this country." Yes, the cash market has been badly damaged. Whose fault is that? Shouldn't we bring it back?
Group health plans in today's system may appear reasonable enough—they seem to resemble "buyers' clubs," where people pool together to get good deals from providers. But in a real buyer's club, each buyer still pays his own bill—you don't go into a Sam's Club and haul off whatever you can with only a fixed $20 copayment. And real buyer's clubs don't depend on where you work. Real buyers' clubs for health services could be a useful way to get competition going and revive the cash-and-carry market for individuals.
A deregulated health-care and health-insurance market can work. We can at least start by removing the obvious elephants in the room: all the legislation, regulation and interventions that needlessly keep prices up, keep competition and innovation out, shelter people from the economic consequences of their decisions, and prevent the emergence of real insurance that follows you from job to job and from health to illness and back.
Mr. Cochrane is a professor of finance at the University of Chicago Booth School of Business and an adjunct scholar at the Cato Institute.
A version of this article appeared April 3, 2012, on page A15 in some U.S. editions of The Wall Street Journal, with the headline: What to Do on the Day After ObamaCare.
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http://www.cbsnews.com/8301-504564_162-57408827-504564/appeals-court-fires-back-at-obamas-comments-on-health-care-case/
Appeals court fires back at Obama's comments on health care case
In the escalating battle between the administration and the judiciary, a federal appeals court apparently is calling the president's bluff -- ordering the Justice Department to answer by Thursday whether the Obama Administration believes that the courts have the right to strike down a federal law, according to a lawyer who was in the courtroom.
The order, by a three-judge panel of the U.S. Court of Appeals for the 5th Circuit, appears to be in direct response to the president's comments yesterday about the Supreme Court's review of the health care law. Mr. Obama all but threw down the gauntlet with the justices, saying he was "confident" the Court would not "take what would be an unprecedented, extraordinary step of overturning a law that was passed by a strong majority of a democratically elected Congress."
Overturning a law of course would not be unprecedented -- since the Supreme Court since 1803 has asserted the power to strike down laws it interprets as unconstitutional. The three-judge appellate court appears to be asking the administration to admit that basic premise -- despite the president's remarks that implied the contrary. The panel ordered the Justice Department to submit a three-page, single-spaced letter by noon Thursday addressing whether the Executive Branch believes courts have such power, the lawyer said.
The panel is hearing a separate challenge to the health care law by physician-owned hospitals. The issue arose when a lawyer for the Justice Department began arguing before the judges. Appeals Court Judge Jerry Smith immediately interrupted, asking if DOJ agreed that the judiciary could strike down an unconstitutional law.
The DOJ lawyer, Dana Lydia Kaersvang, answered yes -- and mentioned Marbury v. Madison, the landmark case that firmly established the principle of judicial review more than 200 years ago, according to the lawyer in the courtroom.
Smith then became "very stern," the source said, telling the lawyers arguing the case it was not clear to "many of us" whether the president believes such a right exists. The other two judges on the panel, Emilio Garza and Leslie Southwick--both Republican appointees--remained silent, the source said.
Smith, a Reagan appointee, went on to say that comments from the president and others in the Executive Branch indicate they believe judges don't have the power to review laws and strike those that are unconstitutional, specifically referencing Mr. Obama's comments yesterday about judges being an "unelected group of people."
I've reached out to the White House for comment, and will update when we have more information.
CBSNews.com Special Report: Health Care Reform
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But we were told the president was a constitutional scholar! :roll:
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BD: Would you please post this on the Legal Issues/Legal Matters thread as well? TIA.
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I am out traveling with limited access, but would otherwise want some of these points discussed in addition to the ones on Legal Issues.
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http://www.powerlineblog.com/archives/2012/03/justice-breyer-flunks-con-law.php
Justice Breyer flunks Con law Scott Johnson, Powerline
Reading the transcript and listening to the audio of day 2 of the Obamacare argument, I was struck by the sheer intellectual laziness and complacency of Justice Breyer. To liken him to a rodeo clown would be to credit him with too much energy. Referring to the key New Deal Commerce Clause case of Wickard v. Filburn, Breyer asked, for example: “Didn’t they make that man growing his own wheat go into the market and buy other wheat for his — for his cows?”
Well, actually, no, Justice Breyer, they didn’t. “They” — Congress in an amendment to the Agricultural Adjustment Act of 1938 — limited the amount of wheat farmer Filburn could grow on his farm under a quota set for him by the geniuses in Washington (or penalized him for exceeding the quota). “They” didn’t make him go into the market and buy wheat for his cows. That’s the point — the point Randy Barnett has argued for the past few years.
The distinction between the case vaguely recalled by Justice Breyer and the one decided by the Supreme Court in the Wickard case might be the difference between a pass or a fail on a fairly graded Con law exam in law school. It goes to the heart of the Obamacare case. Justice Breyer has apparently been pursuing other intersts over the past few months.
As Jeffrey Anderson and Conn Carroll have observed, this wasn’t necessarily Justice Breyer’s only laugh-out-loud moment during day 2 of the oral argument. And if Justice Breyer were not a party-line liberal, you would have heard about it.
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http://www.powerlineblog.com/archives/2012/04/barack-obama-constitutional-ignoramus.php
Barack Obama, Constitutional Ignoramus Steven Hayward, Powerline
I’m grateful for the favor Obama did for us yesterday of exposing his extreme constitutional ignorance, with his comments on how it would be “unprecedented” for the Court to strike down a law passed by a “strong majority” in Congress. (As if a House margin of seven votes is a “strong” majority.) True, he walked back the comment today, but surely because his statement was not merely indefensible but outright embarrassing to his media defenders.
I’ve been growing weary of hearing people mention that he’s a “constitutional scholar,” since he never published a single thing on the subject either as editor of the Harvard Law Review or as a member of the faculty at the University of Chicago Law School. But hey—he taught constitutional law, didn’t he?
Not really.
His course on constitutional law, one of several constitutional law courses on the U of C curriculum, dealt exclusively with the equal protection clause of the 14th Amendment—the favorite, all-purpose clause for liberal jurists to use to right wrongs and make us more equal by judicial fiat. There is no evidence that Obama ever taught courses that considered other aspects of constitutionalism, such as executive power, the separation of powers, the Commerce Clause, or judicial review itself.
I have a copy of one of his final exams. It is a long hypothetical involving civil rights, which begins thus:
In part, Hardsville’s racial isolation is the result of white flight and the limited economic means at the disposal of the black community. It is also well documented, however, that Hardsville’s racial isolation arose in part due to decisions by a white-controlled city government prior to the seventies that were purposely discriminatory.
So you can see what kind of “narrative” this exam question promotes, and hence the kind of answers likely to get an A from Professor Obama. One of the questions students are asked is, “What is the likelihood that the city will be held liable for violating the constitutional rights of blacks under the Equal Protection Clause. . .” There’s a second hypothetical involving potential gender discrimination under the Equal Protection Clause.
A law student in Professor Obama’s class would learn virtually nothing about the constitutionalism of the Founding, or even of John Marshall or Joseph Story.
Now, clearly Obama is hoping to intimidate the Court in the same way FDR did in 1937 with his court-packing scheme. Some time later I’ll discuss FDR’s extraordinary rhetoric attacking the Court that year, but suffice it to say for now that Obama already showed his hand with his inaccurate attack on the Citizens United decision in the State of the Union speech two years ago. As John Steele Gordon put it well, “It seems there is simply no lie President Obama will not tell in pursuit of his agenda.”
Notwithstanding the fact that Justice Alito could be seen mouthing the words, “Not true,” the Supreme Court by its traditions does not hit back at the President or Congress in these kind of brawls. But thank goodness for the Fifth Circuit Court of Appeals, which today rather tartly demanded that the Justice Department please explain, in at least three pages, within 48 hours, its understanding of judicial review. This should be interesting. Here’s a copy of the follow-up letter from the court... more at link
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http://www.powerlineblog.com/archives/2012/04/obama-walks-back-supreme-court-threat-still-gets-it-wrong.php
Obama Walks Back Supreme Court Threat, Still Gets It Wrong
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http://www.powerlineblog.com/archives/2012/04/does-the-commerce-clause-negate-the-rest-of-the-constitution.php
Does the Commerce Clause Negate the Rest of the Constitution?
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http://online.wsj.com/article/SB10001424052702303816504577321844137787970.html?mod=WSJ_Opinion_MIDDLETopOpinion
The Man Who Knew Too Little
President Obama's stunning ignorance of constitutional law.
James Tarranto WSJ, at the link
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"I’ve been growing weary of hearing people mention that he’s a “constitutional scholar,” since he never published a single thing on the subject either as editor of the Harvard Law Review or as a member of the faculty at the University of Chicago Law School. But hey—he taught constitutional law, didn’t he?"
Doug,
Excellent point. I remember at least one faculty colleague of Brock in Chicago state on the Marc Levin show how he never knew Brock show any real interest in Constitutional law.
On Fox they had a former student of Brock come on the show and state how he was literally shocked by Brock's essentially a threat to the Supreme Court concerning their review of the Health Care law and that if they vote against that he will do everything he can to undermine their legitimacy and integrity and paint them as "activist" etc. He said this was unprecedented and Obama clearly knows this. What he was not asked was what he thought of Brock as a Consititutional Law professor. I was hoping they would ask him this.
The evidence I read is the whole "professor thing" was more of a way station while he was honing his political connections.
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http://www.dailymail.co.uk/health/article-2126379/Sentenced-death-old-The-NHS-denies-life-saving-treatment-elderly-mans-chilling-story-reveals.html?ITO=1490
Sentenced to death for being old: The NHS denies life-saving treatment to the elderly, as one man's chilling story reveals
By John Naish
PUBLISHED: 19:30 EST, 6 April 2012 | UPDATED: 21:23 EST, 6 April 2012
When Kenneth Warden was diagnosed with terminal bladder cancer, his hospital consultant sent him home to die, ruling that at 78 he was too old to treat.
Even the palliative surgery or chemotherapy that could have eased his distressing symptoms were declared off-limits because of his age.
His distraught daughter Michele Halligan accepted the sad prognosis but was determined her father would spend his last months in comfort. So she paid for him to seen privately by a second doctor to discover what could be done to ease his symptoms.
Sentenced to death: Michele Halligan fought to get treatment for her father Kenneth Warden after a specialist told her nothing could be done
Thanks to her tenacity, Kenneth got the drugs and surgery he needed — and as a result his cancer was actually cured. Four years on, he is a sprightly 82-year-old who works out at the gym, drives a sports car and competes in a rowing team.
‘You could call his recovery amazing,’ says Michele, 51. ‘It is certainly a gift. But the fact is that he was written off because of his age. He was left to suffer so much, and so unnecessarily.’
More...Women over 40 told: 'Don't take IVF success for granted'
Little boy's life-threatening brain tumour discovered after routine eye check-up
Sadly, Kenneth’s story is symptomatic of a dreadful truth. According to shocking new research by Macmillan Cancer Support, every year many thousands of older people are routinely denied life-saving NHS treatments because their doctors write them off as too old to treat.
It is often left to close family members to fight for their rights. But although it is now British law that patients must never be discriminated against on the basis of age, such battles often prove futile.
Read more: http://www.dailymail.co.uk/health/article-2126379/Sentenced-death-old-The-NHS-denies-life-saving-treatment-elderly-mans-chilling-story-reveals.html
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Excerpted from transcript:
Justice Alito: “...it appears to me that the [Congressional Budget Office] has estimated that the average premium for a single insurance policy in the non-group market would be roughly $5,800 in—in 2016.
Respondents—the economists have supported—the Respondents estimate that a young, healthy individual targeted by the mandate on average consumes about $854 in health services each year.
So the mandate is forcing these people to provide a huge subsidy to the insurance companies for other purposes that the act wishes to serve, but isn't—if those figures are right, isn't it the case that what this mandate is really doing is not requiring the people who are subject to it to pay for the services that they are going to consume? It is requiring them to subsidize services that will be received by somebody else.”
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Herewith a response by an intelligent progressive friend:
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The alternative, in the completely free market, is to allow that discrimination to happen "naturally" as a Darwinian consequence of who has attained sufficient wealth and who has not. This alleviates anyone from being responsible for the plight of another. But the effect is the same. The event described below, ascribed to government in this case, will still happen with regularity. Possibly even more so given where the poverty line is.
So it is bad when government decides but it is acceptable when it "just happens" without anyone to blame (apart from the individual in question for not having been sufficiently financially successful)? I think you would say yes.
Seems like the issue then is not that someone might be denied care as described here - but rather that anyt choices in someone's life are decided by another. Which means this story can be replaced with any other of less dire consequence (such as being told where you will spend your vacation - similarly appalling but much less persuasive).
So chilling? Perhaps. But still a diversion from the real issue.
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Over to you GM , , , and the rest of us. What is the answer to this?
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There are those who choose freedom and those who wish to be wards of the state. Funny how the "progressives" are only generous with other people's money, in our case, the money of generations yet unborn yet leave the vast majority of actual charity work/donations to the ignorant bitter clingers to do.
How did the poor ever get medical care before the invention of the nanny state? Things like Catholic hospitals, which may get out of the business due to the birth control mandate.
"So it is bad when government decides but it is acceptable when it "just happens" without anyone to blame (apart from the individual in question for not having been sufficiently financially successful)? I think you would say yes."
Yes. Why, because freedom is important and a free people get to make their own choices and live and die with the consequences. Do you want to live or die based on the whims of a gov't employee? Why is that something to be preferred?
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"78 he was too old to treat"
Ironic as I don't even think 78 is that old at all anymore.
Indeed this is roughly the average lifes span for a man in the US now.
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My sense of things is that Obamacare is intended to have, and will have, the effect of driving us to monopsony (single payer).
I remember how because I had my own insurance, when my knee was broken I was able to elect to have three extraordinary knee surgeries that replaced the snapped ligaments with tendons from cadavers. IMO (not IMHO!) the expertise to perform such operations would not have existed, nor will exist under single payer. Indeed the "excess of specialists" was one of the rallying cries for Hillarycare in the early 90s. Without these surgeries, I would be a quasi-cripple, reduced to walking with a crutch, or perhaps a cane on level ground. Certainly my life in martial arts would have ended right then and there.
Even if I qualified for the first surgery and the expertise to perform it existed, would I, at 40 years of age, have been green lighted for three surgeries?
The surgeries cost $50k in 1992 dollars. I paid $8 of them. I got a pretty good version of my knee back. THE SYSTEM WORKED AS INTENDED.
My intelligent progressive friend posits the question as "What does it matter who decides?"
Even now, or in the future, with my insurance I decide, regardless of my age. My answer is that it matters nearly everything.
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You will NEVER see any "quality" measures come out of ivy academia for a result such as you describe.
Such superb world class orthopedic care does not show up on any Harvard outcomes study.
We are lumped together into population studies and statistical measures.
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My first post ever (half) agreeing with Barney Frank:
http://www.nationaljournal.com/congress/barney-frank-obama-made-mistake-with-health-care-push-20120416
Barney Frank: Obama Made 'Mistake' With Health Care Push
By Jonathan Miller
Updated: April 16, 2012 | 6:35 p.m.
Rep. Barney Frank, D-Mass., said he advised President Obama against taking up health care reform following a special election in 2010 that changed Democrats' fortunes in the Senate, saying that he should have instead turned his focus to financial reform. (No, that was a disaster too!)
Frank referenced former President Bill Clinton and his failed health care plan from the 1990s. “Obama made the same mistake Clinton made,” Frank said in a wide-ranging interview with New York magazine. “When you try to extend health care to people who don’t have it, people who have it and are on the whole satisfied with it get nervous.”
The outgoing representative from Massachusetts added that after Republican Scott Brown won former Sen. Edward M. Kennedy’s seat, breaking Democrats’ filibuster-proof majority, Obama should have backed down: “I think we paid a terrible price for health care. I would not have pushed it as hard. As a matter of fact, after Scott Brown won, I suggested going back. I would have started with financial reform but certainly not health care," Frank said.
He said that if the president had followed his advice, “you could have gotten some pieces of it.”
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Frank is right on this last part. In the heat of the debate, Obama could have gotten the 'popular' parts of Obamacare passed with bipartisan support - if that was what he wanted and he could have avoided the fiascos of the Cornhusker kickback, deemed passed, broken promises about open debate and time to read the bills and all the rest. He chose not to and paid a heavy price in 2010 and likely became a one-termer.
Jumping the gun here on the upcoming Supreme Court decision, he also could have avoided the fiasco of having his signature achievement ruled to be unconstitutional. His second term election theme then could be to do more instead of creating the need to go back and undo what he got wrong.
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http://washingtonexaminer.com/opinion/editorials/2012/04/examiner-editorial-why-democrats-wont-vote-budget/504281?utm_source=Washington%20Examiner%20Opinion%20Digest%20-%2004/19/2012&utm_medium=email&utm_campaign=Washington%20Examiner:%20Opinion%20Digest
Examiner editorial: Why Democrats won't vote on a budget
April 18, 2012 -- 6:00 PM
Households make budgets. So do businesses and nonprofits. There was also a time when Congress made them, but those days are long gone -- 1,086 days gone, to be precise. That's the last time Democrats, who have controlled one or both houses of Congress this whole time, passed a budget resolution through either the House or the Senate.
On April 15, 2010, both houses failed to meet the statutory deadline for passing a budget for the first time ever. Although the Senate Budget Committee would later pass a plan out of committee, Senate Majority Leader Harry Reid, D-Nev., blocked it from the floor, going so far as to prevent even a debate about the budget.
Asked to explain this bicameral failure in the face of trillion-dollar deficits, House Majority Leader Steny Hoyer said, "It's difficult to pass budgets in election years." Turns out, it is also difficult to get re-elected when you don't pass budgets. Later that same year, House Democrats lost 63 seats.
Senate Democrats lost six seats in 2010 but managed to retain control of the upper chamber. Surely, in the nonelection year of 2011 they would bring a budget to the floor, right? Wrong. Reid told reporters at the time, "There's no need to have a Democratic budget," adding, "It would be foolish for us to do a budget at this stage." In July 2011, Reid's assistant leader, Dick Durbin, D-Ill., went so far as to claim on national television that Republican filibusters prevented a budget from passing. He must have known he was fibbing -- under Senate rules, budget resolutions can pass with a simple majority.
In fact, Democrats just wanted to focus on attacking the "Path to Prosperity" budget proposed by House Budget Chairman Paul Ryan, R-Wis. Sen. Chuck Schumer, D-N.Y., said, "To put other budgets out there is not the point." As Treasury Secretary Timothy Geithner would later say, "We don't have a definitive solution ... We just don't like yours."
Fast forward to this past Monday, when Senate Budget Chairman Kent Conrad, D-N.D., announced he would attempt to pass a Democratic budget out of his committee for the first time since 2009. Conrad even held a press conference Tuesday during which he released a budget document nearly identical to the Bowles-Simpson deficit reduction plan that President Obama rejected in 2010.
But Reid quickly moved to quash this plan, and Conrad, who is retiring after this year, backed off at the eleventh hour. "This is the wrong time to vote in committee; this is the wrong time to vote on the floor," Conrad told reporters late yesterday afternoon.
It is no coincidence that the Democrats' failure to pass a budget began immediately after Obamacare became law. In order to hide its $1.7 trillion price tag and $500 billion in tax increases through 2022, Democrats had already exhausted every last budgeting gimmick. As a result, they had no further tricks up their sleeve to pay for the rest of their spending priorities without voting on the massive tax increases that Conrad's new budget contained -- $2.6 trillion, and not just on the rich.
Put yourself in the shoes of the half-dozen vulnerable Democratic senators who are up for re-election this year. Would you want to vote for that?
That is why Reid forced Conrad to pull his budget, even knowing that such a move would create an embarrassing spectacle. To paraphrase another politician, "We're running for office, for Pete's sake!"
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Obama and California's waste of tax dollars on things that I don't cotton to absolutely had everything to do with me quitting a 100k a year job and moving out of country.
I'll still vote Libertarian or Republican, but they can fund Obummer care, Pelosi field trips, the Dream act, and every other stupid thing on their dime. When enough of the hackers start following suit, the problems and waste will have to be dealt with. America doesn't make herself rich, the efforts of hard working people do, and I'm done being ripped off. They can fund that crap on their Liberal constituent's dimed and see how far/long they go. Slackers. F em n feed em dog st. My two cents.
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GM, I get that there is some sort of connection to Health Care, but that really is a Budget piece, not a Health Care piece. Sorry to be so anal on thread coherency but , , , there it is.
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By ALAN S. BLINDER
Health-care reform, the impossible dream that seemed to become a reality in 2010, is now in mortal danger. Republicans want to repeal it even though the federal law is patterned after a Massachusetts law that their apparent presidential nominee signed in 2006. They can't do that, of course, unless they sweep the next election. So the clear and present danger comes from the Supreme Court, where a majority of justices seemed to snarl at the law in open session last month. Health-care reform is clearly in legal peril.
This is no small matter. Over one-sixth of our economy is at stake. Beyond the economics, our country was founded on the idea that the rights to life, liberty and the pursuit of happiness are inalienable. Access to affordable health care is surely essential to two of these three rights, maybe to all three.
Rights are nice, but someone has to pay the bills. Looking around the world reveals a wide range of health-care payment systems. On a spectrum ranging from 100% payment by the state to 100% payment by private parties, many advanced countries cluster near the 100%-government pole. None is near the 100%-private pole. The United States probably comes closest, with about half the bills paid privately.
Though we Americans spend a much larger share of our GDP than any other nation on health care, we are not healthier. We are also the only rich country that fails to insure all its citizens. The Patient Protection and Affordable Care Act of 2010 seeks to end that. It would be a shame—and I mean that literally—if Republicans repealed the law or if the Supreme Court voided it.
The U.S. health-care payment system has a few oddities we'd be better off without. For one, the tax code incents employers to pay part of workers' wages in the form of health insurance, which is why insurance became tied to employment in the first place. For another, we have somehow decided that the state should provide anyone age 65 or older with health insurance, while everyone younger should fend for themselves. I'd hate to have to explain either of those choices to the proverbial man from Mars.
Now the big question: Does anyone think it is sensible to have nine lawyers decide what sort of health-care payment system the nation should have? Yet that's what may happen when the Supreme Court hands down its ruling.
Those three memorable days in March dealt with many issues, but the Court's main focus was on the individual mandate. Before considering the legalities, let's think about the economics. Why does the law require people to purchase health insurance?
Enlarge Image
blinder
blinder
Chad Crowe
Like most forms of insurance, health insurance is plagued by potential adverse selection. Pick any price, and riskier customers—the people more likely to file claims—will find the insurance policy more attractive than less-risky customers. So in health insurance, in particular, insurance companies expend huge resources trying to screen the bad risks out and the good risks in. One obvious way is to exclude people with pre-existing conditions, but there are others. All this effort adds to national health expenditures, improves insurers' profits, and hurts the bad risks (e.g. sick people).
The essential bargain made in 2010 starts by using the individual mandate to create a huge pool consisting of (almost) all Americans under age 65—just as Medicare now does for the 65-and-over population. With that pool created, the law can then require private insurers to cover (almost) everyone, including those with pre-existing conditions. In return, insurers get a lot more customers and a lot less adverse selection. They also save a ton of money on screening.
The Supreme Court's ruling could unravel this bargain. If the justices void the individual mandate, the adverse selection problem comes roaring back. Then, if the other insurance reforms remain in place, it will be the insurance companies that get sick. They will have to take on the bad risks while some of the good risks opt out, as they do now.
That's where economics and law collide. Economically, the individual mandate and insurance reforms form an unbreakable pair. Legally, they are separate. So the mandate could be ruled unconstitutional while the insurance reforms are not. After all, there is no question that health insurance is interstate commerce, and no question that the federal government can regulate interstate commerce.
So what happens if the justices void the mandate but leave the insurance reforms in place? The answer is: We get incoherence. Which, of course, is why you don't want judges making economic policy.
You could hear the justices grappling with this problem in the hearings. At one point, Justice Antonin Scalia even mused about declaring the entire law—which runs well over 2,000 pages—unconstitutional rather than deciding what stays and what goes. As a citizen untrained in the finer points of jurisprudence, I found that idea rather odd. Wasn't there something about a baby and some bathwater? How in the world can things like health-care quality measurement and disease prevention be unconstitutional?
So what will the Court decide? I claim no special expertise in constitutional law or Supreme Court psychology, but you could also hear hostility toward the mandate emanating from Chief Justice John Roberts, Justice Samuel Alito, and even Justice Anthony Kennedy. I have a simple model of Supreme Court decision making which rarely errs. In cases in which there are clear Democratic and Republican positions on an issue—which certainly includes this case—the Court will vote 5-to-4 Republican. Think Bush v. Gore or Citizens United, for example.
This is another real shame. If we are going to have political decision-making, at least elected politicians should do the deciding. Come to think of it, they already have.
Mr. Blinder, a professor of economics and public affairs at Princeton University, is a former vice chairman of the Federal Reserve.
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Not to be a thorn Guro, but I just walked away from healthcare that I paid for through the company when I left and am now responsible for my own care 100%. Why shouldn't everyone be responsible for themselves? The greatest thing about being truly free is that there is no safety net. We are free to succeed, but we're also free to fail. This is an axiom that exists. If we take that away, we do away with our freedom. Is that worth it? I don't think it i
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GB:
Please understand that I dsagree with the piece I posted. Read the subject and see that I am asking how to give a politically effective retort.
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"Though we Americans spend a much larger share of our GDP than any other nation on health care, we are not healthier."
Do you mean healthier than every other nation?
My answer to that point is - unquantifiable.
a) Remove all American treatments, equipment, medicines and innovations from their systems and let's do a comparison. Canadians are getting better rates on American meds than Americans do, for example. But what do they need those for if their system is superior, lol.
b) Compare SURVIVAL RATES for the afflictions most likely to hit you such as prostate cancer, breast cancer, colon cancer. America beats European in these measures.
c) Remove genetic and cultural factors if you are comparing health care delivery systems. The USA is a melting pot. To compare healthcare systems with a homogenous society like Japan or Norway compare healthcare outcomes of Japanese Americans with the Japanese, Norwegian Americans with the Norwegians, and compare Mexican Americans with Mexicans and African Americans with Africans.
d) The measure the statists always follow with is the percent or number of uninsured which is a healthcare finance outcome, not a healthcare outcome.
"It would be a shame—and I mean that literally—if Republicans repealed the law or if the Supreme Court voided it."
No matter if it violates the constitution? People like that shouldn't be allowed to vote in a constitutional republic, MHO.
"The U.S. health-care payment system has a few oddities we'd be better off without. For one, the tax code incents employers to pay part of workers' wages in the form of health insurance, which is why insurance became tied to employment in the first place."
Repairable without Obamacare.
"For another, we have somehow decided that the state should provide anyone age 65 or older with health insurance, while everyone younger should fend for themselves."
No one is denied healthcare. The argument is over payment systems.
"Now the big question: Does anyone think it is sensible to have nine lawyers decide what sort of health-care payment system the nation should have?"
It wouldn't be before the US Supreme Court if Congress hadn't passed and the President hadn't signed a bill that ELECTED officials in 26 states found to be UNCONSTITUTIONAL. That would be a large number of states opposing even if we did have government by majority rule - AND WE DON'T.
"Why does the law require people to purchase health insurance?"
Do you mean why would they do that when they have no power like that authorized to them in the constitution?
"...no question that the federal government can regulate interstate commerce."
And no question Americans have a COMPETING right of privacy in their affairs. Or is there?
"So what happens if the justices void the mandate but leave the insurance reforms in place?"
Why would they. There is an unseverability clause in the final version. (?) http://www.thepublicinsuranceoption.com/tag/healthcare-reform-legislation If not, as Justice Scalia suggested, they won't be inclined to go back through 2700 pages not even read by the people who passed it and re-write it. That is the legislative branch's job. Looking forward to an improved legislative branch next year.
"I [Alan Blinder] claim no special expertise in constitutional law"
Finally got something right!
"In cases in which there are clear Democratic and Republican positions on an issue—which certainly includes this case—the Court will vote 5-to-4 Republican."
Does that reflect badly on the 5 or on the 4?
"This is another real shame. If we are going to have political decision-making, at least elected politicians should do the deciding."
With no constitutional restraints? He isn't the first or highest up to regret living in a country where we place constitutional limits on governmental powers.
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One of the individual mandate keys as pointed out in the article is adverse selection. It's the elephant in the room, but no one talks about it. Actuaries and Underwriters spend millions of dollars devising ways not to cover sick people. We will never have a "fair" system until this issue is resolved. If you are young and healthy, you can get insurance relatively cheaply, but oddly enough, this group often doesn't buy insurance. If you are truly rich, you don't need it; you can self insure or pay any premium asked. But for the majority out there, people under 65 and not yet eligible for Medicare (isn't that a mandated system?) people who have some medical problem, but were insured at a company for example, if they are laid off, they have no option after COBRA. Many times, coverage can't be found. Or if it can be found, the price is prohibitive. "No one is denied healthcare." True, after you have depleted your savings, sold your house, maybe declared bankruptcy, no one is denied. But without money or insurance, you are a second class citizen receiving second class health care. Good luck.
Is that right? Is that fair?
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The elephant in the room is that they could have written and passed a bill to cover catastrophic injuries and unexpected illnesses in a constitutionally authorized way instead of cradle to grave governing and they would not now be faced with starting completely over - with a new group in power.
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The elephant in the room is that they could have written and passed a bill to cover catastrophic injuries and unexpected illnesses in a constitutionally authorized way instead of cradle to grave governing and they would not now be faced with starting completely over - with a new group in power.
Well, if they can find a way to cover catastrophic injuries and unexpected illnesses plus eliminate all pre existing clauses, in an affordable manner for all Americans, why don't the Republicans propose just that? But they don't......
As for the constitutionality of it, what is Medicare other than a a mandated government plan for all people over age 65?
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Is that right? Is that fair?
Is it right and fair to confiscate money from the young to partially subsidize the care for the older population? Is it right and fair to run up a debt that will crush generations yet unborn? Is it right and fair to flood the world with dollars, resulting in crushing inflation that literally takes food from the mouths of the poorest and most vulnerable people on the globe so Buraq can engage in his insane spending?
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We can debate the constitutionality of Obozocare all you wish, we'll see what the SCOTUS says, more importantly, how do we PAY for it? Much like the deep blue state like California, deep in red ink, there is no more money. Please answer that.
http://www.csmonitor.com/Business/Latest-News-Wires/2011/0613/Medicare-other-entitlements-mean-US-worse-off-than-Greece
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Much of the public focus is on the nation's public debt, which is $14.3 trillion. But that doesn't include money guaranteed for Medicare, Medicaid and Social Security, which comes to close to $50 trillion, according to government figures.
The government also is on the hook for other debts such as the programs related to the bailout of the financial system following the crisis of 2008 and 2009, government figures show.
Taken together – public debt, Medicare and other entitlements, and other debts – Gross puts the total at "nearly $100 trillion," that while perhaps a bit on the high side, places the country in a highly unenviable fiscal position that he said won't find a solution overnight.
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How does (see list below) pay for a Universal Health Care Plan?
Norway
New Zealand
Japan
Germany
Belgium
United Kingdom
Sweden
Canada
Netherlands
Austria
Finland
Slovenia
Denmark
Luxembourg
France
Australia
Ireland
Italy
Portugal
Cyprus
Greece
Spain
South Korea
Iceland
Hong Kong
Singapore
Switzerland
Israel
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By a combination of rationing (death panels) and economy-killing debt, which isn't working out so well for europe, is it?
Did the whole european crisis not make it onto your radar screen?
How does (see list below) pay for a Universal Health Care Plan?
Norway
New Zealand
Japan
Germany
Belgium
United Kingdom
Sweden
Canada
Netherlands
Austria
Finland
Slovenia
Denmark
Luxembourg
France
Australia
Ireland
Italy
Portugal
Cyprus
Greece
Spain
South Korea
Iceland
Hong Kong
Singapore
Switzerland
Israel
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http://theweek.com/article/index/220190/greeces-austerity-driven-health-crisis
Greece's austerity-driven health crisis
Cuts in spending on hospitals and social welfare programs have put health care out of reach for many Greeks
posted on October 11, 2011, at 1:09 PM
People walk past a heap of garbage in an Athens suburb: Between a trash collectors' strike and the stress of ongoing protests, Greece may be on the verge of a health crisis. Photo: REUTERS/Yiorgos KarahalisSEE ALL 51 PHOTOS
Greece's debt crisis isn't just making its citizens mad — it's literally making them sick, according to a report in British medical journal The Lancet. Here's what you should know:
What kind of health problems are on the rise?
All kinds. The number of people reporting general "bad" health has climbed sharply. New HIV infections are expected to rise by 52 percent in 2011. Half of those new infections are expected to be related to a dramatic jump in intravenous drug use. And suicides rose by 25 percent in 2010 over the previous year, according to unofficial statistics.
How is government debt linked to these health problems?
As Greece imposes austerity measures to keep from drowning under its debt, hospital workers have walked out to protest staff cuts. Garbage collectors have been on strike for a week, leaving trash heaps to pile up around Athens. And stress levels are rising for everybody. Plus, the Greek government has slashed spending on hospitals, welfare programs, and just about everything else to avoid defaulting on its debts. Among the cuts: Public hospitals have seen their funding reduced by as much as 40 percent, leaving them short on staff and supplies, even as admissions rose by 24 percent in 2010.
Are hospitals overwhelmed?
Public hospitals are. The economic crisis has left fewer people able to pay for private care. Private hospital admissions have fallen by as much as 30 percent, and patients are instead flooding into public health-care facilities. There are even reports of "bribes given to medical staff to jump queues in overstretched hospitals," the authors of the study in The Lancet wrote. Many Greeks are resorting to visiting street clinics run by humanitarian groups, such as Doctors without Borders, which used to almost exclusively serve low-income immigrants.
Sources: The Lancet, AFP, Huff. Post, BBC News
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By a combination of rationing (death panels) and economy-killing debt, which isn't working out so well for europe, is it?
Did the whole european crisis not make it onto your radar screen?
How does (see list below) pay for a Universal Health Care Plan?
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"death panels"? cute; or should I say hogwash. If you need a liver transplant here in America; a committee decides based on variables who
gets the next liver. Is that a "death panel"? Hardly... Then again, I suppose you would say the person with the most money should get the next liver or kidney.
As for for the European crisis, what does that have to do directly with universal health care? Or is Germany and Canada and Hong Kong doing
well because they have universal health care? A population healthier than ours.
As for Greece, workers are protesting in every industry, not just health care. Odd private hospitals have rooms; why don't they open their doors and help sick Greeks? Oh yeah, their personal oath was to make money, not heal the sick. Ask Doctors to take a pay cut like everyone else? Of course not. It's sort of like asking police to take a pay cut like other government workers here in America; it never seems to happen.
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"death panels"? cute; or should I say hogwash.
That's how socialized medicine works, as has been well documented. There is no magical money tree, so they use set criteria to decide who gets treatment and who dies. So, your wife could have gotten hospice rather than chemo.
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Then again, I suppose you would say the person with the most money should get the next liver or kidney.
I guess you would say the person who can bribe the gov't employee with life or death power or who is hooked into the power structure should get the transplant, right?
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As for for the European crisis, what does that have to do directly with universal health care?
Everything. As politicians grow government to buy votes with "entitlements" including healthcare, they set the stage for what we are seeing in Greece and California.
Or is Germany and Canada and Hong Kong doing
well because they have universal health care? A population healthier than ours.
Hardly, Germany is in the short term doing well, but as they run out of Germans, their future grows dim. HK's system is for the poor, anyone who can gets private healthcare.
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"death panels"? cute; or should I say hogwash.
That's how socialized medicine works, as has been well documented. There is no magical money tree, so they use set criteria to decide who gets treatment and who dies.
That's the problem; we don't have a magical money tree either. I'm not sure they exist. So when when my friend's friend's mother age 92 had heart surgery and died, that drives up the cost for all of us too. If you are 33, and you need liver, you get priority over the drunk who is 78. Liver's are finite. So is money.
HK's system is for the poor, anyone who can gets private healthcare.
I'll accept that and probably that is what we should have been done. Still it needed to be mandatory. For example, a limited (no bells and whistles) HMO plan for the masses and a various supplemental plans for the rich; if I want the the top guy at Harvard to do my surgery I think he should be entitled to charge more. And if I want bells and whistles, I should pay more.
The concept is like car insurance here in CA except with health insurance, you need a rule that says you can't opt out. But you only have to buy the minimum. Still, it's a start.
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I'll accept that and probably that is what we should have been done.
It was done. Ever heard of Medicaid?
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As JDN is administered his daily medicine by Dr. Snark :lol: I will point out that I do agree with him point that as a teamthe Reps have not put forward very much in the way of their own ideas-- contrast Paul Ryan's budget.
I will also agree that the finite supply of livers means that no matter what is done, there is rationing.
I will disagree with the notion that heart surgery for a 92 year old means less heart surgery for other, younger patients. Actually the contrary is true, by increasing the amount of money to be made in heart surgery it motivates entry into that sector and motivates those already in it to increase their capacity.
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The answer is to the same system that has reduced costs and inceased suppy in every place it's allowed to function. The free market.
Can you imagine the nightmare if we bought food the same way we purchased health care? Imagine paying monthly "food insurance" premiums and then going to store, not knowing the prices of various foods and what would or wouldn't be covered. Image fighting with your insurer over the deductable for your Thanksgiving meal....
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I will disagree with the notion that heart surgery for a 92 year old means less heart surgery for other, younger patients. Actually the contrary is true, by increasing the amount of money to be made in heart surgery it motivates entry into that sector and motivates those already in it to increase their capacity.
Yes and no. Most/much of the cost is hospitalization. Further, we the consumers pay for this pointless surgery through higher premiums and/or costs. As costs rise due to unnecessary treatments, something has to give; remember money is finite.
As for motivation, I would agree with you, but it doesn't work that way. The price is basically set by the insurance industry. Further, the doctors are in cahoots. If you wanted to lower the price of heart surgery, just open up the floodgates to foreign doctors. Prices will drop like a rock. As GM points out, supply and demand. But the AMA keeps it limited therefore salaries are high.
However, I think the analogy to buying food is a bit simplistic. I can get by on eating low cost food; if I need heart surgery that is financially fatal.
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"why don't the Republicans propose just that?"
They did that at the time. Pre-existing conditions, cross state lines, malpractice reform, all of the 'popular' pieces of Obamacare were on the table. Democrats should have done a head fake with this monstrosity and locked in all of what at least the most moderate of Republicans were ready to agree to. It was Democrats who did not want that deal. They were willing to write a cornhusker kickback, exempt the Bank of North Dakota from student loan legislation, and build a hospital in Connecticut in order to buy the last Democrat vote and not need a single Republican.
"The concept is like car insurance...except with health insurance, you need a rule that says you can't opt out. But you only have to buy the minimum. Still, it's a start."
Constitutional distinction: a) car ins. is a state law, b) you can opt out - bicycle, bus, let someone else drive, stay home when your finances are down, etc. and c) You used to be able to post some OTHER form of financial responsibility up to the minimum and not HAVE to contract with a psuedo-private insurance company.
"you only have to buy the minimum."
Article Two, or where did that authority come from?
"As for for the European crisis, what does that have to do...with health care?"
Lol.
"How does (see list below) pay for a Universal Health Care Plan?
Norway New Zealand Japan Germany Belgium United Kingdom Sweden Canada Netherlands Austria Finland Slovenia Denmark Luxembourg France Australia Ireland Italy Portugal Cyprus Greece Spain SouKorea Iceland Hong Kong Singapore Switzerland Israel"
The question in a constitutional case is - how did they authorize it?
If you are willing to skip that question then the answer is obvious, move.
GM: "Is it right and fair to confiscate money from the young to partially subsidize the care for the older population?"
Justice Alito had that point quantified and no one corrected him. The ones hit most by the mandate will be mandated topay 6 times what their current burden is on the others. Had that been based on actual costs, the underlying argument they made might have had truth to it.
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Doug, I don't know how the Court will rule. They will tell us if it is constitutional or not. It seems people disagree on the subject.
However, I still don't understand how it's any different than Medicare or for that matter Social Security. They seem to be mandated and no one seems to question the government's authority to do so. Why is merely, in essence, lowering the benefit age for Medicare from 65 to birth any different?
And yes, you can opt out of car insurance since other alternatives are available, but that is exactly the point. You cannot opt out of medical treatment (there is no alternative) if you are suddenly diagnosed with a serious illness. Somebody, i.e. the tax payer has to pay, so to avoid adverse selection, everyone must be covered.
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Somebody, i.e. the tax payer has to pay, so to avoid adverse selection, everyone must be covered.
Which is how every bit of tyranny will be excused. Hey, the taxpayers have to pay, so we'll need to monitor your personal choices and control them.
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However, I still don't understand how it's any different than Medicare or for that matter Social Security. They seem to be mandated and no one seems to question the government's authority to do so. Why is merely, in essence, lowering the benefit age for Medicare from 65 to birth any different?
Do you get that we are the most indebted nation in human history? What part of "deck chairs on the Titanic" do you not grasp? Without wading into penumbras and the Federalist Papers, let's just focus on the fact that THERE. IS. NO. MORE. FCUKING. MONEY!
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Agreed on No Fg Money, but that is a separate point. The question presented is how to logically distinguish the two.
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http://volokh.com/2010/04/02/destroying-the-constitutions-structure-is-not-constitutional/
Destroying the Constitution’s Structure is not Constitutional
David Kopel • April 2, 2010 3:38 am
Thus far, the argument among law professors over the constitutionality of Obamacare has been well represented by scholars who have made pro and con arguments over particular clauses in the constitution, such as the interstate commerce clause, or the tax power. In this post, I would like to examine an insight by Jonathan Turley, which points the way to strong, recent, and repeated precedent suggesting that Obamacare is unconstitutional.
Let’s begin by getting rid of the red herring that questioning the constitutionality of Obamacare requires denying the constitutionality of the New Deal and the Great Society. Orin asks:
In your view, which of the following federal programs or agencies are constitutional?
(a) Social Security
(b) The Federal Trade Commission
(c) Medicare/Medicaid
(d) The Securities and Exchange Commission
(e) The new Health Care mandate
In my view, (a), (b), (c), and (d), are constitutional, but (e) is not. My answer is based on using “constitutional” in the normal sense of the word as it appears in most modern public dialogue. That is, “Should a judge who accurately applies existing precedents, and other sources of legal authority, find the law to be constitutional?” This is the question that federal district judges and circuit court of appeal judges will have to answer, since they have no authority to reject Supreme Court precedent. The Supreme Court can change its own precedents, but for for purposes of argument, I am presuming that the Supreme Court would not overrule any precedents.
As Jack Balkin, Sandy Levinson, and others have ably pointed out, “constitutional” can be used in a different way, in that people express aspirations about what the Constitution should mean, even if that meaning is contrary to current precedents. For example, a person in 1946 might say “Discrimination against women is unconstitutional.” That person would not be describing the current state of the law, but would be making an argument that constitutional intepretation should be changed. Often, these aspirational statements do become constitutional law, especially when they win the hearts and minds of the public. Some of the 1930s decisions upholding parts of the New Deal or its state analogues are examples of the success of this aspirational constitutional rhetoric. For example, the statement in 1890 that “mortgage relief laws are constitutional and do not violate the Contract Clause” would have been incorrect in regard to Supreme Court precedent, and was utterly contrary to the original meaning of the Contract Clause. Nevertheless, the Supreme Court later changed its intepretation of the Contract Clause, so that the aspirational statement became an accurate description of the law.
People are free to argue all they want, on the basis of aspiration, original meaning, or anything else, that items (a) through (d) on Orin’s list are unconstitutional. If these people persuade enough of their fellow Americans, perhaps the Court might eventually narrow or overturn some of the precedents which uphold (a) through (d). However, my argument is based on the law as it actually exists today, and it presumes the continuing validity of all the New Deal and Great Society precedents.
Some parts of Obamacare, such as the calorie labeling requirement for restaurant chains, appear to be solidly within the scope of existing precedents. (At least based on the discussion I’ve heard thus far.)
In contrast, the individual mandate to purchase health insurance is not. It “is unprecedented in our jurisprudence.” Romer v. Evans (1996). It is possible to make arguments for extensions of cases such as Wickard, Raich, and Sonzinsky in support of the mandate. However, such arguments are a plea for extending those cases, not for merely applying them. For example, an application of Wickard/Raich might be a law against a person manufacturing her own medicine at home, rather than purchasing the medicine through the federally-controlled market.
No prior case stands for the proposition that Congress may use the interstate commerce power to order persons to buy a particular product, or may use the tax power to punish people for choosing not to purchase a particular product. I can imagine a judicial opinion that builds on the foundation of Wickard, Raich, and Sonzinsky, and extends those cases much further, in order to uphold the mandate. The Court might do so, but the Court would be doing much more than merely applying precedent.
At this stage in the debate, the only cited instance of Congress ever forcing people to buy particular products have come under the congressional exercise of the enumerated militia powers in Article I, section 8, clause 16, “To provide for organizing, arming, and disciplining, the Militia. . .” Here, the congressional power to mandate is provided in the text itself. Further, the original understanding of the militia was that the militiamen ”were expected to appear bearing arms supplied by themselves and of the kind in common use at the time.” United States v. Miller (1939). The congressional power to provide for arming the militia straightforwardly includes the power to tell militiamen what kind of arms to bring to duty.
The federal militia powers come from the state militia powers, which (by enacting the Constitution) the People and the States chose to give (at least concurrently) to Congress. No one could possibly dispute that state militia powers included the power to require militiamen to bring certain types of arms to duty, and thus to require the purchase of such arms if necessary. The federal power to regulate commerce among the several states was likewise granted to Congress from the powers which were then possessed by the States and by the People. There was certainly no understanding in 1789 that state power to regulate interstate commerce (e.g., by inspecting goods at ports of entry) included the power to compel individuals to purchase goods in commerce.
So neither the Militia arming clause nor any cases provide precedent for the unprecedented mandate to purchase insurance. At best, the mandate is in a constitutional gray zone. To resolve the gray zone question, we are not limited to wondering whether to greatly extend some prior cases on the interstate commerce clause or the tax power. In addition, we can consider the structure of the Constitution itself.
As Jonathan Turley has written, allowing the individual mandate to stand “could amount to a ‘do not resuscitate’ order for federalism.” If judges find this argument (in the greatly eleborated form that will eventually be presented to the courts) to be persuasive, then the Supreme Court precedent is very clear. Several recent cases, including Seminole Tribe of Florida v. Florida (1996), Alden v. Maine (1999), City of Boerne v. Flores (1997), United States v. Morrison (2000), Board of Trustees of University of Alabama v. Garrett (2001), and Nevada Dept. of Human Resources v. Hibbs (2003) have demonstrated the Court’s persistent determination to defend state sovereign immunity. Some of these cases involved the Eleventh Amendment, and some involved the Fourteenth (Cong. powers under sect. 5). In one case (Hibbs), the federal abrogation of sovereign immunity was upheld, partly because the federal law involved a state practice (sex discrimination) that was already unconstitutional.
These decisions have been heavily criticized by the academic Left, and the critics have pointed out that these decisions have much less to do with the constitutional text, or with original meaning of the text, than they do with the Court’s broad view of constitutional structure: the essential nature of state sovereignty, and one of the attributes of sovereignty, namely sovereign immunity.
According to the Court, a Congressional statute making it easier for states to be sued for patent infringement is such a serious violation of federalism that it must be held unconstitutional. Florida Prepaid Postsecondary Educ. Expense Board v. College Savings Bank (1999). (Eugene Volokh’s article on the case is here.) In terms of the practical harm to state sovereignty, the congressional law on patent suits is to Obamacare as a house cat is to lion.
The extensive line of recent cases on state sovereignty is complemented by the Ninth Amendment. The Ninth Amendment may be read to create a presumption of liberty. Randy Barnett, Restoring the Lost Constitution: The Presumption of Liberty (2005). Or it may be read as requirement that enumerated federal powers be narrowly construed so that they do not violate the retained natural rights of the people, including the people’s right of self-government in the states. Kurt Lash, The Lost History of the Ninth Amendment (2009). Either reading raises further doubts about the constitutionality of the insurance mandate.
As the joint complaint of the 13 Attorneys General has argued, Obamacare constitutes an immense assault on federalism. If Obamacare is upheld, the states may be well on the way to becoming like the Roman Senate in 100 A.D.: formerly the an essential component of republican sovereignty, but now a hollowed remnant, possessing the forms of the old republic but really functioning as a mere puppet of the Leviathan.
“[F]ederalism was the unique contribution of the Framers to political science and political theory,” wrote Justice Kennedy. United States v. Lopez (1995) (concurring). To declare Obamacare to be unconstitutional, the Court may take into account the importance of preserving the unique contribution of Our Federalism. In doing so, the Court need not overrule a single precedent, nor need the Court cast into doubt any of the creations of the New Deal or the Great Society. Instead, the Court may simply choose not to invent unprecedented extensions of the interstate commerce power and the tax power.
From federal district court to the Supreme Court, the judges and justices who decide to leave constitutional doctrine exactly as it is today will decline to validate the unprecedented exercise of power in Obamacare. The last fourteen years of the Supreme Court determination to defend our precious constitutional system of dual sovereignty gives reason to hope that the courts will apply the existing law rather than make up new law, and that the insurance mandate will be declared unconstitutional.
And then: Over two thousand pages of laws certainly contain items (e.g., restaurant menu labeling, tanning taxes) that theoretically could have been enacted separately from the mandate, and might be considered severable. But the main provision of Obamacare–turning private insurance companies into ultra-regulated public utilities–makes no sense without the individual mandate; it would not have been enacted without the mandate, and it is not severable.
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Good find; interesting read, but I still don't understand while in his original question the author refers to Medicare (and Social Security) yet never does the article itself again refer to Medicare nor does it say why Medicare is constitutional but Obamacare is not. Or is he simply saying rather than involve private insurance companies (mandate to buy coverage) because that is
unconstitutional Obama should have simply said Medicare will now cover everyone in America; period? That would be then constitutional and ok? Rather disingenuous since I would think Republicans would want the plan administered by private insurance companies versus a government bureaucracy like Medicare.
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Does Medicare require you to purchase anything?
Good find; interesting read, but I still don't understand while in his original question the author refers to Medicare (and Social Security) yet never does the article itself again refer to Medicare nor does it say why Medicare is constitutional but Obamacare is not. Or is he simply saying rather than involve private insurance companies (mandate to buy coverage) because that is
unconstitutional Obama should have simply said Medicare will now cover everyone in America; period? That would be then constitutional and ok? Rather disingenuous since I would think Republicans would want the plan administered by private insurance companies versus a government bureaucracy like Medicare.
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I guess that's my point/question. Medicare, to the best of my knowledge is mandatory in that everyone must participate. Further, almost everyone must pay/purchase/contribute. But private insurance companies are excluded; again you would think Republicans would be horrified about excluding private companies and expanding a government bureaucracy like Medicare, but is that why you think it's unconstitutional? Because everyone must buy insurance versus it being provided directly by the government like Medicare? So if Obama had merely expanded Medicare to cover every American citizen, it would have been constitutional and ok?
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But private insurance companies are excluded; again you would think Republicans would be horrified about excluding private companies and expanding a government bureaucracy like Medicare, but is that why you think it's unconstitutional?
Can the federal gov't require you to purchase a pound of bacon every month,even if you are a vegetarian or follow kosher or halal dietary rules? Are there any limitations on federal powers?
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http://www.humanevents.com/article.php?id=49832
The Institute for Justice has filed a fascinating new legal brief against the ObamaCare individual mandate, raising a devastating point about the damage ObamaCare’s core concept of “mandated commerce” will do to our legal understanding of contract law:
Constitutional law professor Elizabeth Price Foley, who is the executive director of the Institute's Florida Chapter and who co-authored IJ's brief, said, "The individual mandate violates a cardinal rule of contract law—to be enforceable, all agreements must be voluntary. The Framers understood this, and would never have given the federal government the power to force individuals into lifelong contracts of insurance. The Court should not allow the government to exercise this unprecedented and dangerous power."
As IJ's brief shows, the principle of mutual assent, under which both parties must consent for a contract to be valid, is a fundamental principle of contract law that was well understood during the Founding era and is still a cornerstone of contract law today. Indeed, contracts entered under duress have long been held to be invalid. Yet the mandate forces individuals to enter into contracts of insurance that would never be valid under this longstanding principle. (For a copy of IJ's brief, visit: www.ij.org/PPACAbrief.)
If the U.S. Supreme Court fails to strike down the individual mandate, there will be nothing to stop Congress from forcing people into other contracts against their will—employment contracts or union membership, for example. If we still have a constitutional republic in which the federal government's powers are limited, then the Court should strike down this law.
(Emphasis mine.) The Institute also produced a short video explaining their legal brief:
[youtube]http://www.youtube.com/watch?feature=player_embedded&v=BuvkXqE8HDw[/youtube]
http://www.youtube.com/watch?feature=player_embedded&v=BuvkXqE8HDw
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Bacon or eggs; let's not get off the subject. Everyone is pretty much required to participate/pay for Medicare. Social Security for that matter. I can't tell my employer don't deduct my SS contribution from my paycheck. Nor can my employer forgo paying his share. It's not "voluntary". If that is so, why not Obamacare? That's the question on the table. What's the difference?
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Bacon or eggs; let's not get off the subject. Everyone is pretty much required to participate/pay for Medicare. Social Security for that matter. I can't tell my employer don't deduct my SS contribution from my paycheck. Nor can my employer forgo paying his share. It's not "voluntary". If that is so, why not Obamacare? That's the question on the table. What's the difference?
Did you read the above posts? The reason the dems didn't just try to give medicare to everyone is the costs are too massive, so they tried mutiple fig leaves and games to hide the price tag. So, force young healthy people to buy insurance to subsidize the older population. It's not about healthcare, it's about gov't control of the American people. Once the federal gov't owns healthcare, they own you.
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So, what limitations are there on federal power, if any? Can the feds mandate everyone in the US buy a pound of bacon every month? Yes or no?
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You are not answering the question. I did read the above. And I concur; costs are unknown at best, that is why I agree a minimal plan might be good to start with....
I don't agree, "once the federal government owns healthcare, they own you". My father has Medicare; he loves it; yet I don't think my father thinks the government "own"s him.
Anyway, the issue on the table is what the heck is the difference between mandated Medicare, Social Security, and Obamacare?
Quit bring bacon into the equation :-)
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I don't agree, "once the federal government owns healthcare, they own you". My father has Medicare; he loves it;
Yes, it's easy to love free stuff the government gives you when you aren't aware of how they are ruining the future of generations yet unborn to do so.
yet I don't think my father thinks the government "own"s him.
He doesn't think so, but he a dependant class that now must vote for those who provide for his dependency. Now imagine Obozocare, where the US gov't has your medical records with all the intimate details within, that now can force you to comply to any rule created because your behavior impacts the bottom line. We go from being free individuals to serfs on the collective health compound.
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So, what limitations, if any are there on federal power? None?
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Anyway, the issue on the table is what the heck is the difference between mandated Medicare, Social Security, and Obamacare?
Forcing every person in the US to sign a legal contract and purchase a service no matter if they wish to do so or not.
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Forgive my ignorance. Who has to buy Medicare?
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No one. Only Obozocare requires a private citizen purchase a service/sign a contract with a private business as a result of being a live human being in the US.
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Social security is a tax and spend program. Medicare is a tax and spend program. The individual mandate is not.
The GM piece covered it, There is no explicit authority and there is no precedent.
The income tax had the same problem - then they passed an amendment.
People like Alan Blinder (or JDN) can write or talk for hours about how great the benefits will be - everyone covered - like everyone having a home because the law requires you to buy one. If you like that, fine, but you need a super majority to write the authorization for that new power, not an act of congress.
Under Obamacare, you lose liberty and you lose privacy. Liberty is mentioned in at least one founding document - and so is life - which includes life's big decisions, does it not? Privacy is a Supreme Court recognized right. Without it, Roe v Wade falls. You have to buy the policy under Obamacare and therefore you lose privacy - you have to give them all the personal information they require including the most personal things possible, allow them to store it, read it, use it and act on it. What if you don't want to give them your ss number, your birthdate, whether you smoke or not, drink, have sex, have guns in the house, eat right, exercise, or a lot of other things. What if you don't want to buy exactly what is in the plan or don't want to pay for provisions that violate your beliefs or don't fit your needs. What about the freedom to figure this all out for yourself and not subscribe to a one size fits all out of Washington. What about the right to freely consent to your contracts. Anything short of that isn't a valid contract anyway. You lose the right to make all of your own choices including those that could save your life - a quality recognized in at least one founding document. Even the right to make a wrong choice, isn't that a liberty?
If you agree to the loss of these recognized freedoms and established rights in the creation of a new federal govt power that isn't authorized anywhere in Articles One or Two or in any amendment to the constitution or in any court precedent or anywhere else - isn't that the opposite of upholding the constitution?
Is it too much to ask to have an amendment passed for every new power over us that we grant to the federal government?
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OK, that seems pretty clear to me. How about you JDN?
Also, the Kopel article posted by GM seemed to me to be sound in its observations. Nice find.
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Toying with Medicare to fix elex
By BENJAMIN E. SASSE & CHARLES HURT
Last Updated: 1:41 AM, April 23, 2012
Posted: 10:45 PM, April 22, 2012
Call it President Obama’s Committee for the Re-Election of the President — a political slush fund at the Health and Human Services Department.
Only this isn’t some little fund from shadowy private sources; this is taxpayer money, redirected to help Obama win another term. A massive amount of it, too — $8.3 billion. Yes, that’s billion, with a B.
Here is how it works.
The most oppressive aspects of the ObamaCare law don’t kick in until after the 2012 election, when the president will no longer be answerable to voters. More “flexibility,” he recently explained to the Russians.
Getty
Postponing the pain: The administration is temporarily restoring funds to Medicare Advantage so seniors don’t lose coverage before the election.
But certain voters would surely notice one highly painful part of the law before then — namely, the way it guts the popular Medicare Advantage program.
For years, 12 million seniors have relied on these policies, a more market-oriented alternative to traditional Medicare, without the aggravating gaps in coverage.
But as part of its hundreds of billions in Medicare cuts, the Obama one-size-fits-all plan slashes reimbursement rates for Medicare Advantage starting next year — herding many seniors back into the government-run program.
Under federal “open-enrollment” guidelines, seniors must pick their Medicare coverage program for next year by the end of this year — which means they should be finding out before Election Day.
Nothing is more politically volatile than monkeying with the health insurance of seniors, who aren’t too keen on confusing upheavals in their health care and are the most diligent voters in the land. This could make the Tea Party look like a tea party.
Making matters even more politically dangerous for Obama is that open enrollment begins Oct. 15, less than three weeks before voters go to the polls.
It’s hard to imagine a bigger electoral disaster for a president than seniors in crucial states like Florida, Pennsylvania and Ohio discovering that he’s taken away their beloved Medicare Advantage just weeks before an election.
This political ticking time bomb could become the biggest “October Surprise” in US political history.
But the administration’s devised a way to postpone the pain one more year, getting Obama past his last election; it plans to spend $8 billion to temporarily restore Medicare Advantage funds so that seniors in key markets don’t lose their trusted insurance program in the middle of Obama’s re-election bid.
The money is to come from funds that Health and Human Services is allowed to use for “demonstration projects.” But to make it legal, HHS has to pretend that it’s doing an “experiment” to study the effect of this money on the insurance market.
That is, to “study” what happens when the government doesn’t change anything but merely continues a program that’s been going on for years.
Obama can temporarily prop up Medicare Advantage long enough to get re-elected by exploiting an obscure bit of federal law. Under a 1967 statute, the HHS secretary can spend money without specific approval by Congress on “experiments” directly aimed at “increasing the efficiency and economy of health services.”
Past demonstration projects have studied new medical techniques or strategies aimed at improving care or reducing costs. The point is to find ways to lower the costs of Medicare by allowing medical technocrats to make efficient decisions without interference from vested interests.
Now Obama means to turn it on its head — diverting the money to a blatantly nonexperimental purpose to serve his political needs.
A Government Accounting Office report released this morning shows, quite starkly, that there simply is no experiment being conducted, just money being spent. Understandably, the GAO recommends that HHS cancel the project.
Congress should immediately launch an investigation into this unprecedented misuse of taxpayer money and violation of the public trust, which certainly presses the boundaries of legality and very well may breach them.
If he’s not stopped, Obama will spend $8 billion in taxpayer funds for a scheme to mask the debilitating effects on seniors of his signature piece of legislation just long enough to get himself re-elected.
Now that is some serious audacity.
Benjamin E. Sasse, a former US assistant secretary of health, is president of Midland University. Charles Hurt covers politics in DC.
Read more: http://www.nypost.com/p/news/opinion/opedcolumnists/an_billion_trick_ImTBFfz7MeuZLJY7JzXEIJ
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OK, that seems pretty clear to me. How about you JDN?
Also, the Kopel article posted by GM seemed to me to be sound in its observations. Nice find.
Yes, that seems clear thank you. Obama should have designed it to be a tax and spend program like Social Security and Medicare.
He foolishly tried to involved private enterprise; the insurance companies.
Also, I think Doug's points about liberty and privacy are a bit overblown. The government already has my SS#, my DOB, my guns are registered, etc.
As for the rest, whether I smoke, drink or have sex is also already out there in Insurance Companies (pooled) data banks. Notice you sign a release
on every medical form?
Anyway, I guess we will just wait to see what the Court rules.
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"He foolishly tried to involved private enterprise; the insurance companies."
This leads to what I think is a very important point. This is the essence of economic fascism-- when the government co-opts private enterprise as a means of expanding its control. You think the mission of Obamacare is expanding the free market or a co-option that leads to the insuriance companies as facades for single payer or some variation thereof?
I share Doug's concerns about the implications for liberty and privacy.
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While you may personally be opposed to Social Security and Medicare, I bet the overwhelming number of Americans are grateful.
No one is talking about doing away with Social Security or Medicare; but if as you all seem to imply, why not?
And, I would bet that the overwhelming number of Americans would be grateful for Universal Health Care in a few years. Look at
the long list of Countries that have Universal Health Care. Sure there are problems, but overall, the overwhelming number of
citizens would never go back.
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So, you admit that the intention in involving private enterprise is to end its role in health care?
Spain, which I just left, has universal health care , , , and everyone is universally fuct. THEY ARE BROKE. Unemployment is 23%. For the young it is 48%. The birth rate is something like an astonishing 1.1 :-o :-o :-o This is a demographic death spiral. The people are so grateful for what they have , , , that anyone who can is leaving the country.
Oh yeah, they have green solar energy too!
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So, you admit that the intention in involving private enterprise is to end its role in health care?
I never said that. But frankly, having worked in the health care industry I know there are layers upon layers of unnecessary, redundant and costly expenses. Billions could be saved.
Spain, which I just left, has universal health care , , , and everyone is universally fuct. THEY ARE BROKE. Unemployment is 23%. For the young it is 48%. The birth rate is something like an astonishing 1.1 :-o :-o :-o This is a demographic death spiral. The people are so grateful for what they have , , , that anyone who can is leaving the country.
And you are implying that because they have universal health care, that is why they are broke? Facts please. Further, although broke, I bet universal health care is one of the last things
they would vote to repeal. It's that important to them.
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The commerce clause gave power for our government to be the referee, not the participant or architect of private sector commerce and innovation. And it does not negate the other clauses or even the unenumerated rights.
Promote general welfare did not mean government do everything or make all private decisions.
"I share Doug's concerns about the implications for liberty and privacy."
Lots of government programs step on liberty and privacy. I'm just saying that this is a huge, additional theft of liberty and privacy. That, and the fact that 26 states oppose it and the Court chose to hear the case puts a very heavy burden on the proponents of the law to show where the federal government in this case derived its authority to do that. The arguments made before the Court were made public, were quoted and linked in this thread, and I couldn't find in any of that a coherent case for that even a politically liberal leaning Justice could honestly cling to.
Unanswered: In a structure of enumerated powers, why (other than that you don't have the votes) wouldn't you pass a new amendment to authorize a new federal government power.
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I would love to hear bigdog (and anyone else) summarize this historic, constitutional case as he would decide it - before the ruling comes out. What are the strongest arguments in the favor of the losing side of this case and what are the paramount arguments that trump those arguments and make it necessary to upheld or strike down this law?
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In a short time we will know what 9 justices think. I predict struck down 6-3.
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I too would love to have Justice Big Dog give us his pre-decision.
"So, you admit that the intention in involving private enterprise is to end its role in health care?"
"I never said that."
Yeah, you did, you just don't realize it :lol:
"But frankly, having worked in the health care industry I know there are layers upon layers of unnecessary, redundant and costly expenses. Billions could be saved."
YES!!! AGREED!!! The solution however is not an unread 2,700 page law that creates hundreds (?) of bureaucracies with vague directives to write regulations!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! The solution is to look for was to restore the pricing mechanism to people's behavior as much as possible.
"Spain, which I just left, has universal health care , , , and everyone is universally fuct. THEY ARE BROKE. Unemployment is 23%. For the young it is 48%. The birth rate is something like an astonishing 1.1 This is a demographic death spiral. The people are so grateful for what they have , , , that anyone who can is leaving the country."
"And you are implying that because they have universal health care, that is why they are broke?"
No, I am SAYING it :-D
" Facts please. "
Frankly, Life is too short to run this down. Instead I am going for a home cooked Irish dinner 8-)
Further, although broke, I bet universal health care is one of the last things
they would vote to repeal. It's that important to them.
Which is a fine example of why they are fuct.
TAC!
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Further, although broke, I bet universal health care is one of the last things
they would vote to repeal. It's that important to them.
Which is a fine example of why they are fuct.
EXxactly. Socialism is great until you run out of other people's money.... It's almost like JDN can't see the connection.
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No one is talking about doing away with Social Security or Medicare; but if as you all seem to imply, why not?
Social Security and Medicare are going away all on their own.
http://campaign2012.washingtonexaminer.com/blogs/beltway-confidential/long-term-medicare-ss-deficit-tops-63-trillion/497066
Long-term Medicare & SS deficit tops $63 trillion
byPhilip Klein Senior Editorial Writer
Medicare and Social Security, the nation's two largest programs, have long-term deficits of $63.3 trillion, according to annual reports from the programs' trustees released today. The reports underscore the dire need to reform the programs if the nation wants to avert a fiscal crisis.
Though most news reports will focus on the trust fund exhaustion date (2024 for Medicare and 2033 for Social Security) the reality is that the trust fund is a farce. The Social Security program is financed primarily by payroll taxes. When the amount of tax revenue collected exceeds benefits, the surplus is theoretically put in the trust fund. But in reality, the federal government uses that surplus to finance ongoing government operations, and puts a stack of bonds -- or IOUs -- in the funds instead. Ultimately, the money to fund Social Security and Medicare has to come from American taxpayers one way or another, regardless of whether there's a paper "surplus" in the trust funds. A better way to assess the actual budgetary impact of the programs is to look at the deficits they are projected to run. And according to the trustees' reports, they're going to run deficits as far as the eye can see.
"In 2011, Social Security’s cost continued to exceed both the program’s tax income and its non-interest income, a trend that the Trustees project to continue throughout the short-range period and beyond," the Social Security trustees wrote. Though the payroll tax holiday accounted for a large chunk of the deficits in 2011 and 2012, the program still would have run a deficit had it not passed.
As for Medicare, the trustees wrote of the program's core hospital insurance benefit, "Beginning in 2008, expenditures exceeded income, and the Trustees expect this situation to continue throughout the projection period."
The trustees offer projections for the program's anticipated deficits through the 75-year time frame and an "infinite horizon" (given that the 75-year estimates include taxes collected from workers without taking into account the cost to government once they become retirees). I've broken down both sets of numbers in the chart below, which show a combined long-term deficit of $63.3 trillion. Keep in mind that this assumes that certain Medicare cuts go into full effect. For instance, the trustees assume that physician payments get cut by 30 percent in 2013, even though they acknowledge that, "it is a virtual certainty that lawmakers, cognizant of the disruptive consequences of such a sudden, sharp reduction in payments, will override this reduction just as they have every year since 2003." It also takes as a given that all of the Medicare changes in President Obama's health care law will go into effect exactly as written. Of course, Obama's projected Medicare cuts don't actually extend the solvency of Medicare in reality, because the money is already slated to be spent to help finance Obamacare's $1.76 trillion in spending.
(http://campaign2012.washingtonexaminer.com/sites/default/files/Trustees.jpg)
Though it's difficult to grasp numbers so large over such a long time period, it's worth keeping in mind that investors deciding whether or not to purchase U.S. bonds take into account the nation's long-term fiscal picture, and thus could choose to stop buying Treasuries a lot sooner than an actual crisis is projected to hit, driving up borrowing costs dramatically. It's also important to realize that the sooner we take action to reform these programs, the easier it will be to phase in changes to avoid massive tax increases that will crush the economy and much more disruptive cuts. Unfortunately, with a predictable crisis staring us in the face that promises to wreck the futures of younger Americans, Obama has spent his first term avoiding dealing with the problem so he has a free hand to attack his Republican opponents.
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Just to be an add JDN, Congress doesn't pay into social security. So why isn't it optional?
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Ahhh Gator Bait. I suggest you read up. They do pay into Social Security.
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No... I suggest you read up. Until 1983, they weren't paying into it at all, which is to say that they weren't supporting the people that were drawing from it which is something that most people do and to our own peril because the fact remains that Congress has misspent the money and it well may not be there when we are ready to retire. Even today, they contribute to it at a reduced rate, and have their own retirement plan. If that isn't an option (they voted it into place for themselves), I don't know what is.
http://usgovinfo.about.com/od/uscongress/a/congresspay.htm
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Keeping this in healthcare because the proponents of Obamacare argue it has parallels to social security.
The facts about congress paying in or not are interesting but the question POSED TO JDN remains, why isn't social security optional?
The answer is quite simple...
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Congress doesn't pay into social security.
Let me repeat; the answer is YES Congress does pay into Social Security.
Home • Ask FactCheck • Members of Congress Pay Social Security Taxes
Members of Congress Pay Social Security Taxes
Posted on December 17, 2007
Q: Do members of Congress pay Social Security taxes?
A: Yes, ever since 1984.
FULL QUESTION
Do members of Congress have to pay Social Security or are they exempt?
FULL ANSWER
All members of the U.S. Congress pay Social Security taxes and have done so since 1984.
A good deal of false information about the House and Senate pension system has been circulating in chain e-mails and Internet postings, mostly based on information that has been outdated for more than two decades. Prior to 1984, members of Congress were covered only by a separate Civil Service Retirement System that was criticized as being overly generous. They did not pay Social Security taxes and received no Social Security retirement credit for their time in office. However, legislation passed in 1983 required members to begin paying into Social Security, effective January 1984. As the Social Security Administration’s Web site states:
SSA: All members of Congress, no matter how long they have been in office, have been paying into the Social Security system since January 1984.
The myth that members of Congress don’t pay into Social Security has found continued rebirth on the Internet despite having been debunked by myth-busting sites including Snopes, TruthorFiction and UrbanLegends. The SSA includes the false claim among its frequently asked questions, as does the U.S. Senate’s "Virtual Reference Desk." Even the National Taxpayers Union, no friend of congressional pensions, has a page on its site correcting the falsehood.
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Doug, as to why it isn't optional, I don't know, but I'm guessing that the government doesn't want people to be on the dole any more than they are because
they opted out of Social Security, but didn't save their money, and/or lost it in the stock market and therefore at age 65 have absolutely zero.
It's not that much money, but it's something. If you want more, we all do, you have the right to a private pension plan.
Frankly, since this is the Health Care thread, I like the idea of a base medical plan with the right to a deluxe private insurance plan supplementing the base plan.
No one should go hungry, i.e. Social Security, and IMHO no one should go without a basic Health Care plan.
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So JDN, if I pay two cents to support my elders every year, am I paying into Social Security?
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Maybe the part I'm having a hard time with is that they have a separate pension pan that comes from what is ultimately taxpayer dollars...they vote on what they're going to pay themselves ..self employed people get taxed at 10.4% whereas they pay 6.2% that goes to social security and yet another percentage to their festal pension which doesn't feed into social security at all, every penny of which comes right out if our pockets... they then have the audacity to dip into then funds for social security and to keep this in line with Buraq's health care, I'm quite detain we don't need government driven incompetence in anything else whilst they're up there busy awarding themselves for their "hard work" year.
GSA Vegas party anyone?
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So JDN, if I pay two cents to support my elders every year, am I paying into Social Security?
Yep, Gator Bait, if you work hard, but all you can earn is $.50 per year, then you are right, you will pay two cents to support
your elders, like younger Americans will support older Americans, and their young support them, but with your 2cents you have done your part. Congratulations.
By the way, that is mathematically how ALL defined benefit pension plans work, even in private industry. If you would like an actuarial explanation, let me know. :-)
Or maybe it would be good for you to look it up.... Facts and research seem to be a problem for you....
Sorry you are having a hard time understanding...
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Facts and research? Facts like the government is woefully inefficients and if you want them to their your money around that's fine, but they're but going to do it with mine.
Facts like elected members of Congress routinely exempt themselves from laws that they subject us too?
You can be ad liberal ad you want with your money...not mine.
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" I like the idea of a base medical plan with the right to a deluxe private insurance plan supplementing the base plan"
Good thing I am sitting down or the shock might be too much for me! A sound offering from JDN! :-D
If there govt. were to limit itselft to a simple base medical plan I think we would be able to find a grand politifcal compromise that everyone could live with. Unfortunately the next year the progressives would be pushing for more and demanding "compromise" if they didn't get it.
Kinda like how we got to where we are , , ,
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How's that "Social Security Trust Fund" doing? :roll:
Doug, as to why it isn't optional, I don't know, but I'm guessing that the government doesn't want people to be on the dole any more than they are because
they opted out of Social Security, but didn't save their money, and/or lost it in the stock market and therefore at age 65 have absolutely zero.
It's not that much money, but it's something. If you want more, we all do, you have the right to a private pension plan.
Frankly, since this is the Health Care thread, I like the idea of a base medical plan with the right to a deluxe private insurance plan supplementing the base plan.
No one should go hungry, i.e. Social Security, and IMHO no one should go without a basic Health Care plan.
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You mean the one that Baraq has defunded for the past two years by pretending he is cutting taxes?
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JDN: "I like the idea of a base medical plan with the right to a deluxe private insurance plan supplementing the base plan....no one should go without a basic Health Care plan.
Crafty: "A sound offering from JDN!"
It could be a tax on the base of income like SS, and a tax credit for buying the base policy, not a new power, private purchase mandate. Regressive, but so is Obamacare.
What is interesting is that IF the JDN plan was what the Pelosi-Reid-Obama conspiracy had done in the first place, then the argument they were making to the Supreme Court would be true. Force the able bodied to pay their own way, one way or another, for the unexpected emergency services they will most certainly consume. Instead they went for the cradle to grave, social engineering, one size fits all, like it or not route, making the people who don't want to pay the 1/6th of what they consume pay the whole thing that the others consume for healthcare.
I made a trip to the emergency room recently, an interesting experience, my first time in since losing a pedestrian vs. car fight as a kid.
I went into an inner city ER and it was packed with people waiting and I walked out. Drove way out past my home to an exurban hospital and found the place empty with a ready and waiting entry clerk. In screaming pain she had me sit to answer a few questions - quite a few questions - and sign a few forms.
It seems to me, two things: 1) The poor already get free, taxpayer paid health care with or without Obamacare, and 2) if I was not poor but not insured they could have me sign one more form, essentially a patient loan acceptance like a student loan or home mortgage that would ever be forgiven, not even in bankruptcy, until paid. If you are financially able, you are financially responsible. (Imagine that.) Then if young people know these debts will stay with them the rest of their lives, some might choose to buy an affordable, emergency care policy.
You should not have to (by federal law) buy coverage for afflictions that do not apply to you, elective surgeries, routine care that could be fee for service, gender changes and the like, even for heroically expensive efforts to save your life against thin odds like transplants etc. Those could be based on 'choice' or based in the tax system if we so choose. Those rich enough or sufficient in financial responsibility could pledge assets up to the minimum so that doing business with the evil private insurance company is not a universal citizen mandate. You could work, earn, save your way out of it.
JDN bucks the liberal mantra (for just a moment) that whatever the most exotic, expensive medical procedure that any rich person is allowed to buy for themselves must then be extended to all. Two Americas?
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http://thehill.com/blogs/healthwatch/health-reform-implementation/225239-obamas-below-the-radar-healthcare-push
"The Obama administration is employing an aggressive ground game to build support for its controversial healthcare law that often reaches beyond the Beltway."
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"The Obama administration is employing an aggressive ground game to build support for its controversial healthcare law that often reaches beyond the Beltway."
True. But the 'popular' provisions for the most part were on the table in Republican proposals at the time Dems chose to go it alone.
Romney and supporting groups have been quite proficient converting facts into negative ads. The Pelosi-Reid congress and Obama are all on the ballot this time, exposed for one thing on the process of passing healthcare.
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IF ACA is struck down the above bet changes. Both camps will need to respond with a new proposals within the constraints laid out by the Court. The President might get a Mulligan - to lock in a new deal with only the popular provisions included, acceptable to maybe a third of House Republicans, passed and signed. Or he can carry the issue into the election.
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By TOM PERKINS
A recent announcement by the U.S. Preventative Health Service can rather simply be summed up: Most men eventually get prostate cancer, but most don't die from it; those who do are mostly over 75 years of age, so that ends their continuing burden on the public purse. Further, early and prolonged testing is expensive, and can lead to medical complications from biopsy examination.
Happily I can report that I have successfully completed my 80th trip around the sun. A few years ago prostrate cancer was detected by my annual prostate-specific antigen (PSA) test; it was of a particularly aggressive type, as revealed by a routine biopsy.
That test led to surgery, radiation and hormone therapy.
Unfortunately, the cancer returned, and for the last couple of years I have been undergoing both routine and quite advanced experimental therapies, and everything has been monitored and controlled by PSA tests. Happily, the cancer has been knocked off its feet, and though not eliminated, it is controlled to the point that I am writing this from Fiji where I am actively scuba diving every day. (Fiji is a marvelous place for that sport, my favorite.)
Life is full of ironies. The PSA test was developed by a Kleiner & Perkins company, Hybritech, in the mid 1970s. How happy I am that Eugene Kleiner and I backed that effort so long ago; the partnership no longer has the remotest financial interest in the field, so these thoughts are not motivated by any residual economic involvement.
It's hard to avoid a political aside, so I won't try. A healthy market-driven free economy leads to innovation and the development of breakthroughs, like the PSA test. A highly taxed and highly regulated economy leads to "Death Panels," like the U.S. Preventative Health Service.
Mr. Perkins is the founding partner of Kleiner Perkins Caufield and Byers, a prominent Silicon Valley venture capital partnership. He is also a retired director of The News Corporation.
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No one is going to lose their health plan. Really?? (I lost mine.)
Both sides of this debate need a plan to follow the Supreme Court decision, either way, next month.
http://bostonherald.com/news/opinion/op_ed/view/20220529obamacare_diagnosed_as_quackery_court_congress_advised_to_quash_it
Obamacare diagnosed as quackery
Court, Congress advised to quash it
By Sally C. Pipes
Tuesday, May 29, 2012 - Updated 1 day ago
The Supreme Court hasn’t yet rendered its verdict on Obamacare, but the nation’s doctors have. And they think it will wreck America’s health care system.
The latest evidence comes from a new survey of young doctors by the Physicians Foundation. Nearly 60 percent of doctors aged 40 and under are pessimistic about the future of American health care. Just 22 percent are optimistic.
The number-one reason doctors cited for their pessimism? Obamacare, which was singled out by more than a third. Add in related concerns — like distrust of government to do the right thing and the feeling that government intervention hurts patient care — and the docs’ hostility to Obamacare becomes even more intense.
When asked specifically for their diagnosis of Obama- care, just 23 percent say it will have a positive impact on their practice. Half say the effect will be negative.
These findings line up with an earlier survey of doctors by consulting firm Deloitte, which found that two-thirds of all doctors expect the quality of health care to decline under Obama- care.
Physician pessimism is understandable, as Obama- care’s promises are crumbling even before the law takes full effect.
For example, Americans were promised repeatedly that they could keep their insurance if they liked it. But the Congressional Budget Office (CBO) now admits that as many as 20 million people could lose their employer-provided coverage and have to buy insurance on government-run exchanges.
Obamacare was also supposed to bend the health care cost curve down, but the government now estimates that it will add more than $300 billion to the nation’s health tab over the next decade. According to the CBO, the cost of the law over the decade commencing in 2010 has risen to $1.76 trillion — almost double the original estimate of $940 billion.
Why should doctors trust that Obama- care’s other promises about improving the quality of care will be any more reliable? After all, Obamacare contains several provisions expressly designed to limit doctors’ ability to effectively treat their patients.
Take the law’s Accountable Care Organizations (ACOs). These integrated networks of health care providers are supposed to improve the coordination of Medicare patients’ care by bringing multiple doctors under one roof.
Improved communication among doctors should lead to less waste and lower costs — or so the theory goes.
But according to the Cleveland Clinic — one of the health systems that inspired the ACOs — the administration’s rules are “replete with prescriptive requirements that have little to do with outcomes” and “detailed governance and reporting requirements that create significant administrative burdens.”
In other words, ACOs will effectively dictate to doctors how they must treat their patients.
Or consider the Independent Payment Advisory Board (IPAB). The board has broad authority to force Medicare to meet pre-set spending targets.
But the panel cannot make any changes to Medicare’s fee-for-service structure or adjust the level of benefits that seniors receive. So the board has only one legitimate option for getting Medicare spending under the targets — lowering reimbursement rates for doctors, nurses and hospitals.
Lower reimbursements may cause some providers to reduce the number of Medicare patients they’ll see — or refuse to treat them altogether.
Already, some doctors are shutting their doors to senior citizens. An American Medical Association survey found that nearly a third of primary care physicians restrict the number of Medicare patients they will see.
Another Obamacare creation, the Patient-Centered Outcomes Research Institute, will be just as destructive as IPAB. It is supposed to improve health care quality by comparing the effectiveness of different treatments.
But this “outcomes research” will likely be used to create top-down treatment guidelines that physicians will be expected to follow in order to get paid — even if the recommendations contradict their judgment of what’s best for a particular patient.
Such research led federal officials to recommend three years ago that women avoid getting regular mammograms in their 40s, even though breast cancer is the leading cause of death in women aged 35 to 50.
The Supreme Court could invalidate Obamacare in its entirety this June, when it renders its verdict on the law’s constitutionality. If it doesn’t, then Congress will need to heed the warning coming from the nation’s doctors that Obamacare is the wrong prescription for the nation’s health care system.
Sally C. Pipes is president and CEO of the Pacific Research Institute.
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Regarding Crafty's post about the PSA test a few things I would chime in.
Mr. Perkins situation with the prostate cancer is a shame to say the least.
The problem is that the PSA test is not a good screening test.
It is not that it costs too much. It is that studies have not been able to show a net benefit. Not in terms of cost but in terms of human harm vs. good. At best statistically 1,400 men would have to be screened for maybe, one would not die as soon as expected from prostate cancer. Around 50 other will have surgery or radiation without any statistical benefit yet they may be harmed with anxiety, pain, impotence, urinary incontinence and the rest.
While prostate cancer is serious, and many men do die, the vast majority will never know they have it or ever have any problem from it.
Most experts from what I read do not recommend doctors recommend the test unless the patient wants it or has some other high risk to get one.
From what I am rading in the journals is that the only ones who are still recommending it are some of the urologists.
I still do a digital exam and offer the PSA test with more or less the above statistics and allow the patinet the choice.
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Thank you for that.
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In one evaluation 86% lf the time the side that was asked more questions lost their case in front of the Supreme Court.
I wonder what the market will do if the Justices decide against the law either in whole or part of it:
http://www.businessweek.com/news/2012-06-07/voting-rights-surprise-at-high-court-may-foreshadow-health-care#p2
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For better disclosure in that the use of PSA screening is still advocated by many though again it seems like mostly urologists. On one hand the urologist deal with prostate disease more than anyone else and are most qualified. At the same time they also have a financial stake in this. Here is one of the two Fox news health commentators advocating for the test as a screening test. It is noteworthy that he IS a urologist. However, I noted that today, in direct contradiction to himself a few weeks ago Dr. Siegal who is an internist also recommneded the test. I have disagreed with him before and with a few things he said today. In this case I agree with the USPTF that the test appears to do more harm than good and is of unclear or rare benefit benefit. That said, the best course may be to use it with symptoms, with a family history, or if digital rectal exam is abnormal and with full disclosure to the patient about all of the above based upon their decision.
This is my *opinion* along with many, but clearly not all doctors.
http://video.foxnews.com/v/1694183903001/fathers-day-message-from-sunday-housecall
Apparantly the next big *screening* "debate" is going to be for yearly chest cat scans on patients who are high risk for lung cancer - smokers or previous smokers. You will all start hearing more and more about this too.
The infinite iterations of humans and the universe we live in is mind boggling. And exhausting at least to me - not exciting just tiring.
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CDC has good summary of pros and cons of PSA screening. There is a link for a file for African American men that can be found at the CDC website too. They, for unknown reasons, have a higher risk. I think I will start referring people here to read up on testing and let them decide if they want it. While I certainly do not want to be giving advice here on the board, because I have posted previously on the subject, I feel it necessary to clarify with the best available information on the subject which is still a controversial subject. I read at least 3 or 4 reviews that conclude routine screening is probably more harm than good and one author states something to the effect the era of PSA screening for all men is over. Then within a few weeks is the backlash not unlike the breast cancer screening controversy not too long ago. I hope this clarifies to some extnet the present knowledge and I didn't confuse anyone:
http://www.cdc.gov/cancer/prostate/pdf/prosguide.pdf
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http://atr.rollcall.com/indiana-ooops-mourdocks-multiple-choice-scotus-response/
At least one candidate is prepared for however the Supreme Court rules next week on the health care overhaul law — although Indiana’s GOP Senate nominee, Richard Mourdock, probably didn’t want the world to know it.
Mourdock’s campaign uploaded four videos to respond to the high court’s imminent decision — and each one has a different answer depending on the ruling.
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I don't agree with every suggestion here (I disagree with the English rule or shortening the educational requirements) but overall a good effort I think:
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http://pjmedia.com/blog/if-obamacare-dies-whats-next-for-health-care/?singlepage=true
If Obamacare Dies, What’s Next for Health Care?
Eight health care fixes for the Romney campaign to consider.
by
Dr. Peter Weiss
Bio
June 26, 2012 - 12:00 am
The Supreme Court declaring Obamacare dead will not necessarily help Governor Romney and the Republicans — the death of one monarch may lead to another monarch. We need the proper bill to replace it.
When I was a health care advisor for the John McCain campaign — and an ardent, vocal opponent of Obamacare — I wrote of many possible solutions to alleviate our health care dilemma. It is time to reiterate them, with some adjustments. My basic mantra for health care reform: Keep it simple, stupid. Listen up, Governor Romney:
1. Abolish all state mandates. State mandates contribute to billions in additional costs to the basic insurance premiums. Let the market dictate what is covered.
2. Allow health insurance coverage to cross state lines.
3. Allow affinity groups to offer insurance to their members. This would allow churches, synagogues, AAA, AARP, and even Costco to offer health care insurance to their members. The sheer numbers from membership will bring competition from the different carriers to provide the most coverage for the least cost. Some of these groups may even offer lifetime memberships, which in turn would afford the member similar health coverage regardless of job insurance.
4. Allow catastrophic or major illness insurance. By removing forced state mandates, you will allow very reasonable catastrophic insurance policies. A 20-year-old healthy person should not be forced to pay for colon cancer screening.
5. Allow physicians to be just that. If a physician — notice I did not call him or her a health care provider — is a “provider” for a particular health insurance plan, then whatever he or she orders must be accepted by that plan. The insurance company can economically credential these physicians every two years. They can even remove them if they feel they are too “generous.” The patient should not be used as a pawn.
The above five constitute the “easy” solutions. Now come the hard ones.
6. We must remove the Vegas-style gambling on medical law suits. You’ve seen the commercials: “Have you ever had a headache? You may be entitled to compensation.” I’ve proposed several solutions over the past few years, but have come to the conclusion that the simplicity of the English system — the “loser pays” system — would be best for America. No one is prevented from suing, but there would be no free roll of the dice. There must be money on the table to force accountability. There is always risk in life: if you sue and lose, you pay the cost.
7. Allow re-importation of drugs. It is simple and it is safe. Did I mention simple?
8. This one is a stretch, but I love it. Make medical school free, and shorten the four years of college, four years of medical school to six total years. Make all state schools free or nearly so. In return, the young doctor will give back to his state two to three years of service: two years if served after basic training (general practice), or three years after specialty training. This will encourage generalists. Private schools will still run the same, but will be at the cost of the student.
When confronted with a complex medical condition, we as physicians are trained to find as simple a solution as possible by breaking down the components and solving the critical problems first, and then worrying about the minor ailments. While these eight steps may not “cure” what ails all of health care, they will allow the freedom of choice that Americans are entitled to. There is no one-size-fits-all answer.
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Fed task force calls for counselling fatties
http://www.latimes.com/news/nationworld/nation/la-sci-obesity-screening-20120622,0,2815818.story
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So did CCP on this site. Something needs to be done; it's an epidemic.
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A safer version of the desfenfluramine drug approved today - arena pharm - should be marginally helpful
So will vivus pharm combination of topomax/phentermine recommended for approval.
The latter one pisses me off. Around two weeks before it was rec. for approval I read it had up to a 13% weight loss success which is more than any other. I thought I should buy in but was too afraid - every single pharm company I ever bought into was a loss for me. Of course, this time, two weeks later, the price went from 10 or 11 to 22 overnight.
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http://www.cato.org/publications/commentary/states-resist-obamacare
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Good job of getting in the weeds and ferreting the ugly truth out.
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WSJ
Back at the at the dawn of ObamaCare in June 2009, speaking to the American Medical Association's annual meeting, President Obama said: "No matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period."
But will your doctor be able to keep you? Or will your doctor even want to keep you, rather than quit medicine?
For the longest time now, since day one of the Affordable Care Act, we have been having arguments over the mandate to purchase health-care insurance, requirements that insurance companies accept policyholders regardless of health, and price discrimination in insurance policies.
Corbis
.And of course this past week, the Supreme Court—or something resembling the Supreme Court—outputted a decision on the tax status of the insurance-purchase mandate, the states' obligation to pay for Medicaid and as a bonus, the Commerce Clause.
Have you noticed what got lost in this historic rumble? Doctors. Remember them?
ObamaCare has been a war over the processing of insurance claims. It has been fought by institutional interests representing insurance, hospital and pharmaceutical firms. The doctor-patient relationship, or what used to be called "the practice of medicine," has sunk beneath these waves.
Barack Obama, a savvy pol, understood from the start that rationalizing payments claims through the maw of these private and public bureaucracies was not what the average person thinks of as "health care." To any normal person, health care means that when you or yours get really sick, the doctors and nurses who attend to you will push all else aside to give you medical help.
Thus, the constant Obama chorus that you can "keep your own doctor." No one knows better than Barack Obama that his law sends the nation's doctors on a voyage into an uncharted health-care world in which they are just along for the ride with their patients.
A Wall Street Journal story the day after the Supreme Court ruling examined in detail its impact across the "health sector." The words "doctor," "physician" and "nurse" appeared nowhere in this report. The piece, however, did cite the view of one CEO who runs a chain of hospitals, explaining how they'd deal with the law's expected $155 billion in compensation cuts. "We will make it up in volume," he said.
Volume? Would that be another word for human beings? It is now. At Obama Memorial, docs won't be treating patients. They'll be processing "volume." And then, with what time and energy remains in the day, they'll be inputting medical data to comply with the law's new Physician Quality Reporting System (PQRS), lodged in the Centers for Medicare and Medicaid.
Here's the Centers' own description of what PQRS does: "The program provides an incentive payment to practices with eligible professionals (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]) who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS)."
We're all pressed for thinking time these days, but the one group we should make sure has time to focus on what's in front of them is doctors treating patients. Instead, they'll also be doing mandated data dumps for far-off panels of experts.
Doubts, even among believers, have begun to emerge about what ObamaCare could do to the practice of medicine. A remarkable and important piece by Drs. Christine K. Cassel and Sachin H. Jain in the June 17 Journal of the American Medical Association directly asks: "Does Measurement Suppress Motivation?"
The question raised by the article is whether imposing pay-for-performance measurements on individual physicians does more harm than good: "[C]lose attention must be given to whether and how these initiatives motivate physicians and not turn physicians into pawns working only toward specific measurable outcomes, losing the complex problem-solving and diagnostic capabilities essential to their role in quality of patient care, and diminish their sense of professional responsibility by making it a market commodity."
This is an important piece, because Dr. Cassel is part of the intellectual foundation for the measured-directives movement. The saying that comes to mind reading these misgivings is that it's better late than never to notice that the core relationship between doctor and patient is being eroded. Except that in the wake of Chief Justice Roberts's upholding of the Affordable Care Act, it's too late and we're beyond never.
Mitt Romney needs a way to talk about health care in America. This isn't just a fight over insurance companies. It's about the people at the center of health care—doctors. The Affordable Care Act will damage that most crucial of all life relationships, that between an ill person and his physician. Barack Obama's assertion that we all can keep our doctors is false. You could line up practicing physicians from here to Boston to explain to Mr. Romney why that is so.
Write to henninger@wsj.com
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http://pjmedia.com/mihaipacepa/2012/07/06/romanias-20-year-nightmare-unraveling-socialized-health-care/
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• Nurses forgot to give Kane Gorny his medication and he became so delirious he called 999 (their 911)
• His mother said she spent hours trying to convince staff he needed attention but was told he was alright
• Alarm finally raised an hour before his death when a doctor realized how serious his condition was
http://www.dailymail.co.uk/news/article-2167643/Patient-dying-thirst-rang-999-Inquest-hears-mothers-fury-nurses-neglected-son.html
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http://livewire.talkingpointsmemo.com/entries/bill-frist-to-gop-governors-adopt-obamacare-insurance
In an editorial for The Week published Tuesday, the former majority leader of the Senate writes that both parties should support the insurance exchanges, noting that they were originally a “Republican idea.” A doctor, Frist says that he “sees little advantage” for Republican governors to refuse to set up exchanges in their own states and “default to the federally designed, one-size-fits-all exchange when they can design and run their own.”
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But to what requirements are the Obamacare exchanges tied?
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http://www.msnbc.msn.com/id/48328035/ns/us_news/?__utma=14933801.129016654.1342392792.1343263370.1343265883.18&__utmb=14933801.2.10.1343265883&__utmc=14933801&__utmx=-&__utmz=14933801.1342411925.5.3.utmcsr=nbcnews.com|utmccn=(referral)|utmcmd=referral|utmcct=/&__utmv=14933801.|8=Earned%20By=msnbc|cover=1^12=Landing%20Content=Mixed=1^13=Landing%20Hostname=www.nbcnews.com=1^30=Visit%20Type%20to%20Content=Internal%20to%20Mixed=1&__utmk=179933476#.UBCeFECe4T8
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Doctor Shortage Likely to Worsen With Health LawBy ANNIE LOWREY and ROBERT PEAR
Published: July 28, 2012
RIVERSIDE, Calif. — In the Inland Empire, an economically depressed region in Southern California, President Obama’s health care law is expected to extend insurance coverage to more than 300,000 people by 2014. But coverage will not necessarily translate into care: Local health experts doubt there will be enough doctors to meet the area’s needs. There are not enough now.
Other places around the country, including the Mississippi Delta, Detroit and suburban Phoenix, face similar problems. The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.
Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans. It typically takes a decade to train a doctor.
“We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,” said Dr. G. Richard Olds, the dean of the new medical school at the University of California, Riverside, founded in part to address the region’s doctor shortage. “We’ll have a 5,000-physician shortage in 10 years, no matter what anybody does.”
Experts describe a doctor shortage as an “invisible problem.” Patients still get care, but the process is often slow and difficult. In Riverside, it has left residents driving long distances to doctors, languishing on waiting lists, overusing emergency rooms and even forgoing care.
“It results in delayed care and higher levels of acuity,” said Dustin Corcoran, the chief executive of the California Medical Association, which represents 35,000 physicians. People “access the health care system through the emergency department, rather than establishing a relationship with a primary care physician who might keep them from getting sicker.”
In the Inland Empire, encompassing the counties of Riverside and San Bernardino, the shortage of doctors is already severe. The population of Riverside County swelled 42 percent in the 2000s, gaining more than 644,000 people. It has continued to grow despite the collapse of one of the country’s biggest property bubbles and a jobless rate of 11.8 percent in the Riverside-San Bernardino-Ontario metro area.
But the growth in the number of physicians has lagged, in no small part because the area has trouble attracting doctors, who might make more money and prefer living in nearby Orange County or Los Angeles.
A government council has recommended that a given region have 60 to 80 primary care doctors per 100,000 residents, and 85 to 105 specialists. The Inland Empire has about 40 primary care doctors and 70 specialists per 100,000 residents — the worst shortage in California, in both cases.
Moreover, across the country, fewer than half of primary care clinicians were accepting new Medicaid patients as of 2008, making it hard for the poor to find care even when they are eligible for Medicaid. The expansion of Medicaid accounts for more than one-third of the overall growth in coverage in President Obama’s health care law.
Providers say they are bracing for the surge of the newly insured into an already strained system.
Temetry Lindsey, the chief executive of Inland Behavioral & Health Services, which provides medical care to about 12,000 area residents, many of them low income, said she was speeding patient-processing systems, packing doctors’ schedules tighter and seeking to hire more physicians.
“We know we are going to be overrun at some point,” Ms. Lindsey said, estimating that the clinics would see new demand from 10,000 to 25,000 residents by 2014. She added that hiring new doctors had proved a struggle, in part because of the “stigma” of working in this part of California.
Across the country, a factor increasing demand, along with expansion of coverage in the law and simple population growth, is the aging of the baby boom generation. Medicare officials predict that enrollment will surge to 73.2 million in 2025, up 44 percent from 50.7 million this year.
“Older Americans require significantly more health care,” said Dr. Darrell G. Kirch, the president of the Association of American Medical Colleges. “Older individuals are more likely to have multiple chronic conditions, requiring more intensive, coordinated care.”
The pool of doctors has not kept pace, and will not, health experts said. Medical school enrollment is increasing, but not as fast as the population. The number of training positions for medical school graduates is lagging. Younger doctors are on average working fewer hours than their predecessors. And about a third of the country’s doctors are 55 or older, and nearing retirement.
Physician compensation is also an issue. The proportion of medical students choosing to enter primary care has declined in the past 15 years, as average earnings for primary care doctors and specialists, like orthopedic surgeons and radiologists, have diverged. A study by the Medical Group Management Association found that in 2010, primary care doctors made about $200,000 a year. Specialists often made twice as much.
The Obama administration has sought to ease the shortage. The health care law increases Medicaid’s primary care payment rates in 2013 and 2014. It also includes money to train new primary care doctors, reward them for working in underserved communities and strengthen community health centers.
But the provisions within the law are expected to increase the number of primary care doctors by perhaps 3,000 in the coming decade. Communities around the country need about 45,000.
Many health experts in California said that while they welcomed the expansion of coverage, they expected that the state simply would not be ready for the new demand. “It’s going to be necessary to use the resources that we have smarter” in light of the doctor shortages, said Dr. Mark D. Smith, who heads the California HealthCare Foundation, a nonprofit group.
Dr. Smith said building more walk-in clinics, allowing nurses to provide more care and encouraging doctors to work in teams would all be part of the answer. Mr. Corcoran of the California Medical Association also said the state would need to stop cutting Medicaid payment rates; instead, it needed to increase them to make seeing those patients economically feasible for doctors.
More doctors might be part of the answer as well. The U.C. Riverside medical school is hoping to enroll its first students in August 2013, and is planning a number of policies to encourage its graduates to stay in the area and practice primary care.
But Dr. Olds said changing how doctors provided care would be more important than minting new doctors. “I’m only adding 22 new students to this equation,” he said. “That’s not enough to put a dent in a 5,000-doctor shortage.”
Annie Lowrey reported from Riverside, and Robert Pear from Washington.
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http://www.rollcall.com/news/Justice-Antonin-Scalia-Health-Care-Mandate-Can-Not-Be-a-Pig-216540-1.html?pos=hln
Scalia, O'Connor and small discussion on Scalia's retirement.
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Scalia was on Chris Wallace's show this morning and said he had no thought of retirement. Also he did Pierce Morgan's show about a week ago. PM revealed himself to be a progressive ass in way over his head without even realizing it.
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http://www.dickmorris.com/obamacare-causes-doctor-shortage-dick-morris-tv-lunch-alert/?utm_source=dmreports&utm_medium=dmreports&utm_campaign=dmreports
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Notable & Quotable
Yuval Levin on some of the ways Medicare cooks its books compared to private health insurance. .
Yuval Levin writing at National Review Online, Aug. 31:
[T]he notion that Medicare has "less bureaucracy" than private insurers is deeply confused. . . . That sort of argument is often based on the claim that Medicare's ratio of administrative costs (the money it spends on things other than care) to health costs is lower than those of private insurance companies. But this misses some key facts.
To begin with, many of Medicare's most significant administrative costs are just covered by other federal agencies, and so don't appear on Medicare's particular budget, but are still huge costs of the program. The IRS collects the taxes that fund the program; Social Security collects many of the premiums paid by beneficiaries; HHS pays for a great deal of what you would think of as basic overhead, but doesn't put it on the Medicare program's budget. Obviously private insurers have to pay for such things themselves. Medicare's administration is also exempt from taxes, while insurers pay an excise tax on premiums (which is counted as overhead). And private insurers also spend a great deal of money fighting fraud, while Medicare doesn't. That might reduce the program's administrative costs, but it greatly increases its overall costs. Some administrative costs save money, after all: The GAO has estimated that a $1 investment in pre-payment review of claims, for instance, would save $21 in improper Medicare payments.
Moreover, because Medicare covers older (and therefore sicker) patients than most private insurers (who are locked out of that market), the ratio of its spending on coverage to its spending on overhead is very different from the one most private insurers have—if administrative costs for managing two patients are both $100 but one patient has $200 of health expenses in a year and the other has $2,000 of health expenses, the insurer that covers the first patient will have a far higher administrative-cost ratio, even though both have the same administrative costs. On a per-patient basis, Medicare's administrative costs most years are actually higher than those of private insurers, even though the program has all the enormous advantages just described in averting such costs and keeping them off the books.
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"PM revealed himself to be a progressive ass in way over his head without even realizing it."
When he first replaced Larry K I thought he was pretty good. Now I see him as just an opinionated bore. And I thought Larry was too liberal. :-o
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The 60th Vote Regrets
Now Jim Webb and Evan Bayh tell us. .
One of the tragedies of the Obama Administration is the historic political accident that it had 60 Senate Democratic votes in 2009. The ability to break a filibuster without Republican votes empowered the left to think it could pass anything, and so it steamrolled ahead with ObamaCare, which needed every one of those 60 votes to pass.
Now a couple of those Senators are expressing regrets about those votes after the fact. In our pages last week, former Indiana Democrat Evan Bayh rehearsed the looming economic damage from ObamaCare's medical-device tax. He described, as some of us predicted in 2009 during the debate, how the tax is sending jobs and investment overseas in an industry where the U.S. still leads the world. Mr. Bayh, who retired after 2010, provided the 60th vote for ObamaCare to pass.
Another 60th vote, Virginia Senator Jim Webb, is also expressing second thoughts as he heads for retirement this year after one term. "My great regret on that is that I believe the whole health-care issue could have been handled differently by the Administration and over here," he told MSNBC recently. "I think the way that the process was put forward without a clear set of principles from the Administration caused a lot of fear in the country. We had seven different or five different committees boiling up 7,000 pages of contradictory information."
All true, but reporter Chuck Todd pressed if the Senator regretted his vote?
"No, and in the end I voted with the Republicans 18 times, but in the end I voted for it," Mr. Webb added. "We do need to move forward. We need to find different ways to work with these issues. We could have had a smaller, more focused package, and the country would have been a lot more comfortable with the process as well."
Even hedged regrets are welcome, but the irony is that a Senator who says the parties need to work more together will have as his main legacy the most partisan and polarizing legislation of modern times. Had he or any one of the 60 Democrats insisted that the Administration get Republican votes, or drop the bill's worst provisions, history would have been very different.
A second irony is that Democrats only had those 60 Senate votes because of a series of improbable and corrupt events. Mr. Webb won his race by a hair in 2006 after incumbent George Allen stupidly uttered the word "macaca," and the media portrayed him as racist. Alaska's Ted Stevens lost his seat in 2008 by 3,724 votes after he was convicted eight days before the election in a trial in which the Justice Department withheld crucial evidence. He was later exonerated. And Al Franken, who was trailing on Election Day, managed to steal the Minnesota recount in 2008 by 312 votes from a hapless Norm Coleman.
Add the Louisiana Purchase, the Cornhusker Kickback and the other special deals that President Obama used to buy Senate Democratic votes for ObamaCare, and you have the first major new entitlement in history that passed along strictly partisan lines and is as unpopular today as it was on the day it passed.
Messrs. Webb and Bayh can lament what might have been, but the bitter truth is that the only way voters can undo their damage is by defeating Mr. Obama in November and electing a Republican Senate. Otherwise, both men will have left their country economically weaker and health care less affordable than it was when they decided to run for office. That should be their real regret.
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Why Sebelius Campaigns So Hard for Her Boss — and Why He Won’t Fire Her
from Cato @ Liberty by Michael F. Cannon
By Michael F. Cannon
Secretary of Health and Human Services Kathleen Sebelius has been campaigning so enthusiastically for President Obama that she — whoops! — broke a federal law that restricts political activities by executive-branch officials. Federal employees are usually fired for such transgressions, but no one expects that to happen to Sebelius. Heck, she got right back in the saddle.
Every cabinet official (probably) wants to see the president reelected, and no president relishes dismissing a cabinet official. But in this case, there’s an additional incentive for Sebelius to campaign for her boss and for Obama not to fire her.
ObamaCare creates a new Independent Payment Advisory Board that — “fact checkers” notwithstanding — is actually a super-legislature with the power to ration care to everyone, increase taxes, impose conditions on federal grants to states, and wield other legislative powers. According to legend, IPAB will consist of 15 unelected “experts” who are appointed by the president and confirmed by the Senate. Yeah, good one.
In fact, if the president makes no appointments, or the Senate rejects the president’s appointees, then all of IPAB’s considerable powers fall to one person: the Secretary of Health and Human Services. The HHS secretary would effectively become an economic dictator, with more power over the health care sector than any chamber of Congress.
If Obama wins in November, he would have zero incentive to appoint any IPAB members. The confirmation hearings would be a bloodbath, not unlike Don Berwick’s confirmation battle multiplied by 15. Sebelius, on the other hand, would not need to be re-confirmed. She could assume all of IPAB’s powers without the Senate examining her fitness to wield those powers. If Obama fired her, or the voters fire Obama, then the next HHS secretary would have to secure Senate confirmation. Again, bloodbath. That makes Kathleen Sebelius the only person in the universe who could assume those powers without that scrutiny.
No wonder she’s campaigning so hard. No wonder Obama won’t fire her.
Why Sebelius Campaigns So Hard for Her Boss — and Why He Won’t Fire Her is a post from Cato @ Liberty - Cato Institute Blog
http://www.cato-at-liberty.org/why-sebelius-campaigns-so-hard-for-her-boss-and-why-he-wont-fire-her/
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if the president makes no appointments, or the Senate rejects the president’s appointees, then all of IPAB’s considerable powers fall to one person: the Secretary of Health and Human Services.
When the death panel becomes only one person, maybe instead of Czar or Madam Secretary we could call her our Supreme Leader or the Ayatollah of Health Care.
Welcome back BBG! It has been too long!
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if the president makes no appointments, or the Senate rejects the president’s appointees, then all of IPAB’s considerable powers fall to one person: the Secretary of Health and Human Services.
When the death panel becomes only one person, maybe instead of Czar or Madam Secretary we could call her our Supreme Leader or the Ayatollah of Health Care.
Welcome back BBG! It has been too long!
Laws do not apply to loyal party members.
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The Better Solution for 'Pre-Existing Conditions'
There's no need to turn the entire system upside down to help the people who can't buy private insurance..
By JOHN C. GOODMAN
Do you remember the debates over the Affordable Care Act, aka ObamaCare? Now that repeal of the law has become a major campaign issue, it may be helpful to remember why Congress passed it in the first place.
Early in 2010, as the climactic votes neared, a parade of the legislation's defenders—from the House, Senate and Obama administration—appeared across the media. All had the same message: pre-existing conditions. They named the names of families "victimized" by companies that had refused to sell them insurance, had canceled their coverage or had refused to pay their medical bills.
The message surely resonated, but how many people have actually been affected since the law passed? The Affordable Care Act established a federally funded risk pool—the Pre-Existing Condition Insurance Plan—that allows individuals with such disqualifying conditions to buy a policy for the same premium a healthy person would pay. About 82,000 people have signed up as of July 31, according to the Kaiser Family Foundation's statehealthfacts.org.
That is not a misprint. Out of a population of more than 300 million, some 82,000 have the problem that was cited as the principal reason for spending $1.8 trillion over the next 10 years and in the process turning the entire health-care system upside down.
The risk pool surely comes as welcome relief to those who need it. A lot of them are really sick and are running up expensive medical bills. But the three-year cost is about $5 billion, as budgeted in the Affordable Care Act—a tiny fraction of the law's overall burden. Nevertheless, the federal risk pool will be closed down in 2014, when ObamaCare will begin prohibiting insurance companies from charging premiums based on the health conditions of applicants.
Mitt Romney has vowed to repeal ObamaCare if he is elected president, but his plan for addressing pre-existing conditions is similar to it in some respects. Mr. Romney says he would require insurers to ignore pre-existing conditions for anyone who has been insured continuously for a certain period of time, such as through an employer's plan.
But when insurers are forced to charge the same premium to all applicants, regardless of expected health-care costs, prices will be wrong for everyone—and both buyers and sellers of health-care policies will have perverse incentives.
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On the buyer's side, healthy people who are overcharged will underinsure, buying less coverage than they otherwise would. They may even decide to go without insurance, since the ObamaCare penalties for being uninsured are weak and people can always buy a policy after they get sick. People with expensive health problems will overinsure, buying more generous coverage than they otherwise would.
Insurers, on the other hand, will try to sell policies to the healthy, on whom they expect to make a profit, while avoiding the unhealthy, on whom they expect to incur a loss,—and they will change the design of their plans to accomplish this goal.
Preventive care and wellness checkups with no deductible or copayment, for example, will attract and keep the healthy; insurers may even provide memberships in health clubs. But failure to include the best cancer-care center or the top heart clinic in a plan's network will discourage the sick from enrolling. Insurers may also underprovide for unhealthy people by failing to include the latest cancer drugs in their offerings.
These same incentives are present in the current system, but most people have insurance brokers or employers acting as their protectors. In a few years, however, the brokers will likely leave the market altogether and many employers will drop their coverage. Along the way, the federal government will put enormous pressure on insurers to keep their costs down. Then you will be on your own, facing a system that has no interest in spending money on you.
On health insurance generally, Mitt Romney surely has the better approach. He would give the same tax relief to individually purchased insurance as to employer-provided coverage. That would put portable insurance (owned by the individual) on equal footing with group insurance that must be forfeited when people change jobs. Portability would alleviate the problem for individuals who change or lose their jobs but have medical conditions. Also, repealing ObamaCare would mean that people wouldn't be able to game the system by waiting to buy insurance until after they get sick.
For those who have not been continuously insured, Mr. Romney favors risk pools. This is a cheaper and less destructive solution to the problem of pre-existing conditions. But here the danger is that risk pools must be structured judiciously, lest they also encourage the healthy to remain uninsured.
There is an even better idea: to insure yourself against the possibility of becoming uninsurable, as suggested by economists including the University of Chicago's John Cochrane on this page in April. Under this approach, policies would be guaranteed to be renewable and include the right to buy another policy in the future. If your health condition worsens, a new insurer would be free to charge you a higher premium. But the old insurer would pay the extra premium caused by the change in your health status.
Mr. Goodman is president of the National Center for Policy Analysis and author of "Priceless: Curing the Healthcare Crisis" (Independent Institute, 2012).
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"some 82,000 have the problem that was cited as the principal reason for spending $1.8 trillion over the next 10 years and in the process turning the entire health-care system upside down."
Without all the bureaucracy and extra-constitutional powers we could have just given them each $22 million and let them buy healthcare of their own choosing.
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'Concierge' Medicine, ObamaCare and the End of Empathy
Traditional primary-care doctors are finding themselves, and their patients, squeezed by the government and the marketplace..
Article Comments (24) more in Opinion | Find New $LINKTEXTFIND$ ».
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By JERALD WINAKUR
I call my cousin Irene regularly. She is 90, frail, living alone in New York in an apartment in Queens, and I worry about her. This time there is distress in her voice:
"I just don't know what I'm going to do. I got a letter from my doctor, the one I've been seeing for a long time. It said she was making some changes to her practice. I had to go to a reception at a hotel in Manhattan where the details would be explained. I have such a hard time getting into the city, so I called her office to see if someone couldn't just tell me over the phone."
Irene was crying now. "No, they said, I needed to come to the reception. So I paid a car service to take me there and back."
What Irene learned was that her internist was converting her fee-for-service office into a "concierge practice." For a yearly retainer of $2,200 (in addition to the usual charges that would still be billed through Medicare and supplemental insurance), Irene would receive "value-added" services. These include same-day appointments, electronic access to her medical records and lab reports, shortened waiting times, and other "frills" that Irene said her doctor always provided anyway.
"Do you think I should do it?" Irene asked me, her younger cousin, the doctor in the family, the internist and geriatrician. "I don't even own a computer."
My cousin, of course, is not alone. This same question is being asked by patients, many of them elderly, all over the country as more primary-care doctors opt for the concierge model.
Meanwhile, companies are springing up to help doctors make the change. For a piece of the action, they help transform a struggling primary-care practice into a well-oiled profit center.
As one such company, SignatureMD, advertises on its website: "It can be challenging for any physician to remain independent and profitable in the face of severe reimbursement cuts, increased regulation, and increased overhead. Our seasoned team of professionals have devoted years to developing a high reward, low risk concierge practice model. SignatureMD enables you to deliver the care that your patients desire while securing your financial independence."
Don't get me wrong, for nearly 40 years I practiced as a primary-care internist and geriatrician, so I understand both sides of this issue. Primary-care doctors have been undervalued and under-reimbursed by Medicare since the inception of the program. There has not been a real increase in fees in the past decade, during which time costs have soared.
"If you like this doctor, and you want to keep seeing her," I said to Irene, "you won't have a choice—you'll have to join her concierge practice."
The Affordable Care Act, in theory, places more value on primary-care services. But so far this remains just theory. At the medical school where I teach, only a small minority of students are considering primary care as a career choice. That's not unusual. Worse, in an era of burgeoning need, just 2% of young doctors in residency express any interest in geriatric medicine.
Those of us who have spent our careers in the cottage industry of medical practice and working in America's single-payer health-care system known as Medicare hear only this nowadays: "Get ready, changes are coming." The talk is all wonky babble about "primary care medical homes," "accountable care organizations," "service bundling" and "resource-based relative value units." Through the din, one thing is clear: The single practitioner will be unable to survive without joining some much larger entity, or by transforming into a concierge model.
Medicare now looks the other way as the concierge-medicine movement grows. In times past, had physicians attempted to charge Medicare patients additional fees while still billing this agency for services rendered, all manner of fines and sanctions would have been imposed. No more. With the nation short 40,000 primary-care doctors—and that's before 30 million more patients come on board in 2014 due to the Affordable Care Act—the policy gurus have looked around and concluded that they can't afford to alienate the worker bees that still remain.
Yet as financially tempting as a concierge practice might be, I could never have turned away a patient unable to come up with an annual retainer fee. I had a history with each and every one of them. They were my "family." I tried to treat each of my patients equally and with the full measure of my time and concern. To do otherwise violates the basic justice principle of medical ethics that we teach medical students today.
The last time I spoke to Irene, I asked her if she had been back to her internist since she had decided to pay the annual retainer. "I was in to see her last week," she said. "Everything works the same way it did before—even though I'm paying all this extra money. . . . I just don't feel the same about my doctor anymore."
I must ask: Are we witnessing the end of empathy in the practice of medicine?
Dr. Winkaur practiced internal and geriatric medicine for 36 years. He is a clinical professor of medicine at the University of Texas Health Science Center at San Antonio, and the author of "Memory Lessons: A Doctor's Story" (Hyperion, 2009).
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http://effyouitsmyblog.blogspot.com/2012/11/time-to-realize-what-you-voted-for.html
Time to realize what you voted for
It's been hashed out in the comments on this blog before -- contract attorneys in Washington are, by and large, liberals. Usually, very liberal. By this of course, we mean the old-school, early 1900s Progressives, not the classic, Thomas Jefferson liberals. We're talking about the far leftists who changed their label from Progressive to Liberal when Progressive became a pejorative, then back to Progressive when Liberal became a pejorative and people had forgotten that Progressive used to be a pejorative.
Philosophy aside, it is important to realize that elections have consequences. One of the consequences of this election is that Obamacare is here to stay, at least for a while. It is too inherently unworkable to stay for long, but it isn't going away in the next few years. Live with it.
Liberal contract attorneys might want to consider what "live with it" means. Under Obamacare, companies with 50 or more full-time employees either have to provide them with government-approved health insurance policies, or pay a per-employee fine. Further, the fine kicks in at the 31st employee, not the 51st, and it starts at $2,000 per year per employee. It goes up later. Companies, therefore, are discouraged from having full-time employees, or at least 50 or more of them. Hello, part-time employment. Think I'm fucking with you? Think again.
While you're thinking again, start thinking about the industry in which you work. Obamacare, unlike other government regulations, defines a full-time employee as one working 30 hours a week. Every temp agency in town worth a shit has 50 people working "full-time" in any given year under that definition. If you think that temp agencies will give you employer-funded health insurance that meets Obamacare standards (hint: lots of mandates make insurance less affordable), you are delusional. They already didn't offer comprehensive insurance, which was cheaper before Obamacare started affecting rates, so they won't start now. They also are not going to pay the penalty. Margins are too thin. What will the agencies do?
There are only two choices. First, nobody works 30 hours a week for an agency ever again. That probably is an unworkable solution, but it is not unthinkable, given the trend in the industry toward a 40-hour cap on projects. A 30-hour cap would mean more bodies, staggered, but would not be a dramatic departure from the no-OT policy that already governs so many projects. Given the staggering costs of forced health coverage (or penalties), agencies won't consider this option unworkable. They'll think about it, and you'll have to start finding two projects at a time to make a living wage. Assuming, of course, that agencies and the firms that hire them stop enforcing their concurrent employment policies that ban working two projects at a time.
The second choice is, your taxes just got harder. Agencies could deem contract attorneys to be independent contractors and start issuing 1099s instead of W-2s. That means you'll have to make quarterly estimated tax payments for withholding, Social Security and Medicare taxes. Oh, and by the way, it also means you'll be responsible for the employer's half of those Social Security and Medicare payroll taxes, as you will now be self employed. Of course agencies will raise your rates to make up for the fact that your share of the payroll taxes doubled while their share disappeared. Don't doubt it for a second. Yeah, you're fucked.
One way or another, you're fucked. Temporary employment as we know it is unlikely to survive Obamacare, at least as it is currently structured. That's not my opinion, that's what temp agency heads said to Congress. I suggest you read the entire transcript. These guys have a pretty good idea of how Obamacare will fuck their industry and, by extension, you.
But don't worry about them. Maybe they're full of shit. Maybe you'll be fine. Or maybe you're fucked. but hey, that's what you voted for.
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Some details there of which I was unaware :cry:
"Life is tough. It's tougher when we're stupid."
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From GM's post: "Under Obamacare, companies with 50 or more full-time employees either have to provide them with government-approved health insurance policies, or pay a per-employee fine. Further, the fine kicks in at the 31st employee, not the 51st, and it starts at $2,000 per year per employee. It goes up later. Companies, therefore, are discouraged from having full-time employees, or at least 50 or more of them."
What is a full time employee?
The new federal definition of a full time employee is eighteen pages long. http://washingtonexaminer.com/feds-need-18-pages-to-define-full-time-for-obamacare/article/2507528
France, here we come: Why France Has So Many 49-Employee Companies http://www.businessweek.com/articles/2012-05-03/why-france-has-so-many-49-employee-companies
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Capretta and Levin: Why ObamaCare Is Still No Sure Thing
The majority of state governors are Republicans, and they have the power to disarm the health-care law..
By JAMES C. CAPRETTA
AND YUVAL LEVIN
Champions of ObamaCare want Americans to believe that the president's re-election ended the battle over the law. It did no such thing. The Patient Protection and Affordable Care Act won't be fully repealed while Barack Obama is in office, but the administration is heavily dependent on the states for its implementation.
Republicans will hold 30 governorships starting in January, and at last week's meeting of the Republican Governors Association they made it clear that they remain highly critical of the health law. Some Republican governors—including incoming RGA Chairman Bobby Jindal of Louisiana, Ohio's John Kasich, Wisconsin's Scott Walker and Maine's Paul LePage—have already said they won't do the federal government's bidding. Several Democratic governors, including Missouri's Jay Nixon and West Virginia's Earl Ray Tomblin, have also expressed serious concerns.
Talk of the law's inevitability is intended to pressure these governors into implementing it on the administration's behalf. But states still have two key choices to make that together will put them in the driver's seat: whether to create state health-insurance exchanges, and whether to expand Medicaid. They should say "no" to both.
At its core, ObamaCare is a massive entitlement expansion. Between vastly increased Medicaid eligibility and new premium subsidies, it is expected to bring 30 million more people onto the federal government's entitlement rolls. The law anticipates that the states will take on the burden of implementing the expansions, but states can opt out of both.
Running the exchanges would be an administrative nightmare for states, requiring a complicated set of rules, mandates, databases and interfaces to establish eligibility, funnel subsidies, and facilitate purchases. All of this would have to take place under broad and often incoherent statutory requirements and federal regulations that have yet to be written.
The exchanges would create unsustainable pressures on each state's insurance market, treating similarly situated people differently by providing far greater subsidies for those in the exchanges than those in employer plans—yielding perverse incentives that distort consumer and employer decisions and increase costs.
States would endure all this simply to become functionaries of the federal government. The idea that creating state exchanges would give states control over their insurance markets is a fantasy. The states would be enforcing a federal law and federal regulations, with very little room for independent judgment.
Governors know this. A group of them has already indicated that they will not build the exchanges, and several more seemed ready to opt out as the administration's deadline for state decisions approached on Nov. 16. Predictably, Health and Human Services Secretary Kathleen Sebelius tried to head them off by extending the deadline to Dec. 14. She will try to use the extra month to twist governors' arms. They should resist.
By declining to build exchanges, the states would pass the burden and costs of the exchanges to the administration that sought this law. And it is far from clear that the administration could operate the exchanges on its own.
Congress didn't allocate money for administering federal exchanges, and the law as written seems to prohibit federally run exchanges from providing subsidies to individuals. The administration insists that it can provide those subsidies anyway. But if the courts read the plain words of the statute, then federal exchanges couldn't really function.
Thus states that refuse to create their own exchanges would effectively be repealing a large part of the law—sparing their citizens from the job-killing employer mandate and from assaults on their religious liberty. In some cases people would even be spared from the individual mandate to buy coverage, since in the absence of exchange subsidies more families would qualify for exemptions from the mandate.
The Medicaid expansion, meanwhile, would throw millions of additional Americans into a system that is already bankrupting state governments and increasing costs in the private-insurance market. Medicaid's payments for services are so low that many existing beneficiaries have trouble finding physicians and other health-care providers who will accept them as patients. Enrolling more people without reform will push the system to the point of collapse.
In refusing the Medicaid expansion, governors should notify Washington that doing so means freeing themselves of ObamaCare's "Maintenance of Effort" requirements. These would prohibit states participating in the Medicaid expansion from reforming their Medicaid systems to reduce costs.
Instead of following the Obama administration's plan, states should seek real reform. For example, they should demand that Washington transform the federal portion of Medicaid for non-disabled and non-elderly beneficiaries into a uniform block grant, with state discretion over eligibility and benefits. The goal should be to turn Medicaid into a premium-assistance program rather than government-run insurance. Medicaid could then be used to help people enroll in mainstream insurance plans. This is the way to help the low-income uninsured get the same kind of coverage as other Americans.
President Obama won re-election and Democrats maintained control of the Senate this month, but the states hold the future of ObamaCare in their hands. Knowing the harm the law would do to their citizens, to the economy and to American health care, governors should refuse to become its enablers.
Mr. Capretta is a fellow at the Ethics and Public Policy Center and a visiting fellow at the American Enterprise Institute. Mr. Levin is a fellow at the EPPC and editor of National Affairs.
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http://www.youtube.com/watch?v=0uPdkhMVdMQ&feature=player_embedded
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http://www.daybydaycartoon.com/2012/11/27/
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"To be clear, Republicans didn't lose the health care debate in 2009 or 2012. They lost it during the Bush era, when Republicans came to power and failed to advance free market solutions. Unlike issues like guns or taxes, there isn't a strong activist community on the right built around health care. Such activism has only traditionally been created on an ad hoc basis to respond to Democratic efforts to expand the role of government, as with Hillarycare in 1993 and 1994, and Obamacare. As long as Republicans failed to address problems with the health care system, it was inevitable that at some point Democrats would realize their dream of national health care. ... In the coming years, it will be important for conservatives and Republicans to avoid making the same mistake again. Though it's now inevitable that Americans will experience Obamacare, the battle over the future of the health care system is far from over. At some point in the future, liberals will be arguing that any ongoing problems with the health care system are a result of Democrats leaving the private sector with too much control. They'll be renewing their push for a 'public option,' with the ultimate goal of achieving single-payer health care. And if Republicans don't present compelling alternatives, that's exactly where America will end up." --The Washington Examiner's Philip Klein
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They'll be renewing their push for a 'public option,' with the ultimate goal of achieving single-payer health care. And if Republicans don't present compelling alternatives, that's exactly where America will end up." --The Washington Examiner's Philip Klein
We'll have crashed the dollar before we get there.
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Entirely possible GM, but Klein's point remains. The Reps have been quick chicken excrement about standing up for free market solutions.
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Yes, but the bigger problem is the emergence of the Looters and Moochers as the dominant force in American politics.
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Well, part of defeating the looters and moochers requires making the case for Free Minds and Free Markets-- which is the point that Klein is making with regard to the cowardly Reps with regard to the health care market.
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Gee, all we need to do is fix generations of indoctrination from the schools, universities and MSM.
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No one ever said keeping the free republic our Founding Fathers gave us would be easy!
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It's a Mad, Mad, Mad, Mad ObamaCare
The law's implementation is turning into one pratfall after another. .
For sheer political farce, not much can compete with ObamaCare's passage, which included slipping the bill through the Senate before dawn three Christmas eves ago. But the madcap dash to get ready for the entitlement's October 2013 start-up date is a pretty close second.
The size and complexity of the Affordable Care Act meant that its implementation was never going to easy. But behind the scenes, even states that support or might support the Affordable Care Act are frustrated about the Health and Human Services Department's special combination of rigidity and ineptitude.
To take one example, for the better part of a year states and groups like the bipartisan National Governors Association and the National Association of Medicaid Directors have been begging HHS merely for information about how they're required to make ObamaCare work in practice. There was radio silence from Washington, with time running out. Louisiana and other states even took to filing Freedom of Information Act requests, which are still pending.
Now post-election, new regulations are pouring out from HHS—more than 13,000 pages so far and yet nuts-and-bolts questions are still unanswered. Most of what we know so far comes from a 17-page question-and-answer document that HHS divulged this week, though none of the answers have the force of law and HHS says they're subject to change at any moment.
HHS is generally issuing rules with only 30 days for public comment when the standard is 60 days and for complex regulations 90 days and more. But the larger problem is that HHS's Federal Register filings reveal many of the rules were approved in-house and ready to go as early as May. Why the delay?
To take another example, the feds are building a data hub to determine who is eligible for Medicaid and ObamaCare's "exchanges," the bureaucracies that will dispense insurance subsidies and police the market. Many states have cut administrative costs by combining the application process for Medicaid, food stamps, cash assistance and other antipoverty programs, but HHS's privacy rules say the hub can only be used for ObamaCare. So HHS will force states to become less efficient and flatly refuses to reconsider.
In a word, HHS is treating the states not as the partners it needs to give ObamaCare any chance of success, but as serfs.
HHS did finally if "conditionally" approve the exchange blueprints of six states this week, though it has yet to release any formal objective standards for conditional approval. Some 24 states are refusing to participate, so the agency will be running a federal fallback exchange that it won't reveal how it will operate.
A federal exchange is a vast undertaking. The clearinghouses will be open to the uninsured but also to small businesses and people who already buy plans on the individual market. On average about a quarter of a state's population are expected to at least browse the exchange options, and the share will be far higher in states with large numbers of uninsured people under 65, like New Mexico (24%), Georgia (22%) and Texas (27%).
If 20% of Americans use exchanges, that's 62 million people. At a House Energy and Commerce hearing on Thursday, ObamaCare point man Gary Cohen all but took the Fifth on how he'll deal with this and other challenges.
The exchange naysayers now notably include Chris Christie of New Jersey and Bill Haslam of Tennessee. Sure, they're Republicans, but both Governors flirted with the idea and wanted to participate if it would result in a saner and more rational marketplace. The costs and risks were too high.
HHS also declared this week that states can decide either to expand Medicaid (after the Supreme Court decision made it optional), or not. But states are not allowed to make the partial expansion that many states would have considered. This all-or-nothing political gambit is meant to put the Governors in a bad political spot at home if they don't expand, but the irony is that many of them would participate if HHS gave them more flexibility to manage their own programs and control costs.
Yet HHS has made it almost impossible to qualify for Medicaid waivers. States aren't even allowed to "go green" by using digital instead of paper applications. These "maintenance of effort" rules weren't carved in stone tablets by LBJ. HHS formalized them in a regulation this February.
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In other implementation hilarity, no fewer than 18 Democratic Senators and Senators-elect came out last week against ObamaCare's $28 billion tax on medical device sales—and not just the usual penitents from Massachusetts and Minnesota. The list includes Chuck Schumer, Dick Durbin and Patty Murray.
"With this year quickly drawing to a close, the medical device industry has receive little guidance about how to comply with the tax—causing significant uncertainty and confusion for businesses," they write about the tax most of them voted for.
The last entitlement to get off the ground was President Bush's Medicare prescription drug benefit. Those rules were tied up with a bow by January 2005, giving business and government nearly a year to prepare—and that was far simpler than re-engineering 17% of the economy. No one knows where the current magical mystery tour is headed, especially not HHS.
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http://maggiesfarm.anotherdotcom.com/archives/21212-Obama-Vs.-Little-Sisters-of-the-Poor.html
Wednesday, December 19. 2012
Obama Vs. Little Sisters of the Poor
The Little Sisters of the Poor are another example of religious based charitable organizations whose scruples and finances would be violated by Obamacare's requirement that it provide medical insurance that includes contraception and medical treatments that cause sterility or can cause abortions. Aside from its 300 sisters working in their facilities, non-users but still charged for the increased premium, the Little Sisters hires without regard to religion and cares for people without regard to religion. So, according to Obamacare, the Little Sisters of the Poor does not qualify for exemption.
Operating on the principles that are inherent in their religion and such work for the poor and operating on very thin margins, Medicaid providing half the costs of quality care, the Little Sisters of the Poor may have to cease operations in the United States. As the Daily Caller reports from Sister Constance Carolyn Veit:
“As Little Sisters of the Poor, we are not strangers to religious intolerance,” she wrote. “Our foundress was born at the height of the French Revolution and established our congregation in its aftermath. Our sisters have been forced to leave numerous countries, including China, Myanmar and Hungary, because of religious intolerance. We pray that the United States will not be added to this list.”
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http://hotair.com/greenroom/archives/2013/01/03/surprise-obamacare-wary-employers-not-hiring-cutting-hours/
Surprise: Obamacare-wary employers not hiring, cutting hours
posted at 1:16 pm on January 3, 2013 by Guy Benson
The real knife twist in this USA Today piece is the money quote from Mark Zandi, The One’s go-to “independent” economist:
Many businesses plan to bring on more part-time workers next year, trim the hours of full-time employees or curtail hiring because of the new health care law, human resource firms say. Their actions could further dampen job growth, which already is threatened by possible federal budget cutbacks resulting from the tax increases and spending cuts known as the fiscal cliff. ”It will have a negative impact on job creation” in 2013, says Mark Zandi, chief economist of Moody’s Analytics…The so-called employer mandate to offer health coverage doesn’t take effect until Jan. 1, 2014. But to determine whether employees work enough hours on average to receive benefits, employers must track their schedules for three to 12 months prior to 2014 — meaning many are restructuring payrolls now or will do so early next year.
How widespread will the fallout be? Very:
About a quarter of businesses surveyed by consulting firm Mercer don’t offer health coverage to employees who work at least 30 hours a week. Half of them plan to make changes so fewer employees work that many hours. The health care law will particularly affect companies with 40 to 45 workers that plan to expand and hire. Many are holding off so they don’t cross the 50-employee threshold, says Christine Ippolito, principal at Compass Workforce Solutions, a human resource consulting firm in Melville, N.Y. Ernie Canadeo, president of EGC Group, a Melville-based advertising and marketing agency with 45 employees, planned to add 10 next year but now says he may add fewer so he’s not subject to the mandate…Others already over the 50-employee threshold plan to add more part-time workers or cut the hours of full-timers, says Rob Wilson, head of Employco, a human resource outsourcing firm. Many, he says, will hire more temporary workers, whom they won’t have to cover.
Nearly half of retailers, restaurants and hotels will be affected by the law, according to Mercer. They employ large numbers of part-time and seasonal employees, including many who work about 30 hours a week. Since such low-wage workers are widely available, it often hasn’t been cost-effective or necessary for employers to offer them coverage. Providing them benefits could be costly because employees must pay no more than 9.5% of their wages in insurance premiums, forcing employers to contribute significantly more than they do for higher-wage workers. ”I think you may see employees with fewer hours as a consequence,” says Neil Trautwein, vice president of the National Retail Federation.
So the law sets an arbitrary cap on the percentage of wages workers are permitted to contribute to their health benefits — the initial intent of which, presumably, was to compel employers to shell out to help cover more employees. But instead of complying with the mandate and spending money they either (a) don’t have or (b) need for other purposes, cash-strapped small business owners are planning to shave hours and provide less work for their employees. That’s not greed; it’s business reality in a stagnant economy. The clumsy and meddlesome heavy hand of Big Government strikes again, hurting many of very the people it set out to “help.” None of this should surprise anyone, of course. Obamacare opponents have long argued that this project would spike spending and debt, deprive Americans of liberty, and destroy jobs. These predictions are being vindicated with each passing day, hence the law’s enduring unpopularity. And as the article notes, many of the most onerous mandates don’t cycle in until 2014, so the pain is just beginning. For what it’s worth, the CBO has estimated that the president’s signature legislative accomplishment will kill 800,000 jobs.
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U.S. Health Spending Shows Signs It Will Accelerate .
By LOUISE RADNOFSKY
U.S. health-care spending grew at a record low pace for a third consecutive year in 2011, according to federal figures released Monday, but signs are emerging that the slower growth may not last for long.
National health expenditures rose 3.9% in 2011, the same growth rate as in 2009 and 2010, when people cut back on their use of medical services amid the economic downturn. The figures were the slowest growth on record in the 52 years that government actuaries have tracked such spending.
But data published Monday also showed that the amount spent on treating individuals had already begun rising, signaling that changes in the way Americans use health care hadn't become permanent.
Growth in spending on doctors' visits and prescription drugs rose in 2011, while hospital spending continued to slow, the figures showed. Government actuaries said they believed those changes reflected people regaining health coverage through their jobs.
In 2014, Americans are expected to use more health services when millions gain health insurance and greater access to medical care as part of the federal health overhaul. The U.S. figures suggested there had been little impact on spending as a result of the law in 2011, when few of its provisions had taken effect.
Monday's figures give new insight into the drivers of health spending as policy makers wrestle with how to control its growth. Total health expenditures in 2011 were $2.7 trillion, up from $2.6 trillion in 2010. Health-care spending accounts for one-sixth of the national economy and is the biggest long-term driver of federal spending growth.
Medical providers say the impact of the recession was rapidly seen in their practices in 2009 and 2010. National surveys from the Centers for Disease Control and Prevention found around one in 10 respondents reported delaying needed medical care and prescription drugs for cost reasons in that time.
Chad Fleming, a Wichita, Kan., optometrist, said his patients started updating their prescriptions and changing frames for fashion reasons less regularly, and wearing their contact lenses a little longer. He also said that people began asking if they could postpone routine medical eye exams for cost reasons, and asking for generic eye-medicine prescriptions. Those questions started dwindling in 2011, he said.
"Things went back to 'being normal,'" he said. "There were fewer people feeling the need or the urgency to question the cost of anything."
Drug-spending growth almost halted in 2010, rising 0.4%. That was because many people stopped going to the doctor and obtaining prescriptions, said Steve Miller, chief medical officer at Express Scripts Holding Co., which manages pharmacy benefits for 100 million people.
The stall in 2010 also came as several widely used drugs including Merck MRK +0.36%& Co.'s hypertension drug Cozaar, and Aricept, an Alzheimer's disease drug from Pfizer Inc., PFE +0.08%lost their patents and became available in cheaper generic versions. Another, Pfizer's cholesterol-blocking Lipitor, saw its patent expire in 2011.
But drug spending grew 2.9% in 2011, according to the government data. That was attributed in part to the growth in specialty drugs, a group of costly medicines used to treat illnesses such as cancer, multiple sclerosis and hemophilia.
Spending on these emerging medications is soaring, around 20% per year, in sharp contrast to spending on traditional drugs, which is declining, according to Express Scripts. With few, if any, generic alternatives available due to regulatory hurdles, specialty drugs have experienced robust price inflation in recent years, Dr. Miller said.
Health-care executives have said they have detected a leveling off in the decline of doctor's visits, and the 2011 government figures found a 4.3% increase in spending on physician services. The also was an increase in Medicare spending that was attributed in part to greater use of doctors by elderly participants in the federal insurance program.
The federal actuaries noted a 0.5% increase in health-insurance enrollment in 2011 as people started getting employer-sponsored insurance again, after three years of decline from 2008 to 2010. They said that this, rather than rising premium costs, had led to an increase in the amount spent on private health-insurance premiums.
Rebecca Jaffe, a family physician in a three-doctor practice in Wilmington, Del., said some patients were starting to return for visits after regaining health insurance through new jobs, and several came with lists of health services that they had postponed for several years, such as colonoscopies.
"Now that they finally have health care they're very willing to get it done, even anxious, before the next shoe drops," she said.
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One economist on the politics of health care. I would describe him as one of the more conservative members of the "politburo." Note how he predicted that it would take a economic crash like what we saw in 08-09 to get health care reform. The libs were ready. Unlike the smaller minded conservatives who are caught on their heels:
http://www.nytimes.com/2012/03/06/health/policy/an-interview-with-victor-fuchs-on-health-care-costs.html?_r=o
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CCP, I don't support his proposal but the Stanford professor of economics and health research and policy shows as much wisdom on health care as anyone I have read in a long time. I especially like the premise that the search for a solution to the affordable health care problem is still on.
The link, one more time:
http://www.nytimes.com/2012/03/06/health/policy/an-interview-with-victor-fuchs-on-health-care-costs.html?_r=o
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Hi Doug and happy New Year to you and my other forum friends.
Dr. Fuchs has had many articles published in the medical journals so that is where I have seen his views before. One clarification. The interview I posted was March 2012. However, his prediction that it would take some sort of major event (like a market crash) before health car policy change could be implemented politically was, I have read, one he has been making long before. I read his almost verbatim prediction in an article dated back to 2003. I might hazard to guess people like him were thinking the same thing after the Hillary Care failure back in the 90's.
Certainly he is correct that health care cost's are unsustainable. He does seem to agree that whatever the changes are to be made it must take into account our country's perhaps unique political, cultural and social values to get political traction. I am not sure he is enthusiastic about the poltical reality or just recognizing it. I think most conservatives agree that health care costs are unsustainable and prefer market private market forces to fix them. I think he is leaning this way vs the left ultra liberals who simply want to ram down one payor government regulated unversal health care down all our throats.
As I have stated before I am not sure what the answer really is. I still come to the conclusion (and hope) that modern technology will find cures, better treatments for chronic conditions that allow all of us not only to live longer but be productive longer, work longer and not simply live longer taking more social security, medicare dollars using up nursing home space etc.
Fro example a real way to treat osteoarthritis and dementia so people can work and live productive lives longer. Not just play golf longer while collecting their checks.
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The health reform that Mitt Romney passed in 2006 in Massachusetts presaged President Obama's, and its results are showing what we can expect nationwide. The latest warning comes in a huge new tax increase proposed by Governor Deval Patrick.
Last week the second-term Democrat followed his party's recent habit and proposed an increase in the state's single-rate income tax to 6.25% from 5.25%, the first in more than 20 years. The Bay State constitution requires a flat rate, so the Governor is sticking it to all taxpayers.
Mr. Patrick will try to add progressivity by raising the personal exemption, which taxpayer groups will challenge as unconstitutional. His plan would also eliminate 45 income-tax deductions, for such things as the capital-gains exemption on the sale of a home, adoption fees and college scholarships. This is the left's idea for tax reform: raise rates and limit deductions—a revenue twofer.
To help this bad medicine go down, Mr. Patrick would lower the state sales tax to 4.5% from 6.25%. He says the sales levy "is widely regarded to be the most regressive tax that states impose," which is funny given that Mr. Patrick is the same guy who raised the rate to 6.25% from 5% in 2009. Then he said raising the rate was essential to pay state bills and wouldn't hurt the economy. Now he says it's regressive and must be cut.
Business taxes would also rise under the Patrick revenue raid, and Bay State residents would pay higher gas taxes, turnpike tolls and car taxes. All told it's a $1.9 billion a year net tax hike.
Mr. Patrick says the money will fund the usual array of liberal programs. But this is salesmanship to disguise that the state's real spending driver is the exploding cost of RomneyCare. That law was supposed to save the state money. But last August Beacon Hill was forced to impose new price controls and a cap on overall state health spending because "health-care spending has crowded out key public investments," as Mr. Patrick puts it in his budget.
He's right about that: Health care was 23% of the state fisc in 2000, and 25% in 2006, but it has climbed to 41% for 2013. On current trend it will roll past 50% around 2020—and that best case scenario assumes Mr. Patrick's price controls work as planned. (They won't.) In real terms the state's annual health-care budget is 15% larger than it was in 2007, while transportation has plunged by 22%, public safety by 17% and education by 7%. Today Massachusetts spends less on roads, police and schools after adjusting for inflation than it did in 2007.
Mr. Romney expanded coverage without a tax increase at first, but Democrats quickly passed one anyway and now they are tripling down. Call it the return of Taxachusetts, the state's old moniker from the 1970s and 1980s before a string of GOP Governors were elected to hold the line.
Republicans can offer only token resistance now because Democrats hold 127 of the 160 House seats and 36 of 40 Senate seats on Beacon Hill. But will the voters buy it? In the late 1970s Massachusetts helped launch the national tax revolt with property tax measure 2½, and as recently as 2000 59% of voters approved a ballot initiative to cut the state income tax rate to 5%.
Mr. Patrick is gambling that Mr. Obama has so changed the politics of taxes that he can get away with anything. He may also figure that he may skip town soon enough for the Obama Administration—think AG after Eric Holder—that he needn't worry about the political fallout. The lesson for voters is that universal health care is going to have universally large costs. The middle class will pay the bill, as they are starting to do in Massachusetts.
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Rahm's ObamaCare Brainstorm
Chicago may dump its retiree health costs on federal taxpayers. .
Rahm Emanuel's parting gift to national taxpayers upon leaving Washington two years ago was a $1 trillion bill for ObamaCare. Now the Chicago Mayor may add billions more to the tab by dumping his city's retirees on the federally subsidized state health exchange.
This public service announcement is brought to you by a city commission that the mayor appointed last summer to study the cost of continuing health benefits for retired workers. A 25-year-old legal settlement requiring the city and its pension funds to pay between 40% and 55% of most retirees' health costs conveniently expires this June—convenient because the city can't afford the bill.
The city is running a $370 million budget deficit, which will blow up in 2015 when a $1.2 billion balloon payment for pensions comes due. The bill for retiree health benefits is $194 million this year and will grow to $540 million by 2023. Actuaries have recommended that the city sock away $2 billion this year to finance future benefits and pay down a $23 billion unfunded liability. Meanwhile, Chicago's pension funds, which are projected to run dry by the end of the decade, are scraping the bottoms of their barrels to pay for retiree health benefits as required by the settlement.
Enter the Mayor's commission. The four-member panel issued a report this month suggesting that dumping pre-Medicare retirees onto the state's ObamaCare exchange in 2014 could be fab for retirees and city taxpayers. Nearly 60% of retirees and 94% of those who receive subsidies would pay less for their health care on the exchange. Married retirees with dependents would save an average of $4,300.
Chicago and its pension funds in turn would shed $23 billion in liabilities, assuming supplemental benefits for Medicare recipients are also cancelled. (These calculations are based on models that assume public pensions are retirees' only source of income.)
On the other hand, the cost to national taxpayers would be enormous, especially if other local and state governments joined the party. Federal subsidies for Chicago retirees would amount to $44 million in 2014 and increase as more workers retire in their early to mid-50s and health costs grow. All told, state and local governments are on the hook for between $700 billion and $1.5 trillion for retiree health benefits, and like Chicago most will soon be unable to afford even their minimum annual payments.
Offloading the costs on Uncle Sam will look attractive since retiree health benefits don't enjoy the legal protections that some states have bestowed upon pensions. Stockton, California intends to shed its $400 million unfunded liability for retiree benefits in bankruptcy.
Mr. Emanuel says the city's decision on retiree health benefits will "strike the right balance between meeting the needs of the retirees and providing them health-care choices with protecting the interests of the city's taxpayers." So, let's see. On the one hand, Chicago pays, on the other everyone else does. Which do you think he'll choose?
The Chicago report illustrates once again how ObamaCare provides a convenient mechanism and incentive for employers to transfer health-care liabilities to national taxpayers—and how the costs will explode beyond Washington's phony projections.
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"Chicago may dump its retiree health costs on federal taxpayers."
Having helped to design it himself, he should recuse himself from something, maybe citizenship.
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Maybe take his brothers back to Israel. They all live, thrive and are successful capitalists. That is good. They are all liberal socialists in political philosophy. That for me is bad. Is it all a ruse? A way to get rich? Reminds me some of AlGOre...
http://www.washingtonian.com/articles/people/brothers-rahm-emanuel-and-his-family/
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ObamaCare's Broken Promises
Every one of the main claims made for the law is turning out to be false. .
By DANIEL P. KESSLER
As the federal government moves forward to implement President Obama's Affordable Care Act, the Department of Health and Human Services is slated to spend millions of dollars promoting the unpopular legislation. In the face of this publicity blitz, it is worth remembering that the law was originally sold largely on four grounds—all of which have become increasingly implausible.
• Lower health-care costs. One key talking point for ObamaCare was that it would reduce the cost of insurance, especially for non-group insurance. The president, citing the work of several health-policy experts, claimed that improved care coordination, investments in information technology, and more efficient marketing through exchanges would save the typical family $2,500 per year.
That was then. Now, even advocates for the law acknowledge that premiums are going up. In analyses conducted for the states of Wisconsin, Minnesota and Colorado, Jonathan Gruber of MIT forecasts that premiums in the non-group market will rise by 19% to 30% due to the law. Other estimates are even higher. The actuarial firm Milliman predicts that non-group premiums in Ohio will rise by 55%-85%. Maine, Oregon and Nevada have sponsored their own studies, all of which reach essentially the same conclusion.
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.Some champions of the law argue that this misses the point, because once the law's new subsidies are taken into account, the net price of insurance will be lower. This argument is misleading. It fails to consider that the money for the subsidies has to come from somewhere. Although debt-financed transfer payments may make insurance look cheaper, they do not change its true social cost.
• Smaller deficits. Increases in the estimated impact of the law on private insurance premiums, along with increases in the estimated cost of health care more generally, have led the Congressional Budget Office to increase its estimate of the budget cost of the law's coverage expansion. In 2010, CBO estimated the cost per year of expanding coverage at $154 billion; by 2012, the estimated cost grew to $186 billion. Yet CBO still scores the law as reducing the deficit.
How can this be? The positive budget score turns on the fact that the estimated revenues to pay for the law have risen along with its costs. The single largest source of these revenues? Money taken from Medicare in the form of lower Medicare payment rates, mostly in the law's out-years. Since the law's passage, however, Congress and the president have undone various scheduled Medicare cuts—including some prescribed by the law itself.
Put aside the absurdity that savings from Medicare—the country's largest unfunded liability—can be used to finance a new entitlement. The argument that health reform decreases the deficit is even worse. It depends on Congress and the president not only imposing Medicare cuts that they have proven unwilling to make but also imposing cuts that they have already specifically undone, most notably to Medicare Advantage, a program that helps millions of seniors pay for private health plans.
• Preservation of existing insurance. After the Supreme Court upheld the constitutionality of health reform in June 2012, President Obama said, "If you're one of the more than 250 million Americans who already have health insurance, you will keep your insurance." This theme ran throughout the selling of ObamaCare: People who have insurance would not have their current arrangements disrupted.
This claim is obviously false. Indeed, disruption of people's existing insurance is one of the law's stated goals. On one hand, the law seeks to increase the generosity of policies that it deems too stingy, by limiting deductibles and mandating coverage that the secretary of Health and Human Services thinks is "essential," whether or not the policyholder can afford it. On the other hand, the law seeks to reduce the generosity of policies that it deems too extravagant, by imposing the "Cadillac tax" on costly insurance plans.
Employer-sponsored insurance has already begun to change. According to the annual Kaiser/HRET Employer Health Benefits Survey, the share of workers in high-deductible plans rose to 19% in 2012 from 13% in 2010.
That's just the intended consequences. One of the law's unintended consequences is that some employers will drop coverage in response to new regulations and the availability of subsidized insurance in the new exchanges. How many is anybody's guess. In 2010, CBO estimated that employer-sponsored coverage would decline by three million people in 2019; by 2012, CBO's estimate had doubled to six million.
• Increased productivity. In 2009, the president's Council of Economic Advisers concluded that health reform would reduce unemployment, raise labor supply, and improve the functioning of labor markets. According to its reasoning, expanding insurance coverage would reduce absenteeism, disability and mortality, thereby encouraging and enabling work.
This reasoning is flawed. The evidence that a broad coverage expansion would improve health is questionable. Some studies have shown that targeted coverage can improve the health of certain groups. But according to the Robert Wood Johnson Foundation's Economic Research Initiative on the Uninsured, "evidence is lacking that health insurance improves the health of non-elderly adults." More recent work by Richard Kronick, a health-policy adviser to former President Bill Clinton, concludes "there is little evidence to suggest that extending insurance coverage to all adults would have a large effect on the number of deaths in the U.S."
The White House economic analysis also fails to consider the adverse consequences of income-based subsidies on incentives. The support provided by both the Medicaid expansion and the new exchanges phases out as a family's income rises. But, as I and others have pointed out in these pages, income phaseouts create work disincentives like taxes do, because they reduce the net rewards to work. Further, the law imposes taxes on employers who fail to provide sufficiently generous insurance, with exceptions for part-time workers and small firms. On net, it is hard to see how health reform will make labor markets function better.
Some believe that expanding insurance coverage is a moral imperative regardless of its cost. Most supporters of the law, however, use more nuanced arguments that depend on assumptions that are increasingly impossible to defend. If we are ever to have an honest debate about entitlement spending, we will need to distinguish these positions from one another—and see them for what they really are, rather than what we wish they would be.
Mr. Kessler is a professor of business and law at Stanford University and a senior fellow at the Hoover Institution.
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http://www.nytimes.com/2013/02/02/opinion/health-cares-trick-coin.html?nl=todaysheadlines&emc=edit_th_20130202&_r=0
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http://www.washingtontimes.com/blog/inside-politics/2013/feb/5/obama-health-law-will-cost-7-million/
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(http://www.dogbrothers.com/kostas/PoliticsHealthCare.jpg)
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The deadline was Friday.
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"The Department of Health and Human Services had encouraged states to run their own markets, or “exchanges,” that help the uninsured find coverage. Only 17 states and the District of Columbia took on the task, while seven states decided to split the duty with the Obama administration, according to a breakdown by the Kaiser Family Foundation.
http://www.washingtontimes.com/news/2013/feb/16/after-obamacare-health-exchange-deadline-passes-26/#ixzz2LCxmemrv
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http://www.usatoday.com/story/news/nation/2013/02/16/state-health-care-exchange-deadline-passed/1923257/
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ObamaCare Crippled By States
By DICK MORRIS
Published on DickMorris.com on February 19, 2013
President Obama boasts that his ObamaCare legislation will reduce the number of uninsured by thirty million. But recent actions by the states to reject his proposed expansion of Medicaid auger about a 25% reduction in his stated goal.
The Roberts decision affirming the constitutional validity of the individual mandate in ObamaCare left the states free to decline the expansion of Medicaid specified in the legislation without facing a penalty for doing so. ObamaCare mandated - and now suggests - that states cover people for Medicaid up to 133% of the poverty level. For a family of one, that comes to $11,490. For a family of two it is $20, 628. For three it is $26,000 and for a family of four it would be $31,000.
Now, states are going through the process of deciding if they will expand their Medicaid eligibility as Obama suggests or will opt out as the Supreme Court permits.
Twenty-one states -- with almost half of the U.S. population -- have either indicated that they will opt out or are considering doing so.
Obama Donor Tried to Hush My $16.5 Million ‘Mistake’ (Photos)
Now, at least twelve states have decided not to participate: Maine, New Jersey, Pennsylvania, South Carolina, Mississippi, Alabama, Louisiana, Georgia, Texas, Oklahoma, South Dakota, and Idaho. In addition, nine states are considering opting out: Florida, Wisconsin, Utah, Tennessee, North Carolina, West Virginia, Kansas, Alaska, and Indiana.
The combined population of the opt-out states is 86 million (28% of the nation) and the undecided states is 57 million (another 18% of U.S. population).
But, the impact of these opt-outs is even greater than even these numbers would suggest. Of the thirty states (including DC) who have indicated they will participate, six already offer Medicaid to those with 133% of the poverty level. There would be no increase in coverage for these states under the ObamaCare Medicaid provisions. These states have a combined total of fifty million people (16% of the country).
So, 62% of Americans will be unaffected by the ObamaCare expansion of Medicaid!
In addition, twelve states who are accepting the new Medicaid eligibility standards already cover 100% or more of the poverty level. While they will slightly increase their coverage, it would not be by much. These states have a combined population of 68 million (22% of the population).
So, here is the extent of the Medicaid expansion, one of the two key elements in ObamaCare:
• States refusing expansion = 28% of U.S. Population
• States which may refuse = 18% of U.S. Population
• States already over 133% eligibility = 16% of U.S. Population
• States already at 100-133% eligibility = 22% of U.S. Population
Total = 84% of U.S. Population
So, only 16% of the U.S. population stands to "benefit" from the increased Medicaid eligibility levels in ObamaCare.
ObamaCare advertises that it will reduce the number of uninsured by thirty million. About ten million of them were to come from Medicaid expansion. Now it looks like the bulk of this expansion will not happen, potentially lowering the number of uninsured covered to the 22-24 million range, effectively a one-quarter cut in the impact of ObamaCare.
The states are rejecting expansion of Medicaid for several reasons:
• While ObamaCare promises to reimburse states for all the cost of the expansion for three years, it only reimburses 90% after that period is over. Since the full implementation of the ObamaCare standard would increase Medicaid coverage by about 50%, these costs are likely to be severely burdensome.
• Governors are worried that an expansion of Medicaid eligibility will trigger an influx of those now eligible into the Medicaid program. The Kaiser Foundation estimated that half of the growth of Medicaid expected by 2022 would come from those currently eligible. These new Medicaid recipients would be a big burden on states and the feds would only pick up an average of 60% of their cost.
But, Governors are on the lookout and are rapidly mitigating the effects of ObamaCare on their Medicaid costs.
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Ezekiel Emanuel - one of the politburo's hand chosen IVY members will be a speaker at a meeting I am going to on March 8.
Anyone want me to ask him anything or have comments?
He is the ex oncologist who became a policy politburo member because he thought he could help more patients that way - so I am told. Another Saint. I wonder how much he gets to give the speech. I am sure it is all for charity.
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http://www.nytimes.com/2013/02/21/us/in-reversal-florida-says-it-will-expand-medicaid-program.html?smid=tw-share&_r=0
"Gov. Rick Scott of Florida reversed himself on Wednesday and announced that he would expand his state’s Medicaid program to cover the poor, becoming the latest — and, perhaps, most prominent — Republican critic of President Obama’s health care law to decide to put it into effect. "
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CCP, I looked up Rahm's brother Ezekial and found many columns at the NYT:
http://opinionator.blogs.nytimes.com/author/ezekiel-j-emanuel/
Reading through I found him to be somewhat reasonable and restrained for a liberal. I didn't find anything overly provocative or controversial like a Krugman for example.
For a question in a room full of doctors I would look for something where both the question and the answer might resonate with the audience. Perhaps something along the line of asking how can we limit government's role to informing, but not interfere with or replace the judgment of the attending physician.
A not very timely and more hostile question: Given that the more an industry is controlled by government the less they are able to innovate, improve services or control costs, why do we turn over our most important industries to the entity with the worst track record for performance?
His most recent column:
February 14, 2013, 9:11 pm158 Comments
Health Care’s Good News
By EZEKIEL J. EMANUEL
THINK about it. When was the last time you heard the phrases “good news” and “health care costs” in the same sentence?
I can’t remember either.
Most of the recent talk about health care spending has been pretty bleak. Just take a look at the Rate Review Tool on Healthcare.gov and you’ll know why. Major insurers are proposing painful, double-digit premium increases in 2013. In California, Anthem Blue Cross, Blue Shield of California and Aetna all announced rate increases of 20 percent or higher for some of their customers. Many are taking this as a sign that, despite its intentions, the health care reform law is failing and costs are going up as a result.
But there is something bigger going on here, though commentators may not be shouting about it. Health care spending is still going up, but the rate at which it grows year to year has actually been declining for about a decade now.
This is truly a sea change. Look at Medicare: over the last 43 years, costs per beneficiary grew 2.7 percent faster than the overall economy. That’s why Medicare spending rose from $7.7 billion in 1970 (or 0.7 percent of gross domestic product) to $551 billion in 2012 (almost 4 percent of G.D.P.). But this trend has finally reversed; over the last three years, Medicare costs per person have grown 1.3 percent slower than growth in the overall economy. In January, a Department of Health and Human Services report showed that Medicare spending per beneficiary grew just 0.4 percent in 2012. And last week, the Congressional Budget Office lowered its 10-year Medicare spending projection by $137 billion, because “health care spending has grown much more slowly” than “historical rates would have indicated.”
This slowdown is not limited to Medicare, nor is it simply the result of belt-tightening in the wake of the Great Recession. Since 2004 — nearly four years before the economic downturn — the rate of health care inflation per person has been just 0.8 percent higher than the growth of the G.D.P. Between 1965 and 1993, for comparison, it was 3.2 percent higher.
So if the growth of spending is decelerating, why are premiums increasing? First, the big increases were in relatively small parts of the market, among individual and small-business policies. Second, like everyone else in the health care industry, insurance companies are uncertain about the future, particularly about what will happen to their margins when the new exchanges open in October. The natural response to uncertainty is caution, and for insurance companies, the cautious approach is to increase revenue and profits as much as possible in the short term in case Obamacare lowers them in the long term.
But once the exchanges begin to facilitate competition, this fear should dissipate and premiums should come down.
Regardless, the good news on health care costs shouldn’t make us complacent. Despite the slowdown, total Medicare spending is still rising, because more and more baby boomers are becoming eligible for the program every day. The number of beneficiaries is projected to grow 3 percent each year. As a result, total Medicare expenditures are projected to rise to over 4 percent of the G.D.P. by 2023 and to 6.7 percent by 2037. This is a looming threat to the nation’s long-term fiscal stability.
So what more can be done? Here is another piece of good news: there are many common sense reforms that should appeal to both Democrats and Republicans.
One example is competitive bidding. Historically, the government has effectively set prices through Medicare for wheelchairs, hospital beds and other medical equipment. But a demonstration project begun in 2011 introduced competitive bidding in roughly 100 metropolitan areas to see if market forces could bring down prices. The results have been dramatic. Prices for oxygen equipment went down 41 percent; wheelchairs, 36 percent; hospital beds, 44 percent; and the cost of diabetic testing equipment, like glucose strips, dropped by a whopping 72 percent. And research has shown no adverse effects on beneficiaries.
The Affordable Care Act will expand competitive bidding for these items to the rest of the country in 2016. But why wait? We should roll it out nationwide next year. And it shouldn’t just be for medical equipment. In his last budget, President George W. Bush recommended expanding competitive bidding for blood tests and other lab procedures. It could also work for X-rays, CT scans, pacemakers — for all medical commodities. This would drive health care spending growth closer to the increase in G.D.P.
The moderating of health care spending is fantastic news. But now we just have to work harder. If we can push the rate of growth even lower, we will come close to solving our nation’s long-term financial problems.
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On Wednesday Florida Republican Rick Scott became the latest GOP Governor to volunteer to shoulder some responsibility for ObamaCare, which has liberal sages gloating about a resistance-is-futile shift in the GOP. The media don't want to discuss the substance, only the politics, so allow us to report how the flippers are justifying their flips.
• Take the money or run. The Governors now expanding Medicaid are candid about their flight from their own fiscal principles: They want to take political credit for taking "free" money from Uncle Sugar and for appeasing the state hospitals lobbying for federal cash. The Health and Human Services Department will pay 100% of the cost of new beneficiaries, later 90%.
Indiana Governor Mike Pence spoke for the 13 Governors so far who reject this seeming windfall when he called it "the classic gift of a baby elephant," with the feds promising to buy all the hay for only the first few years. So Governors like Mr. Scott and Ohio's John Kasich are trying to inoculate themselves on the right by creating triggers or "sunsets" that would automatically rescind their participation in new Medicaid if—make that when—Washington reneges on funding.
They're only conning themselves. HHS can simply impose a blanket "maintenance of effort" rule that prohibits opting out—or any other change.
• The cost-shift trick. Then again, why would states want to drop out, when they claim that expanding Medicaid will lower health-care costs for businesses and individuals? So-called uncompensated care "drives up the cost of everybody's health insurance," Mr. Kasich said at a recent press conference. "When they visit these emergency rooms and cannot pay, we pay for them."
Hmmm. This is also the justification President Obama used to impose an individual mandate to buy coverage or else pay a penalty. Does Mr. Kasich now support that too?
And do these Republicans really think that private costs will fall by expanding a government program? Unlikely, since the federal statistics put the total amount of uncompensated care due to the uninsured at $12.8 billion—or less than 0.5% of health-care spending. The Ohio Hospital Association estimates its members provide $3.2 billion in uncompensated care—but $1.3 billion is Medicaid losses, more than bad debt or charity care. Ohio price controls are so onerous that hospitals lose 17 cents for every dollar they spend treating Medicaid patients.
• False flexibility. Mr. Kasich claims the feds are granting him the running room to reform Medicaid, on the basis of a late-night phone call from President Obama's consigliere. "I want to thank Valerie Jarrett today for being willing to work with us," he said. "Now I want to be clear to you: We don't know what the details of this are going to be yet. We don't know what the cost is going to be."
When Mr. Kasich is done counting his magic beans, he might look north to Wisconsin for a better Medicaid role model. Last week Scott Walker released an innovative reform that rejects the HHS bribe and will also test the department's putative "flexibility."
Under former Democratic Governor Jim Doyle, Wisconsin greatly expanded its BadgerCare Medicaid program, opening it to everyone earning up to two times the poverty line. Enrollment climbed 73% between 2003 and 2012, state spending increased 99% and proved so expensive that Mr. Doyle was forced to cap enrollment and put eligible people on a wait list.
Mr. Walker wants to roll back Medicaid to the poverty line and use the savings to open up new BadgerCare slots so the truly poor can use the safety-net program intended for them. (Imagine that.) Wisconsin would forgo the 100% federal magic money, because ObamaCare mandates that states expand Medicaid to 138% of poverty and also in this case end the waiting list, which would grow the rolls by another 32%.
The Walker plan would dump a lot of people onto ObamaCare's subsidized insurance "exchanges," though that would happen anyway. At least he would reduce one entitlement and insulate the Wisconsin budget from Washington uncertainty.
• The counsel of despair. Some Republicans are folding apparently because trying to stop ObamaCare is too hard. Though he "never liked the Affordable Care Act," said Governor Brian Sandoval, "I am forced to accept it as today's reality and I have decided to expand Nevada's Medicaid coverage." Now there's a statement of vaulting political ambition.
The reality is that ObamaCare remains deeply unpopular with the public and it will only get worse next year when individuals and small businesses are forced to buy coverage that is 20% or 30% more expensive than what they have. Some younger people will see premium shocks as high as 150% or 200%.
HHS will manage the exchanges in 32 states starting in October but has released only 19 pages of regulatory guidance. ObamaCare is so convoluted, and HHS so incompetent, that the entitlement may explode on the launchpad. Why any Governor would climb on to this ship is a political mystery, but then they have their bad reasons
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Doug I appreciate your thoughts. I am a smaller government guy. I will let the board know if anything interesting comes up at the meeting.
Like Steve Forbes and others have said. Better to recommend stocks then to follow one's own advice. More money to be made that way.
Ezekiel Emanuel must have thought the same thing. Better to tell the country's health industry what to do rather than have to follow his own advise. Less painful and certainly he must be making a much bigger bundle.
He is an Emanuel after all. Another do-gooder who will save us from ourselves.
In April in Atlantic City I see Newt is going to speak about his thoughts on health care.
Somehow I suspect both will say similar things . The difference will only be who enforces the transformation (rams it down our throats). The private or public payers? So far it is both.
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Health care merging with cognitive dissonance of the left: Who knew that the big advances in health care would be coming from the IRS. Rest assured their life-saving work will continue uninterrupted by the sequester.
http://thehill.com/blogs/on-the-money/domestic-taxes/286423-sequester-wont-interrupt-taxes-from-healthcare-law
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Nancy Pelosi said that we’d have to pass the bill to find out what’s in it. Refreshing to hear an honest liberal...
If Congress passes a statute–even one that is 1,600 pages long like Obamacare, but the law can’t go into effect as written, it is not really a law at all. The simple proof is the photo here that Sen. Mitch McConnell’s office has released, showing the 20,000-plus pages of regulations issued so far for the implementation of Obamacare. ”Regulation” is just a multi-syllabic word for “law,” after all. The point is, administrators–the slightly nicer term for “bureaucrats”–now govern us much more than our elected lawmakers do. (Powerlineblog.com)
Comply with THIS! Regulations issued SO FAR for the implementation of Obamacare
(http://2-ps.googleusercontent.com/h/www.powerlineblog.com/admin/ed-assets/2013/03/258x384xObamacare-Regs-copy-403x600.jpg.pagespeed.ic.l93jgTTEkj.jpg)
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ObamaCare Backlash
By DICK MORRIS
Published on TheHill.com on March 19, 2013
It's worth remembering that President Obama decided not to let his new ObamaCare scheme take effect until 2014. At the time of its passage in 2010, it seemed politically wise to delay its implementation. Republicans won the election of 2010 and lost that of 2012. But the full impact of the new law will begin to become apparent in 2014 and the effect will be horrific, deeply damaging the Obama administration and the Democrats who backed it.
The main brunt of the impact will be on premiums for health insurance coverage. They will skyrocket in very short order. The Heritage Foundation estimates the increases by state. Here's a sample:
State Premiums Rise By Percentage
California 42-69%
Florida 61%
Georgia 61-100%
Illinois 61%
Michigan 35-63%
New Jersey 39%
North Carolina 61%
Ohio 55-106%
Pennsylvania 39%
Texas 35-63%
Virginia 75-82%
Why such draconian increases? Heritage ascribes it to two provisions of the new law.
The first restricts health insurers from charging any one age group more than three times the premium it charges any other one. This 3-1 ratio -- typically between the older, non-Medicare portion of the covered population and the young group -- is the brain child of the social planners. The actual figure is about 5-1 -- it costs about five times as much to insure older patients than younger ones. Because, obviously, companies are not going to cut the premiums for the older patients, they will increase them for the younger ones so they can meet the 3-1 ratio. That means big increases for younger families.
The second provision that pushes up premiums is the tendency of the new law to kill its customers with kindness by requiring all manner of illnesses and treatments to be covered, and covered generously. Mental health, dental care and such are all required in any policy. And the law restricts any effort by insurance companies to limit the utilization of these services. So the premiums will rise for everybody.
The result of this premium inflation will be that more and more employers will refuse to continue to cover their workers and will find it far cheaper to pay the penalties in the law than to underwrite the vastly more expensive policies. Tens of millions of Americans will lose their insurance and have to buy coverage from the insurance exchanges Obama is creating -- at a multiple of their current premium's cost. The ObamaCare subsidies are limited and will not begin to make up for the increased costs. And, to make matters worse, employers will be obliged to pay an annual $65 tax per employee to subsidize catastrophic coverage for the most expensive patients.
Obama's real goal, of course, is to destroy employment-related insurance and force everyone into the insurance exchanges. This will lay the basis for single-payer, government-funded, socialized medicine in the United States: his stated goal.
The political consequences of these premium increases are going to be horrific. Voters will realize how fraudulent Obama was in predicting average premium cuts of $2,500 per family. And the full dimensions of this misguided law will become apparent.
The result will be a gradual and continuing erosion of Obama's favorability until he gets his clock cleaned in the 2014 election. Normally, of course, sixth year-elections are a total wipeout for the incumbent party. FDR lost a hundred seats in the House in 1938. Truman lost control of Congress in 1946.
Eisenhower lost more than a dozen Senate seats in 1958. Nixon/Ford suffered massive losses in 1974. Reagan lost the Senate in 1988, as did Bush in 2006. Only Clinton, with Republicans self-destructing over impeachment, avoided severe losses. Obama will fall victim to the general trend, but his losses will increase as the economy fails to recover and health insurance becomes unaffordable.
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Follow up to previous post. Went to meeting of the New Jersey american college of physicians few weeks ago and listened to Ezekiel's talk.
Basically he starts with a bunch of charts and graphs describing what we all know - health care costs are going up and are unsustainable.
His prescription is basically for provider groups to form and control costs by monitoring what they do "outcomes" and basically what managed care has been doing for decades now. I guess the difference is really now the politburo types are requiring we do it on industrial scale with industrial level quality control with reems of data, measurements, more data of the data more measurements and every penny counted. He gave one example from a gourp of several hundred physcians Caremont though I don't remember where they are located and I haven't looked into it - yet.
Supposedly they cut costs while increasing the bottom line. Thus this is a model for all.
He also explains the cost rising is down form over 2% to around 0.8%. Of course he is suggesting he and the rest of the politburo are responsible for cost savings - not that the economy is so bad for most people they can't aford their co pays their deductables their premiums and neither can as many employers.
I only had a chance for one question so I asked him about Clay Christiansens theory that Nurse Practitioners will supplant primary care doctors and it is inevitable and no stopping it. He said PCP's are not replaceabale by nurses and that he doesn't think that would happen - though we are clearly seeing that trend.
He doesn't believe that there is a doctor shortage. Indeed I agree with him on that. There probably is a shortage of a few specialties and doctors in some low income urban areas or in the boondocks but certainly not in the north east and probably the West coast.
Indded if any group feels threateneed by the low wages of illegals /legal immigrants no where is this felt more than in health care.
All we see here are doctors born everywhrere else. The schools of course also like to play the shortage gimmack so they can get more money to churn more graduates out and the nursing programs the same.
Getting back to Emanuel his personality is the same as his brother Rahm. He ran out after one question after mine. I guess he had his next speaking engagement.l
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BTW:
He just happens to have a book about three "remarkable" brothers:
www.economist.com/news/books-and-at/21573953-raising-three-remarkable-children-brother-sarms
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http://reason.com/blog/2013/03/25/californias-910-million-obamacare-exchan
California's $910 Million ObamaCare Exchange
Peter Suderman|Mar. 25, 2013 1:41 pm
Photo credit: Scott Smith (SRisonS) / Foter.com / CC BY-NC-NDHow much does it cost to open one of ObamaCare’s state-run health exchanges? In California, the answer is nearly $910 million and counting.
Health policy consultant Robert Laszewski notes that California has already received a little more than $909 million in federal grants—an amount that’s actually $32 million less than the state’s exchange director asked for. Does that sound like a fair price? It’s not really possible to make a direct comparison to any private sector initiative, but Laszewski provides some useful context:
For some additional perspective I took a look at what it cost to launch the private insurance marketing site, Esurance. That company sells not only health insurance but also things like homeowners and auto insurance across the country. When I put my zip code into their system along with my age, they offered me 87 different health plans from all the big players in my area. Now granted, the new health insurance exchanges are more complex because they have to interface with Medicaid and the IRS as well as calculate subsidies. But the order of magnitude difference in what it cost to launch esurance compared to the California exchange is pretty big.
Privately funded Esurance began its multi-product national web business in 1998 with an initial $5.5 million round of venture fund investment in 1999 and a second round of $34 million a few months later.
The start-up experience of other major web companies is also instructive. Facebook received $13.7 million to launch in 2005. eBay was founded in 1995 and received its first venture money in 1997––$6.7 million in 1997.
Even doubling these investments for inflation still leaves quite a gap.
So where’s all the money going? A big chunk is going to the infrastructure and information technology components—building out the website and database technology necessary to manage the law’s subsidies and facilitate enrollment in the exchange-based health plans. But a lot of it is just going to marketing and enrollment. As Laszewski notes, the state is launching a two-year, $250 million marketing campaign intended to get people to sign up for the exchange. The state is also paying 20,000 part-time "enrollers" $58 an application for each person they sign up. In contrast, California Blue Shield serves 3.5 million members with just 5,000 employees.
Despite the expense there's one thing the state likely won't be getting: a nice, stable insurance market. Few states are more supportive of ObamaCare than California, but the states insurance regulators have warned the Obama administration to expect "rate shock" and "market disruption" as part of the transition to ObamaCare. There are some things money can't buy.
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The Morning Ledger: Restaurant Chains Cut Health-Law Tabs
Restaurant owners, many of whom have been fierce critics of the U.S. health-care overhaul, are now realizing the law may be less costly than they first thought. The primary reason is that many employees will decline company-offered insurance, the WSJ reports. Wendy’s, for example, initially thought the law would increase the cost of operating each of their restaurants by $25,000 a year. But CFO Steve Hare has said that the estimate is down to just $5,000 a year. “That’s still significant costs that we’re adding to not only the company restaurants but to most of our franchisees, who are going to be dragged into this as well,” Mr. Hare said on a recent conference call, Maxwell Murphy reports in CFOJ
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http://www.youtube.com/watch_popup?v=r13uYs7jglg
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By ED MARSH
A fundamental principle in medicine is that if you get the diagnosis wrong, you'll probably apply the wrong therapy. A corollary is that if the therapy isn't working, increasing the dose may make things worse. That's where we are with ObamaCare.
There are shortcomings aplenty in the health-care field, and changes and improvements are required. But never have I seen so many good intentions leading irreversibly to hell.
Personal experience is by its nature parochial. Yet when it invalidates much of what passes for wisdom, there may be value in sharing it. Here are some facts that may illuminate:
When I graduated from medical school in 1962, the profession of medicine was for many graduates an opportunity to provide care—as distinguished from, though aligned with, treatment—and to provide it to individuals, not to populations or governmentally specified groups. Young doctors hoped to establish an independent business, enjoy lifelong intellectual excitement as knowledge and therapies expanded, and have an income sufficient to live decently and support a family. There have always been some who entered medicine, as with any vocation, to maximize income. Yet most of us who came into the profession in the early 1960s had modest financial aspirations and substantial social commitment.
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Chad Crowe
.After eight years of postgraduate study, I opened a solo pediatrics practice in a community of 10,000 souls an hour from Boston. A number of lean years passed before I could build a robust practice. Yet the experience was exactly what I—and I think many of my colleagues—sought: a personal, direct and unimpeded relationship between me and those who chose to become my patients.
A major cause of financial stringency was that there was almost no insurance that covered pediatric care in the office setting. Many pediatricians felt denigrated because the care that they were providing was not regarded as sufficiently consequential to be covered by third parties, as was that of their brethren in internal medicine. Surveys always showed pediatricians to be the poorest-paid of all the specialties.
By current standards, the lack of third-party coverage would be impermissible. But treating patients without insurance meant that I had to give my acute attention to the price of every medical intervention. The costs could have a direct and painful impact on a family's budget. So I had to know the prices for most of the medications I prescribed and of most of the tests I might order. I learned to play for time by waiting, when it was safe to, before ordering an X-ray or a test—and to substitute less-expensive medications for more costly ones wherever possible.
I developed pastimes that were diverting but would permit me to be available to patients 24-7, requiring coverage by a substitute only for a two-week vacation annually. Few physicians nowadays would undertake such an onerous schedule, and yet many of the inconveniences are offset by benefits. If you are caring for your own patients, you know them and their ailments and can manage a great deal over the telephone (or by email these days), with minimal cost to them and minimal intrusion into your own life. By contrast, covering for another physician almost invariably means inefficiency—additional time to learn the patients' relevant history, and often either a direct patient encounter or an outpatient facility visit, all of which greatly add to the cost.
Then, in the mid-1970s, things changed, and we became enlightened. Third parties, typically the insurance companies, were interpolated between the physician and the patient. Some of the consequences were unfortunate.
Patients knew that any suggestions I might make would have negligible consequences for their own budgets, so "more" became the expectation. A sense of entitlement developed. Why would the doctor hesitate to do some procedure, or hesitate to request a test? Everything was already paid for. If I was reluctant, perhaps weighing the cost to them, patients speculated there must be some hidden reason. Perhaps I was, in some obscure way, feathering my own nest. Misgivings arose.
This mistrust heightened—and became rational—when "prepaid" group practices became more prevalent. Physician compensation is tied to "efficiencies," which means reducing the outlays and costs to the group (translation: skimp where possible) and thus generating for internal distribution a larger share of the prepaid premiums.
Second opinions proliferated, upping the costs. Patients could get two opinions for the same price: near zero. I could acquire additional knowledge from the feedback of the consultant and was better positioned should some legal controversy arise. One underexamined aspect of defensive medicine is those excessive referrals to diminish responsibility.
My income rose substantially and pediatricians in general thought that they had arrived in the Promised Land. The submission of some paper to some anonymous third party would not put a dent in any patient's grocery bills. And the consequences of profligacy disappeared, while rational income-building strategies—aka gaming the system—appeared. For instance, since telephone calls weren't reimbursable, additional office visits, which were, supervened.
"Preventive care" became the touchstone. The concept is obvious, but the evidence for its value, and especially its potential for savings, is rarely conclusive.
Insurance relationships drove practice relationships. Patients were more likely to come to me because their insurance told them to, and more likely to leave, despite our congeniality, because their insurance required it. Thus our dealings were less personally rewarding, for my patients and for me.
When it became increasingly difficult to work according to my principles, I closed my practice, first joining a "prepaid" group for 15 years, and then leaving patient care altogether. As more physicians leave active practice, it must be appreciated that a focus on the economics of health care is not the only, and perhaps not even the most important, reason for their disillusionment. The glow of the personal relationship one might have with one's patients is being extinguished.
The medical economist Rashi Fein observed in 1986 that there are only three ways to limit the extravagant demand for medical care: "Inconvenience," the practice used in the military, where one must wait interminably for care. "Rules," the third-party approach by which layers of rules and thousands of regulations are devised, most recently in a fool's quest to contain costs under ObamaCare. And "Price." This last option elicits gasps and chest-clutching from bien pensants who insist that all financial impediments to care must be removed. Yet it has one incontestably beneficial attribute: It requires the physician to study the true cost and benefits of a course of action, and then to present that data to the patient. Who is better suited than the patient to assess the value to him of the proposed treatment? Kathleen Sebelius? You gotta be kidding.
There is no shortage of evidence. ObamaCare will, deliberately and by design, destroy what—while imperfect—has served very well. We have gotten to this point after years of good intentions making bad problems worse. To double down on the very therapy that has brought the system to its present sorry pass is a toe-ticket to the morgue.
Dr. Marsh now raises Christmas trees in Ipswich, Mass.
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Dr. Jeffrey Singer writing in the May issue of Reason magazine:
In the not-too-distant future, a small but healthy market will arise for cash-only, personalized, private care. For those who can afford it, there will always be competitive, market-driven clinics, hospitals, surgicenters, and other arrangements—including "medical tourism," whereby health care packages are offered at competitive rates in overseas medical centers. Similar healthy markets already exist in areas such as Lasik eye surgery and cosmetic procedures. The medical profession will survive and even thrive in these small private niches.
In other words, we're about to experience the two-tiered system that already exists in most parts of the world that provide "universal coverage." Those who have the financial means will still be able to get prompt, courteous, personalized, state-of-the-art health care from providers who consider themselves professionals. But the majority can expect long lines, mediocre and impersonal care from shift-working providers, subtle but definite rationing, and slowly deteriorating outcomes.
We already see this in Canada, where cash-only clinics are beginning to spring up, and the United Kingdom, where a small but healthy private system exists side-by-side with the National Health Service, providing high-end, fee-for-service, private health care, with little or no waiting.
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http://en.wikipedia.org/wiki/richard_Blumenthal
I only recently realized that David is this guy's brother. Another politician health care politburo brother duo like the Emanuels.
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I wonder if brother David is also a decorated war veteran like his brother who according to Marc Levin is asking for campaign donations to fight for the gun control in the memory of the Conneticut massacre.
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http://www.breitbart.com/Big-Government/2013/04/16/ObamaCare-Regal-Employee-hours
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Rove: Steaming Toward the ObamaCare 'Train Wreck'
The implementation of this unpopular law is a story of missed deadlines and general bungling..
By KARL ROVE
In congressional testimony last week, Health and Human Services Secretary Kathleen Sebelius blamed Republican governors for her department's failure to create a "model exchange" where consumers could shop for health-insurance coverage in states that don't set up their own exchange.
Nice try, but GOP governors aren't the problem. Team Obama's tendency to blame someone else for its shortcomings is tiresome. The Affordable Care Act requires HHS to operate exchanges in states that won't operate their own. Since the act became law in March 2010, it has been abundantly clear that the agency would have to deploy a model exchange. It is Ms. Sebelius's fault there isn't one.
There is more to this failure. Even exchanges organized by Democratic and Republican governors may not be functioning by the health-law's Oct. 1 deadline, because HHS has been slow with guidance and approvals.
Last month Gary Cohen, an official with the Centers for Medicare and Medicaid Services who oversees technology for the exchanges, told members of America's Health Insurance Plans (a trade association) that he was "pretty nervous" about implementation. He hoped enrollment is "not a third world experience."
Part of this problem stems from the way the law is crafted. For example, a subsidy to help small businesses provide insurance coverage while ObamaCare ramped up was so complicated and difficult to use that only 1% of its $40 billion budget was spent.
Other provisions have been poorly executed or needlessly delayed. Ms. Sebelius's HHS has missed dozens of deadlines for major rule-making or program start dates required by the law.
For example, ObamaCare created the Small Business Health Options Programs, where small businesses could select insurance plans beginning in October with coverage starting in January. The program has been set up, but employees are offered only one plan, not a choice among many. HHS announced a full range of plans would be delayed until 2015.
Then there is President Obama's promise that no American would be denied coverage because of a pre-existing condition. The Affordable Care Act set aside $5 billion to subsidize, through 2014, coverage for an estimated 270,000 to 350,000 people with pre-existing conditions and no insurance. So far 135,000 have been covered but the $5 billion is nearly exhausted. HHS stopped signing up people in February.
A long-term care entitlement, the so-called Class Act, turned out to be so fiscally untenable that Democratic support evaporated before its 2012 start date. The entitlement program was repealed in the December fiscal cliff deal.
Then there is the Independent Payment Advisory Board, the 15-person committee charged with reducing Medicare spending to a "target level" by 2015. Its recommendations take effect automatically unless overruled by a congressional supermajority.
By law, the board cannot "raise revenues or Medicare beneficiary premiums . . . deductibles, coinsurance, and copayments, or otherwise restrict benefits or modify eligibility criteria." This means that the board would likely have to cut reimbursements to health providers who already receive roughly 80% of what private insurers pay for the same procedures for non-Medicare patients. This will discourage doctors from taking on Medicare patients.
The IPAB's first recommendations are due Jan. 1, 2014 and are supposed to take effect a year after that. The president hasn't appointed anyone to the board, and it's unlikely he can come up with 15 nominees, get them confirmed, and have them in place to deliver recommendations in time. Maybe he plans to leave the recommendations up to the secretary of HHS, which is allowed under the health law, but that ought to concern anyone who's seen Ms. Sebelius in action.
Or maybe the president will just let the deadline for IPAB recommendations slide. An ugly battle in 2014 over Medicare cuts proposed by a committee he appointed might rile up seniors in the midterm elections, leading to the defeat of House and Senate Democrats who voted for the law.
Still, the administration is eager to get one health-care program under way. ObamaCare provides $54 million to hire individuals and groups to facilitate enrollment when the exchanges begin this October.
There are rumblings in Washington that HHS believes more money is needed for these "navigators" or "helpers." The House Energy and Commerce Committee wrote Ms. Sebelius this week asking what kind of groups are eligible, how they'll be selected, what standards must they meet, how they will be trained and supervised, and what the success measures will be. This program could turn into patronage for Mr. Obama's liberal allies such as unions and community activists.
The Affordable Care Act may be unworkable in the aggregate, but it is also dogged by incompetent implementation. Even Democrats are increasingly concerned. At a hearing on Wednesday, Sen. Max Baucus expressed his frustration about a variety of problems, including whether the health-insurance exchanges will be established on time. "I just see a huge train wreck coming down," he told Ms. Sebelius.
Mr. Rove, a former deputy chief of staff to President George W. Bush, helped organize the political action committee American Crossroads.
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http://www.wsbradio.com/ap/ap/health/top-dem-sees-train-wreck-for-obama-health-law/nXPPR/
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http://www.wsbradio.com/ap/ap/health/top-dem-sees-train-wreck-for-obama-health-law/nXPPR/
"A six-term veteran, Baucus expects a tough re-election in 2014. He's still trying to recover from approval ratings that nosedived amid displeasure with the health care law in his home state."
True, the train wreck he sees coming might be his own reelection, Obama lost Montana by 14 points.
"Normally low-key and supportive, Baucus challenged Health and Human Services Secretary Kathleen Sebelius at Wednesday's hearing."
I wonder if there was also a wink from the Senator as the author of the bill got tough with the secretary in committee. She needs him reelected too. I wonder if she could ever get elected in Kansas again. Obama lost Kansas by over 20 points.
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The new health care law mandates that primary care doctors who accept Medicaid patients are guaranteed to be paid the Medicare rates for 2013 and 2014. After that probably the states will be squeezed as we will be though the Politburo is silent at this time.
I signed up and just got credentialed. I thought I was all set. Usually when one signs on to a health plan there is a dozen or so pages of "rules".
Then I was sent the rules regarding Medicaid in NJ. It is a good size box with what looks like hundreds of pages of regulations and rules and Lord knows what else. Additionally our office was recently informed it will months before we see any money regardless.
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Daniel Kessler: The Coming ObamaCare Shock
Millions of Americans will pay more for health insurance, lose their coverage, or have their hours of work cut back. .
By DANIEL P. KESSLER
In recent weeks, there have been increasing expressions of concern from surprising quarters about the implementation of ObamaCare. Montana Sen. Max Baucus, a Democrat, called it a "train wreck." A Democratic colleague, West Virginia's Sen. Jay Rockefeller, described the massive Affordable Care Act as "beyond comprehension." Henry Chao, the government's chief technical officer in charge of putting in place the insurance exchanges mandated by the law, was quoted in the Congressional Quarterly as saying "I'm pretty nervous . . . Let's just make sure it's not a third-world experience."
These individuals are worried for good reason. The unpopular health-care law's rollout is going to be rough. It will also administer several price (and other) shocks to tens of millions of Americans.
Start with people who have individual and small-group health insurance. These policies are most affected by ObamaCare's community-rating regulations, which require insurers to accept everyone but limit or ban them from varying premiums based on age or health. The law also mandates "essential" benefits that are far more generous than those currently offered.
According to consultants from Oliver Wyman (who wrote on the issue in the January issue of Contingencies, the magazine of the American Academy of Actuaries), around six million of the 19 million people with individual health policies are going to have to pay more—and this even after accounting for the government subsidies offered under the law. For example, single adults age 21-29 earning 300% to 400% of the federal poverty level will be hit with an increase of 46% even after premium assistance from tax credits.
Determining the number of individuals who will be harmed by changes to the small-group insurance market is harder. According to the Medical Expenditure Panel Survey, conducted by the Department of Health and Human Services, around 30 million Americans work in firms with fewer than 50 employees, and so are potentially affected by the small-group "reforms" imposed by ObamaCare.
Around nine million of these people, plus six million family members, are covered by employers who do not self-insure. The premium increases for this group will be less on average than those for people in the individual market but will still be substantial. According to analyses conducted by the insurer WellPoint for 11 states, small-group premiums are expected to increase by 13%-23% on average.
This average masks big differences. While some firms (primarily those that employ older or sicker workers) will see premium decreases due to community rating, firms with younger, healthier workers will see very large increases: 89% in Missouri, 91% in Indiana and 101% in Nevada.
Because the government subsidies to purchasers of health insurance in the small-group market are significantly smaller than those in the individual market, I estimate that another 10 million people, the approximately two-thirds of the market that is low- or average-risk, will see higher insurance bills for 2014.
Higher premiums are just the beginning, because virtually all existing policies in the individual market and the vast majority in the small-group market do not cover all of the "essential" benefits mandated by the law. Policies without premium increases will have to change, probably by shifting to more restrictive networks of doctors and hospitals. Even if only one third of these policies are affected, this amounts to more than five million people.
In addition, according to Congressional Budget Office projections in July and September 2012, three million people will lose their insurance altogether in 2014 due to the law, and six million will have to pay the individual-mandate tax penalty in 2016 because they don't want or won't be able to afford coverage, even with the subsidies.
None of this counts the people whose employment opportunities will suffer because of disincentives under ObamaCare. Some, whose employers have to pay a tax penalty because their policies do not carry sufficiently generous insurance, will see their wages fall. Others will lose their jobs or see their hours reduced.
Anecdotal evidence already suggests that these disincentives will really matter in the job market, as full-time jobs are converted to part time. Why would employers do this? Because they aren't subject to a tax penalty for employees who work less than 30 hours per week.
There is some debate over how large these effects will be, and how long they will take to manifest. However, the Bureau of Labor Statistics reports on a category of workers who will almost surely be involuntarily underemployed as a result of health reform: the 10 million part-timers who now work 30-34 hours per week.
These workers are particularly vulnerable. Reducing their hours to 29 avoids the employer tax penalty, with relatively little disruption to the workplace. Fewer than one million of them, according to calculations based on the Medical Expenditure Panel Survey, get covered by ObamaCare-compliant insurance from their employer.
In total, it appears that there will be 30 million to 40 million people damaged in some fashion by the Affordable Care Act—more than one in 10 Americans. When that reality becomes clearer, the law is going to start losing its friends in the media, who are inclined to support the president and his initiatives. We'll hear about innocent victims who saw their premiums skyrocket, who were barred from seeing their usual doctor, who had their hours cut or lost their insurance entirely—all thanks to the faceless bureaucracy administering a federal law.
The allure of the David-versus-Goliath narrative is likely to prove irresistible to the media, raising the pressure on Washington to repeal or dramatically modify the law. With the implementation of ObamaCare beginning to take full force at the end of the year, there will be plenty of time before the 2014 midterm elections for Congress to consider its options.
For those like Health and Human Services Secretary Kathleen Sebelius, who told a gathering a few weeks ago at the Harvard School of Public Health that she has been "surprised" by the political wrangling caused so far by ObamaCare, there are likely to be plenty of surprises ahead.
Mr. Kessler is a professor of business and law at Stanford University and a senior fellow at the Hoover Institution.
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Thousands of would-be entrepreneurs are itching to start their own businesses, but many are shackled to their current employer by health-care benefits they don't think they could otherwise afford. Economists call this phenomenon "job lock," or "entrepreneurship lock."
But the pressure some Americans feel to cling to a corporate job chiefly for the health insurance could, conceivably, ease in coming years. Under provisions of the health-care law, new-business owners will be able to get coverage through public marketplaces, or "exchanges," beginning in October, for policies that will take effect starting in January.
If the law, known as the Affordable Care Act, is implemented as intended, these exchanges could let entrepreneurs buy insurance at reasonable rates, regardless of their health histories. That's far from a sure bet, however, given evidence that premiums for some people—particularly the young and healthy—could rise under the law.
The Obama administration has touted a boost for entrepreneurship as one of the health-care law's key benefits. The Kauffman-RAND Institute for Entrepreneurship Public Policy in Santa Monica, Calif., says the law could increase the number of new U.S. businesses by as much as 33% over several years.
Laura Stoll is among those who dream of living the entrepreneurial life—if robust, affordable coverage becomes available. The 38-year-old Chicagoan left a corporate job with good health coverage in 2006 to start a new business. Along with her husband, Jay Sukow, a 42-year-old improv actor, she founded the Riot Act, a company that integrated sketch comedy into corporate-training programs.
Health insurers denied them coverage while they were self-employed because the couple suffered from allergies and asthma. For five years they avoided doctors and hospitals as much as possible, Ms. Stoll says.
But once Ms. Stoll was ready to start a family, in 2011, she says she decided it would be smarter to return to the corporate world to get insurance for herself, her husband and her future children. "I needed the safety and security of a corporate blanket," she says.
So she and her husband closed their business, and Ms. Stoll accepted a position that year at Ernst & Young, where she now works as an organizational-development consultant. Earlier this year, she gave birth to her first child, a boy.
Many workers, like Ms. Stoll, believe that as independent business owners they might not be able to afford insurance that covers all their medical needs, such as maternity or mental-health care. Other workers say they are stuck in corporate jobs by pre-existing conditions that make them ineligible for insurance on their own.
To be sure, the law's effect on entrepreneurship could be diluted if getting coverage through insurance exchanges involves big administrative headaches. It remains to be seen what types of health plans the exchanges will offer, and what the costs to entrepreneurs will be.
"To see that 33% bump" in entrepreneurship, "people would need to get a plan on the exchanges that is just as good as what they could get from employers," says Susan Gates, director of the Kauffman-RAND Institute. "And at least in the short run, the exchanges likely won't be as good," she says.
Even as state and federal officials prepare to roll out the exchanges, Brian Hassan, founder of BayPoint Benefits, a San Francisco-based health-insurance consulting firm for technology startups, says he has met with budding entrepreneurs at large tech firms who put their startup plans on hold after crunching the numbers. "They kind of hold back a bit when they see the cost of benefits," he says.
Some insurance brokers say insurance premiums for some entrepreneurs won't be cheaper under the law. UnitedHealth Group Inc. UNH +4.29% told brokers in February that rates for some consumers buying their own plans could rise as much as 116% while small-business rates could go up 25% to 50%. And Aetna Inc. AET -0.13% told them last fall that rates on individual plans not being grandfathered under the law could go up 55%, on average, and small-business rates could rise 29%.
UnitedHealth said its figures represent a high-end scenario, not an average, and some consumers could see rate decreases.
A spokesman for Aetna said its estimates represent the average impact in a typical state.
"There are very few people that I speak to who are expecting small-group rates to come down," says Parker Conrad, co-founder of Zenefits, a San Francisco health-insurance broker for startups and small businesses.
Of course, the world doesn't need more bad business ideas, and leaving a secure job to start a business is like "buying a lottery ticket" says Shikhar Ghosh, a senior lecturer at Harvard Business School who studies startup failures. Current failure rates suggest 50% to 75% of entrepreneurs likely won't succeed, and may lose their savings.
Ms. Stoll, the Ernst & Young employee, says she is taking a wait-and-see approach. She isn't likely to jump ship immediately to restart her business, she says, in part because she worries the insurance exchanges might offer coverage that isn't as attractive as what she gets at the accounting firm. Only when the exchanges are established, she says, can she assess the coverage offered. That process, she adds, could take years.
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Some very interesting implications here. If this piece is right, we had best learn its logic lest Obamacare receive credit to which it is not entitled.
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The Health Spending Decline
Why costs have been slowing, at least until ObamaCare kicks in.
To the surprise of both political parties and planners of all types, American health-care spending appears to be slowing down. The health growth rate has flattened out at about 3.9% over the last three years—a record low since the 1960s and down from the old normal of 6.2% to 9.7% in the 2000s.
This is rare good economic news, given that health cost growth sends federal entitlement spending soaring and erodes middle-class wage increases. Can this trend last? Maybe, though not with the Affordable Care Act looming to quash any progress.
At first most observers assumed the slowdown was temporary, an artifact of the 2007-2009 recession and weak recovery. As people lost jobs and thus their insurance, or simply had less income, health spending fell in tandem.
Reflecting this view, the Kaiser Family Foundation and the Altarum Institute recently estimated that underlying economic conditions are responsible for 77% of the current health spending deceleration and that this dip will end when GDP rebounds. Yet health spending growth rates started to decline in 2002, and a provocative paper in the New England Journal last summer suggested that a robust moderation began in mid-2005.
Now comes new evidence that the moderation is durable, and that it is structural—the result of permanent changes in the health system itself rather than the business cycle. These papers look at the historical relationship between GDP and the share of the economy devoted to health care and were published last week in the journal Health Affairs.
The Harvard economist and sometime White House adviser David Cutler and Nikhil Sahni argue that the slowdown has been larger and longer than it should otherwise be. By their model, the recession explains only 37% of the slowdown, and other variables 8%, not Kaiser's 77%.
President Obama naturally says he deserves most of the credit for the slowdown, even though it began well before ObamaCare passed in 2010. His Council of Economic Advisers argues in its 2013 report to Congress that the economy explains just 18% and that the balance includes "early responses to the Affordable Care Act."
But the White House also says that everything that goes wrong in health care is still the fault of Republicans or of private insurers, even though the law was passed (with zero Republican votes) to end the industry's alleged abuses.
A more plausible explanation is offered by Michael Chernew and some Harvard colleagues. Their model suggests that market choice and competition helped produce the slowdown, especially among Mr. Obama's preferred villains. Hide the children: the insurers.
Dr. Chernew investigated changes in the insurance mix at large businesses from 2008 to 2011. Even as these firms did better than their smaller counterparts, their workers shared more of the costs of their own care through higher deductibles, co-pays and new benefit designs. "Rising out-of-pocket payments," he writes, "appear to have played a major role in this decline, accounting for approximately 20% of the observed slowdown."
In a word, patients make better decisions when they have the right incentives and information. Old-style first-dollar insurance coverage is declining in the private economy because employees prefer cash wages and employers can't afford to finance ever-more expensive benefits. One way commercial insurers have responded is with plans that steer consumers to higher-value hospitals, doctors and other providers in return for lower out-of-pocket costs. Think of the way drug formularies encourage generic pharmaceuticals over name brands.
Mr. Obama's economists speculate instead that regulations are requiring providers to be less inefficient, which would be the first time in history that is true. ObamaCare also outlaws most of the experimentation and innovation that is the most likely driver of the slowdown.
Large businesses that self-fund employee benefits operate mostly free of regulations and taxes under a law known as Erisa. Erisa plans cover 60% of the 149 million Americans with job-based coverage, up from 54% in 2005 and 49% in 2000 as businesses have fled government micromanagement.
But everyone else—Medicare, Medicaid and the individual and small-business insurance markets—is now under federal control, and many more will join them if ObamaCare inspires businesses to dump workers into its subsidized "exchanges." The law's actuarial rules and benefit mandates prohibit what the government defines as excessive cost sharing, even as trillions of dollars in subsidies will be pumped into the system to inflate spending growth again.
That will be terrible for the fisc—Dr. Cutler estimates entitlement spending will be $770 billion lower over a decade if the current slowdown holds—and it is another reminder of what a squandered opportunity "health-care reform" was. It increasingly looks as if ObamaCare passed amid a national correction in the health markets that no one in Congress or the White House understood, much less noticed, so naturally Washington moved to create new problems when the old ones were starting to fix themselves.
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http://washingtonexaminer.com/insurers-predict-100-400-obamacare-rate-explosion/article/2529523
Insurers predict 100%-400% Obamacare rate explosion
May 13, 2013 | 3:02 pm
Paul Bedard
Washington Secrets
The Washington Examiner
Internal cost estimates from 17 of the nation's largest insurance companies indicate that health insurance premiums will grow an average of 100 percent under Obamacare, and that some will soar more than 400 percent, crushing the administration's goal of affordability.
New regulations, policies, taxes, fees and mandates are the reason for the unexpected "rate shock," according to the House Energy and Commerce Committee, which released a report Monday based on internal documents provided by the insurance companies. The 17 companies include Aetna, Blue Cross Blue Shield and Kaiser Foundation.
The report found that individuals will face "premium increases of nearly 100 percent on average, with potential highs eclipsing 400 percent. Meanwhile, small businesses can expect average premium increases in the small group market of up to 50 percent, with potential highs over 100 percent."
One company said that new participants in the individual market could see a premium increase of 413 percent when new requirements on age rating and required benefits are taken into account, said the report. "The average yearly cost for a new customer in the individual market grows from $1,896 to $3,708 -- a $1,812 cost increase," it added.
The key reasons for the surge in premiums include providing wider services than people are now paying for and adding less healthy people to the roles of insured, said the report.
It concluded: "Despite promises that the law will lower costs, [Obamacare] will in fact cause the premiums of many Americans to spike substantially. The broken promises are numerous, and the empirical data reveal that many Americans, from recent college graduates to older adults, will not be able to afford the law's higher costs."
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Expert: Premiums for Individual Health Plans in Exchange Will Be High
Next year, premiums for individual health plans offered through the state health insurance exchange will grow significantly from current rates, according to a health insurance expert, the Sacramento Business Journal reports.
Last week, Garry Maisel -- CEO of Sacramento-based Western Health Advantage -- discussed the issue at a Drexel University-sponsored event on health care costs (Robertson, Sacramento Business Journal, 5/10).
Details of Exchange
The exchange -- named Covered California-- primarily will serve individuals and small businesses.
Supporters hope that the exchange will function similar to websites like Amazon and Expedia so that users will be able to choose between various health plans through an easily navigable online store.
The exchange is expected to open for registration in October (California Healthline, 5/10).
On May 23, the exchange is scheduled to name the health insurers that it has selected to offer plans through the online marketplace.
The insurers then will file proposed rates with state regulators.
Details of High Premiums
Maisel said that he thinks premiums for individual health plans "will go up 40% to 70% … and this will cause a national furor."
He said a variety of factors could boost premiums for individual health plans in the exchange, including that:
• Policies will offer more choice and more closely resemble employer-sponsored health insurance;
• Health plans will be paying a greater percentage of health care costs;
• Insurers will not be able to deny coverage for individuals based on pre-existing conditions or charge more for poor health status;
• Health plans will be required to charge younger beneficiaries a higher percentage of what older people pay for insurance;
• Higher enrollment of older individuals will mean higher health care costs; and
• Many individuals will be eligible for health plan subsidies (Sacramento Business Journal, 5/10).
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As far as our group plan premium goes, we are going up "only" 21.8% :-P :x
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Some are starting to figure out the connection between our failed trust in the IRS and the trainwreck known as Obamacare. The first big investment the federal government made in heathcare reform was for the IRS to spend (invest?) nearly a billion and hire thousands of new IRS agents to scrutinize further those of us that they believe need more scrutinizing. http://www.breitbart.com/Big-Government/2012/07/07/ObamaCare-Irs-Agents
Byron York today:
http://washingtonexaminer.com/byron-york-irs-scandal-raises-fears-about-enforcing-obamacare/article/2529589
What's happened heightens fears about how the IRS will handle taxpayer information and wield its power when it enforces Obamacare starting next year."
The IRS is critical to Obamacare. The structure created by the Affordable Care Act requires the government to know about both the health care coverage (or lack of it) and the financial resources of every American. The IRS, which already knows the latter, was the only agency with the reach to do the job.
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A look at the text of the health care law reveals that much of it consists of amending the Internal Revenue Code to give the IRS more power. When Obamacare goes fully into effect in January, every American will have to prove to the IRS that he or she has "qualifying" health coverage, meaning coverage with a list of features approved by Health and Human Services Secretary Kathleen Sebelius. That will be done by submitting a document to the IRS, something like a W-2, to confirm coverage.
The IRS will also decide who is, and who is not, eligible for Obamacare's subsidies. The law authorizes the IRS to share confidential taxpayer information with the Department of Health and Human Services for the purpose of determining those subsidies. And since subsidies don't just apply to a relatively small number of the nation's poorest citizens -- under the law, they can go to a family of four with a household income of nearly $90,000 -- they will affect a huge segment of the population.
In addition, the IRS will keep track of even the smallest changes in Americans' financial condition. Did you get a raise recently? You'll need to notify the IRS; it might affect your subsidy status. Have your hours been reduced at work? Notify the IRS. Change jobs? Same.
Last August, IRS official Nina Olson testified before Congress on the changes Obamacare will bring to Americans' dealings with the nation's tax collector. "Do you believe that most Americans are going to update the IRS or state exchanges when they change jobs, get married, move states, whatever?" Michigan Republican Rep. Tim Walberg asked Olson.
"I think it's going to be a very great learning curve," Olson answered. If Americans don't keep the IRS up to date on their financial status, they might incur penalties, which the IRS will collect by withholding income tax refunds. "I think it will be a surprise to taxpayers if they don't update their information,"
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WSJ today:
A larger government always creates more openings for abuse, as Americans will learn when the IRS starts auditing their health care in addition to their 1040 next year.
"ObamaCare is "the most extensive social benefit program the IRS has been asked to implement in recent history." This March the IRS Inspector General reiterated that ObamaCare's 47 major changes to the revenue code "represent the largest set of tax law changes the IRS has had to implement in more than 20 years." Thus the IRS is playing Thelma to the Health and Human Service Department's Louise. The tax agency has requested funding for 1,954 full-time equivalent employees for its Affordable Care Act office in 2014."
"Instead of going after tax cheats, these bureaucrats will write and enforce tax regulations for parts of the economy in which they have no core competence. For example, do ski instructors or public school teachers count as seasonal workers? How long is a "full time" work week? Is it 40 hours, or 30?"
"...the IRS and HHS are now building the largest personal information database the government has ever attempted. Known as the Federal Data Services Hub, the project is taking the IRS's own records (for income and employment status) and centralizing them with information from Social Security (identity), Homeland Security (citizenship), Justice (criminal history), HHS (enrollment in entitlement programs and certain medical claims data) and state governments (residency)."
http://online.wsj.com/article/SB10001424127887324715704578481461934680982.html?mod=WSJ_Opinion_LEADTop
What could possibly go wrong?
Newt Gingrich: "Why would you trust the bureaucracy with your health if you can't trust the bureaucracy with your politics?"
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The Obama crony in charge of your medical records
By Michelle Malkin • May 22, 2013 06:43 AM
The Obama crony in charge of your medical records
by Michelle Malkin
Creators Syndicate
Copyright 2013
Who is Judy Faulkner? Chances are, you don’t know her — but her politically connected, taxpayer-subsidized electronic medical records company may very well know you. Top Obama donor and billionaire Faulkner is founder and CEO of Epic Systems, which will soon store almost half of all Americans’ health information.
If the crony odor and the potential for abuse that this “epic” arrangement poses don’t chill your bones, you ain’t paying attention.
As I first noted last year before the IRS witch hunts and DOJ journalist snooping scandals broke out, Obama’s federal electronic medical records (EMR) mandate is government malpractice at work. The stimulus law provided a whopping $19 billion in “incentives” (read: subsidies) to force hospitals and medical professionals into converting from paper to electronic record-keeping systems. Penalties kick in next year for any provider who fails to comply with the one-size-fits-all edict.
Obamacare bureaucrats claimed the government’s EMR mandate would save money and modernize health care. As of December 2012, $4 billion had already gone out to 82,535 professionals and 1,474 hospitals; a total of $6 billion will be doled out by 2016. What have taxpayers and health care consumers received in return from this boondoggle? After hyping the alleged benefits for nearly a decade, the RAND Corporation finally admitted in January that its cost-savings predictions of $81 billion a year — used repeatedly to support the Obama EMR mandate — were, um, grossly overstated.
Among many factors, the researchers blamed “lack of interoperability” of records systems for the failure to bring down costs. And that is a funny thing, because it brings us right back to Faulkner and her well-connected company. You see, Epic Systems — the dominant EMR giant in America — is notorious for its lack of interoperability. Faulkner’s closed-end system represents antiquated, hard drive-dependent software firms that refuse to share data with doctors and hospitals using alternative platforms. Health IT analyst John Moore of Chilmark Research, echoing many industry observers, wrote in April that Epic “will ultimately hinder health care organizations’ ability to rapidly innovate.”
Question: If these subsidized data-sharing systems aren’t built to share data to improve health outcomes, why exactly are we subsidizing them? And what exactly are companies like Faulkner’s doing with this enhanced power to consolidate and control Americans’ private health information? It’s a recipe for exactly the kind of abuse that’s at the heart of the IRS and DOJ scandals.
As I reported previously, a little-noticed HHS Inspector General’s report issued last fall exposed how no one is actually verifying whether the transition from paper to electronic is improving patient outcomes and health services. No one is actually guarding against GIGO (garbage in, garbage out). No one is checking whether recipients of the EMR incentives are receiving money redundantly (e.g., raking in payments when they’ve already converted to electronic records). And no one is actually protecting private data from fraud, theft or exploitation.
But while health IT experts and concerned citizens balk, money talks. Epic employees donated nearly $1 million to political parties and candidates between 1995 and 2012 — 82 percent of it to Democrats. The company’s top 10 PAC recipients are all Democratic or left-wing outfits, from the Democratic Congressional Campaign Committee (nearly $230,000) to the DNC Services Corporation (nearly $175,000) and the America’s Families First Action Fund Democratic super-PAC ($150,000). The New York Times reported in February that Epic and other large firms spent hundreds of thousands of dollars lobbying for the Obama EMR “giveaway.”
Brandon Glenn of Medical Economics observes “it’s not a coincidence” that Epic’s sales “have been skyrocketing in recent years, up to $1.2 billion in 2011, double what they were four years prior.”
It’s also no coincidence, as a famous Democratic presidential candidate once railed, that the deepest-pocketed donors “are often granted the greatest access, and access is power in Washington.” That same candidate, Barack Obama, named billionaire Democratic donor Faulkner as the only industry representative on the federal panel overseeing the $19 billion EMR “incentives” program from which her company benefits grandly.
The foxes are guarding the Obamacare henhouse. The IRS vultures are circling overhead. The shadow of tyranny and the stench of corruption are unmistakable. If you see something, say something. BOLO is our watchword.
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An Open Letter to Massachusetts Physicians,
Last summer, the Commonwealth of Massachusetts enacted legislation that will fundamentally alter the physician-patient relationship by giving politicians the right to specify the processes that must occur during an office visit. The relevant law is Section 108 of Chapter 224 of the Acts of 2012, which reads as follows:
The first paragraph of section 2 of chapter 112 of the General Laws ... is hereby amended by inserting (the following)... The board (of Registration in Medicine) shall require, as a standard of eligibility for (medical) licensure, that applicants demonstrate proficiency in the use of computerized physician order entry, e- prescribing, electronic health records and other forms of health information technology, as determined by the board. As used in this section, proficiency, at a minimum shall mean that applicants demonstrate the skills to comply with the “meaningful use” requirements. http://malegislature.gov/Laws/SessionLaws/Acts/2012/Chapter224
Thus, any Massachusetts physician who does not use a Federally certified EMR AND meet the contemporary Meaningful Use requirements will be denied a license to practice medicine effective 2015. Most unfortunately, the Meaningful Use mandates will continue to become every more onerous in Stages 2, 3, 4, 5, 6 and 7.
As we all know, the practice of medicine has become increasingly difficult as a result of external mandates. These mandates specify which medicines we may prescribe, which radiology tests we can order, how many days our patients are allowed to remain in the hospital, which CME classes we must take, etc. And now, the politicians intend to tell physicians which software they must use in their office and which EMR options must be utilized during the office visit.
The Government's decision to foist “certified” EMRs on the medical profession is predicated on the hypothesis that the widespread adoption of EMRs will eventually reduce the cost of healthcare. Unfortunately, data published to-date does not support this hypothesis. (see http:// www.antheliohealth.com/downloads/Council-EHR-commentary.pdf) Thus, the continued imposition of the EMR mandates will only delay the implementation of a truly effective solution that could reduce the cost of healthcare.
As the developer of an EMR, I sincerely believe that a well designed EMR is a useful tool for many practices. However, the Federal and State Government's misguided obsession to stipulate which features must be in the EMRs, and how the physician should use the EMRs in the exam room places the politicians in the middle of the exam room between the patient and the physician, and seriously disrupts the physician-patient relationship.
It is past time that physicians reclaim control of their offices, if not the practice of medicine.
I strongly encourage all Massachusetts physicians you to contact Governor Deval Patrick, Secretary of Health and Human Services John Polanowicz, your Massachusetts state Senator and Representative and ask them to rescind Section 108 of Chapter 224 of the Acts of 2012. Also tell the politicians to desist from interfering in the physician-patient relationship, which is a prerequisite for high quality healthcare.
Please feel free to forward this letter to your colleagues. I also encouraged you to plagiarize this letter, as needed, for your communication to your state representative.
Hayward Zwerling, M.D. FACP, FACE
HZMD@me.com
mobile: 978-407-0101
President, ComChart Medical Software, www.ComChart.com
The Lowell Diabetes & Endocrine Center, www.DiabetesEndocrine.com
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Of course all edited by the liberal politburo members of taxachussets.
Compare the hearty tugging headline with buried deep in the article is the fact that hospitals will have to eat the cost (thus try to recoup somewhere else) by billing everyone else more, or hit the states up for money.
****In 2011 alone, patients and families were spared nearly $150 million in hospital costs.
Hospital emergency room entranceBlend Images | ERproductions Ltd | Blend Images | Getty Images
(HealthDay News) -- An Affordable Care Act provision has shielded thousands of young U.S. adults and their families from millions of dollars in treatment costs for serious medical emergencies, a new study shows.
Starting in September 2010, federal health care reform has required private health plans to cover young adults up to age 25 under their parents' insurance.
More than 22,000 cases of emergency hospital treatment in 2011 involving young adults aged 19 to 25 received coverage under private plans due to the expansion, the study found. The coverage protected patients and parents from an estimated $147 million in hospital charges.
The study was published in the May 30 issue of the New England Journal of Medicine.
"Without this provision, they'd be facing hospital bills," said study author Andrew Mulcahy, a health policy researcher at RAND Health, a nonprofit research organization. "Their family might be on the hook for it. If they can't pay, as a last resort, the hospital might have to eat the cost and write it off. Ultimately, in some states, the taxpayers are on the hook because the state chips in and tries to compensate hospitals for care that is uncompensated."
The study also noted that the provision increased health insurance rates about 3 percent among the young adults who sought emergency treatment.
Recent reports have estimated that this particular provision of the Affordable Care Act has led to the coverage of an additional 3.1 million young adults nationally.
In the study, researchers examined details about emergency medical care provided to adults aged 19 to 31 at 392 hospitals from 2008 through 2011.
The study focused on injuries so severe that the young adults would have to receive emergency treatment regardless of insurance coverage, including broken bones and head injuries.
"We were very careful in looking at the most serious conditions -- conditions so serious you have to go to the ER for treatment," Mulcahy said. "This study is about real-world impact and a very direct test of whether the provision is improving financial protection."
Those sorts of injuries accounted for about 6 percent of emergency department visits by young adults, the researchers concluded.
The research team then compared the coverage of those aged 19 to 25 to patients aged 26 to 31, who were unaffected by the new health care law. That way, they could rule out other trends that might have affected the subjects' insurance coverage.
"We found that the provision resulted in increased financial protection for young adults and the hospitals who provided care for these patients," Mulcahy concluded. "We're careful to say it didn't result in additional visits. It's a shift. The provision didn't lead to more people going to the ER. They would have gone without this provision, but they would have been uninsured."
However, the RAND study's focus on nondiscretionary hospital treatment raises more questions than answers, said health economist Devon Herrick, a senior fellow at the National Center for Policy Analysis, a free-market think tank headquartered in Dallas.
"RAND is touting the financial protection provided by the Affordable Care Act, but then they say only 6 percent of these visits fall under the category of nondiscretionary," Herrick said. "The other 94 percent, to me, is the more interesting story. Are we wasting money on discretionary emergency room treatment? Are they going to the ER for trivial things that would better be left with them covering the cost rather than using their insurance?"
Herrick added that while the study notes in passing a 3 percent increase in insurance rates, it does not go into a more detailed cost-benefit analysis regarding the expanded coverage.
"What is it costing the employers' and parents' health plans, and the young adults?" he asked. "Could the same population have gotten very economical coverage on their own?"
More information
The U.S. Department of Health and Human Services has more about the Affordable Care Act.
SOURCES: Andrew Mulcahy, health policy researcher, RAND Health; Devon Herrick, health economist and senior fellow, National Center for Policy Analysis; May 30, 2013, New England Journal of Medicine
Copyright @2013 HealthDay. All Rights Reserved.****
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I might add that the NEJM has become a political tool for the politburo health care policy makers at the IVys. I believe that opposing views are more or less not printed.
Jama has also succumbed to the political pressure. In one article that was critical of the state of electronic health records and that so far they have not produced any productivity cost savings gains the author who is a IT doctor noted near the end of the article something to the effect that doctors should stop "whining" about EHR and just be glad they are a part of the "first phase" of the IT revolution in medicine. This is akin to changing the phrase global warming to climate change. All of a sudden this is the *first phase*. Now that this guy's scheme is more or less failure. Indeed this scumbag should stop whining about us, the people who are forced to put up with this and admit he has not done HIS job.
I was once asked to respond to a pre-published article about how doctors need to do more. My response was that the author was misguided. Doctors can be good caring doctors but I don't see why you are calling us to be masochistic saints. I never got a response and his article to my knowledge was never published. In any case the medical community is more a less in a reign of quiet terror trying to comply.
You think the IRS is tough?
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http://thehill.com/blogs/healthwatch/health-reform-implementation/302895-court-challenges-could-tear-down-major-pieces-of-obamacare
Court challenges could tear down major pieces of ObamaCare
President Obama’s healthcare law is under attack in the courts even as the administration sprints toward full implementation.
Despite surviving a stiff challenge at the Supreme Court last year, some of the law’s biggest provisions remain at risk from legal challenges. One set of lawsuits accuses the Internal Revenue Service of illegally implementing new subsidies to help people buy insurance. Separately, more than 60 lawsuits have been filed challenging the law’s mandate for health plans to cover birth control.
A loss for the administration on the contraception mandate would undermine a key selling point for the law that Democrats used to court women in the 2012 elections.
The challenge to the law’s insurance subsidies, while more obscure, poses a far bigger and more dangerous threat to the Affordable Care Act. Simon Lazarus, senior counsel at the Constitutional Accountability Center, has argued that there’s a very real chance the Supreme Court’s conservative majority would strike down the IRS’s approach to insurance subsidies if it gets the chance. Lazarus supports the healthcare law and believes the IRS has taken the right approach to implementing its subsidies. But it’s easy to see how the case could play out under the strict “textualist” approach championed by Justice Antonin Scalia, he said.
“One has to be concerned about that,” Lazarus said. If the Supreme Court or judges in the lower courts adopt a narrow reading of the healthcare law, the consequences could be “devastating,” Lazarus said. That’s exactly why the people behind the lawsuit think they have a real chance to win.
The healthcare law sets up new marketplaces where people can buy health insurance. Most people who use the marketplaces will be eligible for a subsidy to help pay for their premiums. The law’s challengers say subsidies should only be available to people who get insurance through a state-run marketplace. If the federal government runs a state’s marketplace — which it will in the majority of states — no subsidies should be available, the lawsuit argues. Why not? Because the text of the Affordable Care Act refers to subsidies flowing through exchanges “established by the state.” The IRS has said subsidies will be available in all 50 states, no matter who runs the exchanges. The law’s critics say that clearly contradicts the text of the statute.
“The IRS rule we are challenging is at war with the Act’s plain language and completely rewrites the deal that Congress made with the states on running these insurance exchanges,” attorney Michael Carvin said in a statement when his clients filed their challenge to the subsidies.
The law’s supporters say the context of the entire statute makes clear that Congress intended for all 50 exchanges to function the same way. “There are layers of reasons why this claim would and should be rejected,” Lazarus said.
But a judge or Supreme Court justice like Scalia could easily hone in on the “established by the state” language, making the case for “textualism” — adhering strictly to the specific words used in a statute, rather than trying to determine its intent. “It’s a way of taking one isolated provision of a statute and just reading that one provision,” Lazarus said. Lazarus has been urging the left to focus aggressively on the subsidies challenge, even though the lawsuits are still in their early stages.
Two suits have been filed challenging the subsidies; neither has gotten a hearing yet in court. There’s a chance the cases would have to wait until at least next year, for procedural reasons. Although they don’t believe the suits stand much chance of success, some supporters of the healthcare law believe their side lost the public relations battle over the Supreme Court’s ObamaCare case, in part because liberal academics didn’t take the challenge seriously.
“However such maneuvers play out in court, the administration and its allies need to play their game out of court as well. Specifically, they need to not repeat their near-death experience with the individual mandate challenge, when they left their adversaries free to frame the legal issues, unanswered, for the media, politicians, and the public,” Lazarus wrote in a recent op-ed.
The more immediate legal threat to the Affordable Care Act comes from challenges to its birth control mandate.
The contraception mandate is a relatively small part of the overall healthcare law, but it is a major talking point for the White House. Obama focused extensively on the birth-control mandate during the 2012 campaign, and Democrats made the policy a cornerstone of their aggressive pitch to female voters. An eventual Supreme Court decision on the contraception policy might not have huge implications for the rest of the healthcare law, but it would be politically explosive.
Two federal appeals courts have heard oral arguments over the contraception policy, and challengers have filed 60 lawsuits in courts across the country. The plaintiffs, most of whom are business owners, say the policy violates their First Amendment right to religious liberty by forcing them to provide a service they find immoral. The Obama administration has given an exemption to churches and houses of worship, and has carved out a middle ground for religious-affiliated employers like Catholic hospitals and universities.
For-profit companies are also challenging the policy. Those cases have moved faster, and though courts have been split on the issue, several have questioned whether business owners can invoke religious liberty over healthcare plans they don’t provide personally, but rather through their companies.
The 3rd Circuit Court of Appeals heard a case this week filed by a cabinet-making company whose owners object to providing contraception. The lower court in that case sided against the company, saying religious liberty belongs to people — not corporations. "Religious belief takes shape within the minds and hearts of individuals, and its protection is one of the more uniquely 'human' rights provided by the Constitution,” the lower court said.
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http://www.forbes.com/sites/theapothecary/2013/06/03/democrats-new-argument-its-a-good-thing-that-obamacare-doubles-individual-health-insurance-premiums/?partner=yahootix
http://www.washingtontimes.com/news/2013/may/2/south-carolina-house-passes-bill-making-obamacare-/
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Couple of thoughts. I don't really know if this is true or not. I've posted before there absolutely is no shortage of doctors in urban areas though the same is not true in many rural areas. Also the source of these numbers stands to gain big from reporting this. There bread and butter is more medical school slots. They along with many other medical organizations have a profound self interest. Frankly I don't trust them. OF course they are going to say we need more. It is like a Democrat politician saying we need more taxes. It is never enough. Don't forget that many physicians come here from other countries. By the thousands every year. Ultimately nurse practitioners will continue to take over primary care and will eventually supplant physician roles in this. It is inevitable.
There are even some who say that certain procedures need no longer be done by doctors. Like colonoscopies. Why not just have techs trained to do these for a lot less money?
http://wallstcheatsheet.com/stocks/does-obamacare-mean-fewer-doctors-and-less-accessible-healthcare.html/?a=viewall
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Can England's NHS Survive?
Nicholas Black, M.D.
June 19, 2013DOI: 10.1056/NEJMp1305771
The past few months have witnessed the most intense and prolonged criticism of England's National Health Service (NHS) in its 65-year history. Some critics have suggested that the NHS faces a crisis that can be resolved only by altering the fundamental principle on which it was founded — provision of funding from general taxation, with care being free at the point of use. Although the criticism was sparked by a February report on an inquiry into shortcomings at one hospital,1 the problems originated in 2010, when two profound forces were unleashed on the NHS: public-sector financial austerity and administrative reorganization. Together, these three factors have created the current turmoil.
Never before has the NHS had to cope with no increase in funding for a sustained period. With rising demand, the NHS is required to improve its productivity at an unprecedented rate of 4% per year.2 The government is convinced that to achieve this improvement, two fundamental changes are needed.
The first concerns the local commissioning organizations that are responsible for purchasing hospital and community services for their geographically defined populations of 200,000 to 1 million people. The 151 existing administrative bodies called Primary Care Trusts, which were led by nonclinical managers, have been replaced by 212 Clinical Commissioning Groups that are led by primary care doctors (general practitioners [GPs]) who, the government believes, will be more effective in controlling the use of the £60 billion (approximately $90 billion) spent on secondary and community care services. (Spending on tertiary care — £20 billion [$30 billion] — will be managed at a national level by a new entity called NHS England.) The second means of achieving better productivity is by increasing the competition among providers of hospital and community services through the greater use of non-NHS providers (including private for-profit, not-for-profit, and charity or volunteer organizations).
Prolonged financial stringency and a reorganization were challenging enough without a high-profile report suggesting that NHS hospitals may not be safe.1 The Francis Report on the inquiry into the Mid Staffordshire NHS Foundation Trust told a sad and troubling story of a hospital in which the humanity of care in some wards was appalling and in which the proportion of deaths deemed avoidable may have been higher than the 5% observed elsewhere in England and in other high-income countries. Despite uncertainty about the appropriateness of allowing public inquiries to influence policy,3 the government has responded by announcing several initiatives:
commitment to a simple single rating of the quality of a hospital (despite the fact that an independent expert review panel established by the government offered no encouragement for taking this approach4); a review of 14 other hospitals considered “suspect” on the basis of their standardized mortality ratios (despite the lack of validity of this measure5); a review of patient safety in the NHS, chaired by Donald Berwick; and the creation of a position for a chief inspector of hospitals to strengthen the existing quality regulator, the Care Quality Commission (despite a lack of evidence that regulation and inspection are effective mechanisms for improvement).
For the NHS to survive in its present form, it will need to overcome four formidable challenges. The first is financial constraint. Although the government claims to be maintaining funding in real terms, high rates of inflation in health care plus some financial maneuvers, such as withholding from the NHS any funds in its budget that it hasn't spent, mean there has been an actual funding reduction of almost 1% per year since 2011. Of greater concern is that social services have undergone a substantial cut of about 7% per year since 2011, which is resulting in more emergency admissions to hospitals and delays in discharges. These problems will be exacerbated if the new GP-led commissioners succeed in shifting some care from hospitals to more appropriate settings, since such a shift will further reduce the funds that hospitals receive. And overshadowing all these funding issues, the government's policy of protecting the level of health care spending is increasingly being questioned in Parliament by backbench members of the ruling party (i.e., those who do not occupy positions in government) who are unhappy about the repercussions that this protection has for other spending areas, such as defense and law enforcement. The final note of gloom is the growing realization that financial austerity seems to be set to continue beyond 2015.
The second challenge is that the NHS may face opposition to its attempts to improve productivity. During the first 2 years of austerity, improvement was achieved mostly by freezing (or even reducing) staff pay, a policy that will not be sustainable. Similarly, driving down prices paid to suppliers for consumables cannot be extended indefinitely. In addition, professionals may oppose changes in working arrangements, such as requirements that hospital doctors work in the evenings and on weekends to boost the intensity of use of hospital facilities. But it's the more major initiatives to improve productivity, such as merging, downgrading, or closing hospitals, that will meet with the greatest opposition — not only from staff and the public, but also from politicians concerned about being reelected. And in the brave new world of markets, opposition to structural changes will even come from the economic regulator seeking to ensure that competition is maintained, regardless of its effect on the quality of care.
The third challenge is a lack of managerial capacity, stemming largely from the government's imposition of a reorganization that had little support from key staff members. This problem has been exacerbated by widespread criticism of managers, in the wake of the Francis Report, by members of the public, the media, and politicians. Although criticisms of some clinical and managerial staff were justified, wholesale condemnation was inappropriate and has contributed to the departure of some excellent managers (particularly when generous retirement options were available). The loss of managers is particularly apparent in the commissioning arena, where the effects will be intensified by the shifting of responsibility to GPs, most of whom will initially lack appropriate experience and training. Although they will receive technical help, it is unclear whether the initial enthusiasm of those GPs who have opted to take on this role will last. The honeymoon might end when GPs realize how uncomfortable it can be to ration care to patients and reduce funds for their local hospital.
Finally, there is concern that the way the NHS has been reorganized will impede attempts to achieve greater integration of services across health care and with social services — integration that is essential to achieving efficient, high-quality care.
So, will the NHS survive these challenges? There are three reasons for optimism. First, there are already examples of enterprising clinicians, managers, and politicians working together to reengineer their local services in imaginative ways. Second, despite legitimate concerns about the quality of some services, public support for the NHS is undiminished, as witnessed by the inclusion of a celebration of the NHS in the Olympics opening ceremony last July and as reflected in national surveys. Public enthusiasm is mirrored not only by that of most clinicians and managers but also by the majority of politicians (including the current government, even if not by all its backbenchers). Though partly ideological, such support reflects the steady annual improvements in the NHS's effectiveness and safety seen in recent years. And third, turmoil provides an opportunity for innovation. It can produce collective efforts in which factional interests are set aside and long-standing controversial issues, such as bringing health care and social services closer together (even by combining their budgets into one), are finally addressed.
Although some of the challenges in England are unique, the underlying problem of meeting rising demand for care with steady or diminishing resources is faced by many countries. Just as we can learn from other health care systems, our experiences over the next few years in redesigning the organization and delivery of services will undoubtedly provide lessons for others.
Disclosure forms provided by the author are available with the full text of this article at NEJM.org.
This article was published on June 19, 2013, at NEJM.org.
Source Information
From the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London.
References
References
1. 1
Report of the Mid Staffordshire NHS Foundation Trust public inquiry (Robert Francis, chair). Staffordshire, United Kingdom: Mid Staffordshire NHS Foundation Trust, February 2013.
2. 2
Roberts A, Marshall L, Charlesworth A. A decade of austerity? The funding pressures facing the NHS from 2010/11 to 2021/22. London: Nuffield Trust, December 2012.
3. 3
Black N, Mays N. Public inquiries into health care in the UK: a sound basis for policy-making? J Health Serv Res Policy 2013;18:129-130
4. 4
Rating providers for quality: a policy worth pursuing? London: Nuffield Trust, March 2013.
5. 5
Shahian DM, Wolf RE, Iezzoni LI, Kirle L, Normand S-LT. Variability in the measurement of hospital-wide mortality rates. N Engl J Med 2010;363:2530-2539[Erratum, N Engl J Med 2011;364:1382.]
Free Full Text | Web of Science | Medline
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second post
By DAVID B. RIVKIN JR. And ELIZABETH P. FOLEY
Signs of ObamaCare's failings mount daily, including soaring insurance costs, looming provider shortages and inadequate insurance exchanges. Yet the law's most disturbing feature may be the Independent Payment Advisory Board. The IPAB, sometimes called a "death panel," threatens both the Medicare program and the Constitution's separation of powers. At a time when many Americans have been unsettled by abuses at the Internal Revenue Service and Justice Department, the introduction of a powerful and largely unaccountable board into health care merits special scrutiny.
For a vivid illustration of the extent to which life-and-death medical decisions have already been usurped by government bureaucrats, consider the recent refusal by Health and Human Services Secretary Kathleen Sebelius to waive the rules barring access by 10-year old Sarah Murnaghan to the adult lung-transplant list. A judge ultimately intervened and Sarah received a lifesaving transplant June 12. But the grip of the bureaucracy will clamp much harder once the Independent Payment Advisory Board gets going in the next two years.
The board, which will control more than a half-trillion dollars of federal spending annually, is directed to "develop detailed and specific proposals related to the Medicare program," including proposals cutting Medicare spending below a statutorily prescribed level. In addition, the board is encouraged to make rules "related to" Medicare.
The ObamaCare law also stipulates that there "shall be no administrative or judicial review" of the board's decisions. Its members will be nearly untouchable, too. They will be presidentially nominated and Senate-confirmed, but after that they can only be fired for "neglect of duty or malfeasance in office."
Once the board acts, its decisions can be overruled only by Congress, and only through unprecedented and constitutionally dubious legislative procedures—featuring restricted debate, short deadlines for actions by congressional committees and other steps of the process, and supermajoritarian voting requirements. The law allows Congress to kill the otherwise inextirpable board only by a three-fifths supermajority, and only by a vote that takes place in 2017 between Jan. 1 and Aug. 15. If the board fails to implement cuts, all of its powers are to be exercised by HHS Secretary Sebelius or her successor.
The IPAB's godlike powers are not accidental. Its goal, conspicuously proclaimed by the Obama administration, is to control Medicare spending in ways that are insulated from the political process.
This wholesale transfer of power is at odds with the Constitution's separation-of-powers architecture that protects individual liberty by preventing an undue aggregation of government power in a single entity. Instead, power is diffused both vertically—with the federal government exercising limited and enumerated powers and the states exercising all remaining authority—and horizontally, with the powers of the federal government divided among the executive, legislative and judicial branches.
This diffusion of power advances another key liberty-enhancing constitutional requirement: accountability. Accountability enables the people to know what government entity is affecting them, so that they can hold officials responsible at the polls. Congress can also hold the executive responsible through oversight and measures like impeachment.
As Chief Justice John Marshall observed in Wayman v. Southard (1825), Congress may delegate tasks to other bodies, but there is a fundamental constitutional difference between letting them "fill up the details" of a statute versus deciding "important subjects," which "must be entirely regulated by the legislature itself." Distinguishing between the two, the court said, requires an inquiry into the extent of the power given to the administrative body.
The power given by Congress to the Independent Payment Advisory Board is breathtaking. Congress has willingly abandoned its power to make tough spending decisions (how and where to cut) to an unaccountable board that neither the legislative branch nor the president can control. The law has also entrenched the board's decisions to an unprecedented degree.
In Mistretta v. United States (1989), the Supreme Court emphasized that, in seeking assistance to fill in details not spelled out in the law, Congress must lay down an "intelligible principle" that "confine the discretion of the authorities to whom Congress has delegated power." The "intelligible principle" test ensures accountability by demanding that Congress take responsibility for fundamental policy decisions.
The IPAB is guided by no such intelligible principle. ObamaCare mandates that the board impose deep Medicare cuts, while simultaneously forbidding it to ration care. Reducing payments to doctors, hospitals and other health-care providers may cause them to limit or stop accepting Medicare patients, or even to close shop.
These actions will limit seniors' access to care, causing them to wait longer or forego care—the essence of rationing. ObamaCare's commands to the board are thus inherently contradictory and, consequently, unintelligible.
Moreover, authorizing the advisory board to make rules "relating to" Medicare gives the board virtually limitless power of the kind hitherto exercised by Congress. For instance, the board could decide to make cuts beyond the statutory target. It could mandate that providers expand benefits without additional payment. It could require that insurers or gynecologists make abortion services available to all their patients as a condition of doing business with Medicare, or that drug companies set aside a certain percentage of Medicare-related revenues to fund "prescription drug affordability." There is no limit.
If the Independent Payment Advisory Board exercises these vast powers, political accountability will vanish. When constituents angrily protest, Congress, having ceded its core legislative power to another body, will likely just throw up its hands and blame the board.
Since ObamaCare eliminates both judicial review for any of the board's decisions and public-participation requirements for rule making, this unprecedented insulation of the board guts due process. Even the president's limited ability to check the board's power—since he can remove members only for neglect or malfeasance—represents a more circumscribed standard than usual for presidential appointees.
The bottom line is that the Independent Payment Advisory Board isn't a typical executive agency. It's a new beast that exercises both executive and legislative power but can't be controlled by either branch. Seniors and providers hit hardest by the board's decisions will have nowhere to turn for relief—not Congress, not the president, not the courts.
Attempts to rein in government spending are laudable, but basic decisions about how and where to cut spending properly belong to Congress. In the 225 years of constitutional history, there has been no government entity that violated the separation-of-powers principle like the Independent Payment Advisory Board does.
While the board is profoundly unconstitutional, it is designed to operate in a way that makes it difficult to find private parties with standing to challenge it for at least its first several years in operation. An immediate legal challenge by Congress might be possible, but also faces standing difficulties. Unless and until courts rule on IPAB's constitutionality, Congress should act quickly to repeal this particular portion of ObamaCare or defund its operations.
Mr. Rivkin, a partner at Baker Hostetler LLP, served in the Justice Department under Presidents Reagan and George H.W. Bush and represented 26 states in challenging ObamaCare. Ms. Foley is a professor of constitutional law at Florida International University and the author of "The Law of Life & Death" (Harvard, 2011).
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Gallup found that more than four in 10 companies have frozen hiring because of Obama-Care, and almost one in five have cut workers to minimize the cost of the law.
Another 38% said they'd "pulled back on their plans to grow their business."
http://news.investors.com/ibd-editorials/062113-661003-obamacare-hurting-hiring-jobs-work-hours.htm
The biggest job growth categories are now temp and part time.
"local governments across the country have been cutting part-time hours to 29 or fewer a week so they can avoid ObamaCare as much as possible"
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Did ANYONE see this coming?
http://dogbrothers.com/phpBB2/index.php?topic=1791.msg68932#msg68932
"Why France Has So Many 49-Employee Companies
http://www.businessweek.com/articles/2012-05-03/why-france-has-so-many-49-employee-companies
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"The ACA requires businesses with 50 or more employees to offer “affordable” insurance to anyone working 30 or more hours per week—which must cost no more than 9.5 percent of the worker’s household income. In addition, businesses must also provide insurance for dependents, though potentially at an additional cost to the employee."
http://inthesetimes.com/article/15092/obamacare_how_it_could_flatline/
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From where I sit the only reason health care spending is down is because so many people are hurt by the economy they can't afford even the copays. Around here every doctor I know states their census is down "15%". Obama care has NOTHING to do with this. It is the poor economy.
Yet we are being lied to. :wink:
As an older primary care doctor I wish the following as true but I know it is not. Primary care will be taken over by nurse practitioners. It is a done deal. The only thing remaining is the political battle between pharmacists, nursing organizations and doctor organizations. For now NPs will jockey themselves upwards for positions once filled by MDs. For now they will sell they are cheaper to the politicians. As they gain power they will start demanding more money the same as us. Done deal. Christiansen certainly was right. Classic disruption. No chance at stopping it. The medical organizations still are in denial. Eventually NPs will slither into specialties too. I predict that. I am ahead of the ball on that to my knowledge.
For everyone else you will get a somewhat lower level of care. For most simple stuff in primary care it doesn't make a lot of difference but for the increasing complicated stuff it does.
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****Reverse the Doctor Shortage by Restoring Primary-Care Prestige (Op-Ed)
LiveScience.comBy Dr. Bruce Koeppen, Quinnipiac University | LiveScience.com – 18 hrs ago..
Dr. Bruce Koeppen is founding dean of the Frank H. Netter MD School of Medicine at Quinnipiac University. He contributed this article to LiveScience's Expert Voices: Op-Ed & Insights.
The United States currently faces a growing physician shortage. While this shortage is across many of the specialties and subspecialties of medicine, it is most acute in the primary-care disciplines, traditionally defined as family medicine, general internal medicine and general pediatrics. As medical educators, we must tackle the challenge of restoring the prestige of a career in primary care.
It is quite an undertaking. Fewer students enter medical school with an eye toward a career in primary-care medicine, and many of those who do often change their mind as they go through training.
The reasons for students' decisions vary, and include perceptions that primary-care medicine is less prestigious than subspecialty medicine, that the knowledge base to be mastered is too broad, that the lifestyle (being on call) is too demanding and that the work-patient interactions are not interesting. Earnings potential may be a factor for some, but for the majority of students, I believe the other factors are more important.
If we are to reverse the trend of fewer medical students choosing careers in primary care, we must address the aforementioned perceptions and change the environment in which primary-care physicians are trained.
The goal of effective primary care is to keep patients out of hospitals . Yet residency training in the primary-care disciplines occurs predominantly in acute-care facilities. It is no wonder that resident physicians surrounded by specialists in this working and learning environment change their minds and pursue careers in subspecialties.
Primary care is delivered outside hospitals, and residency training for primary-care disciplines must also take place, predominately, outside hospitals. The Affordable Care Act provides grants to establish "Teaching Health Centers," environments in which exactly that kind of training takes place. We need to learn from these Teaching Health Centers, expand them and provide new training sites with stable funding beyond the term of these initial grants.
The latest trend in primary-care delivery is the patient-centered medical home, in which teams of health professionals — consisting of physicians, nurse practitioners, physician assistants, physical and occupational therapists, social workers, mental-health counselors, and nutritionists — take care of patients. As delivery of care moves from the traditional solo-practice model to patient-centered medical homes, the perceptions of what it means to be a primary-care physician will change.
In the medical-home model, each professional brings specific expertise to the care of the patient, freeing physicians to focus on aspects of patient care that require their expertise. With each member of the team practicing at the "top of their training," the result is an exciting and fulfilling work environment for all. Most importantly, patients receive better-coordinated, higher-quality care. Done right, this model will lower total health care costs by keeping patients well longer.
Through changes in both training and work environments, I believe we will see more medical students choosing careers in a primary-care discipline that they will find professionally fulfilling. Changes in the reimbursement system for primary-care services will also help.
I believe this is an exciting time to be a primary-care physician. If the U.S. can make the necessary changes, its health care system will be a better place for everyone — the workforce will be happier and more productive, and patients will stay healthier longer.****
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http://www.forbes.com/sites/theapothecary/2013/06/23/even-in-over-regulated-washington-state-obamacare-will-increase-individual-market-premiums-by-34-80-percent/
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http://thehill.com/blogs/healthwatch/health-reform-implementation/309003-obamacares-employer-mandate-delayed
From the article:
The ObamaCare employer mandate requiring businesses to provide their workers with health insurance will be delayed by a year, the administration said Tuesday in a stunning announcement.
Delaying the requirement until 2015 is an enormous victory for businesses that had lobbied against the healthcare law.
It also means that one of healthcare reform’s central requirements will be implemented after the 2014 midterm elections, when the GOP is likely to use the Affordable Care Act as a vehicle to attack vulnerable Democrats.
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Why?
http://thehill.com/blogs/healthwatch/health-reform-implementation/309003-obamacares-employer-mandate-delayed
From the article:
The ObamaCare employer mandate requiring businesses to provide their workers with health insurance will be delayed by a year, the administration said Tuesday in a stunning announcement.
Delaying the requirement until 2015 is an enormous victory for businesses that had lobbied against the healthcare law.
It also means that one of healthcare reform’s central requirements will be implemented after the 2014 midterm elections, when the GOP is likely to use the Affordable Care Act as a vehicle to attack vulnerable Democrats.
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Great quotes:
IOWAHAWK: You know who really feels stupid right now? All those people who bribed the White House for Obamacare waivers. Suckers!
Kristina Ribali@KristinaRibali
Obamacare was so popular it had to be passed in the dead of night and delayed until after two elections.
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George Will today:
Although the Constitution has no Article VIII, the administration acts as though there is one that reads: “Notwithstanding all that stuff in other articles about how laws are made, if a president finds a law politically inconvenient, he can simply post on the White House Web site a notice saying: Never mind.”
Never mind that the law stipulates 2014 as the year when employers with 50 full-time workers are mandated to offer them health-care coverage or pay fines. Instead, 2015 will be the year. Unless Democrats see a presidential election coming.
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Hey Obama – why couldn’t a Republican President delay all of Obamacare for 10,000 years?
As the Obamacare law is written, the employer mandate is to begin in January 2014. This is what the law said when it was passed by the House and Senate, and signed by President Obama in 2010.
However, it has been reported that President Obama has just delayed the employer mandate part of Obamacare until January 2015. Obama did this without approval from Congress.
It was Obama himself who delayed part of Obamacare for one year. If Obama can do this, I would love to hear him explain why a Republican President could not delay all of Obamacare for 10,000 years.
http://danfromsquirrelhill.wordpress.com/
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I find this very hard to believe this is NOT political. A "glitch". Give me a break. Everyone knows there are far more smokers on the lower non-taxpaying socioeconomic side of the voting spectrum.
This appears to be just another Democrat party thing.
******A break for smokers? Glitch may limit penalties
FILE - In this June 11, 2007 file photo, Helen Heinlo smokes outside of a coffee shop in Belmont, Calif. Some smokers trying to get coverage in 2014 under President Barack Obama’s health care law may get a break from tobacco-use penalties that could have made their premiums unaffordable. The Obama administration _ in yet another health care overhaul delay _ has quietly notified insurers that a computer system glitch will limit penalties that the law says the companies may charge smokers. A fix will take at least a year to put in place. (AP Photo/Paul Sakuma, File)
Associated Press
Ricardo Alonso-Zaldivar, Associated Press 31 minutes ago Barack Obama
WASHINGTON (AP) -- Some smokers trying to get coverage next year under President Barack Obama's health care law may get a break from tobacco-use penalties that could have made their premiums unaffordable.
The Obama administration — in yet another health care overhaul delay — has quietly notified insurers that a computer system glitch will limit penalties that the law says the companies may charge smokers. A fix will take at least a year to put in place.
Older smokers are more likely to benefit from the glitch, experts say. But depending on how insurers respond to it, it's also possible that younger smokers could wind up facing higher penalties than they otherwise would have.
Some see an emerging pattern of last-minute switches and delays as the administration scrambles to prepare the Oct. 1 launch of new health insurance markets. People who don't have coverage on the job will be able to shop for private insurance, with tax credits to help pay premiums. Small businesses will have their own insurance markets.
Last week, the White House unexpectedly announced a one-year postponement of a major provision in the law that requires larger employers to offer coverage or face fines. Officials cited the complexity of the requirement as well as a desire to address complaints from employers.
"This was an administration that was telling us everything was under control," health care industry consultant Robert Laszewski said. "Everything was going to be fine. Suddenly this kind of stuff is cropping up every few days."
A June 28 Health and Human Services Department document couched the smokers' glitch in technical language:
"Because of a system limitation ... the system currently cannot process a premium for a 65-year-old smoker that is ... more than three times the premium of a 21-year-old smoker," the industry guidance said.
If an insurer tries to charge more, "the submission of the (insurer) will be rejected by the system," it added.
Starting in 2014, the law requires insurance companies to accept all applicants regardless of pre-existing medical problems. But it also allows them to charge smokers up to 50 percent higher premiums — a way for insurers to ward off bad risks.
For an older smoker, the cost of the full penalty could be prohibitive.
Premiums for a standard "silver" insurance plan would be about $9,000 a year for a 64-year-old non-smoker, according to the online Kaiser Health Reform Subsidy Calculator. That's before any tax credits, available on a sliding scale based on income.
For a smoker of the same age, the full 50 percent penalty would add more than $4,500 to the cost of the policy, bringing it to nearly $13,600. And tax credits can't be used to offset the penalty.
The underlying reason for the glitch is another provision in the health care law that says insurers can't charge older customers more than three times what they charge the youngest adults in the pool. The government's computer system has been unable to accommodate the two. So younger smokers and older smokers must be charged the same penalty, or the system will kick it out.
That's not what insurers had expected. Before the glitch popped up, experts said the companies would probably charge lower penalties for younger smokers, and higher penalties for older ones.
"Generally a 20-year-old who smokes probably doesn't have much higher health costs than someone who doesn't smoke in any given year," said Larry Levitt, an insurance market expert with the nonpartisan Kaiser Family Foundation. "A 60-year-old is another story."
The administration is suggesting that insurers limit the penalties across all age groups. The HHS guidance document used the example of a 20 percent penalty.
In that case the premium for a 64-year-old would be about $10,900, a significant cut from the $13,600 if insurers charged the full penalty.
It's unclear what insurance companies will do. A spokesman for America's Health Insurance Plans, the main industry trade group, said insurers were aware of the issue and expected the administration would fix it eventually.
Another workaround for the companies would be to charge the full penalty to both younger and older smokers. In that case, there wouldn't be any savings for older smokers, and younger ones would see a big price shock.
Levitt said he suspects insurers would keep the penalties low to sign up more young people. Laszweski said he thought they would do the opposite.
"It's going to throw cold water on efforts to get younger people to sign up," he said.
Workers covered through job-based health plans would be able to avoid tobacco penalties by joining smoking cessation programs because employer plans operate under different rules. But experts say that option is not guaranteed to smokers trying to purchase coverage individually. *****
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Obvious question: If Obamacare implementation is taking longer than expected, isn't it also costing more than expected? Isn't that against the law? lol
http://townhall.com/tipsheet/guybenson/2013/07/09/report-white-house-has-known-obamacare-implementation-would-collapse-for-months-n1637123
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12 percent support implementing ObamaCare’s individual mandate
http://www.healthpocket.com/healthcare-research/surveys/people-wanting-obamacare-penalty-waived-outnumber-supporters-three-to-one#.Ud8J_6xHddj
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Why the President's ObamaCare Maneuver May Backfire
By postponing the employer mandate, Obama has given millions of Americans the legal standing to sue.
By DAVID B. RIVKIN JR.and LEE A. CASEY
President Obama's announcement on July 2 that he is suspending the Affordable Care Act's employer health-insurance mandate may well have exposed his actions to judicial review—even though that is clearly what he sought to avoid.
The health-care reform law's employer mandate requires businesses with more than 50 employees to provide a congressionally prescribed set of health-insurance benefits or pay a penalty calculated at about $2,000 per employee. The law was to take effect on Jan. 1, 2014, but Mr. Obama has "postponed" its application until 2015. His aim, the administration said, was to give employers more time to comply with the new rules. But it was also seen as a way to avoid paying at least part of ObamaCare's mounting political price in the 2014 congressional elections.
Whatever the reason, the president does not have the power to stop the implementation of a law. If there is one bedrock constitutional legal principle, it is that the president must "faithfully execute" federal statutes. He cannot suspend laws he dislikes on policy grounds or because he fears their political consequences.
U.S. President Barack Obama speaks about Affordable Care Act at The Fairmont Hotel on June 6, 2013 in San Jose, California.
Mr. Obama, however, has made a habit of exercising an unlawful suspending power, refusing to enforce selected federal laws, including various provisions of the immigration laws against young, undocumented aliens; work requirements enacted as part of the 1996 federal welfare reform law; and the testing accountability provisions of the No Child Left Behind education law.
One key problem with suspension power—aside from the fact that it destroys the balance of power between the two political branches—is that, when skillfully exercised, it sidelines the judiciary. The Constitution requires that a party commencing litigation must have what is commonly called "standing," i.e., the party must have suffered or will suffer a legal injury that a court can redress. A determined president can head off litigation by effectively rewriting federal statutes in ways that do not create individual injuries so no party has standing.
By suspending the Affordable Care Act's employer insurance mandate, however, the president has potentially given millions of Americans the necessary standing to challenge his conduct. This is because the Affordable Care Act is a highly integrated law, with many of its key provisions dependent on each other. In addition to the employer mandate, the law also contains an "individual mandate," requiring most Americans to sign up for a required level of health-insurance coverage or pay a penalty.
The individual mandate was one of the core parts of the Affordable Care Act considered by the Supreme Court in the 2012 case of NFIB v. Sebelius, where the court upheld the statute against constitutional attack. Throughout that litigation, the Obama administration portrayed the individual mandate as an "integral part of a comprehensive scheme of economic regulation" that included the employer insurance mandate, which was intended to give millions of Americans a way of meeting their new obligation to have health insurance. In other words, suspending the employer insurance mandate prevents the individual insurance mandate from working the way Congress intended.
Like the employer mandate, the individual mandate by law will take effect in January 2014 (unless the president postpones that as well). Individuals who will then have to buy their own health insurance will arguably have suffered an injury sufficient to give them standing to sue.
Once in court, these litigants can argue that the very integrated nature of the Affordable Care Act would make it unlawful to apply one part against them, while suspending another section. They can also argue that only Congress can determine whether, once a statute is fundamentally changed post-enactment, it should survive or fall.
This inquiry usually arises when courts, having invalidated on constitutional grounds part of a statute, must determine whether or not Congress would have wanted the valid remaining parts of the law to remain in effect. The relevant constitutional doctrine is called "severability."
As the Supreme Court noted in the leading severability case, Ayotte v. Planned Parenthood of Northern New England (2006), the ultimate fate of the revised statute is decided based on the "legislative intent." In the case of the Affordable Care Act, if the courts were, for example, to determine that the employer insurance mandate is unconstitutional, the well-established severability analysis would lead them to conclude that the individual mandate (and likely the entire law) must also fall because Congress did not intend those provisions to operate in the absence of the employer insurance mandate. The president's suspension of that part of the law, therefore, should also produce the same result, rendering the remainder of the statute unenforceable.
This argument should find favor with judges who are weary of the use of suspension power that improperly aggrandizes presidential authority, diminishes congressional power, and denies the judiciary an opportunity to have its say. Courts would have to conclude that the whole statute must fall while the president's suspension is in effect. While reaching this conclusion, they might also declare the suspension itself unconstitutional. Both results would mark a significant win for the American people.
—Messrs. Rivkin and Casey are lawyers in the Washington, D.C., office of Baker & Hostetler LLP. They pioneered the constitutional arguments against the individual mandate and represented 26 states in challenging ObamaCare before the trial and appellate courts.
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Health Plan Cost for New Yorkers Set to Fall 50%
By RONI CARYN RABIN and REED ABELSON
Published: July 16, 2013 782 Comments
Individuals buying health insurance on their own will see their premiums tumble next year in New York State as changes under the federal health care law take effect, Gov. Andrew M. Cuomo announced on Wednesday.
State insurance regulators say they have approved rates for 2014 that are at least 50 percent lower on average than those currently available in New York. Beginning in October, individuals in New York City who now pay $1,000 a month or more for coverage will be able to shop for health insurance for as little as $308 monthly. With federal subsidies, the cost will be even lower.
Supporters of the new health care law, the Affordable Care Act, credited the drop in rates to the online purchasing exchanges the law created, which they say are spurring competition among insurers that are anticipating an influx of new customers. The law requires that an exchange be started in every state.
“Health insurance has suddenly become affordable in New York,” said Elisabeth Benjamin, vice president for health initiatives with the Community Service Society of New York. “It’s not bargain-basement prices, but we’re going from Bergdorf’s to Filene’s here.”
“The extraordinary decline in New York’s insurance rates for individual consumers demonstrates the profound promise of the Affordable Care Act,” she added.
Administration officials, long confronted by Republicans and other critics of President Obama’s signature law, were quick to add New York to the list of states that appear to be successfully carrying out the law and setting up exchanges.
“We’re seeing in New York what we’ve seen in other states like California and Oregon — that competition and transparency in the marketplaces are leading to affordable and new choices for families,” said Joanne Peters, a spokeswoman for the Department of Health and Human Services.
The new premium rates do not affect a majority of New Yorkers, who receive insurance through their employers, only those who must purchase it on their own. Because the cost of individual coverage has soared, only 17,000 New Yorkers currently buy insurance on their own. About 2.6 million are uninsured in New York State.
State officials estimate as many as 615,000 individuals will buy health insurance on their own in the first few years the health law is in effect. In addition to lower premiums, about three-quarters of those people will be eligible for the subsidies available to lower-income individuals.
“New York’s health benefits exchange will offer the type of real competition that helps drive down health insurance costs for consumers and businesses,” said Mr. Cuomo.
The plans to be offered on the exchanges all meet certain basic requirements, as laid out in the law, but are in four categories from most generous to least: platinum, gold, silver and bronze. An individual with annual income of $17,000 will pay about $55 a month for a silver plan, state regulators said. A person with a $20,000 income will pay about $85 a month for a silver plan, while someone earning $25,000 will pay about $145 a month for a silver plan.
The least expensive plans, some offered by newcomers to the market, may not offer wide access to hospitals and doctors, experts said.
While the rates will fall over all, apples-to-apples comparisons are impossible from this year to next because all of the plans are essentially new insurance products.
The rates for small businesses, which are considerably lower than for individuals, will not fall as precipitously. But small businesses will be eligible for tax credits, and the exchanges will make it easier for them to select a plan. Roughly 15,000 plans are available today to small businesses, and choosing among them is particularly challenging.
“Where New York previously had a dizzying array of thousands upon thousands of plans, small businesses will now be able to truly comparison-shop for the best prices,” said Benjamin M. Lawsky, the state’s top financial regulator.
Officials at the state Department of Financial Services say they have approved 17 insurers to sell individual coverage through the New York exchange, including eight that are just entering the state’s commercial market. Many of these are insurers specializing in Medicaid plans that cater to low-income individuals.
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North Shore-LIJ Health System, the large hospital system on Long Island, intends to offer a health plan for individuals as well as businesses for the first time. Some of the state’s best-known insurers, UnitedHealth Group and WellPoint, are also expected to participate. Insurers may decline to participate after they receive approval for their rates, but this is unlikely.
For years, New York has represented much that can go wrong with insurance markets. The state required insurers to cover everyone regardless of pre-existing conditions, but did not require everyone to purchase insurance — a feature of the new health care law — and did not offer generous subsidies so people could afford coverage.
With no ability to persuade the young and the healthy to buy policies, the state’s premiums have long been among the highest in the nation. “If there was any state that the A.C.A. could bring rates down, it was New York,” said Timothy Jost, a law professor at Washington and Lee University who closely follows the federal law.
Mr. Jost and other policy experts say the new health exchanges appear to be creating sufficient competition, particularly in states that have embraced the exchanges and are trying to create a marketplace that allows consumers to shop easily.
“That’s a very different dynamic for these companies, and it’s prodding them to be more aggressive and competitive in their pricing,” said Sabrina Corlette, a professor at Georgetown University’s Center on Health Insurance Reform.
But some consumers may still find the prices and plans disappointing. Jerry Ball, 46, who owns a recycling business in Queens, said the cost of covering his family increased so rapidly in the last few years that he had to scale back their coverage. Still, he pays nearly $18,000 a year for a high-deductible policy for a family of three.
He said he would be reluctant to part ways with his insurer, Oxford, and was disappointed that even the least expensive Oxford plan being offered next year would cost about as much as he pays now.
With another plan, he said: “Will I be able to maintain my doctors? I’m concerned that some of the better doctors aren’t going to take health insurance.”
He acknowledged that the new law would allow him for the first time to easily switch plans, but it is still hard for him to believe it guarantees coverage for pre-existing conditions. “I have to be careful. I can’t be denied coverage, right?” he asked.
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Heh, let's just see...
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Moderate Democrats are quitting on Obamacare
By Scott Clement, Published: July 23 2013 Washington Post:
The landmark health-reform law passed in 2010 has never been very popular and always highly partisan, but a new Washington Post-ABC News poll finds that a group of once loyal Democrats has been steadily turning against Obamacare: Democrats who are ideologically moderate or conservative.
74 percent of moderate and conservative Democrats supported the federal law making changes to the health-care system. But just 46 percent express support in the new poll.
Just 58 percent of Democrats now support the law
http://www.washingtonpost.com/blogs/the-fix/wp/2013/07/23/moderate-democrats-are-quitting-on-obamacare/
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Stated the other way, 42% of Democrats don't support the agenda.
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Just wait until the pain really sets in.
Moderate Democrats are quitting on Obamacare
By Scott Clement, Published: July 23 2013 Washington Post:
The landmark health-reform law passed in 2010 has never been very popular and always highly partisan, but a new Washington Post-ABC News poll finds that a group of once loyal Democrats has been steadily turning against Obamacare: Democrats who are ideologically moderate or conservative.
74 percent of moderate and conservative Democrats supported the federal law making changes to the health-care system. But just 46 percent express support in the new poll.
Just 58 percent of Democrats now support the law
http://www.washingtonpost.com/blogs/the-fix/wp/2013/07/23/moderate-democrats-are-quitting-on-obamacare/
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Stated the other way, 42% of Democrats don't support the agenda.
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Meantime, here in CA, the Denny family is covered through DB Inc. Our rates went up 27% this year.
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Obama's New York Model
How the state destroyed its insurance market using ObamaCare rules.
President Obama has found a new example for the pending wonders of his health-care reform—New York. In his latest sales pitch last week, he declared that insurance rates in New York's ObamaCare exchange "will be at least 50% lower next year than they are today. Think about that: 50% lower."
Thinking is good, which is why you may have guessed that there's more to this story than a 50% discount. The real news is that New York ruined its individual insurance market two decades ago by imposing the same regulations that ObamaCare is about to impose on every other state. If the Empire State's premiums do now fall, it will be because the Affordable Care Act partially deregulates New York insurance.
The culprit behind New York's long-standing insurance woes is a regulation known as "community rating" that hides in higher premiums the income transfers from one group to another. Insurance works best when people pay rates that are tied to their expected health risks over time. But a few states limit how much premiums can vary from person to person.
ObamaCare takes this community rating national. The law says that no individual can pay more than three times what the least expensive person pays, regardless of risk. Today 42 states have rating bands that are five to one or more.
New York's ratio is one to one. This means that insurers must vastly overprice coverage for, say, a 28-year-old who exercises regularly and doesn't smoke but vastly underprice coverage for a 55-year-old with high-cost chronic illnesses. Democratic Governor Mario Cuomo adopted this rule in 1992.
Premiums shot up 30% to 40% on average in the first year, often much more, and continued to spike. Insurers shed books of business, while customers cancelled their policies. Enrollment fell 38% in three years. About a dozen major insurers at the time sold the dominant style of indemnity coverage, similar to traditional fee-for-service Medicare. By 1996, every one had fled the state.
Bad incentives caused the exodus. The majority of people under 65 with low risks can avoid community rating's economic distortions by not buying coverage, especially because another rule called "guaranteed issue" lets them wait until they are sick before they buy coverage.
And that is what they do. Mutual of Omaha, by far the largest New York indemnity carrier at the time, watched the average age of its membership increase by 11 and a half years before it became the last one to turn out the lights. The average age of people who dropped coverage was 37.5.
In 1996 Albany tried to fix Mr. Cuomo's mess by requiring any managed-care insurer doing business in New York to also sell on the individual market, but the market never recovered. In 1992, some 1.2 million New Yorkers bought individual plans, which fell to 128,000 by 2001, and a mere 31,000 today. Think about that: Out of 19.5 million residents, and with three out of every 15 nonelderly adults uninsured, 0.0016% of the population uses this market.
Liberals claim community rating is a fair trade for subsidizing the needy and to counter the lotteries of disease and accident. But this forces young, generally low-income people starting their careers to pay hundreds of dollars more every month for insurance, rather than simply subsidizing the needy directly.
Individual per person premiums now average about $500 a month, far more in New York City and slightly less upstate. In less regulated Connecticut the comparable figure is $306, and in still less regulated Pennsylvania it is $225. In the Empire State insurance is available to anyone, only the price is unaffordable for millions.
ObamaCare's central planners are hoping to avoid a national reprise of New York by requiring and subsidizing individuals to buy insurance. The White House is planning a national campaign to persuade the young adults and minorities most likely to lack insurance to sign up, just as they turned out at the ballot box in 2012. But being forced to buy an overpriced product is different from casting a vote. Even with subsidies, ObamaCare's plans will sometimes be cheap to consumers, sometimes not, but never free.
Low- to moderate-income people with little net worth are highly sensitive to month-to-month finances. Some 17% of all workers already decline insurance that is sponsored by their employers, preferring more take-home pay. The figure for young workers is 40%. More than one in four of the uninsured are also "unbanked," meaning they lack a checking account or credit card, according to Jackson Hewitt Tax Service.
The ObamaCare gamble is that these Americans will act against their financial self-interest and buy insurance that is more expensive than what they need. But the great liberal fear is that they won't, and that premiums will then have to increase and some exchanges might fail. New York is less a model than a warning.
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Republican Health Care Panic
By PAUL KRUGMAN
Published: July 25, 2013 737 Comments
Leading Republicans appear to be nerving themselves up for another round of attempted fiscal blackmail. With the end of the fiscal year looming, they aren’t offering the kinds of compromises that might produce a deal and avoid a government shutdown; instead, they’re drafting extremist legislation — bills that would, for example, cut clean-water grants by 83 percent — that has no chance of becoming law. Furthermore, they’re threatening, once again, to block any rise in the debt ceiling, a move that would damage the U.S. economy and possibly provoke a world financial crisis.
Yet even as Republican politicians seem ready to go on the offensive, there’s a palpable sense of anxiety, even despair, among conservative pundits and analysts. Better-informed people on the right seem, finally, to be facing up to a horrible truth: Health care reform, President Obama’s signature policy achievement, is probably going to work.
And the good news about Obamacare is, I’d argue, what’s driving the Republican Party’s intensified extremism. Successful health reform wouldn’t just be a victory for a president conservatives loathe, it would be an object demonstration of the falseness of right-wing ideology. So Republicans are being driven into a last, desperate effort to head this thing off at the pass.
Some background: Although you’d never know it from all the fulminations, with prominent Republicans routinely comparing Obamacare to slavery, the Affordable Care Act is based on three simple ideas. First, all Americans should have access to affordable insurance, even if they have pre-existing medical problems. Second, people should be induced or required to buy insurance even if they’re currently healthy, so that the risk pool remains reasonably favorable. Third, to prevent the insurance “mandate” from being too onerous, there should be subsidies to hold premiums down as a share of income. (This paragraph seems important to me-- this is the essence of the Obama argument and one which needs to be answered in as pithy terms as it is made here.-- Marc)
Is such a system workable? For a while, Republicans convinced themselves that it was doomed to failure, and that they could profit politically from the inevitable “train wreck.” But a system along exactly these lines has been operating in Massachusetts since 2006, where it was introduced by a Republican governor. What was his name? Mitt Somethingorother? And no trains have been wrecked so far.
The question is whether the Massachusetts success story can be replicated in other states, especially big states like California and New York with large numbers of uninsured residents. The answer to this question depends, in the first place, on whether insurance companies are willing to offer coverage at reasonable rates. And the answer, so far, is a clear “yes.” In California, insurers came in with bids running significantly below expectations; in New York, it appears that premiums will be cut roughly in half.
So is this a case of something for nothing, in which nobody loses? No. In states like California, which have allowed discrimination based on health status, a small number of young, healthy, affluent residents will see their premiums go up. In New York, people who don’t think they need insurance and are too rich to receive subsidies — probably an even smaller group — will feel put upon by being obliged to buy policies. Mainly, though, those insurance subsidies will cost money, and that money will, to an important extent, be raised through higher taxes on the 1 percent: tax increases that have, by the way, already taken effect.
Over all, then, health reform will help millions of Americans who were previously either too sick or too poor to get the coverage they needed, and also offer a great deal of reassurance to millions more who currently have insurance but fear losing it; it will provide these benefits at the expense of a much smaller number of other Americans, mostly the very well off. It is, if you like, a plan to comfort the afflicted while (slightly) afflicting the comfortable.
And the prospect that such a plan might succeed is anathema to a party whose whole philosophy is built around doing just the opposite, of taking from the “takers” and giving to the “job creators,” known to the rest of us as the “rich.” Hence the brinkmanship.
So will Republicans actually take us to the brink? If they do, it will be crucial to understand why they would do such a thing, when their own leaders have admitted that confrontations over the budget inflict substantial harm on the economy. It won’t be because they fear the budget deficit, which is coming down fast. Nor will it be because they sincerely believe that spending cuts produce prosperity.
No, Republicans may be willing to risk economic and financial crisis solely in order to deny essential health care and financial security to millions of their fellow Americans. Let’s hear it for their noble cause!
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http://washingtonexaminer.com/irs-employee-union-we-dont-want-obamacare/article/2533520?custom_click=rss
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Are Republicans fooling themselves about Obamacare?
By BYRON YORK | JULY 22, 2013 AT 7:40 PM
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When Washington conservatives gather to talk among themselves, and the discussion turns to Obamacare -- it happens pretty frequently -- it's not unusual to hear predictions that the president's health care law will "collapse of its own weight." It's a "train wreck," many say, quoting Democratic Sen. Max Baucus. It's unworkable. It's going to be a big, smoking ruin.
Some predict chaos beginning Oct. 1, when the law requires Obamacare exchanges, the online marketplaces in which people will be able to shop for insurance, to be up and running. And maybe that will happen; the day is a little more than two months off, and the administration seems far behind schedule in the work that needs to be done.
On the other hand, a lot of thoughtful conservatives are looking beyond Oct. 1 to Jan. 1, the day the law (except for the parts the president has unilaterally postponed) is scheduled to go fully into effect. On that day the government will begin subsidizing health insurance for millions of Americans. (A family of four with income as high as $88,000 will be eligible for subsidies.) When people begin receiving that entitlement, the dynamics of the Obamacare debate will change.
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At that point, the Republican mantra of total repeal will become obsolete. The administration will mount a huge public relations campaign to highlight individuals who have received government assistance to help them afford, say, chemotherapy, or dialysis, or some other life-saving treatment. Will Republicans advocate cutting off the funds that help pay for such care?
The answer is no. Facing that reality, the GOP is likely to change its approach, arguing that those people should be helped while the rest of Obamacare is somehow dismantled.
The administration is fully aware of its advantage. Last week officials invited several prominent liberal bloggers to a special White House Obamacare briefing. From the reporting that resulted -- one headline included the declaration "Implementing the Affordable Care Act is going to be a huge success" -- administration officials are quite confident that, whatever problems arise, Obamacare will be solidly in place after the money starts flowing on Jan. 1.
"Neither Democrats nor Republicans liked to emphasize how much the Affordable Care Act debate was about redistribution rather than health care as such, but there's a lot of money here," wrote Slate's Matthew Yglesias, who attended the briefing. "The law is structured to be financially beneficial to a large majority of people, and the infrastructure is in place to make that clear to a critical mass of them."
Truth be told, many Republicans did note that redistribution is at the heart of Obamacare. But the fact is, the redistributing will begin Jan. 1. And whatever else goes wrong with Obamacare, look for the White House to apply whatever fixes it must to make sure the money keeps flowing.
"The last few months have shown us that the administration will do whatever it needs to do -- whether it is in the law or not, within its formal powers or beyond them -- to prop up collapsing elements and avoid political disasters in the near term," said Yuval Levin, a former Bush administration staffer and one of Obamacare's most perceptive critics, in an email exchange. "That often means pure ad hoc governing where they just do whatever they have to in order to avoid allowing the system's worst problems and failings to become apparent in the near term."
None of this is to say Obamacare won't face huge problems. The most obvious is that it will make things worse for more people than it helps. If that disparity is huge -- that is, if on one side there are many millions of people paying more for coverage than they did previously, losing coverage they were satisfied with, and suffering through great uncertainty, while on the other side there are far fewer people receiving direct government subsidies -- if that happens, then the political fight over Obamacare will intensify rather than fade. But even then, the subsidies are unlikely to go away.
Obamacare could face even bigger problems. The most serious is the so-called "death spiral," which could occur if too few young, healthy people sign up for coverage, dramatically raising the cost of covering everyone else.
But collapse of its own weight? The administration's insurance against that is the billions of dollars that will start flowing out of Washington Jan. 1. Once that happens, Republicans will likely stop talking about Obamacare's collapse and will instead start searching for ways to limit the harm done to millions of Americans.
Byron York, the Washington Examiner's chief political correspondent, can be contacted at byork@washingtonexaminer.com. His column appears on Tuesday and Friday on washingtonexaminer.com.
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Hmmm , , ,
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Nothing defines efficiency like massive federal programs, and we are flush with cash so everything should go great!
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As best as I can tell the point that it would be Obama shutting down the government is the key to the politics of it all and saving the nation from Obamacare
By
JIM DEMINT
And
MIKE NEEDHAM
Few Americans are clamoring to shut down the federal government, but polls indicate that a majority of Americans agree that ObamaCare will be a disaster for their family's health care and for the nation's economy. So why is President Obama threatening to shut down the government if Congress sends him a year-end spending bill to fully support government operations but without funding for his (unfair, unworkable and unaffordable) health-care law?
This question is not being addressed fairly by the media, so the American people are not being told the truth about the coming political showdown over ObamaCare. Here's what's really happening.
The full implementation of the federal takeover of America's health-care system is approaching the point of no return, when tens of millions of Americans will be forced to sign up for government-controlled health care beginning this fall. Virtually all Republicans in Congress have run their election campaigns promising to stop ObamaCare, and every one of them has voted to repeal it.
Democrats should have supported repeal as well, because the president's new system will be unaffordable and unfair for many of the nation's low-income and younger Americans. ObamaCare will likely cause insurance premiums to double or triple for the young and healthy, and lead to a decline in wages for low-income Americans due to compliance regulations and penalties on their employers.
House Speaker John Boehner stands next to a printed version of the Patient Protection and Affordable Care Act during a news conference on Capitol Hill in May.
Yet despite all the grand speeches, votes and chest-pounding by Republicans promising to try to stop this destructive new law, none of this has required much courage so far—nor has it been effective. ObamaCare can be stopped only if Congress denies funding for it in the next spending bill, which must be passed in September. That would immediately halt the implementation of ObamaCare and fulfill a defining GOP promise to the American people. Voting for a spending bill that excludes ObamaCare will take courage and integrity.
The president has not been forthright with America about health care. He promised that people would not lose their health-care plan if they wanted to keep it, but now we know that millions will lose their current coverage. He promised that premiums would decrease, but premiums for employer-sponsored coverage have increased, on average, by $2,370 per family since 2009. The president promised that the law would be fair, but he is forcing every American to buy government-approved health-care plans while delaying that mandate for businesses and granting exemptions to members of Congress and unions.
There are some who argue that ObamaCare can't be defunded because most of its spending is deemed "mandatory." Their assertions are wrong. According to the Congressional Research Service, ObamaCare "administrative costs will have to be funded through the annual discretionary appropriations." Furthermore, annual appropriations bills routinely carry funding limitations to mandatory spending and often block a wide range of potential government activities. The Hyde Amendment to a 1976 appropriation bill, for example, blocked all taxpayer funding of abortion, and has every year since 1976. Congress can disallow funding for ObamaCare and effectively stop the implementation of the law.
Yet doing that will require resolve. President Obama, along with all the Democrats, will accuse Republicans of trying to shut down the government by giving the president a spending bill that he must veto. But there is no "must" about it. If the president opts to shut down all of government instead of just ObamaCare, that will be his choice, not the wish of conservatives.
The truth is rarely a factor in today's political battles, though. Much of the media will echo the White House talking points about Republicans shutting down the government. Seniors will be told that Social Security and Medicare are in jeopardy if ObamaCare is not funded, the poor will be threatened with loss of benefits—well, you know the rest.
This is why some Republican leaders and consultants are pleading with conservatives in the House and Senate not to pick a fight with the president over ObamaCare. The Republican old guard warns that any fight could jeopardize the GOP's chances of taking the majority in the Senate in 2014 and keeping the House majority. Their do-nothing strategy? Allow ObamaCare to be fully implemented so the American people will see what a mess it is.
The problem with this logic is that once ObamaCare is fully implemented, it will destroy what's left of our personalized, free-market health system and make it very challenging to bring affordable, high-quality health care to Americans. The bureaucracy and the costs of national health care will grow dramatically, becoming increasingly difficult to dismantle as they grow.
ObamaCare will destroy the private-insurance market, incentivize businesses to cancel current health coverage for their employees, create physician shortages, and force Americans and states into total dependency on the federal government. After all that, it will be difficult, if not impossible, for the free market to resurrect a private health-care system built on doctor/patient decision-making.
So the fight to stop ObamaCare now is an urgent matter. Elected leaders in both parties should summon the courage to put their political futures on the line, because the future of America is truly on the line. Politicians who oppose ObamaCare should not vote to fund it. Those who want a socialized health-care system should vote to fund it. There is no middle ground and no place to hide.
Republicans could lose the national debate. But a failure of Republicans to show the courage of their convictions on such a fundamental issue will inspire no one and will further alienate the American people from their government. This carries far greater risks to the nation's future than the threat of a government shutdown or the risk of losing the next election.
Mr. DeMint, a former Republican senator from South Carolina, is president of the Heritage Foundation. Mr. Needham is president of Heritage Action for America, a grass-roots advocacy organization.
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Many Health Insurers to Limit Choices of Doctors, Hospitals
Main Reason Behind These Limited Plans: Cost
By ANNA WILDE MATHEWS
This fall, Indiana's new online health-insurance marketplace will present some tough choices for consumers like John Nowak, who will be able to pick a plan from his current insurer—or go for one that includes his primary-care doctor.
That is because Mr. Nowak's current insurer won't include Indiana's biggest health-care provider, 19-hospital Indiana University Health, in the plans it sells on the consumer exchange. If Mr. Nowak buys a new exchange plan from WellPoint Inc.'s WLP -1.02% Anthem Blue Cross and Blue Shield, he will generally have to pay the cost out of his own pocket if he sees the system's doctors, because they aren't in the network.
Mr. Nowak, a 48-year-old Indianapolis medical-spa owner, likes WellPoint. But he has been seeing an Indiana University-affiliated physician for five years, and "when you get a trust with a doctor, you want to stick with them," he said.
Similar situations are likely to occur around the country, as details emerge about the coverage available through the new consumer marketplaces created by the federal health law. Many of the plans will include relatively few choices of doctors and hospitals. In some cases, plans will layer on other limits, such as requirements that patients get referrals to see specialists, or obtain insurer authorization before pricey procedures.
A McKinsey & Co. analysis of 955 consumer exchange-plan filings, from 13 states that were among the earliest to make them public, found that 47% were health-maintenance organizations or similarly designed plans. Such plans generally don't pay for care provided outside their networks. A number of other plans, though classed as preferred-provider organizations, or PPOs, will also have limited choices of doctors and hospitals in their networks.
The big reason behind these limited plans: Cost.
Insurers are betting that consumers who buy plans on the exchanges will be willing to trade some choice and flexibility in order to get cheaper premiums. Smaller networks of providers generally translate to lower premiums, because insurers can negotiate discounts with health-care providers who will then have less competition for patients within the network.
WellPoint said it is using more-limited networks for most of the new marketplaces, and it aims to take at least 10% out of the premium costs.
"Individuals are making a lot of choices based on cost, particularly because it's coming out of their pockets," said Steve Hamman, a vice president at Blue Cross and Blue Shield of Illinois, a unit of Health Care Service Corp. He said his insurer's exchange products with smaller provider networks will cost 20% to 30% less than some other plans with a bigger selection of hospitals and doctors that the insurer will also sell in the marketplace.
One upshot of these efforts is that some consumer exchange plans will sideline well-known institutions—some of which may be most likely to balk at discounted rates. In the Chicago area, Blue Cross and Blue Shield of Illinois said it would sell some plans that don't have Rush University Medical Center or Northwestern Memorial Hospital in their networks.
In Los Angeles, most insurers won't include UCLA Medical Center, which struck a deal only with WellPoint. BlueCross BlueShield of Tennessee will have some plans that don't include Vanderbilt University Medical Center.
Traditionally, Americans have been reluctant to accept curbs on their health-care choices, strategies that many rejected in the 1990s. In 2012, just 16% of employees with workplace-provided coverage were enrolled in HMOs, according to a Kaiser Family Foundation survey. HMOs represented less than 5% of the consumer plans sold through eHealth Inc.'s eHealthInsurance.com in a 2012 tally.
But insurer-sponsored research involving tens of thousands of consumers has shown that people buying in the new exchanges, many now uninsured, will be most closely focused on premiums. In tests, many were willing to sacrifice choice of providers for a lower price.
Mary Ann Galloway, 63, an Indianapolis health-care consultant who is uninsured, said that when she looks for coverage on the new exchange, "probably cost is the most overriding issue for me." She would be willing to settle for a smaller choice of providers, and even switch from her current Indiana University-affiliated doctor, "if the costs and benefits were better somewhere else."
Some plans will be built largely around just one hospital system. In New York, North Shore-Long Island Jewish Health System is launching a plan that will generally cover care only at its own 15 hospitals and likely one other it doesn't own, and from doctors who work for the system or an affiliated association.
"We want to be very competitive and provide a good network at low cost," said Michael J. Dowling, North Shore-Long Island Jewish's chief executive.
For some people, smaller-network plans may be the only option. In New Hampshire, WellPoint will be the sole carrier in the new consumer marketplace, where its plans will include 14 of the 26 hospitals, and 65% of the primary-care doctors, that are in its biggest PPO network. WellPoint said limited networks "have the potential to produce cost savings and continue to offer quality care and convenience."
The federal law requires exchange plans to include enough providers so that services are available "without unreasonable delay," and many states also have more specific standards.
A spokeswoman for the federal Department of Health and Human Services said that in the new marketplaces, "plans will compete side by side, and consumers can compare based on the factors that are important to them to find the plan that best fits their needs and budget."
As for Mr. Nowak, he said he'll likely seek a plan that included his doctor.
"The premium is important to me, but my doctor is more important," he said.
Indiana University Health said it would be included in the exchange plans of at least one Indiana carrier, MDwise Inc., a largely Medicaid-focused nonprofit in which it has an ownership stake.
Write to Anna Wilde Mathews at anna.mathews@wsj.com
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Republicans are busy debating what gives them the most "leverage" in their fight to get rid of ObamaCare. One powerful tool, it happens, is an issue that few of them so far have wanted to talk about.
The issue is the White House's recent ObamaCare bailout for members of Congress and their staffs. The GOP has been largely mute on this blatant self-dealing. The party might use what's left of its summer recess to consider just how politically potent this handout is, and what—were they to show a bit of principle—might be earned from opposing it.
The Affordable Care Act states clearly that all members of Congress and their staff must buy their health insurance through an ObamaCare exchange. The law just as clearly does not reconstitute the generous government premium subsidies that members and staff currently receive. Since most members and staffers earn too much to qualify for subsidies in the dreaded ObamaCare exchanges, they were looking at an enormous financial hit come January.
Democrats in particular freaked out, and so the White House in early August conjured out of thin air a bailout for the political elite. The Office of Personnel Management announced—with no legal authority—that Congress could keep receiving its giant subsidies. Oh, and the OPM also declared that each member of Congress also gets to define which of his staff is covered by the law. Chances are many staffers will never have to deal with the exchanges at all.
This deal ought to have led to a wild GOP protest, both on philosophical and legal grounds. Instead, there has been nary a peep of complaint.
[image] Getty Images
The charitable explanation is that the announcement came after Congress had left for recess, giving Republicans little opportunity to unify around a response. The less charitable explanation is that Republicans themselves are under huge pressure from their own staffers to shut up and keep the subsidies flowing.
Some members, like Arkansas's Tim Griffin, went so far as to post on his Facebook page a "myth vs. fact" explanation (read: defense) of OPM's ruling. The responses on his Facebook page were scathing.
Few things infuriate Americans more than special privileges for Washington. The public could care less that insurance hikes might lead to a Washington "brain drain." (Most would view that as progress.) Americans scrabbling for work, struggling to pay bills and facing soaring insurance premiums are not sympathetic to congressional complaints that the loss of their subsidies is unfair. As word has spread about the White House fix, a bipartisan fury has started to build at town-hall meetings, at rallies, and in letters and phone calls to Congress.
With a little fortitude, the GOP still has the opportunity to be on the right side of public opinion. The White House's unilateral bailout is a tailor-made opportunity for the GOP to highlight, yet again, the administration's unequal application of its flawed health law: waivers for Democratic union buddies, exemptions for big business, and now a special handout to Mr. Obama's political class.
The special deal is also an opportunity to oppose, yet again, the White House's extralegal actions.
Mostly, it is an opportunity to insist that Democrats either fully experience their experiment in social engineering—by living without subsidies within the ObamaCare exchanges they created—or give every other American relief. The reality is that Democrats, far more than Republicans, wanted this fix. They are terrified of their own creation. As leverage goes, there's little to compare with Democratic self-interest.
Imagine forcing Democrats, daily, to justify this self-dealing—a gravy handout reviled equally by independent, Democratic and Republican voters. Imagine the House attaching to a must-pass piece of legislation, say, a provision that requires Congress and staffers and administration officials to live uniformly and subsidy-free in the ObamaCare exchanges, or give a pass to ordinary Americans. Let's see Senate Majority Leader Harry Reid handle that one.
A handful of Republicans—Sens. David Vitter and Mike Enzi, and Reps. Ron DeSantis and Shelley Moore Capito—are already calling for action. Any of their legislative approaches might serve as a starting point for a broader effort.
Of course, for Republicans to take this route, they'd have to risk their own self-interest. The GOP is currently sniping over who has more "principles" in the fight against ObamaCare. Those advocating a defund provision for the law this fall seem willing to hold hostage the economy and American households as part of a shutdown fight.
Yet nothing would make a greater statement about principles than a GOP willingness to first hold its own financial self-interest hostage in a fight. If Republicans want to show that they "stand for something," this is it. If they really are willing to do "whatever it takes" to oppose this law, there would be no more meaningful way to prove it.
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The key now for Obamacare's success is to get young people to sign up.
Karl Rove's Crossroads group put out this helpful ad.
[youtube]http://www.youtube.com/watch?v=hfP6LmJiSec[/youtube]
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That , , , is , , , absolutely , , , fg , , , awesome! :evil:
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August 12, 2013
A Limit on Consumer Costs Is Delayed in Health Care Law
By ROBERT PEAR
WASHINGTON — In another setback for President Obama’s health care initiative, the administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care.
The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014.
The grace period has been outlined on the Labor Department’s Web site since February, but was obscured in a maze of legal and bureaucratic language that went largely unnoticed. When asked in recent days about the language — which appeared as an answer to one of 137 “frequently asked questions about Affordable Care Act implementation” — department officials confirmed the policy.
Please click here for the remainder of the article: http://www.nytimes.com/2013/08/13/us/a-limit-on-consumer-costs-is-delayed-in-health-care-law.html?_r=2&utm_source=News+Now+08152013&utm_campaign=News+Now+8%2F15%2F2013&utm_medium=email&&pagewanted=print
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Jeffrey Singer: The Man Who Was Treated for $17,000 Less
Bypassing his third-party payer, my patient avoided a high hospital 'list price.'
WSJ
By
JEFFREY A. SINGER
Every so often I have an extraordinary and surprising experience with a patient—the kind that makes us both say, "Wow, we've learned something from this." One such moment occurred recently.
A gentleman in his early 60s came in with a rather routine hernia in his lower abdomen, one that is easily repaired with a simple outpatient surgical procedure. We scheduled the surgery at a nearby hospital.
My patient is self-employed and owns a low-cost "indemnity" type of health insurance policy. It has no provider-network requirements or preferred-hospital requirements. The patient can go anywhere. The policy pays up to a fixed amount for doctor and hospital bills based upon the diagnosis. This affordable health-insurance policy made a lot of sense to this man, based on his health and financial situation.
When the man arrived at the hospital for surgery, the admitting clerk reviewed the terms of his policy and estimated the amount of his bill that would be paid by insurance. She asked him to pay his estimated portion in advance. (More hospitals are doing that now because too often patients don't pay their portions of the bills after insurance has paid.)
The insurance policy, the clerk said, would pay up to $2,500 for the surgeon—more than enough—and up to $2,500 for the hospital's charges for the operating room, nursing, recovery room, etc. The estimated hospital charge was $23,000. She asked him to pay roughly $20,000 upfront to cover the estimated balance.
My patient was stunned. I received a call from the admitting clerk informing me that he wanted to cancel the surgery, and explaining why. After speaking to the man alone and learning the nature of his insurance policy, I realized I was not bound by any "preferred provider" contractual arrangements and knew we had a solution.
I explained that just because he had health insurance didn't mean he had to use it in every situation. After all, when people have a minor fender-bender, they often settle it privately rather than file an insurance claim. Because of the nature of this man's policy, he could do the same thing for his medical procedure. However, had I been bound by a preferred-provider contract or by Medicare, I wouldn't have been able to enlighten him.
Hospitals and other providers make their "list" prices as high as possible when negotiating contracts with health plans and Medicare regulators. No one is ever expected to pay the list price. Anybody who has seen an "Explanation of Benefits" statement from a health plan will note a very high charge from the provider, and an "adjusted charge" based upon the contracted fee schedule, which usually leaves the patient with little or nothing in out-of-pocket expenses. The only people routinely faced with list prices are those few people who have insurance like my patient's—that doesn't include a pre-negotiated fee schedule with contracted providers—or those who have no insurance.
Most people are unaware that if they don't use insurance, they can negotiate upfront cash prices with hospitals and providers substantially below the "list" price. Doctors are happy to do this. We get paid promptly, without paying office staff to wade through the insurance-payment morass.
So we canceled the surgery and started the scheduling process all over again, this time classifying my patient as a "self-pay" (or uninsured) patient. I quoted him a reasonable upfront cash price, as did the anesthesiologist. We contacted a different hospital and they quoted him a reasonable upfront cash price for the outpatient surgical/nursing services. He underwent his operation the very next day, with a total bill of just a little over $3,000, including doctor and hospital fees. He ended up saving $17,000 by not using insurance
This process taught us a few things. First, most people these days don't have health "insurance." They have prepaid health plans. They pay premiums to take advantage of a pre-negotiated fee schedule arranged for and administered by a third party. My patient, on the other hand, had insurance.
Second, even with the markdown for upfront "cash-pay" patients, none of the providers was losing money on my patient. Otherwise they wouldn't have agreed to the prices. With the third-party payer taken out of the picture, we got a better idea of the market prices for the services. It is the third-party payment system that interferes with true price competition, so "market clearing prices" can't develop.
Take the examples of Lasik eye surgery or cosmetic surgery. These services are not covered by insurance. Providers compete on the basis of quality, outcomes and price. And prices have continually dropped as quality and services have improved—unlike the rest of health care.
When my patient returned for his post-op visit we discussed the experience. It was clear to both of us that the only way to make health care more affordable is to diminish the role of third-party payers. Let consumers and providers interact through market forces to drive down prices and drive up quality, like we do when we buy groceries, clothing, cars, computers, etc. Drop the focus on prepaid health plans and return to the days of real health insurance—that covers major, unforeseen events, leaving the everyday expenses to the consumer—just like auto and homeowners' insurance.
Sadly, we are heading in the exact opposite direction. ObamaCare expands the role of the third party and practically eliminates the role—and the say—of the patient in the delivery of health care. Will they ever learn?
Dr. Singer practices general surgery in Phoenix, Ariz., and is an adjunct scholar at the Cato Institute.
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41% of 603 small business owners said they have delayed hiring because of the federal healthcare law. One in five already cut hours, while 20% have reduced payroll. Mercer, a human resources consulting company, said its own survey found that 12% of all U.S. employers reported plans to reduce workers’ hours as a direct result of the Affordable Care Act. The impact was more pronounced in the retail and hospitality industries, with 20% of employers saying they will cut part-time hours.
http://www.foxbusiness.com/industries/2013/09/11/with-eye-on-obamacare-companies-move-to-cut-workers-hours/
With Eye on ObamaCare, Companies Move to Cut Workers’ Hours
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The administration admits Obamacare will provide coverage next year to only half as many of America's uninsured as anticipated just last year.
http://www.reuters.com/article/2013/09/18/us-usa-healthcare-spending-idUSBRE98H11T20130918
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During his first run for president, Barack Obama made one very specific promise to voters: He would cut health insurance premiums for families by $2,500, and do so in his first term.
But it turns out that family premiums have increased by more than $3,000 since Obama's vow, according to the latest annual Kaiser Family Foundation employee health benefits survey.
http://finance.yahoo.com/news/health-premiums-3-065-obama-224300715.html
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Pew Survey: 53% of Americans Disapprove of Obamacare, (42% approve), Highest Negative Since Law’s Passage
http://www.people-press.org/2013/09/16/as-health-care-law-proceeds-opposition-and-uncertainty-persist/
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The parts of Obamacare that were popular were also available in Republican alternative bills. Now one is being put forward for your consideration:
http://www.nationalreview.com/node/358874/print
American Health Care Reform Act
200 pages versus 2700 for Obamacare
"... letting people purchase plans across state lines and allowing small businesses to pool together to negotiate lower rates. It would also amend existing law to increase transparency in payments and pricing so patients would have a better understanding of the cost of care and ultimately become more discerning consumers.
The plan seeks to “level the playing field” between consumers who receive insurance from an employer and those who purchase insurance on the individual market. The latter group would receive significant tax breaks to offset the cost of buying insurance: Individuals would be able to claim a $7,500 deduction against their income and payroll taxes for qualifying health plans, while families would be able to deduct $20,000. The legislation would also expand access to portable health savings accounts, and increase the maximum allowable contribution to such accounts.
The bill would increase federal funding for state high-risk pools, which insure people with especially expensive and preexisting conditions, by $25 billion over ten years, and would cap premiums in those pools at 200 percent of the average premium in a given state. It would also guarantee that individuals with preexisting conditions could move between insurance plans while maintaining coverage in the interim.
Medical liability law would be reformed to cap awards on punitive damages, as well as attorneys’ fees, in an effort to limit the common (and increasingly expensive) practice of “defensive medicine.” Federal funding for abortion coverage would be explicitly prohibited except in cases of rape, incest, and risks to the life of the mother."
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Lawmakers can prove their backbone by defunding Obamacare
I have been interested in the political atmosphere of our country since my preteen years. It has been particularly interesting to observe the political shenanigans adopted by many of those wishing to obtain or maintain power. Fortunately, there have also been many who were truly interested in serving the people who put them in office. Looking at one’s life, voting record and words can provide significant insight into which of the aforementioned categories a political figure fits.
In the 1960s, John F. Kennedy wrote a book titled “Profiles In Courage,” which was very inspiring, as he examined the lives of individuals who had enough daring to go against the flow and make a real difference in society. As a young, very intelligent president of our country, he was faced with many daunting problems, not the least of which was an attempt by the Russians to supply Cuba with nuclear weapons, which would have been situated just 90 miles off of our shores.
Although there have been many attempts to rewrite the history of the Cuban missile crisis, the bottom line is that Kennedy had the necessary backbone to stand up to Nikita Khrushchev and avert an enormous detrimental shift in the power structure of the world while enhancing America’s international image.
Some readers are probably already irritated that I have said something positive about someone who is not a member of their political party. It is my belief that if JFK were alive today, advocating personal responsibility and patriotism, he might find his views at odds with many in the Democratic Party.
Perhaps it is time to de-emphasize political affiliations and labels, and instead concentrate on the philosophies that define one’s beliefs and actions. The direction of our country is not good, and “we the people” — not we the Democrats or we the Republicans — are in desperate need of courageous leadership, guided by an understanding of our Constitution.
Our divided government was formed by diligent men who had studied the history of governmental structures throughout the world and wanted to design a system that would not succumb to the temptation to continuously expand its size and scope at the expense of the people.
An important concept was the separation of powers with checks and balances among the three branches of government. It was a rather ingenious idea to invest each of the three branches of government with enough power to check unwarranted power grabs by the others.
There is, however, a breakdown in this system when officeholders are more concerned about their legacy or their re-election than they are about the proper functioning of government. Our Founders were most concerned about the possibility of the executive branch seizing power and disregarding constitutional constraints.
I suspect they would have been horrified to witness the manipulative and secretive strong-armed techniques utilized by the current administration to push through Obamacare. I’m sure they would also be shocked to see an administration that picks and chooses the laws it wishes to enforce, thereby diminishing the power of the legislative branch of government.
This practice in some ways resembles that of the centralized government system that swept the Soviet Union, whose notorious founders wrote that it was sometimes necessary to force ideas on a populace that will eventually come to accept and endorse the ideas. Similarly, our current leadership is certain that Americans will eventually see the wisdom of governmental oversight in almost every aspect of their lives.
If we are to pass a free and prosperous nation on to our progeny, it is imperative that the legislative branch of government exhibit the courage to exercise the check function it possesses. Lawmakers cannot be afraid that they will be blamed for a government shutdown if they defund Obamacare.
They have the ability to separate the health care law from the rest of the federal budget and fund one without funding the other. In doing so, they need to make it abundantly clear that they are willing to fund the government and its essential functions, but they feel that Obamacare is detrimental to the future economic health of America.
If the Democrat-controlled Senate reattaches the law, or if the executive branch makes the decision to fund Obamacare at the expense of other vital national functions, the electorate must take notice and act decisively in 2014. Many say that those who want to restore constitutional restraints are fighting a useless battle, but we must remember that freedom is reserved only for those willing to fight for it.
I am confident that the people will awaken from their apathy and vigorously support whoever has the backbone to stand up for them.
Ben S. Carson is professor emeritus of neurosurgery at Johns Hopkins University.
http://www.washingtontimes.com/news/2013/sep/18/carson-a-moment-that-defines-courage/#ixzz2fMM9w77n
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http://www.youtube.com/watch?v=R7cRsfW0Jv8&noredirect=1
http://www.youtube.com/watch?v=BsN75nt1aUU&noredirect=1
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Not too long ago I posted how I cannot understand the reluctance of anyone in public life to call a liar a liar. I guess it is the fear of a slander law suit. That said it is about time liars are being called out for what they are. The next hope is there actually will be political consequences for public servants who lie. So far not much in that department:
*****Republican accuses fellow lawmakers of ‘lying’ about Obamacare exemption
1:15 PM 09/19/2013
Alex Pappas
Political ReporterSee All Articles
Republican Sen. David Vitter is slamming his fellow lawmakers for “lying” and telling their constituents that there is no such thing as an Obamacare exemption for members of Congress and their staff members.
“Some are lying, trying to mislead the public about the Obamacare exemption for Congress,” Republican Sen. David Vitter said in a statement Thursday. “President Obama recently issued a special rule for Congress and congressional staff to get a special subsidy to purchase health insurance on the Obamacare Exchange unavailable to every other American at similar income levels. That’s an exemption, plain and simple.”
Vitter has been leading the Republican fight in the Senate with an amendment that kills federal Obamacare subsidies for lawmakers and their staff. It would require that all members of Congress, the president, vice president, and Obama administration appointees to purchase health insurance on the Obamacare exchange without taxpayer-funded subsidies.
To show that lawmakers are “denying” the existence of the exemption, Vitter’s office on Thursday released to the media a letter that fellow Louisiana Sen. Mary Landrieu, a Democrat, sent to a constituent. She said the notion they are getting special treatment “could not be further from the truth.”
“Once again, let me assure you that there is no exemption for Members of Congress and their staff in the [Affordable Care Act], nor will I ever support an ‘exemption’ for myself of my staff,” Landrieu wrote.
Vitter’s office provided a copy of the letter he sent to the same constituent: “Senator Landrieu is trying to mislead you, to put it kindly. Others might say she is lying.”
“As you have no doubt read, President Obama recently issued a special rule for Congress only. Under it, Congress and congressional staff get a special subsidy to purchase health insurance on the Obamacare Exchange unavailable to every other American at similar income levels,” he said. “That special subsidy is worth approximately $11,000 per family.”
Vitter’s office also released a graphic that he says proves his point:
The Obamacare fix for lawmakers and staff was made because the Affordable Care Act includes an amendment from a Republican senator that changes how the government currently covers most of the cost of health-care premiums for members and their staffers. The new law mandates that members and staff must enter into exchanges or be covered by insurance “created” by law.
The Office of Personnel Management announced in August that it plans to provide a subsidy of about 75 percent of the cost for the healthcare of members and staff.****
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http://www.upworthy.com/his-first-4-sentences-are-interesting-the-5th-blew-my-mind-and-made-me-a-little-sick-2?g=2
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My guess is that his stats are essentially correct, but that doesn't lead to any easy or obvious solution. One might imply from the presentation that we could have costs like whomever if we ran our system like theirs. Not true. Their prices are lower because the largest healthcare market in the world has already paid the bulk of the sunken costs that developed those products and services. For example, the cost of a drug or medical device is largely the research and development which is spent before the first unit hits the shelf. In many cases the US is paying for that. Then when they compete for additional sales on the margin for the contract in Canada, UK, etc. they only have to cover and profit over their variable cost, not the fixed cost that went into it. But if the development cost is not covered by someone else, us, that drug or device would not exist.
If the US bid out the cost of providing replacement hips to one only provider as he suggests, would there be multiple suppliers left to bid next year, operating just fine on zero revenues, ready to compete? If not, we are right back to the price and quality that you get without competition.
The underlying problem in my view is the prevalence of third party pay and the lack of any process of driving the price down on the demand and payer side.
At the heart of it is freer and more open competition. There really isn't any and the solution to it isn't easy. We limit the supply of doctors, nurses, hospital beds, approved drugs, devices and nearly everything else in the industry and by doing so remove the forces that work to lower the costs of all products in all the industries that don't do these sorts of things, such as computers and electronics where the prices are always going down while quality, performance, reliability keep getting better.
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Iraq war a mistake: 53%, not a mistake: 42% - March 2013
Obamacare/Obama's handling of healthcare, disapprove: 58%, approve: 38% - Sept 2103
Obamacare's approval is only 59% with Democrats!
http://www.powerlineblog.com/archives/2013/09/obamacare-more-unpopular-than-the-iraq-war.php
http://www.foxnews.com/politics/2013/09/17/fox-news-poll-68-percent-concerned-about-their-health-care-under-new-law/
http://www.gallup.com/poll/1633/iraq.aspx
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CD,
Perhaps Gilder's entropy theory of new knowledge entropy leading to growth also leads to higher costs. Medicine is certainly one area where knowledge is expanding rapidly and leading to innovation new knowledge and more advanced treatments. It has certainly helped mankind. Most of the entropy is here in the US. Maybe one consequence is higher cost. But why are costs higher than say compared to electronic devices? Let me just say this. Yes the cost of communicating devices may be down but our costs for such things are MUCH higher than 30 yrs ago. Automobiles are far higher than adjusted for inflation with all the engineering that goes into them. One could get a very nice luxury car for 3K in the 60s. Now the same deemed "level" of luxury is 40 to 50 K. That is far higher than inflation. That is far higher than wages.
Back in the day we just had a TV set that cost a few hundred dollars and no cable/satellite or monthly fees. We had land lines (though long distance calls were relatively more expensive) without all these subscriptions for internet.
Doug writes:
"Their prices are lower because the largest healthcare market in the world has already paid the bulk of the sunken costs that developed those products and services."
Nearly all the innovation comes from the West.
Off the top of my head I cannot think of one innovative medicine, device, etc. that was not from America, or Europe.
He is making the case for oligopolies or single payer actually.
There are payers who reimburse less then Medicare so he is wrong about this. Plus Medicare patients can buy supplements if they want.
It seems to me the trend is towards oligopolies anyway. We are seeing huge trends towards hospital consolidation, physicians organizing or aligning with hospitals, hospitals, skilled nursing facilities taking control of the provider market and control costs, providers, increase their bargaining clout. Nurse organizations are gaining more control because (for now) nurses get paid less.
He is also DEAD wrong about doctors ordering tests to "cover their butts" is negated by capping pain and suffering awards aka Texas and some other states. This would have little impact on test ordering. Plainly put, I as well as any other doctor does not want to be sued any less because I may know the damages are capped.
As for how much this accounts for excessive health care I might agree it may not be that much. It is very difficult to determine what is excessive and what is not. Anyone who tells you this is not telling all the details.
Doug writes,
"but that doesn't lead to any easy or obvious solution"
The reason is because there isn't one. It is all an experiment in progress. Yet he seems to be advocating single payer system.
Doug writes,
"We limit the supply of doctors, nurses"
Well in rural fly over areas there is not an overabundance of doctors who like everyone else don't prefer to live in the middle of "no where". But in the North East I can certainly say there is no shortage of most types of physicians though in some specialties that may be the case. The market is flooded with foreign born, foreign trained doctors. Even some of them tell me now they wish the newbies would "stop coming".
As for nurses, with the resurgence of nursing (RNs some years ago were not in demand unless they got their MBA and go into hospital administration etc), NPs, PAs, etc the schools cannot churn them out fast enough. Their ranks were not limited just that it didn't pay to be a nurse. That has swung back the other way.
Just today it is posted the median salary for a surgeon is around 177 K on yahoo and surgery is not all that it is cracked up to be. Many general surgeons are struggling in my area at least. An ortho surgeon ran off from NJ to Montana. A cardiologist left NJ for New Mexico. The 177 seems low to me. OTOH I was recently told of one ortho surgeon who is boarded in spine surgery (apparently rare) and charges 80K for a procedure. The insurance in one case negotiated him "down" to something like 25K. IT was done out of network. The out of network thing seems to be one loophole that works as a way to game the system by some hospitals and doctors.
So while we have some doctors on the one end making huge sums most are not.
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http://finance.yahoo.com/news/the-most-overrated-jobs-of-2013-192901302.html
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http://www.usatoday.com/story/news/politics/2013/09/23/aca-family-glitch-issues/2804017/
'Family glitch' in health law could be painful
Kelly Kennedy, USA TODAY 11:55 p.m. EDT September 23, 2013
It could leave up to 500,000 children without coverage and cost some families thousands of dollars.
WASHINGTON — A "family glitch" in the 2010 health care law threatens to cost some families thousands of dollars in health insurance costs and leave up to 500,000 children without coverage, insurance and health care analysts say.
That's unless Congress fixes the problem, which seems unlikely given the House's latest move Friday to strip funding from the Affordable Care Act.
Congress defined "affordable" as 9.5% or less of an employee's household income, mostly to make sure people did not leave their workplace plans for subsidized coverage through the exchanges. But the "error" was that it only applies to the employee — and not his or her family. So, if an employer offers a woman affordable insurance, but doesn't provide it for her family, they cannot get subsidized help through the state health exchanges.
That can make a huge difference; the Kaiser Family Foundation said an average plan for an individual is about $5,600, but it goes up to $15,700 for families. Most employers help out with those costs, but not all.
"We saw this two-and-a-half years ago and thought, 'Has anyone else noticed this?'" said Kosali Simon, a professor of public affairs at Indiana University who specializes in health economics. "Everyone said, 'No, no. You must be wrong.' But we weren't, and that's going to leave a lot of people out."
The issue has recently received attention, especially after former president Bill Clinton highlighted it in a recent speech.
"The family glitch is definitely a drafting error that Congress made that needs to be fixed," said Joan Alker, executive director of the Georgetown University Center for Children and Families. "But that seems unlikely."
New rules state that those families will not be penalized for not purchasing coverage, but the point of the law was to make coverage affordable for families.
Other challenges for families remain as the Obama administration and the health care industry gear up for the Oct. 1 opening of the exchanges, websites for each state on which customers can shop for and buy health insurance. The law requires uninsured Americans to buy health insurance; many are eligible for government subsidies to help them for the policies. For example:
• Kids may not receive Medicaid or exchange coverage if their parents aren't eligible and, therefore, don't know to check.
• Undocumented immigrants may not learn their children are eligible for insurance.
The law has already helped children, Alker said, because it "stabilizes Medicaid and CHIP," the insurance program for children.
However, 70% of uninsured kids are eligible for Medicaid and CHIP, but they're not all enrolled, she said.
"There has to be a lot of outreach and education about the importance of getting health care," she said. "These kids could enroll today."
If congressional Republicans were to succeed in cutting funding for the law, the CHIP program would expire in October, said Bruce Lesley, president of First Focus, a bipartisan advocacy group for families.
The Children's Health Insurance Program provides insurance for kids whose family incomes are too high for Medicaid, but whose families still can't afford coverage. The Affordable Care Act extended it for two years, which means as many as 6 million children have health care.
Eliminating money for the law would force states to rethink their children's programs quickly, Alker said.
But even with the funding, not all kids are getting coverage. In fact, two-thirds of kids are eligible for Medicaid or CHIP but not enrolled. Advocates hope that adults signing up for insurance through the health exchanges will find out their kids are eligible, and have said as many as 4 million kids could sign up.
Former president Bill Clinton speaks about health care at the Clinton Presidential Center in Little Rock on Sept. 4, 2013.(Photo: Danny Johnston, AP)
"In Massachusetts, the uninsured rate for kids is lower than 2%," Lesley said, explaining that when Massachusetts implemented "RomneyCare," children were enrolled for insurance in droves. The Massachusetts program became law in 2006 under then-Gov. Mitt Romney, last year's unsuccessful Republican nominee for president.
The Obama administration is working with the YMCA and other organizations to get the word out about children's eligibility, he said.
This can be a particularly big deal for immigrant families, where one parent might be a documented immigrant, a second could be undocumented, and the children could be U.S. citizens.
"Most of the kids are United States citizens," said Jenny Rejeske, a health policy analyst for the National Immigration Law Center. "We know already that many kids in mixed-status families don't have insurance."
Though she said the majority of immigrants are in the country legally, undocumented immigrants may be afraid to seek benefits for their children. Those children, she said, need immunizations and preventive care, in part to keep everybody else's kids healthy, too.
"I feel very confident saying it is safe for mixed-status families to sign up," she said. "The information they give will not be used for immigration enforcement."
The information will go only to the agencies that need to see it, and there are "protections" built in to the Affordable Care Act so families will go sign up their children, she said.
Others who might miss coverage options for kids include veterans receiving care through the VA but who don't have benefits for their families, as well as grandparents receiving Medicare. There is a child-only coverage option that would allow the child to receive subsidized insurance.
Alker said kids also benefit when their parents have coverage because the family is more likely to be financially secure. Medical bills are the leading cause of bankruptcy. She also cited examples, such as maternal depression or healthy pregnancy benefits that affect children as well as adults.
According to a Georgetown policy brief, 11.5 million parents and 6.3 million children were uninsured in 2010. Three-quarters of the parents' incomes fell below the poverty line, and 38% lived in deep poverty. About half of them are white, 29% are Hispanic, and 17% are African American.
Despite their concerns, the analysts said several promising things for families have happened through the law, including:
• Foster kids who have "aged out" of the system can continue to receive insurance through Medicaid until they are 26
• American children of immigrant parents -- even undocumented -- can get insurance subsidies through the new health insurance exchanges, and may be eligible for Medicaid.
• The children and spouses of disabled veterans, who receive their health care through Veterans Affairs, could be eligible for subsidized insurance through the exchange, even if the veteran is not. The same could apply to children who live with retired grandparents who receive care through Medicare.
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One reason ObamaCare has held together despite its unpopularity is the phalanx of support from Democrats. They passed it on a partisan basis without a single Republican vote, and they're sticking to it.
So it was news on Thursday when West Virginia Senator Joe Manchin became the first Democrat of note to break with one of ObamaCare's core tenets. The Senator told a media breakfast that he'd vote to support a bill to fund the government that included a one-year delay in the Affordable Care Act's mandate to buy individual health insurance.
"There's no way I could not vote for it," Mr. Manchin said. "It's very reasonable and sensible." He later issued a statement saying the individual mandate shouldn't be used as an excuse to shut down the government, but on the mandate itself he is now committed.
This is progress because a mandate delay may be the price that House Republicans ask in return for an increase in the debt limit or to fund the government. It's eminently fair because it matches the illegal delay in the business mandate to provide health insurance for employees that the Administration announced earlier this year.
One cost of the GOP's internal "defund" blood-letting is that it's taken the political pressure off Democrats from conservative states to repudiate part or all of ObamaCare. It's time to turn up that heat.
============================
Friday Digest
THE FOUNDATION
"They define a republic to be a government of laws, and not of men." --John
Adams
GOVERNMENT AND POLITICS
The Republican Endgame
by Mark Alexander
Despite all the Leftist rhetoric about ObamaCare being "the law which must now
be funded," it was wholly rejected by Republicans in the Senate and House,
along with many House Democrats. Thus, proposals to defund it, delay it or
amend it are exactly in line with what our Founders expected legislators to do
in the interest of defending and sustaining Rule of Law.
After 41 previous attempts to delay or amend this behemoth, House Republicans
attached a "defund" DemoCare condition to its Continuing Resolution
legislation (CR being that "pass the buck" gimmick to fund government without
actually passing a budget -- which has not been done since George Bush's last
year in office). Using the CR to make their case against nationalized health
care effectively elevated Republican objections above the political din --
thanks in large measure to the much-maligned efforts of Sen. Ted Cruz.
Republicans had no intention of "shutting down government," but have used the
CR to force Democrat votes on defunding, delaying or amending key ObamaCare
mandates.
Here is the Republican endgame (yes, there is one, even if GOP "leadership" is
trying to catch up with the rank and file): There is a growing grassroots
storm brewing in opposition to socialized medicine, now that the reality and
consequences of ObamaCare are starting to sink in. Accordingly, some
non-establishment Republicans in the House and Senate have thrown up a
DemoCare dare, a measure to defund this job-killing budget-buster, which is
really a strategic long shot effort to delay implementation of the "individual
mandate" until after the 2014 election when Republicans believe they will have
generated enough political opposition to the plan to significantly modify
major portions of the law. Indeed, Obama has, for political expediency,
already unilaterally (and unconstitutionally) delayed implementation of the
employer mandate.
Of course, the House "defund tactic" won't pass the Demo-controlled Senate, so
Republicans are banking that Demo Majority Leader Harry Reid will strip that
measure from the current Continuing Resolution and send it back to the House,
where Republicans will return a clean CR, but then replace "defund" with
"delay" as a condition for raising the debt ceiling, which we hit sometime
between 17 and 22 October. Additionally, they will return the debt ceiling
legislation to the Senate with a "wish list" of other amendments, which should
include one requiring that all members of the House and Senate and their
staffs will be subject to all provisions of ObamaCare, as well as other items
to include tax reform, approval of the Keystone pipeline, regulatory and
entitlement reforms including means-tested Medicare, and a "chained" Consumer
Price Index (CPI).
The delay measure, and most if not all of the other Republican amendments,
will be rejected by the Senate, at which point Republicans should get out of
the way and let the Senate send the Continuing Resolution and the upcoming
debt ceiling legislation to Obama, thus allowing the ObamaCare mandates to go
into effect as scheduled. (There is an old adage: When your adversary is
defeating himself, don't interfere.)
The net effect of the Republican strategy is that, in advance of 2014,
Democrats in the House and Senate will have to vote on a lot of measures and
then will have to defend those votes ahead of the 2014 elections. In regard to
the measure to "delay" the implementation of ObamaCare, Demo votes against
that "compromise" will be judged harshly in states and districts with only
modest support for ObamaCare, amid growing grassroots protests against Obama's
socialized medicine scheme.
What will drive those grassroots protests?
Obama, the consummate narcissist, having embraced the name "ObamaCare," will
himself, along with current and future generations of Democrats, suffer a
reversal of political fortunes after ObamaCare is implemented. Why? Because
every American of every political stripe who has any issue with health care,
whether a hangnail or heart transplant, a delay in a doctor's office or in
critical care for a loved one, will tie blame for their discontent like a
noose around the necks of Obama and his Democrats, who were solely responsible
for forcing this abomination upon the American people. No matter how
Fab-Tastic ObamaCare may be for some Demo constituencies, Democrats are going
to be the target of every health care complaint.
Even Demo National Committee chair and Florida Rep. Debbie Wasserman Schultz
can see that pitfall from her perspective in the House. She is insisting that
Democrats "must not treat every minute provision in the law as sacred." She
added that Demos "should be open to suggestions for improving the law."
If Republicans successfully herd the inevitable consumer dissatisfaction and
anger toward Democrats, the electoral awards will be substantial in 2014, 2016
and beyond. Of course, given that establishment Republican have a propensity
for snatching defeat from the jaws of victory, that's a big "if."
Adding to the List of Problems
ObamaCare's exchanges are scheduled to kick off Oct. 1 with the individual
mandate going into effect, but they're not ready. And there's another
significant problem with the law as written.
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The Hidden Obamacare Taxes That
Will Crush The Middle Class
By Money Morning Staff Reports
--------------------------------------------------------------------------------
Get ready to be blindsided by a barrage of new taxes. $1 trillion worth...
They'll be coming courtesy of the Affordable Care Act, otherwise known as Obamacare.
And they won't just be affecting those who make over $250,000. The bulk of these taxes will be passed on directly to the middle class.
That's because while a majority of these "stealth taxes" were designed to be taxes on businesses, they're actually transferred directly to ordinary citizens.
MORE: How much extra will you have to pay? To see how Obamacare taxes will directly affect your paycheck, go here.
They include the investment income surtax, a Medicare payroll tax, even a "tanning tax" on those who utilize indoor tanning services.
"Many of those [hidden] taxes, especially those on hospitals, insurers and medical device manufacturers, will ultimately be passed on through higher health costs," said Michael Tanner an expert on the healthcare law.
In fact, analysts estimate Obamacare will cost the average taxpayer nearly $6,000 in extra taxes as early as next year.
Obamacare Tax Hikes Stoke Outrage
The new taxes go into effect January 1, 2014. But they are already infuriating millions of Americans.
While even Obamacare detractors applaud the requirement that insurance companies cover pre-existing conditions and put a stop to lifetime caps on benefits, they say these laudable benefits don't compensate for the bills high cost - especially in new taxes.
According to most experts, Obamacare will create a total of twenty new taxes or tax hikes on the American people.
In fact, the Obama administration has already given the IRS an extra $500 million to enforce the rules and regulations of Obamacare.
The new taxes don't bode well for millions of middle-class Americans. Incomes for the rich have soared this decade but middle class workers have seen their wages stagnate and even drop since the 2008 Great Recession.
Many fear Obamacare with its high insurance costs and new taxes, could provide the middle class a fatal blow.
The 20 new Obamacare taxes are making Americans eyes pop out in disbelief. Take a look.
Of course, the Obamacare plan was primarily designed to decrease the number of uninsured Americans and reduce healthcare costs.
Many experts are saying it will have the exact opposite effect.
That's just one of the reasons why Republicans hope to defund Obamacare before January.
They claim that the taxes and costs needed to pay for Obamacare will crush the middle class and most U.S. taxpayers, as well as trigger job losses in affected industries.
Tax experts say you should try to estimate how much you will have to pay when the law goes into full effect - and take precautions to limit the damage to your bottom line.
What the Experts Say: How to avoid getting your financial neck broken by Obamacare... Watch this video.
One expert, Dr. Betsy McCaughey, a constitutional scholar with a Ph.D. from Columbia University, recently wrote a best-seller showing Americans how they can not only survive Obamacare, but prosper through it.
McCaughey claims to be one of the only people in the country - including members of Congress - who has actually read the entire 2,572 page law.
Her book, titled Beating Obamacare: Your Handbook for Surviving The New Health Care Law, breaks the huge bill down into 168 pages of actionable advice.
The book, written in an easy going, easy to read style, shows some startling facts about Obamacare not seen in the mainstream press.
For example, she points to a little known passage in the bill that shows how you could get slapped with a $2,000 fine for not having health insurance - even if you do actually have it.
She also goes into detail explaining how a third of all U.S. employers could stop offering health insurance to their workers.
In one chapter, she shows how ordinary Americans will get stuck paying for substance abuse coverage - even if they never touched a drink or drug in their life.
According to McCaughey's research, senior citizens will get hit the hardest.
Hip and knee replacements and cataract surgery will be especially hard to get from Medicare in the months ahead thanks to Obamacare, according to McCaughey.
She warns seniors to get those types of procedures done now before Obamacare goes into effect January 1.
Editor's Note: Real facts and figures about the hidden Obamacare taxes and fees and how they will affect everyday Americans and seniors are hard to find. As a courtesy, Money Morning is giving readers a free copy of Betsy McCaughey's new book Beating Obamacare: Your Handbook for Surviving The New Health Care Law. But only a limited number of copies are available. Please go here to reserve yours today.
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http://www.nationalreview.com/node/359861/print
NATIONAL REVIEW ONLINE www.nationalreview.com
October 1, 2013
100 Unintended Consequences of Obamacare
Companies, workers, retirees, students, and spouses all suffer from the law’s inflexible mandates.
By Andrew Johnson
Today, Obamacare’s October 1 launch date finally arrived. Ever since its passage, supporters of the law have made countless attempts to convince the American people of its viability, dismissing predictions of lost jobs, decreased hours, and rising costs, among others.
Yet from major corporations to local mom-and-pop shops, from entire states to tiny school districts, a wide range of companies and institutions have seen Obamacare’s negative impact on their workers, budgets, and production. Here are 100 examples of how Obamacare is falling short of what was promised.
(Note: Some items on this list came via Investor’s Business Daily and the Heritage Foundation.)
Corporations
1. IBM
Earlier this month, the computer giant, once famed for its paternalism, announced it would remove 110,000 of its Medicare-eligible retirees from the company’s health insurance and give them subsidies to purchase coverage through the Obamacare exchanges. Retirees fear that they will not get the level of coverage they are used to, and that the options will be bewildering.
2. Delta Air Lines
In a letter to employees, Delta Air Lines revealed that the company’s health-care costs will rise about $100 million next year alone, in large part because of Obamacare. The airline said that in addition to several other changes, it would have to drop its specially crafted insurance plans for pilots because the “Cadillac tax” on luxurious health plans has made them too expensive.
3. UPS
Fifteen thousand employees’ spouses will no longer be able to use UPS’s health-care plan because they have access to coverage elsewhere. The “costs associated with the Affordable Care Act have made it increasingly difficult to continue providing the same level of health care benefits to our employees at an affordable cost,” the delivery giant said in a company memo. The move is expected to save the company $60 million next year.
4. Caterpillar Inc.
In the law’s first year, the machinery manufacturer estimated before its passage, Obamacare would add more than $100 million in health-care costs. “We can ill afford cost increases that place us at a disadvantage versus our global competitors,” a Caterpillar executive wrote lawmakers, saying that the law would not meet the goal of providing good, inexpensive health care for all Americans.
5. SeaWorld
SeaWorld used to let part-time employees work up to 32 hours per week, but the company is dropping the limit to 28 hours to keep them under the 30-hour threshold at which it would be required to provide health insurance under Obamacare. More than 80 percent of the company’s thousands of employees are part-time and/or seasonal.
Medical-Device Tax
6. Stryker Corp.
Stryker Corp., a Michigan medical-device manufacturer, laid off about 1,000 employees earlier this year due to the Affordable Care Act’s 2.3 percent excise tax on medical devices. The company estimated that the tax would cost it approximately $100 million next year. “Stryker remains significantly concerned with the upcoming medical device excise tax and its negative impact on jobs and innovation and will continue to work with Congress to try to repeal the tax,” said the company’s CEO.
7. Welch Allyn
The manufacturer announced that it will have to cut approximately 10 percent of its 2,750 employees, 275 in all, because of the medical-device tax. The company also plans to consolidate manufacturing centers, moving some operations from Beaverton, Ore., to its facility in Skaneateles Falls, N.Y.
8. Smith & Nephew
The British company informed nearly 100 employees at its Massachusetts and Tennessee facilities that they would be laid off “in order to absorb [the] cost burden” of the tax on medical devices.
Hospitals, Nonprofits
9. Cleveland Clinic, Ohio
One of the world’s best-known hospitals announced in September that it would slash jobs and up to 6 percent of its annual $6 billion budget in anticipation of costs associated with Obamacare’s implementation. A spokeswoman for the clinic announced that approximately $330 million would be cut, but she did not say how many of the 44,000 employees the clinic would let go. The Cleveland Clinic is Cleveland’s largest employer and the second-largest employer in Ohio.
10. Wake Forest Baptist Medical Center, North Carolina
Last November, the Wake Forest Baptist Medical Center, in Winston-Salem, announced that 950 full-time-equivalent positions would have to be eliminated in order to make up costs from the health-care law.
11. Orlando Health, Florida
In that same month, the Orlando Health hospital system announced the biggest staff reduction in its almost century-long history, as part of a “broader effort” to manage the effects of Obamacare, according to the Orlando Sentinel. Orlando Health will cut as many as 400 jobs across the system, in areas ranging from administrative departments to children’s hospitals.
12. Louisiana State University Hospitals
In the same article, the Sentinel noted that LSU hospitals would cut nearly 1,495 positions in order to save $150 million, apparently because of expected reductions in Medicare and Medicaid payments.
13. Delaware Hospice
Due to new interpretations of the rules for reimbursing for hospice services, Delaware Hospice, the Ocean State’s only not-for-profit hospice provider, had to let 52 employees go earlier this year. “It’s really health-care reform in action,” a spokeswoman said. “This is affecting hospices across the country. We’re working through dramatic changes in terms of the hospice-care benefits.”
14. Lawrence + Memorial Hospital, Connecticut
The New London hospital announced earlier this month that Medicare cuts programmed into Obamacare had led to the firing of 33 employees. “L+M and other hospitals are contending with massive structural changes that are happening very rapidly,” the hospital’s president and CEO said.
15. Clifton Springs Hospital, New York
Fifty-eight non-clinical employees were let go from Clifton Springs Hospital in Rochester as the hospital prepared for the changes spurred by the Affordable Care Act. “No one really knows what the impact will be because it really is a very new way for reimbursing for health care,” the hospital’s CEO told a local news station. “So I think everyone is trying to prepare for a change, and a change with less revenue.”
16. Anthem Blue Cross Blue Shield, New Hampshire
The state’s only insurer approved to offer plans on the health-insurance exchanges in New Hampshire has cut the number of hospitals that will participate in the plan from 26 to 14 in order to reach “affordable premium levels,” according to the New Hampshire Union Leader.
17. Mexican American Opportunity Foundation, California
The nonprofit, which looks after 1,100 pre-K children at its eight Southern California child-care centers, has had to reduce the hours of dozens of employees who used to work 30 to 40 hours per week. “We’re fearful it’s going to be hard to negotiate health care in any contract,” one local labor leader said. “Overall [Obamacare] is a positive step, but on a micro level it’s not all roses.”
18. Carnegie Museum, Pennsylvania
A Pittsburgh news station reports that the Carnegie Museum “reluctantly” scaled back the hours of 48 of its 600 part-time employees to less than 30 hours a week to sidestep the mandate to provide health-care coverage.
19. Fort Smith Area Agency on Aging, Arkansas
The nonprofit revealed that all of its health aides and drivers will work a maximum of 28 hours a week, and that the plan it would offer to its remaining full-time employees would be “bare bones.” To make up for additional Obamacare costs, the organization is asking employees to take steps to save money, such as changing vehicle oil after 5,000 miles rather than 3,000.
20. Emory Healthcare, Georgia
A news station in Atlanta reports that Emory Healthcare, the state’s largest health-care system, will lay off more than 100 employees, in part because of Obamacare.
21. CoverTN, Tennessee
Thousands of Tennesseans will lose their coverage under the state’s health-insurance program because it does not meet Affordable Care Act standards for yearly expenditure caps. CoverTN, which was used mainly by small businesses, had a $25,000 yearly benefits limit. “It was all I had,” one Nashville small-business owner said.
State and Local Governments
22. State of Virginia
In February the General Assembly affirmed Governor Bob McDonnell’s decision to limit the state’s part-time employees to 29 hours per week.
23. Township of Middletown, New Jersey
Middletown has also cut the hours of 25 part-time public employees. “Any of those expenses [for insurance] are going to be passed along to the taxpayers, and so in order to avoid having to do that, we chose to modify the work hours,” said the township’s administrator.
24. Brevard County, Florida
Brevard County’s insurance director told a local television station that the county’s 300-plus part-time employees will be “capped at something less than 30” hours to save the county about $10,000 per employee in health insurance.
25. Township of Berkeley, New Jersey
The Sandy-hit Jersey Shore town said it will “take a hard line” in union negotiations in limiting part-time employees’ hours, because additional health-care costs “are out of the question.” “If it came down to shaving hours to save substantial dollars, that’s something that would have to be considered,” the township administrator said.
26. Chesterfield County, Virginia
An administrator with this southern Virginia county told the Richmond Times-Dispatch that “several hundred” part-time employees could have their hours cut back to 28. Most of the employees affected would be from the Department of Mental Health Support Services.
27. City of Lynchburg, Virginia
About 40 percent of the city’s part-time work force saw cuts to their weekly hours to ensure that their totals come in below the 30-hour threshold, according to the local News & Advance. The city’s human-resources director said some departments do not have the financial resources to add employees or raise wages to make up for the lost work time.
28. City of Mason, Ohio
Cut hours for 200 part-time workers or take a $3.4 million hit: That was the decision the southwestern Ohio city faced when it started weighing Obamacare’s impact. It opted for the former. Part-timers had regularly worked more than 30 hours, but the city manager told the JournalNews that their weekly workload has been reduced to 20 hours.
29. Township of Toms River, New Jersey
Government workers in Toms River pushing the 30-hour threshold will be bumped down to “below 25” to ensure that they are considered part-time employees, according to the Asbury Park Press. “I think this was not very well thought out,” the township’s business manager said of the Affordable Care Act. “There was this fallacy that the law provisions didn’t apply to municipal government. It sure does.”
30. Lee County, Iowa
Lee County “could be out a lot of money,” a local newspaper reported a supervisor saying, if the county doesn’t stick to its new policy of holding part-time workers to 28 hours.
31. City of Faribault, Minnesota
Employees working 30 to 38 hours per week with the Minnesota city will be bumped down to part-time status to avoid penalties and costs associated with the mandate.
32. Kansas Turnpike Authority
Three eight-hour shifts per week: That’s the new maximum schedule for part-time toll collectors in Kansas. While the state’s turnpike authority previously had part-time employees who worked more than 30 hours a week, a new policy will limit them to the new schedule.
Education
33. University of Virginia
Because of an additional $7.3 million in health-care costs next year, the University of Virginia alerted some of its employees that it will no longer offer health insurance to their spouses.
34. Community College of Allegheny County, Pennsylvania
The Pittsburgh-area community college informed about 400 part-time employees that they would see a reduction in their hours starting in January of this year to comply with Obamacare regulations. The school had to make this change a year before the law went into effect because Obamacare stipulates that the federal government must look back one year to determine an employee’s status.
35. St. Petersburg College, Florida
To avoid paying an additional $777,000 per year, St. Petersburg College told 250 adjunct professors that their hours would be cut back for upcoming terms. “I never thought it would impact me directly,” a math teacher told NBC News Investigations. “I was stunned when I got the email. . . . I love teaching at St. Pete College, but that is a significant cut.”
36. Hillsborough Community College, Florida
Hillsborough Community College may have to cut the hours of nearly 10 percent of its part-time work force, according to the Tampa Tribune. By keeping those employees under 30 hours per week, the college can avoid an additional $863,500 in total costs for health plans.
37. Hamilton Township School District, New Jersey
Substitute teachers will see their time in the classroom limited to four workdays per week, the cap set in place in June by the school district . The “strict limits” went into effect at the beginning of this school year. According to a report by the Trenton Times, other nearby districts also could consider similar provisions.
38. Purdue University, Indiana
Despite “pretty radical changes” to the university’s health-care plans for its roughly 27,000 employees, Purdue University still won’t be able to skirt $2.8 million in additional costs brought on by the Affordable Care Act.
39. Oneida Special School District, Tennessee
Most of the non-certified personnel in the Oneida Special School District, such as teacher assistants, janitors, and cafeteria workers, will not be allowed to work more than 29 hours a week.
40. Central Michigan University
Some of the 5,700 students hired as employees by Central Michigan University will be barred from working more than 25 hours a week. While students have said the new limits “will sting a little bit” and make it “increasingly harder” to pay for various expenses, CMU’s human-resources vice president told a local news station that the move would “align us with other schools” making similar adjustments. Without the limits, CMU would have to pay as much as a $5 million penalty for not offering student workers health-care coverage.
41. University of North Alabama
Graduate-student workers at this school in Florence, Ala., will be barred from working more than 29 hours a week.
42. Arizona State University
Associate faculty members will be limited to teaching six credit hours, or two classes, per semester as part of an effort to more clearly define full-time versus part-time faculty, according to the Arizona Republic. “It’s like getting a punch in the stomach,” said one religious-studies teacher. “For some people it’s a major financial setback.”
43. Ivy Tech Community College, Indiana
Ivy Tech Community College, where 60 percent of the professors work part-time, will limit its part-time professors to less than 30 hours per week.
44. Maricopa Community Colleges, Arizona
The Phoenix community-college system notified almost 700 adjunct professors and 600 other part-time workers of a new policy that will prevent them from working more than 30 hours a week. An adjunct professor said the changes would affect his personal finances, and he warned that “this is going to come back to bite us” because instructors won’t be able to fill in for one another due to the cap on hours.
45. Granite School District, Utah
Facing at least $14 million in additional health-care costs, the Salt Lake City–area school district, which operates 92 schools, reduced the hours of as many as 1,200 part-time workers. In a letter, the district warned that employees who violate the 29-hour limit for part-time work could be terminated.
46. Alpine School District, Utah
“I would have to look for another job, or we would lose our house,” a school-bus driver told Provo’s Daily Herald after the school district said hourly employees could no longer work more than 27.5 hours per week. “If they cut our hours to 27, we will be up the creek,” another driver said.
47. Fort Wayne Community Schools, Indiana
In May, 610 part-time teaching aides and cafeteria workers were informed by the Fort Wayne Community Schools that their hours would be cut to keep FWCS from having to provide health insurance to those employees. “It’s something that almost all employers with part-time employees are trying to resolve,” a district administrator said.
48. Papillion–La Vista School District, Nebraska
The Affordable Care Act would have added $2.5 million in new health-care costs — or $3.4 million in penalties — to the Papillion–La Vista school district if 281 part-time employees’ hours had not been limited to fewer than 30 a week.
49. University of Akron, Ohio
Already facing a budget deficit, the University of Akron will ask 230 of its part-time faculty members to accept a cut to their work hours to avoid having to provide health insurance.
50. Youngstown State University, Ohio
The university warned part-time faculty members that they will be fired if they surpass the new 29-hour-per-week restriction. “If you exceed the maximum hours, YSU will not employ you the following year,” the school said in an e-mail. “We will have no recourse.”
51. Tredyffrin-Easttown School District, Pennsylvania
In June, the district announced that it would have to “restructure hours” to avoid cost increases to health-insurance plans. A local newspaper detailed a handful of options for the district; almost all resulted in fewer hours for lower pay.
52. Southern Lehigh School District, Pennsylvania
The Lehigh Valley–area district reduced the hours of 51 part-time workers to comply with the 30-hour threshold. The cuts will affect employees across the district, including custodians, cafeteria workers, secretaries, health-services support-staff members, and special-education support employees.
53. Zionsville Community Schools, Indiana
One hundred instructional aides, coaches, and substitute teachers in the Indiana district saw their weekly workload restricted to 29 hours.
54. Spartanburg Community College, South Carolina
Adjunct faculty members taught more than half of the community college’s classes, and all but 23 of the 400 to 500 such faculty members will see their hours slashed to meet the part-time requirement. Otherwise the college would face the choice of paying penalties of up to $2,000 per employee to whom it didn’t offer health coverage or paying up to $1 million for insurance.
55. Finger Lakes Community College, New York
The upstate New York community college has set the maximum weekly work hours for adjunct faculty members at “under 30.”
56. Mount Ephraim School District, New Jersey
At a school-board meeting this year, the district announced that the cost of benefits will rise by 18 percent because of the Affordable Care Act, and the increase will be passed on to taxpayers.
57. Minocqua-Hazelhurst-Lake Tomahawk School District, Wisconsin
The northern Wisconsin school district took steps to ensure that its part-time employees work fewer than 30 hours per week, a local news station reported.
58. Rock Valley College, Illinois
As of July, the two-year Rockford school now hires new employees to work a maximum of 25 hours per week.
Big Labor
59. Teamsters, UFCW, and UNITE HERE
The heads of the International Brotherhood of Teamsters, the United Food and Commercial Workers, and UNITE HERE wrote to Democratic lawmakers in July to warn that Obamacare would “destroy the foundation of the 40-hour work week that is the backbone of the middle class.” While the labor leaders acknowledged their past support for the law, they remarked that their decision had “come back to haunt us.”
60. AFL-CIO
In an interview with Al Jazeera America, AFL-CIO president Richard Trumka conceded that the Affordable Care Act “does need some modifications to it” because companies are “restricting their workforce to give workers 29 and a half hours so they don’t have to provide them health care.”
Restaurants and the Food Industry
61. Cheesecake Factory
The chain restaurant’s CEO warned that while his company already covers its employees who work at least 25 hours, he expects the new law to “be very costly” for most companies. He predicted that if Cheesecake Factory has to expand coverage, the costs will be passed on to consumers with price increases or a lower level of service.
62. Papa John’s Pizza
After causing a stir among Obamacare supporters by suggesting possible price increases and/or cuts to jobs and hours, Papa John’s Pizza CEO reiterated: “It’s common sense. That’s what I call lose-lose.”
63. Buca di Beppo
Buca di Beppo employees across the country say managers told them in June that they would see their weekly hours reduced to less than 30. The founder of the company that owns the restaurants distanced himself from the comments, but employees insist that the Affordable Care Act is the root cause: “I guarantee you it has to do with what’s going on with our country and decisions being made with Obamacare,” said one worker.
64. Fatburger
The CEO of the burger-joint chain announced that franchises have begun making efforts to keep employees under the 30-hour threshold, including some franchises’ engaging in “job sharing.” For example, an employee at one Fatburger could work 25 hours a week at one location, and another 25 hours at a different location with a different owner, without falling under the Obamacare mandate.
65. Wendy’s
An Omaha Wendy’s franchisee alerted almost 100 non-management workers that their hours would be reduced to 28 per week in order to comply with Obamacare mandates.
66. Subway restaurants, Illinois
Employees at 15 Subway restaurants in central Illinois have begun to see a reduction in their hours. “We don’t like doing that,” the owner said. “But if we were to have to pay for everyone to have health insurance or pay the full penalties, we would be out of business.”
67. Subway restaurants, Maine
The owner of 21 Subway franchises in Maine told 50 of his workers that their hours would be reduced to a maximum of 29 a week. “To tell somebody that you’ve got to decrease their hours because of a law passed in Washington is very frustrating to me,” he told NBC News Investigations.
68. PoFolks restaurant, Alabama
The restaurant’s owner told a local news station that he will have to cut the number of full-time employees from 16 workers to four to meet the “great challenge” Obamacare poses to the company.
69. Joe Bologna’s, Kentucky
In order to limit employees’ hours and save money, a Lexington businessman has closed his restaurant on Mondays. He told a local news station that additional costs, which could be as high as $20,000, probably would have to be passed on to customers.
70. Five Guys franchises, North Carolina
The owner of eight Five Guys franchises in the Raleigh-Durham area said he will have to use all the profits from one of his eight stores just to cover “any added costs [that] are going to have to be passed on” by the health-care act.
71. Charco Broiler, Colorado
The Fort Collins restaurant informed three full-time employees that they would drop down to part-time work to keep the company under the 50-employee threshold, above which employers must insure all full-time employees.
72. Shari’s restaurant, Oregon
A Portland-area waitress told a news station that she has struggled to pay her bills after Shari’s relegated her status to part time due to one of the law’s mandates, cutting her schedule by almost ten hours a week.
73. Russ’ Restaurants, Michigan
Non-managerial employees are no longer allowed to work more than 25 hours per week.
74. Burger King, Washington, D.C.
“I’m not sure if Congress understood the devastating effect that this will have on businesses and on employment,” said a human-resources officer for the Maryland-based company that owns Washington, D.C.’s largest Burger King franchise. From the beginning of this year, the company has hired only part-time employees, who are “guaranteed no more than 29 hours per week.”
75. Taco Bell, Oklahoma
No employees at the Guthrie Taco Bell will be allowed to work more than 28 hours a week, resulting in a $200 reduction in one employee’s paycheck. “Several of the other people I work with, some of them are single parents, and we do the best we can, and 28 hours a week just isn’t going to cut it for the bills,” the worker said.
76. A Virginia Beach restaurant, Virginia
The owner of a Virginia Beach restaurant and catering company told Bloomberg that he has stopped hiring people to work full time and is even drawing back on part-time employees’ hours. “I can’t afford health insurance for everyone,” he said.
77. Jim’s restaurants, Texas
The San Antonio restaurant chain might be required to pay as much as $1 million more annually after Obamacare takes effect. In response, Jim’s, like many other companies, is considering a reduction in employees’ hours so it won’t have to provide them with insurance.
78. CiCi’s Pizza restaurants, Texas
Bob Westbrook owned the state’s three top-performing CiCi’s Pizza franchises but calculated that the costs of providing health care under the employer mandate would leave him about $78,000 in the red at the end of the year. Ultimately, Westbrook figured, it was most cost-effective for him to sell his franchises, after nearly 20 years.
Grocery Chains
79. Whole Foods Market
The CEO of Whole Foods may not know exactly what changes will take place when the Affordable Care Act is fully implemented, but he’s sure it will negatively affect workers. While he would like his company to continue offering health insurance to its employees, he said there might have to be a tradeoff in the benefits equation: “That just means there’s less we can pay for wages.”
80. Trader Joe’s
Even though it has previously provided health-care coverage for its part-time employees, an uncommon practice in the industry, next year Trader Joe’s will give employees who work less than 30 hours a week $500 to purchase a plan in the upcoming Obamacare exchanges. With federal subsidies and possible earnings from other employment, the company said, workers can find coverage that will be just as good. One employee described her soon-to-be lost coverage as “one of the best parts about the job,” and her reaction to hearing it would be dumped was “pure panic, followed quickly by anger.”
81. Wegmans
The New York–based grocery chain announced in July that part-time employees will no longer receive health-care coverage due to Obamacare. Wegmans previously offered insurance to part-time employees working at least 20 hours a week.
82. Trig’s Supermarkets, Wisconsin
Sixty-five percent of the 1,100 workers at the Wisconsin supermarket chain will see their hours reduced to below 30 per week. “Doing nothing was not an option,” an executive with the company said. “Within a year, it would have put us out of business.”
83. Waldbaum’s, New York
At least one of the New York City–area supermarket chain’s stores has told employees that they will now be part-time workers, with some seeing a reduction of 20 hours or more from their usual weekly total. Some of Waldbaum’s 100 employees affected by the change are now seeking second or third jobs, according to a local newspaper.
84. Royal Farms, Maryland
The company’s 146 convenience stores in Delaware, Maryland, Pennsylvania, and Virginia are transitioning to an almost entirely part-time work force, reducing even full-timers to fewer than 30 hours a week.
Small Local Businesses
85. Southern Hearth & Patio, Tennessee
Health-insurance costs have more than tripled under the Obama presidency, said the owner of Southern Hearth & Patio in Chattanooga. He’s had to offer smaller bonuses and lower pay raises because of the Affordable Care Act.
86. Tsunami Surf Shop, North Carolina and South Carolina
A manager for Tsunami Surf Shop told a local news station that the company will “have to control the shifts” from now on in order to ensure that employees are working fewer than 30 hours a week.
87. Kerns Trucking, North Carolina
The family-owned trucking company had to cut insurance benefits for 81 workers to avoid having to pay an additional $100,000 under the law’s tax.
88. AAA Parking, Georgia
Next year, AAA Parking will move half of its 500 full-time hourly employees (out of a work force of 1,600) to part-time employment. “Our executive team has spent extensive time evaluating the impact of this mandate, and the financial impact for AAA Parking is dramatic,” a company memo explained.
89. Circle K gas station, Georgia
An employee at the Savannah gas station told a local news station that a supervisor informed workers that they would now work a part-time schedule due to the mandate.
90. Maritz Research, Missouri
The business-research firm informed its 300 employees in July that, starting next year, the company would have to “proactively manage average hours worked on a weekly basis” and enforce a 25-hour threshold.
Premium Rate Increases
91. California
Individual-market premiums in the Golden State could jump as much as 146 percent, according to an analysis of the state’s exchange program by Avik Roy of National Review and Forbes. For example, the cost for a nonsmoking 25-year-old in California who purchases the second-cheapest plan on the exchange would go from $92 to $205.
92. Colorado
Colorado’s cheapest health plans, which are generally geared toward younger people, are expected to rise dramatically in price next year, according to The Hill. Consider a nonsmoker under 30 years old. This year, this Coloradan could have purchased the cheapest catastrophic plan for $56 per month; next year, the cost is expected to climb to $135.
93. Florida
Florida regulators say the average premium for individuals will increase by 30 to 40 percent. For small businesses, the rates will be between 5 and 20 percent higher.
94. Massachusetts
According to a study by the Massachusetts Association of Health Plans and Blue Cross Blue Shield of Massachusetts, well over half of the state’s small businesses will see a rate increase, with some prices potentially doubling.
95. New Mexico
In a study conducted by the Manhattan Institute for Policy Research, by a team including our own Avik Roy, New Mexico was rated the state that would see the largest average hike in premium costs, at 130 percent.
96. Ohio
The cost of the average health-care plan in Ohio is expected to nearly double under Obamacare, according to state insurance regulators. The Hill reports that an 88 percent increase will ultimately mean the cheapest plan on the market after the law goes into effect next year will cost about $280 a month.
97. Oklahoma
In all but one of the insurance plans offered to Oklahoma state employees, premiums will go up by as much as 12 percent; the one plan that does not have an increase is the “cheapest, most basic health plan,” according to The Oklahoman. According to an administrator with the state’s Office of Management and Enterprise Services, a tax associated with Obamacare has led to an increase in the plans’ cost.
98. Rhode Island
According to the state’s health-insurance commissioner, the rate increase for large employers for 2014 will be about 10 to 12 percent, twice as high as the increase this year.
99. Washington
The analysis by Avik Roy and the Manhattan Institute indicates that Washington State residents across all age groups will see significant increases in their rates. Twenty-year-olds will see an average increase of 80 percent; 40-year-olds 50 percent; and 64-year-olds 59 percent.
100 Wisconsin
The state’s health-insurance regulators determined that “premiums will increase for most consumers” in Wisconsin when the law goes into effect in 2014. Young residents will see an estimated 125 percent increase, while seniors will pay as much as 45 percent more.
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Are these the same people who call Congress stupid, immature, childish?
http://www.huffingtonpost.com/2013/10/01/jimmy-kimmel-obamacare-prank_n_4022424.html?utm_hp_ref=mostpopular
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http://washingtonexaminer.com/article/2536702
From the article:
So the standoff continues. But there are signs the terrain of battle has shifted so much that Obamacare -- the reason Republicans fought so hard over resolutions to fund the government in coming months -- is no longer the central issue in the fight.
As the shutdown took hold, the House GOP leadership changed course from trying to limit Obamacare to an effort to mitigate the effects of the shutdown. Boehner and his colleagues came up with bills that would fund the National Park Service, the Department of Veterans Affairs, the Smithsonian, the National Gallery of Art, the Holocaust Museum, and the District of Columbia government. The bills were considered under special rules, which in the end meant that House Democrats were able to kill them -- before Senate Democrats could kill them.
What distinguished the House agenda on Tuesday was that it wasn't about Obamacare. The parks bill, for example, did not contain a provision to defund or delay the president's national health care plan. The Smithsonian bill didn't either. And so on. One could argue that with the government shut down, Obamacare was effectively defunded, at least for the many days the government remains closed. But the fact is, on Tuesday the Republican focus shifted from going after Obamacare to trying to undo the most visible negative consequences of the shutdown.
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http://www.nytimes.com/news/fiscal-crisis/2013/10/03/republicans-say-boehner-has-offered-assurances-on-default/?_r=0
From the article:
The lawmaker, who spoke on the condition of not being named, said Mr. Boehner indicated he would be willing to violate the so-called Hastert rule if necessary to pass a debt limit increase. The informal rule refers to a policy of not bringing to the floor any measure that does not have a majority of Republican votes.
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From Mona,
"The Democrats' reform of the health care system is stumbling into a predictable and predicted morass. Democrats will inevitably conclude that this calls for even more government. Republicans should side with consumers."
Probably most if not some Democrats have already concluded more government is needed. Obama himself is long ago on record stating single payer is the best. I agree with Mona that Democrats will go after insurance companies (Hillary redux) in 2016. I would only add that this is by design. Part of the plan from the get-go. She makes a good point that Republicans should be ready for this. I nominate her to take over for Rove.
****Mona Charen
Mona Charen October 1, 2013 3:00 AM HealthHealth Care PolicyBarack Obama
Want a glimpse of what the Obamacare battle will look like in 2015? Just glance at liberal websites. You'll find a trove of insurance company bashing. Are insurance premiums rising instead of falling by the $2,500 per family that Obama repeatedly promised in 2009? They are. If you consult ThinkProgess, Daily Kos and Physicians for a National Health Program, you'll learn that it's the "greedy insurance companies" that are causing prices to rise, not the risibly titled, "Patient Protection and Affordable Care Act."
You can take this to the bank: In the run-up to the next presidential election, Democrats will be in thorough blame-shifting mode. It wasn't the perverse incentives, byzantine complexity, new taxes and layers of bureaucracy built into Obamacare, they'll insist. It was heartless health insurers who were willing to let people die rather than accept a lower profit margin.
Obama has already shown the way. Stumping for Obamacare in 2010, he said, "(They'll) keep on doing this for as long as they can get away with it. This is no secret. They're telling their investors this — 'We are in the money. We are going to keep on making big profits even though a lot of folks are going to be put under hardship.'"
That's just the way businessmen talk, isn't it? Only in the imaginings of the anti-business left. In any case, the other shoe to drop, after the demonization of the industry, will be the same solution Democrats propose for everything — more government. Obamacare will be said to have failed because private companies put profits ahead of people. The "solution" will be single-payer.
Let's not weep for the health insurance companies. They could have energetically opposed Obamacare, and they chose not to. As Timothy Carney of the Washington Examiner explained, it was in their interest to support a law that would 1) require everyone to purchase their product and 2) provide subsidies directly to insurance companies to help people pay for it. As Carney wrote: "Would you be surprised to hear of corn farmers supporting ethanol subsidies?" There were aspects of the law the insurance industry protested, but for the most part, they were content to be tamely transformed into a regulated public utility.
The health care system that predated Obamacare was already so distorted by government subsidies, regulations and tax incentives as to be quasi state-run. True reform would rip that government IV out of the nation's arm altogether and encourage more competition, not less. True reform would remove the tax deductions handed to employers 60 years ago and give them to individuals instead. True reform would permit individuals to shop nationwide for the best plan and would permit companies to offer truly catastrophic plans for the young and healthy. True reform would create high-risk pools to provide for those with chronic conditions.
As the examples of the insurance industry and the corn growers demonstrate, it's a mistake to rely on the business sector to promote free enterprise. Some businessmen do, but many are happy to engage in rent seeking from the state. Farmers, universities, banks, construction companies, green energy firms, car companies, the telecommunications industry — the list of supplicants for taxpayer subsidies is endless.
Republicans are perceived (and often see themselves) as the pro-business party. They should think of themselves as pro-consumer instead.
Still, Republicans do understand the basics of supply and demand better than Democrats, and many predicted the problems Obamacare is already experiencing. They understood, as Obama and his supporters apparently did not, that the laws of economics are not optional. You cannot extend health care to 30 or 40 or 50 million people (the number kept changing) who previously lacked it and bring down total health spending simultaneously. You cannot force insurance companies to accept all customers regardless of preexisting conditions and expect that premiums will not rise to cover the expense. Further, once people realize that insurance companies cannot reject them when they become sick, the incentive to purchase health insurance among the healthy population disappears. (The small fine for failure to buy insurance will not compensate.) You cannot mandate that employers with more than 50 full-time employees provide government approved insurance without causing employers to shift to part-time employees or decline to hire. You cannot impose a "Cadillac tax" without employers raising premiums or reducing their coverage.
The Democrats' reform of the health care system is stumbling into a predictable and predicted morass. Democrats will inevitably conclude that this calls for even more government. Republicans should side with consumers.
To find out more about Mona Charen and read features by other Creators Syndicate columnists and cartoonists, visit the Creators Syndicate Web page at www.creators.com.
COPYRIGHT 2013 CREATORS.COM****
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I was thrilled to find out that enrolled members of federally recognized tribes are exempted from ObamaDoesn'tCare.
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http://www.wired.com/wiredscience/2013/10/government-shutdown-affects-biomedical-research/
From the article:
But one area where the devastating effects aren’t getting much public attention is basic biomedical research. What’s happening to the thousands of researchers and billions of dollars dedicated to understanding human disease and development? I talked to a government biomedical scientist about the shutdown’s effect. Because the scientist was instructed not to speak with the media, this person will remain anonymous. Below is an edited version of what the scientist told me.
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Ad in poor taste: http://atr.rollcall.com/democrats-new-ad-boehner-is-cry-baby/
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http://www.wired.com/wiredscience/2013/10/government-shutdown-affects-biomedical-research/
From the article:
But one area where the devastating effects aren’t getting much public attention is basic biomedical research. What’s happening to the thousands of researchers and billions of dollars dedicated to understanding human disease and development? I talked to a government biomedical scientist about the shutdown’s effect. Because the scientist was instructed not to speak with the media, this person will remain anonymous. Below is an edited version of what the scientist told me.
:roll:
Perhaps they can get temp jobs reinforcing Barry-cades to keep elderly veterans out of public monuments.
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http://dailycaller.com/2013/09/30/company-with-1-2-billion-obamacare-contract-under-investigation-for-serious-fraud/
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http://dailycaller.com/2013/09/30/company-with-1-2-billion-obamacare-contract-under-investigation-for-serious-fraud/
Chicago-style corruption. Who could have seen this coming?
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(http://tpc.pc2.netdna-cdn.com/images/Democrat_Rights_160.png)
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http://dailycaller.com/2013/10/08/jon-stewart-accuses-kathleen-sebelius-of-lying-to-him-about-obamacare/
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One year ago the use of the word liar would have been politically incorrect. Accuracy and honesty finally trumps PC.
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Suit In Oklahoma Could Knock Out ObamaCare
By DICK MORRIS
Published on TheHill.com on October 8, 2013
Printer-Friendly Version
Why didn't anyone else think of it?
Scott Pruitt, the attorney general of Oklahoma, acting on the research of Jonathan H. Adler and Michael F. Cannon published in the Case Western Reserve Journal of International Law, has brought a new lawsuit, on behalf of the state, against ObamaCare.
Unlike the suit brought by 26 state attorneys general, this lawsuit does not make a constitutional objection to the Affordable Care Act. Instead, it uses the language of the law to challenge the elaborate system of subsidies, tax credits and individual or employer mandates and fines the act has spawned.
Adler and Cannon studied the actual text of the law -- something Congress never did -- and found that it explicitly provided a subsidy only to those who receive their insurance through state exchanges. Indeed, the subsidies and tax credits were intended to be the carrot that induced states to set up exchanges rather than force the feds to set up their own.
The Internal Revenue Service has ruled that the language of the statute should be "interpreted" to extend the subsidies to those enrolled in state or federal exchanges, but that's not what the law says. Section 1401 of the act, according to their article, "authorizes premium-assistance tax credits and makes them available only through state-run Exchanges."
The section says that taxpayers may receive a tax credit only if "the taxpayer is covered by a qualified health plan ... that was enrolled in through an Exchange established by the State under section 1311 of the Patient Protection and Affordable Care Act."
Adler and Cannon argue that "by its express terms, this provision only applies to exchanges 'established by a state' and 'established ... under Section 1311.' Section 1401 further emphasizes that tax credits are available only through Section 1311 exchanges."
The IRS and defenders of the legislation try to stretch the language to imply a mandate to cover those in federal exchanges. Former IRS Director Douglas Shulman, answering a letter from Republican congressmen about whether the subsidies are limited to state exchanges, wrote:
"The statute includes language that indicates that individuals are eligible for tax credits whether they are enrolled through a State-based Exchange or a Federally-facilitated Exchange."
Unfortunately for President Obama, the statute implies no such thing. It is not only silent on any subsidies for federal exchanges, it is clear that the subsidies were intended to encourage states to set up exchanges.
The Oklahoma suit has survived a motion to dismiss and its standing to bring the suit has been affirmed by the District Court. Pruitt hopes for a judgment later this year and feels the case might reach the Supreme Court by late next year.
Godspeed!
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Second post. Coulter can often be an ass, but here she is in fine form. Several really good points:
http://news.yahoo.com/democrats-america-own-government-223010441.html
DEMOCRATS TO AMERICA: WE OWN THE GOVERNMENT!
Ann Coulter
Ann Coulter 13 hours ago
In the current fight over the government shutdown, Republicans are simply representing the views of the American people. Americans didn't ask for Obamacare, they don't want it, but now their insurance premiums are going through the roof, their doctors aren't accepting it, and their employers are moving them into part-time work -- or firing them -- to avoid the law's mandates.
Contrary to Obama's promises, it turns out: You can't keep your doctor, you can't keep your insurance -- you can't even keep your job. In other words, it's a typical government program, but this one wrecks your health care.
Also, the president did raise taxes on the middle class in defiance of his well-worn campaign promise not to. Indeed, Obamacare is the largest tax hike in U.S. history.
Among the other changes effected by this law are:
-- Obamacare will allow insurers to charge 50 percent higher premiums for smokers, but prohibits insurers from increasing premiums for those with HIV/AIDS.
-- Nationally, Obamacare will increase men's individual insurance premiums by an average of 99 percent and women's by 62 percent. In North Carolina, for example, individual insurance premiums will triple for women and quadruple for men.
-- Health plans valued at $27,500 or more for a family of four will be taxed at a rate of 40 percent.
-- No doctors who went to an American medical school will be accepting Obamacare.
-- A 62-year-old man earning $46,000 a year is entitled to a $7,836 government tax credit to buy health insurance. But if he earns an extra $22 in income, he loses the entire $7,836 credit. He will have more take-home pay by earning $46,000 than if he earns $55,000. (If he's lucky, he already works for one of the companies forced by Obamacare to reduce employees' hours!)
-- Merely to be eligible for millions of dollars in grants from the federal government under Obamacare, education and training programs are required to meet racial, ethnic, gender, linguistic and sexual orientation quotas. That's going to make health care MUCH better!
-- Obamacare is turning America into a part-time nation. According to a recent report by economist John Lott, 97 percent of all jobs added to the economy so far this year have been part-time jobs. Ninety-seven percent! (I'm doubting this number-- I thought it was more like 70%?)
-- Obamacare is such a disaster that the people who wrote it refuse to live under it themselves. That's right, Congress won a waiver from Obamacare.
Responding to the people's will, House Republicans first voted to fund all of government -- except Obamacare. Obama refused to negotiate and Senate Democrats refused to pass it.
Then the Republicans voted to fully fund the government, but merely delay the implementation of Obamacare for one year. Obama refused to negotiate and Senate Democrats refused to pass it.
Finally, the Republicans voted to fully fund the government, but added a requirement that everyone live under Obamacare. No more special waivers for Congress and their staff, and no waivers for big business without the same waivers for individuals.
Obama refused to negotiate and Senate Democrats refused to pass it. So as you can see, Republicans are the big holdup here.
A longtime Democratic operative, Karen Finney, explained the Democrats' intransigence on MSNBC to a delighted Joan Walsh (aka the most easily fooled person on TV) by comparing House Republicans to a teenager trying to borrow his mother's car. "No, I'm not negotiating!" Mother says. "It's MY CAR!"
This wasn't a stupid slip of the tongue that other Democrats quickly rejected. Finney had used the exact same metaphor to a panel of highly agreeable MSNBC guests the day before. (MSNBC books no other kind of guest.) The left thinks the government is their car and the people's representatives are obstreperous teenagers trying to borrow the government. Which belongs to Democrats.
That's not how the Constitution views the House of Representatives. To the contrary, the House is considered most reflective of the people's will because its members are elected every two years.
As a matter of fact, the Republicans who mistakenly assume they have something to do with running the government represent most of the people who pay taxes to run it. So it's more like a teenager who is making the car payments, maintaining the car insurance and taking responsibility for registering the car being told: "It's not your car."
But the Democrats refuse to even negotiate. It's their government -- and if you Republicans think you're going out dressed like that, you've got another thing coming! Needless to say, they absolutely will not consider the Republicans' demand that Democrats merely live under Obamacare themselves.
Instead, Democrats say "the Koch brothers" are behind the effort to defund Obamacare.
They say Republicans are trying to "burn the whole house down" (Rep. Debbie Wasserman Schultz); "have lost their minds" (Sen. Harry Reid); are trying to negotiate "with a bomb strapped to their chest" (senior White House adviser Dan Pfeiffer); are "legislative arsonists" (Rep. Nancy Pelosi); and are engaging in "blatant extortion" (White House press secretary Jay Carney).
The MSNBC crowd calls Republicans "arsonists" every 15 minutes. They ought to check with fellow MSNBC host Al Sharpton. He knows his arsonists! In 1995, Sharpton whipped up a mob outside the Jewish-owned Freddy's Fashion Mart with an anti-Semitic speech. Sometime later, a member of the mob torched the store, killing seven Hispanic employees.
Every single Democrat in the country uses the exact same talking point: We "refuse to negotiate with a gun being held to our head."
Which means that the Democrats will engage in no negotiation at all -- not now, not ever. House Republicans have already passed three-dozen bills defunding, or otherwise modifying, Obamacare. Senate Democrats and liberal commentators had a good laugh at Republicans for passing them. Now they're paying attention!
If you are in the minority of Americans not already unalterably opposed to Obamacare, keep in mind that the only reason the government is shut down right now is that Democrats refuse to fund the government if they are required to live under Obamacare.
That's how good it is!
COPYRIGHT 2013 ANN COULTER
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http://www.glennbeck.com/2013/10/10/wolf-blitzer-openly-admits-obamacare-should-have-been-delayed/?utm_source=Daily&utm_medium=email&utm_campaign=2013-10-10_265563&utm_content=5054942&utm_term=_265563_265570
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The Obama administration has an implementation problem. More than any administration of the modern era they know how to talk but have trouble doing. They give speeches about ObamaCare but when it's unveiled what the public sees is a Potemkin village designed by the noted architect Rube Goldberg. They speak ringingly about the case for action in Syria but can't build support in the U.S. foreign-policy community, in Congress, among the public. Recovery summer is always next summer. They have trouble implementing. Which, of course, is the most boring but crucial part of governing. It's not enough to talk, you must perform.
There is an odd sense with members of this administration that they think words are actions. Maybe that's why they tweet so much. Maybe they imagine Bashar Assad seeing their tweets and musing: ""Ah, Samantha is upset—then I shall change my entire policy, in respect for her emotions!"
That gets us to the real story of last week, this week and the future, the one beyond the shutdown, the one that normal people are both fully aware of and fully understand, and that is the utter and catastrophic debut of ObamaCare. Even for those who expected problems, and that would be everyone who follows government, it has been a shock.
They had 3½ years to set it up! They knew exactly when it would be unveiled, on Oct. 1, 2013. On that date, they knew, millions could be expected to go online to see if they benefit.
What they got was the administration's version of Project ORCA, the Romney campaign's computerized voter-turnout system that crashed with such flair on Election Day.
Here is why the rollout is so damaging to ObamaCare: because everyone in America knows we spent four years arguing about the law, that it sucked all the oxygen from the room, that it commanded all focus, that it blocked out other opportunities and initiatives, and that it caused so many searing arguments—mandatory contraceptive and abortifacient coverage for religious organizations that oppose those things, fears about the sharing of private medical information, fears of rising costs and lost coverage. Throughout the struggle the American people must have thought: "OK, at the end it's gotta be worth it, it's got to give me at least some benefits to justify all this drama." And at the end they tried to log in, register and see their options, and found one big, frustrating, chaotic mess. As if for four years we all just wasted our time.
A quick summary of what didn't work. Those who went on federal and state exchanges reported malfunctions during login, constant error messages, inability to create new accounts, frozen screens, confusing instructions, endless wait times, help lines that put people on hold and then cut them off, lost passwords and user names.
After the administration floated the fiction that the problems were due to heavy usage, the Journal tracked down insurance and technology experts who said the real problems were inadequate coding and flaws in the architecture of the system.
There were no enrollments in Delaware in three days. North Carolina got one enrollee. In Kansas ObamaCare was unable to report a single enrollment. A senior Louisiana state official told me zero people enrolled the first day, eight the second. The founder of McAfee slammed the system's lack of security on Fox Business Network, calling it a hacker's happiest nocturnal fantasy. He predicted millions of identity thefts. Health and Human Services Secretary Kathleen Sebelius—grilled, surprisingly, on "The Daily Show"—sounded like a blithering idiot as she failed to justify why, in the middle of the chaos, individuals cannot be granted a one-year delay, just as businesses have been.
More ominously, many of those who got into the system complained of sticker shock—high premiums, high deductibles.
Where does this leave us? Congressional Republicans and the White House may soon begin a series of conversations centering on the debt-ceiling fight. Good: May they turn into negotiations. Republicans are now talking about a grand bargain involving entitlement spending, perhaps tax issues. But they would make a mistake in dropping ObamaCare as an issue. A few weeks ago they mistakenly demanded defunding—a move to please their base. They will be tempted to abandon even the word ObamaCare now, but this is exactly when they should keep, as the center of their message and their intent, not defunding ObamaCare but delaying it. Do they really want to turn abrupt focus to elusive Medicare cuts just when it has become obvious to the American people that parts of ObamaCare (like the ability to enroll!) are unworkable?
The Republicans should press harder than ever to delay ObamaCare—to kick it back, allow the administration at least to create functioning websites, and improve what can be improved.
In the past the president has vowed he'd never delay. But that was before the system so famously flopped when people tried to enroll. A delay would be an opportunity for the president to show he knows what's happening on the ground, a chance for him to be responsive. It would allow him to say the program itself is good but the technological infrastructure, frankly, has not yet succeeded. This would allow him to look like one thing no one thinks he is, which is modest.
A closing thought on the oft-repeated liberal argument that ObamaCare must stay untouched and go forward as written. They say it was passed by Congress, adjudicated by the courts and implicitly endorsed in the 2012 election; its opponents are dead-enders who refuse to accept settled outcomes.
There was always something wrong at the heart of this argument, and it's connected, believe it or not, to a story involving Johnny Carson. His show was a great American institution. When Carson retired in 1992, David Letterman was assumed to be his heir. Instead, NBC chose Jay Leno. In time Mr,. Leno faltered, and NBC came back to Mr. Letterman, who now was receiving more lucrative offers from the other networks. Everybody wanted him. But it was his long-held dream to host "The Tonight Show," and he anguished. Then, as Bill Carter reported in "The Late Shift," his advisers came to him. "The Tonight Show" starring Johnny Carson doesn't exist anymore, they said. It's gone. It's Jay Leno's show now. If you want to take a lesser deal to be his successor, go ahead. But the old "Tonight Show" is gone.
This helped clarify Mr. Letterman's mind. He went with CBS.
OK, the Affordable Care Act doesn't exist anymore. It was passed and adjudicated, but since then it has changed, and something new taken its place. Hundreds of waivers and exceptions have been granted. The president decided he had the power to delay the participation of businesses, while insisting on the continued participation of individuals. The program debuted and the debut was a disaster and Americans who want to be part of it haven't been able to join.
The ACA doesn't exist anymore. It isn't the poor piece of legislation it was, it's a new and different poor piece of legislation.
All of this is highly unusual. A continuation of unusual would therefore not be out of order. Delay the program. It's a mess and an oppression. Improve it.
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Isn't it odd that Democrats have delayed, changed and removed other parts of this but throw a conniption fit when the Republicans try to fund parts of the budget piecemeal.
Isn't it a good thing that each program, even each line item, should have to stand on its own two feet and be reaffirmed in each budget by each chamber? Otherwise, wouldn't government just grow and grow and grow?
Also, it is telling that the Dems know that Republicans delaying it one year means we are trying to kill it. In a way they are admitting that when they pass something that starts small, what they really want a total takeover.
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It bothers me that I don't see privacy issues raised as a major objection. Just the signup site alone is likely to result in millions of identity thefts. Meanwhile thieves across the country are posing as 'navigators' to steal people's most private information.
Combine Obamacare demanding and tracking all things health and financial with the IRS shareware project, NSA merging databases with email, internet and smartphone, and now "Common Core", the vertical and horizontal cradle to grave tracking system from our all-invasive federal education department (I will post more on that separately), the right of privacy is starting to look like a flashing electronic billboard.
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http://www.forbes.com/sites/theapothecary/2013/10/09/now-we-know-obamacares-exchanges-are-a-third-world-experience/
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Obamacare: The Rest of the Story
By BILL KELLER
Published: October 13, 2013 164 Comments
Unless you’ve been bamboozled by the frantic fictions of the right wing, you know that the Affordable Care Act, familiarly known as Obamacare, has begun to accomplish its first goal: enrolling millions of uninsured Americans, many of whom have been living one medical emergency away from the poorhouse. You realize those computer failures that have hampered sign-ups in the early days — to the smug delight of the critics — confirm that there is enormous popular demand. You have probably figured out that the real mission of the Republican extortionists and their big-money backers was to scuttle the law before most Americans recognized it as a godsend and rendered it politically untouchable.
What you may not know is that the Affordable Care Act is also beginning, with little fanfare, to accomplish its second great goal: to promote reforms to our overpriced, underperforming health care system. Irony of ironies, the people who ought to be most vigorously applauding this success story are Republicans, because it is being done not by government decree but almost entirely with market incentives.
Using mainly the marketplace clout of Medicare and some seed money, the new law has spurred innovation and efficiency. And while those new insurance exchanges that are now lurching into business will touch roughly 1 in 10 Americans (the rest of us are already covered by private employer plans or by government programs like Medicare), these systemic reforms potentially touch every patient, every taxpayer.
“This is the 90 percent of the story that doesn’t make the headlines,” said Sam Glick, who follows health care reform for the Oliver Wyman consulting firm.
Since the Affordable Care Act was signed three years ago, more than 370 innovative medical practices, called accountable care organizations, have sprung up across the country, with 150 more in the works. At these centers, Medicare or private insurers reward doctors financially when their patients require fewer hospital stays, emergency room visits and surgeries — exactly the opposite of what doctors have traditionally been paid to do. The more money the organization saves, the more money its participating providers share. And the best way to save costs (which is, happily, also the best way to keep patients alive) is to catch problems before they explode into emergencies.
Thus the accountable care organizations have become the Silicon Valley of preventive care, laboratories of invention driven by the entrepreneurial energy of start-ups.
These organizations have invested heavily in information technology so they can crunch patient records to identify those most at risk, those who are overdue for checkups, those who have not been filling their prescriptions and presumably have not been taking their meds. They then deploy new medical SWAT teams — including not just doctors but health coaches, care coordinators, nurse practitioners — to intervene and encourage patients to live healthier lives.
Advocates of these reforms like to say that they are transforming medicine from the treatment of disease to the treatment of patients — and ultimately the treatment of populations.
At Cornerstone Health Care, a 250-doctor organization in North Carolina, patients with a history of congestive heart failure get a daily phone call from a nurse asking them to step on a scale and report their weight, the best early indicator of an impending emergency. The next stage, Grace Terrell, the president of Cornerstone, told me, will be to give these patients scales that automatically transmit their weight directly to the nurse. (“If the N.S.A. is Big Brother, we’re Big Mother,” Terrell says of the weight surveillance program.) Diabetes patients are invited in for low-cost pedicures. Why? Because diabetics are notoriously vulnerable to infections that lead to amputation, and a common cause of those infections is ingrown toenails. (Both of these practices were pioneered by CareMore, a California-based company that runs clinics for Medicare patients and that has become a major role model since Obamacare.)
The Heritage Provider Network, a huge accountable care organization in California, offers Medicare patients free dance lessons, healthy cooking classes and casino excursions that feature “brain power” activities on the bus. The Greater Buffalo United Accountable Healthcare Network, a new, seven-doctor practice in upstate New York, is building a gym and a teaching kitchen for its patients, who are mostly inner-city minorities.
“Most doctors were on treadmills,” plodding through their routines, said Raul Vazquez, the chief executive of the Buffalo venture. Now they’re reinventing health care for the inner city with an invigorated sense of mission.
This is not the heroic medicine that turns surgeons into gods and emergency rooms into Hollywood material. Don’t expect to see a toenail-clipping episode on “Grey’s Anatomy.” But these services address the embarrassing fact, reiterated in study after study after study, that Americans pay much more for medical care than other developed countries, with no better results. Obamacare addresses this problem by going, as Willie Sutton famously advised, where the money is. It concentrates resources on the unhealthiest. According to Kaiser Health News, the sickest 1 percent of patients account for 21 percent of health care costs; 5 percent account for half of the total costs.
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“There are organizations that are bringing emergency room visits down by 15 to 20 percent,” Glick said. “Hospital admissions, you see numbers like 20 and 30 percent. That can make a huge difference not only in the cost of care but also in the quality of care.”
The best sign that these innovations are beginning to go viral is that they have caught the attention of some giant businesses. Drugstore chains like Walgreens and CVS are now partnering with hospitals or accountable care organizations to give patients convenient points of access and to coordinate treatment. Companies that spend heavily on employee health care plans are learning the best lessons of the Obamacare laboratory. Walmart, the country’s biggest private employer, will fly workers who need transplants or heart or spinal surgery to premier facilities like the Mayo or Cleveland Clinics to assure that their problems get fixed right the first time, avoiding costly readmissions.
Obamacare has also had some important indirect consequences. According to Catherine Dower of the Center for the Health Professions at the University of California at San Francisco, since the Affordable Care Act states have become more aggressive about challenging some of the protectionist laws that prevent well-qualified medical professionals — pharmacists, nurse practitioners, physician assistants, emergency medical technicians — from offering some kinds of primary care. California just passed a law that will allow pharmacists to check your blood pressure and cholesterol level and to dispense prescription birth control and antismoking drugs. Letting pharmacists perform services that don’t require seven years of medical training makes those services cheaper and more convenient, increasing the chances consumers will take better care of themselves.
Dower said that while the formal doctor lobby continues to resist this as a threat to the M.D. cartel, many physicians have embraced it, recognizing that outsourcing some of these services leaves them more time to do what only doctors can do. And with an estimated 29 million new clients expected to join the ranks of the insured, there is a lot of work to share.
The emerging system is far from perfect. As Elisabeth Rosenthal reported in The Times on Sunday, Congress buckled to drug company lobbying and refused to let Medicare use its purchasing power to bring down obscenely inflated drug prices. And like any upheaval, the reform of health care will produce some losers. Not all of the new organizations will make a go of it. Since hospitals account for about a third of our health care bill, they are a particular target of cost-cutters; some will fail to adapt and will go out of business. Taking costs out of the system means taking money out of somebody’s pockets. This is what the business world calls “creative destruction.”
Grace Terrell of Cornerstone said that of its 250 doctors, “20 percent are still, ‘Down with Obamacare,’ though even they like the private-enterprise approach; 30 percent really get it; and the others are moving faster than the market. We may ultimately fail, but we’re pretty far ahead of the curve.”
One reason you may not have heard much about this part of the Obamacare story is that it is numbingly complicated. (Stephen M. Davidson of Boston University has written a concise and accessible guide to the law and its consequences.) But I suspect another reason is partisan spite. The Democrats were passionately in favor of enrolling the uninsured, but many would have preferred a government-run program, or at least a public option. What Obamacare has wrought is the kind of market-driven reformation that Republicans pretend to believe in. Which makes you wonder how much of their opposition rests on the merits, and how much is just a loathing for anything associated with Barack Obama.
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Politics and journalism at its very worst. Once the government takes over the rest of healthcare, that is when we will begin to see real improvements in quality and cost containment - just like, um, name one example please of where else that was the case. Housing finance?
Bill Keller, NYT: "Which makes you wonder how much of their opposition rests on the merits, and how much is just a loathing for anything associated with Barack Obama."
Throw it all on the motives of the opponents if you have no other point to make. What total blather! The opposition is based totally on the lack of merits of this disgusting program and the loathing would be exactly identical if it were Hillary, Howard Dean, John Edwards or anyone else doing this. Does Bill Keller really think Republican opposition would be different if we had elected someone else to transform America in the direction of Stalin and Marx? No he doesn't, and he is perfectly comfortable lying to his readers on his central point.
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http://www.jec.senate.gov/republicans/public/index.cfm?a=Files.Serve&File_id=8e6dbf03-ca4a-44be-9de4-a100c43fb5c8
If this design is so good, I don't see why we don't put the Secretary of Healthcare in charge of all industries!
(http://www.cpt12.org/news/wp-content/uploads/2011/01/Healthcare_Chart.jpg)
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Lower your income, get free Health Care. "If they can adjust their income, they should." "It's not cheating. It's allowed", says Karen Pollitz, a senior fellow with the Kaiser Family Foundation.
Under the Affordable Care Act, if your 2014 income is between 138 and 400 percent of poverty level for your household size, you can purchase health insurance on a state-run exchange (such as Covered California) and receive a federal tax subsidy to offset all or part of your premium.
If your income falls below 138 percent of poverty, you qualify for Medicaid, which provides no-cost health care to low-income people. In California, it's called Medi-Cal.
http://www.sfgate.com/business/networth/article/Lower-2014-income-can-net-huge-health-care-subsidy-4891087.php
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If everyone would lower their income enough, healthcare would be totally free!
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Even better, lots of people are going to have their incomes drop without even trying!
Lower your income, get free Health Care. "If they can adjust their income, they should." "It's not cheating. It's allowed", says Karen Pollitz, a senior fellow with the Kaiser Family Foundation.
Under the Affordable Care Act, if your 2014 income is between 138 and 400 percent of poverty level for your household size, you can purchase health insurance on a state-run exchange (such as Covered California) and receive a federal tax subsidy to offset all or part of your premium.
If your income falls below 138 percent of poverty, you qualify for Medicaid, which provides no-cost health care to low-income people. In California, it's called Medi-Cal.
http://www.sfgate.com/business/networth/article/Lower-2014-income-can-net-huge-health-care-subsidy-4891087.php
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If everyone would lower their income enough, healthcare would be totally free!
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It's nice seeing all the Obama voters finding out just how expensive their magical healthcare law is.
http://finance.yahoo.com/news/obamacare-driving-doctors-stop-taking-221939584.html
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Obamacare Is Driving Some Doctors To Stop Taking Insurance Altogether
By Mandi Woodruff | Business Insider – Wed, May 29, 2013 6:19 PM EDT..
Bangor Daily News
A Portland, Maine family doctor is the latest poster child for private practitioners who are turning their backs on insurers altogether.
In April, Dr. Michael Ciampi stopped accepting all forms of insurance, including Medicare and Medicaid, and started charging for his services a la carte.
"We're asking people to pay at the time of service just like you would pay at your garage or your lawyer or your plumber," Dr. Michael Ciampi told the Bangor Daily News' Jackie Farwell. "Now, I work for patients. I don't work for the government and I don't work for insurance companies."
Primary care doctors are among the lowest paid in the industry, and they've seen big cuts to their bottom line recently, as insurers cap physician fees in order to rein in health care costs. Once Obamacare goes into full effect in 2014, it's predicted that insurance premiums will skyrocket, and all the extra paperwork required will cost private practices like Ciampi's more time, money and manpower.
The Inquisitir explains:
A doctor’s income is what the office takes in payments minus expenses or overhead. Physician overhead cover many things but the most expensive cost is the staff necessary to handle insurance coverage. About 20 to 30 years ago this cost used to be around 15 to 30% of revenue. Now for many doctors this insurance overhead has grown to an outstanding 60% or more, with more staff being hired to handle the quickly enlarging piles of paperwork required by Obamacare.
To top it off, Medicare is beginning to cap payments while the overhead costs remain the same, or worsen. So doctors may stop insurance coverage from Medicare just because they’d see a huge drop in their annual income.
Since the switch, Ciampi says he has been able to slash his prices by half in some cases, just from his overhead savings alone. But he's lost patients in droves, with several hundred of Ciampi's 2,000 patients ditching him altogether.
Nashville, Tenn.-based Dr. Robert Tomsett had similar results after converting to a no-insurance model at his practice in 2011. Unfortunately, his staff paid the price.
"We did have to let some of the existing staff go as our patient count has dropped since initiating our transition to self-pay," Tomsett wrote. "This is typical from accounts by other providers around the country that have converted their practices, some as much as a 75% drop in patient count."
Six weeks into his no-insurance model, Tomsett saw only 75 patients and managed to break even.
"I am able to spend more time with each patient than any other time in my career," he wrote.
In a similar case in San Antonio, Texas, a pair of primary-care physicians made headlines when they stopped accepting third-party insurance a year ago. They told MySanAntonio.com that they moved to a direct pay model because of the " expensive and bloated bureaucracy that drives financial reimbursements."
A 2012 survey of more than 13,500 doctors from around the country found that 26% have already cut services for Medicaid patients due to costs, and within the next two years more than 50% plan to cut some patient access to their services. About 7% plan to switch to cash-only practices, like Ciampi's, or "concierge practices" in which patients pay doctors an annual retainer.
What happens if more doctors follow Ciampi's lead and take matters into their own hands?
You've got a couple of options –– take your business elsewhere or pay the piper. Some insurers will offer partial reimbursements to out-of-network physicians, but the onus will be on you to deal with the paperwork involved.
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Interesting!
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Zero Alaska ObamaCare Enrollees
The rollout of the Healthcare.gov ObamaCare exchanges has largely been a technical disaster and utterly ineffective. Very few people are successfully signing up for coverage through the website, though the clock is still ticking on the individual mandate. The latest news is that after two weeks, no one from Alaska has enrolled. Sen. Lisa Murkowski (R-AK) wrote to HHS Secretary Kathleen Sebelius looking for answers: "This system that cost more than $400 million, took three years to build, and was billed as a one-stop shop for individuals seeking health insurance is not working as advertised." That pretty well sums it up.
If you thought the O'care law was complicated enough, consider the regulations that come with it. According to CNSNews, "Bureaucracies in the Obama Administration have thus far published approximately 11,588,500 words of final Obamacare regulations, while there are only 381,517 words in the Obamacare law itself. That means unelected federal officials have now written 30 words of regulations for each word in the law." We're sure our fellow bureaucrats read all this before implementing it, too.
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O'Care: 'No Expectation of Privacy'?
In the fine print of the ObamaCare web site, at least when it is working, you might want to pay attention to this line from the disclaimer: "You have no reasonable expectation of privacy regarding any communication or data transiting or stored on this information system."
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second post
Jim DeMint: We Won't Back Down on ObamaCare
Fighting a law that is unfair, unworkable and unaffordable is reasonable and necessary.
By
Jim DeMint
Oct. 17, 2013 6:27 p.m. ET
Now that the government shutdown has ended and the president has preserved ObamaCare for the time being, it's worth explaining why my organization, the Heritage Foundation, and other conservatives chose this moment to fight—and why we will continue to fight. The reason is simple: to protect the American people from the harmful effects of this law.
I spent a good part of my summer traveling around the country with the Heritage Foundation's sister organization, Heritage Action, and I heard firsthand from many Americans being harmed by ObamaCare. More and more people have had their work hours cut, their jobs eliminated and their coverage taken away as a result of this new law.
Supporters of ObamaCare usually defend the law by insisting that they want to help people. I won't question their motives. I do wonder, however, if they understand what they're doing to the country.
We know that premiums are going up due to ObamaCare—Americans are getting notices in their mailboxes every day. On Wednesday, Drew Gonshorowski of the Center for Data Analysis at the Heritage Foundation published research that shows exchange premiums are going up in all but five states. In North Carolina, for example, many consumers will find their premiums almost double when shopping on the government exchanges. The hardest-hit states, such as Georgia, Arizona, Vermont and North Dakota, will see premium increases of up to 150%.
Mr. Gonshorowski's research shows that the hardest hit by the increases will be young adults. "A state that exhibits this clearly is Vermont," he writes, "where the increase for 27-year-olds is 144 percent and the increase for 50-year-olds is still 60 percent, but far less. All states exhibit this relationship."
Enlarge Image
We also know that, once established, the cost of ObamaCare's new entitlements will not fall. Historical evidence suggests the opposite. Nearly 50 years ago, at the time of Medicare's enactment, it was projected that the federal government would spend $9 billion on Part A hospital services in 1990. Actual spending in that year totaled $67 billion—an increase of 644% compared with initial estimates.
Likewise, government officials originally projected that Medicare Part B physician services would require "federal appropriations of about $500 million a year from general tax revenues." Last year, the federal outlay for that program was $163.8 billion—overshooting the original estimate by more than 4,400%.
Given this track record, the Congressional Budget Office's projection that ObamaCare will cost "only" $250 billion (you read that right: a quarter-trillion dollars) a decade from now seems far-fetched.
There's a reason Senate Majority Leader Harry Reid recently claimed that ObamaCare will lead to a single-payer health-care system: It happens to be true. Once employers drop health coverage for their low and middle-wage workers, the majority of Americans will be dumped into tightly regulated health exchanges and granted a "choice" of plans that will be more alike than different. The quality of care will suffer, access to doctors and plans you once had and liked will be reduced, and America will deteriorate into a two-tier health system—one in which the well-off can still buy quality coverage, but most Americans are consigned to poor care through the exchanges and Medicaid.
Yes, I can hear many conservative friends saying to me right around this point: "Jim, we agree with you that ObamaCare is going to wreck the country, but elections have consequences." I have three responses.
The first is that ObamaCare was not the central fight in 2012, much to the disappointment of conservatives. Republicans hoped that negative economic news would sweep them to victory, and exit polls confirmed that the economy, not health care, was the top issue. The best thing is to declare last year's election a mistrial on ObamaCare.
Second, the lives of most Americans are not dominated by the electoral cycle. They shouldn't have to wait three more years for Congress to give them relief from this law, especially when the president has so frequently given waivers to his friends. Full legislative repeal may not be possible while President Obama remains in office, but delaying implementation by withholding funds from a law that is proven to be unfair, unworkable and unaffordable is a reasonable and necessary fight.
There's a third reason not to stop fighting. Forget the consultants, the pundits and the pollsters; good policy is good politics. If the Republicans had not fought on ObamaCare, the compromise would have been over the budget sequester. Instead, they have retained the sequester and for the past three months ObamaCare and its failings have been front and center in the national debate. Its disastrous launch was spotlighted by our defund struggle, not overshadowed, as some contend. With a revived and engaged electorate, ObamaCare will now be the issue for the next few years.
These are the reasons we fought so hard to get Washington to listen to the American people and take action to stop ObamaCare, and it is why so many are thankful for the courageous leadership of people like Sens. Ted Cruz and Mike Lee, and conservatives in the House of Representatives. The law is economically unstable, financially irresponsible and harmful to hardworking Americans.
Mr. DeMint, a former senator from South Carolina, is president of the Heritage Foundation.
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O'Care: 'No Expectation of Privacy'?
In the fine print of the ObamaCare web site, at least when it is working, you might want to pay attention to this line from the disclaimer: "You have no reasonable expectation of privacy regarding any communication or data transiting or stored on this information system."
Thank you Crafty for catching and posting this. With or without this offensive and stupid message, the loss of privacy and control over your own life with this bad legislation is monumental.
It bothers me that even opponents of Obamacare focus only on the taxes or spending issues. This intrusion is SO much greater than that!
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Sebelius on the Run
The HHS Secretary refuses to testify about ObamaCare's rollout.
n
Oct. 18, 2013 7:04 p.m. ET
The Affordable Care Act's botched rollout has stunned its media cheering section, and it even seems to have surprised the law's architects. The problems run much deeper than even critics expected, and whatever federal officials, White House aides and outside contractors are doing to fix them isn't working. But who knows? Omerta is the word of the day as the Obama Administration withholds information from the public.
Health and Human Services Secretary Kathleen Sebelius is even refusing to testify before the House Energy and Commerce Committee in a hearing this coming Thursday. HHS claims she has scheduling conflicts, but we hope she isn't in the White House catacomb under interrogation by Valerie Jarrett about her department's incompetence.
The department is also refusing to make available lower-level officials who might detail the source or sources of this debacle. Ducking an investigation with spin is one thing. Responding with a wall of silence to the invitation of a duly elected congressional body probing the use of more than half a billion taxpayer dollars is another. This Obama crowd is something else.
What bunker is Henry Chao hiding in, for instance? He's the HHS official in charge of technology for the Affordable Care Act, and in March he said at an insurance lobby conference that his team had given up trying to create "a world-class user experience." With the clock running, Mr. Chao added that his main goal was merely to "just make sure it's not a third-world experience."
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HHS Secretary Kathleen Sebelius on Capitol Hill in Washington in April. Associated Press
He didn't succeed. Whatever is below third-world standards would flatter the 36 federally run exchanges as they've started up. But perhaps Mr. Chao or someone else, if not Mrs. Sebelius, can answer even the simple question of how many Americans have managed to enroll for coverage. HHS could easily resolve any confusion but it won't even talk to Democratic allies, friendly reporters and what it calls the insurance industry "stakeholders" that it will need to make ObamaCare work.
No doubt a hearing would be a spectacle—with TV cameras on hand—but Mrs. Sebelius can't hide forever. Even pro-entitlement liberals want to know about what went wrong and why, how much if any progress is being made, and whether the ObamaCare website Healthcare.gov will be usable in a matter of months—or years.
More disclosure might also help HHS preserve a scrap of credibility, given that none of its initial explanations has held up. Right now, no one trusts a word that emerges from Fortress ObamaCare.
To take one example, this week the Associated Press obtained an internal HHS memo from September 5, 2013 specifying the Administration's monthly enrollment targets—a half-million sign-ups in October, 3.3 million by December 31, and so on. Asked about this by AP, HHS not only declined to say if it is meeting its projections. The department issued a statement claiming that "The Administration has not set monthly enrollment targets." The spokesman did not cite the classic Marx Brothers line, "Who are you going to believe, me or your own eyes?"
Eventually Mrs. Sebelius will have to make a real accounting of this government failure to someone other than the TV comic Jon Stewart, and perhaps she can also explain why the people who can't build a working website also deserve the power to reorganize one-sixth of the U.S. economy. For now, the Administration that styles itself as the most transparent in history won't reveal the truth—perhaps because it is afraid of what the public will find.
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Surprising considering their cooperation with the other inquiries, Fast and Furious, IRS Targeting, Benghazi, etc.
Wouldn't refusal to accept congressional oversight be valid reason to de-fund?
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who was one of the designers of AHA was Britain's National Health Service.
In a recent Lancet piece the resigning chair of the Royal College of General Practitioners says that primary care is in crises and headed for collapse. Sounds like here in the US:
*****The continuing haemorrhage of UK general practice
The Lancet
Last week was no doubt a sad one for Clare Gerada, who gave her last Chairwoman's speech before stepping down from leading the Royal College of General Practitioners (RCGP) after 3 years. She has been the most visible and successful head of the College in recent memory. Unlike previous Chairs, Gerada has not been afraid to challenge the Government on a wide range of issues. She has led doctors with more confidence, passion, positive vision, and success than the British Medical Association has ever been able to do. She has been the voice of clinical practice in the community for the tens of thousands of GPs who are at the frontline of primary care and the Coalition's bungled health reforms.
At the RCGP's annual conference in Harrogate, Oct 3—5, Gerada hit out at the Government again. At a time when it had just announced plans to increase GP surgery opening times in England from 0800 h to 2000 h, 7 days a week, she presented alarming new figures from the RCGP that general practitioners (GPs) in the UK face a £400 million “black hole” as a result of funding cuts during the past 3 years. This disinvestment equates to a 7% cut in spending per patient. Gerada pointed out that although GPs saw 90% of patients as the first contact, they received only 9% of the entire UK National Health Service (NHS) budget, and that percentage share was falling. “General practice is in crisis”, she lamented. In recent surveys, 85% of GPs also felt general practice was heading for collapse. Quality and safety of patient care are being put in danger, since GPs are seeing up to 60 patients in an 11 h day with far fewer resources. Many predict that patients will have to wait longer for an appointment in the future. Gerada called for general practice to get at least 10% of the NHS budget and 10 000 more GPs.
The Government and its Health and Social Care Act wanted to make general practitioners the clinical leaders of the NHS. But by by withdrawing investment in primary care they have starved general practice of the resources needed to lead the service properly. The result will not only be an inevitable vacuum in leadership but also serious damage to the care of patients.*****
Thanks to the other "Donald".
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Second health thread post.
Perhaps readers might recall how I pointed out how electronic records are simply not ready for prime time. Yes there are hundreds of vendors out there who will sell you that theirs is the one that works great.
But all are clunky cumbersome and frankly a pain in the ass. I recall reading that there was some kick back to the politburo Ivy league know-it-alls. IN one response editorial one of the leading doctor IT cottage industry types basically wrote in his response for us doctors to more or less just stop whining, shut up, and be happy we are getting through the "FIRST PHASE". So now all that IT that is being shoved down our throats is suddenly not the answer but is the first phase.
Now the world with the AHA tech failure can see what we have been living through for the past couple of years. The IT people are already blaming the government on Drudge. Oh they were having to eat pizza and work till 10 etc. No one ever heard a peep from this crowd while they were happily receiving their pay checks probably each and every one of the promising the government they could do the job so they could get the contract.
People, it is all the classic fingers pointing every which way when something is a mess. Don't blame me it is him or her; not me.
Eventually it will be made workable but don't expect any of it to be a breeze. This will take years.
IT does show how government regulations make all of us suffer. While the Obamas of the world promise free health care to all.
Why even that idiot (I have concluded) Peirce Morgan was on last night saying how they have "FREE" health care in Great Britain.
Wow! How do they do that? It's free? Why can't we do what you wizards in Europe do here?
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Health Care Lines
According to a report by The New York Times, as many as 5 million lines of computer code will need to be rewritten before HealthCare.gov works as intended (we'd argue that no amount of rewritten code will make the ACA work, but that's a different discussion). But if 5 million lines of code sounds like a lot (and it is), wait until you hear this: According to one expert familiar with HealthCare.gov, the site's source contains approximately 500 million lines of code. To put that in perspective, the entire Linux operating system kernel that powers the majority of the Web's servers (including HealthCare.gov's) contains just under 16 million lines of code, and is the result of 22 years of ongoing development. The space shuttle's primary flight control system was comprised of 400,000 lines of code. Even Windows XP was built in 45 million lines of code. Once again, we can depend on government (to make things incredibly complicated).
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http://rexharrisonshat.com/healthcare/
Point and Click on Apply Now!
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http://rexharrisonshat.com/healthcare/
Point and Click on Apply Now!
Hahaha!
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Jon Stewart On Obamacare Rollout: "How Are Democrats Going To Spin This Turd?"
Democrat programs are doing badly if Jon Stewart decides to rip on them:
http://www.realclearpolitics.com/video/2013/10/22/jon_stewart_on_obamacare_rollout_how_are_democrats_going_to_spin_this_turd.html
He starts with the obligatory rip on Republicans, then...
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ABC's Jon Karl To Carney: How Can You Tax People For Obamacare When The Website Doesn't Work?
http://www.realclearpolitics.com/video/2013/10/21/abcs_jon_karl_to_carney_how_can_you_tax_people_for_obamacare_when_the_system_doesnt_work.html
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What is wrong with Obamacare is not a software glitch.
"...distracted doctors are seeing more pixels than patients,"
Don't Forget Obamacare's Electronic Medical Records Wreck
Michelle Malkin | Oct 23, 2013
http://townhall.com/columnists/michellemalkin/2013/10/23/dont-forget-obamacares-electronic-medical-records-wreck-n1730172/page/full
Obamacare's top-down, tax-subsidized, job-killing, privacy-undermining electronic record-sharing scheme has been a big fat bust. More than $4 billion in "incentives" has been doled out to force doctors and hospitals to convert and upgrade by 2015. But favored EMR vendors, including Obama bundler Judy Faulkner's Epic Systems, have undermined rather than enhanced interoperability. Oversight remains lax. And after hyping the alleged benefits for nearly a decade, the RAND Corporation finally 'fessed up that its cost-savings predictions of $81 billion a year -- used repeatedly to support the Obama EMR mandate -- were (like every other Obamacare promise) vastly overstated.
In June, the Annals of Emergency Medicine published a study warning that the "rush to capitalize on the huge federal investment of $30 billion for the adoption of electronic medical records led to some unfortunate and unintended consequences" tied to "communication failure, poor data display, wrong order/wrong patient errors and alert fatigue." Also this summer, Massachusetts reported that 60 percent of doctors could not meet the EMR mandate and face potential loss of their licenses in 2015. And a few weeks ago, the American College of Physicians pleaded with the feds to delay the mandate's data collection, certification and reporting requirements.
More at link
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Michelle who is one of my favorite writers, indeed if I was younger and she was available....
Yes we on the front lines of medical care are forced to spend ALL our time collecting and responding to data and data points, and formats, and numbers. The personal touch between patient and doctor and decision making is being taken away. Standards are set primarily by government but the big companies are also using the data to extract every single dime out of humanities daily lives.
A case manager at one of the hospitals I go to recently said to me it is all about the data. Everything we do is for the data. Data can be manipulated. It can be falsified. She said if it isn't written in the data - it doesn't exist.
Hospitals, dialysis, pharmacies, pharmacy benefits managers, pharmaceuticals, urgent care centers, nursing homes are all consolidating and being run by big corporations. Most of this is I think funded via Wall Street. One astute physician suggested how health care is one of the biggest and only drivers of the economy right now. So the 1000 dollar suits are focusing on health care. No one can compete with their billions to throw around.
(The energy sector could also do well if the liberal machine would get the hell out of the way.)
There are more jobs there will be more efficiencies. I don't know if care will necessarily be better or not. One definite thing is that the way it is measured will certainly be distorted to reflect that it is.
One professor who used to do a lot of research pointed out - it is all in the way one measure it.
The data points that are shoved in front of us are the measurements used to reflect better care. We will not see other issues that are not being measured.
I can go on a hospital floor and see rows of nurses sitting at computers. In some locations I have actually had to scramble to even get to a computer terminal before the nurse gets there. Or vice a versa.
We can see first hand how every single human endeavor is being manipulated to squeeze every single penny out of our existence.
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SC Doctor Discusses Reasons to Get Off the Insurance Grid
South Carolina Doctor Mike Vasovski has joined a growing group of doctors and taken his medical practice off the insurance grid.
Last week Dr. Vasovski wrote on his Facebook page:
South Carolina Doctor Mike Vasovski
"My medical practice has gone off line. Effective yesterday, the computers that contain patient's account information including billing diagnosis, have been completely de-linked from the internet. Therefore, your health information is completely secure. Accounting will be done in house with Quickbooks on a PC that is not connected to the internet. We are moving towards a payment at time of service model in which my practice does not participate with insurance companies. Fees will be truly affordable and your medical records will not be in a format that can be accessed electronically. Peace and Liberty, Dr. Mike Vasovski."
In an interview with Joshua Cook, he discussed a variety of reasons – both ideological and practical – for his choice, and described the effects of these actions on patients. Vasovski showed how such practices could keep a free market healthcare system alive even as Obamacare takes effect.
"Off grid" or "cash only" practices collect money directly from the patient at the time of service. Vasovski described two off grid payment models, one in which doctors charged a per month fee in which people could visit as often as necessary, and one in which there is simply a reasonable office visit charge. Vasovski's practice has chosen the second model with a $45 benchmark, and says that is enough to provide most services because most vaccinations and other shots are being provided by pharmacies.
"So we're not responsible for buying those things, storing them and counting them and that kind of stuff." Adding that cost-saving development to the nearly $6000/year saved on insurance software, this becomes an increasingly viable business model. There is also a huge number of generic drugs – over 300 – available for $4/month at major pharmacies. "That's less than a 6-pack and it gets you a month worth of your medicines."
The direct payment business model has a number of benefits for both practices and patients. One of the most topical is security. Because Vasovski's office isn't connected to insurance companies, he has been able to take his entire practice off the internet. No hackers, Assange-like activists, or government entities can access any patient information, like Social Security numbers or health problems.
Even the most "secure" encryption services cannot provide that assurance. He even described a telephone call in which a salesperson tried to sell him a 284 bit encrypted program. When Vasovski asked him what he thought of Julian Assange, he replied that he didn't know who that was. "At that point I said, 'you're trying to sell me a computer security program and you don't know who Julian Assange is?'"
Another benefit Vasovski described is lowered costs. With insurance companies acting as the middle man, there is no check on costs because there is no incentive to cut back on costs. Insurance companies earned more the higher the prices, and consumers aren't paying the bill. "So it looks like healthcare costs more, but that's not the true bottom line." In fact employers had to deal with most of the costs of care. "In the price of a new car from GM, like 14-15% of the cost of the car is nothing but health insurance."
Vasovski also said that the off grid system improves the doctor patient relationship. "You do spend a little more time – not less time – you spend more time with them, and by design, you're going to be a little bit more interested in satisfying them than if it's just a checkmark on a sheet with the bill going to the insurance company."
On a more ideological level, the direct payment model also gets back to the true nature of insurance. "If you're dealing with no deductible or a $20 co-pay for a visit or something, it's not really insurance because then it's like going to eat at the Golden Corral. Once you're in you get to eat all you want." People don't use car insurance for oil changes; they use it for wrecks. A $5000 deductible means people can use insurance for any major event – even a broken leg will cost about $10,000 to fix and any emergency room visit will start at $2,500 – while paying $45 for simple visits. A high deductable "turns it into real insurance. It's only used when there is something really bad, and the rest of the stuff you have to pick up on your own. Then you become a very good shopper."
Dr. Vasovski eliminated the insurance aspect of his practice because he could provide better care cheaper on a free market system. Many doctors who are currently deliberating whether to keep their practices open may choose to convert to such a system, too. Direct pay programs, along with generic drugs and pharmacy-provided shots and vaccinations, mean that the free market will continue to play a role in healthcare and insurance.
Read more: http://freedomoutpost.com/2013/10/sc-doctor-discusses-reasons-get-insurance-grid/
Read more at http://freedomoutpost.com/2013/10/sc-doctor-discusses-reasons-get-insurance-grid/
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Wall Streets shake up artists such as well know Carl Ichan (I wish I bought Cheesepeake when it was at bottom when he got involved - up from 15 to 27!!!), are scouring other energy companies to do the same thing.
The reason I post here is extracting value is EXACTLY what Wall Street is doing in the health care sector. It seems to be under the radar with AHA taking all the headlines. I am not saying it is good or bad. I am just pointing this out. But this struck me as a very good analogy to what I see in health care:
http://www.bloomberg.com/news/2013-10-16/activists-seek-repeat-of-40-billion-oil-patch-windfall-energy.html
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Admin Tells Insurer: Keep Quiet
If you need any indication of just how embarrassed the Obama administration is regarding O'care enrollment numbers, consider this disclosure from reporter Kyle Potter: "The Obama administration asked North Dakota's largest health insurer not to publicize how many people have signed up for health insurance through a new online exchange, a company official says." Potter reveals that "During a Monday forum in Fargo for people interested in signing up for coverage via the exchange, James Nichol of Blue Cross Blue Shield of North Dakota told the crowd his company received the request from the federal government earlier Monday." And for good reason: BCBS spokeswoman Andrea Dinneen shed some light on the figures anyway, saying that only 14 state residents had successfully enrolled since October 1. Press Secretary Jay Carney has repeatedly said that HHS officials will release enrollment figures soon -- as soon as it's politically convenient, that is.
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Your Insurance Terminated
Hundreds of thousands of Americans across the country are getting cancellation notices from various insurers because their plans don't meet O'care requirements. According to Kaiser Health News, "Florida Blue ... is terminating about 300,000 policies, about 80 percent of its individual policies in the state. Kaiser Permanente in California has sent notices to 160,000 people -- about half of its individual business in the state. Insurer Highmark in Pittsburgh is dropping about 20 percent of its individual market customers, while Independence Blue Cross, the major insurer in Philadelphia, is dropping about 45 percent." Consequently, "the cancellation notices ... have shocked many consumers in light of President Barack Obama's promise that people could keep their plans if they liked them." You get what you vote for -- in Obama's case, empty rhetoric.
O'Care Prices 'Incredibly Misleading'
"CBS News has uncovered a serious pricing problem with Healthcare.gov." Uh oh. CBS says that the administration's new "shop and browse" feature sometimes causes customers to pay double the price they see for insurance on the website. The reason is that all comers are divided into two groups: 49 or under and 50 or over. CBS notes, "Prices for everyone in the 49-or-under group are based on what a 27-year-old would pay. In the 50-or-older group, prices are based on what a 50-year-old would pay." Therefore, unless you're 27 or 50, your estimate could be drastically understated. Who knew Hope™ would cost this much.
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http://www.fee.org/the_freeman/detail/can-this-man-save-healthcare#axzz2iMc0hGUm
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Facebook's first six years of operation: $500 million
Twitter's first four years of operation: $360 million
LinkedIn's total operating expenses: $200 million
The new ObamaCare website, HealthCare.us, cost over $500 million over the span of 3 years, and unlike Facebook, Twitter, and LinkedIn, the site isn't functional nor useful.
(I'm seeing quotes of $1B in the last day or two-- Marc)
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Second post
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Sensible remarks WRT healthcare costs:
Dave Macdonald, JD. CEO of Aegle Advisors. There are a number of factors contributing to high-cost hospital environments, which if not dealt with effectively, will continue to drive healthcare costs out of control. The existing organizational structures, productivity expectations and lack of true accountability drive most of the cost. Hospital organizations are not immune to the ever-increasing health insurance and benefit premiums that we see nationally. This tends to be the second-highest cost that a hospital will incur behind salaries and wages. For the last few years, most hospitals have seen double-digit increases in premiums and are often reluctant to pass this increase entirely through to the employees, thus absorbing most of it as an expense. In addition, other benefit costs, like pensions and lucrative time-off allowances, are built into the hospital cost structure, many times driven by union contracts and commitments to employees. However, these costs tend to be higher in comparison to their counterparts in the private sector. Unfortunately, pension costs are difficult to address given the impact to the employees and the political ramifications. In addition, when clinical employees take time off, there is often replacement costs associated with caring for the patients.
All of this is enough to send costs spiraling, but then you add outside forces, such as government agencies for Medicare and Medicaid and third-party payors, and suddenly you've created a system that requires enormous administrative burdens — burdens no other industry is subjected to. Highly skilled and educated providers are constantly being challenged about their clinical decision-making in an effort to slow down payments or completely deny payments to the hospital and or physicians. The cost of redundant systems, and the people and processes to manage multiple systems from different government and private payers, forces hospitals to hire additional staff in order to be compliant with the all of the red tape.
The end result is a high-cost, inefficient healthcare delivery system. Every payor has different rules and/or regulations for a service to be covered and hopefully paid. Both the healthcare organization and the payor have to hire more people to oversee the rules, creating higher premiums and higher administrative costs. Often times, hospitals will have to appeal two to three times simply to get paid for services that were duly earned the day they were performed, not one year from then. Hospitals are forced to spend too much time tracking and chasing payments instead of using their resources to focus on the patient experience and deliver the most efficient and effective care that the patient deserves.
http://www.beckershospitalreview.com/racs-/-icd-9-/-icd-10/a-look-from-within-why-are-us-healthcare-costs-so-high.html
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We are losing to Obamacare precisely because everyone correctly intuits the preceding to be true. Obamacare pretends to offer a solution and does so in terms that people think they understand.
What do we offer?
Back during the battles against the passage of Obamacare we noted here that it included a number of ideas that the Reps called for as well as the Dems. Do any of us remember what they were? Shouldn't they be part of the Rep message now?
Apart from whatever these points were, I'm thinking:
As Glenn Beck notes in a post I made this morning on The Way Forward thread, there is much overlap in many of the progressives criticisms and ours. It makes sense to me that we give these criticisms a more prominent part in our messaging-- which as present tends to focus almost exclusively on why the progressives solutions are wrong.
a) price transparency of health care-- in a way that the government has a proper role in requiring that contents of the box that we are buying be what they are in the amount alleged and not other stuff being in there, is there a role for the government to require that prices be readily known in advance? Without this, how can there be a free market?
b) one national market-- why do we have 50 markets at present?
c) One of the reasons that Obamacare is so expensive is that it requires so many things so many people do not want-- but if we are to have people choose what coverage they do want, the companies must put out their information in a comprehensible manner. Is there a government role for standardizing how the information is to be presented so as to enable comparisons?
d) A FREE MARKET MESSAGE e.g.
Obamacare Side Effect - Doctors abandon the health care insurance system altogether
October 23, 2013 | Author Pater Tenebrarum
Free Market Alert!
Many medical practitioners have apparently simply had enough. Instead of continuing their never-ending struggle with the welfare state's red tape, they have decided to revert to a free market model without insurance. At first glance that seems to represent a barrier to obtaining medical care for poorer strata of the population. However, a second glance reveals that this might actually not be the case. No doubt to the great dismay of the sick-care cartel and the bureaucracy administering it, the refreshing breeze of the free market suddenly intruding upon the system shows what prices actually would be if the State were not involved in health care. According to a recent report on the spreading 'cash only' medical care phenomenon:
“Fed up with declining payments and rising red tape, a small but growing number of doctors are opting out of the insurance system completely. They’re expecting patients to pony up with cash. Some doctors who have gone that route love it, saying they can spend more time with and provide higher-quality care to their patients. Health advocates are skeptical, worrying that only the wealthy will benefit from this system.
In Wichita, Kansas, 32-year old family physician Doug Nunamaker switched to a cash-only basis in 2010 after taking insurance for five years. (“Cash-only” is a loose description. Nunamaker accepts payment by debit or credit card too.)
[..]
Under the traditional health insurance system, a large staff was required just to navigate all the paperwork, he said. That resulted in high overhead, forcing doctors like Nunamaker to take on more patients to cover costs. Plus, the amount insurance companies were willing to pay for procedures was declining, leading to a vicious cycle. “The paperwork, the hassles, it just got to be overwhelming,” Nunamaker said. “We knew that we had to find a better way to practice.”
So Nunamaker and his partner set up a membership-based practice called Atlas M.D. — a nod to free-market champion Ayn Rand’s book Atlas Shrugged. Under the membership plan — also known as “concierge” medicine — each patient pays a flat monthly fee to have unlimited access to the doctors and any service they can provide in the office, such as EKGs or stitches.
The fee varies depending on age. For kids, it’s $10 a month. For adults up to age 44, it’s $50 a month. Senior citizens pay $100.
The office has negotiated deals for services outside the office. By cutting out the middleman, Nunamaker said he can get a cholesterol test done for $3, versus the $90 the lab company he works with once billed to insurance carriers. An MRI can be had for $400, compared to a typical billed rate of $2,000 or more.
[…]
Kevin Petersen, a Las Vegas-based general surgeon, stopped taking insurance in 2005. Petersen named the same reasons as Nunamaker: too much paperwork and overhead, declining payments from insurance companies, and a general loss of control. “The insurance industry took over my practice,” he said. “They were telling me what procedures I could do, who I could treat — I basically became their employee.”
Now Petersen does hernia operations for $5,000 a pop, which includes anesthesia, operating room time and follow-up visits. He negotiates special rates for the anesthesiologist and the operating room, and is able to provide the service for about a third of what a patient might pay otherwise.
Many of his patients are early retirees who are not yet eligible for Medicare but can’t afford a full-fledged health insurance plan, he said, and business is booming. “My practice at this point is the best it’s been in my 26-year career,” he said. “By far.”
While the cash-only model may please doctors, some question whether it’s good for middle- and low-income people. Kathleen Stoll, director of health policy at the consumer advocacy group Families U.S.A., didn’t want to speak directly to either Petersen’s or Nunamaker’s practice, as she didn’t know the specifics of each.
But in general, she fears that doctors who switch to a cash-only model will drive away the patients who can’t afford a monthly membership fee or thousands of dollars for an operation. “They cherry-pick among their patient population to serve only the wealthier ones,” Stoll said. “It certainly creates a barrier to care.”
(emphasis added)
Obviously, both the named and unnamed 'health advocates' and worriers have it completely wrong. People who don't have to pay thousands of dollars for health insurance actually can afford 'thousands of dollars for an operation' that costs only one third of what it would otherwise cost. It is not only the wealthy who can afford this free market care (besides, people who don't want it have the option to continue with the existing system).
Look at those prices! A cholesterol test for “$3 instead of $90” – that is more than 96% less! An MRI for $400 instead of “$2,000 or more” (usually will be 'or more')? Not to mention the fact that these doctors now have more time to actually care for their patients properly. What's not to like.
A Win-Win By Mistake?
Imagine for a moment what might happen if the government were to get out of healthcare altogether and there would be free competition between all health care service providers. What would happen to prices in that case? It is probably fair to assume that they would come down precipitously even from the low prices free market doctors are already able to obtain for their patients nowadays.
It is actually a good bet that the onerous red tape and the likely explosion in costs due to Obamacare will accelerate the move toward a free market in health care – unless the government explicitly forbids it, that is (unfortunately we cannot rule out completely that such tyrannical steps will eventually be taken – the government generally doesn't like it when its 'help' is refused).
If so, the Obamacare Act could turn out to become a win-win by mistake so to speak, as more and more people decide to opt out of the system. It seems clear that the free market solution is preferable to the cartelized health care system imposed by government and the lobbyists that have co-written the laws. The doctors portrayed in the article above are leading by example, and we expect their ranks to swell in coming years.
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http://www.theblaze.com/stories/2013/10/27/you-will-probably-want-to-see-this-saturday-night-live-skit-mocking-the-obamacare-website/
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But What if Obamacare Works?
By ROSS DOUTHAT
Published: October 26, 2013 670 Comments
IN last week’s column, I wrote about what might happen if the new health care law’s Web site remained a festering technological sore for months to come. (The answer: Nothing good.) But it’s still more likely that HealthCare.gov will be fixed by Thanksgiving and millions of Americans will (finally) be able to get a real look at what Obamacare is selling them.
What will they find? One way to understand what is being offered is to think in terms of three “mores.” Insurance à la Obamacare will be more expensive, more subsidized and more comprehensive than what was previously available on the individual market.
This may not be obvious if you’re struggling to log on to HealthCare.gov. But some of the state-level exchange Web sites are working well enough to enable illuminating window shopping.
Take the exchange in my native state, Connecticut. There the “more expensive” part of the new regime is readily apparent. If you look at Connecticut insurance prices for 2013 — that is, pre-Obamacare — on the online clearinghouse eHealthInsurance, monthly premiums for a 30-year-old in good health can start below $100, and under $300 for a healthy 60-year-old.
On the state’s new Obamacare-compliant health care exchange, by contrast, nothing is that cheap. The lowest priced (“bronze”) plan for a 30-year-old Connecticut resident has premiums starting at $224 a month; for a 60-year-old, the cheapest plan starts at $537.
These premium increases, however, don’t tell the whole story, because there are subsidies, which the Connecticut exchange helpfully calculates as well. If our hypothetical 30-year-old makes $30,000 a year, for instance, he or she would be eligible for credits that lower the actual cost of the cheapest plan to $115 a month. A hypothetical 60-year-old making $30,000 would see the cost of the cheapest bronze plan fall to zero. Over all, the premium increases only really bite as subsidies phase out — at incomes above $45,000, or about $62,000 for a family of four.
They bite, in part, because insurance companies now have to take customers with pre-existing conditions, which drives everyone’s rates up. But they also bite because buyers are getting more insurance than the older system’s cheapest plans offered.
Take those low-cost 2013 plans I mentioned above. A typical one — teased at $269 a month for a nonsmoking 60-year-old Connecticut man — comes with a $5,000 deductible, an annual out-of-pocket limit of $12,500, and all kinds of copays and coverage restrictions.
With some grandfathered exceptions, Obamacare makes those kinds of plans illegal. The out-of-pocket limit for individuals is capped at $6,500 a year, preventive services are fully covered, and various “essential benefits” as well.
If we ever get beyond the follies of HealthCare.gov, the politics of the rollout will probably be defined by how (and how vocally) middle-class Americans just above the subsidy threshold react to this “pay more, get more, subsidize other people” deal.
Some of them will be buying for the first time, spurred by the mandate’s penalties; many others will be shopping for a new plan because their previous ones no longer meet Obamacare’s requirements. Will they be grateful for more comprehensive coverage, even though it’s being forced on them and has higher premiums attached? Or will they feel they were misled by the president’s “if you like your insurance plan, you will keep it” rhetoric, and drive a further backlash against the law in 2014 and beyond?
Where the underlying policy debate is concerned, meanwhile, what you think about the three “mores” basically determines whether you belong on the left or on the right. To liberals, more is simply better, and the disappearing low-cost plans deserve to vanish, because they left purchasers potentially exposed to way too much financial risk. (Even the new bronze plans are really too stingy in this view — which is probably why, if you qualify for subsidies, the Connecticut Web site deliberately nudges you toward the pricier silver plans.)
Conservatives agree that these cheaper plans create more risk. But they also create a sensitivity to price — and with it, a curb on cost growth — that’s rare in a system where third-party payment has made prices opaque, arbitrary and inflated. And for a society that pretty clearly spends far too much on health care, sticking with catastrophic coverage frees up money — thousands for individuals and families, billions for the government — to spend on something other than the insurance-medical complex.
Yes, for some that money would ultimately get eaten up, and then some, by unexpected bills. But for others it might be money saved for retirement, money that pays for child care, money used to hire a contractor or buy a house. And for the public sector, it would be money for all the priorities — liberal as well as conservative — that are being undercut by rising health care costs.
This is why the law’s critics believe Obamacare might be a long-term failure even if it survives its launch troubles and works on its own terms for a while. It’s not about the good things the reform delivers: those are real enough. It’s about whether there are too many other goods, for too many people, that the law’s three “mores” end up crowding out.
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No not Obama. Malkin!
Why aren't the dirtballs from these IVY league schools ever held accountable? Like I said, they happily take the government contracts making promises and then have the nerve to point fingers when everything crashes. I notice David Blumenthal, Syd's brother is safely back at Harvard. If he would just damn stay there and stop telling the world what to do.
Now the rest of the US can understand the shit we doctors have had to put up with. Any wonder at my disgust at the Ivy leaguers? They all get their money and benefits all the while there political cronies force their regulatory crap down our throats.
****What happened to all of Obama’s technology czars?
By Michelle Malkin • October 25, 2013 10:04 AM
Copyright 2013
Why does the White House need a private-sector “tech surge” to repair its wretched Obamacare website failures? Weren’t all of the president’s myriad IT czars and their underlings supposed to ensure that taxpayers got the most effective, innovative, cutting-edge and secure technology for their money?
Now is the perfect time for an update on Obama’s top government titans of information technology. As usual, “screw up, move up” is standard bureaucratic operating procedure.
Let’s start with the “federal chief information officer.” In 2009, Obama named then 34-year-old “whiz kid” Vivek Kundra to the post overseeing $80 billion in government IT spending. At 21, Kundra was convicted of misdemeanor theft. He stole a handful of men’s shirts from a J.C. Penney’s department store and ran from police in a failed attempt to evade arrest. Whitewashing the petty thief’s crimes, Obama instead effused about his technology czar’s “depth of experience in the technology arena.”
Just as he was preparing to take the federal job, an FBI search warrant was issued at Kundra’s workplace. He was serving as the chief technology officer of the District of Columbia. Two of Kundra’s underlings, Yusuf Acar and Sushil Bansal, were charged in an alleged scheme of bribery, kickbacks, ghost employees and forged timesheets. Kundra went on leave for five days and was then reinstated after the feds informed him that he was neither a subject nor a target of the investigation.
As I noted in my 2009 book, “Culture of Corruption,” city and federal watchdogs had identified a systemic lack of controls in Kundra’s office. Veteran D.C. newspaper columnist Jonetta Rose Barras reported that Acar “was consistently promoted by his boss, Vivek Kundra, receiving with each move increasing authority over sensitive information and operating with little supervision.” Yet, Team Obama emphasized that Kundra had no idea what was going on in his workplace, which employed about 300 workers.
A mere 29 months after taking the White House job, Kundra left for a cushy fellowship at Harvard University. In January 2012, he snagged an executive position at Salesforce.com, which touted his “demonstrated track record of driving innovation.”
In 2011, Obama appointed former Microsoft executive and FCC managing director Steven VanRoekel to succeed Kundra. At the time, he promised “to make sure that the pace of innovation in the private sector can be applied to the model that is government.” Mission not accomplished.
Next up: Obama’s “U.S. chief technology officer.” In May 2009, the president appointed Aneesh Chopra “to promote technological innovation to help the country meet its goals such as job creation, reducing health care costs and protecting the homeland. Together with Chief Information Officer Vivek Kundra, their jobs are to make the government more effective, efficient and transparent.”
Chopra’s biggest accomplishment? A humiliating cameo in December 2009 on “The Daily Show” with liberal comedian Jon Stewart, who mocked the administration’s pie-in-the-sky Open Government Initiative. Chopra resigned three years later, ran unsuccessfully for Virginia lieutenant governor and now works as a “senior fellow” at the far-left Center for American Progress, which is run by former Clinton administration hit man turned Obama helpmate John Podesta.
Obama replaced Chopra with Todd Park, the former “chief technology officer of the U.S. Department of Health and Human Services.” The White House described him as a “change agent and ‘entrepreneur-in-residence,’ helping HHS harness the power of data, technology and innovation to improve the health of the nation.” Park oversees the “Presidential Innovation Fellows” program and is also a “senior fellow” in health IT and health reform policy at Podesta’s Center for American Progress. CAP has tirelessly defended Obamacare and its global joke of an IT infrastructure.
In 2010, when President Obama first rolled out a dog-and-pony demonstration of Healthcare.gov, Park basked in the glow of positive media coverage. He bragged to TechCrunch.com about working “24/7 … in a very, very nimble hyper consumer focused way … all fused in this kind of maelstrom of pizza, Mountain Dew and all-nighters, and you know, idealism.”
It was, as you all now know, all hype and glory. So who has Obama called in to oversee the HealthCare.gov rescue mission? None other than the administration’s “change agent and entrepreneur-in-residence,” CTO Todd Park, who helped build the broken system in the first place!
Obamacare also created the “Bureau of Health Information” and a new “assistant secretary of health information,” who coordinates with a separate “national coordinator for health information technology” overseeing the equally disastrous electronic medical records mandate. Harvard University’s David Blumenthal held the post from 2009 to 2011 before returning to his Ivy League home.
Screen shot 2013-10-25 at 10.21.18 AM
Then came Farzad Mostashari, who was “at the forefront of the administration’s health IT efforts and is a resource to the entire health system to support the adoption of health information technology and the promotion of nationwide health information exchange to improve health care.” In August 2013, Mostashari announced his resignation, and earlier this month, he became a “visiting fellow” at the Brookings Institution’s Engelberg Center for Health Care Reform.
Those who can, do. Those who can’t, waste our money screwing things up and then run back to academia to train the next generation of incompetent technocrats.****
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Easy Prediction: The Dems are going to use this clustermess to call for what has been the plan all along-- SINGLE PAYER.
Politically speaking, few spoke well of the pre-Ocare system.
So what are the Reps offering?!? This is an essential moment for us to put our ideas forward, but all the Reps are doing is carping (with good reason of course, but it is but carping nonetheless).
I remember that when the Ocare bill was being fought over that we here noted how many things there were that it included that we Rep ideas or that Reps supported. What were they?
WHAT ARE OUR IDEAS NOW?
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Easy Prediction: The Dems are going to use this clustermess to call for what has been the plan all along-- SINGLE PAYER.
Politically speaking, few spoke well of the pre-Ocare system.
So what are the Reps offering?!? This is an essential moment for us to put our ideas forward, but all the Reps are doing is carping (with good reason of course, but it is but carping nonetheless).
I remember that when the Ocare bill was being fought over that we here noted how many things there were that it included that we Rep ideas or that Reps supported. What were they?
WHAT ARE OUR IDEAS NOW?
There is this thing called a free market....
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Of course I get that, but if you just simply say "free market" people are going to think of people being left to die for lack of money. How to answer this?
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Because being left to die after being rejected for treatment by a gov't board is better? Everything the federal gov't sticks it's mitts into it fcuks up, and this latest O-care ClusterFarkNado is a perfect example. Would you want the gov't to provide you "food insurance"?
At least that would fix America's obesity problem....
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http://www.washingtonpost.com/blogs/the-fix/wp/2013/10/22/how-jon-stewart-became-president-obamas-biggest-problem/
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" if you just simply say "free market" people are going to think of people being left to die for lack of money. How to answer this?"
The poor and the elderly already had unlimited free health care and the uninsured were not being turned away from any emergency room. Obamacare was not aimed at anything like that.
Republicans in my view favor reform of the safety net in order to save the safety net.
Healthcare was already more than 50% government-based which was the reason costs were running wild. But above the safety net level, the more that the health care system can be 'free market', the more likelihood there is for innovation and cost containment.
Obamacare is wrongly called the 'Affordable Care Act'. Cost containment is what is lost with central planning and trying to making all policies the same.
Imagine a dynamic system that moves the deductible up to what each person can reasonably afford, encourages personal and family savings for health and involves people mostly spending their own money, as much as practical, for their own choice of services and care, with the government still playing a large role under that system.
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Anything of interest in this?
http://en.wikipedia.org/wiki/Healthy_Americans_Act
Anyway, what I'm looking for right now is for us to develop the sound bites to win and implement something much better than what we have now.
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Anything of interest in this?
http://en.wikipedia.org/wiki/Healthy_Americans_Act
Anyway, what I'm looking for right now is for us to develop the sound bites to win and implement something much better than what we have now.
Of course that plan no longer has Dem support with Obamacare in place and the Republican co-author Bennett was the Senator Mike Lee took down in Utah. That said, the bill is far better than ACA. I think the main Republican alternative standing when Obamacare passed (or deemed) was the Ryan plan: The Patients' Choice Act. http://paulryan.house.gov/healthcare/#.Um6kqX-dVaQ Pelosi-Reid-Obama arrogant Dems should have compromised with one or both of these plans in exchange for a few R votes. Perhaps they could have kept the House and won the support of the center of the country with the new program.
A Republican alternative now cannot look like it has the complexity of Obamacare.
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Howabout the federal gov't should be working on the duties it's actually mandated to perform and gets away from healthcare altogether ?
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A fair point GM, but one that leaves the field to the FUD tactics of the demagogues.
Continuing with our exploration of options out there, here is this:
http://articles.washingtonpost.com/2009-08-05/opinions/36856255_1_health-reform-health-insurance-health-care-cost-curve
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Good analysis here I think. If the judge reads the law strictly and accurately, only citizens in the states that set up exchanges will get subsidies. If so ruled, the lack of nationwide applicants could bring down the program. Or proponents could use that as leverage to force the other states to set up their exchanges.
How the Court Case Against Obamacare Subsidies Stacks Up
By Sean Trende - October 29, 2013 real Clear Politics
Read more: http://www.realclearpolitics.com/articles/2013/10/29/how_the_court_case_against_obamacare_subsidies_stacks_up-2.html#ixzz2j82EGAtE
http://www.realclearpolitics.com/articles/2013/10/29/how_the_court_case_against_obamacare_subsidies_stacks_up.html
http://www.realclearpolitics.com/articles/2013/10/29/how_the_court_case_against_obamacare_subsidies_stacks_up-2.html
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http://www.realclearpolitics.com/articles/2013/10/29/how_the_court_case_against_obamacare_subsidies_stacks_up.html#.UnByzXRrvW4.facebook
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More Wealth Spreading
Our friend Gary Bauer offered this observation about how O'Care is redistributing wealth: "The millions of Americans who are losing their current policies are offset by millions of previously uninsured Americans, who are essentially getting 'free' insurance through the massive expansion of Medicaid or with help from generous taxpayer subsidies. In other words, Obamacare is another massive redistribution of wealth scheme. You don't need to take my word for it. In March 2010, the New York Times described Obamacare as 'the federal government's biggest attack on economic inequality' in decades."
Privately Insured Are Outlaws!
Attempting to excuse the fact that some 16-19 million Americans, who have taken the responsibility of purchasing their own individual insurance policies, but who will soon be getting cancelation notices because their insurers can't afford to comply with O'Care mandates, Obama is trying to deflect accountability for his lies about "keeping your policy." The administration is now suggesting those policies were not actually legitimate insurance policies. Obama spokesman Jay Carney asserted, "So what we're talking about here is the 5 percent in the country who currently purchase insurance on the individual market. And that market has been like the Wild West. It has been under regulated." In other words, if your policy is unregulated (which is also a lie), then your an outlaw and your policy should be canceled?
Insurance Companies Pressured
CNN's Drew Griffin reports that the Obama administration is pressuring insurance companies to be quiet about all the problems caused by ObamaCare. Griffin said, "[W]hat's going on is a behind the scenes attempt by the White House to at least keep insurers from publicly criticizing what is happening on this Affordable Care Act rollout. Basically, if you speak out, if you are quoted, you're going to get a call from the White House, pressure to be quiet." Why would these companies bow to such pressure? Money. Government-backed insurance policies already account for 48% of all policies sold, and that number will only grow exponentially as Obama's designs take effect and private insurers become virtual government utilities.
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http://www.nytimes.com/2013/11/03/magazine/the-president-wants-you-to-get-rich-on-obamacare.html?nl=todaysheadlines&emc=edit_th_20131103&_r=0
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second post of the morning
You Also Can't Keep Your Doctor
I had great cancer doctors and health insurance.My plan was cancelled. Now I worry how long I'll live.
By
EDIE LITTLEFIELD SUNDBY
Nov. 3, 2013 6:37 p.m. ET
Everyone now is clamoring about Affordable Care Act winners and losers. I am one of the losers.
My grievance is not political; all my energies are directed to enjoying life and staying alive, and I have no time for politics. For almost seven years I have fought and survived stage-4 gallbladder cancer, with a five-year survival rate of less than 2% after diagnosis. I am a determined fighter and extremely lucky. But this luck may have just run out: My affordable, lifesaving medical insurance policy has been canceled effective Dec. 31.
My choice is to get coverage through the government health exchange and lose access to my cancer doctors, or pay much more for insurance outside the exchange (the quotes average 40% to 50% more) for the privilege of starting over with an unfamiliar insurance company and impaired benefits.
Countless hours searching for non-exchange plans have uncovered nothing that compares well with my existing coverage. But the greatest source of frustration is Covered California, the state'sAffordable Care Act health-insurance exchange and, by some reports, one of the best such exchanges in the country. After four weeks of researching plans on the website, talking directly to government exchange counselors, insurance companies and medical providers, my insurance broker and I are as confused as ever. Time is running out and we still don't have a clue how to best proceed.
Two things have been essential in my fight to survive stage-4 cancer. The first are doctors and health teams in California and Texas: at the medical center of the University of California, San Diego, and its Moores Cancer Center; Stanford University's Cancer Institute; and the M.D. Anderson Cancer Center in Houston.
The second element essential to my fight is a United Healthcare PPO (preferred provider organization) health-insurance policy.
Since March 2007 United Healthcare has paid $1.2 million to help keep me alive, and it has never once questioned any treatment or procedure recommended by my medical team. The company pays a fair price to the doctors and hospitals, on time, and is responsive to the emergency treatment requirements of late-stage cancer. Its caring people in the claims office have been readily available to talk to me and my providers.
But in January, United Healthcare sent me a letter announcing that they were pulling out of the individual California market. The company suggested I look to Covered California starting in October.
You would think it would be simple to find a health-exchange plan that allows me, living in San Diego, to continue to see my primary oncologist at Stanford University and my primary care doctors at the University of California, San Diego. Not so. UCSD has agreed to accept only one Covered California plan—a very restrictive Anthem EPO Plan. EPO stands for exclusive provider organization, which means the plan has a small network of doctors and facilities and no out-of-network coverage (as in a preferred-provider organization plan) except for emergencies. Stanford accepts an Anthem PPO plan but it is not available for purchase in San Diego (only Anthem HMO and EPO plans are available in San Diego).
So if I go with a health-exchange plan, I must choose between Stanford and UCSD. Stanford has kept me alive—but UCSD has provided emergency and local treatment support during wretched periods of this disease, and it is where my primary-care doctors are.
Before the Affordable Care Act, health-insurance policies could not be sold across state lines; now policies sold on the Affordable Care Act exchanges may not be offered across county lines.
What happened to the president's promise, "You can keep your health plan"? Or to the promise that "You can keep your doctor"? Thanks to the law, I have been forced to give up a world-class health plan. The exchange would force me to give up a world-class physician.
For a cancer patient, medical coverage is a matter of life and death. Take away people's ability to control their medical-coverage choices and they may die. I guess that's a highly effective way to control medical costs. Perhaps that's the point.
Ms. Sundby lives in California.
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Second post of the morning (do pay attention to the first one!)
From time to time I get sidebars from lurkers here. Recently I received one with a question that vexes me. I'd be glad of our group's analysis:
It was from a person, like me, is of Tea Party orientation. He is self-employed. Like many Americans, he is hurting economically. His income is low enough that he is eligible for considerable subsidies. Indeed, his health insurance under Obamacare may become free or virtually free instead of the considerable about he, a family man, now pays (about 25% of his income!). However, he struggles with the morality of signing up for something he believes to be wrong and believes will be bad for America. On the other hand, why should he compete in life with a self-imposed handicap?
The article below gives and idea of the subsidies available:
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http://www.nytimes.com/2013/11/04/business/under-health-care-act-millions-eligible-for-free-policies.html?nl=todaysheadlines&emc=edit_th_20131104
By REED ABELSON and KATIE THOMAS
Published: November 3, 2013 300 Comments
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Millions of people could qualify for federal subsidies that will pay the entire monthly cost of some health care plans being offered in the online marketplaces set up under President Obama’s health care law, a surprising figure that has not garnered much attention, in part because the zero-premium plans come with serious trade-offs.
Three independent estimates by Wall Street analysts and a consulting firm say up to seven million people could qualify for the plans, but federal officials and insurers are reluctant to push them too hard because they are concerned about encouraging people to sign up for something that might ultimately not fit their needs.
The bulk of these plans are so-called bronze policies, the least expensive available. They require people to pay the most in out-of-pocket costs, for doctor visits and other benefits like hospital stays.
Supporters of the Affordable Care Act say that the availability of free-premium plans — as well as inexpensive policies that cover more — shows that it is achieving its goal of making health insurance widely available. A large number of those who qualify have incomes that fall just above the threshold for Medicaid, the government program for the poor, according to an analysis by the consulting firm McKinsey and Company.
The latest analysis was conducted by McKinsey’s Center for U.S. Health System Reform, whose independent research has been cited by the federal government and others.
“The whole point of the law was not only to cover the uninsured, but so people didn’t have to make choices between food or drugs, or going to the doctor or dentist,” said Karen Davis, a health policy expert at the Johns Hopkins Bloomberg School of Public Health. “It’s what it is designed to do.”
Many insurers tried to price their least expensive plans so they would become free or nearly free with the addition of subsidies that are set based on a person’s income and the cost of a midlevel, or silver, plan.
Independence Blue Cross in Philadelphia has four plans that are free to some customers. But the company, along with other insurers, has been careful not to publicize its free coverage for fear of alienating customers who will need to pay more.
“We’re not advertising zero dollar,” said Brian Lobley, a senior vice president at Independence Blue Cross. But the company is promoting monthly premiums in the $20 to $30 range, he said.
The Obama administration has also stressed affordability over coverage with no monthly charge, frequently saying that the cost of coverage will be less than a monthly cellphone bill for many consumers. Officials at the Department of Health and Human Services would not comment on the McKinsey analysis, saying in a statement that the goal of the health law was to provide a range of options for people with differing needs and budgets.
The analysis found that five million to six million people who are uninsured will qualify for subsidies that will be greater than the cost of the cheapest bronze or silver plan. A million more people with individual insurance could also be eligible, according to McKinsey, although estimates of the size of the market for private individual insurance vary widely. None of the people in the analysis qualify for Medicaid.
The availability of zero-premium plans may make the deal especially enticing to the healthy young people the marketplace needs to succeed, said Mark V. Pauly, a professor of health care management at the University of Pennsylvania’s Wharton School. “This is such a good deal that you’d have to believe you were immortal not to really pick it up,” he said.
Although they vary in their design, bronze plans generally cover about 60 percent of a person’s medical costs. All plans, including bronze, must cover standard benefits like prescription drugs, maternity care and mental health treatment.
The availability of the zero-premium plans varies across the country. McKinsey found that about 40 percent of the uninsured in Missouri will be able to select a no-cost bronze plan, for example, compared with 2 percent of the uninsured in New Jersey.
Its estimate, based on an analysis of premiums for plans offered in the marketplaces in all 50 states and the District of Columbia, is in line with two other estimates, by Credit Suisse and Morgan Stanley.
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Under Health Care Act, Millions Eligible for Free Policies
Published: November 3, 2013 300 Comments
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(Page 2 of 2)
The McKinsey researchers also found that about half of the people eligible for zero-premium plans were under 39 and uninsured. The Obama administration has been emphasizing the affordability of its plans for young people, a critical group because their participation in the marketplaces will help keep overall premiums low.
It is impossible to know who will actually sign up, and whether they will choose a zero-premium plan.
For many people, paying slightly more for a silver plan may be a much better option, experts said. Ninety percent of those who will have the option of buying the no-cost plans make less than 250 percent of the federal poverty level, which is $28,725 for an individual, and $58,875 for a family of four. People earning below those thresholds are eligible for the most generous assistance, but only if they choose a silver plan.
About a million of those who will qualify for free coverage will be able to buy a silver plan for no monthly cost. McKinsey, which is releasing a report about the new insurance marketplaces, estimates that the cost of silver plans for the people who qualify for a zero-premium bronze plan will range from $40 to $50 a month.
“They may be getting zero premiums, but they’re also leaving a lot of money on the table if they don’t enroll in a silver-level plan,” said Sabrina Corlette, a professor at Georgetown University’s Health Policy Institute.
All plans, including bronze policies, limit annual out-of-pocket costs to $6,350 for individuals and $12,700 for families. But insurers and advocates said out-of-pocket costs — even those under that limit — can be daunting to people with low incomes.
For Mark and Elisabeth Horst, both artists in Albuquerque, the risks of signing up for a bronze plan were outweighed by the prospect of getting it free. The Horsts, who make $24,000 a year between them, qualified for $612 in monthly subsidies, but the cost of a bronze plan was $581 a month.
“We’re in good health,” Mr. Horst said.
Besides, he said, they can always switch to a better plan next year. “At this point, it’s a little bit of a gamble.”
Not everyone selects the cheapest option. Dante Olivia Smith, a lighting designer from Manhattan, learned that federal subsidies would allow her to buy a bronze plan for $24 a month.
“It was astounding,” she said. “I almost started crying, and called my mom.”
In the end, however, she went with a silver plan for $91 a month that included dental and vision coverage. Ms. Smith, who is 30, said she opted for the more comprehensive plan because of her work, which requires her to climb ladders and use power tools.
“If I had a different job, for 24 dollars a month I would have been like ‘Woo-hoo!' ” she said. “But the reality is, I know what my risks are in my life.”
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As best as I can tell, this moment is an ideal moment for us to change the political landscape for freedom, the free market, and the good of the country. However the Stupid Party is silent on this and instead only carps and complains snarkily. It is all good fun I suppose, but where is the vision for where we want to go?
What occurs to me:
1) A proper function of government is for prices to be knowable and at present there are not. How can market forces work if people cannot price compare? EVERYONE has experienced frustration with this--surely calling for prices to be knowable will make for good soundbites and good law , , ,
2) What about having one national market, instead of 50 markets? Good sound bite? Good law? Seems so to me , , ,
3) I have read good things about HSAs. What are the facts? How can the law be changed to make them even better? What are the sound bites for HSAs?
4) During the debates leading up to Obamacare's passage, we noted here that there were several elements with which our side agreed. What were they? As things sit now, the Reps are identified as against Obamacare-- both the good and the bad. Can we not identify the good with which the Dems agreed with us and promise its continuance in that with which we seek to replace Obamacare?
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As best as I can tell, this moment is an ideal moment for us to change the political landscape for freedom, the free market, and the good of the country. However the Stupid Party is silent on this and instead only carps and complains snarkily. It is all good fun I suppose, but where is the vision for where we want to go?
What occurs to me:
1) A proper function of government is for prices to be knowable and at present there are not. How can market forces work if people cannot price compare? EVERYONE has experienced frustration with this--surely calling for prices to be knowable will make for good soundbites and good law , , ,
2) What about having one national market, instead of 50 markets? Good sound bite? Good law? Seems so to me , , ,
3) I have read good things about HSAs. What are the facts? How can the law be changed to make them even better? What are the sound bites for HSAs?
4) During the debates leading up to Obamacare's passage, we noted here that there were several elements with which our side agreed. What were they? As things sit now, the Reps are identified as against Obamacare-- both the good and the bad. Can we not identify the good with which the Dems agreed with us and promise its continuance in that with which we seek to replace Obamacare?
All good points, and politically necessary to spell out the alternative, not just say no. As Obama found out, it is easier to be a critic than to have a plan and govern.
1) Knowing costs - YES! Why is it so hard to know costs? The billing department knows the costs. Amazon knows that customers who bought this also bought this and this. Why not know before you walk in?
2) YES! The Republican plan allowed people to buy policies across state lines, forcing insurers to compete. Obamcare instead has a different rate for every county in the country. Because of this, some will have to move to buy mandated coverage.
http://www.foxnews.com/politics/2013/10/23/obamacare-too-costly-for-rich-colorado-residents-dem-congressman-says/
3) HSA's - YES! Health savings account means save your money, spend it on your healthcare. Incorporate HSA's with catastrophic coverage for the unexpected above what you can afford, and incorporate both of those with a legitimate safety net for what people trying their best really can't afford.
4) The popular elements of Obamacare were already in the Republican plan. Some method to deal with pre-existing conditions is the big one. Also opening the market to cross state lines and malpractice/medical liability reform. "Can we not identify the good with which the Dems agreed with us and promise its continuance in that with which we seek to replace Obamacare?" - YES!
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Let's keep this going , , ,
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RE: sidebar
As the dems pointed out, ocare is the law of the land. (Funny how selective their interest in the rule of law is.)
He should use it to his advantage and prepare for the coming crash. His patriotism shouldn't require him to be victimized by the Cloward-Piven operation currently in progress.
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The Denny family has been getting its health insurance through Dog Brothers Inc.
Our health insurance agent tells us that we will be losing it however because apparently as of July 2014 husband-wife owned corporations such as ours no longer are allowed.
:x :x :x :x :x :x :x :x :x
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The Denny family has been getting its health insurance through Dog Brothers Inc.
Our health insurance agent tells us that we will be losing it however because apparently as of July 2014 husband-wife owned corporations such as ours no longer are allowed.
:x :x :x :x :x :x :x :x :x
To that news, one could retort something clever about marriage penalty or that if this was a gay marriage the California courts would never allow that. But this is real, and cancellations like what you (and I) received, and things like a doubling of costs for new policies are being received by all kinds of Obama voters and swing voters who swung Democratic over the last 6-8 years.
Note that a website glitch isn't the central problem. If your healthcare costs double or go up by thousands of dollars, how does that affect your outlook for other purchases, and multiply that decrease by 300 million people and guess the macroeconomic effect. People buy less and businesses fail. Incomes go down and more healthcare (and other) subsidies are required. Lower revenues to the government, more spending, more debt and it all just spirals downward. Welcome to Obamanomics, unencumbered by the need to ever again face reelection.
If we chose to pay more to get more, that is different. But this was sold to a bare majority on the basis of, a) no one knows what is in the bill/law, b) it will bring DOWN costs by 2500 per year - code name 'Affordable', and c) if you like your plan you can keep it, so what's the harm in trying. Even if the promises were true (what a joke), it was tyranny of a bare majority to force its way on all the rest. Un-American, one might say.
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Worth noting is that the "bare majority" was in the Congress; a strong majority (60+% to 40-% of the American people opposed at time of passage).
The news this morning reports that Bill Clinton is calling for Obama to keep his promise about people being able to keep their insurance and their doctors. Of course, this would be/is another huge body blow to the "logic" of the fantasy numbers upon which Obamacare is based.
Another thing to keep in mind is that with the illegal deferral of the application of Obamacare to businesses coming to an end next year, is that what we are seeing now in the individual sector is going to be repeated in the business sector.
WHERE ARE THE SOLUTIONS THAT THE REPS SHOULD BE OFFERING IN THIS MOMENT?!?
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A keep-your-plan bill should include a clause to legalize other plans for other people as well. 'Grandfathering' in a few plans is unequal treatment and no way to treat the previously and currently uninsured who might like to buy lesser coverage than the O-care requirement too.
If Obamacare is a tax of a legal choice, and not a mandate, why aren't catastrophic plans allowed and available for those who chose to pay the penalty instead of buy the policy? What happened to the goal of getting more people insured? Isn't partial insurance better no insurance?. Maybe we can offer a partial penalty, something a little easier to repeal.
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http://on.wsj.com/179fXoS
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The Real Healthcare.gov?
Fraudulent ObamaCare websites (other than Healthcare.gov, of course) are popping up everywhere, and the The Wall Street Journal has a helpful tip for those trying to enroll through the exchange: "cam-artist pages ... are now pretending to be Healthcare.gov and are tricking people into divulging sensitive information or buying fake products. Important consumer warning: If an insurance shopping website is usable, it's not the federal government's."
$26.7 Million Per Enrollee
The ObamaCare statistics keep getting uglier and uglier. Senators Orrin Hatch (R-UT) and Chuck Grassley (R-IA) reveal that a grand total of five Washington, D.C. residents have successfully enrolled through Healthcare.gov. But based on numbers from the Centers for Medicare & Medicaid Services, the District received $133,573,928 in grants. As Breitbart's Warner points out, "This means that the cost to the American taxpayers per enrollee in D.C. has been $26,714,785.60 each."
Exchange Built in 3 Weeks
After three years and hundreds of millions of dollars, HHS still hasn't managed to build a functional exchange. Yet three San Francisco programmers managed to create a workable website similar to Healthcare.gov in just weeks. CBS reports, "With a few late nights, Ning Liang, George Kalogeropoulos and Michael Wasser built 'thehealthsherpa.com,' a two-week-old website that solves one of the biggest problems with the government's site. ... Using information buried in the government's own website built by high-priced government contractors, they found a simpler way to present it to users." As we've said repeatedly, the failure of the rollout is but a metaphor for the reality that no government bureaucracy is ever going to successfully manage 18% of the U.S. economy, much less a basic commerce website for insurance comparisons.
O'Care Fraud
Among the provisions deep inside O'Care? An open invitation to fraud. According to Reason's Tori Richards: "Tucked inside nearly 11,000 pages of the Affordable Care Act is a little-known provision that doles out three months of free health care to individuals who choose to default on their premiums. People who receive the federal subsidy to be part of Obamacare will be allowed to incur a three-month 'grace period' if they can't pay their premiums and then simply cancel their policies, stiffing the doctors and hospitals. Their only repercussion is that they have to wait until the following year's open enrollment if they want coverage on the exchange. ... Under Section 156.270 of the Affordable Care Act, the insured needs to pay a premium for just one month before qualifying for the three-month grace period. The insurance company must pay the claims during the first month of the grace period; during the second and third month doctors and hospitals are left to collect unpaid bills."
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This is a plan we should seriously consider. Don't 'fix' Obamacare. Fix what was wrong with health care in the U.S. before Obamacare. - Doug
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http://online.wsj.com/news/articles/SB10001424052702304448204579182203093952642?mod=WSJ_Opinion_LEADTop
A Conservative Alternative to ObamaCare
To avoid a lurch to the left if the current law fails, the time is right to present sensible, market-oriented reforms.
By Ramesh Ponnuru And Yuval Levin
WSJ Nov. 14, 2013
As ObamaCare's failures and victims mount by the day, Republicans have so far mostly been watching in amazement. They expected the law to fail, but even among its most ardent opponents few imagined the scale and speed of the fiasco.
Seeing the pileup, Republicans might be tempted to step aside and let ObamaCare continue to disappoint and infuriate Americans. After all, the GOP doesn't have the power to repeal the law, or even to make meaningful changes to undo its worst effects. So why not just watch the Democrats pay the price for their folly?
But such passivity would actually protect the Democrats from paying that price. What Republicans can and should do is offer the public something better. Now is the time to advance a conservative reform that can solve the serious, discrete problems of the health-care system in place before ObamaCare, but without needlessly upending people's arrangements or threatening what works in American medicine. That the Democrats are now making things worse doesn't mean the public wants to keep that prior system, or that Republicans should.
The biggest Republican misconception about health care is that the system before ObamaCare was a free-market paradise. On the contrary: It has consisted chiefly of massive and inefficient entitlements that threaten to bankrupt the nation; the lopsided tax treatment of employer-provided coverage that creates incentives for waste and overspending; and an underdeveloped individual market struggling to fill the gaps.
Exploding health-care costs and millions left needlessly uninsured are a result of misguided federal policies. Solutions require targeted reforms to those policies.
The outlines of such reforms have been apparent for years. The key is to enable all Americans to purchase coverage and to approach health care as consumers: with an interest in quality and an eye on cost.
The first step of a plan to replace ObamaCare should be a flat and universal tax benefit for coverage. Today's tax exclusion for employer-provided health coverage should be capped so that people would not get a bigger tax break by buying more extensive and expensive insurance. The result would be to make employees more cost-conscious; and competition for their favor would make insurance cheaper.
That tax break would also be available—ideally as a refundable credit sufficient at least for the purchase of catastrophic coverage—to people who do not have access to employer coverage. This would enable people who now choose not to buy insurance to get catastrophic coverage with no premium costs. It also would give those who want more-comprehensive coverage in the individual market the same advantage that people with employer plans get.
Medicaid could be converted into a means-based addition to that credit, allowing the poor to buy into the same insurance market as more affluent people—and so give them access to better health care than they can get now.
All those with continuous coverage, which everyone could afford thanks to the new tax treatment, would be protected from price spikes or plan cancellations if they got sick. This guarantee would provide a strong incentive to buy coverage, without the coercion of the individual mandate. People who have pre-existing conditions when the new rules take effect would be able to buy coverage through subsidized, high-risk pools.
By making at least catastrophic coverage available to all, and by giving people such incentives to obtain it, this approach could cover more people than ObamaCare was ever projected to reach, and at a significantly lower cost.
The new alternative would not require the mandates, taxes and heavy-handed regulations of ObamaCare. It would turn more people into shoppers for health care instead of passive recipients of it—and encourage the kind of insurance design, consumer behavior and intense competition that could help keep health costs down. Redesigned and directed this way, the flow of federal dollars and tax subsidies would do much less to distort health markets than it has for the last several decades, while getting far more people insured.
Conservative policy experts have long proposed such approaches, but congressional Republicans, with a few honorable exceptions, have not taken them up in recent years. In 2009, for instance, House Republicans offered an alternative to ObamaCare that did nothing about today's market-distorting tax policy and thus did not do much to help the people whom that policy—by inflating premiums—has locked out of the insurance market.
Some Republicans think that political success requires nothing more than watching ObamaCare fail. But if the new system quickly implodes, that would be all the more reason to have an alternative on hand—other than another leftward move toward single payer. And it might not implode so quickly.
Other Republicans fear that any alternative would amount to ObamaCare Lite, just another big government health-care program. But a real market-oriented conservative reform would take us toward an actual functioning consumer market in coverage—and so to the right not only of ObamaCare but of the system that preceded it.
There has also been a fear among some Republicans that proposing an alternative would give Democrats a target and distract the public from the expected and now real failures of ObamaCare. But the absence of a credible alternative has been the GOP's greatest weakness in the fight against ObamaCare, and it is probably why polls show that even many people who are skeptical and concerned about ObamaCare do not support full repeal.
Defenders of ObamaCare are using the absence of a Republican alternative to suggest that their law is the only answer to the grave problems of American health care and that without it millions of Americans would continue to lack access to coverage. That argument is their final trump card. It is time for Republicans to take it away.
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Doug:
YES!!! THIS IS THE SORT OF THING WE NEED TO BE OFFERING!!!
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A friend writes:
then Ocare was designed to ultimately fail. Just not by the website. Here is what was probably designed to happen.
1. Limit choices for people going onto the plan to a limited number.
At first, this would only harm a "small portion", but would get them used to it.
2. As more people lost their plans and went onto Ocare, then there would be more complaints, but by the new people only, and who would get over it in time. The "old timers" would now be used to it. Costs would increase for everyone else.
3. The next round of new people would collapse the system, and would require a change.................Single Payer.
And there you have it.
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Patriot Post:
Obama wants you to cling to government, but Americans are clinging to their guns instead. According to statistics from the FBI, there were 1,687,599 firearms background checks processed through the National Instant Criminal Background Check System (NICS) during the month of October. Compare this to the 106,185 individuals who are rumored to have enrolled through O'Care's federal exchange. That's a 15:1 ratio. Indeed, the Second Amendment is the best insurance policy!
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Defund Now!
http://www.senateconservatives.com/site/post/2352/video-ted-cruz-on-the-kelly-file?c=747585b24fc8b6d3edc2d876bb2dcad3
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Affordable Boat Act
The U.S. government has just passed a new law called: "The affordable boat
act" declaring that every citizen MUST purchase a new boat, by April 2014.
These "affordable" boats will cost an average of $54,000-$155,000 each.
This does not include taxes, trailers, towing fees, licensing and registration
fees, fuel, docking and storage fees, maintenance or repair costs.
This law has been passed, because until now, typically only wealthy and
financially responsible people have been able to purchase boats. This new
laws ensures that every American can now have a "affordable" boat of their
own, because everyone is "entitled" to a new boat. If you purchase your
boat before the end of the year, you will receive 4 "free" life jackets; not
including monthly usage fees.
In order to make sure everyone purchases an affordable boat, the costs of
owning a boat will increase on average of 250-400% per year. This way,
wealthy people will pay more for something that other people do not want or
can not afford to maintain. But to be fair, people who can not afford to maintain
their boat will be regularly fined and children (under the age of 26) can
use their parents boats to party on until they turn 27; then must purchase
their own boat.
If you already have a boat, you can keep yours (just kidding; no you
can not). If you do not want or do not need a boat, you are required to buy one
anyhow. If you refuse to buy one or can not afford one, you will be regularly fined
$800 until you purchase one or face imprisonment.
Failure to use the boat will also result in fines. People living in the
desert; ghettos; inner cities or areas with no access to lakes are not
exempt. Age, motion sickness, experience, knowledge nor lack of desire are
acceptable excuses for not using your boat.
A government review board (that does not know the difference between the
port, starboard or stern of a boat) will decide everything, including; when,
where, how often and for what purposes you can use your boat along with
how many people can ride your boat and determine if one is too old or healthy
enough to be able to use their boat. They will also decide if your boat
has out lived its usefulness or if you must purchase specific accessories, (like
a $500 compass) or a newer and more expensive boat.
Those that can afford yachts will be required to do so...it is only fair.
The government will also decide the name for each boat. Failure to comply with
these rules will result in fines and possible imprisonment.
Government officials are exempt from this new law. If they want a boat,
they and their families can obtain boats free, at the expense of tax payers.
Unions, bankers and mega companies with large political affiliations ($$$)
are also exempt.
If the government can force you to buy health care, they can force you to buy a boat....or ANYTHING else..
Yea...it is that stupid...
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ACA Eliminates 98% of Plans
Michael Tanner over at National Review brings us this ObamaCare tidbit: "According to HealthPocket, a health-insurance consulting firm, fewer than 2 percent of individual plans on offer today meet all ACA requirements." But this destruction isn't limited to the individual market. Avik Roy of the Manhattan Institute says that 51% of employer-sponsored plans will get cancelled, as well. As we have said all along, ObamaCare is about remaking the "market," not preserving it.
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ACA Eliminates 98% of Plans
Michael Tanner over at National Review brings us this ObamaCare tidbit: "According to HealthPocket, a health-insurance consulting firm, fewer than 2 percent of individual plans on offer today meet all ACA requirements." But this destruction isn't limited to the individual market. Avik Roy of the Manhattan Institute says that 51% of employer-sponsored plans will get cancelled, as well. As we have said all along, ObamaCare is about remaking the "market," not preserving it.
(http://www.powerlineblog.com/admin/ed-assets/2013/11/FederalRegister0921.jpg)
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Seventeen lies and counting...
1. “…what we’re doing to implement and improve the law.”.
Actually he has blocked any attempt to improve the law, and has insisted on making “administrative changes” – that is, ignoring the law and imposing what he chooses without approval by Congress. For example, the delay in the “employer mandate” – the House passed that but Obama instructed Reid not to take it up, and instead he made that change unilaterally, in violation of the ACA which he signed.
So no, he hasn’t worked to “improve the law,” he has fought efforts to do that.
2. “In the first month, more than 100,000 Americans successfully enrolled…”.
Not true. Based on published reports, about 106,000 have put a plan into their online shopping carts, but far fewer have actually bought the policies. And there is no way to know whether the others ever will.
If a CEO stated, “We sold more than 100,000 widgets last month.” when in fact far fewer had been sold, he could be charged with fraud.
3. “…more than 500,000 Americans could know the security of health care by January 1, many of them for the first time in their lives…”
No, these are not people who have “never known the security of health care,” they are people who either don’t have insurance, or who think they can get better or cheaper insurance through Obamacare. Health care is already available more or less to all of them.
4. “The other problem that has received a lot of attention concerns the Americans who have received letters from their insurers that they may be losing the plans that they bought…”
No, these letters (and I received one) don’t say we “may be” losing our plans. They say we are losing our plans, effective the end of the year. Implying that it is iffy is dishonest.
5. “I’ve said from the beginning, I’m willing to work with Democrats and Republicans to fix problems as they arise. This is an example of what I’m talking about.”
But it’s not.
He is not “working with Democrats and Republicans” to fix this. He is unilaterally stating how it will be, in violation of the ACA, which he signed into law. There are no Republicans involved in this, in any way. Saying this is an example of “working with Democrats and Republicans” to fix this is not true.
6. “[In the Obamacare exchange], [t]here is a good chance they will be able to buy better plans at lower cost.”
Not really. Prices there are very high. If your income is low, the cost may be borne partly by others, but it’s still high. Subsidies don’t lower cost, they just pass it on to somebody else.
7. “I’m not going to walk away from 40 million people who have the chance to have health care for the first time…”
Actually two lies in one phrase here.
First, he’s again using “health care” to mean “health insurance. Almost all these people have had health care, just not insurance. It’s dishonest to imply that if you don’t have insurance you don’t get health care – that is almost 100 percent false.
Second, he is stating that these people have not had “access” to insurance, but most or all of them have had access to insurance, the same as they have had access to food, shelter, and everything else you buy with money. They may not have been able to afford it, or they may have chosen not to buy it, because they wanted to spend their money on something else. (I wonder how many of them smoke or drink…?)
8. “We’re at the opening weeks of a project to build a better health-care system for everybody.”
Again, at least two blatant lies here.
First, the ACA was passed in early 2010, and it presumably had a little thought before it was passed. So it’s been at least 3 1/2 years, not “weeks.”
Second, the bill is constructed to make insurance cheaper for some – those who have low income or pre-existing conditions – at the expense of others. It cannot possibly be claimed to be “better” for those who pay more to subsidize those who get the subsidies.
9. “It’s important that we’re honest and straightforward when we come up with a problem with these reforms and these laws that we address them.”
Not a lie exactly, but what would you call it if a worm said, “It’s important that we have arms and legs!”?
10. [His promise “If you like your plan you can keep it”] “…ended up not being accurate.”
No, it was false when he said it, and he knew that.
He lied, dozens of times.
11. “…premiums would go up an average of 15 percent a year.”
This one would take some research, but he offers no evidence to support this, and I don’t think it’s true. My insurance has been pretty flat for several years, til the ACA was imposed.
12. “…my expectation was that for 98 percent of the American people, either it genuinely wouldn’t change at all, or they would be pleasantly surprised…that proved not to be the case.”
Published reports show that he knew the reality – he was informed years ago – and he went ahead saying “If you like your policy you can keep it” anyway.
13. “The Affordable Care Act is not going to be the factor in what happens with folks in the individual market.”
Of course it is. If he thinks that insurance companies – having put a bunch of effort into re-designing their plans to comply with the ACA, that because he holds a press conference, and says that those parts of the law – which he did not specify – that are causing the problem, are somehow void – but only for 2014 – and that insurance companies will all turn on a dime, without any regard for what might come next – what the rules will be in 14 months – he is absolutely nuts. He can’t be that stupid, so he must be lying.
14. “…the status quo before the ACA was not working at all.”
I guess it all depends what “working” means, but any definition you could apply, if you apply that same definition to any other industry, you would find that nothing in America is “working”, because nothing is perfect. Which may be how Obama views things.
Of course it was “working” to some degree. Most of us were relatively satisfied with our insurance and it was affordable. (I always found that insurance companies’ customer service was horrible, but the products and prices were OK.)
Does he really claim that if everything in an industry isn’t perfect, then something like the ACA is justified? The implications are staggering.
15. “When I see people on Capitol Hill…who want to repeal it…”
Essentially he is claiming that if you favor repeal of the ACA, then you favor the status quo before it was imposed, which is not true at all.
He is pretending not to know that the House has already passed a number of reforms that would reduce cost and increase coverage. He can’t be that poorly-informed, so he must by lying.
16. “…and it certainly wasn’t working for the 41 million people who didn’t have health insurance.”
Of course it was working, for many of them. Some couldn’t afford insurance, but many of those 41 million simply chose not to buy it, because they believed – probably correctly – that it wasn’t worth the money. The President can disagree with them, but only if he looks at an individual’s situation and concludes that person would be better off with insurance. But even then, what counts is each individual’s values and choices – that’s what “better” is in a free society. So those who could afford it and chose not to buy it – for them, the system was working fine.
17. “Somebody sooner or later had to do it.”
He doesn’t say exactly what “it” is, but he was talking about the ACA, so presumably he means “Somebody had to impose something like the ACA.” and that’s obviously not true. The status quo was a viable option, or there were other reform options, like those passed by the House. Nobody “had” to do something like the ACA.
I notice he lies less when he answers questions than when he makes prepared remarks. When he answers questions, he rambles and repeats himself, but he seems to avoid direct lies.
Which suggests that he and his team must sit around, before he speaks in public, and write the lies; they are carefully prepared, not extemporaneous.
Pretty disturbing.
http://www.powerlineblog.com/archives/2013/11/lies-of-obamacare-seventeen-and-counting.php
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President Obama’s press conference yesterday was a fascinating opportunity to observe the mindset of the person who is trying to forcibly reorganize a fifth of the nation’s economy. Four quotes stuck out as particularly revealing.
1. “What we're also discovering is that, you know, insurance is complicated to buy.”
At 52 years of age, the President is finally learning what every adult American already knows. Health insurance is complicated to buy, with hundreds of factors affecting the price and availability of plans.
It is alarming that the President is only now coming to grips with the complexity of the insurance industry that he made it his signature initiative to rearrange--operating on wildly naive assumptions about his ability to do that successfully and to predict the consequences, as should now be clear to everyone on both sides of the aisle.
2. “Another mistake that we made, I think, was underestimating the difficulties of people purchasing insurance online and shopping for a lot of options, with a lot of costs and a lot of different benefits and plans.”
As anyone who has ever bought insurance knows, insurance companies want to know a lot of personal information before agreeing to cover your medical expenses, and buying a policy is not something Americans look forward to. That’s a big part of the reason millions of people are so frustrated that their plans have been cancelled due to the health care law. Many have a hard enough time understanding the details of their policies even once they have one.
Yet apparently the President and the architects of the health care law believed the experience of shopping for insurance would be “the same way you’d shop for a plane ticket on Kayak or a TV on Amazon,” as President Obama put it on October 1.
3. “I don't think I'm stupid enough to go around saying ‘this is going to be like shopping on Amazon or Travelocity,’ a week before the website opens if I thought that it wasn't going to work.”
Taking the President at his word that he didn’t know about the tech failures raises a number of other serious questions. We know that senior officials were warned the website wasn’t ready, so why wasn’t the President informed? Who didn’t tell him? And why hasn’t he fired them?
More importantly, if he wasn’t informed about the centerpiece of his signature policy initiative, what else isn’t he informed about? What doesn’t he know on Iran? Or Syria? Or North Korea?
It is baffling that senior aides could keep such information from the President and still keep their jobs.
4. “I said that I would do everything we can to fix this problem [of policy cancellations], and today I'm offering an idea that will help do it.”
To the millions of Americans who’ve had their insurance plans cancelled despite President Obama’s promises, yesterday the President offered “an idea.” Not a policy change. Not a proposed piece of legislation. Not language to change the rules. An idea--essentially a promise to insurers that the federal government would ignore the law and allow plans that Obamacare made illegal to continue to operate.
Of course, he came up with this “idea” after the insurance companies had already cancelled hundreds of thousands of policies to comply with the law. As the Louisiana Insurance Commissioner--who serves as president of the National Association of Insurance Commissioners--said in his response, “It is unclear how, as a practical matter, the changes proposed today by the President can be put into effect. In many states, cancellation notices have already gone out to policyholders and rates and plans have already been approved for 2014. Changing the rules through administrative action at this late date creates uncertainty and may not address the underlying issues.”
At least one state insurance commissioner who is a Democrat, Mike Kreidler from Washington, has already said he won’t comply--which suggests that the President’s “idea” to keep his promise won’t get past the drawing board in most states, and he probably knows it--or maybe aides didn’t tell him that either.
That was the stunning takeaway from yesterday’s press conference: he wasn’t informed, he didn’t fire anyone over it, he doesn’t understand how impossible a task it is to reorganize a whole industry, and he hasn’t learned much from the experience.
Your Friend,
Newt
:evil:
==================================
And here's one more http://www.theblaze.com/stories/2013/11/16/students-at-historically-black-university-lash-out-at-obamacare-after-this-school-announcement/
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Obamacare Is Dead. Long Live Obamacare!
By Victor Davis Hanson
November 13, 2013 1:00 PM
In the next 90 days, the Obama administration will have to declare victory and then abandon most of Obamacare.
The legislation defies the laws of physics—more and broader coverage for more people at less cost—as well as logic: Young people, on average as a cohort with higher debt and less employment, will pay more for coverage they do not use much to subsidize others, often better off, to pay less for coverage they use a lot. It will be interesting how the administration pulls it off, given its past record of often being successful at this sort of dissimulation.
The “Patient Protection and Affordable Care Act”—despite the euphemistic name, the legislation has caused millions to lose their coverage and upped the costs for millions more—is a stone around the necks of Democratic congressional candidates, and something political will have to be done within the next year to address it. The Obama administration’s first impulse will probably be haphazard and periodic non-compliance with the law in the manner of its treatment of the employer mandate, and, for that matter, all sorts of other “settled” legislation that, for political reasons, it simply chose not to enforce, from pre-election border enforcement and the Defense of Marriage Act to the contractual order of the Chrysler creditors. In that regard, the administration might table the individual mandate or administratively change the wording of required insurance protocols to let people keep their old plans that were recently dismissed as “bad apples” or “junk.” Maybe they could call all that “pro-choice,” or “good apples.”
A second and previously popular Obama strategy—cf. the war on terror rebranded with “workplace violence,” “largely secular,” “man-caused disasters,” and “overseas contingency operations”—would be just to scrap most of the law and keep a tiny sliver like the front-ended goodies (such as not losing your insurance for preexisting conditions or keeping children on parental plans until 26) and restamping that tiny change as the old Patient Protection and Affordable Care Act, while quietly dismantling the program piecemeal.
Each time Obama has had to square the circle—e.g., keeping or expanding the hated Bush-Cheney anti-terrorism protocols while still demagoguing them—he has resorted to philology and simply changed the meanings of things. He will probably tell us the naked health-care emperor is fully dressed in the way that the tenfold expansion of the drone program was a legacy of Bush, or the willingness to exceed the U.N. in Libya, ignore it in Syria, and undermine it with Iran is “working with the UN.”
I don’t see as viable the third, and no doubt favored, solution: a stealth attempt by fiat to implement a single-payer system. Assuring the people that the problem with Obamacare was not enough government rather than too much does not seem like a winner. Somehow the Obama administration took public distrust of insurance companies and transmogrified that suspicion into greater distrust of government. And when they talk of drafting techies to the rescue of the website, they seem not to be talking about more GS somethings, but hip Silicon Valleyites from the correct part of the private sector. For now there can be no more presidential sweeping statements about not losing this or not paying more for that, but probably silence, as administration lawyers administratively chart non-compliance strategies and the usual politicos find ways to call that a smashing success.
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It Is a Trap
By Andrew C. McCarthy
November 14, 2013 10:53 AM
Count me in the Erick Erickson camp when it comes to the Upton gimmickry – because, at best, that’s all it is. Republicans would make a big mistake backing it.
The GOP should not be working to “fix” Obamacare. That would just further tar Republicans as part owners of Obamacare. They should be working to scrap Obamacare now, while the political momentum is swinging to their side. Democrats are rightly starting to panic, so Republicans should be driving a hard bargain – push for repeal, settle for nothing less than delay. The last thing they should be doing is throwing endangered Democrats a lifeline to reelection in 2014.
Even if Obamacare were fixable and the GOP had an interest in helping fix it – and neither is the case – Representative Fred Upton’s “Keep Your Plan Act” nonsense does not come close to being a fix. The Wall Street Journal’s editors acknowledge this morning that the bill is essentially pointless – even though they weirdly give Upton a tepid thumbs-up. Insurance companies have already done the years of planning that competent compliance with the “Affordable” Care Act called for, meaning they have shut down the plans and made new arrangements based on Obamacare’s extensive mandates. That process was and remains complicated and it cannot be undone on the dime. The health-insurance plans that have been lost are gone. You won’t be able to “Keep Your Plan” if the plan no longer exists . . . unless, of course, you believe our Constitution allows Leviathan to order insurance companies to create and issue plans that were dropped precisely because of Obamacare – and we’ll get to that (i.e., Senator Mary Landrieu’s plan) in a second.
In countering Erick Erickson at the Corner, Jeffrey Anderson ends up conceding most of Erick’s case:
Erickson is certainly right that Obamacare is not fixable, that Republican shouldn’t be trying to fix it in any event, and that the only real solution to [Obamacare] is to repeal it. . . . He’s also right that the Upton bill won’t bring back to life all of the plans that Obamacare has already killed off with its coercive mandates.
Yet, Mr. Anderson says Republicans should press ahead with the Upton bill anyway, even though it cannot do what it pretends to do – and that’s not gonna enrage people at all when they figure that out, right? His scattershot reasoning is a good example of why the GOP always gets rolled in these skirmishes.
Even though the insurance plans in question are gone, Anderson urges that if, after Upton has passed, insurers declined to restore them, “the GOP would then be free to criticize those insurers,” who stand to reap a trillion taxpayer dollars. Of course, that is precisely the fraudulent narrative Democrats are desperately trying to sell: “It’s not Obama and congressional Democrats who are responsible for the unfolding catastrophe – it’s the bad insurance companies.” Anderson would have Republicans unwittingly join Democrats in selling this snake-oil.
That, naturally, would ease the way to passage of Landrieu’s alternative (actually, more a companion than an alternative to Upton). As Anderson observes, Landrieu’s bill is “more of the heavy-handed, coercive model of government that gave us Obamacare to begin with.” It purports to force insurance companies to reoffer plans that no longer make business sense due to the very conditions created by Democrats.
Anderson nevertheless sees no tension between supporting Upton and opposing Landrieu because, even as they join Democrats in clubbing the insurers, those ever-deft Republicans will easily be able to mount a simultaneous constitutional argument that Landrieu’s bill violates the Commerce Clause. And yes, that would be the same constitutional argument that failed to stop passage of Obamacare, that took three years for the Supreme Court to resolve, and despite which Chief Justice Roberts contrived a way to uphold Obamacare anyway.
I’m sure the American people will find this GOP constitutional razzmatazz very clear and compelling. By the way, did I mention that Upton, Mr. Ban the Light Bulb himself, has already signaled his support for Landrieu’s coercive bill? Yup, he proclaims it “even a bigger and perhaps better step than what we have in the House.” He sure has mastered those Commerce Clause talking-points, no?
Anderson also contends that the Upton bill would “badly undermine Obamacare’s exchanges, which would then be drained of millions of . . . people whom Obama wanted to compel to buy exchange-based plans.” (Emphasis in original.) What millions of people? As Patrick Brennan recounted here yesterday, even by inflating the numbers to include people who haven’t actually purchased plans, the Obamacare exchanges have barely been able to recruit a hundred thousand people – they are nowhere close to “millions” of applicants. People do not need the Upton bill to grasp that Obamacare is a bad deal and that they’d prefer the plans they were falsely promised they could keep. They got that.
The Upton bill would do nothing to relieve Americans who have lost their plans due to Obamacare, but it would help Democrats (a) demagogue the insurance companies, (b) pass more unconstitutional and coercive legislation, and (c) get reelected. In Louisiana, Republicans would be helping Senator Landrieu campaign as the crusader who fought to save people’s health plans – that would be the same Mary Landrieu who extorted a $300 million kickback (the infamous “Louisiana Purchase”) in exchange for voting to impose Obamacare on the country, and then helped defeat the GOP resolution that would have prevented the millions of insurance-plan cancellations Americans are suffering today.
I confess to being a bit puzzled. Wasn’t it just a couple of weeks ago that Republican leaders were saying that the only way to repeal Obamacare is to win elections?
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http://www.hhs.gov/healthcare/facts/blog/2010/06/grandfathered.html
Keeping the Plan You Like
By Kathleen Sebelius, Secretary of Health and Human Services
Posted June 14, 2010
Throughout the health reform debate, the President has been clear that we should build on the insurance system we have, keeping the parts that work and gradually fixing the parts that don’t.
The Affordable Care Act is designed to let Americans keep their health insurance if they like it while adding important consumer benefits to give businesses, families and individuals higher quality care at lower prices and more control over their own care.
Later today, Labor Secretary Hilda Solis and I will announce the latest step we’re taking to implement the Affordable Care Act with the announcement of a new regulation that is a key part of this approach.
The new regulation will expand new consumer protections to all Americans with health insurance, moving us toward the competitive, patient-centered market of the future. This rule reflects the President’s policy that Americans should be able to keep their health plan and doctor if they want.
Here’s how the new rule will work:
Starting with health plan or policy years beginning on or after September 23, Americans with private health insurance plans will get some new consumer protections. For example, insurance companies will be prohibited from putting lifetime limits on your coverage. And they’ll no longer be able to cancel your insurance when you get sick just by finding an error in your paperwork.
Health coverage that was in effect when the Affordable Care Act was enacted will be exempt from some provisions in the Act if they remain “grandfathered” under a provision in the law. Under the rule issued today, employers or issuers offering such coverage will have the flexibility of making reasonable changes without losing their “grandfathered” status. For example, employers will be able to make some changes to the benefits their plans offer, raise premiums or change employee cost-sharing to keep pace with health costs within some limits, and continue to enroll new employees and their families.
However, if health plans significantly raise co-payments or deductibles, or if they significantly reduce benefits – for example, if they stop covering treatment for a disease like HIV/AIDS or cystic fibrosis – they’ll lose their grandfathered status and their customers will get the same full set of consumer protections as new plans.
The bottom line is that under the Affordable Care Act, if you like your doctor and plan, you can keep them. But if you aren’t satisfied with your insurance options today, the Affordable Care Act provides for better, more affordable health care choices through new consumer protections. And beginning in 2014, it creates health insurance exchanges that will offer individuals and small businesses better, more affordable choices.
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A prescient June 2009 exchange between Georgia Rep. Tom Price and Obama CEA Chair Christina Romer. The exchange took place in a House Education and Labor Committee hearing on a draft of Obamacare. Price pressed Romer to cite a basis for the president’s ["if you like your health care plan, you can keep your health care plan"] promise, and in the process predicted much of what would happen more than four years later, in late 2013. Obama’s promise fell apart right there in the hearing room.” Here is the exchange:
REP. PRICE: You also mentioned, as other folks have, that the president’s goal — and it’s reiterated over and over and over — that if you like your current plan or if you like your current doctor, you can keep them. Do you know where that is in the bill?
MS. ROMER: Absolutely. And things like the employer mandate is part of making sure that large employers that today — the vast majority of them do provide health insurance. One of the things that’s –
REP. PRICE: I’m asking about if an individual likes their current plan and maybe they don’t get it through their employer and maybe in fact their plan doesn’t comply with every parameter of the current draft bill, how are they going to be able to keep that?
MS. ROMER: So the president is fundamentally talking about maintaining what’s good about the system that we have. And –
REP. PRICE: That’s not my question.
MS. ROMER: One of the things that he has been saying is, for example, you may like your plan and one of the things we may do is slow the growth rate of the cost of your plan, right? So that’s something that is not only –
REP. PRICE: The question is whether or not patients are going to be able to keep their plan if they like it. What if, for example, there’s an employer out there — and you’ve said that if the employers that already provide health insurance, health coverage for their employees, that they’ll be just fine, right? What if the policy that those employees and that employer like and provide for their employees doesn’t comply with the specifics of the bill? Will they be able to keep that one?
MS. ROMER: So certainly my understanding — and I won’t pretend to be an expert in the bill — but certainly I think what’s being planned is, for example, for plans in the exchange to have a minimum level of benefits.
REP. PRICE: So if I were to tell you that in the bill it says that if a plan doesn’t comply with the specifics that are outlined in the bill that that employer’s going to have to move to the — to a different plan within five years — would you — would that be unusual, or would that seem outrageous to you?
MS. ROMER: I think the crucial thing is, what kind of changes are we talking about? The president was saying he wanted the American people to know that fundamentally if you like what you have it will still be there.
REP. PRICE: What if you like what you have, Dr. Romer, though, and it doesn’t fit with the definition in the bill? My reading of the bill is that you can’t keep that.
MS. ROMER: I think the crucial thing — the bill is talking about setting a minimum standard of what can count –
REP. PRICE: So it’s possible that you may like what you have, but you may not be able to keep it? Right?
MS. ROMER: We’d have — I’d have to look at the specifics.
Credit: Byron York, Washington Examiner
http://washingtonexaminer.com/four-years-ago-gop-showed-exactly-what-was-false-about-obamas-keep-your-coverage-promise/article/2539266
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Wasn't it about a month ago when dems were insisting that obamacare was the law of the land and any attempt to refund or alter it was an act of sedition?
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Doug: Nice find!
GM: Details, details , , , :roll:
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The part annoying to me is AHA was not a problem with any of these people who thought it would others who would have to pick up the tab. You know. Soak the "rich". No problem taking money from some to give to them. Now that they are going to have to pay more, and only now, it is a problem. It is not the lying. It is now they are adversely affected:
****Breitbart Logo
17 Nov 2013, 10:07 AM PDT 39 post a comment
Campus Reform: Students at Bowie State University assailed the Affordable Care Act (ACA) on Thursday after administrators cancelled a low cost school-wide health care plan due to new regulations in the law. Many students told Campus Reform that the now cancelled plans, which provided coverage for just $50 per semester, were the only insurance they could afford.
"I can't afford anything right now," one said. "I can't even afford my loans."
"We don't have that money," said another. "We can barely afford books."
Several students said that they felt they had been let down.
"It's stupid and it's Obama's fault," one said. "You haven't done anything, Obama, and I'm disappointed in you."
"What it was hyped up to be, was that it was supposed to solve a lot of problems and help a lot of people, and its not really doing that," said another.
Many students had no idea the plans had been canceled, which was announced only in an email to their school addresses.
In a statement to Campus Reform, Bowie State said it was confident that Obamacare would fill the void left by the canceled plans.
"Most students are now able to be covered under their parent’s health plans up to age 26 at no additional cost and new affordable coverage is becoming available through the Maryland State Insurance Exchange System," it read.
Campus Reform conducted the interviews with student Eugene Craig III, who first wrote about canceled plans in an article in the school's alternative newspaper, The Bulldog Collegian. ****
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I was trying to post an article from Journal Of American Medical Association but I cannot do it since I am not technically a member. I get their journal sent to me for free because I am on some sort of list.
It is Donald Berwick the lead politburo guy who was the lead shover of this monstrosity down all out throats complaining about the politics involved (how dare the phrase "death panels"). There are other articles as well from politburo. Not as bitter and obnoxious as well. Emanuel with another one suggesting we need a leader who announces something akin to JFKs we will be on the moon in 10 yrs. or perhaps Nixon's war on cancer etc. but suggesting we apply the same unified goal of fixing health care. I am not adverse to this in theory but I don't want it being a gigantic politburo led government take over of 1/6 of our economy.
I wish their articles in the med journals were posted to public forums.
They are mostly (not all) Columbia types. All the professor elites who are smarter wiser nicer more humane then the rest of humanity.
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This isn't Watergate?
Woodward: The President’s motive here, even though there deep problems with the implementation, he wants to do something good for 30 million people and get them health insurance. So this isn’t Watergate. This isn’t Clinton and Monica Lewinsky.
Obamacare is designed to punish the 30 million that we want to help but won't sign up voluntarily.
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The simple fix is to legalize the plans that people actually want.
-----------------------------------------------
How the GOP Should Fix ObamaCare
Along the way Republicans can create real choice, real competition and real savings while protecting those who need help.
What can be done is Congress creating a new option in the form of a national health insurance charter under which insurers could design new low-cost policies free of mandated benefits imposed by ObamaCare and the 50 states that many of those losing their individual policies today surely would find attractive.
http://online.wsj.com/news/articles/SB10001424052702304439804579208020624280740?mod=WSJ_Opinion_LEADTop
(Read it all!)
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Excellent article Doug!-- with several pithy, penetrating insights e.g.
"The government-run systems you so admire in other countries mostly came about long ago. They came about to expand access to medical care at a time when medical care couldn't do all that much for people. We live in a different age. America, let's face it, would be embarking on a single-payer system not to expand access—though that slogan would be used—but to deny and limit care in order to control runaway spending. Liberals, you think you want to go there but you don't."
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http://finance.yahoo.com/news/obamacare-driving-doctors-refuse-insurance-132541502.html
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Tea Party Patriots
Real Health Care Reform: Share Your Ideas
________________________________________
As we continue to watch the disastrous roll out of Obamacare, it would be easy for us to say that we have been warning about this for the last 4 years. It would be easy for us to say that we had a major impact in the fight for Congress to stop implementation of the law by not wasting any taxpayer money on what was clearly shaping up to be a train wreck - with fierce opposition from both political parties. We could say that we did all of this with the intent to protect the America from the disasters of Obamacare. And it would all be true.
However, right now is not the time for pointing fingers and "we told you so." Right now is time to go back to the drawing board and undo this mess before it continues to do harm to the American people. That's why we are laying out our guidelines for real health care reform.
The first step is full repeal of the Affordable Care Act. Then any new attempt at health care reform needs to include principles that promote health care freedom for all.
Real Health Care Reform would meet the following criteria:
• CONSTITUTIONAL: Real health care reform will be constitutional and protect all Americans' rights.
• COMPREHENSIBLE: Real health care reform will be comprehensible, clear, and simple for everyone to understand.
• DEBT-FREE: Real health care reform will not add to the national debt.
• RELATIONSHIPS: Real health care reform will enhance the doctor-patient relationship.
• FREE MARKET: Real health care reform will draw on the strengths of the free market by encouraging innovation and competition.
• PRIVACY: Real health care reform will minimize the role of the federal government in the health care sector.
• CHARITY: Real health care reform will incorporate opportunities for the private sector to provide charitable solutions.
• CHOICE: Real health care reform will increase consumer choice.
• TRANSPARENCY: Real health care reform will increase transparency.
Congress isn't leading the way on this, so it is time for the American people to step up and guide us to health care freedom. Join in on the conversation by letting us know what Real Health Care Reform looks like to you.
Click for more details on Real Health Care Reform.
===========================
POTH:
http://www.nytimes.com/2013/11/20/us/politics/for-lawmakers-a-gold-plated-insurance-exchange.html?nl=todaysheadlines&emc=edit_th_20131120
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Pelosi: I Never Met ‘Anybody Who Liked His or Her Plan’
Posted By Larry Elder On November 21, 2013 @ frontpagemag.com
Asked whether she needed to apologize to the formerly insured who have lost their health insurance plans, former House Speaker Rep. Nancy Pelosi, D-Calif., said, “Did I ever tell my constituents that if they liked their plan they could keep it? I would have if I’d ever met anybody who liked his or her plan. But that was not my experience.”
Pelosi, whose net worth — combined with her husband’s — is estimated between $35 and $180 million, never “met anybody who liked his or her plan”? Her out-of-touch comment reminds one of then-New Yorker film critic, liberal Pauline Kael. In 1972, after Republican Richard Nixon crushed Democrat George McGovern, 49 states to one, a shell-shocked Kael said, “Nobody I know voted for Nixon.”
Pelosi’s world is that of rich people and government workers whose health care plans are better than those of their counterparts in the private sector. How would she know that, according to a pre-Obamacare ABC News-Kaiser Family Foundation-USA Today survey, “88 percent of the insured rate their coverage as excellent or good” and “89 percent are satisfied with the quality of care they receive”?
Ms. Pelosi, meet Kristen Powers, Fox News analyst and a Democratic strategist. After her policy was canceled and her premiums doubled, Powers said: “My blood pressure goes up every time they say that they’re protecting us from substandard health insurance plans, because there is nothing to support what they’re saying. … I am losing my health insurance. … If I want to keep the same health insurance, it’s going to cost twice as much. There’s nothing substandard about my plan.
“All of the things they say that are not in my plan are in my plan, all of the things they have listed. There’s no explanation for the doubling of my premiums other than the fact that it’s subsidizing other people. They need to be honest about that, that that’s the reason they don’t want to change it.
“It’s because they’re basically taking the people who are responsible enough to get health insurance in the individual market and asking them to subsidize other people. So they’re taking young healthy people and asking them to subsidize other people.” Well, “shared sacrifice” — that’s the whole point behind Obamacare, isn’t it?
Democrats flat-out despise insurance companies. They’ve been called “immoral villains” (Pelosi), “deceptive and dishonest” (President Barack Obama), “fly-by-night” (former Gov. and DNC chair Howard Dean), “rapacious” (Sen. Jay Rockefeller, D-W.Va.) and “greedy” (Sen. Harry Reid, D-Nev.).
Are health insurance companies any greedier than any other for-profit sector of the economy? In 2009, before Obamacare, profit margins for the network and communications equipment industry averaged 20.4 percent; Internet services and retailing was 19.4 percent; pharmaceuticals averaged 19.3 percent; railroads 12.6 percent; gas and electric utilities 8.7 percent; and food consumer products 6.7 percent. Health insurance and managed care companies? They averaged 2.2 percent.
Follow the money.
Of the political contributions by the, say, communications/electronic industry in 2012, $94.6 million went to Democrats, and $55.7 million to Republicans. But from 1990 to the current 2014 cycle, according to OpenSecrets.org, insurance companies gave 63 percent of their political donations to Republicans versus 37 percent to Democrats.
Obamacare is now more unpopular than ever, in large part because of broken promises. At the televised health care summit in February 2010, just before passage of Obamacare, then-Minority Whip Eric Cantor predicted millions would lose their coverage. He had the following exchange with the President:
Cantor: I don’t think you can answer the question in the positive to say that people will be able to maintain their coverage, people will be able to see the doctors they want, in the kind of bill that you are proposing.
Obama: “The 8 to 9 million people that you refer to, that might have to change their coverage … would find the deal in the exchange better.” Yet Obama still publicly assured people that “no one” would take away their policy, if they liked it.
Finally, Obama still gets a pass on a tale he repeatedly told to sell Obamacare. How many times did we hear that Obama’s mom, dying of cancer, had to fight with her carriers to pay her medical and hospital bills? The story, crucial to humanizing the fight, turns out to be bogus. According to a book by an ex-New York Times reporter, the sole dispute was between Obama’s mother and an insurance company over a disability policy his mother had taken out. The insurance company said she’d had a pre-existing condition when she applied for that policy. But her medical bills — and this is what Obama insisted they fought over — were in fact paid by her health care insurer, directly and without dispute.
Yes, our health care system “suffers.” But it suffers from a lack of free markets. The antidote is more competition — reducing barriers to entry, health savings accounts, giving individuals the same health care tax breaks as given to business, competition across state lines, and for tough cases, charity.
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The President chose the sports analogy of fumbles instead of strikes on Obamacare because no one can say exactly how many fumbles you can have before you are out.
“We fumbled the rollout on this health-care law,” he admitted at Thursday afternoon’s news conference. “I am very frustrated, but I’m also somebody who, if I fumbled the ball, you know, I’m going to wait until I get the next play, and then I’m going to try to run as hard as I can and do right by the team.” Four times he mentioned fumbling — both the HealthCare.gov Web site and his promise that people could keep their health plans if they liked them. “These are two fumbles on something that — on a big game, which — but the game’s not over,” he said.
http://www.washingtonpost.com/opinions/dana-milbank-does-health-care-fumble-mean-game-over-for-obama/2013/11/15/77dc0b0a-4dfa-11e3-be6b-d3d28122e6d4_story.html
Let's count strikes in the order that the media and the public finally discovered them:
Strike One: The website failed. A called strike. Government incompetence while the President rested his bat on his shoulder.
Strike Two: The lies and fraud were exposed. You can't keep your plan, your doctor and maybe not even your job or your hours because of Obamacare. It wouldn't have passed without the misrepresentations. The promoters knew that. Swing and a miss.
Strike Three: It isn't "affordable" and that was the name of it. It isn't getting 30 million more people insured and that was the purpose of it. Obamacare is actually resulting in fewer people insured When we recognize this monumental failure, it is strike three and the batter is out.
We gave up freedom, choice and privacy in order to lower the cost of healthcare and get everyone insured. It's doing the opposite. Let's end it now and get back a little bit of our lost individual freedom and privacy.
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http://www.nybooks.com/blogs/nyrblog/2013/nov/23/obama-first-term/
Despite all the lamentations about Barack Obama having second-term blues and bad luck, and the talk about how a painful second term is not atypical, it’s what happened during the first term that matters most. With the exception of possible exogenous events, a president’s first term defines his second one. The enormous difficulties that Obama is having with his signature issue, the health care law, are the shining example of how that can work. Almost everything that has gone wrong with the program was set in motion in the early years of his presidency.
The first term is when the president makes fateful decisions about what kind of people he wants in his White House, how he wants them organized, the nature and role of his cabinet members (are they essentially staff, as most tend to be in the Obama administration?), which initiatives he selects as his most important, whether he builds a strong cadre of outside allies, how he deals with the Congress and how hard he is willing to fight for what he wants.
Not unlike some other presidents, Obama essentially surrounded himself in the White House with his campaign staff, or others he knew well, rather than finding people experienced in governing. Newly elected presidents pay a heavy price if they are themselves inexperienced in governing and select top staff who lack a broad sense of what it means to run a federal government.
The shock of adjusting to the presidency—the myriad amounts of information and decisions to be made thrown at them—hits most newcomers. Where to begin? Which decisions to tell your staff are presidential-level ones and which ones are they to work out on their own? How much authority to give to the cabinet—a set of relationships that is almost always fraught. Only if a newly elected president has served as vice president or in a tiny number of other high offices can he have been given a prior sense of the vast chasm between running for president and being president. There is a lot of talk these days that former governors are the only ones who are truly prepared to occupy the oval office. But that’s hogwash. To my knowledge none have a Pentagon to run, or a raft of foreign policy decisions coming at them every day, or fifty sub-states and a potentially obdurate Congress to deal with. There is no training for the presidency.
Barack Obama had an unfathomable inability, beginning in his early years in office, to grasp the difference between campaigning and governing—and for that he’s been paying a fearful price in his second term. Campaigning and governing call for different kinds of rhetoric. For some reason, Obama never got control of the health care argument. He cited its attractive provisions many times, but he just didn’t get through.
As for his promise that if people liked their health insurance policy they could keep it, former aides say that they were uneasily aware that it was misleading, or oversimplified. But they figured that it represented a small slice of the probably large group who would eagerly sign up for the new plan. They also figured that if the federal website was working the way it should, most people would be aware they had access to better options. They didn’t come clean that some people were going to lose out under the new plan. The president, now on the defensive, and almost groveling, remained unable to get across the enormous benefits of providing some 30 million uninsured people with coverage.
Fateful decisions made in the first term reflected Obama’s lack of understanding of what it meant to govern. Early on, I received a startling insight into how the Obama White House approached working with Congress. I asked a senior presidential aide why the White House hadn’t sent up its own health care legislation, so that there would be something coherent to start with and more leverage. His reply: “Because any time we lost a provision that would be seen as a loss.” This was a most unusual way to deal with Congress—tying one’s own hands at the outset.
As the health care legislation moved through Congress, Obama and his top aides became swallowed up in the details. Rahm Emanuel, Obama’s first chief of staff, had much to recommend him: he’d served in the Clinton White House and been a member of Congress. But he was an inside man, buried in the maw of the legislation—and apparently unable to see the big picture. Moreover, it’s virtually impossible for Congress to write a coherent complex piece of legislation. In this case, particularly large interests are at play: the insurance companies (who would still play the major role as insurers), manufacturers of medical equipment, hospitals, drug companies, religious organizations—and without its own bill the administration had limited leverage over numerous strong-minded legislators. Five hundred and thirty five people are unlikely to produce a fine Swiss watch.
But Obama and his staff’s failures at governing led to the disastrous roll-out of the exchanges. Simply put: they went about it all wrong. Such a major part of the president’s signature initiative should never have been assigned to the multilayered bureaucracy, however honorable and well-intended its people are. Obama needed to put in charge a single strong figure who could go straight to him and was known to have his backing—and, obviously, knew enough about the complexities of such a large high tech program. The president needed to be kept very informed as to where matters stood. (The White House put about after the calamity became clear to the public that the president had occasionally asked how things were going; this wasn’t reassuring.) Short of appointing a strong outside person, the president could have relied on a figure such as Joe Califano, Lyndon Johnson’s chief domestic policy adviser, to be on top of the implementation and raise hell if the people charged with building the exchanges weren’t doing the job.
It remains unclear to this day who in the Obama White House was responsible for seeing to it that the program was on schedule and working as it should—or if anyone was. There’s no sign that the president’s serial chiefs of staff—after Emanuel, who left in October, 2010, and then Bill Daley, Jack Lew, and now Dennis McDonough—were engaged in any meaningful way.
Another misfire was the brobdingnagian nature of the Obama plan, like that of the Clintons’ plan before it: wonks were in charge and there seems to have been little checking to see if real people could handle it. While the Affordable Care Act was moving through Congress, White House aides explained that it would all be very simple: the consumer would go online and pick out a health plan from among choices—just as, they said, people do with Expedia. Quite apart from the federal web site’s own flaws, the Obama plan suffered from an overestimation of computer literacy among the public at large.
Finally, the president’s offhanded way of dealing with Congress in the first term has weakened his hand with members of his own party in the second term, at precisely the point when he needs them most. The very self-contained Obama, less needy than many of his predecessors, and his impatience with some of the folderol of politics—albeit it’s his chosen line of work—left him with few senators or House members, or even outside groups, who would go to the barricades for him when he needed them in the second term. One can understand and even sympathize with Obama’s view of listening to tedious people who lecture him on how things should be done (they might actually know more than he, but he doesn’t care to be told), but it’s been very costly for him.
The health care law is a delicate instrument, built on sets of assumptions which may not pan out, or which could be undermined if out of panic the president or Congress fiddles with the law. The anecdotes about people losing their policies have frequently been over-simplified, but make for more dramatic news stories than the advances already achieved under the law; there’s been little attention to the already slowing rate of growth in the cost of health care—one of the law’s major goals.
Obama’s governing style in his first term lit the fuse for his second term. Politically-driven decisions on the health care law along with a failure to understand some of the rudiments of governing have resulted in his current difficulties. It’s far from over of course, but should his proudest achievement fail to work—its outcome not at all certain at this point—the rest of what he does in his second term may not matter much.
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This sort of message needs to be made:
Letter to my liberal friends: Are you ready to ditch the excuses yet?
Published by: Herman Cain
It's not about political power. It's about people, and they're hurting.
Dear liberal friends,
Get a grip!
You have been lied to, deceived and asked to stay supportive even as your health insurance costs have increased, or are getting ready to increase. It's not a matter of whether they will increase. It's when.
You are now going to pay more and you can't keep your plan. You can't keep your doctor. And you may not be able to go to the hospital nearest your home. You may have to drive past the one closest to you to get to a hospital in “network,” and those specialty hospitals for illnesses like cancer will be at your own cost.
One of the reasons for these limitations is that insurance companies thought they were going to remain profitable because of all the people who would be signing up for ObamaCare, and happily sharing the cost of covering everybody for everything.
Well, people are not signing up in droves and they are not happy, because of problems with the healthcare.gov website, security issues and premium sticker shock.
Even worse! Some people are being caught in the ObamaCare "gap" between insurance they had and insurance they can't yet get! So they are vulnerable until they can find a plan more expensive than what they had, or until they can find one on the ObamaCare exchanges, which will also cost more because of mandated features they may not want or need.
Shortly after President Obama was elected for his first term, he reminded the Republicans that "I'm the president." This was during a photo-op pretending to listen to the other side of the aisle on the national debt and other issues, and the critical need to stop the spending. He didn't listen.
On another occasion, President Obama reminded the Republicans in Congress and the rest of us that he won re-election. He did win by a narrow popular vote margin. But he and his administration thought that was a mandate to push through his tax-and-spend, anti-economic growth and regulatory tyranny agenda on the nation without being noticed or challenged.
Well Mr. President, the 48 percent of us that did not vote for you noticed! And we are not being quiet about it. It's our constitutional right!
Some of my liberal friends are waking up! They include Democrat voters, independents who voted for Obama, young people under the age of 35, and conservatives who thought he might be another JFK-like leader. He's no JFK and he's no leader.
Just like the mainstream media and congressional Democrats, many of my liberal friends have constantly made excuses for Obama and his administration's failures and lingering scandals. But the failure of ObamaCare, the deception, and the parade of scams we are finding out about cannot be excused.
Outrage by conservatives is not new. But many liberals and Obama supporters have openly expressed disappointment and betrayal. They are waking up!
Many of you still do not regret how you voted in the last two presidential elections. That was your choice. But you can now choose to stop drinking the Kool-Aid of excuses for the ObamaCare train wreck, which is only going to get worse.
I'm not suggesting that those of you who are now awakened from the slick and elusive presidential rhetoric blindly vote Republican or declare yourselves conservative. No, because Republicans and constitutionally minded conservatives need to earn your vote. And yes, they have and have had an alternative to ObamaCare all along, but the Democrats and the mainstream media didn't want you to know about it.
But for now, join the chorus of voices that are screaming, "Stop the train wreck. Start over!" It's not about political party, and it should not be about political power.
It's about the people, and the nation is hurting.
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second post
2nd-Year Enrollment Punted Past Midterms
In another sign the Obama administration is getting mighty nervous about the 2014 midterms, the Department of Health and Human Services has conveniently decided to delay the second-year ObamaCare enrollment period until after the November elections. Bloomberg reports: "President Barack Obama plans to push back the second-year start of enrollment in Affordable Care Act health plans, a move that would let insurers adjust to growing pains in the overhaul and potentially stave off premium increases before the 2014 congressional elections. The enrollment period, previously scheduled to begin Oct. 15, 2014, will now start Nov. 15, said an official with the U.S. Department of Health and Human Services who asked not to be identified because the decision isn't public." In other words, they're hoping to dupe the American people ... again.
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Last week, an analysis by the American Enterprise Institute, a conservative think tank, showed the administration anticipates half to two-thirds of small businesses would have policies canceled or be compelled to send workers onto the ObamaCare exchanges. They predicted up to 100 million small and large business policies could be canceled next year.
According to projections the administration itself issued back in July 2010, it was clear officials knew the impact of ObamaCare three years ago.
In fact, according to the Federal Register, its mid-range estimate was that by the end of 2014, 76 percent of small group plans would be cancelled, along with 55 percent of large employer plans.
The reason behind the losses is that current plans don't meet the requirements of ObamaCare, which dictate that each plan must cover a list of essential benefits, whether people want them or not.
"Things like maternity care or acupuncture or extensive drug coverage," said Veuger. "And so now the law is going to force them to buy policies that they could have gotten in the past if they wanted to but they chose not to."
Some plans already have been canceled and employers are getting sticker shock at the new, higher prices under ObamaCare.
One of them is David Allen, president of a company bearing his name in Boulder, Colorado. He told a Congressional hearing recently that his carrier discontinued his company policy because it wasn't compliant with ObamaCare.
"It does not meet the minimum standards as stipulated under the law. Due to this one change," he said, "our premiums are now scheduled to increase by 52.3 percent in January 2014."
http://www.foxnews.com/politics/2013/11/26/evidence-shows-obama-administration-predicted-tens-millions-would-lose-plans/
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Enrollment in the Affordable Care Act through Colorado's health insurance exchange is barely half the state's worst-case projection, prompting demands from exchange board members for better stewardship of public money.
The shortfall could compromise the exchange's "ability to deliver on promises made to Colorado citizens" and threatens the funding stream for the exchange itself, according to board e-mails obtained by The Denver Post in an open records request.
http://www.denverpost.com/news/ci_24593942/board-strife-colorado-exchange-far-behind-projected-enrollment#ixzz2llmf4SR9
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Death spirals, not death panels !! :-D
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Death spirals, not death panels !! :-D
Actually both!
The (stated) purpose was to get more people insured. Young people were not buying health insurance because it was too expensive, a lousy value for them. The answer was to pass a law prohibiting low cost policies and weigh the rest down with all kinds of coverage people don't want or need and make them pay for other people's care. Maternity coverage for celibate men and women with hysterectomies. No customization. We will get more people insured by canceling the majority of all existing policies. The cost per family will go up by $3400 instead of down by $2500, a $6000 per family per year 'rounding error'. Instead of making it affordable we will call it "Affordable". It is the most important item on the entire agenda, so we will have it start right after the next election.
We didn't get the cost down. We didn't get more people covered. But we did get government to take control of our lives. Mission Accomplished!
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Fox's BB SR reports that the State of NH issued more moose hunting permits than people signed up for Obamacare.
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Supreme Court Agrees to Hear Contraception Cases, in Challenge to Health Law
The Supreme Court on Tuesday agreed to hear a pair of cases on whether corporations may refuse to provide insurance coverage for contraception to their workers based on the religious beliefs of the corporations’ owners.
The cases present a new challenge to President Obama’s health care law. The Supreme Court in 2012 upheld another part of the law, one that requires most Americans to obtain health insurance or pay a penalty.
The Obama administration has exempted many religious groups from the law’s requirements for contraception coverage. But it said for-profit corporations could not rely on religious objections to opt out of compliance with the law. The lower courts are divided over whether such corporations may object to generally applicable laws on religious liberty grounds.
READ MORE »
http://www.nytimes.com/2013/11/27/us/justices-take-companies-cases-challenging-contraception-rule.html?emc=edit_na_20131126
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http://pjmedia.com/blog/rigging-the-future-obamacare-creates-50-new-state-databases-with-no-function-beyond-gathering-potential-voter-information-real-or-fraudulent/?singlepage=true
RIGGING THE FUTURE: Obamacare Creates 50 New State Databases With No Function Beyond Gathering Potential Voter Information, Real or Fraudulent
It was never just a health care “fix”: A series of precise, brilliant, secretive, and illegal decisions by Obamacare authors led to the creation of 50 unbeatable election tools — and to nothing else. As you read, try to identify a rational explanation besides malevolence. (This is Part One of a two-part article.)
by David Steinberg
Nov 26, 2013 - 8:25 am
Since the passage of Obamacare, all fifty state Medicaid agencies have been forced to create a new standalone database that contains nothing besides the contact information of Medicaid applicants who used Healthcare.gov.
Some of these new databases mail out voter registration forms automatically. You cannot refuse them.
No worthwhile verification occurs before the forms are mailed. Apply for Medicaid and the form will be mailed to you, be you a verifiable citizen or Ayman al-Zawahiri on a computer in Pakistan.
Further, these new databases are accessible by groups like Organizing for Action, the reconstituted ACORN, and malevolent figures like Chris Tarango.
And no reasonable purpose exists for creating the databases besides making them available to the aforementioned Democratic activists.
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Heard nothing regarding this before? Not only are you not alone, several state secretaries of State we contacted had no clue any of this was occurring under their watch. One source involved in the recently initiated legal battle to expose and dismantle the databases described the situation as follows:
Evil genius.
A complete disregard for certain federal law, the skirting of others, the exploitation of existing Medicaid structures, the issuing of rules and regulations with virtually none of the required paper trail. …
Just evil genius. They friggin’ thought of everything.
The remainder of this article is composed of descriptions of the several decisions made by Obamacare authors that led to the construction of the databases. The listing of these decisions is intended to illustrate the impossibility that these databases were created unintentionally, or due to incompetence — a “fumble.”
We hope to show that a rational, disinterested observer must arrive at the conclusion that these actions could not have been taken for any reason beyond the intended exploitation of the Affordable Care Act as a vehicle for future Democratic election victories.
We invite readers to offer alternative interpretations. We have reached out to several Democratic congressional offices to give them the opportunity to offer their own.
We also have reached out to GOP officials to see if any are willing to go on record stating the lone reasonable conclusion: objectively, some authors of the ACA were not “bleeding hearts,” but white-collar criminals.
Decision #1: The “Honor System”
Applicants to Healthcare.gov must enter their current income level. This is a pivotal piece of data for the system: income alone is used to determine if the applicant will be presented with the option to: a) purchase full-price or subsidized health insurance policies; or b) if the applicant will be directed towards Medicaid/CHIP programs. This determination is calculated according to the new Modified/Adjusted Gross Income (MAGI) scale.
However, Healthcare.gov does not perform any checks at all (such as requiring the submission of pay stubs, the prior year’s tax return, etc.) to verify the income amount entered by the applicant. This all-important piece of data is accepted by Healthcare.gov on the “honor system.”
Decision #2: The Community Organizing, Aggressive Application of “Motor Voter” Law
If an applicant’s entered income is low enough to be eligible for subsidy, the applicant will soon be asked by Healthcare.gov if he or she does not wish to receive a voter registration form. This question alone utilizes aggressive application of three provisions of federal law.
The 1993 National Voter Registration Act, or “Motor Voter,” requires all municipal and government facilities which provide public assistance to also offer voter registration services. The Obama administration claims that “Motor Voter” thus applies to Healthcare.gov, and subsequently Healthcare.gov must provide voter registration services. Some states have disagreed with this application as it relates to state exchanges, but expect those states to face DOJ litigation – Rhode Island and other states have.
1. Since the adoption of Motor Voter in 1993, the Federal Government has successfully forced states to push voter registration in all on-line contexts.
This represents a significant distinction: the federal government has necessarily crafted entirely new fields of law to handle the development of electronic interactions.
2. Motor Voter specifies that facilities offering public assistance must have voter registration services available, and the Federal Government is forcing applications to specifically reject voter registration, sometimes multiple times.
As such, you can draw your own conclusions about the motivation behind applying Motor Voter to the ACA, and behind phrasing the question in that manner.
3. A stunning apparent violation of federal law: In practice, Healthcare.gov does not let you say “no” to a voter registration form.
Even if you say “no,” you may be mailed a form automatically.
You may receive a form that is pre-populated with the identifying information you entered into Healthcare.gov. Comprehension of the form is thus unnecessary; the recipient of the pre-populated form need only determine where to sign it.
As explained below, this will occur at the state level, where the design and implementation of Obamacare regarding voter registration make these transparently intentional abuses of Motor Voter seem tame.
Among sources reached for this article, that phrase “evil genius” was employed when referring to what Obamacare requires of state Medicaid entities; we were told its usage has become commonplace.
Decision #3: Restructuring Medicaid’s — and Only Medicaid’s — Eligibility Screening Procedures
Since the enactment of LBJ’s Great Society public assistance programs, most state Medicaid agencies have not been responsible for handling eligibility screenings.
Generally, screening for the various public assistance programs has instead been handled by state departments of Health and Human Services, or by similar state entities. One system would screen for all of the public assistance programs; the individual state program agencies would only handle administration.
After 50 years of precedence, Obamacare has changed this. But only for Medicaid.
As discussed earlier, if an applicant enters a qualifyingly low income into Healthcare.gov, the applicant is sent to the Medicaid side of the website. At this point, those five decades of established fraud prevention procedures are jettisoned.
Identifying information entered on the Medicaid side of Healthcare.gov is treated differently than identifying information entered while applying to all other public assistance programs.
How it works now: each state Medicaid agency has been instructed to create a new stand-alone database for storing identifying information entered by Medicaid applicants via Healthcare.gov. (Note the word “instructed,” not “required by law” or something similar. We will get to that shortly.) As instructed, all fifty states have created one of these databases.
They have further been instructed that this identifying information should no longer be sent to whichever state organization formerly performed the eligibility screening. The information must only go to these new databases.
Decision #4: The Parting of Data
As instructed, each state designed these new stand-alone databases to be dedicated to storing only the identifying information of Healthcare.gov applicants — but no medical data.
If you happen to be familiar with the basics of both health care and election law, perhaps your pupils just grew wide. Because you are aware that medical records are treated by the law as private and sacrosanct, but voter rolls, consisting of only identifying information, are publicly accessible.
To summarize:
•The federal government instructed states that they could not send any applicant data entered into the Medicaid side of Healthcare.gov to their traditional eligibility screeners.
•They then instructed state Medicaid agencies to create stand-alone databases for this new applicant information, and that these new databases would be forbidden from containing any medical information.
•Per an incorrect application of Motor Voter law, the Obama administration considers the Medicaid side of Healthcare.gov to be a public assistance “office,” and as such, required to offer voter registration services.
•The Obama administration also considers it legal to treat the distribution of voter registration forms as “must opt-out,” instead of “must opt-in.”
These four bullet points are the basis of Decision #5.
Decision #5: The Illegal, Automatic Mailing of Voter Registration Forms and “Opt-Out” Forms
States were instructed that, to comply with Motor Voter, these new databases must automatically mail voter registration forms to each new individual applicant sent over from Healthcare.gov.
Recall, you may have said “no” earlier. It doesn’t matter.
The new databases must also mail a second form that states “I do not wish to register to vote,” which you must sign and return.
Otherwise, it is assumed you wish to register.
If the Feds notice you still haven’t replied?
Remember Decision #4: the new databases are publicly accessible, since they do not contain any medical information.
Anyone – perhaps Organizing for Action, or Battleground Texas – can get their hands on it, and then show up at your door with yet another form.
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Review the prior five decisions: are you able to determine a reasonable explanation for all five of them besides getting potential voter information in the hands of Democratic organizing groups? Groups populated by bad actors like Chris Tarango, but which nonetheless have the blessings of the administration?
Recall that this is voter information gathered via Medicaid applications, a program whose recipients vote almost exclusively Democrat.
If Orwell comparisons strike you as tedious, an additional instruction to the states about how they are allowed to screen eligibility, along with the precedent-breaking, whispered demands from the Centers for Medicare and Medicaid Services (CMS) that follow may have you granting an exception.
Decision #6: Eliminating the State Medicaid Screeners
For the past five decades, states have dedicated a tremendous amount of resources to providing a “second-level review” of applicant information transmitted to them via a federal agency.
But now, and quite simply, that has been ended. But only for Medicaid.
States are no longer allowed to challenge the validity of applicant information sent to them from the Medicaid side of Healthcare.gov.
Instead, states are to assume that if information was transmitted to them, the federal government has deemed that information to be valid. States haven’t simply been instructed to no longer let their traditional public assistance eligibility screeners touch Medicaid information from Healthcare.gov — they have been instructed that state Medicaid agencies can’t screen it, either. This isn’t an administrative shift of the state screening processes, it’s the forbidding of state screening processes.
We already know what little concern Healthcare.gov itself has for the validity of applicant information. The site employs the “honor system” for income, the most important piece of data. Also, as previously reported at PJ Media, the Medicaid side of Healthcare.gov allows anyone on Earth to secure at least 90 days of Medicaid with just two easily forged documents and a lie about being a legal alien.
The security bar is even lower for entrance into one of the new state “Medicaid/voter roll” databases. In fact, it’s non-existent: apply for Medicaid as a citizen, you’re going to end up in your state’s new “Medicaid/voter roll” database.
And the state is forbidden from checking the application’s validity.
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This development represents an endpoint, with identifiable products of those six federal decisions. The products are:
•Fifty unscreened databases, accessible to all, of identifying information of likely Democratic voters.
•Fifty databases of likely Democratic voters, which automatically mail voter registration forms and required “opt-out” forms to each applicant.
What is the rational result of these two final products following their implementation?
•The Democratic Party exploiting a federal law passed without a single Republican vote, a law that mandates citizen participation, a law that mandates citizens purchase a product to sustain the law financially, to produce an unbeatable tool to utilize for winning elections.
•Bad actors within the Democratic Party, both within and outside of government, using this tool to easily commit voter fraud.
•An organized entity hostile to the United States exploiting the massive security holes created by this Democratic law to flood the Medicaid rolls with fraudulent enrollees, rendering the massive program database unusable.
•An organized entity hostile to the United States exploiting the massive security holes created by this Democratic law to flood the voter rolls with fraudulent identities, rendering the administration of elections impossible.
To employ an example from our prior article on fraudulent 90-day Medicaid enrollments:
1.Al-Qaeda leader Ayman al-Zawahiri, from a computer in Pakistan, can tell Healthcare.gov that his income this year is zero.
2.He will be directed to the Medicaid side of the website, where he can claim to be an American citizen temporarily living abroad.
3.He can enter the address of his local post office.
4.Al-Zawahiri will have himself a voter registration card arrive shortly.
5.He can instruct his millions of supporters to do the same.
If Healthcare.gov was actually working, al-Qaeda could get that done by the weekend.
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How did the Obama administration accomplish this? Where’s the paper trail? Aren’t there established processes for the development and implementation of rules and regulations applying to a federal bill, and aren’t all of those deliberations required to be publicly released?
Yes. But in perhaps the Obama administration’s worst “fumble,” they bypassed just about the entire rule-issuance process.
Decision #7: Breaking All the Rules
In Part Two of this article, to be published following the Thanksgiving holiday, we will discuss how the federal government’s Centers for Medicare & Medicaid Services, or CMS, acted in a precedence-shattering, secretive manner in issuing orders to state Medicaid agencies regarding how to construct the databases.
We will also discuss the massive security holes created by the allowance of “telephonic signature,” and the secretaries of State who were left completely in the dark.
We will link, post, and discuss the paper trail — and who was involved.
And we will discuss the George Soros-funded Demos organization, which helped push the “opt-out” approach to Motor Voter, and which happened to be one of the few entities that had any knowledge of the new databases.
Indeed, they happened to have enough knowledge regarding the databases to prepare and publish a report containing state-by-state strategies for taking advantage of them.
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Obama Redistributes Health, Not Just Wealth
By DICK MORRIS
Published on DickMorris.com on November 26, 2013
Printer-Friendly Version
The New York Times, on November 23rd, reports that redistribution has become the unmentionable word at the Obama White House. Former Chief of Staff William Daley says that redistribution is "a loaded word that c0njures up all sorts of unfairness in people's minds." He notes that it is a word that in the political world, you "just don't use."
But the newspaper goes on to note that "the redistribution of wealth has always been a central feature of the ObamaCare law and lies at the heart of the insurance market disruptions driving political attacks this fall."
The New York Times, as usual, misses the point. It is not the redistribution of wealth that is the main problem. It is the redistribution of health that bothers us most of all. Money is one thing. Our health and lives are quite another.
By restricting access to certain doctors, hospitals, and therapies, ObamaCare limits our access to health. There are forty drugs that address specific types of cancer genetically. The average ObamaCare policy covers ten of them. If you have one of the others, you are out of luck.
By cutting reimbursement rates to doctors and encouraging their early retirement, ObamaCare dumbs down health care so everybody gets a little, but nobody gets a lot and many don't get enough. Even with issues of life and death at stake, ObamaCare limits our options.
We cannot go to Sloan Kettering or the Mayo Clinic or Ceders-Sinai if we have cancer. Its not covered. Nor can we count on ever seeing an oncologist. Very few will accept the low reimbursement rates offered by the system.
A heart patient will rarely get to see a cardiovascular specialist nor will someone suffering from colon disease get to see a gastroenterologist. The reimbursement rates are prohibitively low for these specialists. And, if you go out of network, you have to pay the full freight yourself, including any follow on therapies. Not just a penalty, but the full amount you'd have to pay if you had no coverage.
A top New Jersey Orthopedist called into my radio show and said that there was no one in south Jersey in any of the ObamaCare plans who was capable of performing complex spinal surgery.
ObamaCare redistributes wealth by charging those whose policies have been cancelled a premium to cover the uninsured. And, it charges a 40% premium tax on those with good policies. And it charges a fee of $63 a head for group plans. All this money goes for the poor and uninsured.
But it is not the redistribution of wealth that is the key point. It is the redistribution of health that none of us can afford.
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The Next ObamaCare Mirage
The new line is that the health-care law will save money. That's also not true.
By Thomas Miller and Abby McCloskey
Nov. 25, 2013 6:58 p.m. ET
WSJ
Supporters of President Obama are working overtime to backtrack from his promise that "If you like your health-care insurance, you can keep it. Period." While the president has conceded that this statement was inaccurate, the administration doesn't seem to have learned its lesson. The damage control plan is to spread another falsehood about the Affordable Care Act.
The claim this time is that the health-care "cost curve is bending, and the ACA is a significant part of the reason." That was what David Cutler —an influential Harvard economist and senior health-care adviser in Mr. Obama's 2008 presidential campaign—wrote in a Washington Post WPO +0.40% op-ed on Nov. 10.
The president jumped on this theme in his press conference on Nov. 14. "I'm not going to walk away from something that has helped the cost of health care grow at its slowest rate in 50 years," he said. On Wednesday, the White House Council of Economic Advisers published a report claiming that "the ACA is contributing to the recent slow growth in health care prices and spending."
These assertions border on nonsense.
National spending on health care is projected to reach a record $2.9 trillion in 2013, according to the Centers for Medicare and Medicaid Services. This is more than 25% above pre-recession spending levels in 2007. Health-care expenditures per capita and as a percentage of GDP are also at record highs, expected to top out this year at $9,216 and 18% respectively.
The only apparent bright spot is that the average annual rate of health-care spending increases has slowed. Over the past three years, growth in health-care spending averaged 3.9% year-over-year, considerably slower than the historical average.
However, annual health-spending growth rates began to decline a decade ago. In 2002, health-care spending grew by nearly 10% in a single year. The growth rate dropped to 7.1% in 2004, 6.2% in 2007, and bottomed out at 3.9% in 2009—the worst year of the Great Recession, where it has stayed ever since. ObamaCare was enacted in 2010.
CMS and the Congressional Budget Office attribute the general slowdown in health-care spending increases over the past decade to a variety of factors, including increased cost sharing in private health plans and a slower rate of introduction of new health technology. An Urban Institute analysis points to how the mix of health-care payers has shifted over the past decade toward lower-paying government programs providing a greater share of coverage (particularly Medicaid).
Still, the recession is recognized by objective analysts as the single largest driver of slowed health-care spending in recent years. Many who lost their jobs lost their health insurance. Tight on cash, they opted out of surgery, hospital visits and prescriptions.
Changes in health-spending growth rates traditionally lag about two years behind changes in national economic growth. In September 2013, CMS reported that the depth and severity of the recession was more substantial than expected and revised its spending estimates downward accordingly.
In other words, champions of ObamaCare have little to crow about, once one recognizes that the persistently weak economic recovery has overlapped with the law.
And in the future? According to health-care actuaries at the Centers for Medicare and Medicaid Services, health-care spending will begin spiraling upward again starting next year, as the Affordable Care Act takes full effect. It will reach $5 trillion in 2022, or 20% of GDP, or $14,664 per capita. By 2022, ObamaCare alone is projected to increase cumulative health spending by roughly $621 billion, according to CMS.
In his 2008 campaign, Mr. Obama promised that his health-care reform plan would save a typical family $2,500 in annual premiums by the end of his first term. This was Mr. Cutler's prediction, and it was based on projected rapid returns from larger federal investments in health-information technology, new reinsurance subsidies for high-cost workers, and savings on administrative costs for health insurance.
Those cost savings haven't materialized. Mr. Cutler maintains they will, mostly through other untested reforms, and the White House Council of Economic Advisers report points to potential savings from fledgling Accountable Care Organizations, lower Medicare reimbursements, value-based payments and hospital readmission penalties. To be sure, some of these programs have and may result in small savings, but they had little effect on savings claimed from 2010 to 2013. For example, even the president's Council of Economic Advisers hedges that some of the claimed savings from reduced hospital readmission rates "may not be entirely attributable to the ACA payment incentives."
CMS actuaries find that any positive effects of the ObamaCare delivery system experiments on the cost of health care "remain highly speculative." When they compare their September 2013 projections with earlier estimates in April 2010, these actuaries find that the law would increase national health spending higher than previously expected by an additional $27 billion in 2019 alone.
To argue that the Affordable Care Act has been and will be a key driver of slower health-care spending is irreconcilable with the most basic facts about such spending over the last decade, as well as with the judgment of the executive branch's own team of actuaries responsible for health-care accounting and future projections.
Mr. Miller is a resident fellow at the American Enterprise Institute and former senior health economist on the Joint Economic Committee. Ms. McCloskey is program director of economic policy at the American Enterprise Institute.
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Obama-ites are asking Dem Senators to find examples of people having a positive experience with Obamacare and bring forward their stories. The President himself brought forward the story of Jessica Sanford. Oops.
President Obama used Jessica Sanford as an Obamacare success story during his October 21 health care event. However, only three days later, Sanford turned into another Obamacare failure.
CNN reports that Sanford, a 48-year-old single mother from Washington state, purchased health insurance from the Washington state exchange. She was so excited that she emailed the President expressing her gratitude. He read the email during a health care event at the White House Rose Garden.
Three days later, Sanford said that she started receiving letters from her state’s exchange explaining that its tax credit calculator was incorrect, and instead of receiving a federal tax credit, she was not eligible. That meant the cost of her insurance would be higher than she anticipated—so high that she said she could not afford it.
“It was like riding a big rollercoaster,” she said. “They have my credit card, they have the payment date and then, you know, once again I’m knocked down, and this time it’s to zero. And at my rate of pay, with my family size, I just don’t understand why I wouldn’t get at least a little help with a tax credit.”
“It was a huge disappointment,” Sanford said. “Especially since I had, you know, my story had been shared by the President.”
Sanford is not alone, according to CNN’s report. Other Washington state residents also had their tax credits miscalculated.
http://blog.heritage.org/2013/11/19/obamacare-success-story-obamacare-failure-story-just-3-days/
http://www.youtube.com/watch?v=n1oPktLLrmQ
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Offered in the same spirit as Bigdog's Affordable Boat Act post at: http://dogbrothers.com/phpBB2/index.php?topic=1411.msg77023#msg77023
(I hope that everyone procures their affordable boat by the Jan 1 dealine.)
This is CoffeeCare, if buying coffee was like buying health insurance:
[youtube]http://www.youtube.com/watch?v=pCb9g8plGF8[/youtube]
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http://www.newsmax.com/newswidget/poll-gallup-healthcare-insurance/2013/11/25/id/538519
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ObamaCare's Next Legal Challenge
The law says subsidies can only go through state-run exchanges.
by Scott Pruitt
Dec. 1, 2013 6:38 p.m. ET
Oklahoma City
As millions of Americans see their health-insurance premiums increase, have their coverage dropped as a result of the Affordable Care Act, and are unable to use the federal exchange, Oklahoma has sued the Obama administration. The Sooner State and several others are trying to stop the government from imposing tax penalties on certain states, businesses and individuals in defiance of the law. If these legal challenges are successful, the deficit spending associated with the new health-care law could be reduced by approximately $700 billion over the next decade.
While the president's health law is vast and extraordinarily complex, it is in one respect very simple. Subsidies are only to be made available, and tax penalties for not signing up for health insurance are only to be assessed, in states that create their own health-care exchange. The IRS, however, is attempting to enforce tax penalties in all states—including Oklahoma and the majority of the other states that have declined to create their own exchanges. Citizens and businesses in these states must use the federal exchange instead.
Enlarge Image
Bloomberg News
The distinction is critical, because under the terms of the law it is the availability of government insurance-premium subsidies that triggers the penalties against businesses if they fail to provide their employees with health insurance that the administration deems acceptable. This is a huge problem for the administration, which desperately needs to hand out tax credits and subsidies to the citizenry to quash the swelling backlash against the law.
When Oklahoma first raised this challenge in 2012, many experts predicted that the Sooner State would "go it alone" in pursuing this legal strategy. Not so. In Indiana, the state and 15 school districts have filed a lawsuit against the IRS, the agency that collects the penalties. Business owners (who, like the state of Oklahoma, would be subject to penalties as employers) and individuals in Virginia and the District of Columbia have done the same. In the D.C. lawsuit, the presiding judge recently rejected the Obama administration's attempt to have the case dismissed, as the judge in the Oklahoma case did in August.
Motions for summary judgment will soon be filed in federal district courts, and our court system will determine whether what the administration has called its "improvements" to the ACA—essentially by ignoring some of its provisions—are lawful.
They are not. Congress was exceedingly clear that tax credits and subsidies are available to people whose plans "were enrolled in through an exchange established by the State under section 1311 of the Patient Protection and Affordable Care Act." Even so, the administration argues that Congress intended for all Americans to receive subsidies regardless of whether they enrolled in health-care coverage through a state exchange or a federal exchange. But to arrive at that conclusion you have to ignore the plain language of the law. And nowhere in the law did Congress authorize the IRS to provide the credits or subsidies to those other than citizens who buy their insurance through an exchange established under section 1311 of the ACA—i.e., a state exchange.
Congress specified that credits and subsidies are only to be available in states that set up their own health-insurance exchange for a reason: It could not force states to set up exchanges. Instead, it had to entice them to do so. Oklahoma's lawsuit is about preserving the state's authority to make a policy decision granted to states under the Affordable Care Act. Our governor and policy makers in Oklahoma decided it wasn't in the state's best interest to create a health-care exchange. The IRS, at the administration's bidding, is attempting to take away the benefits of that choice by regulatory action. Such attempts to expand the power of the executive branch should be troubling to all Americans.
While much time has been devoted in Washington to the issue of "defunding" the Affordable Care Act, the success of these lawsuits would have much the same effect. Should the courts decide the IRS is exceeding its authority and isn't allowed to assess the employer penalties in states that have not established their own exchanges, the structure of the ACA will crumble—as one of the primary mechanisms the federal government has employed to force people into the health-insurance market evaporates.
As much as we wish the government were run like a business, the administration cannot "improve" upon legislation passed by Congress by rolling out updates in the manner that Silicon Valley does. That's not permitted under the Constitution: Congress passes laws, the president executes them. Period. That's why Oklahoma and other states are fighting to stop the administration's attempt to "fix" the health-care law through executive fiat.
Mr. Pruitt is the attorney general of Oklahoma.
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This is to me an unspeakable and unforgiveable outrage. With all the threats and regulations we as providers of health care face with the Health Insurance Portability and Privacy Act (HIPPA) we now see this:
http://www.cnbc.com/id/101225308 :x
Does this not speak to the dishonesty of this administration as well as many other examples?
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Answer to the following question is yes. Half or more of the country will always hate it. The group that will benefit will love it. And eventually it will be patched up and we know for sure the Crats will go crazy on the airwaves brainwashing us as to how great it is. So yes the Pubs need to be ready. Will they? History tells us no.
IMO Levin is correct about this too. Waiting for AHA to collapse on itself is a major mistake. The Crats won't let it. It has to be appealed.
****Do Republicans need a Plan B on ObamaCare?
By Jon Terbush 7 hours ago The Week
John Boehner may need another playbook.
For years, Republicans have trotted out the same message: ObamaCare is a massive disaster, and the public knows it. And when Healthcare.gov crashed out of the starting gate, that message proved quite resonant.
Yet as ObamaCare begins to turn the corner, Democrats are going back on the offensive, touting the law's benefits and successes in hopes of boosting support for it — and the party — ahead of the 2014 elections. Republicans, meanwhile, have so far stood by the same critiques, betting that the law will still be seen as a failure come Election Day.
Which raises a thorny question for the GOP: What if ObamaCare works?
Undoubtedly, ObamaCare is now functioning better than it was in October. Though problems remain for the exchange site — the back end is still a mess, often sending bogus or incomplete information to insurers — enrollments are reportedly surging through both the federal and state-run marketplaces.
Good news in hand, the White House and congressional Democrats this week launched a campaign of daily pro-ObamaCare messaging to promote the law ahead of the Dec. 23 enrollment deadline for coverage that kicks in Jan. 1, 2014. Their goal is to present a "raw two-sided picture," according to Politico, with "Democrats delivering benefits on one side, and Republicans trying to deny them on the other."
"My main message today is: We're not going back," Obama declared in a reboot speech Tuesday.
If ObamaCare keeps improving, the GOP's "we told you ObamaCare was a mess" pitch could quickly wear thin. And if it does, Republicans will find themselves in need of a new argument or a legislative alternative.
So far, they don't really have either.
On the messaging front, Speaker John Boehner (R-Ohio) on Tuesday repeated boilerplate GOP criticisms that the law was "fundamentally flawed," and that it "continues to wreak havoc on American families, small businesses, and our economy." Other GOP leaders similarly contended that the law was still a problem-plagued failure.
That the message hasn't changed despite ObamaCare's turnaround proves that "Republican complaints of two months ago were purely opportunistic," wrote Jamelle Bouie over at the Daily Beast.
"For them, it just doesn't matter if Healthcare.gov is working, since ObamaCare is destined to fail, reality be damned!" he added. "At most, the broken website was useful fodder for attacks on the administration. Now that it's made progress, the GOP will revert to its usual declarations that the Affordable Care Act is a hopeless disaster."
The GOP has also yet to offer a credible legislative alternative to ObamaCare. Though there are several Republican bills that would reform the health care system, they're generally considered suspect, and none have consensus support within the GOP. Boehner on Tuesday tellingly dodged a question about whether he would even bring up such a bill up for a vote, saying only, "We'll see."
Polls have shown that while voters aren't too keen on the health care law, they're willing to give it a chance. Indeed, the first few months of ObamaCare's disastrous rollout could be a distant memory once coverage and benefits kick in next year.
Which points to another problem for Republicans: Their anti-ObamaCare crusade will be tough to sustain once people begin to see the law's benefits in action. Mother Jones' Kevin Drum sussed out that point, writing, "Once the benefits of a new program start flowing, it's very, very hard to turn them off."
By the middle of 2014, ObamaCare is going to have a huge client base; it will be working pretty well; and it will be increasingly obvious that the disaster scenarios have been overblown…
Given all this, it's hard to see ObamaCare being a huge campaign winner. For that, you need people with grievances, and the GOP is unlikely to find them in large enough numbers. The currently covered will stay covered. Doctors and hospitals will be treating more patients. ObamaCare's taxes don't touch anyone with an income less than $200,000. Aside from the tea partiers who object on the usual abstract grounds that ObamaCare is a liberty-crushing Stalinesque takeover of the medical industry, it's going to be hard to gin up a huge amount of opposition. [Mother Jones]
Republicans have so far committed themselves to staunchly opposing ObamaCare no matter what, even producing a playbook for attacking the law from here to November 2014. But if ObamaCare continues to improve, the GOP might need to draw up a new play — or risk getting burned at the polls****
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I share your frustration. Still it is important to lay the blame for Obamacare on those who support it, not those who oppose it.
Ben Carson had it right. If Obama is going to continue to sell it, Republicans especially in the Senate should be calling for a new authorization vote to see how that sale is going.
What is wrong with Obamacare was not a bogged down website, it is the whole concept from start to finish, mostly the fact that we are handing our individual liberties, choices and privacy over to the government never to get them back.
The problems before Obamacare were two-fold: Not enough people insured and healthcare costs were going up too fast. Too many young people who could afford it were uninsured because they thought it was a lousy value; they would be paying for other people's problems and for a lot of coverage they didn't think they needed.
Enter Obamacare. It makes all of that much worse in price and desirability but adds a government mandate, enforced by the IRS, that is just about to go into effect - or be delayed like everything else.
Not mentioned often anywhere are some of the underlying facts:
1) The poor already had unlimited free healthcare in America. This never was about helping the poorest among us.
2) The old already had coverage.
3) This was mostly to 'help' who didn't want help.
4) The problems with the old system mostly had to do with government already screwing up the market. Healthcare wasn't a free market before Obamacare.
5) At the time of its passage, Republicans had the popular part in their own alternative - a plan to cover people with pre-existing conditions.
The result of Obamacare so far is that we are seeing one new enrollee for every 50 who are losing their plan!
Republicans disagree on tactics for ending the failed program, and the clock is ticking. As ccp suggest, a number of people and groups are going to come to rely on it making repeal harder later.
Democrats are now upside down in 13 states with contested Senate races in less than a year.
Obamacare needs to be repealed by the people left who passed it - Democrats. Where is their plan?
If we merely legalize free choice in a free country, the government plans can compete on a level playing field.
With Obamacare in place we get this, the central planners method of allocating scarce resources, replacing individual choice:
(http://3.bp.blogspot.com/_NdBJQhokgPc/TFbtAAa6LkI/AAAAAAAAAtI/3bE-1dTx1Vs/s1600/Obamacare-flow-chart.JPG)
Please read the details that explain the chart at this pdf!
http://www.jec.senate.gov/republicans/public/?a=Files.Serve&File_id=96b779aa-6d2e-4c41-a719-24e865cacf66
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Eliana Johnson: In the Trenches With the ObamaCare Army
One group of navigators planned to sign up 5,800 people by March. So far: zero.
From the article: "We have yet to see an application from start to finish," he says.
http://online.wsj.com/news/articles/SB10001424052702304439804579208103598316522?mod=WSJ_Opinion_LEADTop
A good piece of journalism, I believe this is young Eliana's first time making the WSJ opinion page.
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Doug wrote:
BEGIN
Not mentioned often anywhere are some of the underlying facts:
1) The poor already had unlimited free healthcare in America. This never was about helping the poorest among us.
2) The old already had coverage.
3) This was mostly to 'help' who didn't want help.
4) The problems with the old system mostly had to do with government already screwing up the market. Healthcare wasn't a free market before Obamacare.
5) At the time of its passage, Republicans had the popular part in their own alternative - a plan to cover people with pre-existing conditions.
END
This is important and needs to be fleshed out.
1) Exactly how did the poor already have unlimited coverage?
2) " " " " old " " " " ?
3) I would restate this as "this was to tax those who didn't really need much insurance".
4) Of course! But we need to have specifics e.g. the fragmentation of the national market into 50 markets, exactly what are the limitations on HSAs-- and the benefits, etc
5) Yes, but we need citations of some sort.
=====================
What could go wrong?
http://www.americanthinker.com/blog/2013/12/healthcaregov_cant_calculate_subsidies_so_will_pay_insurance_companies_whatever_they_ask_for.html?utm_source=twitterfeed&utm_medium=facebook
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Another one of my colleagues expressed his opinion that for doctors it is better to have a single payer. Yes they will control us and squeeze us endlessly. It is his opinion that is preferable to the myriad insurance companies each with their own multiple plans and rules. Certainly they fight us every tooth and nail. We spend fortunes just having to navigate the myriad systems. Not that a single payer Federal system would be a piece of cake but just that we would know exactly what we are dealing with and would eventually learn the system. I definitely don't agree with this. I don't want government controlling our lives. I just mention this to note some doctors do feel differently. We will see more and more of this kind of stuff as the politburo members slowly propagandize us towards a single payer system. The young and dumb will not even know what hit them. We all know there are big problems in health care and we know much of the following to be true. But again this sounds like the opening act to the next big propaganda push we on the right know is coming:
********Advocacy and policy news for internists
U.S. Health Care Falters When Compared With Other Countries, New Survey Finds
More Americans say they forego care because of access problems and a costly, confusing system
The U.S. health care system is a bewildering and expensive muddle that most people would like to see changed, even if they have insurance, according to a report in the November issue of Health Affairs.
It found that three of every four Americans surveyed said they would like to see a fundamental restructuring of health care in the country.
"There is a real call for moving away from the status quo," said study co-author Cathy Schoen, senior vice president for research, policy and evaluation at the Commonwealth Fund, which conducted the survey.
Problems with health care cropped up even among Americans covered by health insurance, the researchers found. As Schoen said, "We have a lot of people who, even when they have an insurance card, their insurance has holes in it."
The survey also included citizens of 10 other countries, and comparing the foreign responses to those of Americans revealed serious differences in the way health care works in the United States compared with elsewhere. For instance:
A third of all Americans, both insured and uninsured, reported going without medical care when sick because of the cost. About 58 percent of the uninsured skipped needed care. By comparison, fewer people reported a cost barrier to care in each of the other 10 countries surveyed. In eight of them, 14 percent or fewer people said they had to skip care because of money concerns.
About two of every five Americans had more than $1,000 in out-of-pocket medical expenses for the previous year, whether or not they had insurance. "Even when we're insured, the United States is an outlier," Schoen said. "The insured went without care because of cost and were on the high end of spending out-of-pocket." Among the other countries, Australia and Switzerland had about 25 percent of their citizens reporting more than $1,000 in out-of-pocket medical spending, but the rest had far fewer people who spent that much.
About 25 percent of Americans said they waited six days or more to see a doctor the last time they needed care. That increased to 40 percent among the uninsured. However, three-quarters of Americans were able to see a specialist in less than four weeks. Access to physicians proved better in most other countries. Only in Canada (33 percent) and Norway (28 percent) did more people have to wait six days or more to see a doctor. Access to specialists was much worse in other countries, though in Switzerland, the United Kingdom and The Netherlands, a comparable number of people were able to see a specialist within a month.
More people in the United States rely on emergency room care, with 36 percent of the insured and 48 percent of the uninsured saying they visited an ER within the last two years. By comparison, about 41 percent of Canadians said they had been to the ER recently, but people in the other nine countries reported less reliance on emergency care. For example, 28 percent of people in New Zealand, Norway and Switzerland had been to an ER in the past two years.
Americans also reported more bureaucratic battling over their health benefits. "A third of people spent a lot of time on paperwork or had insurance disputes where their insurance didn't cover as much as they expected it to," Schoen said. That was more than any other country. The next highest, Switzerland, had 25 percent reporting health benefit problems. Sweden and the United Kingdom had just 4 percent reporting that they had to dispute bills or deal with unexpected costs.
"These are all symptoms of a care system under stress," Schoen said. "We spend more than any other country, but we are more likely to forego care."
A leading health economist, Stuart Altman, said that none of the findings were all that surprising.
"It's all the reasons why we need to cover more people, try to make the system a little simpler, and see if we can get our costs down," said Altman, a professor of national health policy at Brandeis University.
"What's interesting is, even among our wealthier citizens, there is a fair amount of apprehension about the confusing system we live in," Altman said. "That was a very telling piece of their analysis. It's a complicated health care system we have. There's no going around it."
Schoen said she hopes that when the Commonwealth Fund does the survey again in a couple of years, the changes wrought by the Affordable Care Act will improve the cost and access problems that Americans reported in the current survey.
"The hope is we will have brought in the insurance for people who don't have any, and the insurance will be more meaningful," she said. "We're expecting this to look better in the future. It's really a benchmark."
Altman was not as optimistic, however.
"Many of the issues are not going to go away," he said. "The Affordable Care Act is an attempt to reduce the number of people who are uninsured over time, and that's a good thing, but it does not in and of itself make our system less confusing."
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This is exactly why we need to be aggressively presenting our solutions!!!
One that I would put front and center is that prices must be knowable, just as we must be informed about what we buy (ingredients, weight, price). Indeed, with deductibles going so high, oddly enough we can argue that there are some forces for market pricing to come to bear.
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Doug wrote:
BEGIN
Not mentioned often anywhere are some of the underlying facts:
1) The poor already had unlimited free healthcare in America. This never was about helping the poorest among us.
2) The old already had coverage.
3) This was mostly to 'help' who didn't want help.
4) The problems with the old system mostly had to do with government already screwing up the market. Healthcare wasn't a free market before Obamacare.
5) At the time of its passage, Republicans had the popular part in their own alternative - a plan to cover people with pre-existing conditions.
END
This is important and needs to be fleshed out.
1) Exactly how did the poor already have unlimited coverage?
2) " " " " old " " " " ?
3) I would restate this as "this was to tax those who didn't really need much insurance".
4) Of course! But we need to have specifics e.g. the fragmentation of the national market into 50 markets, exactly what are the limitations on HSAs-- and the benefits, etc
5) Yes, but we need citations of some sort.
Getting back to you with some citations on the above...
1) The poor already had unlimited free healthcare in America. This never was about helping the poorest among us.
http://en.wikipedia.org/wiki/Medicaid
Medicaid
In 1966 welfare recipients of all ages received medical care through the Medicaid program. Medicaid was created on July 30, 1965 under Title XIX of the Social Security Act of 1965.
Health care in the United States, Government Health Programs
Federal Employees Health Benefits Program
Indian Health Service
Veterans Health Administration
Military Health System / TRICARE
Medicare
Medicaid / State Health Insurance Assistance Program (SHIP)
State Children's Health Insurance Program (CHIP) ('Children's healthcare isn't just for children anymore!) The program was designed to cover
uninsured children in families with incomes that are modest but too high to qualify for Medicaid.
One public hospital here alone spends half a billion a year on unreimbursed medical expenses, 3 million on translators, 100 million on 'foreign born' patients, etc. http://www.nytimes.com/2009/03/29/health/29immig.html
(No one is alleging the poor didn't already receive free health care in America.)
2) The old already had coverage.
http://en.wikipedia.org/wiki/Medicare_%28United_States%29
Medicare
The Social Security Act of 1965 authorized Medicare and provided federal funding for many of the medical costs of older Americans.[19] The legislation overcame the bitter resistance, particularly from the American Medical Association, to the idea of publicly funded health care or "socialized medicine" by making its benefits available to everyone over sixty-five, regardless of need, and by linking payments to the existing private insurance system.
[Obamacare was not aimed at the aging; they already have a program.]
3) This was mostly to 'help' those who didn't want help.
"this was to tax those who didn't really need much insurance"
Nothing says personal accountability like a government mandate.
Identify people who don't want to pay their fair share and make illegal to pay only their share.
4) "The problems with the old system mostly had to do with government already screwing up the market. Healthcare wasn't a free market before Obamacare."
http://www.coburn.senate.gov/public/index.cfm/pressreleases?ContentRecord_id=5a785b7a-802a-23ad-4816-2aa18d62c3e4&ContentType_id=eb0b88e8-9875-4b39-be9b-3d886daf4835&abb8889a-5962-4adb-abe8-617da340ab8e&63a582cd-9897-45a0-be42-17095ad322e2&efd17605-54a8-44be-90b1-f3794c91987a&d741b7a7-7863-4223-9904-8cb9378aa03a&Group_id=c82e4d0c-906d-4071-bfdf-15e23b7100a3
Dec 04 2009: New CRS Report Shows Government Already Controls 60 percent of Health Care in the U.S.
5) "At the time of its passage, Republicans had the popular part in their own alternative - a plan to cover people with pre-existing conditions."
Citations:
http://www.forbes.com/sites/aroy/2011/09/28/paul-ryan-in-a-major-speech-proposes-universal-health-coverage-via-tax-credits/
http://www.npr.org/blogs/health/2013/03/12/174126064/ryan-budget-proposal-echoes-obamacare-while-rejecting-it
The Ryan[plan] ... would have to "offer guaranteed issue and community rating" and that "insurers would be unable to deny coverage based on pre-existing conditions."
http://www.nationalreview.com/article/355963/tom-prices-plan-replace-obamacare-andrew-stiles
http://www.kaiserhealthnews.org/stories/2009/november/03/republican-health-bill.aspx
http://www.nytimes.com/2009/11/04/health/policy/04health.html?_r=0
Eric Cantor of Virginia, said high-risk pools and reinsurance programs would “guarantee that all Americans, regardless of pre-existing conditions or past illnesses, have access to affordable care.”
http://cnsnews.com/news/article/republicans-have-offered-three-alternative-health-care-reform-bills
Republicans Have Offered Three Alternative Health Care Reform Bills
August 21, 2009
The “Patients Choice Act” has been referred to the Senate Finance Committee, which is set to release a Democratic-crafted bill from that committee when Congress returns after Labor Day. In June, DeMint, chairman of the Senate Steering Committee, introduced the “Health Care Freedom Plan,” which was analyzed by the Heritage Foundation. The conservative policy think tank said DeMint’s bill could reduce the number of uninsured by 22.4 million people in five years. It also provides grants to help people with pre-existing conditions gain access to affordable insurance, and allows Americans to purchase health savings accounts to pay for insurance.
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"The result of Obamacare so far is that we are seeing one new enrollee for every 50 who are losing their plan!"
http://www.breitbart.com/Big-Government/2013/11/13/ObamaCare-cancellation-to-enrollee-ration-50-to-1
ObamaCare Cancellation to Enrollee Ratio: 50 to 1
Though the number is estimated to eventually hit as high as 10 to 15 million, right now the number of insurance policies canceled due to ObamaCare is 5 million. Wednesday, the Obama administration claimed that 106,185 Americans enrolled in ObamaCare. Except, according to the White House, those are not actual enrollments. Some have not paid for but have only only "selected a marketplace plan." Orwellian nonsense aside, that is still somewhere around a 50-to-1 ratio of cancellations to enrollees.
"Democrats are now upside down in 13 states with contested Senate races in less than a year. "
2014 is one 6 year senate term (Al Franken, et al) since Barack Obama's Hyde Park speech ("We are the ones we've been waiting for", "the moment when the rise of the oceans began to slow and our planet began to heal") and the exciting Dem sweep of 2008.
http://www.electionprojection.com/blog/archives/nov13/2014-senate-elections-preview-110613.php
Of the 14 Republican seats up next year, just one, Susan Collins' seat in Maine, will be held in a state won by President Obama. The other 13 are in states Mitt Romney won by at least 5 points, and nine of those are in states he won by 15 points or more.
http://www.nationaljournal.com/politics/democrats-fear-obamacare-will-cost-them-the-senate-20131126
Landrieu's approval rating is now underwater; she tallied only 41 percent of the vote against her GOP opposition. In Arkansas, where advertising on the health care law began early, Sen. Mark Pryor's approval sank to 33 percent, a drop of 18 points since last year. A new Quinnipiac survey showed Sen. Mark Udall of Colorado, who looked like a lock for reelection last month, in a dead heat against little-known GOP opponents. Even a Democratic automated poll from Public Policy Polling showed Sen. Kay Hagan of North Carolina running neck-and-neck against Republican opposition, with her job disapproval spiking over the last two months. These are the types of numbers that wave elections are made of.
Republicans need a pick up of 6. Democrats are defending seats in 7 states won by Romney,
http://www.politico.com/story/2013/12/republican-gop-targets-blue-states-democrats-senate-2014-elections-100458_Page2.html
The median Dem dropoff from 2012 to 2013 elections was roughly 5 points (and it is getting worse). Democrats must defend 13 Senate seats that Obama carried by 55% or less. http://www.realclearpolitics.com/articles/2013/12/04/democrats_2013_drop-off_problem.html#ixzz2midNyTOt
Nothing says repeal and replace like voting the perps out.
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"The poor already had unlimited free healthcare in America. This (Obamacare) never was about helping the poorest among us."
It seems to me that too many people are unaware that the poorest among us are receiving more than 4400/yr subsidy PER PERSON for free health care. No one fully understands federal social spending programs, but Medicaid mostly addresses the so-called poor, CHIPS is aimed at up to 200% of the poverty line. Obamacare gives subsidies up to about 400% of the poverty line. And then, of course, we don't count money like this when we measure their income. Please read this in its entirety.
1.46 million of the first 1.6 million to sign up for 'Obamacare' are really enrolling in Medicaid (Is it hard to 'sell' free health care?)
http://nypost.com/2013/12/07/the-medicaid-time-bomb/
ObamaCare created a Medicaid time bomb
By Michael D. Tanner
December 7, 2013 | 9:15pm
Modal Trigger
ObamaCare created a Medicaid time bomb
The good news, if you want to call it that, is that roughly 1.6 million Americans have enrolled in ObamaCare so far.
The not-so-good news is that 1.46 million of them actually signed up for Medicaid. If that trend continues, it could bankrupt both federal and state governments.
Medicaid is already America’s third-largest government program, trailing only Social Security and Medicare, as a proportion of the federal budget. Almost 8 cents out of every dollar that the federal government spends goes to Medicaid. That’s more than $265 billion per year.
Indeed, already Social Security, Medicare and Medicaid account for 48% of federal spending. Within the next few years, those three programs will eat up more than half of federal expenditures.
And it’s going to get worse. Congress has shown no ability to reform Social Security or Medicare. With ObamaCare adding to Medicare spending, we are picking up speed on the road to insolvency.
The Congressional Budget Office projects that, in part because of ObamaCare, Medicaid spending will more than double over the next 10 years, topping $554 billion by 2023.
And that is just federal spending.
State governments pay another $160 billion for Medicaid today. For most states, Medicaid is the single-largest cost of government, crowding out education, transportation and everything else.
New York spent more than $15 billion on Medicaid last year, roughly 30% of all state expenditures. The Kaiser Foundation projects that over the next 10 years, New York taxpayers will shell out some $433 billion for the program.
But none of these projections foresaw that so many of ObamaCare’s enrollees would be Medicaid eligible.
To be sure, the health-care law’s designers saw the expansion of Medicaid as an important feature of their plan to expand coverage for the uninsured. Still, they expected most of those enrolling in ObamaCare to qualify for private (albeit subsidized) insurance.
It’s beginning to look like that was just another miscalculation, one that could have very serious consequences for the program’s costs.
Moreover, any projection of Medicaid’s future cost to New York taxpayers assumes that the federal government keeps its promise to pay 100% of the cost for Medicaid’s expansion over the next three years and 90% thereafter. But given the growing burden that Medicare will put on a federal budget already facing high debt levels, how likely is it that changes in the federal share of Medicaid will stay off the table?
In fact, as part if last December’s fiscal-cliff negotiations, the Obama administration briefly considered changing to a “blended” reimbursement rate, somewhere between the current and promised rates. The administration quickly backed away from the offer, but it’s likely to come back in the future. If it does, it would cost New York tens of millions of dollars.
Every bit as bad as the cost is the fact that for all this money, recipients are going to get pretty lousy health care.
Of course, one might say that even bad health care is better than no health care. But, unfortunately, for Medicaid, that’s not true.
The Oregon Health Insurance Exchange study, the first randomized controlled study of Medicaid outcomes, recently concluded that, while Medicaid increased medical spending increased from $3,300 to $4,400 per person, “Medicaid coverage generated no significant improvements in measured physical-health outcomes.”
Other studies show that, in some cases, Medicaid patients actually wait longer and receive worse care than the uninsured.
While Medicaid costs taxpayers a lot of money, it pays doctors very little. On average, Medicaid only reimburses doctors 72 cents out of each dollar of costs. ObamaCare does attempt to address this by temporarily increasing Medicaid reimbursements for primary-care doctors, but that increase expires at the end of next year.
Because of the low reimbursement, and the red tape that accompanies any government program, many doctors limit the number of Medicaid patients they serve, or even refuse to take Medicaid patients at all. An analysis published in Health Affairs found that only 69% of physicians accept Medicaid patients. A study published in the New England Journal of Medicine found that individuals posing as mothers of children with serious medical conditions were denied an appointment 66% of the time if they said that their child was on Medicaid (or the related CHIP), compared with 11% for private insurance — a ratio of 6 to 1.
Even when doctors do still treat Medicaid patients, they often have a harder time getting appointments and face longer wait times. One study found that among clinics that accepted both privately insured children and those enrolled in Medicaid, the average wait time for an appointment was 42 days for Medicaid compared to just 20 days for the privately insured. One study found that among clinics that accepted both privately insured children and those enrolled in Medicaid, the average wait time for an appointment was 42 days for Medicaid compared to just 20 days for the privately insured.
That’s one reason why so many Medicaid patients show up at the emergency room for treatment. They can’t find a doctor to treat them otherwise.
This not only increases the strain on already overburdened emergency room doctors, but increases the wait for those who arrive with real emergencies.
As bad as this is now, ObamaCare will make it worse by increasing the number of people on Medicaid without doing anything to increase the number of doctors treating them.
We don’t know yet whether the rush to Medicaid will continue. It may be that the troubles with the ObamaCare website might have skewed the early signups. But if ObamaCare really does lead to a massive expansion of this costly and inefficient program, that’s bad news for taxpayers, providers and patients.
Michael D. Tanner is a senior fellow at the Cato Institute.
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Bundler Bets Against Exchange
The UNaffordable Care Act is destined to be such a flop that one of Obama's biggest campaign bundlers is betting against the federal exchange. The Washington Free Beacon has more: "A major campaign bundler for President Barack Obama is betting on the failure of one of the top federal contractors responsible for the disastrous rollout of the website for the federal government's insurance marketplace. James Chanos made his fortune by short-selling companies before the value of their stock plummeted, most notably the defunct energy firm Enron. His latest target is CGI Group, which is the parent company of CGI Federal. CGI Federal is the lead contractor responsible for Healthcare.gov, the glitch-plagued website of the federal Obamacare insurance exchange." Chanos raised up to $500,000 for Obama's reelection bid. He'll likely make that number look minuscule with the profit he'll make betting on O'Care's demise.
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second post
http://communities.washingtontimes.com/neighborhood/allen-west-out-foxhole/2013/dec/9/president-and-media-ignore-conservative-alternativ/
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"WHAT ARE OUR IDEAS NOW?"
"...we need to be aggressively presenting our solutions!!!"
The right answer from my point of view is to get the government, especially the federal government, out of healthcare, except for basic and essential regulations.
To clarify the question though, I think what we are seeking is the best political compromise that could realistically get us out of this train wreck known as Obamacare in the least sociailistic, totalitarian, big government way possible.
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Colin Powell Pitches Single-Payer Health Care in US
ABC News
By
Colin Powell Pitches Single Payer Health Care in US
General Colin Powell attends the
Former Secretary of State Colin Powell has waded into the health care debate with a broad endorsement of the kind of universal health plan found in Europe, Canada and South Korea.
"I am not an expert in health care, or Obamacare, or the Affordable Care Act, or however you choose to describe it, but I do know this: I have benefited from that kind of universal health care in my 55 years of public life," Powell said, according to the Puget Sound Business Journal, last week at an annual "survivors celebration breakfast" in Seattle for those who, like Powell, have battled prostate cancer. "And I don't see why we can't do what Europe is doing, what Canada is doing, what Korea is doing, what all these other places are doing."
Europe, Canada and Korea all have a "single-payer" system, in which the government pays for the costs of health care.
Some Democrats who strongly advocated for, and failed to get, a single-payer system in the 2010 Affordable Care Act, still believe the current law doesn't go far enough to reform the US health system.
A retired four-star general and former chairman of the Joint Chiefs of Staff, Powell told the audience about a woman named Anne, who as his firewood supplier, faced a healthcare scare of her own. Anne asked Powell to help pay for her healthcare bills, as her insurance didn't cover an MRI she needed as a prerequisite to being treated for a growth in her brain. In addition, Powell's wife Alma recently suffered from three aneurysms and an artery blockage. "After these two events, of Alma and Anne, I've been thinking, why is it like this?" said Powell.
"We are a wealthy enough country with the capacity to make sure that every one of our fellow citizens has access to quality health care," Powell. "(Let's show) the rest of the world what our democratic system is all about and how we take care of all of our citizens."
Powell, who has taken heat from Republicans for twice endorsing President Obama's election and reelection bids, said he hopes universal healthcare can one day become a reality in the U.S. "I think universal health care is one of the things we should really be focused on, and I hope that will happen," said Powell. "Whether it's Obamacare, or son of Obamacare, I don't care. As long as we get it done."
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OK gents:
In semi-sound bite fashion, how do we answer the argument that Powell is making here?
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Medicaid Expansion Takes Over The States
By Dick Morris on December 10, 2013
The growth of Medicaid under ObamaCare effectively takes over all of state spending for the next few years. Forget improvements in education, state universities, or other programs. All the money is going to go for Medicaid.
Already Medicaid accounts for 15% of all state spending totaling $450 billion a year. But, under ObamaCare, it is exploding.
In the state of Washington, where the enrollment process is the furthest advanced, 90% of the enrollments in the state exchanges has been in Medicaid — 52% among those newly eligible under the expansion contained in the ACA and 38% who were previously eligible but hadn’t enrolled.
While the feds will pay the full costs for those who are newly eligible for three years, 90% for another three years, and who knows how much after, the states will only get their normal federal reimbursement for those who have always been eligible but only now applied. Caught up in the hoopla about getting insurance, they are logging onto their state and federal sites only to be told that they are eligible for Medicaid and always have been. But now they are signing up. And the states will only, on average, be able to look to Uncle Sam for about 60% of the cost.
This dragnet is transforming Medicaid from a large program into an enormous one and, with the states on the hook for almost half of the costs for those already eligible, it is a program that the states themselves must finance.
Preliminary estimates suggest that the state share of the new Medicaid expansion could exceed $5 trillion — about 15% of all state revenues. And this sum will come due all at once in the next fiscal year.
Forget any other program. Forget education. Forget about better schools. Forget better roads or mass transit or policing or mental health or local aid. Medicaid is going to suck up all the oxygen in the room.
Indeed, de facto, Medicaid is becoming the single payer that Obama and the liberals have always dreamed of. It stems from the failure of ObamaCare to truly appeal to the middle income middle class. But Medicaid is the de facto order of the day and its expansion is dooming states to a high tax, low services future.
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1. We are the most indebted country in human history. We can't handle the debt we have now, so throw more massive debt onto the pile?
2. Gov't health care is a massive failure everywhere it's tried. The fcuking post office can't even deliver letters without going into the red every year, but gov't healthcare will be different ?
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In semi-sound bite fashion, how do we answer the argument that Powell is making here?
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Okay, you first!
My view is that we need a clean and simple political compromise that a number of Senate DEMOCRATS in red and swing states can grab onto to save face. Amend the Affordable Care Act to allow affordable plans to qualify. Combine this with other cost savings reforms including an individual tax deduction to match what employers take, selling across state lines, healthcare tort reform and mandatory price disclosures. Then move on to improving affordability by improving economic growth!
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Powell: "I don't see why we can't do what Europe is doing, what Canada is doing, what Korea is doing, what all these other places are doing."
What these other places are doing to a large extent is paying only the variable cost of what is developed in the US. Along with rationing via queue. Average wait between GP referral and receiving orthopedic surgery in Canada is 40 weeks? http://www.fraserinstitute.org/research-news/display.aspx?id=20516
Powell, as a four-star general in a military hospital, always had good service. Ya think? How are the rest doing at the VA?
Two countries in the world do not have a private healthcare system operating alongside the public system, Canada and North Korea. In Canada, the private healthcare system is to travel to the US. - leaving North Korea alone in that distinction.
Americans just saw the failure of a bureaucracy-based transformation of healthcare. We weren't ready for the full government takeover in 1993 or in 2009. Post-Obamacare, we really aren't ready now! If you take away the private system altogether and there are 80 million or so dissatisfied in the US, where do they go for healthcare. To a private system in Canada?? There is no such thing.
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1) Most of these other countries are going broke even though they have lived under the US defense umbrella
2) Due to the tax and regulatory burdens of the nanny state these other countries are not having enough children and their populations are contracting, leading to highly unfavorable and worsening ratios between the working and the consuming
3) long lines, assembly line practices, no tech advancements,
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IMHO this is a hyperventilating source. Caveat lector.
http://capoliticalnews.com/2013/12/11/next-new-problem-obamacare-to-cut-drug-reimbursement-force-pharmacies-to-lose-money-or-leave-program/
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Patriot Post
Oregon Trail of Cash
The state of Oregon was supposed to be a poster state for setting up its own ObamaCare exchange. It is, but not in the way we were led to believe. The state squandered more than $300 million in building its exchange only to sign up a grand total of 44 people so far. According to HHS, that's the fewest people in the nation. Remember, this isn't some stubborn red state hoping to torpedo ObamaCare due to ideological opposition. Oregon is a blue state that enthusiastically embraced ObamaCare, agreeing early on to set up its own exchange. Only California and New York received more federal money to make it happen. But nearly $7 million per enrollee isn't too bad.
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Obamacare’s Fatal Flaw
by Martin Feldstein, Professor of Economics at Harvard University and President Emeritus of the National Bureau of Economic Research, chaired President Ronald Reagan’s Council of Economic Advisers from 1982 to 1984.
http://www.project-syndicate.org/commentary/martin-feldstein-on-how-america-s-health-care-reform-could-unravel#12WRmL5SgZI0xvYd.99
The potentially fatal flaw in Obamacare is the very same feature that appeals most to its supporters: the ability of even those with a serious preexisting health condition to buy insurance at the standard premium.
That feature will encourage those who are not ill to become or remain uninsured until they have a potentially costly medical diagnosis. The resulting shift in enrollment away from low-cost healthy patients to those with predictably high costs will raise insurance companies’ cost per insured person, driving up the premiums that they must charge. As premiums rise, even more relatively healthy individuals will be encouraged to forego insurance until illness strikes, causing average costs and premiums to rise further.
...
The “wait-to-insure” option could cause the number of insured individuals to decline rapidly as premiums rise for those who remain insured.
"...a better plan: eliminate the current enormously expensive tax subsidy for employer-financed insurance and use the revenue savings to subsidize everyone to buy comprehensive private insurance policies with income-related copayments. That restructuring of insurance would simultaneously protect individuals, increase labor mobility, and help to control health-care costs."
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Crafty,
Very interesting post on the "pharmacists". However today most pharmacists are not in their own business like days past when they were their own professionals in their own practices. They are part of huge chains. Hospitals, physicians and nursing homes and others are all becoming corporatized and bigger and bigger corporate chains.
The bigger the better able to cope with all the red tape.
So what do these cuts mean to Walgreens CVS etc.?
I guess the Obama shots response would be they can make it up on volume. Sure, I am happy to make 50% less because I know I can simply make it up by working 50% harder to see 50% more people per day. I get paid less, work harder, patients get less time with me and we are all one happy bunch.
Those who did not have insurance make out like bandits now.
No problem right Gen. Colin Powell - you fool.
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A persuasive article on the healthcare cost trends:
http://www.economics21.org/commentary/no-grounds-claim-obamacare-lowers-healthcare-costs
No Grounds for Claim that Obamacare Lowers Healthcare Costs
"the public is being told that the ACA is responsible for government actuaries’ improved health spending projections, when an examination of those projections clearly shows that not to be so. "
Charles Blahous is a senior research fellow for the Mercatus Center, a research fellow for the Hoover Institution, and a public trustee for Social Security and Medicare.
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Doug,
The plan is to get to single payer and then control our health care through a gigantic managed care program. Rationing through restricting resources, use the cheapest drugs possible and a gigantic academic research complex employed to do studies that will support the restrictions.
The 80s show that managed care will control costs for a while till they start to go up again. But it will not be fun or pleasant except for the stakeholders. The providers and patients will be inconvenienced and hassled up the arse. The way care is measured will show that there is not a huge difference in negative "outcomes" so the politburo will claim victory. The truth is that it all depends on the outcomes being measured. Don't think for a second this will be not be manipulated.
Individuals are no longer important - it is all population based measurements. I did see one article questioning the validity of such measurements.
Like I have posted before results of studies can be statistically manipulated in various ways to make them sound like more important than they are.
The pharmaceutical companies do do the same thing. Everyone plays the numbers games to their advantage. The truth is much harder to discern.
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I recall Donald Berwick bitching how an insurance company would not let his daughter have a test he said she needed. Well apparently the insurance company thought she did not. He was saying he did not know the criteria they used to deny the test. We need to go in with our eyes open not closed. As if to say when his beaucracy denies care at least there will be some sort of study to back it up.
Well I can tell you the insurance companies also have studies to back up their denials. They don't just deny care totally out of thin air.
So Berwick didn't like being denied but he has no problem being one who denies others when HE decides it ok.
I didn't learn if his daughter who ultimately got the test actually benefitted from it. I can almost guarantee she didn't. But he didn't mind. He didn't pay for it.
Hypocrite. Like most libs.
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"Doug, The plan is to get to single payer..."
Very true. Liberals are not startled by the failure of this complex public-private fiasco, even though it is their own. Tthey will argue for simplicity and point to the way it 'works' for everyone else.
Republicans should have united by now on a solution and alternative to take away the false claim of Dems that R's want to take us back to the way it was, which was the old Dem plan of only 60% government control and runaway costs.
It is frustrating to lack both leadership and a message.
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"It is frustrating to lack both leadership and a message."
Amen!
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Agreed ditto
I suppose we will win by default.
The only reason not to come out with a plan sooner is the Clintons will coop and act as though it was their idea all along.
Classic Clinton.
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http://reallifeofjulia.tumblr.com/
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"Obamacare-the-sequel is nothing more that “a nationwide high-risk pool for the middle class"
http://www.washingtonpost.com/blogs/right-turn/wp/2013/12/23/obama-has-begun-repealing-obamacare/?hpid=z2
For the billions we are spending on a million, at most, people in the exchanges, we could give them their own doctors and unlimited taxi rides to free appointments.
the goal in 2014 for Republicans, namely to deal with the middle class hard- to-insure while working on the “affordable” part of the equation for others who have or had insurance (before Obamacare took it away)
- Jennifer Rubin, Washington Post
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George will, back in form:
Obamacare now is a tapestry of coercions mitigated by random acts of presidential mercy
http://www.realclearpolitics.com/video/2013/12/23/george_will_obama_is_a_tapestry_of_coercions_mitigated_by_random_acts_of_presidential_mercy.html
SHANNON BREAM: So we have another delay in signing up for Obamacare. Today was the drop dead deadline. It was December 15th. That got changed to today. Then quietly there's what they’re calling a grace period, George. How do you think this is going to go over?
GEORGE WILL: You used the word quietly and that's exactly it. This is a -- Obamacare now is a tapestry of coercions mitigated by random acts of presidential mercy announced in the most bizarre ways. Months ago, when they announced the suspension of the employer mandate, it was an assistant secretary of the Treasury, of whom there are twelve, posted it on the Treasury website.
Then, when they a few days ago suspended the individual mandate for certain preferred people, that was announced in a letter from Secretary Sebelius to six Democratic senators, as though this law of the United States was their private property.
This change today wasn't even announced. It was sort of discovered by the Washington Post and it was made on the pretext that they're gearing up for an expected surge of traffic. Which is kind of interesting because the one person we know who signed up today, the president, doesn't even get his health care from anything associated with Obamacare.
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Doug and Ginger Chapman with their son Charlie Galanes, 11. They are looking for new coverage after their plan was canceled.
The cheapest insurance plan they can find through the new federal marketplace in New Hampshire will cost their family of four about $1,000 a month, 12 percent of their annual income of around $100,000 and more than they have ever paid before.
Even more striking, for the Chapmans, is this fact: If they made just a few thousand dollars less a year — below $94,200 — their costs would be cut in half, because a family like theirs could qualify for federal subsidies.
...
Christian Johnsen, a bakery owner who lives with his wife and two children in Big Sky, Mont., and has an income of about $88,000, will probably be eligible for subsidies next year. As a result, the family could buy a midlevel insurance plan for about $697 a month.
But if the bakery does better next year, the family could be asked to pay a lot more. Without any subsidy, the same plan would cost $822.
http://www.nytimes.com/2013/12/21/business/new-health-law-frustrates-many-in-middle-class.html?smid=pl-share&_r=0
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I have not followed this thread or any others in any detail— it has been a very busy few months. However, here are some things I noticed.
This is a very small sample size of a little less than 20.
The vast majority of my new health insurance clients this month could not have purchased health insurance on the individual market last year because of diabetes or other medical problems. Currently about half of my clients are getting subsidies and about half aren’t. Both of those may look different in a few months. The older you are the more impressive the subsidies. Subsides are the best deal for Small Business Owners who are able to write off most of their income. Most people who aren’t working with an agent have no idea what they are buying and will be in for a rude awaking when they find out their out of pocket costs and the size of their network.
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One school of thought says, do not interrupt when opponents are making fools of themselves. But silence on a real solution to the current healthcare trainwreck will most certainly leave us with a worse sequel. What is the right way forward? Find it and demand it. WSJ today:
What to Do When ObamaCare Unravels
Health insurance should be individual, portable across jobs, states and providers, and lifelong and renewable.
http://online.wsj.com/news/articles/SB10001424052702304866904579265932490593594?mod=WSJ_Opinion_LEADTop
The unraveling of the Affordable Care Act presents a historic opportunity for change. Its proponents call it "settled law," but as Prohibition taught us, not even a constitutional amendment is settled law—if it is dysfunctional enough, and if Americans can see a clear alternative.
This fall's website fiasco and policy cancellations are only the beginning. Next spring the individual mandate is likely to unravel when we see how sick the people are who signed up on exchanges, and if our government really is going to penalize voters for not buying health insurance. The employer mandate and "accountable care organizations" will take their turns in the news. There will be scandals. There will be fraud. This will go on for years.
Yet opponents should not sit back and revel in dysfunction. The Affordable Care Act was enacted in response to genuine problems. Without a clear alternative, we will simply patch more, subsidize more, and ignore frauds and scandals, as we do in Medicare and other programs.
There is an alternative. A much freer market in health care and health insurance can work, can deliver high quality, technically innovative care at much lower cost, and solve the pathologies of the pre-existing system.
The U.S. health-care market is dysfunctional. Obscure prices and $500 Band-Aids are legendary. The reason is simple: Health care and health insurance are strongly protected from competition. There are explicit barriers to entry, for example the laws in many states that require a "certificate of need" before one can build a new hospital. Regulatory compliance costs, approvals, nonprofit status, restrictions on foreign doctors and nurses, limits on medical residencies, and many more barriers keep prices up and competitors out. Hospitals whose main clients are uncompetitive insurers and the government cannot innovate and provide efficient cash service.
We need to permit the Southwest Airlines, LUV -0.16% Wal-Mart, WMT +0.21% Amazon.com AMZN +0.55% and Apples of the world to bring to health care the same dramatic improvements in price, quality, variety, technology and efficiency that they brought to air travel, retail and electronics. We'll know we are there when prices are on hospital websites, cash customers get discounts, and new hospitals and insurers swamp your inbox with attractive offers and great service.
The Affordable Care Act bets instead that more regulation, price controls, effectiveness panels, and "accountable care" organizations will force efficiency, innovation, quality and service from the top down. Has this ever worked? Did we get smartphones by government pressure on the 1960s AT&T T +0.03% phone monopoly? Did effectiveness panels force United Airlines and American Airlines to cut costs, and push TWA and Pan Am out of business? Did the post office invent FedEx, FDX +0.79% UPS and email? How about public schools or the last 20 or more health-care "cost control" ideas?
Only deregulation can unleash competition. And only disruptive competition, where new businesses drive out old ones, will bring efficiency, lower costs and innovation.
Health insurance should be individual, portable across jobs, states and providers; lifelong and guaranteed-renewable, meaning you have the right to continue with no unexpected increase in premiums if you get sick. Insurance should protect wealth against large, unforeseen, necessary expenses, rather than be a wildly inefficient payment plan for routine expenses.
People want to buy this insurance, and companies want to sell it. It would be far cheaper, and would solve the pre-existing conditions problem. We do not have such health insurance only because it was regulated out of existence. Businesses cannot establish or contribute to portable individual policies, or employees would have to pay taxes. So businesses only offer group plans. Knowing they will abandon individual insurance when they get a job, and without cross-state portability, there is little reason for young people to invest in lifelong, portable health insurance. Mandated coverage, pressure against full risk rating, and a dysfunctional cash market did the rest.
Rather than a mandate for employer-based groups, we should transition to fully individual-based health insurance. Allow national individual insurance offered and sold to anyone, anywhere, without the tangled mess of state mandates and regulations. Allow employers to contribute to individual insurance at least on an even basis with group plans. Current group plans can convert to individual plans, at once or as people leave. Since all members in a group convert, there is no adverse selection of sicker people.
ObamaCare defenders say we must suffer the dysfunction and patch the law, because there is no alternative. They are wrong. On Nov. 2, for example, New York Times NYT +1.40% columnist Nicholas Kristof wrote movingly about his friend who lost employer-based insurance and died of colon cancer. Mr. Kristof concluded, "This is why we need Obamacare." No, this is why we need individual, portable, guaranteed-renewable, inexpensive, catastrophic-coverage insurance.
On Nov. 15, MIT's Jonathan Gruber, an ObamaCare architect, argued on Realclearpolitics that "we currently have a highly discriminatory system where if you're sick, if you've been sick or you're going to get sick, you cannot get health insurance." We do. He concluded that the Affordable Care Act is "the only way to end that discriminatory system." It is not.
On Dec. 3, President Obama himself said that "the only alternative that Obamacare's critics have, is, well, let's just go back to the status quo." Not so.
What about the homeless guy who has a heart attack? Yes, there must be private and government-provided charity care for the very poor. What if people don't get enough checkups? Send them vouchers. To solve these problems we do not need a federal takeover of health care and insurance for you, me, and every American.
No other country has a free health market, you may object. The rest of the world is closer to single payer, and spends less.
Sure. We can have a single government-run airline too. We can ban FedEx and UPS, and have a single-payer post office. We can have government-run telephones and TV. Thirty years ago every other country had all of these, and worthies said that markets couldn't work for travel, package delivery, the "natural monopoly" of telephones and TV. Until we tried it. That the rest of the world spends less just shows how dysfunctional our current system is, not how a free market would work.
While economically straightforward, liberalization is always politically hard. Innovation and cost reduction require new businesses to displace familiar, well-connected incumbents. Protected businesses spawn "good jobs" for protected workers, dues for their unions, easy lives for their managers, political support for their regulators and politicians, and cushy jobs for health-policy wonks. Protection from competition allows private insurance to cross-subsidize Medicare, Medicaid, and emergency rooms.
But it can happen. The first step is, the American public must understand that there is an alternative. Stand up and demand it.
Mr. Cochrane is a professor of finance at the University of Chicago Booth School of Business, a senior fellow of the Hoover institution, and an adjunct scholar of the Cato institute.
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"""One school of thought says, do not interrupt when opponents are making fools of themselves. But silence on a real solution to the current healthcare trainwreck will most certainly leave us with a worse sequel."""
No doubt about it. Republicans can't just sit around complaining about AHA. Eventually the Democrats will fix it enough to get as many people hooked on it as possible. It will not crash onto itself.
Talk about leading from behind.
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http://www.daybydaycartoon.com/2013/12/27/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+daybydaycartoon%2FkUnt+%28Day+by+Day+Cartoon+by+Chris+Muir%29#007220
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Ccp,
If you can see a way the dems can fix obamadoesntcare, you are way ahead of the dems.
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***If you can see a way the dems can fix obamadoesntcare, you are way ahead of the dems.***
GM. The truth doesn't matter. You can fool some of the people all of the time. The rest one party needs to gain a 51% majority can easily be bribed:
http://www.politico.com/story/2013/12/obamacare-launch-white-house-101583.html
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This should go in cognitive dissonance of the left. Maybe everything should go there.
http://moneymorning.com/ob-article/obamacare-democrats.php?src=t-oc-dems
"Obviously, we didn't do a good enough job in terms of how we crafted the law," "I am sorry that they, you know, are finding themselves in this situation, based on assurances they got from me." - President Obama
"His major accomplishment was Obamacare, and the implementation of it now is questionable at best." - 39th President Jimmy Carter
"I think we paid a terrible price for health care." - Barney Frank, former Massachusetts Congressman:
"The Affordable Care Act's Rate-Setting Won't Work." - Former Democratic Presidential candidate and current Chairman of the Democratic National Committee, Howard Dean:
"Obamacare will cost taxpayers at least an additional $400 billion more than originally proposed." - McKinsey report
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I've already posted how some doctors have already made their personal mea culpa and come to the conclusion that for them they think single payer is better. Which is worse for doctors one gigantic government run system or myriads of private greedy business men controlling them?
I have made clear I don't want government controlling my life. But others in my profession have concluded otherwise. Many are my fellow Jewish doctors as this one here. They are all die hard Democrats. I must ask if they would feel so strongly about this if a Republican was promoting AHA. I doubt it. Some of my fellow Indian and Muslim and African colleagues also have expressed a desire for single payer. Doctors from the Eastern Europe theater tend to be disgusted with the shift to totalarism (sp?) exactly what they fled.
One must also keep in mind "correspondents" or whatever she is called like Snyderman make at least hundreds of thousands a year for the networks in these mouthpiece positions. Either way she is doing great. I wish I could get paid handsomely telling others to get in line with the State.
I can tell you this line is complete nonsense:
"Increase the bottom line for doctors so they don’t feel like they’re being nickeled and dimed with 10% less than Medicare, 5%... Docs just want to be reimbursed a fair amount for hard work."
I have never heard a doctor accuse Medicare of paying them a fair wage. In fact it is just the opposite. Insurers often follow Medicare reimbursement cuts. So this claim is ridiculous. Nonetheless some doctors have concluded that for their pocketbooks Medicare is the less of two evils. Personally I look at the broader picture beyond my pocketbook. I see the Government taking over our lives. Doctors, patients, all of us. To call signing up to Obamacare our patriotic duty is right out of the Communist Party playbook.
*****NBC’s Chief Medical Editor Forced Her Kids to Sign Up for Obamacare as Their ‘Patriotic Duty’
"So I made my kids sign up, because I just said this is your patriotic duty."
On Morning Joe Monday, NBC’s chief medical editor Dr. Nancy Snyderman, after arguing that the “biggest fix” for the American healthcare system would be single-payer, proudly declared that she had forced her own kids to sign up for Obamacare as their “patriotic duty.”
Snyderman was brought on to discuss a number of issues, but when hosts Harold Ford, Jr. and Wes Moore turned the discussion to Obamacare, Snyderman revealed just how far left her expert opinion leans, using the failures of the ACA as a means to push for a single-payer system.
Ford: As a physician, what’s the biggest fix that can be done to ensure that better care, affordable care gets to people that don't have it?
Snyderman: I think there should be a single-payer system. And, increasingly, you're seeing physicians in their late 50s, 60s, and 70s, who are saying, “You know what, we got it wrong. We should have taken Medicare, expanded it, and done it smarter. Increase the bottom line for doctors so they don’t feel like they’re being nickeled and dimed with 10% less than Medicare, 5%... Docs just want to be reimbursed a fair amount for hard work. This is making the terrain much, much, much, more difficult.
With Snyderman’s comments about Obamacare turning increasingly critical, Moore stepped in and tweaked the direction of the conversation to a more solution-based talking point:
“
Moore: You know what's interesting? So you talk about your kids and you talk about... one of the big challenges for Obamacare and the rollout so far has been how do we get the young and how do we get the healthy to sign up for healthcare? Which was a dynamic prior to Obamacare. How do we get the young and how do we get the healthy... That's the reason they came up with the plan.
Snyderman: So I made my kids sign up, because I just said this is your patriotic duty.
The expert opinion of NBC’s chief medical editor.*****
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http://en.wikipedia.org/wiki/Health_care_in_Israel
From the entry:
Israel has maintained a system of socialized health care since its establishment in 1948, although the National Health Insurance law was passed only on January 1, 1995. The state is responsible for providing health services to all residents of the country, who can register with one of the four health service funds.
...
Participation in a medical insurance plan with one of the four national HMOs is compulsory for all citizens, who can select and participate in any one of them regardless of factors such as age, gender, or pre-existing conditions.
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Ah, the last vestiges of Israel's failed experimentation with socialism mean we should also have our own massive failures!
http://en.wikipedia.org/wiki/Health_care_in_Israel
From the entry:
Israel has maintained a system of socialized health care since its establishment in 1948, although the National Health Insurance law was passed only on January 1, 1995. The state is responsible for providing health services to all residents of the country, who can register with one of the four health service funds.
...
Participation in a medical insurance plan with one of the four national HMOs is compulsory for all citizens, who can select and participate in any one of them regardless of factors such as age, gender, or pre-existing conditions.
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Failed how? It appears that the services provided are excellent. It is also a large portion of the country's homeland security, even without being law enforcement.
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http://dailycaller.com/2013/12/29/obama-administration-announces-net-loss-of-at-least-4-million-insurance-plans/
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Failed how? It appears that the services provided are excellent. It is also a large portion of the country's homeland security, even without being law enforcement.
So your definition of homeland security is unsustainable government spending?
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If there is something that I've learned over the years it's that you (think you) know more than experts.
I'll trust this guy:
NADAV MORAG is a faculty member at the Center for Homeland Defense and Security (CHDS), US Naval Postgraduate School. At CHDS he teaches courses on policy analysis and research methodology as well as a course entitled "Comparative Government for Homeland Security." He has authored articles on terrorism, strategy, and the Middle East, including "The Economic and Social Effects of Intensive Terrorism: Israel 2000-2004" (Middle East Review of International Affairs) and "Measuring Success in Coping with Terrorism: The Israeli Case" (Studies in Conflict and Terrorism). He previously served as a senior director at Israel's National Security Council where he was responsible for developing policy recommendations in areas of national security for the prime minister and the cabinet.
Who wrote this: http://www.wiley.com/WileyCDA/WileyTitle/productCd-0470497149.html
Failed how? It appears that the services provided are excellent. It is also a large portion of the country's homeland security, even without being law enforcement.
So your definition of homeland security is unsustainable government spending?
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I see that law enforcement is covered in chapter 4. I don't see government healthcare-generational theft schemes listed. And, no public health isn't included in that. Stopping pandemics/bioweapons is different than mandating the public buy insurance that covers gender reassignment surgery.
One thing I've noticed about you is that you are all too willing to grovel before anyone you think has the proper credentials. It's what academia does, I know. Unfortunately all that time in the ivory tower prevents one from tangible real world experience, which might allow one to discern bullshit, even when it's wrapped in an academically compliant or MSM shiny package.
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"I see that law enforcement is covered in chapter 4. I don't see government healthcare-generational theft schemes listed. And, no public health isn't included in that. Stopping pandemics/bioweapons is different than mandating the public buy insurance that covers gender reassignment surgery."
You are quite right: law enforcement is covered. But there is, in fact, so much more that law enforcement covered in the book. Israel includes public health in its responses to homeland security threats.
"One thing I've noticed about you is that you are all too willing to grovel before anyone you think has the proper credentials. It's what academia does, I know. Unfortunately all that time in the ivory tower prevents one from tangible real world experience, which might allow one to discern bullshit, even when it's wrapped in an academically compliant or MSM shiny package."
I actually came back to edit the beginning of my previous post. I was frustrated about something else. Too late for that, but thanks for making my point for me. You are probably right. I can't imagine how some who "previously served as a senior director at Israel's National Security Council where he was responsible for developing policy recommendations in areas of national security for the prime minister and the cabinet" might have proper credentials to know a damn thing about Israeli homeland security.
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That was a more general statement and not a critique of the above author.
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http://www.nytimes.com/2014/01/03/health/access-to-health-care-may-increase-er-visits-study-suggests.html?nl=todaysheadlines&emc=edit_th_20140103
Supporters of President Obama’s health care law had predicted that expanding insurance coverage for the poor would reduce costly emergency room visits because people would go to primary care doctors instead. But a rigorous new experiment in Oregon has raised questions about that assumption, finding that newly insured people actually went to the emergency room a good deal more often.
The study, published in the journal Science, compared thousands of low-income people in the Portland area who were randomly selected in a 2008 lottery to get Medicaid coverage with people who entered the lottery but remained uninsured. Those who gained coverage made 40 percent more visits to the emergency room than their uninsured counterparts during their first 18 months with insurance.
The pattern was so strong that it held true across most demographic groups, times of day and types of visits, including those for conditions that were treatable in primary care settings.
The findings cast doubt on the hope that expanded insurance coverage will help rein in emergency room costs just as more than two million people are gaining coverage under the Affordable Care Act. And they go against one of the central arguments of the law’s supporters, that extending insurance to large numbers of Americans would reduce emergency room use, and eventually save money.
In remarks in New Mexico in 2009, Mr. Obama said: “I think that it’s very important that we provide coverage for all people because if everybody’s got coverage, then they’re not going to the emergency room for treatment.”
The study suggests that the surge in the numbers of insured people may put even greater pressure on emergency rooms, at least in the short term. Nearly 25 million uninsured Americans could gain coverage under the law, about half of them through Medicaid. The first policies took effect on Wednesday.
“I suspect that the finding will be surprising to many in the policy debate,” said Katherine Baicker, an economist at Harvard University’s School of Public Health and one of the authors of the study.
An administration spokeswoman, Tara McGuinness, said that the time frame was too short to expect much of a change, and that over the longer term, use would most likely decline. She pointed to a longer-term study in Massachusetts, which expanded coverage for its residents in 2006, that found an 8 percent decline in emergency department use over a period of several years.
“Medicaid saves lives and improves health outcomes,” Ms. McGuinness said. “Plenty of studies show that.”
But many economists say that the emphasis on emergency room use, both in policy and in political speeches, is misplaced, as it makes up only a small part of health care costs in the United States. A federal government health survey found that emergency departments accounted for about 4 percent of total health spending in 2010, far less than inpatient hospital visits, which accounted for about 31 percent. Certain populations, however, like low-income people with chronic illnesses, have much higher rates of use.
Dr. Baicker and Amy Finkelstein, an economist at the Massachusetts Institute of Technology, another author, said the increased use of emergency rooms is driven by a basic economic principle: When services get less expensive, people use them more. Previous studies have found that uninsured people face substantial out-of-pocket costs that can put them in debt when they go to the emergency room. Medicaid reduces those costs.
Medicaid coverage also reduces the costs of going to a primary care doctor, and a previous analysis of data from the Oregon experiment found that such visits also increased substantially.
“This is just one piece of an increase we found across every type of care,” said Bill J. Wright, an author of the new study who is the associate director of the Center for Outcomes Research and Education in Portland, a part of Providence Health and Services, a large health care provider.
The study’s authors emphasized that Medicaid had many benefits. Previous analyses from the experiment found that gaining coverage reduced the incidence of depression and increased feelings of financial stability.
The study drew on data from the Oregon Health Insurance Experiment that included about 90,000 low-income Oregonians and randomly assigned about 30,000 of them access to Medicaid. Health experts say the experiment’s design — random assignment of coverage through a lottery — allowed them to isolate and evaluate the effects of the program. Such designs are the gold standard in medical research, but are rarely used for domestic health care policy.
continues , , ,
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****"One thing I've noticed about you is that you are all too willing to grovel before anyone you think has the proper credentials. It's what academia does, I know. Unfortunately all that time in the ivory tower prevents one from tangible real world experience, which might allow one to discern bullshit, even when it's wrapped in an academically compliant or MSM shiny package."
I actually came back to edit the beginning of my previous post. I was frustrated about something else. Too late for that, but thanks for making my point for me. You are probably right. I can't imagine how some who "previously served as a senior director at Israel's National Security Council where he was responsible for developing policy recommendations in areas of national security for the prime minister and the cabinet" might have proper credentials to know a damn thing about Israeli homeland security.****
From the education thread is my proposal to beware the academic industrial government complex.
OF course there is much to learn from our scientific community. But much harm can come from it too.
We are seeing an infinite exponential rise in "studies" and experiments the vast majority of which are total BS. We see it in the health field ALL the time. If one or two percent of all the research done actually gives us new meaningful information that changes the way we practice medicine that is a lot.
Indeed look at how many times over the last decade we in the medical community have kept changing our recommendations.
For example I just read online that Vit E supposedly helps delay Alzheimer's ( a tad by maybe six months - at best). In the nineties this was claimed too until additional tests suggested it might worsen or not help. So which the "f" is it? I would not recommend anyone waste their money on high doses of Vit E (2,000 IU per day).
I guarantee one thing. We will hear over the radio, the cable, the online airwaves many shysters selling us their Vit E promoting with this study as the evidence that it is real.
I do question whether these professors have already cut deals with the promoters of these products to cash in. They are supposed to report "conflict of interests". Don't count on it. And don't think for one second this doesn't happen either.
There are many great men and women in academia. But there are just as many scum bags as every other sector of society. So GM is absolutely correct in taking academic's claims with some skepticism.
The spread of controlled trials into economics is just another example of the tumbleweed spreading of "science". Also I have shown in posts years past how anyone can often juggle the data to suggest any outcome best for their cause.
The academic industrial government complex. To all of us - BEWARE.
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http://en.wikipedia.org/wiki/Health_care_in_Israel
From the entry:
Israel has maintained a system of socialized health care since its establishment in 1948, although the National Health Insurance law was passed only on January 1, 1995. The state is responsible for providing health services to all residents of the country, who can register with one of the four health service funds....
Participation in a medical insurance plan with one of the four national HMOs is compulsory for all citizens, who can select and participate in any one of them regardless of factors such as age, gender, or pre-existing conditions.
I think the importance of this post was missed and deserves addressing. I was confused by the title and others went off on other tangents. If I am not mistaken, Bigdog is asking, if this works in Israel, why not here?
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Nice catch Doug.
Yes, the question is worthy.
My first stab at it: Would Israel be able to afford it without US military and economic aid? I am not asserting here, I am asking.
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I asked no questions, I was merely pointing to fact.
http://en.wikipedia.org/wiki/Health_care_in_Israel
From the entry:
Israel has maintained a system of socialized health care since its establishment in 1948, although the National Health Insurance law was passed only on January 1, 1995. The state is responsible for providing health services to all residents of the country, who can register with one of the four health service funds....
Participation in a medical insurance plan with one of the four national HMOs is compulsory for all citizens, who can select and participate in any one of them regardless of factors such as age, gender, or pre-existing conditions.
I think the importance of this post was missed and deserves addressing. I was confused by the title and others went off on other tangents. If I am not mistaken, Bigdog is asking, if this works in Israel, why not here?
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Don’t Bail Out the Big Insurance Companies
When so many Americans are paying much higher prices for health insurance under Obamacare and others can’t even afford to buy coverage, it is wrong for our money to be used to bail out giant insurance companies. But as Charles Krauthammer points out in his recent column, an insurance company bailout is already written into the law, just waiting to kick in if the best-laid plans of the politicians and the bureaucrats go awry.
To keep their costs (and our premiums) under control, insurance plans need about 4 in 10 of those who enroll to be young and relatively healthy -- the type of people who might be less inclined to buy insurance in the first place. If the rate of young people signing up for coverage is much lower than that, insurers will be in a financial bind, paying the expensive medical bills of older Americans without more profitable young customers to balance out the cost.
Normally that would force the insurance companies to raise their premiums to cover the shortfall. President Obama, however, knew that a process of rising prices and declining healthy enrollees would destroy Obamacare. They needed a solution that would hide the true costs. That solution was a taxpayer bailout for insurance companies.
To compensate the insurance companies for the risk of signing on to Obamacare, the law's designers slipped in a massive bailout provision: if the companies’ costs turned out to be higher than they “anticipated,” the federal government can cover as much as 80 percent of their losses.
This is a system that encourages the insurance companies to be unrealistic about their risks because you the taxpayer are set up to cover their mistakes.
After months of failing exchanges, there’s good reason to believe that the customers who endured the frustration of online enrollment are the ones who need health coverage the most--in other words, the most expensive customers. Compounding the problem, the Obama administration has been modifying the law by presidential pronouncement, largely in ways that will diminish the number of young and healthy people enrolling. As Krauthammer describes in his column: First, it postponed the employer mandate. Then it exempted from the individual mandate people whose policies were canceled (by Obamacare). And for those who did join the exchanges, Health and Human Services Secretary Kathleen Sebelius is “strongly encouraging” insurers — during the “transition” — to cover doctors and drugs not included in their clients’ plans.
The insurers were stunned. Told to give free coverage. Deprived of their best customers. Forced to offer stripped-down “catastrophic” plans to people age 30 and over (contrary to the law). These dictates, complained an insurance industry spokesman, could “destabilize” the insurance market. These modifications threaten to make the insurance plans on the Obamacare exchanges financially unsustainable, which would put the taxpayers on the hook for an expensive--in fact, virtually unlimited--bailout of the insurance companies.
Americans should say “no” to a bailout of the giant insurance companies. Read Charles Krauthammer’s column here. Then sign our petition:
I call on Congress to block any bailout for big insurance companies under Obamacare by repealing sections 1341 and 1342 of the Affordable Care Act. When Americans have to pay more for insurance and many cannot even buy insurance it is totally wrong for our money to be used to bail out giant insurance companies.
I will let my friends know that they should sign this petition also.
No taxpayer bailout for insurance companies.
Sign the Petition Now
Your Friend,
Newt
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Patriot Post
Hope 'n Change: The Big Insurance Bailout
While a lot of conversation is percolating about ObamaCare being the gateway to a single-payer health care system such as those strangling Canada and the United Kingdom, there's another financial concern for the interim and it involves those insurance companies allowed to participate in the various federal and state exchanges. Few can escape the fact that health plans now feature higher premiums and deductibles than the ones we were supposed to be able to keep if we liked them. Since there's such a disincentive to purchase, Democrats had to ensure that insurance companies would survive. That requires the right incentives and enough taxpayer money to make it worth their while.
Charles Krauthammer shrewdly points out in a recent column that Sections 1341 and 1342 of the Patient Protection and Affordable Care Act provide a means for the federal government to bail out insurers who are seeing the coveted youth market decide to forgo coverage while those who can afford the coverage thanks to massive federal subsidies tend to be older and sicker. In a normal market, this would be a recipe for failure.
But Section 1341, writes Krauthammer, provides for a $20 billion "reinsurance" fund over the next three years while Section 1342 allows insurers who have costs as little as 8% over a predetermined "target" amount to recoup 80% of these excesses. As Newt Gingrich notes, "This is a system that encourages the insurance companies to be unrealistic about their risks because you the taxpayer are set up to cover their mistakes."
As Krauthammer sees it, the solution would be to excise both these bailouts from ObamaCare, either as a standalone measure or as an amendment to the upcoming debt ceiling bill. In the current political climate, though, the question is whether GOP leadership would carry through with such a fight.
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Hey, let future generations pick up the tab! What's a couple trillion more among friend?
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Hat tip to my friend Walter:
http://www.huffingtonpost.com/2014/01/09/ron-johnson-obamacare-doctor_n_4571524.html
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Ezra Klein is a liberal commentator, is correcting liberals here, and has a liberal idea of where healthcare should go. Opinions and solutions aside, I think he does a pretty good job here getting at key facts on health care systems and participants.
What Liberals Don’t Get About Single Payer
By Ezra Klein Jan 8, 2014 Bloomberg
http://www.bloomberg.com/news/2014-01-08/what-liberals-don-t-get-about-single-payer.html
Documentarian Michael Moore greeted the introduction of Obamacare with an admission many liberals will cheer. “Obamacare is awful,” he wrote.
Its awfulness, Moore said, stems from “one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go.”
Like Moore, I’d prefer a more nationalized health-care system. But his analysis relies on a common mistake that distorts both the benefits of single-payer systems and the deficiencies peculiar to Obamacare.
Insurers are the bogeymen of American health care. That’s in part because they do a lot of the unpopular stuff: They’re the ones who charge you money for health care, who say you can’t get something you want, who your bosses blame when they deduct more money from your paycheck to cover health costs. And it’s hard to see what value they add to the system.
Yet the problem with the Affordable Care Act isn’t the insurance industry. In fact, the main benefits of nationalized health care can be achieved in systems with hundreds, even thousands, of for-profit insurers.
Insurers aren’t even where the big money goes. In 2009, Forbes ranked health insurance as the 35th most profitable industry, with an anemic 2.2 percent return on revenue. To understand why the U.S. health-care system is so expensive, you need to travel higher up the Forbes list. The pharmaceutical industry was in third place, with a 19.9 percent return, and the medical products and equipment industry was right behind it, with a 16.3 percent return. Meanwhile, doctors are more likely than members of any other profession to have incomes in the top 1 percent.
In general, Americans don’t use more health care than citizens of other countries. But we pay a lot more for the health care we do get. Data gathered by the International Federation of Health Plans show that an MRI costs, on average, $1,121 in the U.S. and $363 in France. An appendectomy costs $13,851 in the U.S. and $4,782 in Switzerland. A birth by cesarean section costs $3,676 in the U.S. and $606 in Canada. A bottle of Nexium -- a common acid-reflux drug -- costs $202 in the U.S. and $32 in the U.K.
The dirty truth about American health care is that it costs more not because insurers are so powerful, but because they’re so weak.
There are few truly single-payer systems in the developed world. Canada has one, as does Taiwan. Most countries rely on many, many insurers. Germany, for instance, has more than 150 “sickness funds.” The Swiss and Dutch health systems look a lot like Obamacare’s health-insurance exchanges. In France, about 90 percent of citizens have supplementary health insurance. Sweden has moved from a single-payer system to one with private insurers. Yet all these countries pay vastly less for drugs, surgeries or doctor visits than Americans do.
Why? Because in every case the government sets prices for health-care services and products. Insurers in Switzerland don’t negotiate drug prizes with Pfizer. The Swiss government simply sets its drug prices and lets Pfizer decide whether to sell in Switzerland -- or not.
“The problem is that in the U.S. payers are fragmented while in other countries they are unified even if there are many insurers,” said Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins University.
In the U.S., insurers negotiate with hospitals and drug companies on their own -- and they pay more as a result. In fact, because of their weak negotiating position they frequently use whatever price Medicare is paying as a baseline and then, because they lack the power to strike a similar deal, add a percentage on top. Joshua Gottlieb, an economist at the University of British Columbia, found that when Medicare increases what it pays for a service by $1, private insurers increase their payments by $1.30.
That leaves the U.S. with the worst of both approaches: Prices aren’t set by the market, but they also aren’t set by the government. Consequently, Medicare’s negotiating power is weakened by the threat that drug companies or hospitals will opt to do business only with higher-paying private insurers. We simultaneously miss out on the efficiency of a purely private system and on the savings of a purely public one.
If insurers lose on negotiating with medical providers, however, they’re much better than the government at innovating on insurance design. Co-pays and deductibles aren’t popular, but they work. Many insurers are experimenting with ways to create incentives for better health, including using personal technology -- everything from e-mails to smartphone cameras. (The disastrous introduction of the Obama administration’s HealthCare.gov website hardly instills confidence in the government’s capacity to exploit digital medicine with similar efficiency.)
“Single payer isn’t a panacea,” said Uwe Reinhardt, a health economist at Princeton University. “The magic they have is setting rates. But neither Medicare nor Canada has done anything innovative on the delivery side. Taiwan is trying a little bit but not a whole lot. By and large they just pay bills.” The limitations of single-payer systems became clear during the health-care debate, when the Congressional Budget Office projected that premiums for a public option would be higher than premiums for private insurance -- unless a public option could avail itself of Medicare’s pricing power.
A health-care system that followed international best practices would direct the government to set rates. Or it would let insurers band together and negotiate rates collectively -- a practice called “all-payer rate setting.” But it wouldn’t need to eliminate private insurers. It’s good for consumers to have a choice of insurers, who have real incentives to innovate and devise better ways to keep customers healthy and costs down.
It’s health-care providers -- not insurers -- who have too much power in the U.S. system. As a result, they have the most to lose if health-care prices fall. But, as is often the case, political power flows in part from popularity. So politicians who routinely rail against for-profit insurers are scared to criticize -- much less legislate against -- for-profit hospitals, doctors or device manufacturers (though drug companies come in for a drubbing now and then). These are the people who work every day to save our lives, even if they make us pay dearly for the privilege.
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http://www.bankrate.com/finance/taxes/top-1-percent-earn.aspx
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Ummm , , , did you mean to put this in the Political Economics thread?
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Obamacare, also known as Generational Theft 2.0, is advertising aggressively to young people. It's hip, it's cool to go to the exchanges and get covered. It is also kind of a silly (and wasteful) exercise to advertise that which will shortly be mandated. We need young, healthy people who won't use the services to sign up and pay to cover old sick people who will sign up and use/over-use the services.
Real ads to sell things have prices in the ads: iphones, cars, tires, furnaces. Healthcare coverage is just hip, and easy! Just a click or two and give away every personal piece of information you have away from new coverage.
So how is the government healthcare ad campaign to young people going?
Besides the disappointing total number of people signing up, less than a quarter of them are young people when the targeted percentage was 40%.
With its first public disclosure of Obamacare demographic data, the Department of Health and Human Services said that of the 2.2 million who enrolled in new health plans through federal and state exchanges by Dec. 28, just 24 percent were between the ages of 18 and 34. …
The White House, however, originally estimated that 2.7 million of a projected 7 million people — or nearly 40 percent — enrolling in Obamacare by the end of March would be from the youngest demographic.
http://washingtonexaminer.com/quarter-of-obamacare-sign-ups-are-young-adults-short-of-target/article/2542085
79% of all signups are eligible for subsidies. The small minority who do not receive subsidies (21%) are obviously not enough to pay the freight for the 79% who get government money, so it is hard to see how Obamacare can ever add up as a sustainable program. Unless the administration assumes that it will be an endless drain on the federal budget.
http://www.powerlineblog.com/archives/2014/01/obamacare-numbers-arent-adding-up.php
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http://www.foxnews.com/tech/2014/01/16/world-greatest-hacker-calls-healthcaregov-security-shameful/
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A survey by management consulting firm McKinsey & Co. found that only 11 percent of consumers who purchased new coverage under ObamaCare were previously uninsured. The survey was based on a sampling of 4,563 consumers between November and January, according to The Wall Street Journal.
http://www.foxnews.com/politics/2014/01/18/most-obamacare-enrollees-already-have-health-plans-report-says/
http://www.forbes.com/sites/theapothecary/2014/01/18/coverage-expansion-fail-less-than-one-third-of-obamacare-exchange-enrollees-were-previously-uninsured/
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It's about seizing power and control over the public. It was never about insuring the uninsured.
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Patriot Post
Former Marine Corps cyberwarfare expert David Kennedy has been testing Healthcare.gov for some time, warning all along about its security vulnerabilities. Now that the administration has "fixed it," however, he says the site is "much worse off" than ever. As for no successful hacks to date, Kennedy warns, "They haven't detected any attacks on the website, because they don't have the capability to detect them." That's bad, but it gets worse. He says you don't even really have to "hack" the website because it's more akin to leaving your car doors wide open: "You can literally just open up your browser, go to this [query] and extract all this information." If you like your security, you can keep it.
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Besides hope and change and finding out what's in it after 'we' pass it, what was the point of this legislation again?
http://www.nbcnews.com/health/health-care-law-affects-those-insurance-through-work-too-2D11959089
The law may prompt some companies to drop coverage for their part-time workers and send them to public health insurance exchanges. - AP / NBC News, Jan. 21, 2014
MINNEAPOLIS, MN Jan. 22, 2014 (UPI) --
U.S. retail giant Target Corp. said that due to the healthcare law it would discontinue health insurance options for part-time workers.
Twin Cities Business magazine: http://tcbmag.com/News/Recent-News/2014/January/Target-Cuts-Hundreds-Of-Jobs,-Drops-Insurance-For
Target Cuts 475 Jobs, Drops Insurance For Part-Timers
http://online.wsj.com/news/articles/SB10000872396390443437504577545770682810842
Deloitte: One in 10 US Employers to Drop Health Coverage - WSJ July 12, 2012
http://online.wsj.com/news/articles/SB10001424052748703431604575522413101063070
Sept. 30, 2010
McDonald's Corp. has warned federal regulators that it could drop its health insurance plan for nearly 30,000 hourly restaurant workers unless regulators waive a new requirement of the U.S. health overhaul.
http://www.mckinsey.com/insights/health_systems_and_services/how_us_health_care_reform_will_affect_employee_benefits
A February 2011 [McKinsey] survey of private sector employers offers a snapshot of attitudes that suggests the shift away from employer-provided health insurance could be greater than expected
http://www.denverpost.com/business/ci_23930637/companies-dropping-spouses-health-insurance-coverage
Companies cutting health insurance cost may mean dropping coverage for spouses
http://www.businessweek.com/articles/2013-03-08/why-your-employer-may-drop-your-health-care-plan
Why Your Employer May Drop Your Health-Care Plan
March 08, 2013
http://www.kaiserhealthnews.org/stories/2013/october/21/cancellation-notices-health-insurance.aspx
Oct 21, 2013
Health plans are sending hundreds of thousands of cancellation letters to people who buy their own coverage, frustrating some consumers who want to keep what they have and forcing others to buy more costly policies.
http://www.huffingtonpost.com/2013/09/11/trader-joes-obamacare_n_3902341.html
Trader Joe's To Drop Health Coverage For Part-Time Workers Under Obamacare
09/11/2013
http://insurance.about.com/od/HealthIns/a/In-2014-Ten-Precent-Oflarge-Employers-May-Cease-Health-Benefits.htm
acorrding to new emploer surveys nearly 1 of every 10 midsized or big employers expect to stop offering health coverage to workers after insurance exchanges begin operating in 2014 as part of President Barack Obama's PPACA health legislation.
http://money.cnn.com/2013/08/21/news/companies/ups-obamacare/
UPS cuts insurance to 15,000 spouses, blames Obamacare August 22, 2013
http://www.cnbc.com/id/100456557 CNBC 13 Feb 2013
Drop Coverage or Cut Hours? Big Companies Grapple With Obamacare
http://www.naturalnews.com/041815_us_companies_healthcare_plans_obamacare.html
Forty percent of U.S. companies to alter health care plans, drop coverage, due to Obamacare
http://www.cbsnews.com/news/arrival-of-obamacare-forcing-insurers-to-drop-customers-with-low-coverage/
Arrival of Obamacare forcing insurers to drop customers with low coverage
http://www.nationalrighttolifenews.org/news/2013/10/list-of-companies-that-will-drop-health-insurance-under-obamacare-spreads-to-include-a-quasi-public-entity-the-fairfax-county-water-authority/
List of companies that will drop health insurance under ObamaCare spreads to non-profits and public entities
http://cnsnews.com/news/article/30-percent-employers-drop-health-coverage-because-obamacare
A survey of 1,300 employers finds that 30 percent will “definitely or probably” stop offering health insurance to their employees due to new requirements imposed by the Obamacare health reform law. June 7, 2011
Who knew?! No, really, who knew? Were the people who wrote and the people who passed it really too stupid or naive to know this would happen? DO THEY STILL NOT KNOW??!!
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Famous people are reading the forum, or maybe it's just that perplexed minds think alike.
Last night, I wrote:
"what was the point of this legislation again?"
http://dogbrothers.com/phpBB2/index.php?topic=1411.msg78572#msg78572
This morning on National Review:
So What Was The Point of Obamacare Again? By Jonah Goldberg January 23, 2014 7:40 AM
http://www.nationalreview.com/corner/369238/so-what-was-point-obamacare-again-jonah-goldberg
He also seems to have lifted a joke from G M. Goldberg tweeted:
”They said if I voted for Mitt Romney, the ranks of the uninsured would continue to swell. And they were right!”
From the National Review article:
"[Obamacare] created more uninsured people than it gave insurance to. And it promises to create even more."
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:-o :-o :-o :-o :-o: From Forbes:
Matthew Herper
Matthew Herper, Forbes Staff
I cover science and medicine, and believe this is biology's century.
1/28/2014 @ 4:14PM |185,868 views
The Proposed Republican Replacement For ObamaCare Is A Big Tax Hike
Sen. Orrin Hatch (AP Photo/J. Scott Applewhite)
Sen. Orrin Hatch (AP Photo/J. Scott Applewhite)
Yesterday, three Republican Senators — Tom Coburn (Okla.), Richard Burr (N.C.), and Orrin Hatch (Utah) – put forward a plan to “repeal and replace” the Affordable Care Act, otherwise known as Obamacare. They call it the Patient CARE Act, and my colleague Avik Roy says it is “the most credible plan yet” offered by the GOP.
Senate Republicans Develop The Most Credible Plan Yet To 'Repeal And Replace' Obamacare Avik RoyAvik Roy Forbes Staff
ObamaCare Raises Health Insurance Premiums, Especially For The Young Matthew HerperMatthew Herper Forbes Staff
The Chart That Could Sink Obamacare Chris ConoverChris Conover Contributor
Except the Coburn-Burr-Hatch plan (read it here) amounts, among other things, to a big tax increase. The main way that it remains budget neutral is by making employer-provided health insurance plans, which are currently not taxed, partially taxable as income. In fact, this income replaces income that, under ObamaCare, comes from taxing companies, including the tax on medical device companies paid by firms like Medtronic and Stryker .
This fact has not escaped the notice of some prominent health reform allies. “It is a huge tax increase on workers without any confidence that they will be able to afford health insurance in the future,” says Bob Kocher, a partner at venture capital firm Venrock who previously worked in the Obama administration.
It is “essentially a very large Republican tax increase,” says Ezekiel Emanuel, the Diane V.S. Levy and Robert M. Levy University Professor of Medical Ethics and Health Policy at the University of Pennsylvania and another former Obama advisor. “It’s quite clear the plan is to put a bigger burden on middle class Americans.”
Here’s what the Senators propose: right now, health insurance is not taxed as income. This is arguably the original sin of the U.S. healthcare system, which has insulated consumers from health costs and allowed prices to skyrocket. During World War II, wages were frozen but pensions and benefits were exempted; in 1943 the Internal Revenue Service ruled that these benefits weren’t taxable, either.
Many health economists believe this is a bad thing, because it shields people from paying their own premiums, and Coburn, Burr, and Hatch deserve credit for tackling this head on. But that doesn’t make this any more politically workable – or appealing to those of us who get health insurance through our employers.
They write:
“
Therefore, our proposal caps the tax exclusion for employee’s health coverage at 65 percent of an average plan’s costs. The value of employer-sponsored health insurance would be capped and indexed to grow at an annual rate of CPI +1.
Taxing 35% of the average plan – and more than that for plans that are above-average, as half are, could amount to a substantial tax. Tying the growth of the tax-exempt portion of the plan to the Consumer Price Index would also limit the cost of plans, pushing cost-saving measures.
How big a tax might this be for an average American family? Ezekiel has some numbers. The average employer health plan for a family of four costs $16,351, according to the Kaiser Family Foundation, and the employer covers 72% of that, or $11,772. Thirty-five percent of $11,772 is $4,120.35. The employee’s share of the Social Security and Medicare payroll tax is 7.65%, or $315.21. Assuming this family of four is in the 25% marginal income tax bracket, that would add another $1,030.09, for a total tax increase of $1,345. (For more from Emanuel, see this Times piece.)
Up to 300% of the poverty line, there would be subsidies to help people buy insurance. It’s not immediately clear how these compare to the subsidies offered by Obamacare; they don’t look greater.
Removing a bunch of corporate taxes so that the middle class can pay more seems like a political non-starter, even given the public backlash against Obamacare. This plan would likely mean that more people would lose insurance, or be forced to go to smaller networks of doctors. Those are the same criticisms levied against the Affordable Care Act.
Another notable thing about the proposal is how much of the ACA it keeps: it gets rid of state healthcare exchanges, but it keeps the basic structure of trying to keep people in the insurance system (in this case by making pre-existing conditions something that insurers can’t use against you until you fail to sign up for coverage – and then you get slammed) and of paying subsidies to help poor people get insurance. Allowing less comprehensive benefits and allowing insurers to charge five times as much for their sickest and oldest customers as for their youngest and healthiest, compared to three times under Obamacare, could lower the cost of insurance for young people and get more of them in the system.
“The plan makes specific proposals worthy of serious consideration- although I doubt it receives it at this moment,” says Ronald Williams, the former chairman of Aetna. “Perhaps in the future it could be the foundation of serious conversations which could lead to bipartisan evolution of the current bill.”
What the plan does emphasize is the degree to which any plan to reform the insurance system can seem like a zero-sum game – the money has to come from somewhere. For insurers involved in the ObamaCare exchanges, like Humana, Molina Healthcare, and Centene, the legislative roller-coaster ride may be far from over.
Senator Hatch’s office did not return a request for comment.
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subsidies shall be available to persons who purchase health insurance in an exchange “established by the state.”
Four words in the ACA could spell its doom
http://www.washingtonpost.com/opinions/george-f-will-four-words-in-the-aca-could-spell-its-doom/2014/01/29/e26a33cc-884a-11e3-a5bd-844629433ba3_story.html
By George F. Will, Published: January 29
Someone you probably are not familiar with has filed a suit you probably have not heard about concerning a four-word phrase you should know about. The suit could blow to smithereens something everyone has heard altogether too much about, the Patient Protection and Affordable Care Act (hereafter, ACA).
Scott Pruitt and some kindred spirits might accelerate the ACA’s collapse by blocking another of the Obama administration’s lawless uses of the Internal Revenue Service. Pruitt was elected Oklahoma’s attorney general by promising to defend states’ prerogatives against federal encroachment, and today he and some properly litigious people elsewhere are defending a state prerogative that the ACA explicitly created. If they succeed, the ACA’s disintegration will accelerate.
Because under the ACA, insurance companies cannot refuse coverage because of an individual’s preexisting condition. Because many people might therefore wait to purchase insurance after they become sick, the ACA requires a mandate to compel people to buy insurance. And because many people cannot afford the insurance that satisfies the ACA’s criteria, the ACA mandate makes it necessary to provide subsidies for those people.
The four words that threaten disaster for the ACA say the subsidies shall be available to persons who purchase health insurance in an exchange “established by the state.” But 34 states have chosen not to establish exchanges.
So the IRS, which is charged with enforcing the ACA, has ridden to the rescue of Barack Obama’s pride and joy. Taking time off from writing regulations to restrict the political speech of Obama’s critics, the IRS has said, with its breezy indifference to legality, that subsidies shall also be dispensed to those who purchase insurance through federal exchanges the government has established in those 34 states. Pruitt is challenging the IRS in the U.S. District Court for the Eastern District of Oklahoma, and there are similar challenges in Indiana, Virginia and Washington, D.C.
The IRS says its “interpretation” — it actually is a revision — of the law is “consistent with,” and justified by, the “structure of” the ACA. The IRS means that without its rule, the ACA would be unworkable and that Congress could not have meant to allow this. The ACA’s legislative history, however, demonstrates that Congress clearly — and, one might say, with malice aforethought — wanted subsidies available only through state exchanges.
Some have suggested that the language limiting subsidies to state-run exchanges is a drafting error. Well.
Some of the ACA’s myriad defects do reflect its slapdash enactment, which presaged its chaotic implementation. But the four potentially lethal words were carefully considered and express Congress’s intent.
Congress made subsidies available only through state exchanges as a means of coercing states into setting up exchanges.
In Senate Finance Committee deliberations on the ACA, Chairman Max Baucus (D-Mont.), one of the bill’s primary authors, suggested conditioning tax credits on state compliance because only by doing so could the federal government induce state cooperation with the ACA. Then the law’s insurance requirements could be imposed on states without running afoul of constitutional law precedents that prevent the federal government from commandeering state governments. The pertinent language originated in the committee and was clarified in the Senate. (See “Taxation Without Representation: The Illegal IRS Rule To Expand Tax Credits Under The PPACA,” by Jonathan H. Adler and Michael F. Cannon in Health Matrix: Journal of Law-Medicine.)
Also, passage of the ACA required the vote of every Democratic senator. One, Nebraska’s Ben Nelson, admirably opposed a federal exchange lest this become a steppingstone toward a single-payer system.
If courts, perhaps ultimately including the Supreme Court, disallow the IRS’s “interpretation” of the law, the ACA will not function as intended in 34 states with 65 percent of the nation’s population. If courts allow the IRS’s demarche, they will validate this:
By dispensing subsidies through federal exchanges, the IRS will spend tax revenues without congressional authorization. And by enforcing the employer mandate in states that have only federal exchanges, it will collect taxes — remember, Chief Justice John Roberts saved the ACA by declaring that the penalty enforcing the mandate is really just a tax on the act of not purchasing insurance — without congressional authorization.
If the IRS can do neither, it cannot impose penalties on employers who fail to offer ACA-approved insurance to employees.
If the IRS can do both, Congress can disband because it has become peripheral to American governance.
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When discussing health care issues, sometimes I run into people who are intrigued by what I am saying but then bring up something like this:
http://iwastesomuchtime.com/on/?i=86534
"WTF?" they say-- "Is this what you want to go back to with your repeal of Obamacare? WHY DOES THIS HAPPEN? Isn't Spain socialized medicine? Why shouldn't we do that here?"
Frankly, I don't have a good concise answer for that , , , and if I can't be concise, do I really understand?
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One politburo member's answer.
****Why Does Health Care Cost so Much in America? Ask Harvard’s David Cutler
BY Paul Solman November 19, 2013 at 5:23 PM EST
By David Cutler
The American health care system is structured differently from systems in other countries, making it more expensive. Photo courtesy of Joe Raedle/Getty Images.
Paul Solman: Harvard’s David Cutler is among the country’s foremost health economists, famous for — among other research — a controversial paper arguing that even our exorbitant health care industry, in terms of increased productivity and life span outcomes, delivers more than what we pay for it.
Cutler, who was profiled by Roger Lowenstein in the New York Times Magazine in 2005, subsequently worked for President Barack Obama on health care issues, and talked to us recently for a story about cost savings. But far more of what he had to say seemed worthwhile than what we have time to air. Here is some of it.
Paul Solman: Why does health care cost so much in America?
David Cutler: Let me give you three reasons why. The first one is because the administrative costs of running our health care system are astronomical. About one quarter of health care cost is associated with administration, which is far higher than in any other country.
Paul Solman: What’s the next highest?
MORE FROM THE BUSINESS DESK:
Harvard’s David Cutler on How to Cut Health Care Costs
David Cutler: About 10, 15 percent. Just to give you one example, Duke University Hospital has 900 hospital beds and 1,300 billing clerks. The typical Canadian hospital has a handful of billing clerks. Single-payer systems have fewer administrative needs. That’s not to say they’re better, but that’s just on one dimension that they clearly cost less. What a lot of those people are doing in America is they are figuring out how to bill different insurers for different systems, figuring out how to collect money from people, all of that sort of stuff.
The second reason health care costs so much in America is that the U.S. spends more than other countries do on many of the same things. Drugs are the most commonly noted item, where a branded drug will cost much more in the U.S. than in other countries. But, for example, doctors also earn more for doing the same thing in the U.S. than they do in other countries, and a lot of suppliers charge more for things like durable medical equipment in the U.S. than in other countries.
Paul Solman: And that’s not only doctors being paid more in this country, but the United States making the decision as a government not to buy drugs in bulk and therefore to bid down the price that pharmaceutical companies can charge.
David Cutler: The lowest prices for pharmaceuticals, and a variety of other medical devices and payments to physicians, are in government plans. So Medicaid gets the best prices on pharmaceuticals. In terms of physician payments, Medicaid payments are the lowest. Medicare payments are above that and private payments are above that. The more leverage the buyer has, the lower the price they get. That’s true in every industry. In health care, the United States doesn’t utilize that leverage as much as other countries do.
Paul Solman: Okay, so that’s two and what’s the third reason?
David Cutler: The third one is Americans receive more medical care than people do in other countries, not so much in terms of doctor visits, but if a person has a heart attack in the United States, they’re much more likely to get open heart surgery than they are in most other countries.
Go back to Canada. In all of Ontario there are 11 hospitals that can do open heart surgery. Pennsylvania has roughly the population of Ontario and it has a bit over 60 hospitals that can do open heart surgery. So there’s no way you can operate on as many people in Ontario as you can in Pennsylvania even if you operated around the clock.
Paul Solman: But that means that the people in Canada or in Ontario have to wait longer right?
David Cutler: Sometimes they wait longer. What’s much more common is that there’s a lot of gray area where it’s not clear if you need the open heart surgery or not, and in the U.S., people will get it and in Canada, they don’t. The interesting thing about it is that life expectancy or one-year mortality after a heart attack is the same in the two countries.
Is The Rise of Costs Inevitable?
Paul Solman: Are medical costs going to inevitably go up because there will always be new technologies and new technologies are always expensive?
David Cutler: Technology is the underlying driver and there will always be some of that, which is why health care will not be like other industries in terms of always, always going down in price.
On the other hand, there’s so much waste in the system — our best guess is that about a third of medical spending is not associated with improved outcomes — that for the next 15 to 20 years people believe that costs could be stable or falling as a share of the economy without cutting into necessary services — just by eliminating the things that are not necessary…
What we’ve done in Massachusetts is we’ve said, don’t just give people very high cost-sharing in general; do what’s called tiering it — that is, tell people that if you look for basic levels of care, you’re not going to face very high costs, but if you want to go to the teaching hospital for the routine procedure, you’re going to have to pay a lot for that. And we mandate that insurance companies have to tell people the price of any service. So if your doctor says you need an MRI, you can go on the computer and your insurance company’s website and figure out exactly your cost sharing at each place where they would do the MRI.
Paul Solman: So that will provide comparison shopping.
David Cutler: That’s on the demand side. Give people more skin in the game and give them the information so they can do real shopping.
Paul Solman: More skin in the game, meaning higher co-pays?
David Cutler: Higher co-pays. We know that people respond to co-payments and they like cheaper care. So the hope is to steer people to less expensive sites. We’ve also pushed very strongly that insurance payments to doctors and hospitals and other care providers not be based on volume (so-called “fee for service”), but instead be value-based payments.
So say, here’s a person with coronary artery disease. Pay a fixed amount for that person and let the medical professionals figure out how to treat that person, not with the incentive to do more and earn more, but with the incentive to figure out how to do what’s right and keep them from using very expensive services.
Paul Solman: But doesn’t that provide an incentive or a prod to the provider to stint on the services, stint on the MRI, say, that I might otherwise get?
David Cutler: What that’s being coupled with is a very aggressive approach to measuring quality. … Really what we’re doing is two things: one is on the demand side trying to make people smarter consumers, and the second is on the provider side, eliminating the monetary incentives to do more testing and procedures. Instead, let’s move to a system that says, “do what’s appropriate, make the patients better and you’ll get rewarded for it.”
What If I Want a Certain Procedure?
Paul Solman: Well it sounds ideal, but I just keep thinking that I’d want to go to the dermatologist every six months, say, just to check out every possible discoloration. I’m a little crazy that way, but also, I feel, maximally prudent.
David Cutler: A lot of provider organizations are putting the doctors on a salary basis. Let’s gather our doctors together to figure out what the evidence says is right. If the literature is clear, let’s make sure we do that 100 percent of the time. If the literature is not clear, let’s go through our records and see how we can do better. If the patient then wants more, then say, “Okay, fine, you can have that, but you’re going to pay a little more because that’s not what the literature says is necessary in your case.”
Paul Solman: Well, of course, presumably my insurance company is already trying to do that.
David Cutler: Typically they’re very bad at it though, and when they tell the doctors they’ve imposed this, it goes poorly.
Paul Solman: So right now, I go to a dermatologist on a regular basis — I’ve always had some skin difficulties, but I’ve never had a melanoma — and that’s covered by my insurance. You’re saying, hey, if I’m a little paranoid with regard to discolorations, fine, let me go, but then I ought to pay to do that?
David Cutler: Increasingly, I believe insurers will make you pay more for care that you want to do that’s not medically necessary.
Paul Solman: Well medically necessary by what standards?
David Cutler: Care that’s ordered; that’s not following some accepted standard. You see this in certain parts of the country where the insurers say, “We’ll pay only a fixed amount for a knee replacement. We’ve determined that high quality knee replacement can be had for $8,000 nearby you. So we’ll give you $8,000. Now if you want to go to someone else who charges $20,000, fine, but you’re gonna pay the extra $12,000.”
Paul Solman: And my insurer did that recently with regard to a bronchial inhaler and said, “No, you can’t get that one; you can only get this cheaper one.”
David Cutler: Exactly, it’s what they’ve been doing with drugs for quite a long time. The generic version is very cheap; the branded drug is much more expensive.
In a lot of parts of the country, they’re just saying, “Look, if you want this service at all, you’re going to pay a lot of money.” The trend in health care nationally is to put more and more on the patient.****
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Interesting, thank you for that , , , but even more so now my question remains :-D
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This is interesting as I had patients coming in reporting they did not want drugs I prescribed because they were too expensive. I was shocked since these were drugs that should have been quite inexpensive.
Now I connect the dots.
Thanks again Brock and your liberal revolutionaries:
http://www.breitbart.com/Big-Government/2014/01/31/Why-Are-Costs-For-Generic-Medications-Soaring
What a great well meaning guy he is..... :-P
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From Crafty's link:
"The average cost of a hip replacement in the US is $40,364."
"The same operation in Spain costs an average of $7371."
"I don't have a good concise answer for that , , , and if I can't be concise, do I really understand?"
There are two aspects to this: Why is healthcare here so expensive, and a specific example is cited of the same procedure performed in two different places.
If the price difference is more than a plane ticket, and the quality, availability, reliability etc. are identical, why would people not just go there? http://www.nytimes.com/2013/08/04/health/for-medical-tourists-simple-math.html?_r=0
Prices are not coming down because there is no competitive market to drive them down, before or after Obamacare.
From the NY Time piece: "hospital charges (for hip replacement) run $65,000, not including the surgeon’s fee".
If you asked the surgeon what exactly he needs in a hospital room to perform a hip replacement, I don't see how it comes to $65,000. The surgical time for a hip replacement is 25 to 30 minutes. http://medicine.missouri.edu/ortho/Bal/hip-replacement-basics.html
US heathcare is a cartel, IMHO. State law (MN) requires all hospitals to be "non-profit" which makes it worse. Obamacare continues all those problems and adds a plethora more. Everything we do in terms of public policy and healthcare policy, it seems to me, is designed to make things more expensive.
The non-profit requirement is a joke. The NFL is a non-profit and the commissioner makes $30 million/yr. http://www.showbiz411.com/2014/01/21/nfl-commish-makes-29-5-mil-a-year-15-times-more-than-tax-free-org-gives-to-charity-more-than-ceos-of-ford-heinz-fedex Large hospitals take in and disburse hundreds of millions of dollars per year (or more).
Our system is flawed, and the Soviet-style, central-planned model is worse.
I'm sure that still did not answer your question. But if you look into the Spanish system, I'm sure you will find they use their single payer clout to drive the cost down to only cover the variable cost to build the hip, like Canadians buying US medicines. That doesn't work for the largest economy in the world because if someone did not pay for the fixed costs and development costs, the products never would be developed.
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Agreed that pre-Obamcare we were quite far from free market, but when we talk about free market people hear "If you don't have enough money you will be allowed to die in the street" etc.
With what we have had in the last few entries still does not give me (us?) the sort of concise, to the point answer that one must have in order to be persuasive in these sorts of conversations.
For example, at present I have:
a) greater competition through a unified national market, instead of 50 separate markets
b) greater transparency as to what policies do and do not cover; analogous to the list of contents on a package of food;
c) greater freedom of choice as to what coverage you buy;
d) transparency as to prices so as to enable competition via price.
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*****For example, at present I have:
a) greater competition through a unified national market, instead of 50 separate markets
b) greater transparency as to what policies do and do not cover; analogous to the list of contents on a package of food;
c) greater freedom of choice as to what coverage you buy;
d) transparency as to prices so as to enable competition via price.*****
You have just described the reason for the single payer system. :cry:
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I would be curious to also find out if the hospitals that encouraged admission to be able to bill also encourages rapid as possible discharge to avoid accumulating costs vs. the fixed reimbursements. The latter happens all the time not always unethical or wrong but the other end of the same coin I guess:
******Suits: How a Hospital Chain Schemed to Boost Profits
'NYT' looks at lawsuits against Health Management Associates
By Arden Dier, Newser Staff
Posted Jan 24, 2014 9:41 AM CST
(Newser) – The New York Times today takes a look at whistle-blower lawsuits claiming for-profit hospital chain Health Management Associates employed a strategy to up admission—whether or not patients needed care—in order to boost Medicare and Medicaid payments. The paper shares one tactic, in which ER scorecards were posted daily, showing doctors who met an admission target in green. Doctors who were close to the figure were in yellow, and failing doctors in red. That target? Admitting at least half of patients over 65 who visited the emergency room. In another case, a baby was admitted with a "fever" despite a normal temperature of 98.7 degrees.
When the CEO of an HMA-owned North Carolina hospital reported that his doctors wouldn't go along with the revenue-boosting policies, former HMA chief exec Gary Newsome—who made $22 million in three years—allegedly replied, "Do it anyway." Threats and financial incentives were also allegedly used, while execs who questioned the policies were often fired and reports on admission rates were burned, the Times adds. So far eight whistle-blower lawsuits have been filed against HMA in six states; last month, the Justice Department joined in, but one expert says typical penalties number in the 8-figure-range—pennies compared to the profits. She predicts it would take a settlement of at least $500 million to make an impact. To wit, the Times reports that when HMA revealed the DOJ was stepping into the lawsuits, its stock hardly moved.*****
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"You have just described the reason for the single payer system. cry"
Huh? :?
I thought I am describing something rather close to a free market, not a monopsony.
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http://hotair.com/archives/2014/02/04/great-news-obamacare-website-written-by-belarus-linked-programmers/
Great news: ObamaCare website written by Belarus-linked programmers
posted at 12:01 pm on February 4, 2014 by Ed Morrissey
Don’t worry. I have it on good authority from a Nigerian prince and a friend who lost his wallet in Vladivostok that these guys were totally on the level:
U.S. intelligence agencies last week urged the Obama administration to check its new healthcare network for malicious software after learning that developers linked to the Belarus government helped produce the website, raising fresh concerns that private data posted by millions of Americans will be compromised.
The intelligence agencies notified the Department of Health and Human Services, the agency in charge of the Healthcare.gov network, about their concerns last week. Specifically, officials warned that programmers in Belarus, a former Soviet republic closely allied with Russia, were suspected of inserting malicious code that could be used for cyber attacks, according to U.S. officials familiar with the concerns.
The software links the millions of Americans who signed up for Obamacare to the federal government and more than 300 medical institutions and healthcare providers.
“The U.S. Affordable Care Act software was written in part in Belarus by software developers under state control, and that makes the software a potential target for cyber attacks,” one official said.
We’ve been hearing all along that the architecture of the Healthcare.gov website is particularly susceptible to hacker penetration. David Kennedy, a former Marine Corps cyberwarfare expert turned Internet security consultant, has warned since October that the system leaves critical identity information exposed. That got worse rather than better after the operational fixes made in November, and HHS doesn’t even have systems in place to detect such intrusions.
Small wonder why the Obama administration didn’t want to brief Congress on security issues in December. These security gaps were presumed to be the product of incompetent programming and management. Until now, we didn’t realize that the subcontracts for programming went in part to a firm connected with a hostile regime. Belarus has remained a satellite to Moscow with a dictator in charge ever since the breakup of the Soviet Union, Alexander Lukashenko, and the regime is decidedly unfriendly to the West. Currently, the US doesn’t even recognize the legitimacy of Lukashenko’s government after his rigged 2010 election.
How did this happen? Normally, we’d pay good money to keep hostile regimes from penetrating our government operations. In this case, it looks as though we paid them to do it. Great job, HHS!
But it’s not all bad. If you think your identity information has been hijacked, just call the ObamaCare hotline. Be sure to ask for Peggy.
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The Jobless Care Act
Congress's budget office says ObamaCare will increase unemployment.
Feb. 4, 2014 7:08 p.m. ET
There are 7.8 million Americans working part-time who want full-time work, including a fry cook whose restaurant cut his hours to avoid Affordable Care Act mandates and confronted President Obama in an online Google GOOG -0.11% Q&A last week: "We can't survive. It's not a living." Mr. Obama changed the subject to raising the minimum wage. But he can't dodge reality forever as the evidence piles up that ObamaCare is harming the labor market.
On Tuesday no less than the Congressional Budget Office reported that the health law is causing Americans to work less or not at all, in a remarkable intellectual turnabout for the budget shop that Democrats cited repeatedly when selling ObamaCare. Now CBO—full of liberal-leaning economists—says the economy will lose the equivalent of two million full-time workers by 2017 and 2.5 million over the next decade, a threefold increase over its prior estimate.
CBO's analysis is rooted in ObamaCare's complex design that includes new subsidies, taxes and mandates. For low-wage, lower-skilled or discouraged workers in particular, ObamaCare offers incentives that can force them to trade jobs for entitlement benefits.
CBO's conclusion is that ObamaCare will encourage people to supply less labor by deciding not to take a job or by working fewer hours. The law's insurance subsidies are gradually taken away as income rises, "creating an implicit tax on additional earnings," the CBO observes. These effective marginal tax rates reduce the rewards for work—whether it be overtime, accepting a promotion, or training in the hope of higher future earnings. CBO doesn't note, though we will, that simply extending "free" coverage skews job search decisions by offering an in-kind bonus for unemployment.
CBO's job-loss prediction is all the more remarkable because it doesn't include the impact of ObamaCare's employer mandate, which requires businesses with 50 or more full-time employees to offer insurance or pay a $2,000 penalty for each worker beyond 30 employees. CBO more or less punts on the issue because the White House delayed the mandate for a year and the changes would be hard to model. But this means CBO is probably still underestimating job losses because common sense says that labor mandates raise hiring costs and induce businesses to hire less, or pay lower wages, or slash hours, or all three.
Too bad this reality isn't permeating the liberal force field of thinking only positive thoughts. "Claims that the Affordable Care Act hurts jobs are simply belied by the facts in the CBO report," the White House declared Tuesday. By "facts," the White House seems to mean that the report is positive because "individuals will be empowered to make choices about their own lives and livelihoods" and "have the opportunity to pursue their dreams." There you have it: the new American dream of not working.
All of this is one more contradiction of the arguments that were used to sell ObamaCare. The law would reduce health-care costs and shrink the deficit, you could keep your health plan and your doctor, and businesses could hire more workers and be more competitive. All of this is turning out to be false, and now we learn that the law is a job destroyer that is removing rungs from the ladder of upward economic mobility.
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WSJ interview with Casey Mulligan, University of Chicago, National Bureau of Economic Research, the economist who predicted ACA would contract the labor market by 3%.
"Taking away benefits has the same effect as a direct tax, so lower-income workers are discouraged from climbing the income ladder by working harder, logging extra hours, taking a promotion or investing in their future earnings through job training or education."
http://online.wsj.com/news/articles/SB10001424052702304680904579367143880532248?mod=WSJ_Opinion_LEADTop
The Economist Who Exposed ObamaCare
The Chicago professor examined the law's incentives for the poor not to get a job or work harder, and this week Beltway budgeteers agreed.
In September, two weeks before the Affordable Care Act was due to launch, President Obama declared that "there's no serious evidence that the law . . . is holding back economic growth." As for repealing ObamaCare, he added, "That's not an agenda for economic growth. You're not going to meet an economist who says that that's a number-one priority in terms of boosting growth and jobs in this country—at least not a serious economist."
In a way, Mr. Obama had a point: "Never met him," says economist Casey Mulligan. If the unfamiliarity is mutual, the confusion is all presidential. Mr. Mulligan studies how government choices influence the incentives and rewards for work—and many more people may recognize the University of Chicago professor as a serious economist after this week. That's because, more than anyone, Mr. Mulligan is responsible for the still-raging furor over the Congressional Budget Office's conclusion that ObamaCare will, in fact, harm growth and jobs.
Enlarge Image
Rarely are political tempers so raw over an 11-page appendix to a dense budget projection for the next decade. But then the CBO—Congress's official fiscal scorekeeper, widely revered by Democrats and Republicans alike as the gold standard of economic analysis—reported that by 2024 the equivalent of 2.5 million Americans who were otherwise willing and able to work before ObamaCare will work less or not at all as a result of ObamaCare.
As the CBO admits, that's a "substantially larger" and "considerably higher" subtraction to the labor force than the mere 800,000 the budget office estimated in 2010. The overall level of labor will fall by 1.5% to 2% over the decade, the CBO figures.
Mr. Mulligan's empirical research puts the best estimate of the contraction at 3%. The CBO still has some of the economics wrong, he said in a phone interview Thursday, "but, boy, it's a lot better to be off by a factor of two than a factor of six."
The CBO's intellectual conversion is all the more notable for accepting Mr. Mulligan's premise, which is that what economists call "implicit marginal tax rates" in ObamaCare make work less financially valuable for lower-income Americans. Because the insurance subsidies are tied to income and phase out as cash wages rise, some people will have the incentive to remain poorer in order to continue capturing higher benefits. Another way of putting it is that taking away benefits has the same effect as a direct tax, so lower-income workers are discouraged from climbing the income ladder by working harder, logging extra hours, taking a promotion or investing in their future earnings through job training or education.
The CBO works in mysterious ways, but its commentary and a footnote suggest that two National Bureau of Economic Research papers Mr. Mulligan published last August were "roughly" the most important drivers of this revision to its model. In short, the CBO has pulled this economist's arguments and analysis from the fringes to center of the health-care debate.
For his part, Mr. Mulligan declines to take too much credit. "I'm not an expert in that town, Washington," he says, "but I showed them my work and I know they listened, carefully."
At a February 2013 hearing he pointed out several discrepancies between the CBO's marginal-tax-rate work and its health-care work, and, he says, "That couldn't persist forever. There would have to be a time where they would reconcile those two approaches somehow." More to the point, "I knew eventually it would be acknowledged that when you pay people for being low income you are going to have more low-income people."
Mr. Mulligan thinks the CBO deserves particular credit for learning and then revising the old 800,000 number, not least because so many liberals cited it to dispute the claims of ObamaCare's critics. The new finding might have prompted a debate about the marginal tax rates confronting the poor, but—well, it didn't.
Instead, liberals have turned to claiming that ObamaCare's missing workers will be a gift to society. Since employers aren't cutting jobs per se through layoffs or hourly take-backs, people are merely choosing rationally to supply less labor. Thanks to ObamaCare, we're told, Americans can finally quit the salt mines and blacking factories and retire early, or spend more time with the children, or become artists.
Mr. Mulligan reserves particular scorn for the economists making this "eliminated from the drudgery of labor market" argument, which he views as a form of trahison des clercs. "I don't know what their intentions are," he says, choosing his words carefully, "but it looks like they're trying to leverage the lack of economic education in their audience by making these sorts of points."
A job, Mr. Mulligan explains, "is a transaction between buyers and sellers. When a transaction doesn't happen, it doesn't happen. We know that it doesn't matter on which side of the market you put the disincentives, the results are the same. . . . In this case you're putting an implicit tax on work for households, and employers aren't willing to compensate the households enough so they'll still work." Jobs can be destroyed by sellers (workers) as much as buyers (businesses).
He adds: "I can understand something like cigarettes and people believe that there's too much smoking, so we put a tax on cigarettes, so people smoke less, and we say that's a good thing. OK. But are we saying we were working too much before? Is that the new argument? I mean make up your mind. We've been complaining for six years now that there's not enough work being done. . . . Even before the recession there was too little work in the economy. Now all of a sudden we wake up and say we're glad that people are working less? We're pursuing our dreams?"
The larger betrayal, Mr. Mulligan argues, is that the same economists now praising the great shrinking workforce used to claim that ObamaCare would expand the labor market.
He points to a 2011 letter organized by Harvard's David Cutler and the University of Chicago's Harold Pollack, signed by dozens of left-leaning economists including Nobel laureates, stating "our strong conclusion" that ObamaCare will strengthen the economy and create 250,000 to 400,000 jobs annually. (Mr. Cutler has since qualified and walked back some of his claims.)
"Why didn't they say, no, we didn't mean the labor market's going to get bigger. We mean it's going to get smaller in a good way," Mr. Mulligan wonders. "I'm unhappy with that, to be honest, as an American, as an economist. Those kind of conclusions are tarnishing the field of economics, which is a great, maybe the greatest, field. They're sure not making it look good by doing stuff like that."
Mr. Mulligan's investigation into the Affordable Care Act builds on his earlier work studying the 2009 Recovery and Reinvestment Act, aka the stimulus.
The Keynesian economists who dominate Mr. Obama's Washington are preoccupied by demand, and their explanation for persistently high post-recession unemployment is weak demand for goods and thus demand for labor. Mr. Mulligan, by contrast, studies the supply of labor and attributes the state of the economy in large part to the expansion of the entitlement and welfare state, such as the surge in food stamps, unemployment benefits, Medicaid and other safety-net programs. As these benefits were enriched and extended to more people by the stimulus, he argues in his 2012 book "The Redistribution Recession," they were responsible for about half the drop in work hours since 2007, and possibly more.
The nearby chart tracks marginal tax rates over time for nonelderly household heads and spouses with median earnings. This index is a population-weighted average over various ages, jobs, employment decisions like full-time versus part-time. Basically, the chart shows the extra taxes paid and government benefits foregone as a result of earning an extra dollar of income.
The stimulus caused a spike in marginal rates, but at least it was temporary. ObamaCare will bring them permanently into the 47% range, or seven percentage points higher than in early 2007. Mr. Mulligan says the main response to his calculations is that people "didn't realize the cumulative effect of these things together as a package to discourage work."
Mr. Mulligan is uncomfortable speculating about whether the benefits of this shift outweigh the costs. Perhaps the public was willing to trade market efficiency for more income security after the 2008 crisis. "As an economist I can't argue with that," he says. "The thing that I argue with is the denial that there is a trade-off. I argue with the denial that if you pay unemployed people you're going to get more unemployed people. There are consequences of that. That doesn't mean the consequences aren't worth paying. But you can't deny the consequences for the labor market."
One major risk is slower economic growth over time as people leave the workforce and contribute less to national prosperity. Another is that social programs with high marginal rates end up perpetuating the problems they're supposed to be alleviating.
So amid the current wave of liberal ObamaCare denial about these realities, how did Mr. Mulligan end up conducting such "unconventional" research?
"Unconventional?" he asks with more than a little disbelief. "It's not unconventional at all. The critique I get is that it's not complicated enough."
Well, then how come the CBO's adoption of his insights is causing such a ruckus?
"I would phrase the question a little differently," Mr. Mulligan responds, "which is: Why didn't conventional economic analysis make its way to Washington? Why was I the only delivery boy? Why wasn't there a laundry list?" The charitable explanation, he says, is that there was "a general lack of awareness" and economists simply didn't realize everything that government was doing to undermine incentives for work. "You have to dig into it and see it," he explains. "The Affordable Care Act's not going to come and shake you out of your bed and say, 'Look what's in me.' "
Judging by their reaction to the CBO report, the less charitable explanation is that liberals would have preferred that the public never found out.
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Is this what Nancy Pelosi meant by have to pass it to find out what's in it? Why wasn't an honest and dynamic assessment of its impact a requirement for passage?
From the Congressional Budget Office: http://www.cbo.gov/sites/default/files/cbofiles/attachments/45010-Outlook2014.pdf
CBO estimates that the ACA [Affordable Care Act] will reduce the total number of hours worked, on net, by about 1.5 percent to 2.0 percent during the period from 2017 to 2024, almost entirely because workers will choose to supply less labor—given the new taxes and other incentives they will face and the financial benefits some will receive.
Greg Mankiw, Harvard: http://gregmankiw.blogspot.com/2014/02/sentence-of-day.html
Implicit in this estimate are elasticities that measure how much people respond to incentives. My sense is that CBO is typically conservative when it come to gauging these incentives effects. So I would take their estimate of the impact on hours worked as a lower bound. The actual figure (of jobs and work lost) may be higher (than 2.5 million).
Perfect leftism. We will achieve prosperity by having fewer workers work shorter hours at a lower wage rate.
Who knew this would happen (in 2009)?
http://www.nytimes.com/2009/11/01/business/economy/01view.html?_r=0
The signature domestic issue in President Obama’s first year in office — health care reform — is shaping up to be the antithesis of President Reagan’s supply-side economics. The starting point for Ronald Reagan was the idea that people respond to incentives. ... President Obama has said he wants to raise marginal tax rates on high-income taxpayers. Yet under his policies, the largest increases in marginal tax rates may well apply not to the rich but to millions of middle-class families. These increases would not show up explicitly in the tax code but, rather, implicitly as part of health care reform.
One might hope that such a large climb in marginal rates is a bug in the Senate Finance bill (2009, which became the ACA), one that could be fixed before the legislation became law. But there is no simple fix. Higher marginal tax rates are an integral part of the Obama health plan.
Health reformers start with the problem that some people are expensive to insure, because of pre-existing health conditions. Their solution is to require insurers to sell insurance to everyone (a policy called guaranteed issue) at the same price (called community rating).
This solution, however, causes another problem. For healthy people, insurance is now a bad bet. A person without significant medical needs has an incentive to wait — to buy insurance later if and when he gets sick, a decision that raises the cost of insurance for everyone else. This problem, according to the reformers, calls for another solution: a mandate requiring people to buy health insurance.
But this mandate leads to yet another problem. Requiring an expensive purchase like health insurance can be onerous for low-income families. So the health reformers offer subsidies.
Which brings us back to marginal tax rates. If large health insurance subsidies were offered to all Americans, regardless of income, the program’s cost would be exorbitant, requiring substantial increases in explicit taxes. So, instead, the subsidies are phased out as income rises. As a result, we get implicit marginal rates like those in the Senate Finance bill [ACA]. - Greg Mankiw, NY Times, Oct 31, 2009
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Remember that ObamaCare insurance bailout? Well, the first stats are in for
one insurer and it's not pretty. The American Enterprise Institute's Scott
Gottlieb writes
(http://www.forbes.com/sites/scottgottlieb/2014/02/06/obamacare-bailout-for-one-insurer-450-million-in-2014/),
"Humana announced that it expects to tap the three risk adjustment mechanisms
in ObamaCare for between $250 and $450 million in 2014. This amounts to about
25 percent of the insurer's expected exchange revenue." That's also just one
insurer! More will undoubtedly follow. Not only that, but Humana enrolled
202,000 people via the ObamaCare exchanges as of Jan. 31, and some 82% of them
were eligible for subsidies. The price of Hope 'n' Change™ just keeps going
up.
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Humana is extraordinarily brutal health insurer. It is always about the bottom line for them. They are moving into Jersey I am told in a big way by offering the best deals. Sounds good now but once they gain market share they will start turning the screws not only on providers but patients too.
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Obama Enemedia Machine: It’s not Obamacare-induced unemployment, it’s “escape job lock”
Posted By Pamela Geller On February 9, 2014
The Washington Post is packaging joblessness as …… freeing.
The Obama propaganda machine is in fifth gear. Even Hitler’s Minister of Propaganda didn’t try to sell unemployment to the Germans. They used it to sell …. war, but this is Goebbels to the next level. And it’s voluntary state media — this is The Washington Post spreading this manure.
I don’t know who or what we are, but this is not America. It’s war on every basic and good fundamental value America ever held dear.
“Just when you think the Washington Post has hit rock bottom, they sink deeper into the tar-pit” By Director Blue [2]
To paraphrase Jim Geraghty [3], in a nation of 320 million people, I’m sure you can find someonewho’s happy with Obamacare. [4]And guess what? The execrable Washington Post and someone named “Sandhya Somashekhar” [5] – which I’m pretty sure is pronounced “Gesundheit!” — found someone delighted that they can quit their job. You know, to “escape job lock”, which is the new term for Obamacare-induced unemployment.
And guess what? The execrable Washington Postand someone named “Sandhya Somashekhar” [5] – which I’m pretty sure is pronounced “Gesundheit!” — found someone delighted that they can quit their job. You know, to “escape job lock”, which is the new term for Obamacare-induced unemployment.
Count Polly Lower among those who quit their jobs because of the health-care law… It happened in September, when her boss abruptly changed her job description. She went from doing payroll, which she liked, to working on her boss’s schedule, which she loathed…
Hold up: Polly had to work on her boss’s schedule? Oh, the humanity!
At another time, she might have had to grit her teeth and accept the new position because she needed the health benefits… But with the health-care law soon to take effect, she simply resigned — and hasn’t looked back.
“It was wonderful. It was very freeing,” said Lower, 56, of Bourbon, Ind…
Yes, isn’t being jobless an aspirational goal for everyone? You know, so they can pursue their goals, like writing cowboy poetry or weaving risque macrame.
…[Lower] is now babysitting her 5-year-old granddaughter full time. With the help of federal subsidies that kicked in Jan. 1, she is paying less than $500 a month for health coverage for herself and her husband.
So let’s state this more clearly: thanks to Obamacare, Lower has now joined the roughly 100 million Americans collecting an average of $9,000 each from more than 80 means-tested welfare programs [6].
The Washington Post found … Lower through Families USA, a health advocacy group that supports the health-care law and maintains a database of people who have benefited from it.
[7]And just who is Families USA? They’re an SEIU front group [7] that has been pushing for socialized medicine for years [8].
In short, the Washington Post is doing its level best to protect Democrats as we head into the 2014 midterm elections even as millions lose their jobs and their health care; and as many as 100 million more may be similarly impacted in 2015, unless the Imperial President rewrites the Obamacare law again through executive edict.
And where does “Sandhya Somashekhar” and the Washington Post find their loathsome propaganda? Why a hardcore, militant labor union aligned with the Marxist-Leninist movement [9], of course!
Our goal as socialists is to abolish private ownership of the means of production. Our immediate task is to limit the capitalist class’s prerogatives in the workplace…In the short run we must at least minimize the degree of exploitation of workers by capitalists. We can accomplish this by promoting full employment policies, passing local living wage laws, but most of all by increasing the union movement’s power…
I’ll let Jonah Goldberg dispense with Gesundheit and her Marxist propaganda [10] in his usual, incisive fashion.
…the real CBO story should be: “That awkward moment when everyone realizes Obamacare was a huge mistake.” The same CBO report projects that by 2024 the number of non-elderly uninsured will be — drum roll, please — 31 million Americans.
And that’s why all of this talk of Democrats as the Job-Lock Liberators is pathetic and hilarious at the same time. Virtually every promise has been broken, every prediction falsified. And now, at a time when millions want work that doesn’t exist, Democrats are claiming victory by trimming the amount of work actually being done.
Hopefully voters will look for ways to liberate these Democrats from the curse of job-lock come November.
The title of the WaPo secretion is “They quit their jobs, thanks to health-care law.”
I don’t think that headline means what they think it means.
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Humana is extraordinarily brutal health insurer. It is always about the bottom line for them. They are moving into Jersey I am told in a big way by offering the best deals. Sounds good now but once they gain market share they will start turning the screws not only on providers but patients too.
If you think Humana is brutal, wait until the feds really run healthcare.
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"If you think Humana is brutal, wait until the feds really run healthcare."
In my experience this is not true.
I worked for Humana. On one hand they paid the bills. On the other, they never let anyone know otherwise. It was literally a battle between the patients and the insurer over coverage. Every day and all day. One of Humana's medical directors said point blank, they [patients] are the enemy. It is us against them. Another Humana administrator said with a smile about someone who would not accept to go into hospice, "look your dead, your dead, your dead".
The Feds are not as brutal (at least yet).
But, I choose a free marketplace. I don't wish for a Federal politburo controlling the entire healthcare industry.
That said I am a squirt. My thoughts are worthless in the real world as they are against anyone with political or financial connections or anyone with real world power and know how.
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http://capoliticalnews.com/2014/02/10/obama-uses-obamacare-to-punch-middle-class-in-the-wallet/
http://www.breitbart.com/Big-Journalism/2014/02/10/Sen-Durbin-s-Claim-That-10-Million-Have-Insurance-With-Obamacare-Rated-False?utm_source=e_breitbart_com&utm_medium=email&utm_content=Breitbart+News+Roundup%2C+February+11%2C+2014&utm_campaign=20140211_m119141871_Breitbart+News+Roundup%2C+February+11%2C+2014&utm_term=More
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Medicaid Or Education?
By DICK MORRIS
Published on TheHill.com on February 11, 2014
In state capitals throughout America, a drama will play out this coming year and in every subsequent year for at least a decade.
Legislators and governors will find themselves unable to provide decently for education without cutting back on the ambitious Medicaid expansion built into ObamaCare. Even in those states that opted not to participate in raising the eligibility levels for Medicaid -- and took the out Chief Justice John Roberts gave them -- the Medicaid rolls will rise as more of those previously eligible sign up through the well-publicized federal exchanges.
The explosion in Medicaid cost and enrollment represents a dire threat to educational quality in all 50 states. Simply put, improving our failing schools will have to wait, as ObamaCare drives up state healthcare spending.
Last year, according to usgovernmentspending.com, education ate up $286 billion of the $1.5 trillion in state spending -- about 19 percent. But Medicaid gobbled up $478 billion -- or 32 percent.
But this is just the beginning. Due to lower medical inflation, Medicaid spending has grown only at about 2 percent a year during the past two budget cycles. However, due to ObamaCare's increased Medicaid enrollment, Medicaid spending is projected to rise 12.2 percent in 2014, 7.9 percent in 2015 and 2016, and 6.6 percent per year thereafter. Meanwhile, state total spending is projected to hold fairly steady at $1.5 trillion.
The left is going to have to choose between Medicaid and education. We cannot afford both. Of course, states can still raise taxes and join jurisdictions like Detroit into their slow spiral to oblivion.
Is the Medicaid spending worth it? Is it a good trade to swap our children's future for a perceived increase in healthcare quality for today's poor? Does increasing Medicaid help to improve the health of the new recipients? The seminal study says: Not much.
The study came about when Oregon expanded its Medicaid program in 2008, using a lottery to determine who would benefit from the limited expansion. Amy Finkelstein, an economics professor at MIT, and Katherine Baicker from the Harvard School of Public Health, analyzed the results in what came to be called the Oregon Health Insurance Experiment.
The researchers found "no measurable health benefits in the Medicaid group for several chronic conditions, including hypertension, high cholesterol and diabetes."
They did find that expanding Medicaid coverage caused the newly enrolled to throng emergency rooms. Finkelstein said: "Medicaid coverage increases emergency department use, both overall and for a broad range of types of visits, conditions, and subpopulations, including visits for conditions that may be most readily treatable in primary care settings." In fact, she reported a 40 percent hike in ER visits among the newly enrolled.
The control population and the Medicaid population in the study differed only in "the fact that some have insurance and some don't."
So is the Medicaid expansion worth it? Is it an effective way to use state resources to tell an entire generation of children that they will have to wait for good schools until the Medicaid expansion experiment has run its course? Or will it be too late for them then?
In view of the lack of evidence showing the benefit to providing poor adults under the age of 65 with free medical care, are we justified in diverting funds that would likely otherwise go to schools, better teachers and enriched curriculums? With students throughout the nation no longer able to study such subjects as science, social studies and foreign languages due to financial limitations, are we right to make Medicaid the sole object of our generosity?
Ask the kids.
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(http://ace.mu.nu/Windows-Live-Writer/Overnight-Open-T_F403/DarthObama_thumb.jpg)
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http://hotair.com/archives/2014/02/12/how-many-obamacare-enrollees-have-paid-for-coverage/
How many ObamaCare enrollees have paid for coverage?
posted at 3:21 pm on February 12, 2014 by Ed Morrissey
The White House and its supporters have begun bragging that the ObamaCare system has started to function as planned, with sign-ups increasing as the deadlines approach for the individual mandate deadline. But how many of those sign-ups turned into actual enrollments through the payment of the premium? As it turns out, not nearly as many as the top-line numbers suggest:
While the number of states reporting this information is small, they actually make up a good chunk of Obamacare’s currently accepted 3 million nationwide enrollment total. According to the Obama administration’s most recent detailed report on enrollment data, these five states — New York, California, Washington state, Nevada and Rhode Island — account for a third.
California’s exchange last reported that three-fourths of its reported enrollees had paid their first premiums, according to California Healthline; Washington’s totals released Tuesday indicate that only 51 percent have purchased their plans.
New York’s numbers are fuzzier, since the exchange itself doesn’t separate applications for Medicaid and private plans. It counts 412,221 enrollments for public and private coverage (just 251,000 are private plans), but notes that another 697,000 customers have completed applications on the exchange website. If the entire 421,221 have paid (or accepted the low- to no-cost Medicaid coverage), New York’s payment rate is only 59 percent.
Nevada’s payment rate is just 66 percent — 14,999 out of 22,597 so far — and Rhode Island has by far the best total, with 14,086 paid customers out of 16,512, for a payment rate of 85 percent.
Those numbers aren’t much improved from a month ago, when industry expert Bob Laszewski estimated the payment figure at 50%. The federal system’s back end for dealing with those issues is still missing in action, too, which means it’s going to be even more problematic. We’re about a month out from the big deadline for the April 1 cutoff for enforcement, and at the very best, we can say that the signup-to-paid ratio isn’t improving by much, if at all.
That may be a surprise to Laszewski, who predicted an 80% clearance rate by this time, which only Rhode Island appears to be achieving. He also noted a multitude of issues in the federal system still awaiting resolution:
Last fall I said that I thought it would be late January or early February before Healthcare.gov would generally be fixed.
Boy, was I wrong.
The to-do list still includes:
Problems with the government sending enrollment transactions to the carriers––the 834s––that are still having error rates much too high for high volume processing.
The inability of the government to do an automated enrollment reconciliation with the carriers––to be able to sort out who really is covered and who is not––because that system still hasn’t been built.
The inability of the government to pay carriers because that system hasn’t been built––carriers are sending estimated bills to the feds.
The inability of the government to add and delete people from the system for things like a newborn or a divorce because that system hasn’t been built yet.
The inability of the government to handle appeals when people think their eligibility or subsidy calculation is wrong because that system hasn’t been built yet.
The inability of the government to cancel people off of Healthcare.gov because they never built that functionality. As a result, I expect they will be reporting bloated enrollment numbers for some time.
At least two carriers have told me that because the government can’t cancel people off the system, it the person shows up next month they can’t reenroll on Healthcare.gov because the government can’t get the old enrollment off the system.
What kind of progress is being made in Minnesota, where the MNSure administrator ended up getting fired over its launch failures? Investors Business Daily offers a look, and it’s not pretty:
Minnesota’s exchange enrollment goal of 67,000 seemed within reach on Jan. 4, when signups stood at 25,860.
But after surging by more than 4,000 per week in the prior five weeks, signups collapsed back to November’s pace of less than 700 per week. …
Only 21% of signups were in the key 18-34 demographic vs. 35% ages 55 to 64. Minnesota officials have been taken by surprise at the share of people signing up for ObamaCare’s richest “platinum” coverage, which reimburses 90% of the covered group’s qualifying expenses.
Fully 29% have signed up for low-deductible platinum policies — compared to a projection of 5%. Such policies would tend to be favored by people who want to guard against high medical expenses, while someone expecting minimal costs might go for a high-deductible bronze plan.
In fact, the shortfall of sign-ups — let alone actual enrollments — threatens to create a budget crisis:
Enrollment is currently at 92,000, which is still way short of their goals by for enrollment prior to March 31. The worry is if they don’t have enough people paying into MNsure, it won’t be sustainable and they’ll have to ask the legislature for more money.
Minnesota lawmakers have warned leaders of MNsure that they must figure out budget needs soon as insurance enrollment trends point to a 2015 deficit. MNsure must give lawmakers a proposed 2015 budget by March 15.
The 92,000 figure includes the Medicaid enrollments through the system, too. The problem is in the lack of private-insurance enrollments, and it’s going to be a huge problem for the state legislature, which is already strapped for funds as it is.
Guy Benson hits the numbers:
This portends two separate risk pool problems. First, not enough young and healthy people are signing up — a trend that has been well established for some time. Minnesota’s 21 percent figure is nearly identical to what health insurer Humana is reporting in its nationwide risk pool so far — and roughly half of the administration’s initial goal within this demographic. Second, a surprisingly high number of enrollees are selecting “platinum” plans, indicating that they anticipate incurring high levels of annual medical expenses and are looking to minimize out-of-pocket costs. Add these two together, and you’re staring at an adverse selection problem, which may result in larger taxpayer bailouts of on-the-hook insurers.
Also take note of the paltry payment rate of “enrollees” in Washington State so far … Washington has a payment rate of just 50 percent, with Nevada sitting at 66 percent. Both states are far off pace to hit their 2014 targets, even counting unpaid “enrollments.”
Be sure to read it all.
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When did we know he wasn't the best person to stop Obamacare?
"Frustration with the broken Massachusetts Health Connector website and the paperwork backlog was evident Thursday, when Jean Yang, the agency’s executive director, wept as she told the [Health] Connector board how demoralized her staff is.
“These people came here to lead and innovate, and instead they’re doing manual workarounds,” Yang said. “And they are embarrassed to tell friends and family that they work for the Health Connector,” once considered a national model."
http://www.bostonglobe.com/metro/2014/02/14/health-connector-has-backlog-paper-insurance-applications/n8IEAFGvEnlQPvd4NzsYlJ/story.html
Boston Globe: 50,000 filings for health coverage in limbo
State may need months to process paper applications
By Michael Levenson February 14, 2014
“The market cannot wait and people need help,” said Health Connector head Jean Yang.
About 50,000 health insurance applications, many filed by low-income Massachusetts residents, have yet to be processed by the state’s troubled insurance marketplace, officials disclosed Thursday, and it may take months to get all these people enrolled in subsidized plans.
For several months, residents have been encouraged to file old-fashioned paper applications because the state’s insurance website has been hobbled by error messages and has crashed frequently since it was revamped in October to comply with the more complex requirements of the federal health care law.
Frustration with the broken Massachusetts Health Connector website and the paperwork backlog was evident Thursday, when Jean Yang, the agency’s executive director, wept as she told the Connector board how demoralized her staff is.
“These people came here to lead and innovate, and instead they’re doing manual workarounds,” Yang said. “And they are embarrassed to tell friends and family that they work for the Health Connector,” once considered a national model.
She made clear that she was not looking for sympathy.
“We have to work harder,” she said. “That means I need to tell the staff members they’re not doing a good enough job, and I’m telling them that, even though they have been doing this tirelessly for months and they’re exhausted.”
Sarah Iselin, a health insurance executive whom Governor Deval Patrick last week put in charge of fixing the website, said the state is bringing in 300 people from Optum, a private contractor, to process the applications. The state is also working to develop a faster data-entry system, though that task alone could take three weeks, she said.
Currently, it takes two hours to enter each application into a computer database. Each application may represent a family or an individual.
“We’ve got to catch up,” Iselin said at the Connector board meeting. “That’s priority number one.”
The website was working smoothly until it was overhauled by the tech firm CGI in a botched attempt to comply with the federal Affordable Care Act. Since then, the state has resorted to off-line workarounds and has put many people into temporary health plans. But an unknown number of other people may be uninsured because their applications have sat untouched.
Yang’s unusual display of emotion at a meeting normally focused on dry policy discussions came a day after she, Iselin, and other state health insurance officials were grilled by angry legislators who complained bitterly that many of their constituents have been unable to find coverage.
Yang said those concerns have been driving her and her staff to lose sleep. “The market cannot wait, and people need help,” she said. “That’s what keeps me up at night.”
Dolores L. Mitchell, a Connector board member, thanked Yang.
“A shaky voice every now and then sends a powerful message about how much you care,” Mitchell told her. “You’re going to get it right. I know you are.”
Despite the many problems, officials said they had received some encouraging news: On Wednesday night, federal officials granted a three-month extension for 124,000 people with subsidized health insurance who were set to lose their coverage on March 31 because it did not comply with the federal law.
The state had requested a six-month extension, but Iselin said the three months will give the state extra time to enroll those people in plans of their choosing.
Iselin said another 32,000 people with insurance that is not subsidized and whose coverage expires March 31 are being mailed paper forms that will allow them to “sign, pay, and enroll” in plans that comply with the federal law, without having to use the faulty website.
The state has also opened a command center in Quincy where state Medicaid officials and Connector staff are working with CGI and Optum, which was hired to make fixes. Iselin said staff are there around the clock, although she could not say when the website will be operating properly.
Optum is being paid $9.8 million for the first month of services, but is expected to work through the end of the year.
“There’s clearly been a failure of the actual coding of this beast,” said Jonathan Gruber, a Connector board member and MIT economist.
Board members floated the idea of hiring a “dream team” of computer programmers to help Optum, with the promise that they would be showered with praise for their work.
Connector staff said they would explore the idea, which is based on last year’s “tech surge,” when the Obama administration enlisted engineers from Google and other firms to help Optum repair the troubled HealthCare.gov website.
In the meantime, the Connector is operating a call center with 270 staff members fielding questions about insurance coverage from anxious residents, up from 65 several weeks ago.
“We know we’re not where we need to be,” Iselin said. “We’re disappointed to be in this position. And we are determined and committed to fixing it.”
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One of the biggest of claims of Obamacare was that of coverage pre-existing conditions. Whoops! The coverage does not include drugs that keep people alive.
http://capoliticalnews.com/2014/02/16/another-obama-lie-exposed-obamacare-denying-meds-from-people-with-serious-pre-existing-diseases/
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second post
http://www.nytimes.com/2014/02/17/us/politics/on-health-act-democrats-run-to-mend-what-gop-aims-to-end.html?nl=todaysheadlines&emc=edit_th_20140217&_r=0
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At this point, what difference does it make?
http://www.realclearpolitics.com/video/2014/02/20/minnesota_dems_hesitate_to_answer_obamacare_question_at_town_hall.html
Minnesota Dems Hesitate To Answer Obamacare Question At Town Hall - Video at link
U.S. Sen. Amy Klobuchar with Congressmen Tim Walz and Collin Peterson (all D-MN) faced a question about Obamacare at a town hall meeting.
"I thought the Affordable Care Act would save $2500 per family," a resident asked. "What happened?"
After a pause, Peterson grabbed the microphone and said, "I voted 'no,' so I'll let these guys handle that."
(Peterson is chair of the House Ag. committee, one of very few Dems who voted no.)
The expressions, blank stares, and laughter is priceless. Klobuchar smiles and throws her hands up in the air.
Too bad Sen. Klobuchar didn't face a serious challenge to reelection last year. We'll see what Sen. Franken's excuse is soon.
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Economist article explains why health "tourism" has not taken off as expected:
http://www.economist.com/news/international/21596563-why-health-care-has-failed-globalise-m-decine-avec-fronti-res
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They are insisting that I accept cookies, blah blah. May I ask you to share it here?
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They are insisting that I accept cookies, blah blah. May I ask you to share it here?
Medical tourism
Médecine avec frontières
Why health care has failed to globalise
Feb 15th 2014 | From the print edition
CLARE MORRIS hardly noticed when she tore the meniscus in her knee while dancing. The pain started only when she heard that repairing the damage at a hospital in South Carolina, where she lives, would cost $15,000. With limited insurance, she would have had to pay much of that herself. But after shopping around she found that she could have her knee repaired at a good hospital in Costa Rica for $7,400—and take a holiday, too.
Just a decade ago, stories like hers seemed to point to the future of health care. If a person could save thousands by shopping in the global health market, the reasoning went, insurers and governments could save billions. A knee replacement costs $34,000 in America, but just $19,200 in Singapore, $11,500 in Thailand and $9,500 in Costa Rica, according to Patients Beyond Borders, a consultancy. Even within Europe savings are to be found: a hip replacement is $4,000 cheaper in Spain than in Britain.
In the mid-2000s American insurers set out to find these savings by touring foreign private hospitals. They found that many were as good as their rich-world counterparts, and far cheaper. A big shake-up seemed likely. In 2008 Deloitte predicted an “explosive” boom in medical tourism, saying that the number of Americans going abroad for health care would grow more than tenfold by 2012.
It did not happen. Poor data were part of the problem: whereas Deloitte counted 750,000 American medical tourists in 2007, McKinsey, another consultancy, found at most 10,000 a year later. It is generally agreed that the number of medical tourists has grown since then—Thailand’s Bumrungrad hospital, which is popular with foreign patients, reports “steady growth”. But the data are still fuzzy. Patients Beyond Borders estimates that as many as 12m people globally now travel for care, perhaps 1m of them Americans. Industry insiders admit that growth has not matched the initial heady expectations.
Patient interest also turned out to be lower than predicted. Though some patients in the rich world seek out deals, most receive adequate health care at a manageable price and would prefer to stay at home. Potential savings are often insufficient to trump concerns about quality and the lack of recourse if something goes wrong. In 2008 Hannaford, an American supermarket chain, offered to pay the full cost of hip and knee replacements for its employees, including travel and patients’ usual share—provided they would go to Singapore. None took up the offer.
The predicted growth depended on medical tourism evolving from an individual pursuit to a cost-saving measure embraced by insurers and governments. But without reliable projections, insurers were reluctant to invest in the idea, says Ruben Toral, a health-care consultant. And cooler measures of the size of the opportunity dimmed their ardour. In 2009 Arnold Milstein of Stanford University estimated that less than 2% of spending by American insurers went on the kind of non-urgent procedures that might be moved abroad.
The legwork required also turned out to be formidable. Insurers had to choose foreign hospitals, negotiate contracts and malpractice insurance, and arrange follow-up care with American providers. They also risked upsetting the locals who would continue to take most of their custom. By the time the battle over Obamacare distracted them from contemplating transnational forays, most seemed to have concluded that they would not be worthwhile anyway. Companion Global Health Care, a subsidiary of Blue Cross Blue Shield, is the only big medical-tourism offshoot of an American insurer.
Governments have shown a similar lack of enthusiasm, perhaps because state promotion of medical tourism is usually seen as an admission of policy failure. In 2002 Britain allowed patients facing long waits to seek treatment elsewhere in Europe. Liam Fox, the shadow health secretary at the time, called the decision “humiliating” and criticised the government for not spending more at home. In Germany patient advocates blame government stinginess for the fact that some retired people choose, for reasons of cost, to live in eastern European care homes. Overall, only 1% of public health-care spending in Europe now crosses borders.
But the mere possibility of medical tourism is starting to change health care in unexpected ways. The biggest gains have gone not to patients, insurers or governments, but to hospitals, which have calculated that they could win more business by reversing the trend and going abroad to find patients. America’s Cleveland Clinic will open a branch in Abu Dhabi next year. (It already manages Sheikh Khalifa Medical City, a 750-bed hospital in Abu Dhabi.) Singapore’s Parkway Health has set up hospitals across Asia. India’s Apollo Hospitals, a chain of private hospitals, has a branch in Mauritius.
And though American firms and insurers have mostly stopped scouring the globe for bargains, some have negotiated bulk rates with top-notch hospitals at home. Lowes, a home-improvement firm, offers workers all around the country in need of cardiac care the option of going to the Cleveland Clinic in Ohio. PepsiCo, a food giant, made a deal with Johns Hopkins in Maryland. Other firms are said to be working on similar schemes. The future of medical tourism may be domestic rather than long-haul.
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AMA Calls For ICD-10 Delay
The costs to medical practices for implementing the International Classification of Diseases-10th Revision (ICD-10) coding system have been grossly underestimated, according to a recent study by Nachimson Advisors for the American Medical Association (AMA).
The association is calling for a delay in the October 1, 2014, ICD-10 go-live date in order to give practices more time to prepare for the financial and administrative requirements.
Small practices can expect to spend between $56,639 and $226,105 and medium-size practices can spend between $213,364 and $824,735 to implement ICD-10. Expected costs include up to $100,000 in payment disruption for small practices, and up to $166,000 in productivity losses for medium-size practices.
Large practices can expect to spend between $2 million and $8 million to implement the new coding system, according to the study. The study estimated that two-thirds of physicians will pay the upper range of cost estimates. In 2008, the AMA estimated that it would cost a small practice $83,290 to implement ICD-10.
“The markedly higher implementation costs for ICD-10 place a crushing burden on physicians, straining vital resources needed to invest in new health care delivery models and well-developed technology that promotes care coordination with real value to patients,” AMA President Ardis Dee Hoven, M.D. said in a press release. “Continuing to compel physicians to adopt this new coding structure threatens to disrupt innovations by diverting resources away from areas that are expected to help lower costs and improve the quality of care.”
The AMA sent a letter to the Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, outlining the hardships physicians are facing in implementing ICD-10. The letter calls for Medicare to offer “true end-to-end testing” of ICD-10 coding to ensure practices and payers will be able to communicate.
“While it will allow a physician to know whether his or her claim was received or not, it does not give any indication as to whether it will be paid, how much it will be paid, whether they have used the correct ICD-10 code, or whether Medicare believes more information is needed to adjudicate the claim,” James L. Madara, MD, AMA’s assistant director of federal affairs said in the letter. “To draw a simple analogy, this is like receiving a package on your doorstep that you can only view from your window. While it is helpful to know the package has arrived, you have no idea what is inside until you are able to open it.”
Other suggestions include expanding advance payment options and offering free Medicare billing software for practices facing financial hardships. The AMA also requests that the Centers for Medicare and Medicaid Services allow for a two-year implementation period where miscoded claims are not denied, but are returned to physicians with feedback on how to correct them.
According to a February survey by the Medical Group Management Association, 79% of physicians report that they haven’t begun ICD-10 implementation, or were “somewhat ready.”
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Thank you for everything - Brock. :x
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http://www.theblaze.com/stories/2014/02/26/alaska-family-living-in-nightmare-after-son-declared-ward-of-state-following-hospital-visit/
In a related vein: http://www.theblaze.com/stories/2014/02/25/a-national-outrage-father-of-15-year-old-at-center-of-boston-childrens-controversy-says-were-fighting-evil/
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With regard to the first case in Boston there sounds like there is disagreement as to the diagnosis. One group thinks it is some rare mitochondrial disorder and the other thinks it is psychiatric.
I can tell you there occasionally are cases like this which are extraordinarily difficult.
I wonder if the parents of the child cannot accept a psychiatric diagnosis and hence are making the situation worse by insisting on it being the other.
Look at autism and vaccines. There are parents who will insist to their dying days it is the vaccine that caused the autism. Despite evidence to the contrary. Just some thoughts.
It is interesting that there is a gag order in effect. Judges are from what I have seen rarely willing not to give a family the benefit of the doubt.
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http://www.washingtontimes.com/news/2014/feb/28/weber-obamacares-punch-to-home-health-care/
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Impossible to Cancel Plans
A Florida man found out the hard way that he's keeping his insurance plan --
whether he likes it or not. When Andrew Robinson signed up for coverage under
ObamaCare but then realized he couldn't afford it, he quickly signed up for a
different plan and called Florida Blue to cancel the first one. WFTV Orlando
reports (http://youtu.be/lNEsaalrC0Y), "But he quickly learned canceling
Obamacare is no easy task. ... More than six weeks later after spending 50 to
60 hours on the phone his policy is still not canceled and he is still waiting
for the payment Florida Blue withdrew from his account to be refunded." But
not to worry; Harry Reid says the horror stories aren't true
(http://patriotpost.us/posts/23645).
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I happened to sit on a long flight next to a stuffy snooty very smart doctor who was a prof at a med school (I forget which). We got to talking and it turns out he was also on the AMA's advisory board for Obamacare. He was quite emphatic that the ACOs described in this article will be a good thing.
http://www.newrepublic.com/article/116752/ezekiel-emanuel-book-excerpt-end-health-insurance-companies
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I happened to sit on a long flight next to a stuffy snooty very smart doctor who was a prof at a med school (I forget which). We got to talking and it turns out he was also on the AMA's advisory board for Obamacare. He was quite emphatic that the ACOs described in this article will be a good thing.
http://www.newrepublic.com/article/116752/ezekiel-emanuel-book-excerpt-end-health-insurance-companies
Of course. There are lots of books filled with dreamy plans for eutopia. Funny how those tend to work out.
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I guess this is what Rush was referring to when he noted ZEEK said something to the effect that the plan of Obamacare was to put insurance companies out of business. Some providers have had integrated systems. I know I worked for one 25 years ago. It was called managed care. The ACO concept is just a variation. The providers take the "full risk" not the third party insurance company or "middle man" as ZEEK calls them. Guidelines are just that. They are guidelines. If anyone thinks insurance companies are rough just wait till the providers have big stakes on restricting services.
But I digress. Rush is not accurate if this is what he was talking about. This just means replacing insurance companies with ACOs and hospital systems. Some will be run by doctor groups. Most and the largest and the most powerful will simply be run by large business hospital or other conglomerate chains.
****Obamacare Architect: ‘Be Prepared to Kiss Your Insurance Company Good-Bye Forever’
Mar. 3, 2014 7:29pm Jason Howerton
Ezekiel Emanuel, one of the architects behind Obamacare, is now claiming that “insurance companies as we know them are about to die.” Critics of President Barack Obama’s signature health care law have long alleged that one of the real goals of the law was to put private insurance companies out of business.
“The good news is you won’t have insurance companies to kick around much longer. The system is changing,” Emanuel writes in an op-ed on New Republic. “As a result, insurance companies as they are now will be going away. Indeed, they are already evolving. For the next few years insurance companies will both continue to provide services to employers and, increasingly, compete against each other in the health insurance exchanges.”
Due to Obamacare, “new actors will force insurance companies to evolve or become extinct,” he continues. Instead, new groups called “accountable care organizations” (ACOs) must start competing directly in the health care exchanges for exclusive contracts with employers.
In this March 11, 2009 photo, Dr. Ezekiel J. Emanuel, special advisor for health care at the Office of Management and Budget, speaks at the American Medical Association's annual conference at the Grand Hyatt Hotel in Washington, Ezekiel J. Emanuel values intelligence, but don't accuse him of Harvard-itis. He'll tell you an Ivy League degree doesn't prove anyone's worth. (AP Photo/J. Scott Applewhite)
In this March 11, 2009 photo, Dr. Ezekiel J. Emanuel, special advisor for health care at the Office of Management and Budget, speaks at the American Medical Association’s annual conference at the Grand Hyatt Hotel in Washington, Ezekiel J. Emanuel values intelligence, but don’t accuse him of Harvard-itis. He’ll tell you an Ivy League degree doesn’t prove anyone’s worth. (AP Photo/J. Scott Applewhite)
The ACOs will have “standardized, guideline-driven care plans for most major conditions and procedures to increase efficiency,” says Emanuel, the brother of Obama’s former chief of staff and current Chicago Mayor Rahm Emanuel.
“They will have figured out how to harness their electronic medical records to better identify patients who will become sick and how to intervene early as well as how to care for the well-identified chronically ill so as to reduce costs,” he notes.
The key skill these ACOs and hospital systems lack—the skill insurance companies specialize in—is the actuarial capacity to predict and manage financial risk. But over the next decade this is something they will develop—or purchase. After all, actuarial science is not rocket science, even if it involves a lot of mathematical equations. And with that skill, ACOs and hospital systems will become integrated delivery systems like Kaiser or Group Health of Puget Sound. Then they will cut out the insurance company middle man—and keep the insurance company profits for themselves. Therefore, increasingly these ACOs and hospital systems will transform themselves into integrated delivery systems, entering insurance exchanges and negotiating with employers, in direct competition with insurance companies.
As the ACOs become more established, Emanuel claims contracts between the health systems and employers will become more common, thus “cutting out the insurance companies.”
Once the health systems “make the jump to offering coverage in the exchanges, the health insurance companies will only have a few options if they want to survive, according to Emanuel.
“First, they can refuse to change, in which case they will eventually go out of business,” he writes. “Second, they can shift their business to focus on offering services they have expertise in, particularly analytics, actuarial modeling, risk management, and other management services.”
Finally, the “third evolutionary path is that health insurance companies may transform themselves into integrated delivery systems.”
“So be prepared to kiss your insurance company good-bye forever,” Emanuel concludes.
Read the entire article here.
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Programming note: Is this the end of health insurance as we know it? Glenn Beck and his producers debated the impact of this story in Tuesday’s morning editorial meeting. Watch it tonight at 5pm ET on TheBlaze TV.
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Hillary Rodham Clinton: Let evidence lead the healthcare reform fight
HIMSS keynote speaker calls on physicians, health IT, policymakers to face challenges of access, delivery, and technology
Publish date: FEB 28, 2014
Print
By: Daniel R. Verdon
Hillary Rodham Clinton HIMSS 2014Former Secretary of State Hillary Rodham Clinton gave the keynote address at the HIMSS 2014 conference in Orlando, FL. (Photo courtesy of HIMSS)The “hyper-politicized debate” about healthcare reform needs to shift to a thoughtful dialogue about evidence and data, according to former Secretary of State Hillary Rodham Clinton.
In addressing thousands of health information technology professionals at the recently concluded HIMSS 2014 conference in Orlando, Florida, Clinton called on healthcare thought leaders to let evidence guide decisions and development to improve quality and reduce cost of the American healthcare system.
“I am a believer that good data helps to make good decisions,” Clinton says. “It’s true in medicine; it’s true in business; it’s true in government, and it’s true in life…. Unfortunately, the hyper-politicized debate about the Affordable Care Act (ACA) has been often more about ideology than data.”
Clinton called on policymakers and healthcare professionals to debate ways to improve the U.S. healthcare system.
“I want us to have a healthcare debate where our differences are fully aired," Clinton says. "We don’t have a one-size-fits all; our country is quite diverse. What works in New York City is not necessarily going to work in Harrison, Arkansas or Albuquerque. We do need to have people who are looking for ways to use evidence but leave their blaming, their gaming, their shaming, their point scoring at the door.”
There are many reform provisions in the ACA that attempt to improve the system, Clinton says. Some examples include:
•measuring outcomes,
•covering preventive care,
•shifting from fee-for-service to rewarding quality and value,
•building pricing transparency,
•using comparative effectiveness research,
•opening up access to healthcare coverage to millions of Americans who were previously uninsured,
•allowing children to stay on their parents’ coverage until they are 26,
•“liberating employees” from staying in jobs solely to access health insurance because a family member has a pre-existing or chronic health condition.
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Hillary Rodham Clinton: Let evidence lead the healthcare reform fight
HIMSS keynote speaker calls on physicians, health IT, policymakers to face challenges of access, delivery, and technology
Publish date: FEB 28, 2014
Print
By: Daniel R. Verdon
“There are many provisions embedded in this act that most Americans, if asked, would support,” Clinton contends. And there are just as many challenges facing the system.
“What happens when us Baby Boomers double the number of Medicare beneficiaries from 40 million to 80 million people?" Clinton asks. "How do we prepare for that dramatic increase? How could we improve coordination and communication among all healthcare providers responsible for a patients’ well-being? Will advances in technology combined with comparative effectiveness research continue providing patients and providers with more and better information about what works and what doesn’t in ways that will reduce cost and improve outcomes? How might we replace, once and for all, our fee-for-service model (with a system) that provides provider-led, community-wide care?”
The case for electronic health records
The challenges facing healthcare are also calling for its modernization through technology, Clinton says.
The need for digitizing medical records was clearly evident following the devastation of Hurricane Katrina in 2005, which decimated parts of New Orleans and other areas on the Gulf Coast.
Millions of pages of medical records were lost during that storm.
“I saw firsthand when I went to meet with survivors and refugees from Katrina. People were just totally bewildered. Elderly people didn’t know what medicine they were taking. They couldn’t explain what that little blue pill was they took 3 times a day. We know how important this is. When you are in the middle of a medical emergency, accessing information can literally make the difference between life and death,” Clinton says.
Squeezing healthcare costs
Technology will ultimately lower healthcare costs to Americans, Clinton says. And this country has made some progress. “Healthcare costs are growing at the slowest rate in 50 years, just around 4%. That has significant implications for our economy going forward.”
“There is a lot of misinformation and a lot of anxiety (about healthcare reform),” she says. “(People) are worried about what they might lose. We need to clear the smoke, and figure out what is working and what isn’t. It would be a great tragedy, in my opinion, to take away what has now been provided to the millions of people who now have Medicaid or a health insurance plan for the first time.”
Clinton was one of four keynote presenters at HIMSS 2014, which drew more than 37,000 healthcare IT professionals. Other presentations were delivered by Mark Bertolini, CEO of Aetna; Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services (CMS), and Karen DeSalvo, MD, MPH, Office of the National Coordinator for Health Information Technology.
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She is slick. IMHO there are some point in there that everyone agrees with e.g. having records available.
IMHO we need to say "We are glad she agrees with Newt Gingrich on the importance of electronic records." Indeed this is a "no brainer". However when she says "We need to clear the smoke, and figure out what is working and what isn’t" she is blowing smoke. she is obscuring the fact that the smoke comes from Obamacare itself. Winging it and expecting everyone else to come along and wipe up the mess of a system that defies economic literacy is a classic misdirect by a politician who is a master of misdirects.
We need to operate by the common sense fundamentals that we all know work:
*Prices should be known to all,
*There should be one national market for all, not 50 separate markets;
*There should be equal tax treatment of individuals and those who get their insurance through their jobs;
*health savings accounts should have their legal limitations lifted.
etc etc etc
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ObamaCare's Secret Mandate Exemption
HHS quietly repeals the individual purchase rule for two more years.
March 11, 2014 7:15 p.m. ET
ObamaCare's implementers continue to roam the battlefield and shoot their own wounded, and the latest casualty is the core of the Affordable Care Act—the individual mandate. To wit, last week the Administration quietly excused millions of people from the requirement to purchase health insurance or else pay a tax penalty.
This latest political reconstruction has received zero media notice, and the Health and Human Services Department didn't think the details were worth discussing in a conference call, press materials or fact sheet. Instead, the mandate suspension was buried in an unrelated rule that was meant to preserve some health plans that don't comply with ObamaCare benefit and redistribution mandates. Our sources only noticed the change this week.
That seven-page technical bulletin includes a paragraph and footnote that casually mention that a rule in a separate December 2013 bulletin would be extended for two more years, until 2016. Lo and behold, it turns out this second rule, which was supposed to last for only a year, allows Americans whose coverage was cancelled to opt out of the mandate altogether.
In 2013, HHS decided that ObamaCare's wave of policy terminations qualified as a "hardship" that entitled people to a special type of coverage designed for people under age 30 or a mandate exemption. HHS originally defined and reserved hardship exemptions for the truly down and out such as battered women, the evicted and bankrupts.
Agence France-Presse/Getty Images
But amid the post-rollout political backlash, last week the agency created a new category: Now all you need to do is fill out a form attesting that your plan was cancelled and that you "believe that the plan options available in the [ObamaCare] Marketplace in your area are more expensive than your cancelled health insurance policy" or "you consider other available policies unaffordable."
This lax standard—no formula or hard test beyond a person's belief—at least ostensibly requires proof such as an insurer termination notice. But people can also qualify for hardships for the unspecified nonreason that "you experienced another hardship in obtaining health insurance," which only requires "documentation if possible." And yet another waiver is available to those who say they are merely unable to afford coverage, regardless of their prior insurance. In a word, these shifting legal benchmarks offer an exemption to everyone who conceivably wants one.
Keep in mind that the White House argued at the Supreme Court that the individual mandate to buy insurance was indispensable to the law's success, and President Obama continues to say he'd veto the bipartisan bills that would delay or repeal it. So why are ObamaCare liberals silently gutting their own creation now?
The answers are the implementation fiasco and politics. HHS revealed Tuesday that only 940,000 people signed up for an ObamaCare plan in February, bringing the total to about 4.2 million, well below the original 5.7 million projection. The predicted "surge" of young beneficiaries isn't materializing even as the end-of-March deadline approaches, and enrollment decelerated in February.
Meanwhile, a McKinsey & Company survey reports that a mere 27% of people joining the exchanges were previously uninsured through February. The survey also found that about half of people who shopped for a plan but did not enroll said premiums were too expensive, even though 80% of this group qualify for subsidies. Some substantial share of the people ObamaCare is supposed to help say it is a bad financial value. You might even call it a hardship.
HHS is also trying to pre-empt the inevitable political blowback from the nasty 2015 tax surprise of fining the uninsured for being uninsured, which could help reopen ObamaCare if voters elect a Republican Senate this November. Keeping its mandate waiver secret for now is an attempt get past November and in the meantime sign up as many people as possible for government-subsidized health care. Our sources in the insurance industry are worried the regulatory loophole sets a mandate non-enforcement precedent, and they're probably right. The longer it is not enforced, the less likely any President will enforce it.
The larger point is that there have been so many unilateral executive waivers and delays that ObamaCare must be unrecognizable to its drafters, to the extent they ever knew what the law contained.
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Obama shut down the government rather than have Obamacare postponed, but the Pravdas seem not to notice that , , , in violation of his oath to enforce the law he blocked the Reps from changing he has postponed the law. Truly we are in Alice in Wonderland territory , , ,
ObamaCare's Individual Mandate Effectively Postponed -- For 3 Years -- For Policies That Were Cancelled
By DICK MORRIS
Published on DickMorris.com on March 12, 2014
In a policy retreat that is little known and virtually uncovered in media circles (except for the Wall Street Journal), the Obama Administration has effectively postponed, for three years, any requirement that those whose health care policies were cancelled or will be cancelled from having to buy health insurance.
This regulatory decision, coupled with the delays granted to employers large and small in the mandate that they cover their workers, so truncates ObamaCare as to amount to its a virtual repeal.
Specifically, by delaying the individual mandate for three years, Obama has given the GOP everything it sought in its abortive government shutdown in October, 2013.
Now, those whose health care policies were cancelled can opt out of the individual mandate -- and not pay the fine for being uncovered -- simply by checking a box on the form.
Under the new rules, according to the Wall Street Journal, "all you need to do is fill out a form attesting that your plan was cancelled and that you 'believe that the plan options available in the [ObamaCare] Marketplace in your area are more expensive than your cancelled health insurance policy' or 'you consider other available policies unaffordable.'
You can even opt out of the requirement to buy new insurance if "you experienced another hardship in obtaining health insurance." Documentation? The regulation only requires that you provide it "if possible."
Effectively, this means that anyone who wants an exemption from ObamaCare who previously had a policy that was cancelled can get one simply by asking for it. No proof. No documentation.
The policy retreat is the latest in a series of Administration attempts to backpedal on the law and its requirements as their reality dawns on voters in swing states and on Democratic Senators trying to entice them to back their re-election.
The previous step back was an announcement last week that the one year moratorium on cancellations would be extended to three years, effectively pushing it out past the 2016 elections.
But, that postponement will not affect many of the states where endangered Senate Democrats live. That is because the original decision to postpone the cancellations was subject to the approval of the state insurance commissioner in each locale. The blue state commissioners mostly rejected the option and ordered the cancellations to proceed. As a result, the president's offer of a postponement for two more years of the cancellations will avail little marginal Senate Democratic candidates in Alaska, Arkansas, Colorado, Minnesota, and West Virginia.
Altogether, the retreat of this president from the enforcement of his signature program is breathtaking and can only be summed up as a repeal, or postponement of the bulk of the ObamaCare Law's provisions.
Can Obama repeal and postpone his way to keeping a Senate majority in the fall? We'll see.
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"Can Obama repeal and postpone his way to keeping a Senate majority in the fall?"
And can he lie and distort and conceal along with willing MSM accomplices till then?
My guess is no. How convenient that he is safely re elected some Dems will speak out against him only to set the stage for their next front person.
Morris said Brock is now doing the same thing Clinton did during Lewinsky by announcing policy programs and changing the subject every day.
Remember when we seem to have had thrust in our faces every single day an adorable announcement by Clinton? Now we see the Brock doing the same thing to constantly change the subject and announce liberal crap every day. Raise the min wage. Raise overtime pay and so on.
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The whole point of health care reform (and the first name of the act) was (is) affordability. Affordability has two components, the cost of your healthcare and the size of your income.
To address the affordability 'crisis' we committed maybe a trillion dollars so far to a program that made costs go up, incomes go down, and made affordability much worse. (The law of holes suggests it is time to stop digging?)
Another approach (looking backward or looking forward) would be to grow personal, household and national incomes to make basic expenses like food, clothing, shelter, transportation, and yes, healthcare, more affordable.
Imagine instead if we had legalized free enterprise, encouraged the productive use of capital, removed burdensome regulations, simplified and lowered tax rates, opened up competition (in all industries), employed idle labor, and massively grown the private sector instead of this 7 year project of super-sizing our federal government. What would that do or have done to the affordability of health care?
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Yes, but there are no opportunities for graft and control over the masses if you did that.
The whole point of health care reform (and the first name of the act) was (is) affordability. Affordability has two components, the cost of your healthcare and the size of your income.
To address the affordability 'crisis' we committed maybe a trillion dollars so far to a program that made costs go up, incomes go down, and made affordability much worse. (The law of holes suggests it is time to stop digging?)
Another approach (looking backward or looking forward) would be to grow personal, household and national incomes to make basic expenses like food, clothing, shelter, transportation, and yes, healthcare, more affordable.
Imagine instead if we had legalized free enterprise, encouraged the productive use of capital, removed burdensome regulations, simplified and lowered tax rates, opened up competition (in all industries), employed idle labor, and massively grown the private sector instead of this 7 year project of super-sizing our federal government. What would that do or have done to the affordability of health care?
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(http://tpc.pc2.netdna-cdn.com/images/various_uploads/Poster_Boot_Obamacare_Uninsured_160.png)
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http://www.nytimes.com/2014/03/26/opinion/why-im-jealous-of-my-dogs-insurance.html?emc=edit_th_20140326&nl=todaysheadlines&nlid=49641193
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Let me see if I have this right.
Since the beginning of Obamacare, it has taken weeks or months to get vague, incomplete numbers. Now, in one day, they declare 7.1 million?
Six million people had their individual health insurance cancelled, so that leaves a net difference of 1.1 million. Per insurance company data which shows that 15-20% of "enrollees" have not paid, deduct from the 7.1 million 1.65 million to 1.42 million.
In short, less people have insurance than when we started.
Yes?
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Obama would never lie to the American people.
If you think otherwise, you are obviously raaaaaaaaacist!
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Oh, and crunching numbers is just patriarchal, heteronormative, and an example of white privilege.
Luckily, our professional journalists, like Martha Raddatz wouldn't dream of asking such questions.
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I think some competing drugs are on the way:
*****Insurers Are Really Mad at Sovaldi, the $1,000-a-Day Miracle Drug
The Atlantic Wire
By Polly Mosendz 23 hours ago
In December 2013, the FDA approved Sovaldi a drug developed by Gilead Sciences that promises to do wonders for patients with hepatitis C. Since then, insurers and the government have grown incredibly angry and frustrated with the company.
Sovaldi is a revolutionary advance that promises to cure 90% of targeted patients. Without this treatment, patients could develop liver cancer or require liver transplants. The FDA has said "it is the first drug that has demonstrated safety and efficacy to treat certain types of HCV infection without the need for co-administration of interferon." It was granted the FDA's coveted Breakthrough Therapy Designation, becoming approved in under a year. Director of the Office of Antimicrobial Products at the FDA's Center of Drug Evaluation and Research, Edward Cox, M.D., believes Sovaldi is life changing: “[Sovaldi's] approval represents a significant shift in the treatment paradigm for some patients with chronic hepatitis C.”
Yet, insurers cannot stand this life saving, revolutionary medication. That's because it runs $1,000 a day and the average patient requires a 12-week treatment of Sovaldi. That's $84,000 for one cycle. For patients with a strain that is more difficult to treat, the regiment is 24 weeks. That comes in at $168,000. It is projected to rake it between $5 billion and $9 billion in profits in the United States this year alone. There are an estimated 4 million Americans with Hepatitis C, and 15,000 are killed each year by untreated chronic infections.
Unfortunately, there is not much insurers can do about the price. A comparable drug is not yet on the market. The most similar medication, Incivek, runs $68,000 for 12-week course, but it is much less effective. Comparatively, Sovaldi is still much cheaper than the next-best alternative: a liver transplant. Transplant surgery runs at least $175,000 per patient, not including complications and other associated costs. Additionally, the risks of surgery are far greater than the drug: the body can reject a transplant, it is major surgery, and the recovery time is much longer. There is also a wait list, and a hepatitis C patient may not be eligible for a liver in time.
Gilead Sciences believes the focus is in all the wrong places. "[Critics] have focused on the per-pill cost or per-bottle cost, but that is really not relevant here. It's how much it costs to cure your patient," said Gregg Alton, Gilead's executive vice president of corporate and medical affairs.
Regardless, insurers are battling to lower the cost of the drug. Molina Healthcare, which is set to see earnings decline by 18 percent if (though more realistically, when) the drug reaches $6 billion in sales, is trying to limit which patients have access to the treatment. Mario J. Molina, chief executive of Molina Healthcare gave this statement: “If you’ve got a patient who is advanced and has liver disease and is about to get a liver transplant, it makes sense to give treatment. [W]hat do we do about everybody else? If everyone in the U.S. with hepatitis C were treated with Sovaldi at its list price, it would cost $227 billion compared with the estimated $260 billion spent a year in the country for all drugs.”
Express Scripts is working with doctors to determine which customers can be put on a wait list until a rival, and presumably less expensive, drug is available.
Representative Henry Waxman has taken direct aim at Gilead Sciences as well. In a public letter sent March, 20th, Waxman questioned the pricing: "Our concern is that a treatment will not cure patients if they cannot afford it. [...] According to a recent Reuters report, 'many doctors are requesting a $150,000 combination of Sovaldi ... and Olysio. These costs are likely to be too high for many patients, both those with public insurance and those with private insurance." ********
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Interesting.
For the medical side of things let's post on the Health thread on the SCH forum.
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second post
Numbers Games
An unpublished RAND Corporation study on ObamaCare enrollment has been kept
under wraps and it's not hard to see why. While the White House trumpeted
meeting its goal of 7.1 million enrollees this week, RAND says the number
actually enrolled -- having paid their premium -- could be as few as 858,000.
Just 23% of enrollees were previously uninsured. Even if the true number is
somewhere in the middle, Democrats running for election in November will rue
the day 7.1 million was mentioned. And how did the administration get its
numbers so fast anyway? A couple of months ago Jay Carney stonewalled, saying,
"I'm not going to cherry-pick numbers," meaning, tell you any. Now he says
they know to the decimal point because "our system has gotten a lot better."
Color us skeptical.
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Is she serious? She claims she does not understand the opposition to the ACA! Why would anyone be so upset about all the free or cheap benefits it brings she wonders?
Totally absent from her argument is who is paying for this stuff and loss of freedom. Not one iota mentioned of that. She completely blocks it all out. Most people I see have higher deductibles and copays, higher rates, more restricted formularies and other tests. This aspect is totally ignored by the left.
******IRRATIONAL HATRED OF OBAMACARE IS HARD TO FATHOM
Cynthia Tucker
By Cynthia Tucker 5 hours ago
My friend Isatou has just received an invoice from Kaiser Permanente, testament to her new coverage through the Affordable Care Act -- usually called "Obamacare." She's thrilled to finally have health insurance so she can get regular checkups, including dental care.
A reasonably healthy middle-aged woman, she knows she needs routine mammograms and screenings for maladies such as hypertension. But before Obamacare, she struggled to pay for those things. She once had to resort to the emergency room, which left her with a bill for nearly $20,000. (She settled the bill for far less, but it still left her deeply in debt.)
She is one of more than 7 million people who have signed up for health insurance through the ACA, stark evidence of the overwhelming market demand. Despite a badly bungled initial roll-out, a multimillion dollar conservative media campaign designed to discourage sign-ups, and a years-long Republican crusade against it (50 votes to change the law), millions got health insurance.
That hardly means Obamacare is a raging success. It's much too early to know how it will affect health outcomes for the previously uninsured. But it's abundantly clear that the ACA has already made great strides in improving access to health care. And that alone is quite an accomplishment.
Now, young adults can stay on their parents' health insurance policies until they are 26 years old -- a boon in an economy where many young folks are struggling to find decent jobs. Now, patients with previously diagnosed illnesses ("pre-existing conditions," in insurance lingo) can't be denied coverage. Now, the chronically ill don't have to worry about hitting a lifetime cap that would deny them essential procedures or pharmaceuticals. Now, working folks who don't get insurance through their employers can purchase affordable policies.
Factoring in the Medicaid expansion, the ACA has extended health care coverage to an additional 9.5 million people, according to the Los Angeles Times, which gathered data from national surveys. Needless to say, millions more would have been covered if so many Republican governors, mostly located in Southern states, had not callously refused to accept the Medicaid expansion despite the fact that it is largely paid through federal government funds.
The GOP's relentless opposition has been puzzling. Republicans have resorted to extreme measures to try to derail Obamacare, including an implicit threat to prevent the National Football League from participating in a marketing campaign to encourage people to sign up.
Oh, did I mention 50 votes to repeal or alter the law?
Even acknowledging that our politics have become bitterly polarized, I don't understand this one. Even taking into account the GOP's irrational hatred for President Obama, I don't get it. Even though I know that Republicans believe in less government, I don't understand their approach to Obamacare.
First off, the ACA adheres to market-based ideas, many of which were first suggested by conservatives. Instead of a single-payer system like, say, Medicare, the ACA relies on private insurance companies. It adopts the individual mandate that was supported by many Republicans, including Newt Gingrich, back in the 1990s and later adopted by Mitt Romney in Massachusetts.
Second, Republicans are free to offer up a health care scheme that is more in keeping with conservative principles. But the "repeal and replace" mantra is rarely heard anymore since it has become increasingly clear that the GOP has no intention of coming up with a plan to replace Obamacare. While there are various counter-proposals floating about, none has garnered the support of a majority of Republicans in Congress.
Is the ACA perfect? Absolutely not. There is much in the law that needs to be worked on, refined, improved. But the GOP doesn't seem interested in that. Instead, its members have taken to engaging in increasingly ridiculous criticisms, including the charge that the White House has made up the number of successful enrollees.
It's strange. Could it be that Republicans are simply furious that millions of Americans like Isatou finally have health insurance?
(Cynthia Tucker, winner of the 2007 Pulitzer Prize for commentary, is a visiting professor at the University of Georgia. She can be reached at cynthia@cynthiatucker.com.)
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http://online.wsj.com/news/articles/SB10001424052702303603904579495064052562826?mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424052702303603904579495064052562826.html
Sebelius: The Greatest Hits Collection
It's been quite a year for the outgoing HHS secretary. And now she won't get to keep her health plan.
Kathleen Sebelius, who has presided over the disastrous rollout of the Affordable Care Act, is expected to resign as Secretary of Health and Human Services. The news comes less than two weeks after she told the Huffington Post that she would "absolutely" stay in office through November. A Journal editorial notes that her departure "before the election reckoning" is "best understood as one more attempt to dodge political responsibility."
It's been quite a year for the former Kansas governor. At around this time in 2013 Ms. Sebelius was pressuring private companies she regulates to make "independent" donations to outfits promoting ObamaCare.
But the aggressive sales job could not overcome defects in the product. October brought the failed launch of the healthcare.gov website, which Ms. Sebelius initially characterized as simply the result of surging consumer demand for ObamaCare and a "great problem to have."
December brought more embarrassing news as Ms. Sebelius waived the law's individual mandate to buy insurance by categorizing ObamaCare itself as a hardship worthy of exemption.
This was just one of many on-the-fly rewrites the administration claimed the authority to make under a law passed by Congress and signed by the President. As recently as last month, Ms. Sebelius enacted what a Journal editorial called "ObamaCare Delay Number 38"—an extension of the deadline for individuals to enroll in an insurance plan— just weeks after she told Congress that such a delay would not occur.
Though she is leaving now, her legacy is secure, as her name adorns several of the most consequential federal cases resulting from the law. Halbig v. Sebelius is testing whether the Obama Administration can continue to subsidize insurance exchanges created by the federal government, even though the law says it cannot. And the cases of Sebelius v. Hobby Lobby and Conestoga Wood Specialties v. Sebelius test whether the Obama Administration can force the owners of private businesses to violate their religious beliefs.
Of course there's a reason that the law isn't called SebeliusCare. She is merely the person charged by the President with imposing the law upon American patients and doctors. Her resignation doesn't change the fact that Democrats will remain politically accountable for a law sold on a fraudulent promise from Mr. Obama.
But this latest news does mean that not even the Secretary of Health and Human Services will get to keep her insurance plan.
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By Daniela Drake 16 hours ago The Daily Beast
Why Your Doctor Hates His Job
By the end of this year, it’s estimated that 300 physicians will commit suicide. While depression amongst physicians is not new—a few years back, it was named the second most suicidal occupation—the level of sheer unhappiness amongst physicians is on the rise.
Simply put, being a doctor has become a miserable and humiliating undertaking. Indeed, many doctors feel that America has declared war on physicians—and both physicians and patients are the losers.
Not surprisingly, many doctors want out. Medical students opt for high-paying specialties so they can retire as quickly as possible. Physician MBA programs—that promise doctors a way into management—are flourishing. The website known as the Drop-Out-Club—which hooks doctors up with jobs at hedge funds and venture capital firms—has a solid following. In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession.
It’s hard for anyone outside the profession to understand just how rotten the job has become—and what bad news that is for America’s healthcare system. Perhaps that’s why author Malcolm Gladwell recently implied that to fix the healthcare crisis, the public needs to understand what it’s like to be a physician. Imagine, for things to get better for patients, they need to empathize with physicians—that’s a tall order in our noxious and decidedly un-empathetic times.
After all, the public sees ophthalmologists and radiologists making out like bandits and wonder why they should feel anything but scorn for such doctors—especially when Americans haven’t gotten a raise in decades. But being a primary care physician is not like being, say, a plastic surgeon—a profession that garners both respect and retirement savings. Given that primary care doctors do the work that no one else is willing to do, being a primary care physician is more like being a janitor—but without the social status or union protections.
Unfortunately, things are only getting worse for most doctors, especially those who still accept health insurance. Just processing the insurance forms costs $58 dollars for every patient encounter, according to Dr. Stephen Schimpff, an internist and former CEO of University of Maryland Medical Center who is writing a book about the crisis in primary care. To make ends meet, physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes.
Neither patients nor doctors are happy about that. What worries many doctors, however, is that the Affordable Care Act has codified this broken system into law. While forcing everyone to buy health insurance, ACA might have mandated a uniform or streamlined claims procedure that would have gone a long way to improving access to care. As Malcolm Gladwell noted, “You don’t train someone for all of those years in [medicine]… and then have them run a claims processing operation for insurance companies.”
In fact, difficulty dealing with insurers has caused many physicians to close their practices and become employees. But for patients, seeing an employed doctor doesn’t give them more time with the doctor—since employed physicians also have high patient loads. “A panel size of 2,000 to 2,500 patients is too many,” says Dr. Schimpff. That’s the number of patients primary care doctors typically are forced to carry—and that means seeing 24 or more patients a day, and often these patients have 10 or more medical problems. As any seasoned physician knows, this is do-able, but it’s certainly not optimal.
Most patients have experienced the rushed clinic visit—and that’s where the breakdown in good medical care starts. “Doctors who are in a rush, don’t have the time to listen,” says Dr. Schimpff. “Often, patients get referred to specialists when the problem can be solved in the office visit.” It’s true that specialist referrals are on the rise, but the time crunch also causes doctors to rely on guidelines instead of personally tailoring medical care. Unfortunately, mindlessly following guidelines can result in bad outcomes.
Yet physicians have to go along, constantly trying to improve their “productivity” and patient satisfaction scores—or risk losing their jobs. Industry leaders are fixated on patient satisfaction, despite the fact that high scores are correlated with worse outcomes and higher costs. Indeed, trying to please whatever patient comes along destroys the integrity of our work. It’s a fact that doctors acquiesce to patient demands—for narcotics, x-rays, doctor’s notes—despite what survey advocates claim. And now that Medicare payments will be tied to patient satisfaction—this problem will get worse. Doctors need to have the ability to say no. If not, when patients go to see the doctor, they won’t actually have a physician—they’ll have a hostage.
But the primary care doctor doesn’t have the political power to say no to anything—so the “to-do” list continues to lengthen. A stunning and unmanageable number of forms—often illegible—show up daily on a physician’s desk needing to be signed. Reams of lab results, refill requests, emails, and callbacks pop up continually on the computer screen. Calls to plead with insurance companies are peppered throughout the day. Every decision carries with it an implied threat of malpractice litigation. Failing to attend to these things brings prompt disciplining or patient complaint. And mercilessly, all of these tasks have to be done on the exhausted doctor’s personal time.
Almost comically, the response of medical leadership—their solution— is to call for more physician testing. In fact, the American Board of Internal Medicine (ABIM)—in its own act of hostage-taking—has just decided that doctors should be tested not every ten years, but every two years. If a physician doesn’t comply by the end of this month, the ABIM will strip away the doctor’s board certification status.
In an era when nurse practitioners and physician assistants have shown that they can provide excellent primary care, it’s nonsensical to raise the barriers for physicians to participate. In an era when you can call up guidelines on your smartphone, demanding more physician testing is a ludicrous and self-serving response.
It is tone deaf. It is punitive. It is wrong. And practicing doctors can’t do a damn thing about it. No wonder doctors are suicidal. No wonder young doctors want nothing to do with primary care.
But what is a bit of a wonder is how things got this bad.
Certainly, the relentlessly negative press coverage of physicians sets the tone. “There’s a media narrative that blames physicians for things the doctor has no control over,” says Kevin Pho, MD, an internist with a popular blog where physicians often vent their frustrations. Indeed, in the popular press recently doctors have been held responsible for everything from the wheelchair-unfriendly furniture to lab fees for pap smears.
The meme is that doctors are getting away with something and need constant training, watching and regulating. With this in mind, it’s almost a reflex for policy makers to pile on the regulations. Regulating the physician is an easy sell because it is a fantasy—a Freudian fever dream—the wish to diminish, punish and control a disappointing parent, give him a report card, and tell him to wash his hands.
To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and driving out doctors. Maybe it’s too much to ask for empathy, and maybe physician lives don’t matter to most people.
But for America’s health to be safeguarded, the wellbeing of America’s caretakers is going to have to start mattering to someone.
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http://www.thedailybeast.com/articles/2014/04/14/how-being-a-doctor-became-the-most-miserable-profession.html
How Being a Doctor Became the Most Miserable Profession
by Daniela DrakeApr 14, 2014 5:45 am EDT
Nine of 10 doctors discourage others from joining the profession, and 300 physicians commit suicide every year. When did it get this bad?
By the end of this year, it’s estimated that 300 physicians will commit suicide. While depression amongst physicians is not new—a few years back, it was named the second-most suicidal occupation—the level ofsheer unhappiness amongst physicians is on the rise.
Simply put, being a doctor has become a miserable and humiliating undertaking. Indeed, many doctors feel that America has declared war on physicians—and both physicians and patients are the losers.
Not surprisingly, many doctors want out. Medical students opt for high-paying specialties so they can retireas quickly as possible. Physician MBA programs—that promise doctors a way into management—areflourishing. The website known as the Drop-Out-Club—which hooks doctors up with jobs at hedge funds and venture capital firms—has a solid following. In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession.
It’s hard for anyone outside the profession to understand just how rotten the job has become—and what bad news that is for America’s health care system. Perhaps that’s why author Malcolm Gladwell recently implied that to fix the healthcare crisis, the public needs to understand what it’s like to be a physician.
Imagine, for things to get better for patients, they need to empathize with physicians—that’s a tall order in our noxious and decidedly un-empathetic times.
After all, the public sees ophthalmologists and radiologists making out like bandits and wonder why they should feel anything but scorn for such doctors—especially when Americans haven’t gotten a raise in decades. But being a primary care physician is not like being, say, a plastic surgeon—a profession that garners both respect and retirement savings. Given that primary care doctors do the work that no one else is willing to do, being a primary care physician is more like being a janitor—but without the social status or union protections.
Unfortunately, things are only getting worse for most doctors, especially those who still accept health insurance. Just processing the insurance forms costs $58 for every patient encounter, according to Dr. Stephen Schimpff, an internist and former CEO of University of Maryland Medical Center who is writing a book about the crisis in primary care. To make ends meet, physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes.
Neither patients nor doctors are happy about that. What worries many doctors, however, is that the Affordable Care Act has codified this broken system into law. While forcing everyone to buy health insurance, ACA might have mandated a uniform or streamlined claims procedure that would have gone a long way to improving access to care. As Malcolm Gladwell noted, “You don’t train someone for all of those years in [medicine]… and then have them run a claims processing operation for insurance companies.”
In fact, difficulty dealing with insurers has caused many physicians to close their practices and become employees. But for patients, seeing an employed doctor doesn’t give them more time with the doctor—since employed physicians also have high patient loads. “A panel size of 2,000 to 2,500 patients is too many,” says Dr. Schimpff. That’s the number of patients primary care doctors typically are forced to carry—and that means seeing 24 or more patients a day, and often these patients have 10 or more medical problems. As any seasoned physician knows, this is do-able, but it’s certainly not optimal.
Most patients have experienced the rushed clinic visit—and that’s where the breakdown in good medical care starts. “Doctors who are in a rush, don’t have the time to listen,” says Dr. Schimpff. “Often, patients get referred to specialists when the problem can be solved in the office visit.” It’s true that specialist referrals areon the rise, but the time crunch also causes doctors to rely on guidelines instead of personally tailoring medical care. Unfortunately, mindlessly following guidelines can result in bad outcomes.
Yet physicians have to go along, constantly trying to improve their “productivity” and patient satisfaction scores—or risk losing their jobs. Industry leaders are fixated on patient satisfaction, despite the fact that high scores are correlated with worse outcomes and higher costs. Indeed, trying to please whatever patient comes along destroys the integrity of our work. It’s a fact that doctors acquiesce to patient demands—for narcotics, X-rays, doctor’s notes—despite what survey advocates claim. And now that Medicare payments will be tied to patient satisfaction—this problem will get worse. Doctors need to have the ability to say no. If not, when patients go to see the doctor, they won’t actually have a physician—they’ll have a hostage.
But the primary care doctor doesn’t have the political power to say no to anything—so the “to-do” list continues to lengthen. A stunning and unmanageable number of forms—often illegible—show up daily on a physician’s desk needing to be signed. Reams of lab results, refill requests, emails, and callbacks pop up continually on the computer screen. Calls to plead with insurance companies are peppered throughout the day. Every decision carries with it an implied threat of malpractice litigation. Failing to attend to these things brings prompt disciplining or patient complaint. And mercilessly, all of these tasks have to be done on the exhausted doctor’s personal time.
Almost comically, the response of medical leadership—their solution— is to call for more physician testing. In fact, the American Board of Internal Medicine (ABIM)—in its own act of hostage-taking—has decided that in addition to being tested every ten years, doctors must comply with new, costly, "two year milestones." For many physicians, if they don't comply be the end of this month, the ABIM will advertise the doctor's "lack of compliance" on their website.
In an era when nurse practitioners and physician assistants have shown that they can provide excellent primary care, it’s nonsensical to raise the barriers for physicians to participate. In an era when you can call up guidelines on your smartphone, demanding more physician testing is a ludicrous and self-serving response.
It is tone deaf. It is punitive. It is wrong. And practicing doctors can’t do a damn thing about it. No wonder doctors are suicidal. No wonder young doctors want nothing to do with primary care.
But what is a bit of a wonder is how things got this bad.
Certainly, the relentlessly negative press coverage of physicians sets the tone. “There’s a media narrative that blames physicians for things the doctor has no control over,” says Kevin Pho, MD, an internist with apopular blog where physicians often vent their frustrations. Indeed, in the popular press recently doctors have been held responsible for everything from the wheelchair-unfriendly furniture to lab fees for pap smears.
The meme is that doctors are getting away with something and need constant training, watching and regulating. With this in mind, it’s almost a reflex for policy makers to pile on the regulations. Regulating the physician is an easy sell because it is a fantasy—a Freudian fever dream—the wish to diminish, punish and control a disappointing parent, give him a report card, and tell him to wash his hands.
To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and driving out doctors. Maybe it’s too much to ask for empathy, and maybe physician lives don’t matter to most people.
But for America’s health to be safeguarded, the wellbeing of America’s caretakers is going to have to start mattering to someone.
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Brace For ObamaCare
By Dick Morris on April 23, 2014
Published on TheHill.com on April 22, 2014
ObamaCare has signed up 8 million people. Democrats are breathing a sigh of relief, but their trials have only just begun.
Now a large swath of America will experience firsthand the shortages of doctors, the limited access to hospitals, the high deductibles, the large co-pays, the significant co-insurance requirements and the long delays in care that will accompany Obama-Care’s implementation. These Americans will see, firsthand, what government-run medicine is like. And the rest of the electorate will have a front-row seat from which to watch the debacle.
The fundamental problem facing ObamaCare is the same as it was when the misbegotten program was launched: You cannot expand the number of patients without expanding the number of doctors. If you try, as the Affordable Care Act does, you will have long waits to see doctors, big increases in costs and unsatisfactory patient outcomes.
The increases in cost that we are now seeing in the healthcare sector come, of course, from an increase in demand with no commensurate rise in the supply. These price hikes will trigger the most deeply disturbing — and controversial — of ObamaCare’s provisions, the Independent Payment Advisory Board (IPAB).
Appointed by the president and confirmed by the Senate, this 15-member board will be charged with requiring alterations in Medicare practice to hold down costs sufficiently to cut program spending by $500 billion over the next decade. The formulae it develops will, undoubtedly, be adopted by states seeking to contain Medicaid costs and by private insurance firms.
The IPAB has not yet come into existence because the rate of medical inflation has not required it. But now, with prices rising, it will become central.
Each January, the IPAB will issue a cost-reduction plan. It will proscribe the use of certain high-cost medicines, limit access to diagnostic tests and condition approval of certain surgeries and treatments based on the number of “quality-adjusted life years” left to each patient, all to bring Medicare costs into line.
Congress may override the IPAB recommendations by a three-fifths vote of each House. Otherwise, they automatically take effect by Aug. 15.
Each year, the administration will face a bruising fight over the IPAB recommendations. Patients will protest, and doctors will warn of bad outcomes. Sarah Palin’s “death panel” will begin its reign.
At the local level, cancer patients will find that the nearest and the best hospitals won’t take them. Pharmacies won’t fill their prescriptions. Doctors will turn away patients. As the ObamaCare bureaucracy struggles with the rising costs it caused, it will ration access to medicines, hospitals, surgeries and elective procedures for all in its reach.
Meanwhile, all Americans under the age of 65 who are not on Medicaid — both those on ObamaCare and covered by private plans — will find huge premium increases throughout the remainder of 2014 and during 2015. Deductibles will skyrocket. Stories of the financial hardship of paying the new premiums will abound.
And the cancellations will continue. Small employers will shut down their policies rather than accept the new higher premiums, and their workers will have to fend for themselves in the high-cost ObamaCare market. Those insured by large companies will see big increases in premiums and deductibles. And employees will continue to see a reduction in their weekly work hours as their bosses squirm and maneuver to limit ObamaCare’s universal coverage mandate.
Meanwhile, many of the 8 million enrollees will not pay up, eroding the program, and those who go without health insurance will hate every penny of the fine Obama will impose on them — or, they just won’t pay it.
For those who feel the political damage of ObamaCare is behind them, you ain’t seen nothin’ yet!
View my most recent videos in case you missed them!
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The Coming Two-Tier Health System
ObamaCare is already creating one class of care for the poor and middle class and another for the affluent.
By Scott W. Atlas
WSJ
April 30, 2014 7:01 p.m. ET
With the unveiling of the Affordable Care Act's website, the public experienced a painful reminder of the consequences of the government's new authority over health care. While millions signed up for insurance, millions of others abruptly lost their existing coverage and access to their doctors because that coverage didn't fit new ObamaCare definitions.
The health-care law was generated by an administration promoting government as the solution to inequality, yet the greatest irony of ObamaCare is what will undoubtedly follow as a long-term, unintended consequence of the law: a decidedly unequal, two-tiered health system. One will be for the poor and middle class, and a separate system will be for those with the money or power to circumvent ObamaCare.
With the Affordable Care Act, the government has dramatically expanded its authority as final arbiter over health insurance and consequently over access to medical care. After the law's Medicaid expansion and with the population aging into Medicare eligibility, the 107 million under Medicaid or Medicare in 2013 will skyrocket to 135 million five years later, growing far faster than the ranks of the privately insured.
Add to that centralization of power the Independent Payment Advisory Board (IPAB), ObamaCare's group of political appointees tasked with reducing payments to doctors and hospitals. Even Howard Dean, former chairman of the Democratic National Committee, warned that "The IPAB is essentially a health-care rationing body. By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them."
The hidden truth is just around the corner—those more dependent on public insurance, mostly the poor and middle class, will have limited access to medical care. About one-third of primary-care physicians and one-fourth of specialists have already completely closed their practices to Medicaid patients. Over 52% of physicians have already limited the access that Medicare patients have to their practices, or are planning to, according to a 2012 survey by Merritt Hawkins for the Physicians Foundation. More doctors than ever already refuse Medicaid and Medicare due to inadequate payments for care, and that trend will only accelerate as government lowers reimbursements.
At the same time, ObamaCare is squeezing out the middle class from affordable private insurance that correlates with far better disease outcomes than government insurance. By bloating coverage requirements and minimizing the consideration of risks fundamental to pricing insurance, the law has already increased premiums by 20%-200% in more than 40 states, according to a 2013 analysis by the Manhattan Institute's Avik Roy and others.
Less widely known is that inadequate reimbursement by government insurance to doctors substantially increases private-insurance prices. According to a December 2008 Milliman report presented by Will Fox and John Pickering, a shortfall of more than $88 billion in payments from Medicaid and Medicare beneficiaries added more than $1,500 extra a year in premiums and $1,800 extra in total out-of-pocket costs to every family of four with private insurance. With increasing enrollment into government insurance, private premiums will undoubtedly rise even more.
Even inside Medicare, two-tiered access will occur. Under political pressure in advance of this fall's midterm elections, the administration backed off from the ObamaCare plan to eliminate affordable private drug-coverage options inside Medicare, options that all Medicare beneficiaries enjoyed before the law. These substantial cuts will likely return post-election, limiting those choices to more-affluent seniors.
Despite the government's assertion that the health-care law increases insurance choices, the ObamaCare exchanges do the opposite for those dependent on them and the government subsidies they offer. The average number of plans offered in individual states has decreased from 117 in 2013 to 41 in the new exchanges; consumers in 16 states now suddenly have their choices limited to three or fewer insurers.
ObamaCare is also eliminating access to many of the best specialists and the hospitals for middle-income Americans. To meet the law's requirements, major insurers are declining to participate in the exchanges, or only offering plans that restrict choice of doctors and exclude many of America's best hospitals. McKinsey reported a marked narrowing of hospital networks on the ObamaCare exchanges: In 2013, 33% of individual insurance offerings contained narrow or very narrow networks, but this year under the exchanges 68% of options cover only those limited networks.
For cancer care, the overwhelming majority of America's best hospitals in the National Comprehensive Cancer Network—including MD Anderson Cancer Center of Houston, New York's Memorial Sloan-Kettering, Barnes Hospital in St. Louis, and the Seattle Cancer Care Alliance uniting doctors from Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Children's—are not covered in most of their states' exchange plans.
Meanwhile, concierge practices are increasing rapidly, as patients who can afford it, along with many top doctors, rush to avoid the problems of an increasingly restrictive health system. The American Academy of Private Physicians estimates that there are now about 4,400 concierge physicians, 30% more than last year. In a recent Merritt Hawkins survey, about 7% to 10% of physicians planned to transition to concierge or cash-only practices in the next one to three years. With doctors already spending 22% of their time on nonclinical paperwork, they will find more government intrusion under ObamaCare regulations taking even more time away from patient care.
As America doubles down on government authority over health care, Europeans with the means to do so are increasingly circumventing their own centralized systems. In Britain, even though they're already paying for the National Health Service, six million Brits—two-thirds of citizens earning more than $78,700—now buy private health insurance. Meanwhile, more than 50,000 travel out of the U.K. annually, spending more than $250 million, to receive treatment more readily than they can at home. Even in Sweden, the mother of all welfare nations, half a million Swedes now use private insurance, up from 100,000 a decade ago.
Unless ObamaCare is drastically altered, America's health care will also become even more divided, with rising inequality. Just as in the U.K. and other countries where governments take an outsize role in dictating health-care policy, only the lower and middle classes in America will suffer the full consequences of ObamaCare.
Dr. Atlas is a physician and a senior fellow at Stanford University's Hoover Institution.
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"Howard Dean, former chairman of the Democratic National Committee, warned that "The IPAB is essentially a health-care rationing body"
Well of course. That is also what the whole electronic medical record, the expansion of codes by several times, the reporting of "data" are about. It is all about control and cutting costs. Under the guise of better "quality" care of course.
As for the rich being able to get better care - it has and will always be that way. This is NOT new. Anyone know of any famous person who could NOT get an organ transplant?
Name one!
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http://m.washingtonexaminer.com/veterans-affairs-puts-3-on-leave-congress-threatens-subpoena/article/2547983
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http://media.wix.com/ugd/520423_fa60e0dba4e14293aeaebbe01fd5ed80.pdf
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My post from last year. I pointed out I agreed with Ezekial Emanuel that there IS NO shortage of doctors or at least primary care:
*****Follow up to previous post. Went to meeting of the New Jersey american college of physicians few weeks ago and listened to Ezekiel's talk.
Basically he starts with a bunch of charts and graphs describing what we all know - health care costs are going up and are unsustainable.
His prescription is basically for provider groups to form and control costs by monitoring what they do "outcomes" and basically what managed care has been doing for decades now. I guess the difference is really now the politburo types are requiring we do it on industrial scale with industrial level quality control with reems of data, measurements, more data of the data more measurements and every penny counted. He gave one example from a gourp of several hundred physcians Caremont though I don't remember where they are located and I haven't looked into it - yet.
Supposedly they cut costs while increasing the bottom line. Thus this is a model for all.
He also explains the cost rising is down form over 2% to around 0.8%. Of course he is suggesting he and the rest of the politburo are responsible for cost savings - not that the economy is so bad for most people they can't aford their co pays their deductables their premiums and neither can as many employers.
I only had a chance for one question so I asked him about Clay Christiansens theory that Nurse Practitioners will supplant primary care doctors and it is inevitable and no stopping it. He said PCP's are not replaceabale by nurses and that he doesn't think that would happen - though we are clearly seeing that trend.
He doesn't believe that there is a doctor shortage. Indeed I agree with him on that. There probably is a shortage of a few specialties and doctors in some low income urban areas or in the boondocks but certainly not in the north east and probably the West coast.
Indded if any group feels threateneed by the low wages of illegals /legal immigrants no where is this felt more than in health care.
All we see here are doctors born everywhrere else. The schools of course also like to play the shortage gimmack so they can get more money to churn more graduates out and the nursing programs the same.
Getting back to Emanuel his personality is the same as his brother Rahm. He ran out after one question after mine. I guess he had his next speaking engagement.l****
The doctors exist and are being churned out left and right. Except is some rural areas as always. If there are going to be longer waits it would be a result of some doctors refusing to accept patients our of principle or more they refuse to accept the lower pay coverage. As always follow the money.
http://www.usatoday.com/story/news/nation/2014/05/10/obamacare-surge-primary-care-overload/8894227/
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Most employers could shift healthcare coverage to exchanges by 2020, report says
Switch from employer to individual plans could save businesses $3.25 trillion
Publish date: MAY 15, 2014
Print
By: Rachael Zimlich
A new report is gaining attention for its prediction that U.S. companies could save trillions of dollars over the next decade by using the Affordable Care Act's (ACA) healthcare exchanges, and eliminating employee health plans.
The report, prepared for the financial services industry by S&P Capital IQ Global Markets Intelligence, predicts that companies could shift 90% of their workers from employer-based healthcare to individual coverage on insurance marketplaces by 2020. If all U.S. companies with 50 or more employees transferred coverage for their employees to the marketplace, they could save $3.25 trillion by 2025, the report predicts. If only Standard & Poor’s (S&P) 500 companies did so, they would save between $690 billion and $800 billion over the same period.
The premise of the ACA is to shift the responsibility for healthcare insurance to employees. This will put corporate America in a position to redefine its role in healthcare, the report states.
S&P 500 companies employ about 138 million people, or 20% of the American workforce. So when S&P companies adopt a practice, it often indicates the start of a new, large-scale trend among employers.
The report predicts that when the switch from employer to individual insurance begins, it won’t take long to complete, with 10% of S&P companies expected to begin transferring coverage to workers by 2016, 30% by 2017, 70% by 2019 and 90% by 2020. Low- and middle-income employees, entry-level workers or new college graduates, and part-time employees will be pushed into individual coverage first and will receive federal subsidies to help afford their new plans. Higher-income workers will follow later, likely with stipends to help cover the cost of their coverage, the report predicts. Those stipends will eventually become part of employee pay, completing the transition to a complete corporate abandonment of providing healthcare coverage.
But with all that money saved, someone is going to have to pay more, whether it is employees or the government. According to the report, employees moved to the exchange would pay nearly $2,800 more for their health benefits in 2016 compared with what they paid under an employer-provided insurance plan, or an increase of about 50%. But many low-wage, and even some middle-wage, employees will be eligible for a government subsidy to offset the cost of their their premiums which will also increase the financial burden of subsidizing healthcare for the federal government, the report predicts.
On the other hand, the more individuals that purchase healthcare coverage through the exchanges, the more affordable and competitive the market will become, the report explains. Purchasing individual coverage also will reduce the stress caused by changing jobs, because coverage won’t change with the employment. Overall, the shift could give employees more control over their healthcare coverage and more stability, but could also result in higher premiums for anyone not eligible for federal subsidies or offered stipends from their employers.
The report predicts that employee costs for healthcare will more than double by 2025, although they will be paying the same percentage—about 26%—of their premiums over that period. Employers’ share of premiums will drop from roughly 70% to 33%, while the government’s share is predicted to jump from less than 4% to about 41%.
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Yes. And we have already tried the single payer system - over at the Veterans Administration. That's what people want?!
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As an aside, I suggest we first vote to re-name ACA at least one day before repealing it. Don't give the media the headline that Republicans repealed Affordable Healthcare their first day in power.
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http://www.tpnn.com/2014/05/28/flashback-new-york-times-praises-va-as-a-model-for-obamacare/
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http://www.tpnn.com/2014/05/28/flashback-new-york-times-praises-va-as-a-model-for-obamacare/
Wow! Krugman got that right. Although it's really a best case scenario.
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http://www.washingtonpost.com/blogs/wonkblog/files/2014/05/ParenteAnalysis.pdf
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http://finance.yahoo.com/news/cbo-quietly-drops-forecast-obamacare-180500918.html
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As a primary I don't want another burden hoisted on me by another entity interested only on THEIR bottom line. I spend half the day performing someone else's requirements to help them supposedly in the fraudulent claim it is for the "care of the patient". I can confidently tell you it ain't and all information coming in is that statistical measurements are not showing more than very minimal if any gains in overall health. It is all a bunch of people and business finding ways to cut costs are generate income. And I am in the middle. :oops:
***********Hospitals Spy on Your Purchases to Spot Bad Habits
By Shannon Pettypiece and Jordan Robertson Jun 26, 2014 12:01 AM ET
You may soon get a call from your doctor if you’ve let your gym membership lapse, made a habit of picking up candy bars at the check-out counter or begin shopping at plus-sized stores.
That’s because some hospitals are starting to use detailed consumer data to create profiles on current and potential patients to identify those most likely to get sick, so the hospitals can intervene before they do.
Information compiled by data brokers from public records and credit card transactions can reveal where a person shops, the food they buy, and whether they smoke. The largest hospital chain in the Carolinas is plugging data for 2 million people into algorithms designed to identify high-risk patients, while Pennsylvania’s biggest system uses household and demographic data. Patients and their advocates, meanwhile, say they’re concerned that big data’s expansion into medical care will hurt the doctor-patient relationship and threaten privacy.
“It is one thing to have a number I can call if I have a problem or question, it is another thing to get unsolicited phone calls. I don’t like that,” said Jorjanne Murry, an accountant in Charlotte, North Carolina, who has Type 1 diabetes. “I think it
Acxiom Corp. (ACXM) and LexisNexis are two of the largest data brokers who collect such information on individuals. They say their data are supposed to be used only for marketing, not for medical purposes or to be included in medical records.
While both sell to health insurers, they said it’s to help those companies offer better services to members.
Much of the information on consumer spending may seem irrelevant for a hospital or doctor, but it can provide a bigger picture beyond the brief glimpse that doctors get during an office visit or through lab results, said Michael Dulin, director of research and evidence-based medicine at Carolinas HealthCare System.
Carolinas HealthCare System operates the largest group of medical centers in North Carolina and South Carolina, with more than 900 care centers, including hospitals, nursing homes, doctors’ offices and surgical centers. The health system is placing its data, which include purchases a patient has made using a credit card or store loyalty card, into predictive models that give a risk score to patients.
Within the next two years, Dulin plans for that score to be regularly passed to doctors and nurses who can reach out to high-risk patients to suggest interventions before patients fall ill.
Buying Cigarettes
For a patient with asthma, the hospital would be able to score how likely they are to arrive at the emergency room by looking at whether they’ve refilled their asthma medication at the pharmacy, been buying cigarettes at the grocery store and live in an area with a high pollen count, Dulin said.
The system may also score the probability of someone having a heart attack by considering factors such as the type of foods they buy and if they have a gym membership, he said.
“What we are looking to find are people before they end up in trouble,” said Dulin, who is also a practicing physician. “The idea is to use big data and predictive models to think about population health and drill down to the individual levels to find someone running into trouble that we can reach out to and try to help out.”
While the hospital can share a patient’s risk assessment with their doctor, they aren’t allowed to disclose details of the data, such as specific transactions by an individual, under the hospital’s contract with its data provider. Dulin declined to name the data provider.
If the early steps are successful, though, Dulin said he would like to renegotiate to get the data provider to share more specific details on patient spending with doctors.
“The data is already used to market to people to get them to do things that might not always be in the best interest of the consumer, we are looking to apply this for something good,” Dulin said.
While all information would be bound by doctor-patient confidentiality, he said he’s aware some people may be uncomfortable with data going to doctors and hospitals. For these people, the system is considering an opt-out mechanism that will keep their data private, Dulin said.
‘Feels Creepy’
“You have to have a relationship, it just can’t be a phone call from someone saying ‘do this’ or it just feels creepy,” he said. “The data itself doesn’t tell you the story of the person, you have to use it to find a way to connect with that person.”
Murry, the diabetes patient from Charlotte, said she already gets calls from her health insurer to try to discuss her daily habits. She usually ignores them, she said. She doesn’t see what her doctors can learn from her spending practices that they can’t find out from her quarterly visits.
“Most of these things you can find out just by looking at the patient and seeing if they are overweight or asking them if they exercise and discussing that with them,” Murry said. “I think it is a waste of time.”
While the patients may gain from the strategy, hospitals also have a growing financial stake in knowing more about the people they care for.
Under the Patient Protection and Affordable Care Act, known as Obamacare, hospital pay is becoming increasingly linked to quality metrics rather than the traditional fee-for-service model where hospitals were paid based on their numbers of tests or procedures.
Hospital Fines
As a result, the U.S. has begun levying fines against hospitals that have too many patients readmitted within a month, and rewarding hospitals that do well on a benchmark of clinical outcomes and patient surveys.
University of Pittsburgh Medical Center, which operates more than 20 hospitals in Pennsylvania and a health insurance plan, is using demographic and household information to try to improve patients’ health. It says it doesn’t have spending details or information from credit card transactions on individuals.
The UPMC Insurance Services Division, the health system’s insurance provider, has acquired demographic and household data, such as whether someone owns a car and how many people live in their home, on more than 2 million of its members to make predictions about which individuals are most likely to use the emergency room or an urgent care center, said Pamela Peele, the system’s chief analytics officer.
Emergency Rooms
Studies show that people with no children in the home who make less than $50,000 a year are more likely to use the emergency room, rather than a private doctor, Peele said.
UPMC wants to make sure those patients have access to a primary care physician or nurse practitioner they can contact before heading to the ER, Peele said. UPMC may also be interested in patients who don’t own a car, which could indicate they’ll have trouble getting routine, preventable care, she said.
Being able to predict which patients are likely to get sick or end up at the emergency room has become particularly valuable for hospitals that also insure their patients, a new phenomenon that’s growing in popularity. UPMC, which offers this option, would be able to save money by keeping patients out of the emergency room.
Obamacare prevents insurers from denying coverage because of pre-existing conditions or charging patients more based on their health status, meaning the data can’t be used to raise rates or drop policies.
New Model
“The traditional rating and underwriting has gone away with health-care reform,” said Robert Booz, an analyst at the technology research and consulting firm Gartner Inc. (IT) “What they are trying to do is proactive care management where we know you are a patient at risk for diabetes so even before the symptoms show up we are going to try to intervene.”
Hospitals and insurers need to be mindful about crossing the “creepiness line” on how much to pry into their patients’ lives with big data, he said. It could also interfere with the doctor-patient relationship.
The strategy “is very paternalistic toward individuals, inclined to see human beings as simply the sum of data points about them,” Irina Raicu, director of the Internet ethics program at the Markkula Center for Applied Ethics at Santa Clara University, said in a telephone interview.
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So not making the employer pay for post conception birth control now jeopardizes women's health?
It seems most medical organizations have been hijacked by the left. Donna Marbury and the ACP (I am a member to help me keep up with advances in medical care) do not represent me. As always claiming to be objectively scientific and nonpartisan so common with the left Marbury claims this position paper is non partisan. :roll::
****Will the Hobby Lobby decision allow employers to ignore medical evidence?
ACP says SCOTUS ruling could jeopardize women’s health
Publish date: JUL 01, 2014
By: Donna Marbury
As stakeholders across the country debate the religious, gender and political implications of the U.S. Supreme Court ruling in favor of Hobby Lobby, one physician advocacy group worries that the decision ignores the practice of evidence-based medicine.
The Supreme Court ruled on June 30 that "closely held" for-profit corporations can hold religious objections that allow them to opt out of the requirement to provide no-cost contraceptives for female employees under the Affordable Care Act (ACA). The justices' 5-4 decision is the first time the high court has ruled in favor of for-profit businesses holding religious views under federal law.
The American College of Physicians (ACP) released a statement concerning the ruling, saying that it could undermine physicians’ authority to treat patients and have adverse affects on women’s health. The ACP states that the decision could lead to challenges of other government mandated, and evidence-based healthcare.
“We have no position or expertise on the legal arguments and precedents involved in the Hobby Lobby case; our expertise is based on the potential impact of the decision on public health, and specifically, the adverse health impacts on the patients seen by the 137,000 internal medicine specialists and medical students who are members of ACP,” David A. Fleming, MD, FACP, president of the ACP said in a written statement. “We are concerned that allowing employers to carve-out exemptions to the ACA’s requirements that health insurance plans cover evidence-based preventive services without cost-sharing, including but not necessarily limited to contraception, will create substantial barriers to patients receiving appropriate medical care as recommended by their physicians.”
Under the ACA, companies with 50 or more employees who offer health coverage that does not include all U.S. Food and Drug Administration (FDA)-approved contraception methods for women without cost-sharing would face fines of up to $100 a day per worker. Large employers not offering coverage would face a fine of $2,000 for most employees. For example, Hobby Lobby would have faced fines of $475 million per year for excluding some forms of birth control from its health coverage.
As a result of the decision, the companies filing suit—Hobby Lobby Stores and Conestoga Wood Specialties, as well as Hobby Lobby subsidiary Mardel Christian book stores—will not have to offer women employees all FDA-approved contraceptives as part of a package of preventive services required to be offered without copays or deductibles.
The Christian-based companies object mainly to the emergency contraceptives known as Plan B and Ella, and two types of intrauterine devices, on the grounds that the therapies are abortion equivalents that violate their religious convictions. Medical research from the National Institutes of Health, the Mayo Clinic and several other authorities has proven that emergency contraceptives do not cause abortions. Nearly 50 businesses have sued over
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http://www.tpnn.com/2014/07/03/the-new-welfare-berkeley-to-start-giving-free-marijuana-to-homeless-and-the-poor/
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"It’s unbelievable that we have reached a place in society where free marijuana is treated as a right for those who cannot afford to buy their own weed."
This says it all. :cry:
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That's why today's dems are more accurately called the Free Shit Army.
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All incentives have been turned upside down. It used to be that you had to use your hard earned money to buy the stuff and hide it from the government. One of the pundits had it right. As soon as something is legal, it has to be mandatory, and free and provided to you by others.
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More Than Expected Will Drop Out Of Colorado’s Obamacare Program
Nearly twice as many people are expected to drop out of Colorado’s state-run health care exchange in the coming years than originally projected, leading to nearly $2 million lost in associated fees for the financially embattled program over the next two years.
http://dailycaller.com/2014/07/09/report-more-than-expected-will-drop-out-of-colorados-obamacare-program/#ixzz36yJp05ga
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ObamaCare Enrollment Numbers Unreliable, Audit Finds
By JOHN MERLINE, INVESTOR'S BUSINESS DAILY
Posted 07/08/2014 06:59 PM ET
Buried in a largely overlooked government audit of the Obama-Care exchanges is a finding that casts still more doubt on the reliability of the 8 million enrollment number commonly cited by the administration and the press.
In a section titled "Other Issues," an inspector general report released last week found that the HealthCare.gov marketplace couldn't show it had been reconciling its monthly enrollment numbers with insurance companies.
That's despite the fact that the law specifically calls for this reconciliation, and the fact that, as the IG report notes, "the federal marketplace obtained the services of a contractor to reconcile enrollment information."
Obama administration officials "stated that the system to support reconciliations had yet to be developed."
But as the IG makes clear, without this monthly reconciliation, the government "cannot effectively monitor the current enrollment status of applicants, such as ... termination of plans."
Perhaps Far Fewer Enrollees
In other words, there could be far fewer enrollees than advertised if these numbers were reconciled as required by law.
Investor's Business Daily: http://news.investors.com/politics-obamacare/070814-707833-obamacare-enrollment-numbers-unreliable-government-audit-finds.htm#ixzz36yKHET6C
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Most transparent administration in history, and they all seem so honest...
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http://www.washingtontimes.com/news/2014/jul/8/carson-better-than-obamacare/
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http://www.capoliticalreview.com/capoliticalnewsandviews/surgery-center-of-oklahoma-proving-free-market-medicine-works/
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second post
http://www.capoliticalreview.com/capoliticalnewsandviews/million-more-patients-in-california-25-less-doctors-for-medi-cal/
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Health Law Subsidies Upheld, Conflicting With Ruling Hours Earlier
Two federal appeals court panels issued conflicting rulings Tuesday on whether the government could subsidize health insurance premiums for people in three dozen states that use the federal insurance exchange. The decisions are the latest in a series of legal challenges to central components of President Obama’s health care law.
The United States Court of Appeals for the Fourth Circuit, in Richmond, upheld the subsidies, saying that a rule issued by the Internal Revenue Service was “a permissible exercise of the agency’s discretion.”
The ruling came within hours of a 2-to-1 ruling by a panel of the United States Court of Appeals for the District of Columbia Circuit, which said that the government could not subsidize insurance for people in states that use the federal exchange.
That decision could cut potentially off financial assistance for more than 4.5 million people who were found eligible for subsidized insurance in the federal exchange, or marketplace.
Under the Affordable Care Act, the appeals court here said, subsidies are available only to people who obtained insurance through exchanges established by states.
READ MORE »
http://www.nytimes.com/2014/07/23/us/court-rules-against-obamacare-exchange-subsidies.html?emc=edit_na_20140722
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http://www.forbes.com/sites/michaelcannon/2014/07/25/obamacare-architect-jonathan-gruber-if-youre-a-state-and-you-dont-set-up-an-exchange-that-means-your-citizens-dont-get-their-tax-credits/
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http://www.weeklystandard.com/blogs/florida-obamacare-premiums-jump-132_802050.html
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I've heard this is the most expensive hospital in the country. One of the guys who bought the hospital at basement rates, who used to be with Blackstone got his Wall Street buddies to finance fixing the place up and embarked on an out of network strategy and then resold it for something like a 40 million profit. The health care mogul as he was called in a news article now has a mansion in the Hamptons. So this poor guy gets stuck with a 9K bill.
I have a patient who told me he went to this hospital which is much farther from here than several others to have a procedure done via a limousine. In this way the patient got in his mind "first class treatment". The bill is usually multiples of what it would otherwise cost. I explained this abuse to the patient. His response: "but it didn't cost me anything". I asked him doesn't this dishonest game playing while using you as the pawn bother you? His response, was again "it didn't cost me a thing".
So there you have it. I replied, but it costs everyone else a bundle to finance this. What do you think happens to everyone's insurance rates with this going on? No response from him. No concern.
*********Hospital ER Charges $9,000 to Bandage Cut Finger
Money Talks News
By Krystal Steinmetz 8 hours ago
A New Jersey teacher was stunned when he received a $9,000 bill after his cut finger was bandaged in a hospital emergency room. Baer Hanusz-Rajkowski cut his finger with the claw end of a hammer. After waiting a few days to see if it would heal on its own, Hanusz-Rajkowski decided to go to the emergency room at Bayonne Medical Center in New Jersey, according to NBC New York. It was determined (without X-rays) that his finger didn’t need stitches. So Hanusz-Rajkowski left with a bandaged middle finger. NBC New York said he was surprised to get this in the mail:
Hanusz-Rajkowski got hit with an $8,200 bill for the emergency room visit. On top of that, Bayonne Medical Center charged $180 for a tetanus shot, $242 for sterile supplies, and $8 for some antibacterial ointment in addition to hundreds of dollars for the services of the nurse practitioner.
That $9,000 bill left Hanusz-Rajkowski speechless. From NBC:
“I got a Band-Aid and a tetanus shot. How could it be $9,000? This is crazy,” Hanusz-Rajkowski said. “If I severed a limb, I’d carry it to the next emergency room in the next city before I go back to this place.”
Why was the bill so high? The answer isn’t clear. It’s more of a he said, she said. Carepoint Health bought Bayonne Medical Center about six years ago, making it a for-profit business, NBC said. Dr. Mark Spektor, president and CEO of the medical center, said the big bill is the fault of Hanusz-Rajkowski’s insurance company, United Healthcare, which no longer has an in-network pricing contract with the hospital. Spektor said United doesn’t offer fair reimbursement rates. According to NBC, Mary McElrath-Jones, spokeswoman for United Healthcare, disagrees with Spektor. “United Healthcare is deeply concerned about hospitals establishing an out-of-network strategy to hike the rate they charge for emergency room services, often surprising patients,” she said. Regardless of whether there’s an in-network price deal, New Jersey law demands that insurers cover the costs of ER visits, NBC said. United Healthcare ended up paying $6,640 on the bill. After the story hit the news, the hospital wrote off Hanusz-Rajkowski’s portion of the bill. Some people are calling for a price cap on ER procedures, NBC reported. Spektor said that would put the hospital, which was once on the brink of bankruptcy and is now profitable again, at risk.
“Insurance companies in the state of New Jersey particularly have had record profits last year. Billions of dollars in profits while hospitals are struggling and closing. That is the real story,” Spektor said.
What do you think of Hanusz-Rajkowski’s hospital bill? Do you think you’ve been massively overcharged at a hospital? Share your comments below or on our Facebook page.
This article was originally published on MoneyTalksNews.com as 'Hospital ER Charges $9,000 to Bandage Cut Finger'.
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This should also go in the President Rubio thread.
http://www.foxnews.com/opinion/2014/08/08/more-obamacare-woes-congress-must-act-to-block-health-insurance-bailout/
More ObamaCare woes: Congress must act to block health insurance bailout
By Sen. Marco RubioPublished August 08, 2014FoxNews.comFacebook431 Twitter217 livefyre325
As evidence mounts of a looming taxpayer-funded bailout of health insurance companies under ObamaCare, the urgency grows for Congress to take this possibility off the table for good.
As expected, ObamaCare's costs are rising, and health insurers are passing them along to patients in the form of higher premiums and deductibles.
Just this week, a majority of insurers offering health plans in Florida announced rate increases ranging from 11 to 23 percent. This means that if patients balk at paying this sharp increase and drop their coverage, these health insurers will have to make up the difference somehow.
Enter section 1342 of the ObamaCare law, which established so-called "risk corridors".
According to this provision, taxpayers will make up the difference for health insurance companies whose plans lose money under ObamaCare. Last November, as it became clearer what this section of the law actually meant, I introduced legislation repealing it and protecting taxpayers from being forced to cover insurers' ObamaCare losses.
Afterwards, as pressure from taxpayers mounted on the Obama administration, it announced that it had no intention of operating this bailout program at a net cost to the American people. As expected, health insurers and their lobbyists revolted. I called the administration's bluff, and introduced new legislation that would codify into law what they have promised and prohibit this "revenue neutrality" from being achieved through use of taxpayer funds. Not surprisingly, it's gone nowhere in the Democratically-controlled Senate, and the White House won't go anywhere near it.
In recent weeks, the public has learned that senior White House officials have been working closely with insurers behind the scenes to make sure that their earlier bailout deal, which helped assure ObamaCare's passage in 2010, would stand and that a taxpayer-funded bailout was still, in fact, on the table.
According to a recent investigation conducted by the House Oversight and Government Reform Committee chaired by Darrell Issa, insurers widely expect to receive funds from the bailout program. One large health insurer recently filed financial statements claiming they expect part of their revenue to come from American taxpayers via the ObamaCare bailout "fund".
This "fund" brings us to another dimension of the Obama administration's maneuvering to make sure that health insurers get paid. Knowing that the current U.S. House of Representatives will never appropriate money for this bailout, the Department of Health and Human Services (HHS) figured out a way to use general funds available through the Centers for Medicare and Medicaid Services to pay off health insurers. The effect is to circumvent Congress' power of the purse for the purpose of bailing out health insurers with taxpayer funds.
On this ObamaCare bailout, as with so many issues, Washington politicians are misleading average Americans and planning to stick them with the bill. This is government favoritism and corporate cronyism at its worst.
With ObamaCare's costs rising and projected to cost more than $2 trillion over the next decade, its damage on people's jobs and work hours continuing, and the prospect of a taxpayer-funded bailout of health insurers still alive and well, it's clear this law has failed. It's time to repeal and replace it, but at the very least, we should make it the law of the land that health insurers won't be bailed out by taxpayers because ObamaCare has not proven to be as profitable as its proponents hoped it would be.
Republican Marco Rubio represents Florida in the U.S. Senate. He is a member of the Senate Committee on Commerce, Science and Transportation.
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"According to this provision, taxpayers will make up the difference for health insurance companies whose plans lose money under ObamaCare. Last November, as it became clearer what this section of the law actually meant, I introduced legislation repealing it and protecting taxpayers from being forced to cover insurers' ObamaCare losses."
Again the top health care companies stocks and their top officials are making millions and are at all time highs and the rest of us get bulldozed. Their employees can't even afford their own health care.
My rates going up another 50% despite sky high deductibles. The whole thing will crash.
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Republicans should circle back to the Obamacare failure, especially in the NINE Senate toss up races. Great article:
http://www.thefiscaltimes.com/Columns/2014/08/20/6-Reasons-Obamacare-Can-Win-Senate-GOP
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DC Circuit Agrees to En Banc Hearing of ObamaCare Ruling
In July, the U.S. Court of Appeals for the DC Circuit ruled in Halbig v. Burwell that ObamaCare subsidies given through the federal exchanges were illegal because the law provides for them only through state exchanges. It was a huge blow for the law's supporters, who ironically argued the law doesn't mean what it says. However, the full court has granted a rehearing en banc in December. Clearly, Barack Obama hopes for a favorable ruling this time before the case heads to the Supreme Court. This is exactly why Senate Majority Leader Harry Reid went nuclear to change confirmation rules so Obama could pack the court with his jurists favorable to his lawlessness.
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This is just one reason why we don't centralize all our personal and governmental functions, any more than necessary.
http://www.dailymail.co.uk/news/article-2744241/Foreigners-hacked-Obamacare-website-July-HHS-just-discovered-10-days-ago-claims-no-consumer-data-stolen.html
Foreigners hacked Obamacare website on July 8 – but HHS only discovered it 10 days ago
Malicious code was inserted into an Obamacare server and lay dormant, waiting for a command to attack other computers
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CBO: Cost of Obamacare Subsidy Will Increase 8-Fold in 10 Years
(The increases in the out-years are most certainly UNDER stated. - Doug)
http://www.cbo.gov/sites/default/files/cbofiles/attachments/45653-OutlookUpdate_2014_Aug.pdf
(http://cnsnews.com/sites/default/files/imagecache/large/images/OBAMACARE%20SUBSIDIES-PHOTO.jpg)
(http://cnsnews.com/sites/default/files/imagecache/large/images/MEDICAID%20SPENDING-OBAMACARE-CBO-PHOTO.jpg)
Under the Patient Protection and Affordable Care Act, the federal government requires Americans to purchase a health-insurance plan that meets government specifications. If they buy that insurance through a government-run exchange, and earn less than 400 percent of the federal poverty level, the U.S. Treasury will pay a part of their premium. The amount the Treasury pays decreases as a person’s income increases toward the 400-percent-of-poverty level.
At the same time, the Affordable Care Act expands the Medicaid rolls by providing subsidies to states that make people earning up to 133 percent of poverty eligible for the program. People signing up for insurance on the exchange whose income is below that level must be enrolled in Medicaid.
“ACA’s Medicaid expansion provisions have the potential for affecting eligibility for premium credits if certain low to middle income individuals and families seek health insurance through the exchanges,” says the Congressional Research Service. “Under ACA, states have the option to expand Medicaid eligibility to include all nonelderly, non-pregnant individuals (i.e., childless adults and certain parents, except for those ineligible based on certain noncitizenship status) with income up to 133% FPL.”
“States that choose to implement the ACA Medicaid expansion will receive substantial federal subsidies,” says the Congressional Research Service. “If a person who applied for premium credits in an exchange is determined to be eligible for Medicaid, the exchange must have them enrolled in Medicaid.”
http://cnsnews.com/news/article/terence-p-jeffrey/cbo-cost-obamacare-subsidy-will-increase-8-fold-10-years
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:-o :-o :-o
http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html?emc=edit_th_20140921&nl=todaysheadlines&nlid=49641193&_r=0
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http://online.wsj.com/articles/how-to-game-obamacare-1412032995
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http://www.tpnn.com/2014/10/02/obamacare-one-year-later-five-lessons-learned/
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http://www.capoliticalreview.com/capoliticalnewsandviews/calif-governor-vetoes-bill-to-protect-assets-from-medi-cal/
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Enter: The GOP Alternative To ObamaCare
By DICK MORRIS
Published on DickMorris.com on November 10, 2014
The Supreme Court decision to hear challenges to the legality of giving subsidies to families and individuals who signed up for ObamaCare through federal exchanges could lead to the de facto repeal of the program. And, with the Republican victory in the midterm elections, the next step could be the passage of the Republican version of ObamaCare -- an excellent piece of legislation that the country will happily accept.
The Republican alternative to ObamaCare, passed by the House but, obviously, never brought up for a vote in the Democratic Senate, provides for tax credit subsidies for all who need them to buy health insurance and incorporates the basic consumer protections embedded in the Affordable Care Act. Insurers cannot discriminate based on pre-existing conditions under the GOP bill nor can they either terminate coverage or raise rates when their customers become ill.
But the Republican alternative eliminates the coercive aspects of ObamaCare. Nobody has to buy insurance nor does any employer have to offer it. And those who do purchase insurance can get as much or as little coverage as they want. One size will no longer attempt to fit all.
A particularly important provision of the bill extends Medicare coverage to those who are sickest with the highest medical bills, so the government pays for all their costs.
Would Obama veto the Republican bill?
Much as his veto pen will be itching to do so, he really won't be able to use it. Once ObamaCare subsidies are struck down by the Supreme Court, seven million or more Americans will be out of health insurance entirely. Most will have once had adequate policies for which they paid themselves, only to find that Washington forced cancellation of their policies and made them buy insurance on the federal exchanges. Having gotten more coverage, at a higher cost, than they could either afford or need, they became dependent on the federal subsidies the court will have just thrown out.
Obama and the Republican Congress will have a moral and political imperative to restore their coverage. They and most of America will approve of the Republican alternative and Obama will be unable to veto it with the presidential elections looming.
So the ObamaCare saga will have had a happy ending with a good bill filling a gap in our healthcare coverage. And all the wrangling will seem to have been so unnecessary.
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I'd insist on full repeal, let Obama veto each one.
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http://www.theblaze.com/stories/2014/11/17/guess-how-john-kerry-described-jonathan-gruber-in-2009/
Even has him saying that Gruber did the numbers when the CBO would not!
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During the 2008 presidential campaign, Barack Obama attacked Hillary Clinton's health care plan because "it forces everyone to buy insurance, even if you can't afford it, and you pay a penalty if you don't." Gee, that sounds familiar. Oh, that's right -- it's a critical part of ObamaCare now. What changed Obama's mind? Jonathan "Stupid American Voters" Gruber, of course. After adding Gruber to his transition team and meeting with him about health policy, Obama came out in favor of the mandate in July 2009. And, according to a 2012 New York Times report, "It is [Gruber's] research that convinced the Obama administration that health care reform could not work without requiring everyone to buy insurance." It's no wonder Obama has tried to distance himself from Gruber, saying, "I just heard about this" kerfuffle, and, "The fact that an adviser who was never on our staff expressed an opinion that I completely disagree with in terms of the voters is not a reflection on the actual process that was run." Sure thing.
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In a case likely to be heard in March and decided in June, the justices will dissect the meaning of four words on page 95 of the 906-page Patient Protection and Affordable Care Act — four words that could render health insurance premiums unaffordable for millions of Americans.
Tax credits will be available through so-called exchanges, or online marketplaces, "established by the State."
http://www.usatoday.com/story/news/politics/2014/11/22/supreme-court-obama-health-care/19271273/
Whether you look at meaning of the words or context, tax credits are only available through so-called exchanges, or online marketplaces, established by the State.
Now we will see if 5 Justices can read written law.
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The starting point for a full replacement plan should be a rational synthesis of the two best reform plans now on the table: one developed by the 2017 Project (a group dedicated to developing a conservative reform agenda for the next administration) and the other by Republican Senators Richard Burr, Tom Coburn, and Orrin Hatch. The two plans share much in common. They are practical, market-based solutions. They both retain the employer-based health-insurance system for the vast majority of Americans, even as they would encourage more cost discipline in the most expensive job-based plans with a limitation on the federal tax break for employer-paid premiums. To broaden insurance enrollment and to correct an inequity in current law, they also would provide a new federal tax credit to households without access to employer coverage. The credit would be adjusted by age (and, in the case of Burr-Coburn-Hatch, by income) and could be used to purchase any state-approved health-insurance product. Finally, the plans would create a new “continuous-coverage protection” construct: People who stay continuously enrolled in health insurance would be protected from premium hikes based on their health status and from exclusions from coverage based on a preexisting condition.
— James C. Capretta, AEI
http://www.nationalreview.com/article/393678/how-replace-obamacare-james-c-capretta
2017 Project: http://2017project.org/site/wp-content/uploads/2014/02/An-Obamacare-Alternative-Full-Proposal.pdf
Burr, Coburn, Hatch: http://www.coburn.senate.gov/public/index.cfm?a=Files.Serve&File_id=871b0ef8-7705-4f72-aef2-e81d01b9c009
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Too bad candidate Romney never understood or articulated this point.
"Overall, the ACA erodes nationwide average work incentives about eleven times more than Romneycare did in the state of Massachusetts"
http://acasideeffects.com/
http://caseymulligan.blogspot.com/2014/11/professor-krugman-continues-to.html
http://caseymulligan.blogspot.com/
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The gaffe was that he told the truth, right up until he was sworn in to tell the whole truth and nothing but the truth. Then this 40-something, apparently healthy economist started to lose all important recollections.
Read Byron York: http://www.washingtonexaminer.com/jonathan-gruber-and-the-ocare-memory-hole/article/2557215
"Complicating the picture, Gruber's was a specialized type of memory loss: the more difficult and challenging the question about his notorious descriptions of Obamacare's birth, the more tenuous Gruber's memory became."
...
The questioner, again, was Turner. "You said this bill was written in a tortured way to make sure CBO did not score the individual mandate as taxes," Turner said to Gruber. "Did you ever speak to anyone in the administration who acknowledged that to you?"
"That was an inexcusable term used by — " Gruber began.
"I'm not asking you about how you believe that whether or not you should have said that or not," Turner replied. "It's a factual statement you're making. Did anybody in the administration ever have that conversation with you?"
"I do not recall anyone using the word 'tortured,' " Gruber said.
"Did they have the conversation with you that it had to be drafted in a way that the CBO did not score the individual mandate as taxes?" Turner persisted.
"I don't — " Gruber began.
"You're under oath."
"I honestly do not recall."
When the talking point (what I said was inexcusable) didn't work, and then when the parsing (no one used the word 'tortured') didn't work, Gruber went to Plan C, the last resort: I don't recall. And just for emphasis, he added that he honestly did not recall.
...
In all, Gruber said "I don't recall" or some variant of the phrase about 20 times during his testimony, frustrating the Republicans who had hoped to elicit actual information during the hearing. What the GOP got instead was one of the nation's foremost experts on healthcare who, for a few hours at least, could barely remember his name.
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Very important piece, IMHO. He discusses the balancing act Republicans will face as they attempt to undo this mess. The public disapproves of Obamacare, but doesn't want empty repeal with a return to all that was wrong before. And conservatives will revolt if they see Republicans acting like Democrats, tinkering around the edges or replacing with their own government monstrosity. Not having a plan isn't going to work any longer. Take the best of the market driven, conservative plans and start making the positive case for change.
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Getting beyond Obamacare
It’s time to make the case for replacing it, not fixing it.
By Ramesh Ponnuru, National Review, December 8, 2014
http://www.nationalreview.com/article/394161/getting-beyond-obamacare-ramesh-ponnuru
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Now at age 37 the nation's surgeon general. I used to get emails from this big socialist liberal to join his Obama Care fan club. This is a joke. All politics. Has nothing to do with medical care. All about promoting obama care. The damage continues for the next two years:
****Washington (CNN) -- The Senate confirmed Vivek Murthy as surgeon general on Monday night as Democrats -- in the final days of their majority control of the chamber -- overcame stiff opposition from the National Rifle Association.
The 51 to 43 vote ends more than a year of uncertainty over Murthy's nomination. Obama had tapped the founder of the pro-Obamacare group Doctors for America for the post in November 2013.
But a confirmation vote had been held up after the gun lobby pointed to a letter Murthy had signed calling for new gun control measures in the wake of the Newtown, Connecticut, school shootings, and promised to score a vote in Murthy's favor against senators in its ratings of how strongly lawmakers support gun rights.
Murthy, 37, is America's youngest-ever top doctor, and he is also the first surgeon general of Indian-American descent.
Obama lauded Murthy's confirmation, saying he will help the United States combat the threat of Ebola.
"As 'America's Doctor,' Vivek will hit the ground running to make sure every American has the information they need to keep themselves and their families safe. He'll bring his lifetime of experience promoting public health to bear on priorities ranging from stopping new diseases to helping our kids grow up healthy and strong," Obama said in a statement.
Opinion: Surgeon general's win is a political miracle
"Vivek will also help us build on the progress we've made combating Ebola, both in our country and at its source," he said. "Combined with the crucial support for fighting Ebola included in the bill to fund our government next year, Vivek's confirmation makes us better positioned to save lives around the world and protect the American people here at home."
But soon-to-be Senate Majority Leader Mitch McConnell, the Kentucky Republican whose party will take control of the chamber once new members are in place next month, called Murthy a political appointment.
"The surgeon general is known as America's doctor and the men and women chosen to fill that role in the past have usually been highly qualified individuals with substantial experience in patient care," McConnell said in a statement.
"Unfortunately, Dr. Murthy's nomination had more to do with politics -- he was a founder in 2008 of a group called Doctors for Obama, and has been an outspoken political advocate of Obamacare and gun control -- than his medical experience," he said. "With America facing the challenge of Ebola and other serious health challenges, it's unfortunate that the President chose a nominee based on the candidate's political support instead of a long career delivering patient care and managing difficult health crises."
Democrats taunt Cruz over surgeon general vote
This story has been updated****
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"I've know him for years!"
http://michellemalkin.com/?p=162894
At this rate we will have a
federal holiday (government employees get the day off) for him.
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The Revolution at the Corner Drugstore
The CVS chief executive on upending the debate about costly specialty drugs and how he’s going to make sure you take your medicine.
By Joseph Rago
Jan. 23, 2015 6:42 p.m. ET
WSJ
For the better part of a year, the worlds of health-care finance and health-care politics have been scandalized by the specialty drug called Sovaldi. The $84,000 cost for a course of treatment of this hepatitis-C cure was said to reveal that pharmaceutical prices were irrational or abusive; that markets were helpless to respond; and that, absent government intercession, this new wave of complex biological therapies would bankrupt the nation.
Then, this winter, all of a sudden, discipline and competition arrived. The response has largely come in the form of new hep-C medicines and pharmacy-benefit managers, or PBMs, a kind of quasi-insurance company that purchases medications in bulk from drug makers, negotiates prices and oversees patient drug plans. The controversy continues to boil, though the CEO of the second-largest PBM in the U.S., Larry Merlo, exhibits little of the Sovaldi-fueled acrimony of his industry colleagues, much less the self-defeating policy responses.
“We saw the expected growth in specialty pharmacy coming. The latest trends around specialty say that unabated—unabated—we’re going to see midteens growth for the foreseeable future,” Mr. Merlo says of the rise of specialty-drug spending, tapping the table in his office with an index finger for emphasis. In other words, there are real problems, but there are solutions too, and the costs are manageable.
Mr. Merlo heads CVS Health, which in the age of the Affordable Care Act is expanding beyond the drugstore around the corner, sometimes radically. About 100 million Americans are CVS customers each year, whether in a brick-and-mortar outlet, paying a visit to one of its 960 “minute clinics,” or through its PBM unit, Caremark. CVS fills more than one of every five prescriptions in the U.S., either in-store or via mail. The company supplies fully 1% of all federal corporate-tax revenue.
In the case of specialty drugs, CVS is now the largest supplier and dispenses about 25% of prescriptions in the $86 billion business. Mr. Merlo expects these therapies to grow to 50% of total pharmaceutical spending, from 38% today, as innovations for unmet medical needs—or even common conditions like high cholesterol, which will be targeted by the forthcoming PCSK9 inhibitors—come to market.
So what to do? Think of an “illustrative trend” of a 20% growth rate in specialty drug costs, Mr. Merlo says. He estimates that CVS Caremark, which covers 65 million people, can erase as much as 16 percentage points. PBMs create tiers of preferred drugs, for example, which give patients an incentive to choose cheaper generics over name brands. Other management tools, like drug formularies, narrow pharmacy networks, care coordination, step therapy and the like, can add to the savings.
The hepatitis-C shakeout is more contested. The first-to-market maker of Sovaldi, Gilead Sciences, followed with a next-generation treatment called Harvoni, while AbbVie brought out Viekira Pak. More are in the pipeline. Express Scripts , the largest PBM and a vocal Gilead critic, signed an exclusive deal with AbbVie. In January, CVS turned around and made Harvoni and Sovaldi the preferred hep-C treatments on its own PBM formularies. Both PBMs almost certainly received concessions on list prices in return for offering one therapy in lieu of competitors, though details haven’t been disclosed.
One way of reading all this is that the drug makers are being forced to compete, even while they retain intellectual-property protection. But it has stirred a new debate about patient access to needed medicines, and whether the limits of closed formularies will interfere with medical decision-making and in the long run cost patients or society more.
Obviously PBMs make individual exceptions and conduct clinical reviews, with a goal of generating the best value at the lowest cost. But the strategies do illustrate the trade-offs that are increasingly coming to define U.S. health care—and who will decide.
***
Mr. Merlo observes that CVS Caremark’s clients—whether health plans, self-insured employers or government programs like Medicare and Medicaid—“can pick and choose, they can mix and match, how aggressive they want to be to satisfy the goal of the appropriate level of cost, not at the expense of quality.” But as he sees it, individuals are increasingly dominant.
What Mr. Merlo calls “the retailization of health care” is accelerating, with consumers taking more responsibility for their own care choices, sharing more of the costs and becoming “part of the thought process and part of the solution. . . . I think consumers will have more decision-making, and with that comes more accountability.”
In part, this trend is a response to what Mr. Merlo sees as the defining challenge of American health care: “the quality-cost conundrum,” or how “to improve health outcomes at lower costs” amid a changing mix of how the U.S. finances health care. The Affordable Care Act is expanding insurance coverage, especially through Medicaid. What he calls the “silver tsunami,” or the 10,000 people turning 65 each day, is swelling the Medicare rolls. Employers and health plans are as “intensely focused” as ever “on reducing the cost of care.”
Mr. Merlo thinks the “ultimate answer” for high drug prices are payment methods that reward value and outcomes and allow everyone “to share the benefits.” He adds: “We’ve operated on a fee-for-service model, you know, forever.” That is changing, but “we’re in the top of the second inning. We’re very, very early.”
Still, “consumers have been left out of the process for years,” Mr. Merlo says, and now require new “education, tools and transparency.” The third-party-payer system for decades cast medicine as business-to-business transactions and thus left many health-care companies with no comprehension of normal people and their needs, preferences and sometimes irrationalities. Long retail experience is providing different answers.
“Obviously you think of our retail pharmacies,” says Mr. Merlo, a pharmacist by training and CVS chief since 2011. He is repositioning the company and thinks the better description of CVS is “an integrated pharmacy-care organization. Our purpose, our goal is to help people on their path to better health.”
Take CVS’s 960 walk-in clinics in 31 states and growing, which together constitute the biggest retail clinic in the country, with 23 million visits to date. Nurse practitioners treat minor acute ailments like strep throat, ear infections or sprains, and offer immunizations. Convenient (open on nights and weekends, with no appointments) and affordable (40% to 80% lower than traditional providers, with posted prices), these clinics can help solve one problem: “the confluence between more people entering the insured market and at the same time a growing shortage of primary-care physicians,” Mr. Merlo says.
They can also reduce spending by migrating treatment “at a fraction of the cost” from more-expensive settings like emergency rooms. “We have a lot of employees here at CVS Health”—about 200,000—“and sometimes that becomes our best learning,” Mr. Merlo explains. A recent internal study of CVS workers who used its walk-in clinics suggested their overall health costs are 8% lower than those with the same age and health status who don’t. A shelf of academic research shows the quality of care at such clinics is the same or sometimes better than the ER.
The pharmacist, Mr. Merlo says, isn’t often imagined on the front lines of medicine—but should be. Advanced pharmaceutical therapies, for diseases like multiple sclerosis and HIV, are often more complex than simply taking a pill. But sometimes the opposite is true, and Mr. Merlo notes that adherence—ensuring that patients take the medications they are prescribed—is one area where CVS can contribute.
About half of all Americans suffer from one or more chronic conditions such as high cholesterol, diabetes or asthma. “More times than not,” Mr. Merlo says, “the treatment for those diseases is prescription therapy, and that’s where the statistics start to get alarming—it’s a huge opportunity to take unnecessary costs out of the system. One out of four people drop off therapy. They don’t even get the first refill. By the time one year goes by after someone is newly diagnosed, as many as three of four will stop taking their medication or not take the medication as prescribed.”
One consensus economic estimate is that this adds about $300 billion a year to national health expenditures—as when a patient fails to take statins and has a heart attack or stroke. The tragedy is that the sickest people tend to be the least adherent.
“There’s no one reason, there’s no one answer,” Mr. Merlo says. Forgetfulness is common. The medication’s benefits may be imperceptible and patients may not feel any different as a result, or they experience side effects like the muscle cramps of statins, or they find a treatment regimen involving multiple drugs and doses too complex to understand.
CVS has launched a campaign “to make sure that the right patient is on the right therapy at the right time at the right dosage,” Mr. Merlo says. The company aims to improve adherence by as much as 15% by 2017. The goal is to “manage the pharmacy patient, not just the administration of the drug.”
To take one example, only a few years ago prescriptions were printed out and handed to the patient or submitted to the pharmacy by fax. Physicians and pharmacists often had no idea what happened next or any reliable method to know. Now 70% of prescriptions are submitted electronically, creating a digital trail and actionable information.
CVS technologists mine prescription and claims data and “identify gaps in care and keep people on their medications,” Mr. Merlo says. The system might then send a text message when someone has forgotten to refill a prescription. A pharmacist is prompted to discuss the importance of taking medication during the patient’s next visits, and CVS alerts the prescribing doctor.
But most often, a trusted clinician who listens and seems to care is best. For all the technological progress, CVS figures a one-on-one conversation with a pharmacist is two to three times more effective than any other method to change patient behavior—in a way, the human element that often goes missing in the U.S. health-care debate.
“I can pick up the phone and in a matter of minutes I can talk to the pharmacist, I can have a conversation,” Mr. Merlo says. “Can I really do that anywhere else across health-care delivery?”
Mark it down as another way that private innovation is finding ways to serve patients despite, or because of, the policy mess in Washington.
Mr. Rago is a member of the Journal editorial board.
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Some of what Merlo says has validity from my point of view. Some of it is clearly propaganda. People can come up with data to say almost anything.
Like this notion about empowering the patient to be part of the solution and have a day in their drugs. There is nothing new here. This was done years ago with managed care.
One can turn it around just the opposite and say the insurance companies won't pay for the better more expensive drugs so they push the cost onto the insured.
Pharmacy benefits managers are middle men effectively so they have to justify themselves in every way imaginable.
I also question physician shortages. By constantly claiming there are he justifies the use of nurses which he can pay less.
Even Emanuel didn't believe there is a shortage.
Of course I am biased so no one has to take my word for anything.
But listen to the central planners with a open skeptical mind.
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Worthy comments.
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"the patient to be part of the solution and have a day in their drugs"
Correction: I meant "have a day in selecting their drugs" with the ones not contracted to between the PBM and the drug companies having a higher co-pay cost to the patient.
What I want to ask is exactly how much of these elevated copays (making patients have skin in the game - which by itself is probably a good thing) actually translates to lower costs to all of us at the bottom line. How do we know these savings are not mostly kept by these middle men or CVS itself?
And worst of all - whose answers to these questions - are we to believe? Good luck.
Please recall that I mentioned that probably 95 % of medicine research is not definitive and of questionable value. So one can only speculate on the validity of data business people will make pronouncements about. My ex brother in law who is a dentist once told me the dental literature was even worse than the MDs. Of less validity.
I am not saying most of it is purposely manipulated. I don't think that, but just that much is no of significance enough to be valid. Listen to all the radio shows and online sales "gurus" who tell us about dozens, sometimes hundreds of research studies that purport to show a benefit of some "natural" substance in slowing disease, reversing disease, helping us live longer, feel more energy, sleep like babies, copulate like porno kings, remember everything, and have less pain. Even the shark tank guys agreed on one show these are ALL cons. But most if not all of these wild claims come from academic research. I am coming to the opinion that many of these professors have to be in on these money making schemes in some way. Either through grants, investments in some of these "businesses", or possibly even kick backs.
It is of supreme importance to think about who is doing the research.
Everyone who post on this board already knows these things but for the rest,
Don't assume just because it comes from an academic center it doesn't have personal or political interests. Sad to say. Look at how environmentalists twist and cherry pick data.
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http://patriotpost.us/posts/32644
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This is from a progressive site, but the point is dead on: The Reps are years past where they should have a list of bullet points to answer the question presented here:
http://www.ifyouonlynews.com/politics/boehner-mcconnell-humiliated-when-asked-about-gop-obamacare-alternatives-they-still-got-nothin-video/
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This is from a progressive site, but the point is dead on: The Reps are years past where they should have a list of bullet points to answer the question presented here:
http://www.ifyouonlynews.com/politics/boehner-mcconnell-humiliated-when-asked-about-gop-obamacare-alternatives-they-still-got-nothin-video/
"Our bloated government healthcare duster cluck is better than Obama's!"
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Still nothing! Wow!
:cry:
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This is from a progressive site, but the point is dead on: The Reps are years past where they should have a list of bullet points to answer the question presented here:
http://www.ifyouonlynews.com/politics/boehner-mcconnell-humiliated-when-asked-about-gop-obamacare-alternatives-they-still-got-nothin-video/
Republicans have alternative plans, but they don't have a consensus on one - or leadership. They can't do anything until 2017, but they can't do anything then, either, if they don't get clear and persuasive and win the argument about where we need to be heading.
http://www.burr.senate.gov/public/index.cfm?FuseAction=PressOffice.PressReleases&ContentRecord_id=5103477b-cca0-2f3a-dd0e-a7ac35366eb4
http://2017project.org/
http://dogbrothers.com/phpBB2/index.php?topic=1411.msg84940#msg84940
http://www.nationalreview.com/article/394161/getting-beyond-obamacare-ramesh-ponnuru
Republicans need to reassure conservatives that they really will repeal Obamacare if given the chance and reassure the public at large that they will replace it in a way that does not leave millions of beneficiaries bereft. They could accomplish both of these tasks at once if they devised a conservative health-care plan that replaces Obamacare without threatening people’s coverage. Then they could commit themselves to that plan without making swing voters anxious, and thereby begin showing conservatives that they have a real plan to get rid of the law.
This course of action does not amount to searching for a unicorn. Several plans that meet these criteria have been put forward, such as the CARE Act, proposed by Senators Orrin Hatch, Richard Burr, and Tom Coburn, and a plan put forth by the 2017 Project, a conservative nonprofit (links above). The key step would be to change the tax treatment of health insurance. We now have a tax break for employer-provided health insurance, including fairly expensive employer-provided insurance. That break should be flattened — so that it no longer rewards people for choosing the most expensive insurance options, and so that people who do not have access to employer-provided plans can use an equivalent tax break to buy insurance on the individual market.
A replacement plan should also make existing entitlement programs more market-friendly. Most of Medicaid should be converted into subsidies that help beneficiaries buy into this enlarged individual market. Ideally, Medicare, too, would be converted into a system in which private plans compete for the business of empowered consumers, as almost all Republicans have already endorsed.
Plans along these lines have been estimated to be competitive with Obamacare on the number of people insured, and superior to it in cost and choice of doctors. A higher proportion of the insured would have protection from large medical expenses, and coverage would generally be of higher quality than Medicaid (which is responsible for most of Obamacare’s expansion of coverage). The resulting system would feature lower premiums and taxes than Obamacare. It would lack the law’s centralizing Medicare board and essential-benefits package, its employer mandate, and its individual mandate. It could be structured to avoid discouraging work, as Obamacare’s subsidies do.
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We could let the free market actually determine prices and let free individual determine what kind of health care they wanted to obtain, and insurance companies could compete for business. :-o
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We could let the free market actually determine prices and let free individual determine what kind of health care they wanted to obtain, and insurance companies could compete for business. :-o
Exactly. And free choices and competition are the only way that costs come down. Now welcome to a world where the right answer is not the right answer. Also, that is the reason why R's haven't easily settled on a solution. The question at the moment is, what canl realistically move us in that direction. What will turn the liberal wedge upside down? What reverses Cloward-Piven and the current, rules for radicals sequence?
We've created generations of people for whom working for a living is an abstraction. http://en.wikipedia.org/wiki/Cloward%E2%80%93Piven_strategy
Now we need to create generations of people where the vast majority have a stake in the success of our society and feel it. Healthcare is a big part of it. Too many people today are ready to give up on working and earning more in order to qualify for free healthcare for life. How do we show them the opportunity to grow their incomes to the point where market price for healthcare is affordable and acceptable?
On our current course, the government is on track to make up 66% of healthcare spending.
http://www.forbes.com/sites/chrisconover/2012/08/07/takeover-government-on-track-to-make-up-66-of-healthcare-spending-obamacare/
An element of dependency comes with that. (!)
Immediate elimination of the federal government's (mostly unconstitutional) role in healthcare opens the door for the endless and successful, taking-away-Granny's-meds, commercials and guarantees losses in elections. Every cut in O-care will elicit the Republicans-want-to-kill-you response, but the accusation sticks better with some proposals than with others.
The Republican plans listed above do not remove the federal government but hopefully remove the dynamic where people give up and take whatever the government will give them. The plans listed have some level of government support based on need, yet leave people with choices and, more importantly, a stake in their costs and coverage, resulting in what GM wrote above - free markets determining prices, individuals determining what kind of health care they want, and insurance companies competing for business.
The so-called ACA does none of what it promised to do. We will not end it by standing out on a precipice and giving our opponents a clear shot to take us down. (MHO)
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I don't care for the tone of the article, but the question posed is one we must address.
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/15/why-an-mri-costs-1080-in-america-and-280-in-france
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I don't care for the tone of the article, but the question posed is one we must address.
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/15/why-an-mri-costs-1080-in-america-and-280-in-france
http://www.theglobeandmail.com/life/health-and-fitness/access-to-mris-ct-scans-improving/article1389394/
An older article I saw stated that Pittsburg, PA. Had more MRI machines than all ofCanada.
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I don't care for the tone of the article, but the question posed is one we must address.
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/15/why-an-mri-costs-1080-in-america-and-280-in-france
http://www.theglobeandmail.com/life/health-and-fitness/access-to-mris-ct-scans-improving/article1389394/
An older article I saw stated that Pittsburg, PA. Had more MRI machines than all ofCanada.
On the same line, the southwest suburbs of Mpls (also) has more MRI machines than all of Canada. Canada has a population of 35 million so this is screwed up by a factor between 10 and 20-fold. (I don't know about the French)
The question I think is asking us to compare apples with oranges. One is the price charged for immediate usage of available equipment. The other is the hypothetically cost of a service not available without unacceptable delay - in Canada, up to 270 days for a routine orthopedic procedure.
The US cost is inflated with government dollars and other third party money payers can push the buyers out of pocket cost toward zero. The French cost is artificially low and doesn't likely provide enough incentive to increase the large fixed cost supply of these machines to meet the demand for their service at that price. Countries like that limit the number served some other way such as queuing and service denial.
Imagine if we legalized the MRI service and let the forces of supply and demand set the price at market equilibrium. Wouldn't that be better than these other misallocations?
(https://figures.boundless.com/14813/full/supply-demand-graph.jpeg)
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Good post Doug.
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There will be a crush of middle players finding ways to ring money out of this. Will this save us money? Short answer: no. While I am not totally against this as IMHO there is some reasonable aspects to this, I won't like how it will be "sold" to the public. It will be sold as "all in the interests of patient care". The real driver is costs.
****IMPROVING PATIENT CARE
Engaging Public Health in End-of-Life Issues: It Is Time to Step Up to the Plate
Jaya K. Rao, MD, MHS, Deputy Editor
The Doctor: For Life and at the End of Life
Ann Intern Med. 2015;162(3):230-231. doi:10.7326/M14-2479
This article was published online first at www.annals.org on 9 December 2014.
In September 2014, the Institute of Medicine (IOM) released its fifth full report on end-of-life issues, “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life” (1). Acknowledging the substantial progress made since its first report on these issues was published in 1997 (2), this report identifies recommendations within 5 domains. It is particularly encouraging to see the following recommendation for public education and engagement in the report: “Civic leaders, public health and other governmental agencies ... should engage their constituents and provide fact based information about care of people with advanced serious illness to encourage advance care planning and informed choice based on the needs and values of individuals.” Because I was one of the first authors to articulate a role for public health with respect to end-of-life issues (3) while I was working at the Centers for Disease Control and Prevention (CDC), it is noteworthy that this is the first IOM report to explicitly mention that public health has a role in this arena. By describing the work on end-of-life issues done by the public health community during the past decade, I hope that policymakers, members of the IOM Committee, and health professionals can use and build on these efforts.
Although end-of-life issues have long been considered a societal problem that needs to be improved, the field of public health has only begun to embrace end-of-life as a health concern. Because public health's primary focus is to prevent illness and premature death due to chronic disease and other health threats, public health professionals' reluctance to acknowledge death or its circumstances may be understandable. However—whether we wish to admit it or not—prevention has its limits, and everyone will die eventually. Some public health professionals may also believe that end-of-life issues are a health system problem rather than a priority to be addressed through population health efforts. Public health priorities tend to have at least one of the following characteristics: a large population burden, a major effect in terms of health and other consequences, and the potential for prevention.
In 2002, a literature review that I coauthored (3) clearly showed that end-of-life issues met the criteria of a public health priority. This review was designed as a primer to document the relevance and importance of these issues to the public health community. Given that public health is a key partner of the health care system for many health issues, we proposed that public health could disseminate culturally appropriate materials about advance care planning to the public, thus reaching persons before they were faced with making end-of-life decisions. In addition, we made a case for considering advance care planning as a critical part of chronic disease management programs.
Working closely with the CDC, chronic disease partners in state health departments identified priority end-of-life actions for public health (4). More than 200 public health stakeholders were engaged in this effort and made 103 recommendations for end-of-life activities across a range of topics (for example, public education, professional education, and research and evaluation). Of note, 3 of the 5 initial priorities identified as public health end-of-life actions are consistent with the spirit of the IOM's recommendation to educate and engage the public: to educate the public about hospice and palliative care and the importance of having an advance directive or health care proxy and to collect, analyze, and share data about the end of life through state surveys.
One of these actions has resulted in the development of online information on advance care planning for the public and public health and aging services professionals. For example, the CDC's Healthy Aging Web site (www.cdc.gov/aging/advancecareplanning/index.htm) presents materials for the public on advance care planning, including links to decision aids, state-specific advance directive forms, legal guides, and other end-of-life resources (such as hospice and palliative care organizations and information for caregivers). An online modular training course on advance care planning also was developed for public health and aging services professionals. Since then, more than 1000 health professionals have completed the course (Anderson L. Personal communication.), which is available for free and offers continuing education credits (www.cdc.gov/aging/advancecareplanning/care-planning-course.htm).
In addition to providing educational materials to the public, the 2014 IOM report suggests that government agencies undertake and share behavioral research aimed at assessing public perceptions and actions with respect to end-of-life care. Although national polls in the United States have provided periodic insights into public perspectives on end-of-life issues, ongoing population-based national surveys currently do not include questions about the end of life (5). Recently, end-of-life surveillance items were administered to a nationally representative sample of U.S. consumers to assess factors associated with completion of advance directives. This survey found that 26.3% of respondents had an advance directive and nearly 70.0% had concerns about end-of-life care, such as the costs of care, the pain that they might have, or their comfort and dignity during this period (6). Black or Hispanic persons or those who lack the knowledge to have concerns about the end of life were less likely to have advance directives; these groups may represent potential targets for intervention.
Although a PubMed search for “public health” and “end of life” still yields few articles addressing a population approach to end-of-life issues (most of which are presented here), the broader public health community has recently begun to acknowledge this issue. Several states (5, 7) and communities included palliative care questions as state-added items to the Behavioral Risk Factor Surveillance System. Other authors have declared end of life as a public health crisis (8) and the dying as a vulnerable population that should be a concern of public health (9). More recently, the American Public Health Association adopted a policy statement in 2013 on the role of public health in addressing unmet needs in serious illness and at the end of life (10). Such steps represent incremental progress.
In making its recommendations, the IOM appropriately considered the end of life as an issue that requires the involvement of sectors beyond the health care system. Hopefully, public health will heed the IOM's call for action and continue to build on the recommendations of the IOM and key public health stakeholders with respect to end-of-life issues. And, when the IOM writes its next end-of-life report, perhaps public health can influence the next set of recommendations.
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I really don't want to be a government employee but this is where it is going. I no of no significant scientific evidence that sex is a decent form or aerobic exercise unless one is being whipped while running on a treadmill. This is just patently ridiculous:
*****British Doctors Told to Prescribe Sex as Exercise
by A.B. Sanderson13 Feb 201586
Medical experts have recommended that exercise is something which GPs should be prescribing more often, describing it as “a wonder drug” which is important in the prevention of many common diseases.
The report from the Academy of Medical Royal Colleges says that physical activity plays a significant role in the management of long term conditions but its impact is so positive that it needs to take a greater role in the daily routine of children and adults, the Daily Mail reports.
There is, it says, a direct correlation between the increasingly sedentary lifestyle and conditions such as diabetes and obesity.
And worryingly, over 40 per cent of adults do not reach the minimum recommended level of 30 minutes of moderately intense exercise five times per week.
Regular exercise can prevent dementia, type 2 diabetes, some cancers, depression, heart disease and other common serious conditions – reducing the risk of each by at least 30% – better than many drugs.
But rather than simply telling doctors to send their patients down the gym or pounding the streets in lycra, the authors suggest there are a huge number of ways to raise the heart rate which fit into a person’s schedule.
The report says that fun activities are more likely to be sustained, suggesting many activities can be promoted including dog walking, dancing and even having sex. ‘Basing activities in communities leads to sustained acceptance’ it says, although the report offers no comment on whether this applies to the latter activity.
And it is not just the health of patients which will improve with more adults taking part in community dance classes or training for charity events: The costs of physical inactivity to the UK, the NHS and other public bodies are estimated to be in excess of £15bn.
There are also other costs which are less simple to quantify, including the effects of bad health on families and communities. Lack of physical activity is, is says, acknowledged as one of the top four factors responsible for premature deaths and long term diseases.
Chairman of the Academy of Medical Royal Colleges Professor Dame Sue Bailey sailed:
“This is about people and their doctors believing that the small effort involved is worth it because they are worth it.
“There really is a miracle cure staring us in the face, one which too many patients and doctors have quite simply forgotten about.
“This is about people and their doctors believing that the small effort involved is worth it because they are worth it. This needs to work across the life-course, from children to the very elderly.”
But the advice was not welcomed everywhere, with Joyce Robins of Patient Concern saying, “It’s none of GPs’ business to be talking about patients’ sex lives. I would take amiss at that and I’m sure many others would too.
“This is particularly true as nowadays most patients don’t even know their family doctor.”*****
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http://www.newsweek.com/obamacare-picture-health-305471
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The speaker I heard today could answer this. The numbers and stats above are probably all distortions. The Affordable Health Care Act has done little if anything to reduce costs. The administrative costs could be as high as 30%. The only ones who did well are the same ones who havce done well in the rest of the economy - big companies who have the resources to squeeze out all competition and soak the system. Without the input of tax dollars to supplement these companies they would go out of business. We are supplementing them with tax money.
I ask everyone who reads this board:
How much less are you paying for your insurance and is your plan better than last year or the year before that?
I know the answer.
The speaker I heard advocates for single payer. He made a strong case and almost has me convinced he may be right.
If I can find the website he recommended I'll post but I lost the site when I left a piece of paper somewhere while answering a page.
Based on what his presentation concluded based on a lot of statistics and sources the Newsweek piece is exactly what one would expect from a veiled Democrat outlet - pure propaganda.
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This is one article from the organization the speaker (I noted in the previous post) was promoting. I am not a member and would not.
A rather socialistic group. Yet they are right about pointing out the large layer of administrative costs.
He thinks the AHA is going to fail in a few years. One could argue it is designed to fail in the march to single payer. I don't know.
http://www.pnhp.org/news/2015/march/health-care-law-did-not-end-discrimination-against-those-with-pre-existing-condition
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POTH
WASHINGTON — In 2012, the Supreme Court declared that Congress had put “a gun to the head” of states by pressuring them to expand Medicaid, and it said that such “economic dragooning” of the states violated federalism principles embedded in the Constitution.
Now, in a separate case, comments by several justices indicate that they could uphold a pillar of the Affordable Care Act — insurance subsidies for millions of lower-income people — by invoking those same principles.
In 2012, the court said it would be unconstitutional for Congress to cut off all Medicaid payments to states that refused to expand eligibility, and this ruling instantly transformed the expansion of Medicaid into a state option.
That precedent echoed through oral arguments last week before the court; justices again expressed respect for federalism and state sovereignty.
Under the health care law, Congress gave states a choice: They could establish and operate their own competitive insurance marketplaces, or they could rely on one established by the federal government. It was, several justices said, inconceivable that Congress would then punish states that used the federal exchange by denying insurance subsidies to their residents.
Justice Anthony M. Kennedy suggested that such a choice could coerce states in a potentially unconstitutional way. Under the theory favored by critics of the health care law, Justice Kennedy said last week, “the states are being told either create your own exchange, or we’ll send your insurance market into a death spiral,” and “the cost of insurance will be sky high.”
Mark H. Gallant, a health lawyer at Cozen O’Connor in Philadelphia, said: “Justice Kennedy’s take on this case was a brilliant touch. He used the plaintiffs’ own argument against them to suggest that it would be unconstitutionally coercive if Congress made the subsidies depend on a state’s decision to establish an exchange.”
Plaintiffs in the case, King v. Burwell, say the Affordable Care Act authorizes subsidies only in states that created their own insurance exchanges.
Justice Antonin Scalia said it was “gobbledygook” for the Obama administration to suggest that an exchange set up by the federal government “qualifies as an exchange established by the state.” When the language of the law is clear and unambiguous, he said, the court cannot twist the words to avoid “untoward consequences.”
And Justice Samuel A. Alito Jr. said the court could delay the impact of its ruling if the consequences were as disruptive as the administration said.
But the Obama administration argues that the subsidies are available in all states, including more than 30 that refused to establish exchanges and rely on the federal marketplace. Without the subsidies, it says, many people would be unable to afford insurance, and healthier consumers would go without coverage, leaving insurers with a sicker, more expensive pool of customers.
The Affordable Care Act has begun reducing the number of uninsured in two main ways: by expanding Medicaid and by providing tax credits to subsidize private insurance purchased through the public exchanges. The court, which focused on Medicaid three years ago, is now examining the subsidies.
Continue reading the main story Continue reading the main story
Continue reading the main story
Justice Sonia Sotomayor told the plaintiffs’ lawyer, Michael A. Carvin, that if the court accepted his argument, it would be “intruding on the federal-state relationship, because then the states are going to be coerced into establishing their own exchanges.”
And Justice Elena Kagan said Congress had not warned states of the consequences if they chose to use the federal exchange. In interpreting statutes, Justice Kagan said, the court presumes that “Congress does not mean to impose heavy burdens and draconian choices on states unless it says so awfully clearly.”
For decades, more conservative justices have emphasized respect for state sovereignty. The court often uses “basic principles of federalism embodied in the Constitution to resolve ambiguity in a federal statute,” Chief Justice John G. Roberts Jr. said in his opinion for the court in an unrelated case nine months ago.
The oral arguments also showed how the court, in the digital age, could be influenced by a flood of research, analysis and commentary from bloggers, scholars and advocates forecasting dire consequences if insurance subsidies end. More than 20 legal briefs have conveyed those concerns to the court, citing studies by groups like the Commonwealth Fund, the Urban Institute, the Kaiser Family Foundation, the RAND Corporation and Families USA.
“In the last six weeks,” said Abbe R. Gluck, a law professor at Yale, “people finally woke up and became aware of the drastic real-world consequences.”
A typical study, from the Urban Institute, based on a computer model of the health care system, was titled: “Implications of a Supreme Court Finding for the Plaintiff in King v. Burwell: 8.2 Million More Uninsured and 35 Percent Higher Premiums.”
When ruling on appeals, judges typically make decisions by closely reading the law and applying it to the facts of a case, as revealed in a trial court. But in the subsidies case, supporters of the health care law found a way to bring their predictions to the Supreme Court justices’ attention.
The government argued that Congress could not have imposed such drastic consequences on states without discussing the impact and without giving clear, explicit notice to the states.
“If that was really the plan, then the consequence for the states would be in neon lights in this statute,” said Solicitor General Donald B. Verrilli Jr.
Justice Kennedy has long been a protector of the states. They need clear notice of the conditions attached to federal funds so they can “guard against excessive federal intrusion into state affairs and be vigilant in policing the boundaries of federal power,” he wrote in 1999.
The Affordable Care Act expanded federal power, but preserved a large role for states.
Mr. Carvin, the plaintiffs’ lawyer, said the law had offered an irresistible incentive — “billions of free federal dollars” in subsidies — as an inducement for states to set up exchanges.
“That’s hardly invading state sovereignty,” Mr. Carvin said.
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What say we?
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Future Obamacare Costs Keep Falling
By Nick Timiraos and Stephanie Armour
CONNECT
Floridians sign up for the Affordable Care Act in February. The nonpartisan Congressional Budget Office projects the law will cost the government 11% less than their forecast six weeks ago.
Nearly five years after President Barack Obama signed the Affordable Care Act into law, federal budget scorekeepers have sharply revised down the projected costs of the signature bill.
In the latest projection, published by the nonpartisan Congressional Budget Office on Monday, the major provisions of the law will cost the government 11% less than they forecast six weeks ago, or $142 billion over the coming decade.
Overall, the health-care law will now cost 29% less for the 2015-19 period than was first forecast by the CBO when the law was signed in March 2010. Back then, the CBO and the congressional Joint Committee on Taxation estimated that for the last five years of their 10-year projection, Obamacare would cost $710 billion. Now, they expect it will cost $506 billion for the same period.
In 2019, for example, the agencies project Obamacare will cost $116 billion, which is down 33% from the initial forecast for the same year made in 2010.
Monday’s report illustrates two dynamics at play. First, health-care costs are rising more slowly than previous forecasts assumed. And slightly fewer people than anticipated are signing up for health insurance through federal exchanges.
The CBO estimates the government will spend 20% less on subsidies provided to individuals who purchase health insurance through the federal health exchange, or around $209 billion in lower-than-projected costs over the coming 10 years.
The government won’t see all of that savings, however, because the CBO also estimates that the government will collect less money from taxes on certain high-premium insurance plans. The latest forecast now projects taxes on those so-called “Cadillac” plans will bring in 41% less money, or $62 billion in reduced revenues. The CBO forecast shows that in 2022, the tax will bring 71% less than projected in 2012.
The decrease in government spending on the health-exchange subsidies is linked in part to projections of slower growth in health care spending. The growth in private health insurance spending per enrollee over the 2006-2013 period averaged 1.8% per year, compared with an average rate of 5% per year during the 1998-2005 period, according to the report.
In the past, the CBO had assumed that the recent slowdown in health-care inflation was temporary and would quickly reverse. The latest projections assume that health-care inflation will rise more modestly.
The slower growth in health care spending is attributed in part to the slow economic recovery and more insurance cost-sharing requirements like deductibles, which have prompted consumers to rein in their own spending on medical care. Medicare spending growth has also slowed.
The CBO report also decreased its estimate of the number of people who will be without health insurance to around 25 million, from its prior forecast of 27 million.
The report also reflects lower-than-expected enrollment in federal and state exchanges set up under the Affordable Care Act. The Obama administration said about 11.4 million people signed up for private insurance through the health law’s exchanges so far this year.
The CBO earlier estimated that 13 million people would enroll in private health plans in 2015 but has since lowered that projection.
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The Ugly Civil War in American Medicine
By Kurt Eichenwald 3/10/15 at 12:04 PM
A group of doctors is charging that the American Board of Internal Medicine has forced them to do meaningless work to fatten the board’s bloated coffers. Blend Images/Alamy
Are physicians in the United States getting dumber? That is what one of the most powerful medical boards is suggesting, according to its critics. And, depending on the answer, tens of millions of dollars funneled annually to this non-profit organization are at stake.
The provocative question is a rhetorical weapon in bizarre war, one that could transform medicine for years. On one side is the American Board of Internal Medicine (ABIM), which certifies that doctors have met nationally recognized standards, and has been advocating for more testing of physicians. On the other side are tens of thousands of internists, cardiologists, anesthesiologists and the like who say the ABIM has forced them to do busywork that serves no purpose other than to fatten the board’s bloated coffers.
“We don’t want to do meaningless work and we don’t want to pay fees that are unreasonable and we don’t want to line the pockets of administrators,’’ says Dr. Paul Teirstein, a nationally-prominent physician who is chief of cardiology at Scripps Clinic and who is now leading the doctor revolt.
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The physicians lining up with Teirstein are not a bunch of stumblebums afraid of a few tests. They include some of this nation’s best-known medical practitioners and academicians, from institutions like the Mayo Clinic, Harvard Medical School, Columbia Medical School and other powerhouses in the field.
This spat is hardly academic, though. Some doctors are leaving medicine because they believe the ABIM is abusing its monopoly for money, forcing physicians to unnecessarily sacrifice time with their patients and time for their personal lives.
A little history: For decades, doctors took one exam, usually just after finishing training, to prove they had absorbed enough medical knowledge to treat patients. Internists—best known as primary care physicians—would take one test while those who chose subspecialties of internal medicine—cardiovascular disease, critical care, infectious disease, rheumatology—sat for additional exams. Doctors maintained their certification status by participating in programs known as “continuing medical education,” which, when done right, keep physicians up on developments in their field.
The value to a doctor of being certified can scarcely be overstated. Many organizations will not hire uncertified doctors. And, without that stamp of approval, even doctors who open their own practices rarely receive permission from hospital boards to treat their patients in hospitals. It was a sensible way to make sure doctors stayed on top of their game and weed out incompetent clinicians.
Someone, of course, had to pay for the testing and continuing education, and it was usually the doctors. So physicians shelled out money to the ABIM to take the tests, and then ponied up more cash to attend conferences and other programs for continuing medical education. Few objected—it was worth the money to keep up the profession’s standards.
But then ABIM decided that rather than just having doctors take one certification test, maybe they should take two. Or three. Or more. Under this new rule adopted in the early 1990s, internists and subspecialists recertify every 10 years with new tests. In other words, a doctor certified at the age of 30 could look forward to taking an ABIM exam at least three more times before retirement. This was not cheap—doctors spend thousands of dollars not only for the tests, but for review sessions, for time away from their practices. And with each new test, the ABIM made more money.
Physicians sheepishly went along with the process, assuming their good old pal the ABIM was working hard to make sure medical practitioners were fully qualified.
Then, something strange happened, doctors say. The tests started including questions about medical problems that had nothing to do with how doctors did their jobs. For example, anesthesiologists who worked exclusively with adults were required to answer questions about pediatric anesthesiology. To the layman, those might not sound like a big difference, but it completely ignores how medicine is practiced. For the anesthesiologist, for example, the measurements, methods and almost every other element of putting a child to sleep for surgery is completely different than for an adult (what is the perfect measurement for an adult in a particular scenario could kill the child). And these aren’t calculations that are pulled off a chart; they involve very technical analysis that adult anesthesiologists don’t even know how to do, because they never use them. So the doctors have to spend hours reviewing issues they hadn’t seen since medical school to learn how to do something they have never—and will never—do. Then there are the internists, who are forced to learn details of a subspecialty that they would never use because, in the real world, the first thing they would do is call a subspecialist colleague for a consult—so again, the doctors have to spend time re-learning information that has nothing to do with the actual practice of medicine.
Videos and study sessions sold to help doctors prepare for re-certification exams often featured instructors saying physicians would never see a particular condition or use a certain diagnostic technique, but they needed to review it because it would be on the test. “Exam questions often are not relevant to physicians’ practice,” Teirstein says. “The questions are often out-dated. Most of the studying is done to learn the best answer for the test, which is very often not the current best practice.”
The result? According to the ABIM’S figures, the percentage of doctors passing the recertification test started dropping steadily. In 2010, some 88 percent of internists taking the maintenance of certification exams passed; by 2014, that had fallen to 80 percent. Hematologists dropped from 91% to 82%. Interventional cardiologists went from 94% to 88%. Kidney specialists, 95% to 84%. Lung experts, 90% to 79%.
Wow. Was it Obamacare? Ebola? A sign of the end times? What was turning so many American doctors so stupid all of sudden? Not to worry, the ABIM declares—the board could help doctors keep their certification. All they had to do was pay to take the tests again. Making doctors appear ignorant became big business, worth millions of dollars, and the ABIM went from being a genial organization celebrated by the medical profession to something more akin to a protection racket.
The ABIM disputes that characterization. Lorie B. Slass, a spokesperson for the ABIM, says “there have been and always will be” fluctuations in test results, since different groups of doctors are taking the exam each year. But in each of the categories cited above, there are no statistically significant fluctuations—the passing rate keeps going down. So the point remains: Either doctors are getting dumber each year, or the test that helps determine who gets to practice medicine has less and less to do with the actual practice of medicine.
Slass says the suggestion that the ABIM is “purposefully failing candidates on their exams to generate more revenue is flat-out wrong.” Maybe so, but according to the Form 990s filed with the Internal Revenue Service, in 2001—just as the earliest round of new-test standard was kicking in, the ABIM brought in $16 million in revenue. Its total compensation for all of its top officers and directors was $1.3 million. The highest paid officer received about $230,000 a year. Two others made about $200,000, and the starting salary below that was less than $150,000. Printing was its largest contractor expense. That was followed by legal fees of $106,000.
Twelve years later? ABIM is showering cash on its top executives—including some officers earning more than $400,000 a year. In the tax period ending June 2013—the latest data available—ABIM brought in $55 million in revenue. Its highest paid officer made more than $800,000 a year from ABIM and related ventures. The total pay for ABIM’s top officers quadrupled. Its largest contractor expense went to the same law firm it was using a decade earlier, but the amounts charged were 20 times more.
And there is another organization called the ABIM Foundation that does...well, it’s not quite clear what it does. Its website reads like a lot of mumbo-jumbo. The Foundation conducts surveys on how “organizational leaders have advanced professionalism among practicing physicians.” And it is very proud of its “Choosing Wisely” program, an initiative “to help providers and patients engage in conversations to reduce overuse of tests and procedures,” with pamphlets, videos and other means.
Doesn’t sound like much, until you crack open the 990s. This organization is loaded. In the tax year ended 2013, it brought in $20 million—not from contributions, not from selling a product, not for providing a service. No, the foundation earned $20 million on the $74 million in assets it holds.
The foundation racked up $5.2 million in expenses, which—other than $245,000 it gave to the ABIM—was divided into two categories: compensation and “other.” Who is getting all this compensation? The very same people who are top earners at the ABIM. Deep in the filings, it says the foundation spends $1.9 million in “program and project expenses,” with no explanation what the programs and projects are.
There are some expenditures, though, that are easy to understand: The foundation spends $153,439 a year on at least one condominium. And it picks up the tab so the spouse of the top-officer can fly along on business trips for free.
The ABIM is not what it was. Its original mission was to make sure doctors provide patients with the best care. When condominiums and lavish salaries and free trips and making money off of physicians failing tests became a priority, the evidence suggests the organization lost its way.
But that may not matter soon. In January 2014, when the ABIM issued a series of new requirements for maintaining certification—that would have generated all new fees—Teirstein and his colleagues declared “enough.” They recently formed a new recertification organization called the “National Board of Physicians and Surgeons.” It will only consider doctors for recertification who have passed the initial certification exam that has been required for decades. Doctors must also log a set number of hours with programs that qualify under guidelines as continuing medical education. The group’s fees are much, much lower than those charged by the ABIM. And its board and management—all top names in medicine—work for free.
This new board is not just about breaking the ABIM monopoly, Teirstein says, but is also part of an effort to put the right people in charge of the profession’s future. Medicine has been “controlled by individuals who are not involved with the day to day care of patients,” he says. “It is time for practicing physicians to take back the leadership.”
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http://www.ifyouonlynews.com/weird-news/conservative-forbes-admits-obamacare-is-adding-jobs-and-helping-the-economy/
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http://www.ifyouonlynews.com/weird-news/conservative-forbes-admits-obamacare-is-adding-jobs-and-helping-the-economy/
Lol. Not exactly Forbes the conservative, but a writer found a sentence regarding jobs in the health sector that didn't mention the anti-job effect of two dozen tax increases within Obamacare, the loss of full time jobs elsewhere, the shift from full time to part time work, the stampede of working age adults leaving the work force, the permanent loss of trillions of dollars of GDP or the epidemic of people going on food stamps and permanent disability. The article admits the oddity of finding a sentence in a report like not also pointing out the economic damages of Obamacare and other Obama policies.
84% of Obamacare enrollees are on government subsidy. We already had free healthcare for the poor. Obamacare is a welfare dependency program for people who were once self sufficient and middle class. As Elizabeth Warren would say, good for them. (Really it isn't.) Shifting of resources was bound to occur in a trillion dollar program but no jobs and no wealth is created by robbing Peter to pay Paul.
From the article: The health care industry added 22,000 jobs last month, which was about on par with February totals for health services jobs, according to the jobs report issued Friday by the U.S. Department of Labor’s Bureau of Labor Statistics.
That statistic counts part time workers at minimum wage with no benefits on an equal footing with doctors leaving their practices. Some economic measure!
This was in Forbes too: Worst recovery since WWII. " ...total of about 10 million missing jobs."
http://www.forbes.com/sites/peterferrara/2013/06/02/economically-could-obama-be-americas-worst-president/
The unemployment rate today is 9.8% calculated at the workforce participation rate we had when Barack Obama was first inaugurated. The median wage is up by zero and income inequality is widening. The growth rate for all of last year was a miserable 2.2% and Q1 2015 was even worse. You have to be a blindfolded liberal or First Trust economist to see any of this as positive economic news for Main Street America.
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http://www.nytimes.com/2015/04/11/us/texas-medical-panel-votes-to-limit-telemedicine-practices-in-state.html?emc=edit_th_20150411&nl=todaysheadlines&nlid=49641193
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The million dollar question:
"But Mr. Chicotel of the California advocacy group said the Kaiser example pointed to a broader tension within the quickly changing health care world: At what point does a desire to keep costs low trump concerns for quality?"
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As Nursing Homes Chase Lucrative Patients, Quality of Care Is Said to Lag
****The New York TimesThe New York Times
The New York Times
By KATIE THOMAS8 hrs ago
A USS Arizona survivor salutes the remembrance wall of the USS Arizona during a memorial service for the 73rd anniversary of the attack on the US naval base at Pearl harbor, on December 7, 2014, in Pearl Harbor, Hawaii
Dr. Lois Johnson-Hamerman, a retired neonatologist, entered a Philadelphia nursing facility for short-term rehabilitation of an injured foot. She later required hospitalization for an infected bedsore. © Jessica Kourkounis for The New York Times Dr. Lois Johnson-Hamerman, a retired neonatologist, entered a Philadelphia nursing facility for short-term rehabilitation of an injured foot. She later required hospitalization for an infected bedsore.
Promises of “decadent” hot baths on demand, putting greens and gurgling waterfalls to calm the mind: These luxurious touches rarely conjure images of a stay in a nursing home.
But in a cutthroat race for Medicare dollars, nursing homes are turning to amenities like those to lure patients who are leaving a hospital and need short-term rehabilitation after an injury or illness, rather than long-term care at the end of life.
Even as nursing homes are busily investing in luxury living quarters, however, the quality of care is strikingly uneven. And it is clear that many of the homes are not up to the challenge of providing the intensive medical care that rehabilitation requires. Many are often short on nurses and aides and do not have doctors on staff.
A report released in 2014 by the Department of Health and Human Services’ Office of the Inspector General found that 22 percent of Medicare patients who stayed in a nursing facility for 35 days or less experienced harm as a result of their medical care. An additional 11 percent suffered temporary injury. The report estimated that Medicare spent $2.8 billion on hospital treatment in 2011 because of harm experienced in nursing facilities.
“These nursing homes were not built for this purpose,” said Dr. Arif Nazir, an associate professor of clinical medicine at Indiana University who studies geriatrics. He said many patients leave hospitals with acute medical needs, before infections have been fully treated, or as they adjust to new medications.
“These patients are leaving the hospital half-cooked, and believe me, the latter part of the cooking is the hardest part,” he said.
Competition for these patients has become intense because Medicare, the health insurance program for older adults, pays 84 percent more for short-term patients than nursing homes typically get from Medicaid, the health insurance program for the poor, for long-term residents.
At the same time, hospitals are trying to cut costs by pushing some patients out early — like those who have had hip replacement or heart surgery, for example. Not quite ready to go home, they need continuing care somewhere. And for older adults, Medicare usually pays the bill.
The combination of factors has created a bull market in the once-struggling industry as investors clamor to snatch up homes with the most potential to bring in short-term patients. Sale prices of nursing homes averaged $76,500 per bed last year — the second consecutive year of record-breaking prices, according to Irving Levin Associates, which analyzes the senior housing market.
So lucrative are Medicare payments that some homes have decided not to take lower-paying Medicaid patients at all.
The shifting landscape, some say, marginalizes poor long-term residents with extensive medical needs. “This focus on Medicare, Medicare, Medicare has pushed out people in the custodial care world,” said Anthony Chicotel, a staff lawyer at California Advocates for Nursing Home Reform, who says he fields calls at least once a week from residents who are being evicted because their Medicare coverage, which lasts 100 days, is expiring and the residents will transition to lower-paying Medicaid insurance. “They’re being pushed out, and they don’t have anywhere to go, really, that can take care of them.”
Representatives of nursing homes acknowledge that the challenges are substantial, but they are optimistic about the progress they are making.
“It’s uneven, but I think, that said, we’re trending in the right direction,” said Dr. David Gifford, the senior vice president of quality and regulatory affairs at the American Health Care Association, an industry trade group. “I think you’re seeing a much greater linking of quality, and an emphasis on it,” he added.
Dr. Gifford and others say they are paying close attention to quality — not only because it is the right thing to do, but because hospitals and large health systems are beginning to demand it. Under the new health care law, hospitals may be penalized if too many of their patients are readmitted within a certain time.
“Hospitals are starting to get really worried, and when hospitals are worried, skilled nursing facilities are worried, because they are their sources of patients,” said David Grabowski, a professor of health care policy at the Harvard Medical School.
Promises of Care
Dr. Lois Johnson-Hamerman, a retired neonatologist, said she thought she had done her homework when she checked into the Watermark at Logan Square, a nursing facility in Philadelphia.
The home had a reputation for quality and got high marks from the federal government. Until a recent revision, its website promised “top-notch health care” with amenities including a staff willing to administer a “decadent hot bath” at any hour of the day.
But just one month after arriving at Watermark for short-term rehabilitation of an injured foot in 2012, Dr. Johnson-Hamerman ended up in the emergency room with a severe bedsore that had become dangerously infected. Far from the service she said she had been promised, she said the workers never gave her a full bath or shower, were slow to respond to her requests to have her diaper changed and did not turn her every few hours, a crucial step in preventing bedsores.
She said she left the facility only after friends, including doctors and nurses, became so horrified by her care that they insisted that she be taken to a hospital.
Geriatric researchers call this disconnect the “chandelier effect.” Attractive lobbies and enticing amenities do not always mean that a home provides good medical care.
In reality, said Dr. Steven Handler, a geriatrician and assistant professor at the University of Pittsburgh School of Medicine, many nursing homes are struggling to provide consistent, quality care despite genuine efforts. “The nursing homes are kind of stuck in an older model that is based on a very small operating margin, low-staffing model and low physician presence,” he said.
Dr. Johnson-Hamerman, who is 87, is suing Watermark over what she describes as negligent care.
“At least I’m still here,” she said recently at her home. “But where would I be if I didn’t have the friends and resources to do something about it?”
C. Jill Hofer, a spokeswoman for Watermark, said that the home was committed to providing quality care and that it denied the allegations in the lawsuit.
Bull Market for Short-Term Homes
The nursing home industry has long argued that it relies on higher Medicare payments to offset the rates it receives from Medicaid, which usually pays for the care of long-term residents.
And indeed, even though facilities earned a 2 percent overall profit in 2013, they lost about 2 percent on non-Medicare patients, according to the Medicare Payment Advisory Commission, or Medpac, an agency of Congress.
But in recent years, that focus on Medicare patients has intensified as many long-term residents have moved to assisted-living facilities and hospitals have sought to discharge patients earlier. On a typical day in 2000, about 9 percent of residents in an average nursing home were covered by Medicare, according to federal data. By 2014, that had risen to 15 percent.
Some companies are now eliminating Medicaid payments entirely by building homes solely for the more lucrative short-term patients.
Santé Partners, a developer in Arizona, recently opened four nursing homes that do not accept any long-term residents. A fifth is set to break ground this summer.
The buildings resemble hotels, with high-quality restaurants and private rooms that have kitchenettes. Developers say their singular focus allows them to provide better care.
“I think pretty much every company now is going in this direction,” said C. Mark Hansen, the president and chief executive of Santé Partners.
Some for-profit chains have aggressively increased their numbers of Medicare patients. In California, the share of Medicare patients at several large chains has far outpaced the state average, according to an analysis of state nursing home data by The New York Times.
On a typical day in 2012, about 11 percent of beds in California nursing homes were occupied by Medicare patients, The Times’s analysis showed.
But at HCR ManorCare, one of the nation’s largest chains, 32 percent were Medicare patients at its California nursing homes. At the Ensign Group, a large chain based in California, Medicare covered 20 percent of patients on a typical day in 2012.
HCR ManorCare said that it had invested in treating patients with complex medical needs and that that helped explain why its percentage of Medicare patients was higher than the state average. A spokeswoman for Ensign declined to comment.
Ensign is one of several chains that has recently paid federal fines to settle charges that they exaggerated the therapy needs of patients to increase Medicare payments. The company paid $48 million in 2013 to settle such claims. In October, a large Canadian company, Extendicare Health Services, paid $38 million in a similar case.
Even homes with a history of poor care are marketing their high-end amenities. The Medford Multicare Center for Living on Long Island recently opened a wing intended for short-term care known as “The Lux at Medford.” Guests have access to a putting green, a model apartment and a parked PT Cruiser to teach them how to resume their day-to-day activities.
The New York State attorney general sued the facility last year over issues of quality, and seven employees were indicted on a range of charges related to the death of Aurelia Rios, a patient in the facility’s ventilator unit. Federal officials recently placed the home on a watch list of the nation’s poorest-performing facilities.
Jason Newman, a spokesman for the home, says the owners of Medford dispute the charges. “The owners of this facility care very, very much about this place,” he said.
Claims of Lapses, and Death
Deaths attributed to lapses in care are not uncommon. In 2010, Mary Dwyer checked into Harborview Healthcare Center in Jersey City to recuperate after dislocating her shoulder in a fall.
Ms. Dwyer, who was 87, planned to return home, but her condition deteriorated rapidly because of what her family described as negligent care. Staff members were so overworked that Ms. Dwyer was not fed properly and not repositioned frequently in her bed, according to a lawsuit the family later filed in New Jersey state court alleging negligence and wrongful death.
In a month, Ms. Dwyer lost 20 pounds and developed a bedsore so severe that it exposed her bone.
She was treated at a hospital for her injury, and she died about a month later. Last year, a jury awarded her family more than $13 million.
The amount has since been reduced to $4.75 million and the case is being appealed by the nursing home. A spokeswoman for Harborview said the company denied the charges and maintained an outstanding record for quality.
“Nobody really took responsibility,” Ms. Dwyer’s daughter, Henrietta Dwyer, said recently. “It seemed nobody was accountable for anything.”
Industry specialists say that competition is so intense that eventually quality will prevail, as hospitals and insurers, who cover some Medicare patients, will balk at sending patients to homes that perform poorly.
Siblings Georgette Dwyer, left, Henrietta Dwyer and James Dwyer. Within a month of checking into a nursing home after dislocating her shoulder, their mother lost 20 pounds and developed a severe bedsore. She died a month later. © Bryan Anselm for The New York Times Siblings Georgette Dwyer, left, Henrietta Dwyer and James Dwyer. Within a month of checking into a nursing home after dislocating her shoulder, their mother lost 20 pounds and developed a severe bedsore…
Hospitals now pay penalties if too many patients are readmitted.
And under new payment models, health systems are beginning to coordinate the care of patients even after they leave the hospital. They are rewarded for keeping costs low, but they also must prove that certain quality goals are met.
The Medford Multicare Center for Living on Long Island has a wing for short-term care known as “The Lux at Medford.” It includes a parked car so residents can practice getting in and out. © Kirsten Luce for The New York Times The Medford Multicare Center for Living on Long Island has a wing for short-term care known as “The Lux at Medford.” It includes a parked car so residents can practice getting in and out.
“It’s happening at a head-spinning rate,” said Dr. Nazir of Indiana University. “It has been a very positive thing.”
Dr. Gifford of the industry trade group said his group’s members had reduced re-hospitalization rates by 14 percent. And the group has supported other measures to improve quality, he said, including one passed by Congress last year that will withhold a percentage of Medicare payments from facilities, who can then earn back some of the money if they meet certain standards.
Mr. Hansen, the chief executive of Santé Partners, said his facilities did not bring in high profits because the company invests heavily in quality. That investment pays off, he said, because he can demonstrate that his facilities provide good care at a lower cost than, say, a hospital.
“It’s bringing down the total cost of the health care spend,” Mr. Hansen said.
Still, some insurers and hospitals continue to send patients to homes with poor records.
Kaiser Permanente, which combines a nonprofit insurance plan with its own hospitals and clinics, sends patients to a network of outside nursing homes in Maryland and Virginia that the organization says meet its “high standards of care.” However, of the 12 so-called core nursing homes in Kaiser’s network, four held a one-star rating for their health inspection. One was ranked five stars, the highest score.
After The New York Times contacted Kaiser, a spokesman said it would end its association with one of the poorly rated homes, Commonwealth Health & Rehab Center in Fairfax, Va.
The spokesman said that the company sends Kaiser doctors and staff members to the facilities to treat its patients, and that most of them are placed in homes with the higher ratings. He said Kaiser was working with the low-rated homes to improve their conditions.
“The care and safety of our members and patients are our top priorities,” said the spokesman, Marc Brown.
But Mr. Chicotel of the California advocacy group said the Kaiser example pointed to a broader tension within the quickly changing health care world: At what point does a desire to keep costs low trump concerns for quality?
“I think a lot of the time when it comes to managed care, it’s a race to the
bottom"
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U.S. Emergency-Room Visits Keep Climbing
By Stephanie Armour
May 4, 2015 12:01 a.m. ET
Emergency-room visits continued to climb in the second year of the Affordable Care Act, contradicting the law’s supporters who had predicted a decline in traffic as more people gained access to doctors and other health-care providers.
A survey of 2,098 emergency-room doctors conducted in March showed about three-quarters said visits had risen since January 2014. That was a significant uptick from a year earlier, when less than half of doctors surveyed reported an increase. The survey by the American College of Emergency Physicians is scheduled to be published Monday.
Medicaid recipients newly insured under the health law are struggling to get appointments or find doctors who will accept their coverage, and consequently wind up in the ER, ACEP said. Volume might also be increasing due to hospital and emergency-department closures—a long-standing trend.
“There was a grand theory the law would reduce ER visits,” said Dr. Howard Mell, a spokesman for ACEP. “Well, guess what, it hasn’t happened. Visits are going up despite the ACA, and in a lot of cases because of it.”
The health law’s impact on emergency departments has been closely watched because it has significant implications for the public. ER crowding has been linked to longer wait times and higher mortality rates.
More than half of providers listed in Medicaid managed-care plans couldn’t schedule appointments for enrollees, according to a December report by the Health and Human Services Office of the Inspector General. Among providers who could offer appointments, the median wait time was two weeks, but more than a quarter of doctors had wait times of more than a month for an appointment.
Many doctors don’t accept Medicaid patients because the state-federal coverage provides lower reimbursement rates than many private health-insurance plans. The waits for primary and specialty care by participating doctors appear to be leaving some Medicaid patients with the ER as the only option, according to ACEP.
“We’re seeing a huge backlog in the ER because the volume has increased,” said Ryan Stanton, an emergency-room doctor at Baptist Health Lexington in Kentucky. “This year we already have had to board people in the ER because of the sheer volumes,” he said, referring to a practice of keeping patients in the ER until a hospital room becomes available.
Dr. Stanton said ER volume rose about 10% in 2014 from 2013, and was up almost 20% in the first few months of this year.
The ACEP survey also found that ERs are seeing sicker patients: About 90% of the doctors polled said the severity of illness has stayed the same or gotten worse. That might be explained in part by an aging population, newly insured people with multiple maladies, and people delaying care because they have high-deductible insurance plans.
Nicholas Vasquez, a medical director for an emergency department in Mesa, Ariz., said volume rose 5% in a year, representing about 10 more patients a day. The stress from bigger caseloads prompted some nurses to resign, he said. “Physicians are working more shifts—that pushes them a lot,” Dr. Vasquez said. “If they work too much, they get burnt out. For patients, it means longer waits.”
Some states have been trying to curb ER use by Medicaid recipients by requiring higher copayments for visits deemed nonurgent. Critics have denounced that practice as punitive, and warn that it will dissuade low-income patients from seeking care that may be necessary.
A 2013 study by Truven Health Analytics that examined insurance claims for more than 6.5 million ER visits by commercially insured people under age 65 found just 29% of patients required immediate attention. Twenty-four percent didn’t require immediate attention, 41% received care that could have been provided in a primary-care setting, and 6% got care that would have been preventable or avoidable with proper primary care.
More than 40% of emergency physicians said they expect emergency-room visits to increase if the Supreme Court rules that subsidies provided to people who obtain insurance on the federal exchange are invalid. The court is expected to rule by late June.
Write to Stephanie Armour at stephanie.armour@wsj.com
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http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande
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http://www.wsj.com/articles/health-insurers-seek-hefty-rate-boosts-1432244042
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http://www.smashwords.com/books/view/428864
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http://www.nytimes.com/2015/05/26/health/rural-nebraska-offers-stark-view-of-nursing-autonomy-debate.html?emc=edit_th_20150526&nl=todaysheadlines&nlid=49641193
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If the SCOTUS decision goes our way, how does this measure up?
http://www.capoliticalreview.com/capoliticalnewsandviews/contrary-to-media-gop-has-plan-to-replace-obamacare-with-real-health-care-reform/
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If the SCOTUS decision goes our way, how does this measure up?
http://www.capoliticalreview.com/capoliticalnewsandviews/contrary-to-media-gop-has-plan-to-replace-obamacare-with-real-health-care-reform/
Great question. I will look into it, and want to also know what Crafty and others think. The Republicans need a plan. This is the plan. Just saying no government or federal involvement isn't going to cut it. Does this move us in the right direction and solve enough politically to allow us to win and privatize healthcare further in the future? We know this issue is going to get demogogued as soon as the Republicans take action. I guess we also know Obama will veto anything they pass. It better be their best effort, one they can hold firm on as while an insincere jerk makes straw arguments back against them from the bully pulpit.
(More likely Republicans will fear Obama, fold and give him everything he demands.)
From the link:
“Highlights of the bill include removing any subsidy assistance, increasing tax benefits, expanding federal funding for state “high-risk pools,” allowing Americans to purchase policies across state lines, reforming medical liability laws, and investing in research for the most common causes of death in the United States.”
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"allowing Americans to purchase policies across state lines"
I've pushed this one here for a while now. This is the only one I see that is likely to gather positive notice.
"reforming medical liability laws"
Good idea but not a particularly potent idea. Question-- Isn't this a matter of State laws?
"removing any subsidy assistance"
Politically this will be a BIG negative. Something potent will be needed to offset this and then some.
"increasing tax benefits"
In that the rich are the ones paying taxes, this will be portrayed as subsidizing the rich while ending subsidies for the poor.
"expanding federal funding for state “high-risk pools,”"
probably a good idea to answer the pre-existing condition issue.
"and investing in research for the most common causes of death in the United States.”
Pork to placate; I doubt it will serve that function very well.
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"allowing Americans to purchase policies across state lines"
I've pushed this one here for a while now. This is the only one I see that is likely to gather positive notice.
"reforming medical liability laws"
Good idea but not a particularly potent idea. Question-- Isn't this a matter of State laws?
"removing any subsidy assistance"
Politically this will be a BIG negative. Something potent will be needed to offset this and then some.
"increasing tax benefits"
In that the rich are the ones paying taxes, this will be portrayed as subsidizing the rich while ending subsidies for the poor.
"expanding federal funding for state “high-risk pools,”"
probably a good idea to answer the pre-existing condition issue.
"and investing in research for the most common causes of death in the United States.”
Pork to placate; I doubt it will serve that function very well.
Good work answering this.
1. Agree, open up commerce across state lines.
2. 'Isn't medical malpractice/liability a matter of state law?' By their standard, nothing is a state matter. This affects interstate commerce, right?
3. "removing any subsidy assistance" Agree, this is the landmine they left behind. 84% of Obamacare enrollees are subsidized. Republicans / reformers have to deal with this economically and politically or they have walked into the trap. I don't have the answer for how to replace socialism with socialis, or to have people who left work for subsidy suddenly become self sufficient.
4. "increasing tax benefits" Agree with you, playing with fire here.
5. "expanding federal funding for state “high-risk pools,” Agree again with you, a program for dealing with pre-existing conditions is a political must. This was a point Republicans already agreed to before Obamacare. This should be a shrinking pool if more and more now have coverage, unless people are losing their coverage. It seems to me the govt enters into a contract with the individual similar to what was done with welfare reform. If we subsidize, you have to maintain payment on your portion of the coverage to remain eligible.
6. "investing in research" Right. Don't we already do that? Another socialist answer to a private sector challenge?
None of these, it seems to me, addresses the underlying problem that our healthcare system is overly bureaucratic and inefficient and therefore overpriced by several-fold. There will be short term and long term agenda items. If/when the Supreme Court strikes down federal subsidies to individuals in states with no exchange, we need to some plug in that hole. That will require positive legislation from a Repulican congress to a signature from the President. I don't know the specifics, but we should agree to the short term fix only if he/they agree to a long term fix which must necessarily include a pathway to giving consumers more power and responsibility. The proposed reforms don't get us there other than ending subsidies, which is a political disaster. We know negotiating with the President is a losing proposition. The plan has to be good enough to take to the people and win. We could use some real leadership here. Maybe one of our 19 candidates can step forward and do that prior to being elected.
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"2. 'Isn't medical malpractice/liability a matter of state law?' By their standard, nothing is a state matter. This affects interstate commerce, right?"
But this is supposed to be OUR offering!!!
Anyway, what to do, what to do , , ,
As I have stated here previously, the sound bite gist of it is this:
"Insurance is for unexpected and potentially catastrophic events-- flood, fire, earthquake, tornado, big accidents, serious disease. Insurance is NOT for overflowing toilets, burnt bacon in the kitchen, a lamp falling over during a tremor, or the boo boos and sniffles that you may have. If insurance is used in that way, then everyone is spending the insurance company's money and not their own and the discipline of the market on prices is vitiated.
Therefore day to day stuff is out of pocket. Towards that end, PRICES MUST BE KNOWN; THEY MUST BE READILY AVAILABLE TO ALL POTENTIAL PATIENTS.
This approach will dramatically lower premium costs and restore market driven price behaviors to the health care market.
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"Therefore day to day stuff is out of pocket. Towards that end, PRICES MUST BE KNOWN; THEY MUST BE READILY AVAILABLE TO ALL POTENTIAL PATIENTS."
Agreed. That is exactly the focus we need.
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Perhaps this shouldn't be under the "politics" of health care thread but I post this article because it shows 4 things.
1) How studies are misleading. First a drug with a suspected 28% increase risk of heart failure turns out not to be true at all - not surprising.
2) That this article is in an investment magazine, Forbes, tells us how literally interwoven Wall Street is with our health system. There could have been more investor analysts at a recent cancer conference looking for an insider edge than there were oncologists.
3) The fact that it reports DDP 4 inhibitors may not decrease risk of stroke or heart attack. So the "f" what. Does that suggest the drug is no good or we shouldn't worry about lowering elevated blood glucose? NO!!
4) The lesson to take away is question the MOTIVES as well as the reported results of all research today. I can vouch first hand how money corrupts many in the health field just like everyone else.
http://www.forbes.com/sites/matthewherper/2015/06/08/giant-study-boosts-januvia-mercks-6-billion-drug/2/
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It's now called SCOTUScare.
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The American College of Physicians represents me about as much as the Republican party. Actually they are s0cialists like the Democratic party. Here is their predictable response to the SCOTUS decision.
***Reaction by Internal Medicine Physicians to Supreme Court Opinion
American College of Physicians (ACP) Applauds SCOTUS for Upholding Subsidies
(Washington, June 25, 2015) The American College of Physicians – the nation’s largest medical specialty society and second largest physician group – applauds today’s opinion of the Supreme Court of the United States in the King versus Burwell case.
In an opinion issued today, the Supreme Court ruled that the premium subsidies created by the Affordable Care Act (ACA), which are essential to making coverage affordable to millions, will continue to be available in states where the federal government manages their health insurance marketplaces.
ACP President Dr. Wayne J. Riley, MPH, MBA,MACP said, “we are thrilled and gratified by the Court’s ruling, which affirms that the citizens of all 50 states will have the opportunity to access either a state or federal exchange to obtain subsidies to purchase health insurance policies which benefits themselves, their families and loved ones.”
In March, the College joined with other health advocacy organizations in an amicus brief urging the court to uphold the subsidies, because of the grave danger a ruling against them would pose for patient care and the health and well-being of all Americans.
Dr. Riley further added that “the Patient Protection & Affordable Care Act of 2010 is now more than ever, the law of the land and we urge the Congress to work with this and future administrations to improve it in the years ahead.”
To illustrate, had the Supreme Court ruled with the petitioners in King versus Burwell and overturned the subsidies, the Kaiser Family Foundation estimates 6.4 million people would have been in immediate danger of losing their premium tax credits, and subsidized enrollees would have seen a 287 percent average premium increase. The Urban Institute/Robert Wood Johnson Foundation estimates the number of uninsured would have increased by 8.2 million.
For many years, ACP has advocated for every American to have access to affordable coverage, knowing that uninsured people live sicker and die younger than those with insurance. By upholding the ACA’s premium subsidies in all states, the Supreme Court decision will ensure continued coverage for many millions of Americans—and as a result, better health for them.
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The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 141,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.
Contact: David Kinsman, (202) 26****
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"attract a new type of student" :-o
"Test takers will now have to define terms like "institutional racism" and "social constructionism," :-o
Political correctness has no bounds:
****Medical School Hopefuls Grapple With Overhauled Entrance Exam
JUNE 29, 2015 3:50 PM ET
It's T minus four days until exam day, and Travis Driscoll is practically living at his desk.
"Each day, I'm easily here for five hours," he says. "I haven't done much of anything else but studying for the last two months."
Driscoll is one of 13,000 medical school applicants across the U.S. taking the new Medical College Admissions Test, or MCAT. He's got stacks of science books on his desk to help him prepare and a rainbow of biochemistry charts pasted to the walls: glycolysis, citric acid cycle, electron transport chain, mitosis, meiosis and DNA replication.
He also has a thick prep book on psychology and sociology — new ground for this year's MCAT takers.
The test has been thoroughly revamped and is now three hours longer. It takes 7 1/2 hours to complete, including breaks, and covers four new subjects, including a combined section on psychology and sociology that account for a quarter of the overall score.
Dr. David Muller, dean of medical education at Mount Sinai, believes that including in each medical school class some students who have a strong background in the humanities makes traditional science students better doctors, too.
SHOTS - HEALTH NEWS
A Top Medical School Revamps Requirements To Lure English Majors
Test takers will now have to define terms like "institutional racism" and "social constructionism," and answer applied questions about how race and class affect health.
Driscoll, who works in a San Francisco theater, focused on biomedical engineering in college. So for him, the new psychology/sociology section is the one he's most nervous about.
"It's at the end of the test, which makes it more difficult because you're pretty tired by then," he says. "And it's the thing I had the least experience with."
Bringing Test Up To Date
The Association of American Medical Colleges, which administers the MCAT, wants to make sure the doctors of tomorrow are better prepared to care for an increasingly diverse patient population in a rapidly changing health care system. Administrators say the exam changes are necessary to bring it up to date with how medicine is practiced, and with all the scientific discoveries that have been made since the test was last revised, more than 20 years ago.
Research on genetics and the social factors that affect health, in particular, have advanced significantly.
"Whether or not someone becomes ill has a lot to do with the society in which they live," says Catherine Lucey, vice dean of education at University of California, San Francisco School of Medicine and a member of the committee that will assess the new MCAT.
For example, she says, we now know a lot more about what happens to children who are exposed to violence before they turn 5.
"If they live in a violent neighborhood, if they hear gunshots all the time, if they themselves are the victims of interpersonal violence or child abuse," Lucey says, "they are much more likely to develop diabetes, high blood pressure, obesity, and many other chronic conditions, because of their social environment."
How those conditions are treated has also evolved. Doctors know how to treat acute infection now. But managing chronic disease has become a much bigger part of medical care, and doctors need to develop different skills and a different kind of relationship with the patient. Doctors need to build trust, Lucey says, to understand how patients think and make decisions, in order to convince them to exercise more and change their diet.
"My ability as a physician to affect that patient's health is not only dependent on medical knowledge, in terms of what drug should I give this individual, but on my ability to support this patient in the decisions they're making on a daily basis," she says.
Attracting A New Type Of Students
While the test prep industry adapted quickly to the new MCAT, enrollment in prep courses at the Princeton Review and Kaplan is only starting to pick up.
The real rush was last fall, when students flocked to take the old test, says Krissi Taylor Leslie, tutoring director at the Princeton Review in Northern California.
There was a recognition among students "that was my chance at the 'easier' test and now I'm up against this beast," Leslie says.
She says the new social sciences section is already attracting a different kind of student to consider med school.
"It entices certain students to come in and consider this test when they might not have otherwise," she says. "For instance, an increase in the number of English majors, of psychology majors."
And philosophy majors, like Ari Fischer. He started thinking about a career in medicine the summer after his junior year, when his grandfather was diagnosed with cancer.
"And that's when I was first shown, hands on, what physicians do every day," he says.
He started taking medical ethics classes — one was called "Life and Death" — where he read works about immortality, the meaning of death and the meaning of life in the face of death.
Fischer says he can imagine drawing on this knowledge one day if he has a patient facing tough end-of-life decisions.
"There's always a scientific view, then there's the theological views, or philosophical views. Knowing what other disciplines believe is going on at the same time, I think that could really help me in a daily practice of medicine," Fischer says. "What a cool way to take my degree in philosophy and turn it into a helpful, practical skill."
Fischer took the MCAT on the first testing date for the new exam in April, and just got his full score back on Tuesday. He did best on the social sciences section and the verbal, analytic reasoning. Overall, he landed in the 87th percentile.
"Perhaps Harvard will think I'm lacking in my MCAT score," he says. "For myself, I did well enough."
Altogether, he's applying to 38 schools. He says he's willing to go anywhere that will take a humanities major like him.
"All I've ever wanted out of the MCAT really is a score that's good enough to not get me kicked out of the pile when it comes to admissions decisions," he says. "Any school that gives me a shot, I'm going to be thrilled."**
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Yes, we will soon have Gender Studies majors and cultural sensitivity experts replace Biology majors in our medical schools - to improve health care.
Speaking of MCAT and Medical Schools limiting the supply of doctors, when will the cartel get opened up?
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"Speaking of MCAT and Medical Schools limiting the supply of doctors, when will the cartel get opened up?"
I am not aware that the supply of doctors is limited. What cartel? One just needs good grades to get in.
Probably half of doctors now are trained in foreign countries.
Still not enough?
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This source frequently hyperventilates, so read with care; however the larger point remains
http://www.capoliticalreview.com/capoliticalnewsandviews/hepatitis-drug-could-cost-california-taxpayers-5-billion-a-year-not-a-typo/
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ObamaCare’s Prices Will Keep Surging
After this year’s spike, the average family plan will go up another 11.2% in 2016.
ENLARGE
Photo: Getty Images
By Stephen T. Parente
July 16, 2015 6:54 p.m. ET
42 COMMENTS
Americans who purchase health insurance on the Affordable Care Act’s exchanges should buckle up. Within the month, state regulators will begin approving premium hikes for plans sold in every state. The Centers for Medicare and Medicaid Services (CMS) has already released the premium increases that health insurers have requested for their 2016 plans. By law, insurers must receive regulatory approval for any increase more than 10%—and more than 10% is what many of them want.
The numbers are staggering. According to the rate requests posted on Healthcare.gov, nearly every state has multiple plans that are facing a more than 10% premium increase. Many plans—including some offered by state-market leaders—could see hikes of more than 30%, 40% or even 50%. Though most of these requests have not been approved, nor have all of the rate hikes that are less than 10% been unveiled, it is undeniable that millions of Americans are facing double-digit premium increases for health insurance next year.
For the first time since the law went into effect three years ago, insurers are basing their rate-hike requests on more than a year of data. For 2014 plans, they had to make educated guesses on how to price their never-before-sold ACA-compliant plans. For 2015 estimates, insurers had about six months of information to work with, and the final average premium increase was 5.4%. Now that insurers have a more complete picture, it is clear that costs are increasing much faster than anticipated.
It’s only going to get worse after 2016, as I’ve written in these pages, when two de facto bailouts for insurance companies expire. Through “risk corridors,” taxpayers are on the hook for patients who spend more on health care than insurers predicted. Through “reinsurance,” taxpayers are heavily subsidizing the most-expensive patients—those who make more than $70,000 in claims in 2015. Thanks to these two programs, insurance companies are able to artificially lower their premiums for consumers—by between 10%-15% in 2014, according to CMS—while charging the taxpayer for their losses. Reinsurance alone cost taxpayers $7.9 billion in 2014.
But consumers will pick up that tab once these programs disappear at the end of 2016. Health insurers are aware of this fact, and it’s in their interest to avoid the negative attention—and angry customers—that dramatic premium increases will cause. They thus have an incentive to spread out the coming hikes over both 2016 and 2017, rather than confine them to next year.
Using the latest health-insurance-exchange enrollment data and a microsimulation model funded in part by the Health and Human Services Department, I estimated the premium increases that could occur as a result of the expiration of risk corridors and reinsurance. My model also assumes that 2017’s big premium increases will be spread out over both 2016 and 2017 rates.
My research shows that the average 2016 family plan could experience premium increases of 11.2%, compared with 8% hikes for individual plans. The relatively cheap bronze plans, which cover 60% of a consumer’s health-care costs, could see the highest jumps—16.6% and 11.5%, respectively. Individual silver plans could see a relatively low increase—3.1%—but families won’t be so lucky, potentially paying 8.4% more.
That won’t stay the same in 2017, however, when individual silver-plan premiums could rise by an average of 12.1%, surpassing a 9.2% increase for families. Across every type of health-care plan—bronze, silver, gold, platinum and catastrophic—families could be looking at average increases of 7.3%, compared with 11% premium hikes for individual plan holders.
To put these numbers in context: For consumers with silver plans, which account for about two-thirds of the ACA market, the average individual could see annual premiums rise to $3,700 over the next year and a half from $3,200. A family could expect an increase to $15,400 from $13,000 over the same period.
After 2017, most ACA-compliant plans will likely fall into a pattern of annual premium increases of between 3%-6%, which will persist for the next decade and likely beyond. By 2023, I estimate that the average family plan could be 61% more expensive than it is in 2015, with individual plans only one or two percentage points behind. These increases are so high that direct taxpayer subsidies to consumers are unlikely to keep up. So the cost, both financially and politically, will become increasingly intolerable.
Policy makers should keep this in mind in the wake of the Supreme Court’s decision upholding federal subsidies in King v. Burwell . Despite the court’s decision, and the president’s claims to the contrary, the Affordable Care Act remains unaffordable for too many Americans—and that will only get worse in the coming years.
Mr. Parente, a professor of health finance, is an associate dean at the Carlson School of Management at the University of Minnesota.
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When a Doctor Is Always a Phone Call Away
Many of the 136 million ER visits in 2011 could have been replaced with a $50 telemedicine consultation.
By
Richard Boxer
Aug. 2, 2015 5:30 p.m. ET
42 COMMENTS
A 39-year-old truck driver was hauling through the Midwest in the middle of the night in 2011 when he began to feel a bit of indigestion. Then a lot of indigestion. He pulled over, recalling that his company had recently signed on with Teladoc, for which I was then the chief medical officer. The service allowed him to get a doctor on the phone within 15 minutes. He called and described his symptoms: nausea, chest pain, a little numbness in his left arm. He was having a heart attack, and his GPS guided him to the nearest emergency room.
Getting that doctor on the phone saved his life, and potentially the lives of whoever his 10-ton rig might have plowed into had he keeled over behind the wheel. If efficient and affordable quality treatment is the goal, telemedicine should be the future of health care.
When it comes to health care, “efficient” is a word that frightens people, calling to mind a soulless bureaucracy with an eye on the company’s bottom line. But it is inefficiency that is overburdening the medical system. Consider a woman with a urinary-tract infection who has to leave work to obtain a prescription from a doctor for a drug she already knows she needs. Or a man with a fever and hacking cough who has good health insurance, but who goes to the emergency room because his doctor’s office is closed.
Americans are struggling to obtain affordable, convenient care, and 103 million people in the U.S. live in areas with a shortage of primary health-care providers, according to the Health Resources and Services Administration. Yet the country is dependent on expensive, brick-and-mortar facilities that require time-consuming travel.
Primary-care doctors tend to cluster in urban areas. If you get sick in rural Wyoming, even during the workweek, your only choice might be the emergency room. In 2011, the Centers for Disease Control and Prevention reports, 136 million people were seen in an ER; many of those visits could have been replaced with a $50 telemedicine consultation. Researchers at the University of Rochester found that 28% of the visits at one pediatric emergency room involved ailments such as ear infections or sore throats that could be diagnosed over the phone.
These problems are exacerbated by the increase in the elderly population, coupled with tens of millions of patients newly insured by the Affordable Care Act. A study in the Annals of Medicine projects that the U.S. will need 52,000 more primary-care doctors by 2025. Those positions aren’t filled easily. It takes 12 years and hundreds of thousands of public dollars to educate one primary-care doctor.
But there is an untapped resource: the many doctors leaving their practices, fed up with the regulations and other hassles, but who love their patients, and the older physicians eyeing retirement because they no longer want to maintain an office. Why not let these doctors offer their expertise to patients by smartphone?
Doctors who contract with a telemedicine company can opt for a specific block of time when they are “on call” to patients, picking up the phone and answering questions in 10- to 15-minute intervals. The doctor is paid and the patient gets a prompt and inexpensive answer to a concern.
Home care of individuals with major chronic conditions would also substantially benefit from telemedicine. Millions of houses have cable and satellite connections that can be used to monitor patients wearing wireless devices, allowing health professionals to intercede at the first sign of trouble. This can reduce rates of hospitalization by half or more, some studies suggest.
While there is worry about the quality of these interactions, telemedicine companies assess their doctors routinely and maintain strong quality-assurance programs. Every doctor is taught in medical school that 80% of diagnoses are obtained through a medical history and symptoms, and not by what a doctor sees, touches or tests.
Telemedicine will never completely supplant face-to-face visits, and most doctors naturally would prefer to treat a patient in person. The American Medical Association, for instance, has encouraged restriction of telemedicine to patients who have an established relationship with a doctor, and some state medical boards try to enforce that view.
But the perfect cannot be the enemy of the good—and by continuing to practice medicine as usual, we are making it so. Millions of Americans live in areas that are short of primary-care doctors, and millions more go to the emergency room when they have a sore throat. Entrepreneurs have responded by creating methods of connecting patients to doctors remotely, which reduces costs and satisfies patients.
There is no scenario for sustaining or improving health care in America without telemedicine. State and federal governments, as well as the medical establishment, should embrace the technology. For one thing, they should change Medicare and Medicaid to allow reimbursement for telemedicine consultations, most of which are currently not covered. Ask that truck driver if he thinks talking to a doctor over the phone has value: He is still alive and trucking.
Dr. Boxer is the chief telehealth officer of Pager and chief medical officer of Well Via.
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"My expectation is that [rate increases] come in significantly lower than what's being requested," Barack Obama told a Nashville audience last month. After all, he promised ObamaCare would bend the cost curve down, right? And that it would save the typical family $2,500 a year in premiums, right? Wrong. So much for that. According to The Wall Street Journal, Tennessee Insurance Commissioner Julie Mix McPeak "answered [that question] on Friday by greenlighting the full 36.3% increase sought by the biggest health plan in the state, BlueCross BlueShield of Tennessee. She said the insurer demonstrated the hefty increase for 2016 was needed to cover higher-than-expected claims from sick people who signed up for individual policies in the first two years of the Affordable Care Act." So, Madam Commissioner, you're telling us the Affordable Care Act isn't exactly, uh, Affordable? So far, Tennessee's rate increase is the highest approved this year, but two other states — North Carolina and Maryland — exceeded 30%, and half a dozen more were in double digits. Others, like Minnesota (seeking a whopping 54% hike), are yet to be determined. And lest anyone think higher premiums were paying for better coverage, most insurance carriers are also increasing deductibles and copays. Our own plan here in our humble shop now offers this wonderful trifecta of higher premiums, higher deductibles and higher copays. So we pay more up front, we pay more before we can receive care, and then we pay more when insurance finally does kick in. Remind us again how great ObamaCare is...
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Largest ObamaCare Co-Op Admits Failure, Starts Closing Shop
Joining three other ObamaCare health care co-ops that already found themselves unable to operate in the current health care landscape, Health Republic, the co-op servicing the State of New York, started closing down its operation Friday, Sept. 25. "[A]fter coordinating with state and federal regulators, Health Republic will begin winding down operations in an orderly manner starting today," CEO of Health Republic Debra Friedman wrote to the co-op's members. "While we are deeply disappointed with this outcome, we believe it is in the best interests of our members. Starting a new insurance company is a daunting task in any environment, but the systemic challenges placed on us by the structure of the CO-OP program were simply too difficult to overcome." In other words, ObamaCare's worst enemy in this case was its own regulations. As The Daily Signal reported, the government loaned out $265 million to get the co-op off the ground. You shall know the program by its fruits: In this case, an effort by ObamaCare to provide more solutions and health care "competition" yielded government waste and failure.
Surprise!
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Largest ObamaCare Co-Op Admits Failure, Starts Closing Shop
Joining three other ObamaCare health care co-ops that already found themselves unable to operate in the current health care landscape, Health Republic, the co-op servicing the State of New York, started closing down its operation Friday, Sept. 25. "[A]fter coordinating with state and federal regulators, Health Republic will begin winding down operations in an orderly manner starting today," CEO of Health Republic Debra Friedman wrote to the co-op's members. "While we are deeply disappointed with this outcome, we believe it is in the best interests of our members. Starting a new insurance company is a daunting task in any environment, but the systemic challenges placed on us by the structure of the CO-OP program were simply too difficult to overcome." In other words, ObamaCare's worst enemy in this case was its own regulations. As The Daily Signal reported, the government loaned out $265 million to get the co-op off the ground. You shall know the program by its fruits: In this case, an effort by ObamaCare to provide more solutions and health care "competition" yielded government waste and failure.
Surprise!
Shocking!
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I have made this point about pricing more than once before. IMHO this may be the single biggest and most effective thing we can do-- make prices knowable, in advance!
https://reason.com/archives/2015/10/05/the-maddening-world-of-hospital-pricing
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The Republican candidates need to talk about this in the upcoming debate:
Anybody Checked on Obamacare Lately?
October 19, 2015
Obamacare, That Big Issue Barely Mentioned in the Debates… Hey, remember Healthcare.gov? You know, the $2 billion web site that didn’t work at first and now works “for the most part”? The construction of healthcare.gov involved 60 companies, supervised by employees of the Centers for Medicare and Medicaid Services instead of a lead contractor, according to the inspector general at the Health and Human Services Department. The project was marked by infighting among the contractors, CMS officials and top officials at HHS, the Cabinet-level department that oversees CMS, according to e-mails released Sept. 17 by the House Oversight and Government Reform Committee.
Or maybe it costs $2.5 billion by now. It’s hard for the federal government to keep track of the money it spends, apparently: The Medicare agency and independent auditors have had trouble tracking the costs of Affordable Care Act programs. The Government Accountability Office, a congressional agency, said in a Sept. 22 report that it was “difficult and time consuming” to obtain financial information for the Center for Consumer Information and Insurance Oversight, the CMS office that manages many ACA programs, and that it “could not determine the reliability of most of the amounts” CMS provided.
A mere three years after the launch, the web site is now including the ability to search for a doctor and what plans they accept.
President Obama keeps going around the country, insisting everything’s working fine; the numbers indicate the administration and the Democratic Congress had no idea how difficult this would be when they passed the law: The effort to ease the consumer experience is driven by the administration’s push to reach the 10.5 million people who Sylvia Mathews Burwell, the secretary of Health and Human Services, says are still uninsured but eligible for marketplace coverage. While 9.9 million people have received health insurance through the exchanges as of June 30, the law has far to go to reach the 21 million people the Congressional Budget Office estimated in March would be enrolled next year.
Federal health officials say that target is too optimistic, but they have yet to announce their own numerical goal.
Meanwhile, out in Oregon: Health Republic Insurance, one of two nonprofit insurers created in Oregon under President Obama’s health care law, announced Friday that it is shutting down. Health Republic will continue to pay claims through the rest of the year but won’t sell policies for 2016, the company said. The 15,000 individuals and 800 small businesses that get insurance through Health Republic will have to turn to another insurer. The company blamed a reduction in federal payments that are supposed to help insurers smooth out the risk of taking on newly insured patients under the Affordable Care Act. CEO Dawn Bonder said the company assumed it would get those payments when it set premiums, but due to a change made last year by Congress, insurers are receiving less than 13 percent of the money they’d expected. For Health Republic, that represented a hit of $20 million for 2014 and 2015. Co-ops like Health Republic were created as part of a compromise in the Affordable Care Act to compete with for-profit insurance companies.
But that’s just Oregon. Surely things are better in New York… Regulators will shut down Health Republic Insurance of New York, the largest of the nonprofit cooperatives created under the Affordable Care Act, in the latest sign of the financial pressures facing many insurers that participated in the law’s new marketplaces. The insurer lost about $52.7 million in the first six months of this year, on top of a $77.5 million loss in 2014, according to regulatory filings.
…or Kentucky! Democrats are always pointing to the success in Kentucky… Kentucky Health Cooperative, a nonprofit insurer known as a co-op, explained that it could not stay financially afloat after learning of a low payment from an ObamaCare program called “risk corridors.” That program was intended to protect insurers from heavy losses in the early years of the health law by taking money from better-performing insurers and giving it to worse-performing ones. However, the Obama administration announced on Oct. 1 that the program would pay out far less than requested, because the payments coming in were not enough to match what insurers requested to be paid. Therefore, insurers only will receive 12.6 percent of the $2.87 billion they requested.
Okay, how about Colorado? Colorado’s biggest nonprofit health insurer announced its closure Friday, forcing nearly 83,000 Coloradans to find a new insurer for 2016. Colorado HealthOP announced Friday that the state Division of Insurance has said it can’t keep selling health insurance. That’s because the cooperative relied on federal support, and federal authorities announced last month they wouldn’t be able to pay most of what they owed to a program designed to help health insurance co-ops get established.
Okay, but in Tennessee, things are bet-oh, wait, never mind. Community Health Alliance will no longer offer insurance coverage next year, forcing about 27,000 enrollees to find new health insurance plans. The Knoxville-based health insurance cooperative, created under the Affordable Care Act, will continue to pay out existing claims but will wind down its coverage by not taking on new customers.
You would think a sentence like this one would be spurring a national discussion: “Nearly a third of the innovative health insurance plans created under the Affordable Care Act will be out of business at the end of 2015.”
Read more at: http://www.nationalreview.com/corner/425760/anybody-checked-obamacare-lately-jim-geraghty?laEe6PhO29kLW8Hp.01
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Updated Oct. 25, 2015 9:52 p.m. ET
863 COMMENTS
ObamaCare’s image of invincibility is increasingly being exposed as a political illusion, at least for those with permission to be honest about the evidence. Witness the heretofore unknown phenomenon of a “free” entitlement that its beneficiaries can’t afford or don’t want.
This month the Health and Human Services Department dramatically discounted its internal estimate of how many people will join the state insurance exchanges in 2016. There are about 9.1 million enrollees today, and the consensus estimate—by the Congressional Budget Office, the Medicare actuary and independent analysts like Rand Corp.—was that participation would surge to some 20 million. But HHS now expects enrollment to grow to between merely 9.4 million and 11.4 million.
Opinion Journal Video
Editorial Board Member Joe Rago explains why the president’s signature healthcare law is failing to meet its enrollment projections. Photo credit: Getty Images.
Recruitment for 2015 is roughly 70% of the original projection, but ObamaCare will be running at less than half its goal in 2016. HHS believes some 19 million Americans earn too much for Medicaid but qualify for ObamaCare subsidies and haven’t signed up. Some 8.5 million of that 19 million purchase off-exchange private coverage with their own money, while the other 10.5 million are still uninsured. In other words, for every person who’s allowed to join and has, two people haven’t.
Among this population of the uninsured, HHS reports that half are between the ages of 18 and 34 and nearly two-thirds are in excellent or very good health. The exchanges won’t survive actuarially unless they attract this prime demographic: ObamaCare’s individual mandate penalty and social-justice redistribution are supposed to force these low-cost consumers to buy overpriced policies to cross-subsidize everybody else. No wonder HHS Secretary Sylvia Mathews Burwell said meeting even the downgraded target is “probably pretty challenging.”
The HHS survey shows three of four ObamaCare-eligible uninsured people think having coverage is important—but four of five say they couldn’t fit their share of the premiums into their budgets even after the subsidies. They’re not poor; they tend to have jobs in industries like construction, retail and hospitality but feel insecure financially; and they prioritize items like paying down debt, car repairs or saving to buy a home over insurance.
The law’s failure to appeal to the young and rising middle class is already cascading through the insurance markets. Researchers at the Robert Wood Johnson Foundation and Urban Institute recently published a remarkable study of the industry barometer called medical loss ratios, or MLRs, and the pressure is building fast.
MLRs measure the share of premium revenue that flows to reimbursing medical claims. ObamaCare sets an MLR floor of 80% for patient care, with one-fifth left over for overhead like administration and profits, and the pre-ObamaCare 2010-13 historical trend for the individual market ranged from 79% to 86%.
The researchers found that in 2014—the first full year of claims experience in ObamaCare—average MLRs across all health plans sold on 16 state exchanges roamed from 90% to 99%. Average MLRs in 11 states climbed to 100% or more, reaching as high as 121% in Massachusetts. A business can’t stay solvent for long spending $1.21 for every $1 that comes in.
The 2014 MLRs are used to set rates for 2016 premiums, which are still under regulatory review. But the researchers estimate that to rebound to an MLR of 85%, premiums in the 11 money-losing states need to rise by 10% to 36% in the best estimate and 23% to 52% in the worst scenario. The familiar danger is that as rates rise, more people drop out, and thus rates must rise still higher, as the states that attempted ObamaCare-like regulatory schemes in the 1980s and 1990s discovered.
ObamaCare liberals pose as what-works-and-what-doesn’t technocrats. So perhaps they’d care to explain what it says about their creation that so many rational adults are willing to pay a fine of $695 or 2.5% of their earnings, whichever is higher, for the privilege of not buying an ObamaCare-compliant health plan.
***
ObamaCare will almost inevitably be reopened in 2017, whoever wins the election. The good news is the emerging consensus among Republican candidates about a credible, pragmatic and optimistic alternative. Jeb Bush was the latest to release a plan two weeks ago—and this is a debate that has always deserved to be litigated at the presidential level to create a mandate for reform.
The basic approach is to deregulate insurance and medical practice while replacing ObamaCare’s complex subsidy schedule with a refundable tax credit for individuals who lack job-based coverage. Unchained from benefit and redistribution mandates, insurance products and prices would come to reflect what consumers want. The credit would be sufficient to buy at least coverage for catastrophic expenses if people get sick, and the trade-offs of such skinnier plans might look better to voters priced out of ObamaCare.
GOP reformers also recognize that the Cadillac tax on high-cost employer-sponsored health plans is a heat shield that might let them solve some of the problems of the pre-2010 health finance status quo. Substituting a cap on the tax-code subsidy that helps drive medical inflation is more politically plausible with the Cadillac tax in place than without.
Mr. Bush was shrewd to frame his proposal with the vocabulary of innovation and aspiration. ObamaCare is built on a 20th-century chassis that is ever less relevant to modern medicine and consumer finance. If the law continues to underperform, voters may be open to a new model that puts their choices and needs ahead of the political class’s.
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http://hotair.com/archives/2015/10/28/obamacare-premiums-soar-60-in-mississippi/
Cost curve accidentally bent in wrong direction...
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Orange County Register:
http://www.ocregister.com/articles/obamacare-691964-government-insurance.html
Obamacare at 5: Sick and getting worse
Nov. 14, 2015
By MARK LANDSBAUM
Big government’s health care solution is imploding. Soon it will be undeniable to even its most ardent champions that Obamacare is the unmitigated disaster critics predicted when, literally, only Democrats voted it into law, most without reading it.
Despite innumerable warnings that it was an unworkable, extremely costly Rube Goldberg contraption doomed to fail, those advancing it didn’t care. When it finally implodes, they knew, it will create the opportunity to rush to the rescue by doubling down on the bad bet.
Obamacare always was intended to pave the way for full-blown nationalized health care, as is so common in Europe. That’s why it wasn’t important to know the details. They knew the destination.
As with every Big Government program, failure becomes the excuse to do more of the same, rather than to kill the contrivance and get government out of the equation. In the face of mounting deficits, escalating costs and failed bureaucracies, Big Government champions from Bismarck to Obama always insist failures happen because they just didn’t have enough time, enough money and enough control. The day nears when Obamacare’s failure will prompt demands for more time, more of your money and more control over your life.
Let’s not lose sight of how this scheme was born. Obamacare’s failure was set in motion not by one-party dominance in Congress, and not even by FDR’s trailblazing socialism. The real seed of this evil may not be immediately obvious. But the root of this malevolency is taxes. Explanation to follow.
First, let’s review how catastrophic the Obamacare adventure has become in five short years.
Instead of people shopping for insurance or health care they can afford, making tradeoffs as they would with a car purchase or restaurant meal, they have been told what to buy and how much to spend, even if they don’t want what’s being sold. Instead of providers competing by offering varieties of services at fluctuating prices, allowing demand to ebb and flow, insurance companies, doctors and hospitals are dictated to from D.C. Those with more clout have the scheme rigged to their advantage. Those with less clout, less so.
In 2009, starry-eyed Big Government worshippers swallowed Barack Obama’s promise that Obamacare would lower a typical family’s premiums by $2,500 a year. Instead, premiums increased about an equal amount. In 2016, people who don’t qualify for taxpayer-financed subsidies will see a very expensive market “become even more expensive,” according to an insurance comparison website. Of course, you also were promised to be able to keep your doctor and health plan, and that the whole rigmarole wouldn’t increase the deficit.
Hundreds of New York cancer patients are losing hospital coverage because they signed up with Obamacare insurance co-ops, reports the New York Post. Indeed, more than half the nonprofit co-ops formed through Obamacare have left the market, the Washington Post reports. Nearly half a million Americans are left searching for health care.
Two days into the new enrollment season, Michigan’s Consumers Mutual Insurance announced it won’t sell coverage for 2016, becoming the 12th plan to fail in the past year, leaving only 11 operational.
Harbingers of bad news continue. A key Obamacare program to protect insurers from high costs faces massive cash shortages, Standard and Poor’s reports. The risk pool holds only $1 to cover every $10 in claims, the Hill reports. Simultaneously, people who don’t receive subsidies paid by taxpayers and who buy the cheapest Obamacare health plans, “face the largest increases for premiums and out-of-pocket costs in 2016,” CNBC.com reports. A new study by McKinsey & Co. found insurance companies lost $2.5 billion in 2014 and “will have to charge higher premiums or quit.”
Yet, even in failure there are those who profit, big time. Executives who ran failed co-ops were paid as much as $414,000 a year, and averaged $245,000, for steering their government-created contraptions essentially into bankruptcy. For perspective, median family income in 2014 was $53,657.
If profiteering from the rigged system is bad, how much worse is it that the government itself reported twice since July that basic information to determine enrollment and subsidy eligibility was not verified by the federal Health Insurance Marketplace or insurance exchanges examined in California and Kentucky? To test the system, investigators submitted 10 fictitious applications. All 10 were approved. One study concluded the government “could not verify” $2.8 billion in financial assistance payments through April 2014.
Central planners never can include enough protections and contingencies to thwart self-interested human behavior. Neither can Washington foresee how markets will behave by artificially limiting and directing responses.
How was such a beast born? Taxes.
Taxes feed mammoth government. Taxes pay bureaucrats to control you. Taxes reward political cronies at taxpayers’ expense. You can’t persuade people who already have your money that they shouldn’t spend it. You must deny them the money. Follow the money to see who’s in control. It’s not you.
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http://mobile.nytimes.com/2015/11/15/us/politics/many-say-high-deductibles-make-their-health-law-insurance-all-but-useless.html?ref=health&_r=1&referer=http%3A%2F%2Fpjmedia.com%2Finstapundit%2F
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http://www.dickmorris.com/category/lunchtime-videos/
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The ObamaCare-Immigration Collision
Keeping millions of illegal immigrants in the U.S. and virtually ensuring that they will cost American jobs.
ENLARGE
Photo: Getty Images/Imagezoo
By Andy Puzder
Dec. 3, 2015 7:10 p.m. ET
52 COMMENTS
The Justice Department last month asked the Supreme Court to review a preliminary injunction blocking the Obama administration from implementing the president’s immigration executive order, which would defer deportations for up to five million undocumented immigrants.
When President Obama announced his executive action, he acknowledged in his televised speech the concern that such immigrants “would take our jobs” and “stick it to the middle class.” He assured us that this is “not what these steps would do.” But he didn’t consider how this new edict would interact with his other legal inventions, namely ObamaCare.
The government’s petition says that the executive action intended to provide “work authorizations” so that undocumented immigrants could find jobs in the U.S. without working illegally for less than market wages, which might harm American workers. But wait: Employers aren’t required to offer ObamaCare coverage or subsidies to these immigrants. The statutory language in the Affordable Care Act says that only “lawful residents” are eligible, and the government’s petition specifically notes that the immigration action does not “confer any form of legal status in this country.”
Opinion Journal Video
Business World Columnist Holman Jenkins Jr. on why the president’s signature health care law may soon collapse. Photo credit: Getty Images.
In short, companies will be encouraged to hire these immigrants over U.S. citizens. ObamaCare requires employers to offer all full-time employees health insurance that meets the law’s standards. For businesses that offer health-insurance coverage, the government enforces this rule by imposing a penalty of up to $3,000 a year for each full-time employee who receives a federal subsidy, a proxy for each full-time employee who doesn’t receive compliant coverage. The penalty is triggered if a single full-time employee purchases coverage on the marketplace and receives a subsidy.
But none of this matters if your employees are immigrants freed up by Mr. Obama’s executive order. Companies could save $3,000 in penalties or the cost of insurance—about $3,300—for every one of these immigrants they employ over a U.S. citizen or lawful resident.
Suppose businesses subject to ObamaCare employ only 40%, or two million, of the up to five million immigrants covered by the president’s executive action. At $3,000 an employee, businesses would save about $6 billion a year. Companies already dealing with the added expense of operating in the Obama economy—burdened by regulations, high taxes and other barnacles—would find those savings hard to pass up.
The administration may yet find some justification for granting ObamaCare benefits to immigrants covered by the president’s executive action. The law’s 2,407 pages of text, backed up by more than 20,000 pages of regulations, are full of ambiguities and inconsistencies, leaving ample room for invention. Fixing this discrepancy may be the administration’s next tweak to ObamaCare.
But that would conflict with the president’s statement that he was not offering these individuals “the same benefits that citizens receive,” not to mention ObamaCare’s text. And it is hard to argue that Congress intended to grant ObamaCare benefits to a group of people who weren’t legally in the U.S. when Congress passed the law.
Exempting employers who hire these immigrants from the law’s penalties gives the immigrants a distinct market advantage over U.S. citizens. That flies in the face of the president’s statement that his executive action would not “stick it to the middle class” by allowing these individuals to “take our jobs.” It is also contrary to the government’s statement that the executive action would make it less likely that these undocumented immigrants hurt American workers by “illegally” working “for below market rates.” They could still work at below-market rates, only it would be legal.
All of this was inevitable. The root problem with ObamaCare is that one party rammed it through Congress without a single Republican vote, while the law’s supporters didn’t even read it, let alone vet it through congressional committees. As a result, ObamaCare as written was unworkable, and the administration has had to repeatedly amend it by constitutionally dubious executive fiat.
Now this flawed law is clashing with yet another constitutionally dubious executive action that the administration couldn’t be bothered to pass through the legislature. That’s one reason the Supreme Court should allow the existing injunction to stand and avoid the conflict.
But the immigration-ObamaCare nexus is only the latest example of how untenable and incomprehensible the Affordable Care Act is. The only real solution is to scrap the law and replace it with something that works. Republican candidates— Jeb Bush and Marco Rubio, for instance—have proposed just such market-based plans. Let’s hope one of those plans gets a chance to work.
Mr. Puzder is the chief executive officer of CKE Restaurants.
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I don't recall physician organizations that are fronts for every major liberal policy agenda before but here is another one.
From climate change, to guns, to fracking, to planned parenthood. You name it:
http://npalliance.org/blog/2015/10/04/upcoming-amsa-npa-webinar-physician-gag-laws-surrounding-fracking-industry/
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http://www.nationalreview.com/article/428475/single-payer-health-care-model-lawyers
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Yup.
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I bought my healthcare plan when I went self employed for $40/month. That policy was canceled by Obamacare and replaced with a worse one. I received notice from MN Blue Cross Blue SHield this month that my new premium is $800 / mo. for one person, high deductible, no real coverage, so I have decided to cancel it as and go on the official state site as they want me to and become a ward of the state or whatever you call a person who can't to pay their own basic living expenses.
The site being unworkable I looked up an official "healthcare navigator". For people having trouble with their internet, that is as easy as downloading a 111 page pdf, unsorted and finding out they don't have one anywhere near where I live. So I drove this morning to the nearest public 'navigator' where my phone directions program put me in endless u-turns on a state highway until I took it offline and drive some frontage roads, found the building, rode the elevator to the top floor and discovered no one there would see me without an appointment and that no appointments are available until well into the new year even though I need coverage to start on the first or else I will have the hated lapse in coverage which seems to bother only me.
So I called another agency in St. Paul they referred me to who was also unable to help; they have their Hennepin County office closed on the busiest week of the year, and then I called MNSure directly. After 40 minutes on hold, sitting in a cold car with my phone battery depleting I reached a somewhat helpful worker who led me through how to navigate the confusing state website for myself, though also told me I wouldn't be able to get coverage to start until February 1st - the state apparently doesn't care if I go without even though I am will to spend days trying and willing to pay whatever it costs.
So I went the state website, divulged all my most personal information again for the 4th or 5th time, through a public wifi connection and received the following error message instead of healthcare coverage:
Online service problems
One of our internal services has failed. We apologize for the inconvenience. Please come back later and try to create your account again.
Error Code: M002
Now I am wondering what else the government might be able to help me with...
That government-involved Life of Julia is looking a little depressing about now.
Update: I called the number for MN Gov Mark Dayton. Someone from the Lt Gov office answered on the first. Told him the above. He took my info and said he would call the HHS commissioner.
So I've got that going for me.
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These guys really thought offering people chump change was going to have them lose 15% of their weight for a year? Lets see. If you deny yourself what you crave to eat will pay you $550 bucks. That will work. Well Dr. Patel got his name in the paper I guess. I don't know why these pencil pushing data crunching faux pax researchers are taken seriously. Thanks Bamster care.
http://www.npr.org/sections/health-shots/2016/01/08/462380096/why-employers-incentives-for-weight-loss-fall-flat-with-workers
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http://freedompartners.org/latest-news/2016-obamacare-premium-increases/?utm_source=jolt&utm_medium=email&utm_campaign=Jolt01112015&utm_term=Jolt
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At last.... the chickens are coming home to roost.
http://www.bloombergview.com/articles/2016-01-14/gaming-of-obamacare-poses-a-fatal-threat?cmpid=yhoo.headline
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I don't know. I kind off resent these fabulously rich companies asking for tax paid government handouts to research drugs that are needed but as profitable.
I don't believe they cannot fund research in the area of superbugs. I just do not buy it but feel like we are being played again.
http://www.bizjournals.com/philadelphia/morning_roundup/2016/01/pharma-firms-worlwide-unite-to-battle-superbugs.html?ana=yahoo
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American College Of Physcians
If they had their way they would ban all guns so they have toned it down some recently. I agree their is a connection between mental health and guns but I wish ACP would stay in the bounds of that link rather than agreeing with Da Bamster about "closing loopholes". As usual the medical organizations have sold us down the politically correct toilet. That is my opinion on this board before that also gets flushed down the toilet. From the ACP in my email box helping cheer my day:
*****Advocacy and policy news for internists
Presidential Action on Firearms Meets With Approval From ACP
Steps to address health consequences of gun violence are in sync with College policies, officials note
President Obama's executive order aimed at lowering the toll of gun violence in the United States has elicited positive reactions from the American College of Physicians.
"The president's actions are consistent with ACP advocacy and policy positions in support of improved background checks, more resources for the FBI to conduct those checks and expanded research at the CDC and other centers into firearm violence," said Dr. Wayne J. Riley, president of ACP.
But, Dr. Riley said, more work still needs to be done.
"Although the president's actions are clearly helpful, it is important that Congress pass commonsense legislation to curb firearm violence, given its epidemic proportions," he said. "Legislation alone cannot totally stop firearm deaths and violence, but we know it has the real prospect of markedly decreasing such events."
Noting that gun violence has resulted in more than 100,000 deaths in the United States in the past decade, President Obama announced on Jan. 4 a series of executive actions regarding firearms:
The federal government is clarifying who qualifies as a gun seller and thus must get a license and conduct background checks. It's also clarifying who must undergo a background check when buying a weapon.
The FBI is overhauling its system for doing background checks, with an eye toward creating a 24/7 program. More than 230 examiners and other staff members will be hired.
The president will seek budget funding for 200 new agents and investigators for the Bureau of Alcohol, Tobacco and Firearms who would be devoted to firearms issues.
The president will seek $500 million in new funding to improve access to mental health care and to improve background checks on people who should be prohibited from owning weapons because of mental health issues.
Federal agencies will conduct or sponsor research into gun safety technology.
"We're very supportive," said Bob Doherty, ACP's senior vice president for governmental affairs and public policy. "Our support is based on ACP's policies dating back to the 1990s, which focus on the need to address the consequences of firearm violence from a health standpoint."
ACP has emphasized the importance of closing loopholes in the system that allow some people to buy guns despite potentially dangerous mental health issues -- a stance in line with the president's actions, Doherty said.
However, ACP has cautioned that improvements in restrictions on firearm ownership should not cast a wide net. The law shouldn't further stigmatize the mentally ill by labeling people as dangerous if they are not a danger to themselves or others, Doherty said.
"The vast majority of people with mental illness are not at risk of committing gun violence," he said. "In fact, they're more likely to be victims of gun violence."
In addition, "we support more research into making guns safer so they're less likely to be set off by a toddler or child in a house," Doherty said. "We want more progress toward safety precautions, like guns that can't be fired except by the owner."
The problem, he noted, is that commonsense firearm regulations have not gotten congressional support. But Doherty said he's hopeful that Congress will work in a bipartisan way to increase funding for mental health care, as the president has proposed.
What about critics who say the new executive order is an abuse of power?
"Actually, what it does is better enforce current law," Doherty said. "This doesn't go around current law. Instead, it enforces current law."
Going forward, ACP plans to continue its advocacy toward smart restrictions on firearms.
"We still need legislation from Congress, and we need to see the states step up and make improvements in their policies, including legislation to close loopholes," Doherty said. "This is not the end of the story."*****
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Not much word on why herein , , ,
================
http://www.nytimes.com/2016/01/29/us/drug-shortages-forcing-hard-decisions-on-rationing-treatments.html?emc=edit_na_20160129&nl=bna&nlid=49641193&te=1&_r=0
Drug Shortages Forcing
Hard Decisions on
Rationing Treatments
Such shortages are the new normal in American medicine. But the
rationing that results has been largely hidden from patients and the public.
By SHERI FINKJAN. 29, 2016
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CLEVELAND — In the operating room at the Cleveland Clinic, Dr. Brian Fitzsimons has long relied on a decades-old drug to prevent hemorrhages in patients undergoing open-heart surgery. The drug, aminocaproic acid, is widely used, cheap and safe. “It never hurt,” he said. “It only helps.”
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Then manufacturing issues caused a national shortage. “We essentially did military-style triage,” said Dr. Fitzsimons, an anesthesiologist, restricting the limited supply to patients at the highest risk of bleeding complications. Those who do not get the once-standard treatment at the clinic, the nation’s largest cardiac center, are not told. “The patient is asleep,” he said. “The family never knows about it.”
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In recent years, shortages of all sorts of drugs — anesthetics, painkillers, antibiotics, cancer treatments — have become the new normal in American medicine. The American Society of Health-System Pharmacists currently lists inadequate supplies of more than 150 drugs and therapeutics, for reasons ranging from manufacturing problems to federal safety crackdowns to drugmakers abandoning low-profit products. But while such shortages have periodically drawn attention, the rationing that results from them has been largely hidden from patients and the public.
Photo
When a shortage developed for a decades-old drug to prevent hemorrhages in patients undergoing open-heart surgery, “We essentially did military-style triage,” said Dr. Brian Fitzsimons, an anesthesiologist at the Cleveland Clinic, restricting the limited supply to patients at the highest risk of bleeding complications. Credit T.J. Kirkpatrick for The New York Times
At medical institutions across the country, choices about who gets drugs have often been made in ad hoc ways that have resulted in contradictory conclusions, murky ethical reasoning and medically questionable practices, according to interviews with dozens of doctors, hospital officials and government regulators.
Some institutions have formal committees that include ethicists and patient representatives; in other places, individual physicians, pharmacists and even drug company executives decide which patients receive a needed drug — and which do not.
An international group of pediatric cancer specialists was so troubled about the profession’s unsystematic approach to distributing scarce medicine that it developed rationing guidelines that are being released Friday in The Journal of the National Cancer Institute.
“It was painful,” said Dr. Yoram Unguru, an oncologist at the Children’s Hospital at Sinai in Baltimore and a faculty member at the Berman Institute of Bioethics at Johns Hopkins University. “We kept coming back to wow, we’ve got that tragic choice: two kids in front of you, you only have enough for one. How do you choose?”
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“Two kids in front of you,
you only have enough for
one. How do you choose?”
Dr. Yoram Unguru
At the Cleveland Clinic, which has been unusually proactive in dealing with shortages and allowed a reporter access to personnel making decisions about them, one scarce leukemia drug, daunorubicin, was saved for patients in clinical trials, to avoid making the results invalid by substituting another drug. But when a different drug, methotrexate, was in short supply, pediatricians stopped giving it to all patients who required high doses, including those in research trials. “We didn’t want to say just because you’re on a clinical trial you get an advantage,” Dr. Rabi Hanna said.
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Patients’ weight can be taken into account. Obese patients, who researchers found needed up to three times the amount of an antibiotic before surgery than average-size patients, were given only the standard dose at the Cleveland hospital until a shortage subsided.
Some institutions prioritize based on age; others do not. Marc Earl, a Cleveland Clinic pharmacist, said children were not favored over adults during chemotherapy shortages. But at other hospitals, they have been, because of their potentially longer life span or because they sometimes require smaller doses of a drug.
“We do play the pediatric card for sure,” said Alix Dabb, a pharmacy specialist in pediatric oncology at Johns Hopkins Hospital. Dr. Kenneth Cohen, director of pediatric neuro-oncology there, and his colleagues were close to being forced into making “very, very hard decisions,” he said. “The discussions became, ‘Why are two kids more important than one adult?’”
Ning-Tsu Kuo, a pharmacist at the Cleveland hospital’s home infusion pharmacy, said children came first during shortages of nutritional products such as intravenous vitamins and fats for patients who cannot absorb food. The logic was that adults have more reserve. But after one man pleaded not to have his dose cut, Dr. Kuo agreed. When reprimanded by colleagues, she recalled saying: “Patients are not equally the same. You need to look case by case.”
‘Downright Scary’
Such decisions have real consequences. For some shortages, doctors can soon see the effects of rationing, such as increased pain or nausea when drugs typically used to control symptoms are withheld, or patients who have to undergo invasive surgery to control cancer when anti-tumor medications are delayed.
Studies have associated alternative treatments during drug shortages with higher rates of medication errors, side effects, disease progression and deaths. For example, children with Hodgkin’s lymphoma who received a substitute to the preferred drug had a higher rate of relapse, researchers found, and adults with a genetic disorder called Fabry disease had decreased kidney function when their medication was cut by two-thirds. One alternative guideline adopted during a shortage of intravenous nitroglycerin “was downright scary from a clinical perspective,” according to Dr. Nicole Lurie, a senior federal health official.
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“Patients are not equally
the same. You need
to look case by case.”
Ning-Tsu Kuo
Physicians say that many of the changes they are compelled to make appear to do no harm. But, they acknowledge, typically no one is tracking outcomes in patients who get a drug and others who get a substitute or delayed treatment.
Doctors and hospitals often do not tell patients about shortages and the resulting rationing because they do not want them to worry, especially when alternative drugs are available, or because they feel it would stir up too much anger.
Dr. Ivan Hsia, an anesthesiologist in Ontario, Canada, said many physicians in his field adopt what he called “the paternalistic model — like I’ll inform them when I think it’s unsafe enough to inform them.”
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When he and his colleagues surveyed hundreds of patients at the Mayo Clinics in Arizona and Florida and others in Canada about their preferences, the results surprised him. Most wanted to know about a drug shortage that might affect their care during elective surgery, even if there was only a minor difference in potential side effects, and many said they would delay surgery.
When the study was published last year in the journal Anesthesia and Analgesia, an accompanying editorial urged health professionals to disclose shortages and their implications. “Patients want to know and they should know,” the editorial said. “There is no ethical ambiguity.”
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Photo
Beverly Smith, a Cleveland Clinic patient who has Crohn’s disease, said she had no idea that an important ingredient had been removed from the daily intravenous nutritional treatments she depends on until she developed side effects from the deficiency. “Why didn’t anybody tell me?” she asked. Credit Andrea Bruce for The New York Times
Dr. Eric Kodish, a children’s cancer doctor who heads the Cleveland Clinic’s center for ethics, humanities and spiritual care, said patients should be told. “It’s their bodies and their lives that are on the line.”
Indeed, Beverly Smith, a Cleveland patient who has Crohn’s disease, said she had no idea that an important ingredient had been removed from the daily intravenous nutritional treatments she depends on until she developed side effects from the deficiency. “Why didn’t anybody tell me?” she asked.
Who Gets Preference?
In a basement storeroom filled with plastic crates and cardboard boxes, Chris Snyder, a Cleveland Clinic pharmacist and the point man for drug shortages, spends part of each workday poring over the hospital’s drug orders.
He tracks a list of shortages that included more than 75 drugs the first week of January. Dr. Snyder moves stocks among the hospital’s campuses, identifies alternatives, and — in the most dire situations — helps devise and enforce restrictions on which drugs can be ordered for which types of patients.
Photo
Top, Chris Snyder, a pharmacist at the Cleveland Clinic, tracks a list of shortages that included more than 75 drugs the first week of January. Bottom, pharmacy technicians in a compounding clean room that is used to prepare drugs for use within the clinic. Credit T.J. Kirkpatrick for The New York Times
Many drugs are made by only one manufacturer, so production or safety problems at a single plant can have big effects. For another company to begin making the products and getting them approved by regulators requires the right combination of manufacturing capabilities and economic incentives.
The chances of getting a drug also depend in part on where a patient happens to live, how adept the local hospital is at finding — and hoarding — scarce drugs, or a patient’s access to a major medical center.
The Cleveland Clinic, for example, has an advanced compounding room where workers swaddled in disposable gowns, bouffant caps and blue gloves mix up remedies from raw ingredients. During a shortage of papaverine, a drug used for surgery on blood vessels, the clinic produced its own version. When other hospitals began asking about it, Dr. Snyder said he had to tell them, “It’s a franchised recipe we can’t give out.”
At Cleveland, decisions about conserving, substituting and allocating scarce drugs typically are made by small groups of doctors and pharmacists; Dr. Kodish’s ethics committee is not involved. But such decisions are not always made by doctors or hospitals. One company, Janssen, chose to ration its ovarian cancer and multiple myeloma drug Doxil on a first-come-first-served basis during a prolonged shortage.
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“We’ve been forced into
what we think is a
highly unethical corner.”
Dr. Peter Adamson
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Another company, Jazz Pharmaceuticals, recently consulted a small group of oncologists to recommend how to allocate its cancer drug, Erwinase, if it ever became necessary. “Who deserves the drug more than anyone else?” said Dr. Wendy Stock, a leukemia specialist at the University of Chicago Medicine, who participated in the discussion. “We gave them some guidelines on that. ”
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Recent Comments
Grossness54 15 minutes ago
This is exactly what to expect when profits are considered more important than people's lives. And to think we actually hanged people who...
Science Teacher 15 minutes ago
This isn't the sole fault of the Republicans although many will try to pin all the blame on them - put a lot of the fault in Obamacare -...
Jeff Byrne 15 minutes ago
Any supply chain expert (and there are loads of them in the pharm industry) could tell you that these shortages are a direct result of...
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In a survey of cancer doctors conducted in 2012 and 2013, 83 percent of respondents who regularly prescribed cancer drugs reported having been unable to provide the preferred chemotherapy agent at least once during the previous six months. More than a third of them said they had to delay treatment “and make difficult choices about which patients to exclude,” according to a letter published in The New England Journal of Medicine.
The threat of future shortages in children’s treatments is serious enough that Dr. Peter Adamson, who leads the Children’s Oncology Group, the largest international group of children’s cancer researchers, assigned his organization to set priorities. “We’ve been forced into what we think is a highly unethical corner,” he said in an interview.
The effort, led by Dr. Unguru, the Baltimore oncologist, recommended that the drugs be rationed based on the ability to save lives or years of life, including curability of a child’s cancer and the importance of the drug in improving the chances. It also recommended that children participating in clinical research should not get priority over those who are not, because of concerns about coercing families into trials. The group also advised that allocation decisions be public.
Photo
Dr. Yoram Unguru, an oncologist at the Children’s Hospital at Sinai in Baltimore, said that developing rationing guidelines for scarce medicines “was painful.” Credit Matt Roth for The New York Times
A recent shortage of a therapy for bladder cancer, BCG, demonstrates how the lack of national guidance can lead to very different decisions. One Cleveland Clinic urologist, Dr. Andrew Stephenson, said he came up with BCG rationing guidelines that were used with dozens of patients after being shared with colleagues. “We tried to reserve the BCG for those patients who needed it the most,” he said.
Merck, the manufacturer, said it filled requests from a waiting list in the order received, and left rationing decisions to doctors. Some cancer centers reduced the length of BCG treatment from three years to one, because the benefit may be smaller after the first year. Others restricted BCG to patients whose tumors were mostly likely to spread or recur. And still others decided to reduce the typical dose so that each vial could be used for three patients instead of one, which some experts say raises questions about efficacy. Some outpatient clinics just ran out.
In interviews and comments on a support website, Inspire, patients seemed confused about why they were or were not getting BCG. “I found out people were getting it in different parts of the country,” said Don Keating, whose bladder cancer was diagnosed in 2014. He was told by his doctor in Boston that he needed BCG, but that it was not available.
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“I believe if I had gotten it
when it was first prescribed,
I wouldn’t have had to go
through those operations.”
Don Keating, a cancer patient
Mr. Keating had to wait about six months before obtaining the drug, during which time his cancer recurred. “I believe if I had gotten it when it was first prescribed, I wouldn’t have had to go through those operations,” he said.
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Many urologists said they saw similar recurrences possibly due to the shortage, and that some patients underwent high-risk bladder removal surgery that probably would have been avoided if BCG had been fully available.
Dr. Kamal Pohar, a urologist at Ohio State University’s cancer hospital, said he remembered driving home, wondering if he was making the right calls for his patients. “I can still feel the stress,” he said. “I’ve never been faced with this.” Supplies of BCG are again adequate, Merck and doctors report.
The vagaries in distribution and inconsistencies in rationing have led to calls for change. Doctors and others have suggested the creation of a clearinghouse of scarce drugs and voluntary sharing to promote equitable access for patients. Others argue that there should be a registry of patients given nonstandard treatments so the results can be tracked.
Dr. Lurie, the federal health official in charge of emergency preparedness and response, said that the government was working to encourage hospitals to conserve and substitute drugs to avoid a crisis and trying to fill gaps in manufacturing. Steps taken by the Food and Drug Administration have also helped reduce the number of shortages, she said.
Still, she argued that tools developed for disaster response, including ethical and procedural guidelines, should be applied. “Different places around the country are each doing their best to patch together their own guidelines,” she said, adding, “if they’re doing anything at all.”
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Mark Levin has pointed out for years that the ban on DDT was junk science and proven false yet the left trumpets this as some sort of progess:
http://www.breitbart.com/big-government/2016/02/09/physician-mosquito-borne-zika-virus-should-prompt-rethinking-of-ddt-ban/
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http://thelibertarianrepublic.com/sweden-is-evolving-to-private-healthcare/
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I wonder if part of the reason for this is their idiotic open borders to migrants. I think the Swedes are figuring out they are stooges to invite all these people in and then have to shell out money to pay for their health care.
Here, being stupid is as per the left, "the right thing to do".
Especially when it is always *other* people's money that gets spent.
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I moved this post over from the Clinton thread where it is pointed out that emails to Clinton showed Obama new full well it would not control costs. We in health care also assumed it would not. Maybe bending the rise in costs down some was about as good as we expected.
But the health companies have all done great. And the mergers and acquisitions among health insurance companies and providers will just keep squeezing any small players out and those at the very top will do great as pan all the gold out of the system for themselves they can. And the "pay for performance" line is all about trying to control costs.
It is very similar to what HMOs did in the 80s and 90s. Cost do start to come down for awhile. Then they will start to go up again. At that point we will see more rationing of care , more denials, more restrictions, more control from the bid data elites at the policy level and people will start getting more and more pissed off. Those who have never had care will be content because something is better than nothing. The rest will be then grudgingly get what they need but necessarily want they want. The system will become an adversary to many. Like I saw seniors do with the brutally cost controlling Humana Health system when I was in Florida in the early 90's they would come in ready to do full out battle with us to get "approved" every little thing.
Fro example I still recall one patient who a specialist was told to get a soft neck brace for the neck pain he had from arthritis. I wrote him the referral and it turned out it was not covered. The guy spent the next 2 or 3 weeks fighting this with administration who kept telling him we don't supply those. Finally just to get him to stop they finally agreed to pay for it if he goes to a medical supply store and then gives them the receipt. The total cost - $12. They guy had spent all this time and effort to save a grand total of $12. He was so proud of himself . He won his case with the big bad HMO.
This seems to me to be likely what we are headed for.
Now if we go single payer it will be like in England where the people are all brainwashed and used to being on the dole. they seem to accept their lot and figure well it is "free" (as two Brits told me) like Sanders tells the kids - "free" college, health care etc.
They don't seem to connect the dots that they are paying massively in taxes for all this - at least some are.
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I have no opinion on this analysis though it sounds reasonable:
http://www.foxnews.com/opinion/2016/03/03/physicians-take-on-trumps-health-care-plan.html
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I have no opinion on this analysis though it sounds reasonable:
http://www.foxnews.com/opinion/2016/03/03/physicians-take-on-trumps-health-care-plan.html
It at least solves the problem for him politically t get through the primaries. It's similar enough to Cruz and Rubio and also to whatever Paul Ryan comes out with shortly. His problem is that knowing nothing about it just days ago means he won't be the best person to defend it in the general election.
Republicans have to face the contradiction that people want no consequence for pre-existing conditions and they want no mandate:
In a Feb. 18 interview with CNN, Trump indicated he would keep ObamaCare’s individual mandate, which makes you pay a fine if you don’t have health insurance. But the next day he tweeted that he would remove the mandate (a central piece of ObamaCare) and install a “backstop for pre-existing conditions."
What is a 'backstop for pre-existing conditions' and how do we all get one?
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Medical EconomicsEHRLog in to save to my locker
Your Voice: EHRs can’t replace face-to-face patient care
February 25, 2016
Elizabeth Pector, MD, regrets that electronic health record (EHR) interoperability is sub maximal. (“An interoperability report from the field: It’s not pretty,” October 10, 2015) That prevents the flow of continuity of care documents and hence clinical usefulness. She ascribes this to those who insist on using old technologies such as “Egyptian papyrus” and even ‘facsimiles.”
I am, however, perplexed. All doctors, even technomanics, are heavily besieged to practice EBM (evidence-based medicine) and we should. EBM is based on clinical studies, either randomized clinical trials, or retrospective studies.
But there are few studies for EHRs. So would it not be instructive and useful, if the profession had a large study, 100% interoperable with CCD’s, over many years using a large cohort? That would prove that EHRs lower costs, and improve morbidity and mortality (M&M).
But we are in luck. There is such a study–retrospective–35 million people over three years, in my native Canada. And did it reduce M&M? Nope. But it did save a lot of money–$750 million. But that is only 0.2% of all medical spending in Canada.
So Canada presses ahead with the folly but at least has made EHRs optional, except in hospitals. And so has Western Europe, including the UK after spending billions on interoperability, CCDs and other acronymic addictions.
So once again the U.S. insists on mandatory EBM but not EBSM (evidence based social engineering.) In return for such folly the technomanics have again conned the profession into another Trojan horse. The winners are the EBCPV, (ecosystem of bureaucrats, coders, publishers and vendors).
The losers, once again, are physicians who are forced to spend billions on systems, and of course, lose more autonomy. And above all, the sacred patient/doctor interface is further dehumanized by morphing doctors into sterile wedges.
February 25, 2016
But there is hope for Dr. Pector and real clinicians. It is the mother of all acronyms, TAHBLATTOTD (taking a history by listening and talking to other treating doctors.) It was a technology developed by an ancient teacher – Sir William Osler. It is accomplished by two simple actions:
1) Sitting face to face, rather than face to keyboard, with a live subject and talking and listening.
2) Using a device called a telephone. It’s very simple. And it has great advantages over the other EHRs. It is hack resistant, HIPAA compliant, costs much less than $50,000 per user, seldom needs IT repair, is user friendly, interoperable, portable, and reaches all 50 states in real time.
Above all, it excludes about 95% of the vapid, useless information in current EHRs. It is also Osler compliant: “observe, record, tabulate, communicate use your five senses. Learn to see, hear, feel, smell and become expert” (ancient adage, circa, 1920).
I am far from being a Luddite but the current infatuation with EHRs to the exclusion of all else borders on lunacy. It should not and must not subsume clinical medicine. It should augment and not replace face to face. Such is rarely mentioned in articles by technocrats.
Unfortunately the combo probably won’t catch on. It prevents profiteering by EBCPV. So the profession will absorb this latest Trojan horse fostered upon us by those who created 40 years of acronyms “HMO, PPO, HPS, DRG, RPR, PQRS, MU, etc., none of which have slowed costs or improved much care.
Which reminds me, in keeping with Dr. Pector’s theme, of another ancient papyrus. It is an observation although non-Egyptian – “there is no new thing under the sun” (Ecclesiastes 1:9, circa 300 BCE.)
Calvin Ennis, MD
Pascagoula, MiSsissippi
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In boxing this has been called "punch drunk" for decades. Remember the scene in 'Requiem for a Heavyweight' where there are a bunch of retired old professional boxers standing around sounding like total retards? Remember Jerry Quarry?
If one looks at some of the hits these giants on steroids take this is not surprise. Just wait to see what the UFC guys will look and sound like in another 10 or 20 years.
I am not sure what is new about it other than a whole lot of money at stake:
http://espn.go.com/espn/otl/story/_/id/14972296/top-nfl-official-acknowledges-link-football-related-head-trauma-cte-first
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Please post on the concussion/head injury thread on the MA forum.
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Check out the advisors and board on Theranos. You will see many familiar political names. Now they have fund raiser for Hillary. Apparently some think it worth $700 to 2,700 to meet Chelsea.
The nepotism is just so rampant.
The public still is not apprised as to exactly what these corporations get in return for bribes. If it is just the chance to market their interests or open some exposure I am ok with it. But one cannot help but suspect there is much more behind the scenes.
No one has been able to get past the facades on this:
http://fortune.com/2016/03/14/chelsea-clinton-theranos-fundraiser/?xid=yahoo_fortune
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I don't why the CDC is issuing guidelines on pain management. They have gotten increasingly political over the years. Pollution, gun control, cigarettes, and more. Stick to infectious disease IMHO:
http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1er.htm?s_cid=rr6501e1er_w
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http://www.judicialwatch.org/blog/2016/03/12-obamacare-insurance-co-ops-fold-after-getting-1-2-bil-from-govt/?utm_source=SilverpopMailing&utm_medium=email&utm_campaign=Judicial%20Watch%20Tipsheet%20-%20Template%202%20%2813%29&utm_content=
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At a bargain at 14K per year. Oh but think of the money they save from preventing heart attacks. What a rip off.
http://www.seattletimes.com/business/breakthrough-cholesterol-drugs-fizzle-amid-price-pushback/
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Hurricane Katrina used as a 'climate change' phenomenon and doctors who then are identifying Hurricane Katrina mood disorder. Thus these nut jobs now can claim this as a connection to people's healths and climate change. I thought we were trained to use logic.
The only disease I can establish is "liberal thought delusional disorder":
http://associationsnow.com/2016/04/physicians-take-strong-stance-on-climate-change/
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http://aclj.org/human-rights/aclj-calls-decision-by-army-to-retain-decorated-green-beret-hero-a-significant-victory-saying-justice-has-been-served?utm_content=sf46024154&utm_medium=spredfast&utm_source=facebook&utm_campaign=Informational&sf46024154=1
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Want to spend over $1500 to hear Jeb speak? Bizarre speaker at a healthcare forum. I guess he has to earn some cash to payback those he fleeced. I guess when he is not giving bankers advice his vision of the problems facing the country today qualify him to be main speaker at some sort of busines of health care forum:
https://www.ahip.org/events/instituteexpo/?gclid=CKbR7fv-vcwCFVFZhgod8L0Hrg
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https://www.yahoo.com/news/federal-ban-on-gay-blood-donors-causes-confusion-among-lawmakers-163120735.html
"“There were so many gay victims involved with the attack, and so many of their loved ones were moved to step up and help their fellow Americans — but were unable to,” Rep. Jared Polis, D-Colo., told the Daily Beast. “All of the pretenses of this policy are gone — it was never based on science in the first place"
Oh really! No science to back it up? Wrong. Amazing how liberals want to stick science in our conservative faces every day except when it is not convenient for their agendas:
1 - http://www.cdc.gov/std/syphilis/stats.htm
2 - http://www.cdc.gov/hiv/statistics/overview/ataglance.html
Book showing how politics trumped science in the early spread of AIDS in NYC back in the 1980s.
http://www.nejm.org/doi/full/10.1056/NEJM199302113280623#t=article
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"how politics trumped science in the early spread of AIDS in NYC back in the 1980s"
That was the story of Arthur Ashe. At 36, he was in NYC working with inner city youth, suffered a heart attack that he survived. He was given HIV through NYC's contaminated blood supply during a transfusion. Dead at age 49.
https://en.wikipedia.org/wiki/Arthur_Ashe
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http://freebeacon.com/issues/most-obamacare-coops-have-now-failed/
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Like I have posted before. The major medical organizations seem to have become tools of the Left's propaganda. Surprising this is in the LA TImes:
http://www.latimes.com/opinion/op-ed/la-oe-berezow-hartsfield-obama-jama-20160718-snap-story.html
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Challenges Mount for Affordable Care Act as Fourth Year Approaches
Election outcome seen as key to resolving latest marketplace issues
Premium increases and the departure of several large companies from the health insurance marketplaces are among an assortment of issues paving a bumpy path to 2017 for the Affordable Care Act.
"I don't think the marketplace is particularly healthy," said Zack Buck, an assistant professor with the University of Tennessee College of Law, who studies health insurance. "This year in particular has shown a jarring amount of turbulence, and whenever you have companies leaving a market, it's not a good sign."
However, that doesn't mean it's time to play Taps for the Affordable Care Act, which is nearing the end of its third year in operation. Rather, the November election is being seen as crucial to the future of the marketplaces.
"It really depends on who's elected and what happens to the makeup of Congress," said John R. Bowblis, an associate professor of Economics at Miami University of Ohio, who also studies health insurance.
If Republicans are ascendant, "there doesn't seem like there's much willingness to add to subsidies or change the system," Bowblis said. "If that's the case, Obamacare looks like more of a failure." If Democrats take power, he said, there might be attempts to fix the system, such as adding the so-called public option (an alternative insurance plan offered by the federal government), increasing subsidy payments and boosting the non-participation penalty to force more people to buy insurance.
With the fourth-annual marketplace open enrollment period set to begin Nov. 1, three major insurers -- Aetna, Humana and UnitedHealthcare -- have announced plans to withdraw partially or fully from the marketplaces.
"The issue is that some of the smaller players seem to have been potentially successful, but the larger for-profit insurers haven't been," Bowblis said. This may be because larger insurers have traditionally been more focused on serving the needs of employers who are self-insured and less on accepting the financial risk from insuring individuals. "They don't have the same experience at tweaking expenses to try to control costs," he said.
Also, "when it came to the people who were selecting to buy plans, the people who were more expensive by being sicker tended to choose the big-name plans like Aetna," Bowblis said. That increased costs for the major insurers.
However, Buck said that one school of thought holds that the departure of the big insurers might not be as bad as it seems. It "suggests that this may be a realignment, that the national insurance companies may not be the best equipped to sell insurance plans on the exchanges, and that smaller, regional carriers are better at selling these plans," he explained.
Even if that's true, "it is not a great sign that Aetna and others are pulling out," Buck said. In late September, "Blue Cross/Blue Shield of Tennessee left the exchanges in Tennessee's three largest markets, leaving one insurer on the exchange for a huge swath of counties in this state," he said. "That is not a good thing for the consumer."
Another issue raising questions concerns the penalties for not buying insurance.
Tax penalties are typical for Americans who don't buy insurance, but Bowblis said the penalties don't seem to be high enough to force enough people to buy coverage in order to avoid paying a penalty.
"The penalties are significantly lower than the cost of insurance, especially in light of deductibles," he said. As a result, "insurers wound up getting sicker people than expected, and it disproportionately affected the bigger insurers."
Subsidies are available to people with lower incomes, but they're not a draw for everyone. Subsidies have the biggest influence at the bottom of the income scale, where they're largest, but "enrollment figures suggest that higher-income people who receive smaller subsidies or none at all have not seen insurance as such a bargain," according to a report published Oct. 2 in The New York Times.
Younger people are another challenge: They aren't signing up for insurance in large enough numbers, although the Obama administration recently began a push to get millennials to sign up for coverage.
The major presidential candidates differ on what should be done. Republican candidate Donald Trump wants to eliminate the health insurance mandate, boost the use of health-savings accounts and encourage insurers to sell across state lines. Democratic contender Hillary Clinton supports the public option, which would make government-run insurance plans available on the marketplaces as an alternative to coverage from private insurers.
"I think the creation of a public option would help hold down cost increases, but I'm not sure that Congress has the political will to provide a fix that would work," Buck said. "I would prefer congressional inaction to the wrong action -- i.e., removing the individual mandate, limiting tax subsidies, etc. Those reforms are essential for the law to work, and removing them would be disastrous."
In addition, "one also has to be careful about allowing reforms that water down the quality of insurance plans," he said. "We don't want to open up the marketplaces to low-quality insurance plans that don't provide enough coverage for their beneficiaries. That, I think, would be a step backward."
For their part, American College of Physician members are being urged to keep an eye on relevant issues before Congress -- like the public option, which has been introduced in the Senate -- and, most importantly, to vote.
"It is said that all elections have consequences, and that is especially true in 2016, including for American health care," said Bob Doherty, ACP's senior vice president for governmental affairs and public policy.
"To become better informed voters, we encourage ACP members to look to independent sources to learn more about the potential impact of Mrs. Clinton's and Mr. Trump's proposals on access to health insurance coverage for tens of millions of Americans, the affordability of prescription drugs, and much more," Doherty said. "Such issues are simply too important to rely on the candidate's own talking points. And we encourage them to check out ACP's own guide to the top 10 health care issues being debated in this election."
More Information
ACP's 2016 Presidential Election section on its website includes information on how the ACA affects internists, their practice and their patients as well as information on critical issues in health care facing candidates this fall.
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http://www.weeklystandard.com/fewer-americans-have-private-health-insurance-now-than-in-2007/article/2004964#.WAgDIBgX0rY.facebook
Fewer Americans Have Private Health Insurance Now Than in 2007
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No progress whatsoever in 10 years since Democrats took Washington. More people can't stand on their own, need government assistance. Remember when we used to judge their effectiveness by how many people no longer need the program?
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http://www.weeklystandard.com/fewer-americans-have-private-health-insurance-now-than-in-2007/article/2004964#.WAgDIBgX0rY.facebook
Fewer Americans Have Private Health Insurance Now Than in 2007
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No progress whatsoever in 10 years since Democrats took Washington. More people can't stand on their own, need government assistance. Remember when we used to judge their effectiveness by how many people no longer need the program?
Now lefties tout how popular free sh*t is with the public.
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https://www.acponline.org/advocacy/acp-advocate/issue/article/715888
Keep in mind that many of the policy makers and evaluators are in their hearts, for a single payer system.
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http://www.weeklystandard.com/fewer-americans-have-private-health-insurance-now-than-in-2007/article/2004964#.WAgDIBgX0rY.facebook
Fewer Americans Have Private Health Insurance Now Than in 2007
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No progress whatsoever in 10 years since Democrats took Washington. More people can't stand on their own, need government assistance. Remember when we used to judge their effectiveness by how many people no longer need the program?
Now lefties tout how popular free sh*t is with the public.
Yes, rob Peter to pay Paul. And Amanda, Julia, Maria, Laquisha, Jose and Youssef. And only getting the latter group's consent.
We made private healthcare unaffordable through government interference while pushing tens of millions into healthcare subsidies.
The argument their side makes is do more of it. Kill off other people's money while making nearly everyone dependent on it.
The argument our side fails to make is that shutting down the vibrant and dynamic private sector that allows wealth creation to pay for public benefits hurts the recipients of the public benefits system more than it hurts the wealthy - if you can look past your next check. How are the public benefits recipients doing in Haiti, Venezuela and Republic of the Congo - where wealth doesn't exist? Not possible that could happen here? We went from 6% growth to 1% growth and it is the low growth that is unsustainable, held up only by temporary, artificial measures like quantitative expansion and massive debt spending schemes. We jeopardize our real safety net when we shut down our productive, private economy.
Free shit in Sweden including health care (along with open border migration) eventually brought in crime, riots, violence, police no-go zones and civil war. Native people quit reproducing and new people came for the wrong reasons. Generous Minnesotans have known that for decades. Murders in the worst areas have a Chicago migrant connection to them and dozens of Somalis have been arrested for joining al Qaida. Screw up the price, cost and incentive systems and people respond with the rewarded, unproductive behaviors.
No one aspires to be Peter anymore, the one they all want to rob from. But without Peter's continued income, we don't pay Paul and all the rest.
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ccp: "Keep in mind that many of the policy makers and evaluators are in their hearts, for a single payer system.
That's right. Isn't it sick that it's actually the left, the designers and supporters of Obamacare who wish it to fail, oblivious to the human tragedy of that. Conservatives just want it repealed, not wish harm on the recipients.
Government healthcare in every other nook of the world is helped by what's left of private sector innovation here. When we go under, there isn't some other US for people to turn to. The leading edge treatments are the most expensive and scarcity is always rationed one way or another. If not by price then by queuing.
Waiting times for medically necessary treatments in Canada are up 97% in 20 years.
4 week wait for oncology radiation, that doesn't hurt outcomes, does it?
Waits for orthopedic procedures are far worse.
43.1 week on Prince Edward Island for "medically necessary treatments"?
8.4% of the populations in Newfoundland & Labrador are waiting for treatment.
https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2015-report
Same system here would yield far worse results.
The top 1% don't wait, at least 52,000 came to the US last year for non-emergency treatment, up 25% in one year.
https://www.fraserinstitute.org/sites/default/files/leaving-canada-for-medical-care-2015.pdf
Where would Americans go after we abandon private care?
In the UK, the top 10% buy private coverage in addition to their NHS membership.
https://www.quora.com/What-percentage-of-the-UK-population-buys-private-healthcare-insurance
62% in the UK believe the private sector has a role to play in reducing NHS waiting lists.
https://yougov.co.uk/news/2013/06/17/healthcare-choices-nhs-versus-private/
I wonder if anyone has polled Venezuelans recently (or socialist North Koreans) on healthcare satisfaction. Hugo chose Cuba over the Mayo Clinic for his treatment, ideology over outcomes. How is that working out?
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Democrats are already looking beyond ObamaCare’s slow-motion failure, and Colorado is showing where many want to go next: Premiums across the state are set to rise 20.4% on average next year, and some have concluded that the solution is more central planning and taxation. Voters will decide on Nov. 8 whether to try the single-payer scheme that blew up in Vermont.
Amendment 69 would alter the state’s constitution to create a single-payer health system known as ColoradoCare. The idea is to replace premiums with tax dollars, and coverage for residents will allegedly include prescription drugs, hospitalization and more. Paying for this entitlement requires a cool $25 billion tax increase, which is about equal to the state’s $27 billion budget. Colorado would introduce a 10% payroll tax and also hit investment income, and that’s for starters. California would look like the Cayman Islands by tax comparison.
Every other detail is left to the discretion of a 21-member panel. The board of trustees would determine what benefits are offered—say, whether your pricey cancer drug makes the cut. The board would also set reimbursement rates for doctors and hospitals, as well as patient co-payments.
Trustees would be elected to four-year terms and not subject to recall elections. In other words, ColoradoCare would evade nearly all democratic accountability. Amendment 69 stipulates that the entity is “not an agency of the state and is not subject to administrative direction or control by any state executive, department, commission, board bureau or agency.” ColoradoCare could bust constitutional limits on tax increases and spending.
No one thinks this project will float on its planned $38 billion budget. An analysis from the Colorado Health Institute found that ColoradoCare would post a $253 million loss in its first year and would then “slide into ever-increasing deficits in future years unless taxes were increased.” The other options are reducing benefits or cutting payments to doctors—assuming providers haven’t fled the state. ColoradoCare will have evicted whatever remains of the private insurance market, so residents may have nowhere to turn.
The best independent study on single payer is Vermont, which abandoned the idea in 2014: Governor Peter Shumlin, a Democrat, dumped his signature campaign issue once he figured out it’d require an 11.5% payroll tax and an individual levy as high as 9.5%. Mr. Shumlin admitted that “the risk of economic shock is too high at this time to offer a plan I can responsibly support.”
Remarkably, Colorado has managed to build on Vermont’s failures. For one, the plan aspires to cover more than five million people, not Vermont’s 625,000. Anyone who claims to live in Colorado qualifies, so get ready for a crush of beneficiaries who don’t pay anything. ColoradoCare would be enshrined in the constitution, which is much harder to scrap than legislation.
The good news is that Amendment 69 has created a rare moment of bipartisanship: Former Democratic Governor Bill Ritter is working with Colorado’s Republican Treasurer, Walker Stapleton, to defeat the measure. Democratic Governor John Hickenlooper is also opposed. Voters hate the idea the more they learn: A September poll showed only 27% support, down from 43% in January.
Then again, Bernie Sanders supports it, and Hillary Clinton wants a “public option” that is another giant step toward single payer. Coloradans have the opportunity to reject what progressives would love to achieve if they didn’t have to bother with voters: socialized medicine.
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Obamacare Premiums Up 30% In TX, MS, KS; 50% In IL, AZ, PA; 93% In NM
http://www.zerohedge.com/news/2016-10-21/obamacare-premiums-30-tx-ms-ks-50-il-az-pa-93-nm-when-does-death-spiral-blow
http://www.wsj.com/articles/rate-increases-for-health-plans-pose-serious-test-for-obamas-signature-law-1476822335
Approved Hikes Just Under 20%: Colorado, Florida and Idaho
Approved Hikes 20% to 29%: Connecticut, Georgia, Indiana, Kentucky, Maine, Maryland
Approved Hikes 30% to 49%: Alabama, Delaware, Hawaii, Kansas, Mississippi, Texas
Approved Hikes 50% to 92%: Arizona, Illinois, Montana, Oklahoma, Pennsylvania, Tennessee
Approved hikes 93%: New Mexico
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Hillary will "fix " AHA " by expanding the government control of more and more of us until the [claimed] only "hope" is *single* payer.
And the Liberal's dream will come true: We will be *a people for the government, of the government, and by the government*:
********From my post of March 8,2015:
At least some knew the AHA would fail if not all of them. From posts I made in early 2015:
this from a speaker to a medical conference who is for single payer (Medicare for all):
The speaker I heard today could answer this. The numbers and stats above are probably all distortions. The Affordable Health Care Act has done little if anything to reduce costs. The administrative costs could be as high as 30%. The only ones who did well are the same ones who havce done well in the rest of the economy - big companies who have the resources to squeeze out all competition and soak the system. Without the input of tax dollars to supplement these companies they would go out of business. We are supplementing them with tax money.
I ask everyone who reads this board:
How much less are you paying for your insurance and is your plan better than last year or the year before that?
I know the answer.
The speaker I heard advocates for single payer. He made a strong case and almost has me convinced he may be right.
If I can find the website he recommended I'll post but I lost the site when I left a piece of paper somewhere while answering a page.
Based on what his presentation concluded based on a lot of statistics and sources the Newsweek piece is exactly what one would expect from a veiled Democrat outlet - pure propaganda.
ccp
Power User
***
Posts: 6202
At least some knew the AHA would fail if not all of them. From posts I made in early 2015:
Re: The Politics of Health Care
« Reply #1404 on: March 08, 2015, 09:47:41 AM »
This is one article from the organization the speaker (I noted in the previous post) was promoting. I am not a member and would not.
A rather socialistic group. Yet they are right about pointing out the large layer of administrative costs.
He thinks the AHA is going to fail in a few years. One could argue it is designed to fail in the march to single payer. I don't know.
http://www.pnhp.org/news/2015/march/health-care-law-did-not-end-discrimination-against-those-with-pre-existing-condition
Logged
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http://www.realclearpolitics.com/video/2016/10/26/obama_architect_jonathan_gruber_obamacare_is_not_imploding_working_as_designed.html
October 26, 2016
Obamacare Architect Jonathan Gruber: "Obamacare Is Not Imploding," "Working As Designed"
MIT professor Jonathan Gruber, a well-known architect of President Obama's Affordable Care Act, tells CNN that the law known as 'Obamacare' is working exactly as intended.
Full transcript, via CNN:
JONATHAN GRUBER: Obamacare's not imploding. The main goal of Obamacare was two-fold. One was to cover the uninsured, of which we’ve covered 20 million, the largest expansion in American history. The other was to fix broken insurance markets where insurers could deny people insurance just because they were sick or they had been sick. Those have been fixed, and for the vast majority of Americans, costs in those markets have come down, thanks to the subsidies made available under Obamacare...
The 22% increase [in health care premiums], let’s remember who that applies to. That applies to a very small fraction of people, who have to buy insurance without the subsidies that are available.
85% of people buying insurance on the exchanges get subsidies. And for those people, this premium increase doesn’t affect them.
Now, for those remaining people, that is a problem, and that’s something that we need to address, but it’s not a crisis. It doesn’t mean the system’s collapsing. And most importantly, it doesn’t affect the 150 million Americans who get employer insurance, who have actually seen their premiums fall dramatically, relative to what was expected before Obamacare.
CAROL COSTELLO, CNN: OK. So let's talk about how exactly you can fix Obamacare. And I just need you to be specific, because I think people really want answers. So Hillary Clinton says she can fix Obamacare. So what would be one fix that would drive premiums down.
GRUBER: Look, once again, there's no sense of oh it just has to be fixed. The law is working as designed; however, it could work better, and I think probably the most important thing experts would agree on is that we need a larger mandate penalty. We have individuals who are essentially free riding on the system. They're essentially waiting until they get sick and then getting health insurance. The whole idea of this plan which was pioneered in Massachusetts was that the individual mandate penalty would bring those people into the system and have them participate. The penalty right now is probably too low and that's something ideally we would fix.
COSTELLO: So somebody who is president could go to congress and say, "You know what, lawmakers, this is a fix. Can you pass this?" Is that what would have to happen to put that fix into place?
GRUBER: Basically, it's hard to know what dramatic fix we could do without congress participating in the process. We could do things like a stronger mandate is one. We could do things like increasing the pressure on states to expand their Medicade programs, a horrible act of political malpractice where states have left millions of people of their lowest income citizens uncovered. We could do things like that, but a lot of that would involve congressional participation. It's hard to know what you can do just on your own as a new administration.
COSTELLO: What about the insurers who have fled the system? How do you convince them to come back or new companies to sign on? GRUBER: Once again, I think the press here has been misleading. Some insurers are leaving. Other insurers are thriving. I think what you have is a system where we've shaken up the status quo, exactly what we expect of new innovation, disruptive innovation if you will, to do. Insurers who were thriving in the old system are finding this new system sort of hard for them. Other insurers are doing really well and what's going to happen is the natural process as the market evolves. These premiums are going to increase. That's going to allow profitable opportunities for new insurers to enter they are(ph) and bring premiums back down. So we're just seeing the ups and downs of a new market. What you have to remember is that premiums in 2014 came in way below what we expected. In fact, where they are today is exactly where they thought they'd be today. It's just they came in lower than we thought and they rose faster than we thought. And that's just some of the unpredictability of a new market. That will settle down over time. And new insurers will enter.
COSTELLO: OK. So hindsight is 20/20, right?
GRUBER: Yes.
COSTELLO: Looking back, is there one thing that you wish was done differently?
GRUBER: I think there's really probably two things I wish was done differently. One is I wish the mandate penalty was stronger. The other, I wish the federal government had done more to get states to expand their Medicaid programs. I think that this is a fundamental flaw in our system that states are leaving so many systems uncovered and citizens who are sick who are coming into this exchange pool and making it more expensive.
COSTELLO: So realistically, you know, after the next president is put into office, what do you think will happen with Obamacare?
GRUBER: I think nothing much is going to happen, to be honest. I think that basically a system that largely works , that the flaws your seeing now or the premium increase you're seeing now are just the natural dynamics of a market as it transitions to its new state, and I think that we're just going to let it go for a couple years and it's going to get better on its own. And basically I think it's a system which largely works.
COSTELLO: What if Donald Trump becomes president, he has a republican congress, and he does repeal it? What happens then?
GRUBER: Well, first of all he won't repeal it. Remember, the whole argument and public debate against this law is that people didn't get to keep insurance they liked. Well, you're going to have 20 million Americans or more who are now getting insurance that they like. You're not going to take that away from them. And let's be clear, there is no replace. There is only repeal. There is no Republican alternative to this law, and the reason is because this is fundamentally a bipartisan legislation that was originally drafted on Republican principles, to be honest. And so there is no Republican alternative. And so his repeal and replace is just repeal and leave people uninsured. That's not going to happen.
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"The main goal of Obamacare was two-fold. One was to cover the uninsured, of which we’ve covered 20 million, the largest expansion in American history. The other was to fix broken insurance markets where insurers could deny people insurance just because they were sick or they had been sick."
Name me a Rep who answers this cogently and tell me what he says.
"Well, first of all he won't repeal it. Remember, the whole argument and public debate against this law is that people didn't get to keep insurance they liked. Well, you're going to have 20 million Americans or more who are now getting insurance that they like. You're not going to take that away from them. And let's be clear, there is no replace. There is only repeal. There is no Republican alternative to this law, and the reason is because this is fundamentally a bipartisan legislation that was originally drafted on Republican principles, to be honest. And so there is no Republican alternative. And so his repeal and replace is just repeal and leave people uninsured. That's not going to happen."
How is this wrong?
Even Trump has not noticed that Dr. Ben has a very good alternative or maybe he has but lacks the verbal skills to describe and explain it. Maybe we need to give Dr. Ben a pot of coffee and put him in front of a video camera and then play it at accelerated speed.
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By Gerard Baker and
Monica Langley
Updated Nov. 11, 2016 3:33 p.m. ET
WSJ
NEW YORK—President-elect Donald Trump said that, after conferring with President Barack Obama, he would consider leaving in place certain parts of the Affordable Care Act, an indication of possible compromise after a campaign in which he pledged repeatedly to repeal the 2010 health law.
In his first interview since his election earlier this week, Mr. Trump said one priority was moving “quickly” on the president’s signature health initiative, which he argued has become so unworkable and expensive that “you can’t use it.”
Yet, Mr. Trump also showed a willingness to preserve at least two provisions of the health law after the president asked him to reconsider repealing it during their meeting at the White House on Thursday.
Mr. Trump said he favors keeping the prohibition against insurers denying coverage because of patients’ existing conditions, and a provision that allows parents to provide years of additional coverage for children on their insurance policies.
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Apparently Trump was too fact unaware to realize that the plan passed by Ryan and the House included protection of pre-existing conditions.
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Apparently Trump was too fact unaware to realize that the plan passed by Ryan and the House included protection of pre-existing conditions.
Never his strong suit. We knew this long ago.
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"Mr. Trump said he favors keeping the prohibition against insurers denying coverage because of patients’ existing conditions, and a provision that allows parents to provide years of additional coverage for children on their insurance policies."
I agree with this. I don't see any choice.
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"Mr. Trump said he favors keeping the prohibition against insurers denying coverage because of patients’ existing conditions, and a provision that allows parents to provide years of additional coverage for children on their insurance policies."
I agree with this. I don't see any choice.
I'm going with.... no one knows anything that will happen until Trump is actually in office. He didn't change his tune until after the election and after he met with BO.
Anything Trump does or says until he actually takes office can be taken as nothing more than strategy.
Trump still has the Left rioting, attempting to get the electoral college voting to support Clinton, Clinton and Soros still lurking around, the media STILL against him (though they say otherwise), some politicians acting like they like Trump (when they hated him just days previosuly), and BO still in office all the way until January.
Personally, I am buying nothing at face value until then.
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Trump Indicates He May Preserve Some Parts Of ACA
The Wall Street Journal (11/11, A1, Baker, Langley, Subscription Publication) reported that during an interview, President-elect Donald Trump signaled an openness to keeping at least two provisions of the Affordable Care Act intact while repealing other parts of President Obama’s signature healthcare law.
The New York Times (11/11, Hulse, Davis, Rappeport, Haberman, Subscription Publication) reported that during the Wall Street Journal interview, “Trump said he told the president that he would consider keeping two provisions of the law: the prohibition against insurers denying coverage because of a patient’s pre-existing condition; and the one that allows parents to keep their children on their insurance plans until they turn 26.” But, according to the Times, if the ACA mandate were eliminated, this “could send insurance companies into a tailspin, because their costs would rise with sicker customers, and that would not be offset by healthy consumers forced to buy insurance.”
The Washington Post (11/11, Goldstein) reported that just a few days after the election, Trump began “to revise his health-care agenda in ways that conform more closely to the heart of Republican thinking in recent decades.”
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https://www.yahoo.com/news/donald-trump-walks-back-stance-205921490.html
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https://www.yahoo.com/news/donald-trump-walks-back-stance-205921490.html
Making a provision for pre-existing conditions is quite popular. The individual mandate is not, but perhaps needed to keep people from waiting until they need expensive treatment to buy a policy.
Does someone, Trump, Ryan, McConnell, have another way of solving this?
I can think of some ways but they wouldn't be popular.
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Go for it! :-D
Also, does someone have a good summary of Dr. Carson's proposed solutions?
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Emphasis on Health Savings Accounts supplemented with major medical insurance policies. He is right in the general concept, pay as much of the nation'a healthcare expenses with people's own money, first party pay. Then let them buy policies they choose to cover their major medical with high deductibles, if that is what will bring their monthly and annual costs down.
This does not answer all the questions.
https://www.bencarson.com/issues/health-care/
First-dollar coverage for out-of-pocket expenses and premiums to buy the insurance of your choice.
Your Money. Your Account belongs to you, whether you change jobs or cross state lines.
Transferable between family members, because each of us has different medical needs.
Save Medicare and Medicaid by putting beneficiaries in control:
Give Medicare beneficiaries a fixed contribution to buy the health insurance they actually want and need.
Give Medicare and Medicaid enrollees HEAs to cover first-dollar expenses and insurance premiums for coverage they get to choose
Modernize Medicare to keep pace with medical advances by gradually increasing the eligibility age (by 2 months each year) until it reaches age 70.
Treat Medicare and Medicaid beneficiaries like the rest of us. Give Medicaid beneficiaries the same insurance coverage, doctors and choices that other Americans enjoy, with HEAs to provide first-dollar coverage, supplemented by a major medical insurance plan of the patient’s choice.
Save Medicaid by providing fixed-dollar support to the states, which must use the funds for premium payments and HEAs for beneficiaries — not wasteful state bureaucracies.
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For people without insurance through their jobs, the Republicans would establish a refundable tax credit. Obamacare also provides subsidies for people to buy insurance if they do not qualify for Medicaid.
It also includes long-held Republican proposals such as allowing consumers to buy health insurance across state lines, expanding health savings accounts, reforming medical liability rules and giving block grants to states to run Medicaid programs for the poor.
http://www.reuters.com/article/us-usa-election-healthcare-ryan-idUSKCN0Z80AQ
https://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf
Also does not have all the answers.
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http://www.nationalreview.com/article/442233/obamacare-repeal-preexisting-conditions-affordable-care-act-donald-trump-republicans
Yes, We Should Protect People with Pre-existing Conditions
by RAMESH PONNURU , November 16, 2016 4:13 PM
There is a way to repeal Obamacare that accomplishes that goal.
President-elect Donald Trump has repeatedly said that he wants to replace Obamacare while keeping its protections for people with pre-existing conditions. I agree with Trump that Obamacare should be repealed and that people with pre-existing conditions should be protected, and recently wrote here about how these goals could be reconciled.
The key, in my view, is to alter an Obamacare regulation that prevents insurers from charging the sick more than the healthy. That regulation gives healthy people an incentive not to buy insurance: They can always buy it when they get sick. But insurance markets won’t work if only sick people buy insurance. That’s the reason the Obamacare legislation coupled this regulation with the infamous “individual mandate” requiring most people to buy health insurance.
Many Republicans have suggested a different regulation: Insurers could be required to charge people with pre-existing conditions the same as healthy people so long as those people had maintained their insurance coverage. That regulation would not create an incentive to forgo coverage; it would add to the incentive to get it. And so the mandate would no longer be needed.
At the same time, I suggested, the government should give people who do not have access to employer-based coverage a tax credit that would allow them to purchase catastrophic health insurance (or more extensive coverage if they supplement that credit with their own money). This coverage would no longer be subject to Obamacare’s definition of essential benefits; the states would return to being the primary regulator of benefits, as they were before Obamacare. But individuals would be free to buy insurance from other states, which would be particularly helpful if their own states’ regulations were too costly.
Michael Cannon, the Cato Institute’s health-policy expert (and a friend of mine), disagrees with both Trump and me. He raises four objections to my suggestions and advances his own alternative.
The first objection is that the new regulation would create perversities of its own. Every year the sickest people would choose the most generous plan, and insurers would try to make their policies unfriendly to the sick to counteract their efforts. This concern seems greatly overstated. The regulation should be drawn to provide a narrow protection: If you had maintained your insurance coverage, getting sick would entitle you to get coverage comparable to what you had at the same rate as healthy people. That should nullify this objection.
Cannon’s second point is that the tax credit is the equivalent of an individual mandate. The mandate fines you for not buying insurance. The credit gives you a tax break for buying insurance. Either way, you pay more taxes if you don’t buy insurance. So are they really the same thing? No. Obamacare attempted to make it illegal for people to choose not to buy health insurance. That’s why the individual mandate went to the Supreme Court. The mortgage-interest deduction didn’t, even though you could apply the same argument to try to present it as a “house-buying mandate.” Maybe the mortgage-interest deduction is good policy and maybe it isn’t, but it’s not a mandate. The same goes for a tax credit to buy catastrophic health insurance.
Third, Cannon argues that getting rid of Obamacare’s employer mandate and providing a tax credit to people who don’t have employer-based coverage would give employers an incentive to drop their plans. But we have had very little of such employer dumping even though the employer mandate has not been put into effect and individuals without employer coverage have been able to use tax credits on Obamacare’s exchanges. Again, the concern seems exaggerated. Republicans are leery of simply abolishing Obamacare’s protections for people with pre-existing conditions for both humanitarian and political reasons.
Fourth, Cannon says that replacing Obamacare along the lines I’ve discussed would “entrench Obamacare’s worst features into federal law, permanently, by giving them a Republican imprimatur.” To accept this conclusion requires both buying those three prior points and losing all sense of perspective. The replacement I’m talking about would get rid of the individual and employer mandates, the essential-benefits regulations, federal support for the exchanges, the medical-device tax, the Independent Payment Advisory Board, and more. The federal government would have a smaller distortionary role in health care than it did before Obamacare, let alone than the one it has played since then. For example, the federal government would no longer be giving people with access to employer coverage a much larger tax break than people without such access, and it would do a lot less to push people to buy the most expensive health plans available.
Republicans are leery of simply abolishing Obamacare’s protections for people with pre-existing conditions for both humanitarian and political reasons. Cannon proposes a way to handle that problem: Abolish as much of Obamacare as possible except for its regulations on pre-existing conditions. “Americans will see the actual costs of those supposedly beneficent and popular provisions when they cause insurance markets to collapse. The damage would be so swift and severe, Congress would quickly repeal the pre-existing-conditions provisions, filibuster or no filibuster.”
Either you can see instantly that this strategy is a terrible one or you can’t, so there’s not much to say about it. Besides this: I cannot imagine House and Senate Republicans’ pursuing it. — Ramesh Ponnuru is a senior editor at National Review.
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https://pjmedia.com/trending/2016/12/04/va-scandal-4-quit-after-ok-veteran-dies-with-maggots-in-wound/
https://www.buzzfeed.com/andrewkaczynski/7-times-barack-obama-promised-to-reform-the-va?utm_term=.br3g8nYWX#.ccx8EdZp7
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https://pjmedia.com/trending/2016/12/04/va-scandal-4-quit-after-ok-veteran-dies-with-maggots-in-wound/
https://www.buzzfeed.com/andrewkaczynski/7-times-barack-obama-promised-to-reform-the-va?utm_term=.br3g8nYWX#.ccx8EdZp7
http://abc7chicago.com/news/va-hospital-dentist-may-have-exposed-veterans-to-hiv-hepatitis/1636473/
Perhaps Obama will fix the VA in the next week or two...
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The excrement hits the fan:
http://www.washingtontimes.com/news/2016/dec/15/obamacare-subsidies-increase-by-10-billion-as-cost/?mkt_tok=eyJpIjoiWm1ZeE5HVmhOVGd4WVRreiIsInQiOiIrbTQ2Y0Rhb0g1dnlRcmZJSkRTTDFLd3lJOWlEeVNhUG5hNENkcGRCcFVVNkY2a1J5XC9TWmNXMGlJMlhWVURKM2NLaHJXRFJWeGJ3QmtjXC9rV3dCN0JDR2VcL0IyZ1BBdU5vZFlBQVJWMmNFZENwTUhuQVlYZlJDTWsxTHBYTFk4MSJ9
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https://finance.yahoo.com/news/gop-universal-access-health-care-164900664.html
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An interesting articulation of the problem. I will need to think more on this:
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We all want world class health care. And at the same time we want someone else to pay for it.
There appears no way to get around the fact that to pay for pre existing conditions all of us will have to pay. Hence reason for the "mandate"
http://www.nationalreview.com/article/443502/republicans-obamacare-repeal-plan-preexisting-coverage-problem
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Good article.
The final paragraphs get to what I have been saying here for a very long time. Prices need to be knowable.
I would like to explore the notion that prices need to be the same for everyone, be they insured or uninsured.
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Good article.
The final paragraphs get to what I have been saying here for a very long time. Prices need to be knowable.
I would like to explore the notion that prices need to be the same for everyone, be they insured or uninsured.
If I as the seller of a good or service decide to set the price differently for different customers, who is to tell me otherwise?
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A fair question, but let me bounce it back at you:
As a customer, how would you feel if the supermarket charged you more for a given food item than someone else?
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How To Repeal ObamaCare
By DICK MORRIS
Published on DickMorris.com on January 4, 2017
A recent column by Heather R. Higgins and Phil Kerpen really points the way to how to get rid of this obnoxious program. Their ideas are similar to ones I have ventured in this space.
Zero fund the fines for failure to buy insurance or offer it to one's workers. No need to repeal it which would take 60 votes. Just zero out the penalty and leave the "fine" on the books to rot away. Zero fund the fines that penalize people for buying healthcare plans that are not as extensive or expensive as the bureaucrats want. Let folks buy what they want -- or nothing at all -- and let them keep, or revert if they can, to their old policies. Any state approved plan should be OK under ObamaCare.
Keep the subsidies in place but with less coverage and lower premiums, the subsidies will drop.
Keep coverage of pre-existing conditions and the prohibition against terminating a plan or raising premiums if people become ill.
And then bring under Medicare -- or some other government subsidy -- everyone whose illness is so bad and chronic that they can't meet their needs through insurance.
But Higgins and Kerpen add a new wrinkle -- they ask that Trump rescind the Obama Administration ruling exempting members of Congress and their staffs from ObamaCare requirements. In practice, this means cutting their premium subsidies that currently pay for up to three-quarters of the cost. As Higgins and Kerpen point out, "there is nothing as motivating as skin in the game." By making members and staffers on Capitol Hill pay for more of their insurance, you can bet a sharp reduction of cost will be soon coming.
Republicans can only pass bills that come under the reconciliation procedure that only requires a simple majority in the Senate. The parliamentarian decides what is kosher for reconciliation and what is an overreach. But Republicans should feel free to override the parliamentarian's orders if they need to do so.
Don't let the Republicans sell the idea that a full repeal has to wait for years while a meaningless resolution signaling an intention to repeal takes effect. This dodge and evasion would leave millions of people with plans they can't afford or deductibles that bar access to services.
By a combination of executive orders and legislation that would not require 60 votes (because it is passed under reconciliation), get rid of this law now!
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A fair question, but let me bounce it back at you:
As a customer, how would you feel if the supermarket charged you more for a given food item than someone else?
Can I go to another supermarket?
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In this case of health care, thanks to government meddling no you can't.
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GM: If I as the seller of a good or service decide to set the price differently for different customers, who is to tell me otherwise?
I believe the criteria for determining legal discrimination is 'rational basis'.
If the provider can collect sooner or with greater certainty, say with cash or guaranteed payment, the price might be lower. There still can be prices published, easy to access that can also list available discounts and surcharges.
Yesterday I had the vocation of 'medical coding' explained to me. CCP likely knows more. The medical coder goes through the doctor's notes and writes down the codes and from that the computer bills it out - based on the doctor's handwriting!
If the computer knows the codes and all the rates, why can't the consumer?
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CCP:
We all want world class health care. And at the same time we want someone else to pay for it.
There appears no way to get around the fact that to pay for pre existing conditions all of us will have to pay. Hence reason for the "mandate".
This question seems to be stumping everyone. It seems to me that to qualify for the pre-existing conditions benefit you have to do a few things, sign up for coverage, pay extra, keep coverage as long as you have income, etc. If it is subsidized, that subsidy should come out of general revenues and not drive up the rates for others making healthcare costs further out of reach for more and more people.
The federal budget already spends 1 trillion a year on healthcare. We don't need to instantly or ever hit a zero number. We can subsidize some healthcare and some people will still get healthcare for free. The point of reform is to get more and more people, hundreds of millions of them, to be choosing and paying for their own private sector healthcare and for the government to be paying for less and less of it, at least as a proportion of the economy. Within that privatization movement, the government can require better and better disclosure on services and prices, IMHO.
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How do we answer the charts and attendant assertions herein?
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-obamacare-charts-20170104-story.html
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How do we answer the charts and attendant assertions herein?
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-obamacare-charts-20170104-story.html
Good question and we can add to this with data but the simple answer is that the piece is deceptive by its omissions. For example my plan was lost due to Obamacare. I am switching doctors a second and third time due to Obamacare. My cost has roughly doubled each year due to Obamacare. The plan I choose to be on is illegal due to Obamacare. I went from self-sufficient to subsidized due to Obamacare. I am a ward of the state and disgusted by the thought of it. (Yet I pay more than 100% of my take home income in taxes.) Government subsidized healthcare is a concern and an extremely high marginal tax rate that faces each low to mid-income worker wishing to increase their income. In other words, it keeps poor people poor, cripples the growth in the economy, and Democrats love that? Converting to subsidy is not lowering the cost. On their charts I count as 'insured' and presumably satisfied with Obamacare - because I signed up for a lousy policy that has paid none of my actual expenses as opposed to breaking the law and paying penalties in addition to the cost of self-paid, over-priced healthcare.
The last article published in Harrisburg (the political center of) Pennsylvania on healthcare before the election was that premiums are going up another 33% per year, in addition to all the other increases we had while Obama and Democrats were losing the House, Senate, state Houses and Governorships largely due to government over-reach and Obamacare. Republicans hadn't carried PA (or MI or WI) in a Presidential election since Reagan's 49 state win in 1984. Trump carried Pennsylvania by a greater margin, 67,000 votes, than Hillary had in NH, MN, NV and ME. And it wasn't because of his high approvals! People hate Obamacare and all it symbolizes in our government-run lives. Club for Growth Republican Pat Toomey won reelection in (formerly) blue PA, by a wider margin than Trump. Conservative Marco Rubio won Florida by eight times the margin of Trump, a combined margin of well over 2 million in a swing state over the nearest Democrat in 2 races since Obamacare. Democrats lost 90% of their Presidential margin in MN in 8 years from 2008 to 2016.
The insurance companies failed and are pulling out of states and markets. The risk corridors failed. People are given fewer and fewer choices, less competition. The system is broken. It was broken before Obamacare. Obamacare was sold on lies, rammed down our throats and made things worse. If the charts don't show that, it's time for new and better charts.
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I stopped paying for health insurance and broke out my Tribal ID card and went to the local tribal health clinic. The prescription I used to pay 30 bucks a month for now costs one dollar.
Indians are exempted from Obamacare!
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This is POTH, but it makes clear the wisdom of Trump's tweets of yesterday about making sure the Dems own the disaster. At the moment it looks like the Reps are about to step in to take the blame. Stupid party once again?
http://www.nytimes.com/2017/01/04/us/affordable-care-act-congress-repeal-plan.html?emc=edit_th_20170105&nl=todaysheadlines&nlid=49641193
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I get this stuff in the mail and while I agree health care has needed changes I don't agree with the government taking over all of it which the ACA was to be the first step in that direction:
https://www.acponline.org/advocacy/acp-advocate/issue/article/718592
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Just as liberal as the rest of academia. In medical journals , other non medical magazines, Smithsonian, National Geographic they are all being overwhelmed with agenda driven liberals. I quit my NEJM subscription some years ago for this reason. Any moe Nat Geo stuff like last months ( *cover to cover* - not an article of even 2 but the entire magainze in my face diatribe on LBGTQ and 40 other letters) and that will be cancelled as well.
http://www.nationalreview.com/article/443876/public-health-crisis-gun-violence-debunked
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But this is probably right:
https://www.conservativereview.com/commentary/2017/01/gop-plan-to-dupe-members-into-keeping-obamacare/
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https://www.acponline.org/advocacy/acp-advocate/issue/article/718907
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One facet of the dynamic of knowable prices that I have been talking about here for quite some time:
http://time.com/4649914/why-the-doctor-takes-only-cash/
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I stopped paying for health insurance and broke out my Tribal ID card and went to the local tribal health clinic. The prescription I used to pay 30 bucks a month for now costs one dollar.
Indians are exempted from Obamacare!
I have never paid a dime and refuse to.
I don't know how true it is, but I read today, that the Don just signed an executive order, eliminating the IRS fines for not purchasing that polished t.rd.
EDIT: Yep... he's only signed one order thus far, but here it is....
"Sec. 2. To the maximum extent permitted by law, the Secretary of Health
and Human Services (Secretary) and the heads of all other executive departments
and agencies (agencies) with authorities and responsibilities under
the Act shall exercise all authority and discretion available to them to
waive, defer, grant exemptions from, or delay the implementation of any
provision or requirement of the Act that would impose a fiscal burden
on any State or a cost, fee, tax, penalty, or regulatory burden on individuals,
families, healthcare providers, health insurers, patients, recipients of
healthcare services, purchasers of health insurance, or makers of medical
devices, products, or medications. "
https://www.gpo.gov/fdsys/pkg/FR-2017-01-24/pdf/2017-01799.pdf
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https://www.dentaloptimizer.com/dental-cost-calculator/
Dentists mostly don't accept insurance except for minor things like cleanings and a few other things.
It is interesting to see the range of prices. And the huge differences between states. Of course like anything else price does not always guarantee quality. Paying less does not mean one would get less and paying more does not mean it is worth the extra amount.
As Mark John Geragos stated on cable news some years back something to the effect, "being successful in law is all sales".
Medicine is now that way.
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More medical organizations getting into raw politics that in my view they should stay out of. Wow *2* residents who are members are inconvenienced by Trump's travel ban. Thus it is an infringement on their rights and religion yada yada. The travesty and the inhumanity of it. :roll:
(And next will be the comparisons to Nazi Germany.)
https://www.acponline.org/acp-newsroom/acp-comprehensive-statement-us-immigration-policy
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I don't disagree to take more time. The AHA took decades to formulate. Replacing it with something that works better is no cinch. For sure no matter what any one comes up with will have some body some where bitching about it.
https://www.breitbart.com/big-government/2017/02/08/white-house-objects-to-drudge-criticism-gop-needs-time-to-replace-mammoth-obamacare/
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The GOP’s Health-Care Offensive
A new coalition aims to pitch Republicans’ ObamaCare overhaul to the wider public.
Photo: Getty Images
By Kimberley A. Strassel
Updated Feb. 9, 2017 7:45 p.m. ET
149 COMMENTS
When Dave Hoppe recalls his first big health-care fight, one memory stands out. It was the summer of 1994, and Sen. George Mitchell, the Democratic majority leader, had canceled August recess to force a debate over his party’s health-care monster: HillaryCare.
Senators weren’t happy about losing their break, remembers Mr. Hoppe, who at the time was an aide. “And yet, Republican senators were lining up in the cloakroom; they couldn’t wait to get to the floor,” he says. “They knew this issue. They’d studied it. They were better informed than Democrats about HillaryCare. There was such an esprit de corps. It was energizing.”
Twenty-three years later, Mr. Hoppe’s mission is to re-create that energy—only this time for a Republican Party that wants to pass a health-care bill, not stop one. He is helping to assemble a sweeping new alliance—underground until now—called One Nation Health. This “inside-out” coalition—a fast-growing collection of elected officials, staffers, grass-roots groups, think tanks, trade associations, donors and corporations—will serve as the GOP’s voice for selling the country on a “replace/repair” plan for ObamaCare.
One Nation Health is the brainchild of another veteran of the policy wars: David Wilson, the CEO of a Midwestern company called Asset Health. An advocate for individual health empowerment, Mr. Wilson has been in the arena since the Reagan days, and has recently worked on the leading conservative blueprints for reform.
Mr. Wilson grew concerned after last fall’s election that Republicans weren’t coordinating to explain what underpinned their ideas. “The right-of-center approach has a set of core principles—with regards to greater access, benefits, choices, health savings, responsibility, rewards to all Americans,” he says. “It is a unifying concept, and one [that] people can understand.”
One of his first calls was to an old friend, Mr. Hoppe, a respected D.C. fixture, both off Capitol Hill (as a consultant) and on (most recently as chief of staff to Paul Ryan). Mr. Hoppe was also concerned by GOP inaction, especially given the depth of determination on the left to thwart reform.
Mr. Hoppe had watched as powerful liberal groups, such as Families USA, launched a save-ObamaCare coalition within 24 hours of the 2016 election. He had seen Democrats begin a full-throated scare campaign about the risks of ending the health law. He had heard that deep-pocketed donors were committing to fund a massive PR effort. He had even witnessed President Obama sojourn to Capitol Hill to exhort Democrats to do whatever necessary to defend his signature law. Mr. Hoppe knew that the right needed its own campaign, and he agreed to help Mr. Wilson set up One Nation Health.
The umbrella group isn’t a policy shop. It isn’t a vehicle to push one GOP health plan over another. And it isn’t a lobbying outfit intended to corral votes in a legislative debate.
Instead, One Nation Health is a clearinghouse, a place for conservatives to meet, share notes, craft messages for the public, and unite on talking points. It will facilitate progress between Congress and the White House. The model was used successfully in 1993-94 by former Sens. Phil Gramm and Paul Coverdell in the fight against HillaryCare, leading to moments, like the Harry and Louise ads, that tipped the scale.
Mr. Hoppe spends every day on calls, and he held the group’s first big meeting two weeks ago. The coalition includes everyone from health policy gurus like the American Enterprise Institute’s James Capretta and the Heritage Foundation’s Bob Moffit to advocacy groups like the American Action Network, which is already running $1 million worth of TV ads, in 15 House districts, arguing for an ObamaCare replacement. Congressional leadership is on board. Rep. Kevin Brady, chairman of the Ways and Means Committee, addressed the group’s inaugural session. Mr. Hoppe says people are joining so fast that his biweekly conference calls are ballooning.
What they all understand: “We’ve got to explain to Americans that the end of ObamaCare doesn’t mean going back to the old system,” Mr. Hoppe says. “It’s about creating a whole new, better system.” That message might help buy Republicans some time to get a reform in place.
Another thing One Nation Health is: an experiment. The right is great at opposing things. It isn’t so great at unifying in support of ideas. Can the GOP flip the HillaryCare model on its head? The One Nation Health umbrella is a first big attempt to answer that question. The hope is that the very act of focusing conservatives on shared themes will remind them how much they have in common. If it works, it could be a model for other big reform efforts.
If it fails, Mr. Hoppe doesn’t like to consider the consequences. “Not everyone is going to get what they want in any reform effort,” he says. “But we’re here to remind people that this is an opportunity of a generation. And if we aren’t successful now, it’ll be generations before we get another shot.”
Write to kim@wsj.com.
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"Hate is both deadly and contagious. Now is the time to engage the medical profession in eradicating it."
Those who are intolerant are medically ill. I suppose this is aimed at the deplorable people who are "intolerant":
http://jamanetwork.com/journals/jama/fullarticle/2601506
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"Hate is both deadly and contagious. Now is the time to engage the medical profession in eradicating it."
Those who are intolerant are medically ill. I suppose this is aimed at the deplorable people who are "intolerant":
http://jamanetwork.com/journals/jama/fullarticle/2601506
The Soviet Union did a lot of the pioneering work on using mental health facilities for treating counterrevolutionary badthink.
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As a doctor I resent colleagues suggesting I use my position to enforce liberal propaganda
And the LEFT has the nerve to tell us we are closed minded.
All the while how they are recruiting armies of propagandists who are telling us how to think speak and behave and conform to their ideals.
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"Hate is both deadly and contagious. Now is the time to engage the medical profession in eradicating it."
Those who are intolerant are medically ill. I suppose this is aimed at the deplorable people who are "intolerant":
http://jamanetwork.com/journals/jama/fullarticle/2601506
The Soviet Union did a lot of the pioneering work on using mental health facilities for treating counterrevolutionary badthink.
http://jaapl.org/content/jaapl/30/1/136.full.pdf
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http://www.capoliticalreview.com/capoliticalnewsandviews/more-doctors-turn-to-fee-based-concierge-medicine-to-ease-insurance-woes/
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https://www.acponline.org/advocacy/acp-advocate/issue/article/719877
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http://thehill.com/policy/healthcare/321460-top-house-conservative-wont-back-draft-obamacare-replacement
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http://thehill.com/homenews/senate/323092-trump-courts-former-foe-ted-cruz
Paul Ryan got a lot of time on Tucker Carlson tonight and did a good job of explaining/defending the House's bill.
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http://thehill.com/homenews/senate/323092-trump-courts-former-foe-ted-cruz
Paul Ryan got a lot of time on Tucker Carlson tonight and did a good job of explaining/defending the House's bill.
This bill is part one of a three-part plan. Only what can go through reconciliation is included. Otherwise willl be filibustered.
Part 2 goes through the full Senate process, includes things like selling across state lines.
Part 3 is the executive branch implementing the law.
Amazing how this issue is splitting the right. Hard to know who to believe. One negative indicator is Paul Krugman saying positive things about it today (?).
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IIRC you have Parts 2 and 3 reversed.
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http://www.breitbart.com/big-government/2017/03/10/nancy-pelosi-we-have-a-right-to-know-whats-in-health-care-bill-before-it-passes/
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Not sure that I agree, but he makes his case well.
http://www.dailywire.com/news/14325/should-republicans-just-let-obamacare-fail-here-ben-shapiro?utm_source=shapironewsletter&utm_medium=email&utm_content=070516-news-title&utm_campaign=lead
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https://www.forbes.com/sites/theapothecary/2017/03/14/believe-it-or-not-cbos-score-of-house-gop-obamacare-replacement-is-better-than-expected/#3f1488f75951
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https://www.forbes.com/sites/theapothecary/2017/03/14/believe-it-or-not-cbos-score-of-house-gop-obamacare-replacement-is-better-than-expected/#3f1488f75951
Interesting - for as far as it goes. CBO is scoring part one of a three part plan.
"[AHCA cuts taxes, cuts spending, cuts the deficit...] And that’s before you take into account the macroeconomic effects that those tax cuts would have on economic growth, and thereby on greater tax revenues."
It's 2017 and a multimillion dollar study cost and they can't even attempt dynamic scoring?
Score part of a plan without considering the benefits of the legislation? Yes, that is their mission, incomplete and therefore false scoring.
Obamacare was written to score under one trillion in cost over ten years. Is there one honest observer who believes that was true?
Repealing 24 Obamacare taxes on the economy will grow the economy and increase employment and incomes, all not considered in the numbers. Removing the largest shackle in the economy on employment won't increase jobs and incomes? Increased income is not a factor in affordability? I thought it was the denominator. To CBO, it margin of error, or in this case, just error.
The cost to be covered will not go down when simpler, catastrophic plans are legalized? Other reforms will also not have downward pressure on prices, such as allowing plans sold across state lines, malpractice reform, etc.? Cost of plans is not a factor in affordability? I thought it was the numerator. Who that is working a good, full time job would not choose to pay a small or reasonable and affordable amount for coverage against an unaffordable health catastrophe? The more you make, the more you save, the more you are worth, the more likely you are to insure against a severe financial setback, I would think. Oddly, not figured in the numbers.
If you are CBO, increasing incomes, increasing the size of the workforce, increasing per capita incomes and lowering the costs of coverage, these are not factors of significance when calculating how many people will purchase healthcare policies.
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My understanding is that as part of its "nonpolitical" mission, CBO as a matter of policy does not do dynamic scoring.
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My understanding is that as part of its "nonpolitical" mission, CBO as a matter of policy does not do dynamic scoring.
Deniers of science. CBO will tell you they do figure in dynamic, macroeconomic effects,
https://www.cbo.gov/publication/50919
yet they understate the real effects every single time.
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http://www.vox.com/policy-and-politics/2017/3/14/14921594/obamacare-implosion-ahca
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http://www.vox.com/policy-and-politics/2017/3/14/14921594/obamacare-implosion-ahca
That is the fake news story of the day, Obamacare isn't failing. "Trump can fix Obamacare ... by doing nothing". Good luck with that. I'm not sure Vox is pulling for his success.
We just have to fund the "risk corridors". And it's already Republicans fault: http://www.dailykos.com/story/2016/11/7/1592247/-How-the-GOP-Broke-Obamacare
Republicans have been undermining it from the start!
Premiums are going up 25-70% PER YEAR, your plan is gone, your doctor is gone, your premiums and deductibles are higher than ever before, and you went from self-sufficient to becoming a ward of the state if you are a median income earner, but the program IS NOT FAILING or in a death spiral. Good grief.
The article begins: "Beyond its eye-popping findings on higher premiums and large-scale coverage loss..." Sorry, but they already got me there. What is beyond screwing up the system and the economy? More static numbers - based on assumptions already known to be false.
What the hell was the purpose of the ACA again? Higher premiums and large scale coverage losses?? Costs far beyond what were promised? Competition lost and "risk corridors' created that mean insurance companies aren't insuring us at all?
http://dailysignal.com/2016/07/26/16-obamacare-co-ops-collapsed-heres-how-the-rest-are-faring/
http://hotair.com/archives/2016/09/12/coming-risk-corridors-bailout-obamacare/
http://thehill.com/blogs/congress-blog/healthcare/309902-obamacares-risk-corridor-corruption-never-ends
What they miss goes back to the (lack of) dynamic scoring question. This largest ever new entitlement is already keeping our economy from growing; it's not just a healthcare system or insurance issue. As the economy stagnates or shrinks and fewer employers go out and hire and fewer and fewer people go out and earn their own way and more and more people become dependent on the government for their largest and fastest growing expense and vote for more and more benefits and larger and larger subsidies, the whole economy goes down, not just the healthcare system. And then you go in needing surgery and there is a 270 day wait, you know why they called it a death spiral.
That's the kind of small thing one might miss with static analysis. MHO.
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Some interesting points in here.
https://www.washingtonpost.com/opinions/the-real-world-of-obamacare-repeal/2017/03/16/cba55228-0a71-11e7-b77c-0047d15a24e0_story.html?utm_term=.101fbfef8b8a
The real world of Obamacare repeal
By Charles Krauthammer. March 16
The Lord giveth and the Lord taketh away, but for governments it’s not that easy. Once something is given — say, health insurance coverage to 20 million Americans — you take it away at your peril. This is true for any government benefit, but especially for health care. There’s a reason not one Western democracy with some system of national health care has ever abolished it.
The genius of the left is to keep enlarging the entitlement state by creating new giveaways that are politically impossible to repeal. For 20 years, Republicans railed against the New Deal. Yet, when they came back into office in 1953, Eisenhower didn’t just keep Social Security, he expanded it.
People hated Obamacare for its highhandedness, incompetence and cost. At the same time, its crafters took great care to create new beneficiaries and new expectations. Which makes repeal very complicated.
The Congressional Budget Office projects that, under House Speaker Paul Ryan’s Obamacare replacement bill, 24 million will lose insurance within 10 years, 14 million after the first year.
Granted, the number is highly suspect. CBO projects 18 million covered by the Obamacare exchanges in 2018. But the number today is about 10 million. That means the CBO estimate of those losing coverage is already about 8 million too high.
Nonetheless, there will be losers. And their stories will be plastered wall to wall across the media as sure as night follows day.
That scares GOP moderates. And yet the main resistance to Ryan comes from conservative members complaining that the bill is not ideologically pure enough. They mock it as Obamacare Lite.
For example, Ryan wants to ease the pain by phasing out Medicaid expansion through 2020. The conservative Republican Study Committee wants it done next year. This is crazy. For the sake of two years’ savings, why would you risk a political crash landing?
Moreover, the idea that you can eradicate Obamacare root and branch is fanciful. For all its catastrophic flaws, Obamacare changed expectations. Does any Republican propose returning to a time when you can be denied health insurance because of a preexisting condition?
It’s not just Donald Trump who ran on retaining this new, yes, entitlement. Everyone did. But it’s very problematic. If people know that they can sign up for insurance after they get sick, the very idea of insurance is undermined. People won’t sign up when healthy, and the insurance companies will go broke.
So what do you do? Obamacare imposed a monetary fine if you didn’t sign up, for which the Ryan bill substitutes another mechanism, less heavy-handed but still government-mandated.
The purists who insist upon entirely escaping the heavy hand of government are dreaming. The best you can hope for is to make it less intrusive and more rational, as in the Ryan plan’s block-granting Medicaid.
Or instituting a more realistic age-rating system. Older patients use six times as much health care as their younger counterparts, yet Obamacare decreed, entirely arbitrarily, that the former could be charged insurance premiums no more than three times that of the latter. The GOP bill changes the ratio from 3-to-1 to 5-to-1.
Premiums better reflecting risk constitute a major restoration of rationality. (It’s how life insurance works.) Under Obamacare, the young were unwilling to be swindled and refused to sign up. Without their support, the whole system is thus headed into a death spiral of looming insolvency.
Rationality, however, has a price. The CBO has already predicted a massive increase in premiums for 60-year-olds. That’s the headline.
There is no free lunch. GOP hard-liners must accept that Americans have become accustomed to some new health-care benefits, just as moderates have to brace themselves for stories about the inevitable losers in any reform. That’s the political price for fulfilling the seven-year promise of repealing and replacing Obamacare.
Unless, of course, you go the full Machiavelli and throw it all back on the Democrats. How? Republicans could forget about meeting the arcane requirements of “reconciliation” legislation (which requires only 51 votes in the Senate) and send the Senate a replacement bill loaded up with everything conservative — including tort reform and insurance competition across state lines. That would require 60 Senate votes. Let the Democrats filibuster it to death — and take the blame when repeal-and-replace fails and Obamacare carries on and then collapses under its own weight.
Upside: You reap the backlash. Downside: You have to live with your conscience.
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Dr. Kruathmmer writes:
"People hated Obamacare for its highhandedness, incompetence and cost. At the same time, its crafters took great care to create new beneficiaries and new expectations. Which makes repeal very complicated.
One doctor who had a hand in "crafting" the AHA said quite explicitly less then on year ago is it "won't get repealed". It would be political suicide because of the people now on it who had no insurance otherwise.
The game of chicken absolutely was part of the calculation. We dare your!!
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https://www.yahoo.com/news/woman-confronts-trump-health-secretary-at-town-hall-over-defunding-planned-parenthood-134609221.html
Hillary's adoring friend in the press , named Dana Bash points out that 105 counties in the US only have planned parenthood to provide full spectrum of BCP in US
First there are over 3000 counties in the US so 105 is a small fraction ~ 3 % .
Second what stops a person from simply driving over to the next county?
I thought HHS sec Price did very well with his answer.
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Democrats, for all their flaws, are geniuses at framing the argument. The repeal of Obamacare issue has been framed by the question of, what are you going to do with the 20 million that got their healthcare through the program?
CBO raises the number to 24 million who will lose that healthcare. Krauthammer says it's really 10 million:
"The Congressional Budget Office projects that, under House Speaker Paul Ryan’s Obamacare replacement bill, 24 million will lose insurance within 10 years, 14 million after the first year.
Granted, the number is highly suspect. CBO projects 18 million covered by the Obamacare exchanges in 2018. But the number today is about 10 million. That means the CBO estimate of those losing coverage is already about 8 million too high."
It's a trap. While we fight their false numbers and they never concede, it is taken as admitting that 10 millions will be left out, still too many.
But of course it's a false argument. Healthcare was getting unaffordable before Obamacare and last 8 years made it a national crisis. The program IS in a death spiral. You can't effectively compare a new proposal to something that can't be sustained anyway and we can't compare anything accurately with static analysis. And what about the 20 million and more that lost their plans over Obamacare? That gets lost in the other arguments. Liberals framed the issue.
Affordability has two components, cost and income. Big government in general and Obamacare in particular make it impossible to grow incomes. Look at the stagnation in median incomes or listen to a Bernie Sanders speech. That has to end. Incomes have to grow if we are ever going to able to afford all the treatments for all the ailments that will ail an aging population. The first point of affordability is grow the economy. Excess regulations look like they are getting disrupted fast, but we kicked tax reform down the road. Bad choice, it should ALL be on the table.
On the cost side, no one seems to be able to point to the one reason why healthcare costs go up and up and up. Maybe that's because there isn't just one reason! Why need to go after all the causes and come up with the best solutions possible. In a nutshell that answer is to return the free market discipline that other industries have to healthcare. I hate to be a pessimist, but my thought at the moment is, good luck doing that.
What we have instead is Republicans fighting with Republicans over different proposals that will never pass and become law. Our side needs to come together and put it all on the table - now - with the best, compromise solution possible. Or be governed by their policies. Like when Republicans continued CRAp into the financial crisis, Obamacare is still the law of the land and so is the Democrats convoluted tax plan.
This doesn't get easier later.
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I am a humble person but I remember that after reading three thousand pages of NAFTA in 1993, I bragged that I could write an international free trade agreement on the back of a cocktail napkin.
Then came the complexities of Hillarycare (see chart):
(http://www.motherjones.com/files/ClintonHealthCareChart630.jpg)
The people rose up against that federal monstrosity but fast forward 16 years and along came Obamacare, and the people rose up against that and along came Trump or Ryan Care.
Before we criticize others for taking on the most difficult task of designing a healthcare system that meets all the requirements for all the peope, we should each answer the question of what our own proposal would look like. With that in mind, today I release my US Government federal healthcare proposal as follows, hat tip to the authors of the 10th amendment.
Doug's Federal Healthcare Reform Proposal, March 2017:
"Powers, such as anything to do with the people's individual and family healthcare, that are not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."
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Doug's Federal Healthcare Reform Proposal, March 2017:
"Powers, such as anything to do with the people's individual and family healthcare, that are not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."
How are the various political entities supposed to wet their beaks with this? I see no opportunity for graft or rentseeking. This is madness!
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"How are the various political entities supposed to wet their beaks with this? I see no opportunity for graft or rentseeking. This is madness!"
Imagine the economic energy that could be generated if the massive industry of lawyers, lobbyists and rent-seekers seeking favor with the government had to produce something of value instead of feed off of the efforts of others.
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http://www.nbcnews.com/politics/congress/biden-defends-obamacare-hill-republican-leaders-hunt-votes-n737086
The problem is with the Republicans
major majority and still probably can't get bill passed . OF course *every single crat* is against.
I would like for it to pass for the sake of the party . i don't love the bill but we need to get this first step passed.
As far as my point of view as a physician I have no care one way or another though . It is all back and forth BS with me plodding on.
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http://www.nbcnews.com/politics/congress/biden-defends-obamacare-hill-republican-leaders-hunt-votes-n737086
The problem is with the Republicans
major majority and still probably can't get bill passed . OF course *every single crat* is against.
I would like for it to pass for the sake of the party . i don't love the bill but we need to get this first step passed.
As far as my point of view as a physician I have no care one way or another though . It is all back and forth BS with me plodding on.
There sure are a lot of "Republicans" (cough)... from Blue (or almost Blue) states in the list of 29 who don't support the rest of the GOP.
Here are the House Republicans who are either against the bill or leaning against it. NBC News will update this list:
Jim Jordan (R-OH)
Mark Meadows (R-NC)
Justin Amash (R-MI)
Dave Brat (R-VA)
Raul Labrador (R-ID)
Mo Brooks (R-AL)
Rob Wittman (R-VA)
Thomas Massie (R-KY)
Tom Garrett (R-VA)
Ileana Ros-Lehtinen (R-FL)
Leonard Lance (R-NJ)
Mark Amodei (R-NV)
Jim Bridenstine (R-OK)
Louie Gohmert (R-TX)
John Katko (R-NY)
Brian Fitzpatrick (R-PA)
Walter Jones (R-NC)
Ted Budd (R-NC)
Mark Sanford (R-SC)
Rick Crawford (R-AR)
Ted Yoho (R-FL)
Scott DesJarlais (R-TN)
Warren Davidson (R-OH)
Paul Gosar (R-AZ)
Rod Blum (R-Iowa)
Andy Harris (R-MD)
Dan Donovan (R-NY)
Frank LoBiondo (R-NJ)
David Young (R-IA)
Bold being solidly BLUE, Underlined being generally Blue except for the last presidential election, and italicized being true battleground states, showing at least 14 very problamatic people on that list that are either bold or underlined.
Edit: Extra Credit - I've seen brie cheese that wasn't as white as this list is.... kind of shoots the Democrat's "racist, Republican party" garbage, down in flames. There's not a miniority on that list...
Also... Ileana Ros-Lehtinen.... looks like Matt Farley's twin sister... maybe she "live(s) in a van down by the river."
(http://static.makers.com/maker/Ileana_Ros_Lehtinen_YAM_MAKERS3_0102-Ileana-Ros---Lehtinen_A.jpg)
(http://www.270towin.com/presidential_map_new/maps/bRgO6.png)
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The rinos love to act as the Washington Generals as the dems play as the Globetrotters.
http://www.nbcnews.com/politics/congress/biden-defends-obamacare-hill-republican-leaders-hunt-votes-n737086
The problem is with the Republicans
major majority and still probably can't get bill passed . OF course *every single crat* is against.
I would like for it to pass for the sake of the party . i don't love the bill but we need to get this first step passed.
As far as my point of view as a physician I have no care one way or another though . It is all back and forth BS with me plodding on.
There sure are a lot of "Republicans" (cough)... from Blue (or almost Blue) states in the list of 29 who don't support the rest of the GOP.
Here are the House Republicans who are either against the bill or leaning against it. NBC News will update this list:
Jim Jordan (R-OH)
Mark Meadows (R-NC)
Justin Amash (R-MI)
Dave Brat (R-VA)
Raul Labrador (R-ID)
Mo Brooks (R-AL)
Rob Wittman (R-VA)
Thomas Massie (R-KY)
Tom Garrett (R-VA)
Ileana Ros-Lehtinen (R-FL)
Leonard Lance (R-NJ)
Mark Amodei (R-NV)
Jim Bridenstine (R-OK)
Louie Gohmert (R-TX)
John Katko (R-NY)
Brian Fitzpatrick (R-PA)
Walter Jones (R-NC)
Ted Budd (R-NC)
Mark Sanford (R-SC)
Rick Crawford (R-AR)
Ted Yoho (R-FL)
Scott DesJarlais (R-TN)
Warren Davidson (R-OH)
Paul Gosar (R-AZ)
Rod Blum (R-Iowa)
Andy Harris (R-MD)
Dan Donovan (R-NY)
Frank LoBiondo (R-NJ)
David Young (R-IA)
Bold being solidly BLUE, Underlined being generally Blue except for the last presidential election, and italicized being true battleground states, showing at least 14 very problamatic people on that list that are either bold or underlined.
(http://www.270towin.com/presidential_map_new/maps/bRgO6.png)
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The rinos love to act as the Washington Generals as the dems play as the Globetrotters.
Yes they do.... I'm curious what the demographic particulars of their individual districts look like.
I almost don't even have to look it up... but since I'm bored and the wife isn't home... :-D :-D :-D
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The rinos love to act as the Washington Generals as the dems play as the Globetrotters.
Yes they do.... I'm curious what the demographic particulars are of their individual districts look like.
I almost don't even have to look it up... but since I'm bored and the wife isn't home... :-D :-D :-D
I don't think it's the demographics as much as it's the DC uniparty power structure.
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http://thehill.com/policy/healthcare/325568-trump-tells-gop-to-take-it-or-leave-it-on-obamacare-repeal
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The doctor who during a meeting I was in who said he thought the Repubs would not be ABLE to repeal Obamster care because of this simple phrase: "20 million people will lose their insurance"
Ryan terrified and inept at dealing with this is giving as a lite alternative that makes EVERYONE unhappy.
Just wait till we get to the tax cut issue. We will not be able to access the internet or turn on a TV without hearing "tax cuts for the rich" on the wall to wall liberal MSM day and night.
Why can I not be justifiably angry that so many people in this country are getting something for nothing while I struggle for 5 months a year to pay for it. Why do I NEVER have a voice? Why is there no one who will stand up for me? Why am I always taken for granted?
Rush Limbaugh acknowledged a caller last week made a GREAT point as to why he thought Trump has such strong backing from a group of people.. These are the people who day in and day out pay INTO a system and never get ANYTHING back and are constantly forced to hear about everyone else's sob stories. All the other "victims" and identity BS.
Trump was the closest thing to giving us for the first time in 29 years a voice. (flawed for sure but at least a voice nonetheless) Including us in "America". Not the world but us here all together in America.
And then Ryan Republicans just refuse to fight for this concept.
Instead we get Republican social engineering which is a loser anyway.
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ccp: The doctor who during a meeting I was in who said he thought the Repubs would not be ABLE to repeal Obamster care because of this simple phrase: "20 million people will lose their insurance"
An exchange on this thread Oct-Nov, 2016:
Gruber:"The main goal of Obamacare was two-fold. One was to cover the uninsured, of which we’ve covered 20 million, the largest expansion in American history. The other was to fix broken insurance markets where insurers could deny people insurance just because they were sick or they had been sick."
Crafty: Name me a Rep who answers this cogently and tell me what he says.
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It was 100% foreseeable and unavoidable all along that you would be accused of taking health insurance away for 20 million if you "repeal Obamacare lock, stock and barrel".
Any pure conservative, libertarian or federalist can see that health insurance is not the domain of the federal government for a host of reasons. And any honest historian can tell you that we have not only never ended a major entitlement after it is in effect, have we ever even cut the growth rate of one?! CBO was wrong on Medicaid by 17-fold as it grew and expanded.
At the very minimum, moving forward on repeal/reform requires consensus of 50% plus one vote of the House, 50 Senators and the White House. A pure view that the federal government has no business at all in health care may be exactly right but isn't going to ever reach that threshold, no matter what Ted Cruz and the Freedom caucus say. Do any of them say they have the votes?
Pointing out that the 20 million is really 10 million, http://dogbrothers.com/phpBB2/index.php?topic=1411.msg102499#msg102499, or that more than 20 million lost their policies because of Obamacare doesn't make the question go away, what are you going to do about the 20 million (that is really 10 million) that will lose their healthcare if Obamacare is repealed?
Republicans propose tax credits - violation of our principles, new entitlement. Another option is a transition period, two year delay or phase-out. It still begs the question, what are we going to do with the 20 million (10 million)?
It partly comes down to policy and it partly comes to surrendering the war of messenging over the last over the last 8 (or 100) years.
To the naysayers of the Ryan and Trump plan, you better do something because doing nothing is worse and will truly lead to socialized medicine if not stopped now.
And to the writers of the Ryan and Trump 3-part plan, this better be good - and prove the naysayers wrong.
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Addressing another point from ccp:
...Why can I not be justifiably angry that so many people in this country are getting something for nothing while I struggle for 5 months a year to pay for it. Why do I NEVER have a voice? Why is there no one who will stand up for me? Why am I always taken for granted? ...
ccp, You (we) will NEVER win the political argument that taxes are unfair to the productive and relatively well-paid. It has to be won on the other side of it. Big government and all these spending programs are hurting the beneficiaries. Look at the inner city, the war on poverty and the cycle of dependence and perpetual low income created. With SSI, Section 8, food stamps, FAFSA and on and on including Obamacare, recipients essentially enter a contract with the government to stay poor or lose benefits. As the benefits get larger and larger, the contract to be permanently low income becomes unbreakable.
People on the cusp of receiving or losing benefits face a far higher than a 100% marginal tax rate, making the earning of the next dollar of income a very bad economic decision. They can make $500 or a thousand more and lose tens of thousands of benefits. They would need to more than double or triple their income to replace what they will lose, and that is not instantly possible. Crucial rungs of the economic ladder just above them were torn out by our entitlement system. Obamacare, unrepealed, brings permanent dependency to millions more people. The rich will need to make more and more to pay for it or it folds and people with currently lower incomes get locked into lower incomes long term. Who does that help?
The poor in America had free health care before Obamacare - and after it, if repealed. Obamacare was aimed primarily at the second quintile, to subsidize comprehensive healthcare for those who work for modest incomes and don't get employer healthcare. It was also aimed at taking the opportunity to enact an irreversible federal government takeover of the whole system that would eventually lead to whatever you want to call it, single, federal government payer, universal care, socialized medicine.
How do you explain to those losing their O'care subsidy is in their best interest? That where they were paying $100 of an $800 policy, and now will pay 799 because of some minor deregulation will help them? It is a tough sell. That is why you look for a wedge in the opposite direction of the ones planted by the left.
You must make it possible and desirable for them to make more income and rise out of subsidy. The rising tide, JFK called it. You make it beneficial for them to make more and more income, not punishing at the lower end (or at the high end). You make it legal and possible for them to buy less expensive healthcare policies to cover basic needs while they raise their incomes to pay for larger plans if they want them. You take the part of the cost out of it that is paying for someone else's care, young paying for the old etc. Your policy cost covers you and your risks, not the ills of the system. We need to message better. We are not replacing a system that works; we are replacing a system that already failed, is unfunded and in a death spiral.
Create an environment where people want to be off the dole, not on it. If we can accomplish that in less than 100 years, we are doing better than anyone thought possible. In the meantime, dismantle this new entitlement the best you before it gets any further entrenched.
This isn't going to be easier later.
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http://www.dickmorris.com/house-revolt-revolting/
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Bill developed behind closed doors with a couple of add-ons patched on. Ryan introduced the bill before the CBO had scored it. CBO's number of 24 million to lose coverage was devastating (also assertion the Ocare was not imploding)-- Reps had no political response. Sec HHS Price said next to nothing about what he would do for Phase Two and no one said anything specific about Phase Three. The bill had 17% support from the public.
Now the devastation that comes should be laid at the feet of those responsible for Ocare.
==========================
https://alibertarianfuture.com/big-government/healthcare-obamacare/house-freedom-caucus-endorsed-rand-paul-obamacare-replacement-bill/
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Second post
http://www.aei.org/publication/the-little-death-spiral-that-couldnt/?utm_source=paramount&utm_medium=email&utm_content=AEITODAY&utm_campaign=032217
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http://www.zerohedge.com/news/2017-03-27/forget-obamacare-ryancare-or-any-future-reformcare-healthcare-system-completely-brok
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Why can I not be justifiably angry that so many people in this country are getting something for nothing while I struggle for 5 months a year to pay for it. Why do I NEVER have a voice? Why is there no one who will stand up for me? Why am I always taken for granted?
[...]These are the people who day in and day out pay INTO a system and never get ANYTHING back and are constantly forced to hear about everyone else's sob stories. All the other "victims" and identity BS.
Hear, hear.
Addressing another point from ccp:
...Why can I not be justifiably angry that so many people in this country are getting something for nothing while I struggle for 5 months a year to pay for it. Why do I NEVER have a voice? Why is there no one who will stand up for me? Why am I always taken for granted? ...
ccp, You (we) will NEVER win the political argument that taxes are unfair to the productive and relatively well-paid. It has to be won on the other side of it. Big government and all these spending programs are hurting the beneficiaries. Look at the inner city, the war on poverty and the cycle of dependence and perpetual low income created. With SSI, Section 8, food stamps, FAFSA and on and on including Obamacare, recipients essentially enter a contract with the government to stay poor or lose benefits. As the benefits get larger and larger, the contract to be permanently low income becomes unbreakable.
Nature's Law... "Produce or get smashed."
Take away every safety net and let Nature run its course.
I'm saying that knowing that I full well, paid for years, to support my political opponents. I have no wish in doing so, and I'm not apologetic about it. I worked two full time jobs for over a year, in the States, only to never see my daughter and have most of it seized in taxes, to go support a breeding factory that gets compensated accordingly for being more productive, who will all grow into votes that are cast directly against my interest. No thanks.
Let them find work of starve. Everyone on this thread has to. I have no pity and it isn't because I've worked here. It's just common sense. By the way, I purposely left race out of that. I don't care who it is.
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From somewhere in my readings this morning, these are the votes in the House that the Ryan-Trump-GOP bill did not win, 15 in 'Freedom' caucus, 10 'moderates' and 8 'other'. There is no way to perfectly measure because they never took the vote.
All accounts either blame the Freedom Caucus ("far right") for not agreeing to what they don't strongly oppose, or blame Speaker Ryan for failing to get consensus. But a 216 vote consensus was not possible when people strongly disagree with each other at both ends and the middle.
[Doug's proposal here: http://dogbrothers.com/phpBB2/index.php?topic=1411.msg102574#msg102574]
The Freedom caucus does not want a new entitlement or anything that would accurately be labeled Obamacare-Lite. They (correctly) believe in market solutions, government's role if they have one is in the safety net, not to design and run the system. I agree, but do THEY have 216 votes? No one asks them, see Jim Jordan on Fox News Sunday, because it is obvious they don't.
Moderates worry about the political (and human) consequences that they will be blamed for keeping 24 million people off of coverage. See false CBO report - that is required to bring the bill to a vote. (Change that rule!)
Put in even fewer subsidies and write a purer, market oriented billl for the right and you lose more votes on the left. Leave it they way it is now and all Republicans (and all Americans) are screwed.
So what next for reform? What force moves the needle or tips the balance? Hopefully they are reading the polls in the aftermath of this and figuring out an answer. If they wait until after the mid-terms to primary and challenge each other, the majority will be lost along with the once in a lifetime opportunity to end this disaster.
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Here is how I see it:
A) Insurance is for catastrophic events, but what we have now and what informs people's sense of things is analogous to thinking car insurance should pay for gas, oil, tires, windshield wipers, detailing, everything!
B) This creates a situation where the user/consumer does not pay for what he consumes; he does not care about price. Surprise! Prices rise faster than inflation!
C) Surprise! This results in a market where prices are unknown, and virtually unknowable, even for the most diligent. Those outside of the bulk discounts achieved by insurance companies get anally raped by prices lacking sanity or the discipline of market forces.
D) These means pretty much EVERYONE is terrified of being left responsible for paying for their medical care; thus they demand that insurance cover everything and the vicious feedback loop continues.
When I come back from the gym, I will offer what I believe to be the conceptual basis of the solution.
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I have no ideas other than my basic instincts (which is every man for himself).
Interested to see what GC's take is on it.
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http://fortune.com/2013/05/23/what-tummy-tucks-can-teach-us-about-health-care-reform/
What tummy tucks can teach us about health care reform
Shawn Tully
May 23, 2013
Despite growing demand for cosmetic surgery, prices are rising more slowly than inflation.
Fortune -- We’re constantly hearing why the market forces that bring us great deals on cars, cellular phones, and houses can never work in health care.
One leading myth is that each patient is so different, and every procedure so tailored, that doctors can’t determine the cost, or tell patients the price, in advance. Hence, providing consumers with prices they can compare is totally impractical. Another holds that medicine is so sophisticated that consumers are incapable of choosing deals that combine low cost with the promise of excellent outcomes. A third is the concept that -- in contrast to every other area of the economy -- new technology inevitably makes everything more expensive.
Those oft-repeated beliefs are wrong. And the best evidence is the ultra-competitive field of cosmetic surgery and minimally invasive treatments.
A new paper from conservative think tank the National Center for Policy Analysis, shows just how the industry’s dynamics follow the patterns that prevail everywhere else. The author, economist Devon Herrick, collected and analyzed data from the annual statistical surveys of the American Society of Plastic Surgeons, and the trends he has identified are extraordinary.
Over the past two decades, U.S. medical prices –– not total spending –– have been rising at around 5% per year, or twice the increase in the CPI. By contrast, prices for cosmetic surgery are inching forward at just 1.3% a year, or a full 1.2 percentage points lower than inflation.
The reason is that patients spend their own money on cosmetic treatments, and in doing so behave just like consumers everywhere else. They shop for the best deals and love doing it. In every other medical field, costs are largely covered by third parties, employers, insurers, or Medicare and Medicaid.
Consumers pay just 11 cents for every dollar in care they consume. The rewards for seeking the most favorable prices are nil.
It’s just the opposite in cosmetic surgery: Whatever you can save on a facelift or Botox treatment is money you get to spend on a vacation or your kid’s tuition. Doctors compete vigorously to win business using steep discounts. Websites such as Groupon (GRPN, -1.14%) and LivingSocial regularly offer “deals-of-the day” for cosmetic procedures. The average cost of Botox, Herrick found, dropped from $500 in 2007 to $365.
The growth in cosmetic procedures outstrips virtually every other area of health care. The volume of surgical procedures, such as facelifts and liposuction, is rising at 8% a year, while minimally invasive treatments like hair and spider vein removal with lasers are increasing 28% annually.
Yet the explosive demand has not been accompanied by big prices. The keen competition forces doctors to prize efficiency. Most of the procedures are conducted in clinics where costs are far lower than in hospital surgery rooms. The supply of practitioners and facilities is highly elastic -- a great argument for why allowing manpower to freely follow the market works in medicine just as everywhere else.
For example, nurses and aestheticians perform many of the minimally invasive treatments, including teeth-whitening and chemical peels. Physicians don’t need to be board certified plastic surgeons to do chin implants. And OB/GYNs are becoming experts in tummy tucks.
Doctors are also touting enhanced and advanced procedures to garner premium prices. A case in point is Lasik eye surgery. The going rate for basic Lasik was $2,100 per eye in 1999. By 2011, the price had dropped 18% to $1,630. So ophthalmologists developed Custom Wavefront, a laser procedure that better customizes the surgery to the exact shape of the patient’s eye.
Custom Wavefront commands a premium price of $2,151 per eye –– about the same rate standard Lasik cost over two decades ago. As Wavefront grows in popularity, it’s likely that competition will hold down its price, just as it did for basic Lasik. In eye care, it’s clear that new technology coupled with stiff competition leads to reasonable, and even declining prices, but still gives doctors an incentive to get at least a temporary premium through innovation.The market will work in medicine. Rules that lavishly subsidize demand and at the same time shackle supply are not the answer. Follow the lessons from facelifts and tummy tucks: The more consumers spend their own money, the more efficient health care will become.
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GM's tummy tuck post makes the point I make.
Here is how I see it:
A) Insurance is for catastrophic events, but what we have now and what informs people's sense of things is analogous to thinking car insurance should pay for gas, oil, tires, windshield wipers, detailing, everything!
B) This creates a situation where the user/consumer does not pay for what he consumes; he does not care about price. Surprise! Prices rise faster than inflation!
C) Surprise! This results in a market where prices are unknown, and virtually unknowable, even for the most diligent. Those outside of the bulk discounts achieved by insurance companies get anally raped by prices lacking sanity or the discipline of market forces.
D) These means pretty much EVERYONE is terrified of being left responsible for paying for their medical care; thus they demand that insurance cover everything and the vicious feedback loop continues.
E) The solution as I see it, and Dr. Ben Carson was my starting point here, is to
a) limit health insurance to true catastrophes after a pretty big deductible;
b) take the money used to everything-is-covered health insurance use it to fund Health Savings Accounts for low income folks, and
c) require prices be known.
Thus, market discipline is brought to prices and consumption of services, and the cost of insurance comes way down.
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For as far as it goes, Crafty has this exactly right IMHO for how a successful American healthcare system needs to work - as a long term solution. The ONLY forces that contain costs are market competition and the budget constraints of the customers, of which we now have neither. One legitimate role for government is to make providers provide transparent pricing wherever possible.
Can such a program alone (described below) win 216 votes in the House right now, 51 (or 60) votes in the Senate and get signed by the President? - No. Why not? Republicans will be (falsely) accused of putting 24 million people out of healthcare. 100 million adults plus nearly all children under 16 don't work. That fact doesn't change instantly and doesn't change much over time. It will take time to repeal the Obama era caps on growth and then take time for incomes and workforce participation to grow and for costs to be contained. Meanwhile, new cures for ailments will be developed, be expensive and people will demand them.
There needs to be a plan for the transition to a market system. 10 million people are receiving an average of 3600/year subsidy not counting government healthcare in Medicaid, Medicare, VA, government employee plans, etc. Very few representatives will support any kind of pure, market solution that leaves them open to criticism of being heartless and leaving real people without coverage. (cf. The freedom caucus plan had far less support than the Ryan-Trump plan.)
We need a plan that can: 1) pass now, 2) provide adequately for the transition, and 3) leave us in the end with a privatized, market system where consumers have at least as much power as providers and government.
We also need the other reforms, especially of the tax and entitlement systems, that are necessary to grow national income and reduce program dependency or we aren't going to ever grow past rampant government dependency. Income is an essential component in affordability.
All bills that address a healthcare transition will be flawed, and socialistic, and Obamacare Lite-like, but the consequences of passing none of them right now will be catastrophic.
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Crafty's plan:
a) limit health insurance to true catastrophes after a pretty big deductible;
b) take the money used to everything-is-covered health insurance use it to fund Health Savings Accounts for low income folks, and
c) require prices be known.
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Without the persuasive articulation of the big picture we offer, we will fail to get there.
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Imagine if we had such a system for food distribution ?
Might help with the obesity rate.
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It has worked that way for Venezuela , , ,
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Hat tip to our Objectivist:
IMHO Ann Coulter is a very uneven writer-- sometimes brilliant, sometimes glib and specious while drifting into nastiness and performance art, but when she is on she is on.
A HEALTH CARE PLAN SO SIMPLE, EVEN A REPUBLICAN CAN UNDERSTAND!
March 29, 2017 – Ann Coulter.
It's always impossible to repeal laws that require Ann to pay for greedy people, because the greedy run out on the streets wailing that the Republicans are murdering them.
Obamacare is uniquely awful because the free stuff isn't paid for through income taxes: It's paid for through MY health insurance premiums. This is unfortunate because I wanted to buy health insurance.
Perhaps you're not aware -- SINCE YOU EXEMPTED YOURSELVES FROM OBAMACARE, CONGRESS -- but buying or selling health insurance is illegal in America.
Right now, there's no free market because insurance is insanely regulated not only by Obamacare, but also by the most corrupt organizations in America: state insurance commissions. (I'm talking to you, New York!)
Federal and state laws make it illegal to sell health insurance that doesn't cover a laughable array of supposedly vital services based on bureaucrats' medical opinions of which providers have the best lobbyists.
As a result, it's illegal to sell health insurance that covers any of the medical problems I'd like to insure against. Why can't the GOP keep Obamacare for the greedy -- but make it legal for Ann to buy health insurance?
This is how it works today:
ME: I'm perfectly healthy, but I'd like to buy health insurance for heart disease, broken bones, cancer, and everything else that a normal person would ever need, but no more.
INSURANCE COMPANY: That will be $700 a month, the deductible is $35,000, no decent hospital will take it, and you have to pay for doctor's visits yourself. But your plan covers shrinks, infertility treatments, sex change operations, autism spectrum disorder treatment, drug rehab and 67 other things you will never need.
INSURANCE COMPANY UNDER ANN'S PLAN: That will be $50 a month, the deductible is $1,000, you can see any doctor you'd like, and you have full coverage for any important medical problems you could conceivably have in a million years.
Mine is a two-step plan (and you don't have to do the second step, so it's really a one-step plan).
STEP 1: Congress doesn't repeal Obamacare! Instead, Congress passes a law, pursuant to its constitutional power to regulate interstate commerce, that says: "In America, it shall be legal to sell health insurance on the free market. This law supersedes all other laws, taxes, mandates, coverage requirements, regulations or prohibitions, state or federal.”
The end. Love, Ann.
There will be no whining single mothers storming Congress with their pre-printed placards. People who want to stay on Obamacare can. No one is taking away anything. They can still have health insurance with free pony rides. It just won't be paid for with Ann's premiums anymore, because Ann will now be allowed to buy health insurance on the free market.
Americans will be free to choose among a variety of health insurance plans offered by willing sellers, competing with one another to provide the best plans at the lowest price. A nationwide market in health insurance will drive down costs and improve access -- just like everything else we buy here in America!
Within a year, most Americans will be buying health insurance on the free market (and half of the rest will be illegal aliens). We'll have TV ads with cute little geckos hawking amazing plans and young couples bragging about their broad coverage and great prices from this or that insurance company.
The Obamacare plans will still have the "essential benefits" (free pony rides) that are so important to NPR's Mara Liasson, but the free market plans will have whatever plans consumers agree to buy and insurance companies agree to sell -- again, just like every other product we buy here in America.
Some free market plans will offer all the "essential benefits" mandated by Obamacare, but the difference will be: Instead of forcing me to pay a premium that covers Mara Liasson's special needs, she'll have to pay for that coverage herself.
I won't be compelled to buy health insurance that covers everyone else's gambling addiction, drug rehab, pregnancies, marital counseling, social workers, contact lenses and rotten kids -- simply to have insurance for what doctors call "serious medical problems.”
Then, we'll see how many people really need free health care.
Until the welfare program is decoupled from the insurance market, nothing will work. Otherwise, it's like forcing grocery stores to pay for everyone to have a house. A carton of milk would suddenly cost $10,000.
That's what Obamacare did to health insurance. Paul Ryan's solution was to cut taxes on businesses -- and make the milk watery. But he still wouldn't allow milk to be sold on the free market.
Democrats will be in the position of blocking American companies from selling a product that people want to buy. How will they explain that to voters?
Perhaps Democrats will come out and admit that they need to fund health insurance for the poor by forcing middle-class Americans to pay for it through their insurance premiums -- because otherwise, they'd have to raise taxes, and they want to keep their Wall Street buddies' income taxes low.
Good luck with that!
STEP 2: Next year, Congress formulates a better way of delivering health care to the welfare cases, which will be much easier since there will be a LOT fewer of them.
No actual money-making business is going to survive by taking the welfare cases -- the ones that will cover illegal aliens and Mara Liasson's talk therapy -- so the greedy will get government plans.
But by then, only a minority of Americans will be on the "free" plans. (Incidentally, this will be a huge money-saver -- if anyone cares about the federal budget.) Eighty percent of Americans will already have good health plans sold to them by insurance companies competing for their business.
With cheap plans available, a lot of the greedy will go ahead and buy a free market plan. Who wants to stand in line at the DMV to see a doctor when your neighbors have great health care plans for $50 a month?
We will have separated the truly unfortunate from the loudmouthed bullies who simply enjoy forcing other people to pay for their shrinks and aromatherapy.
And if the Democrats vote against a sane method of delivering health care to the welfare cases, who cares? We have lots of wasteful government programs -- take it out of Lockheed Martin's contract. But at least the government won't be depriving the rest of us of a crucial product just because we are middle class and the Democrats hate us.
There's your health care bill, GOP!
COPYRIGHT 2017 ANN COULTER
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Without the persuasive articulation of the big picture we offer, we will fail to get there.
That sums up what happened on the last go-around.
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Same as adults. Everyone wants health care insurance but just that some one else should pay for it. Their parents , the "government". Just not out of their pockets:
http://www.newsmax.com/Newsfront/US-Poll-Young-Americans-Health-Overhaul/2017/04/05/id/782588/
In many respects it is socialism that exemplifies peoples' selfishness and greed more then capitalism.
People feel they are entitled to so much and others should pay for it. What can be more selfish then that? This is a far more selfish concept then those who work hard and take responsibility earn fair and square these things.
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Obamacare required young people to pay for the health care of old people. Wouldn't it be enough to ask the young and healthy to pay for catastrophic coverage for their own risks?
We already had a federal program of healthcare for the old, Medicare, and health care for the poor, Medicaid, and other programs and state programs. But no, we had the mess up, prohibit, ban, the right to just buy a policy that covers your own risks. We defined poor as people making 4 times the poverty level and created a system of incentives for all these people to limit their work and keep their incomes low forever. What could possibly go wrong?
Even a monopoly insurer can't make money under this atrocious system! And the Republicans great idea after sweeping the elections is to fight with each other and leave it all in place.
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IF I recall Scott Gottlieb had worked with George Gilder on the biotech report:
http://www.cnn.com/2017/04/04/health/fda-gottlieb-background-qualifications/index.html
Here it is :
https://www.forbes.com/2002/08/06/0806watch.html
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IF I recall Scott Gottlieb had worked with George Gilder on the biotech report:
http://www.cnn.com/2017/04/04/health/fda-gottlieb-background-qualifications/index.html
Here it is :
https://www.forbes.com/2002/08/06/0806watch.html
Betsy DeVos was opposed by Democrats for being too inexperienced and lacking knowledge. Gottlieb is opposed by Democrats for being too experienced and knowledgeable. Go figure.
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"Health care spending as a share of program spending and health care
spending as a share of the economy, shows clearly that the recent period
of 1998 to 2015 saw provincial governments increase health care spending
at an unsustainable pace. "
https://www.fraserinstitute.org/sites/default/files/sustainability-of-health-care-spending-in-canada.pdf
Falling short on efficacy measures too:
"It’s performing poorly across a range of indicators including wait times, access to medical technologies and supply of doctors."
http://www.macdonaldlaurier.ca/momentum-building-for-health-care-reform-sean-speer-in-the-montreal-gazette/
Coverage is not universal for: drugs, dental, and out-patient services.
http://www.macdonaldlaurier.ca/17456/
Throw those in and the whole system collapses - sooner.
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My first objection to government-run health care is that innovation, as we knew it, essentially ends.
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My objection to government run healthcare is that it is a failure everywhere it's tried and ultimately acts as a form of control over the population.
"Health care spending as a share of program spending and health care
spending as a share of the economy, shows clearly that the recent period
of 1998 to 2015 saw provincial governments increase health care spending
at an unsustainable pace. "
https://www.fraserinstitute.org/sites/default/files/sustainability-of-health-care-spending-in-canada.pdf
Falling short on efficacy measures too:
"It’s performing poorly across a range of indicators including wait times, access to medical technologies and supply of doctors."
http://www.macdonaldlaurier.ca/momentum-building-for-health-care-reform-sean-speer-in-the-montreal-gazette/
Coverage is not universal for: drugs, dental, and out-patient services.
http://www.macdonaldlaurier.ca/17456/
Throw those in and the whole system collapses - sooner.
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My first objection to government-run health care is that innovation, as we knew it, essentially ends.
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I get it for free:
http://jamanetwork.com/journals/jama/fullarticle/2618610?widget=personalizedcontent&previousarticle=0
http://jamanetwork.com/journals/jama/fullarticle/2616408
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I can guarantee you one thing. There were very few , if any women who had much to do with Obama's health care act.
Look at the policy research published in medical journals . The academics who come up with these "fixes". I don't recall any of them being women.
So Olympia Snow was a Senator involved. All the others were men. And I believe all white men. Why was that not an issue when it is a coat bill?:
http://www.breitbart.com/video/2017/05/07/andrea-mitchell-price-white-men-cutting-heath-care-women/
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I can guarantee you one thing. There were very few , if any women who had much to do with Obama's health care act.
Look at the policy research published in medical journals . The academics who come up with these "fixes". I don't recall any of them being women.
So Olympia Snow was a Senator involved. All the others were men. And I believe all white men. Why was that not an issue when it is a coat bill?:
http://www.breitbart.com/video/2017/05/07/andrea-mitchell-price-white-men-cutting-heath-care-women/
Imagine any other group being blamed.
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# 1 the amount of "waste" from "overtreatment" of the dying is disgusting.
me - > What is correct treatment of a dying person is subjective not objective and every case is unique to some extent?
So this statement is a over simplification
# 2 said he would prefer Medicare for all. "I would police it pretty hard to keep out the fraud,
Berkshire Hathaway (NYSE: BRK.A) Vice Chairman Charlie Munger told CNBC on Monday the U.S. health-care system is "ridiculous" in its complexity.
me - > At the same time he says the government is not very good at doing things
# 3 US companies are at disadvantage due to competing with other nations that have single payer government health care
me -> ( I presume he means we need government single payer too). So he feels tax payers should have no choice but to go into a single payer system.
--------------------------
Munger:
"The amount of waste from overtreatment of the dying is just disgusting," the 93-year-old Munger said on " Squawk Box ," speaking alongside billionaires Warren Buffett and Bill Gates. "There's a lot wrong with the system."
Munger said the current health system gives U.S. companies a big disadvantage in competing with other manufacturers.
"They've got single payer medicine and we're paying it out of the company," he said.
Instead, Munger, a Republican, said he would prefer Medicare for all. "I would police it pretty hard to keep out the fraud," he said. "There's a lot of fraud and abuse in the workman's comp system. And the only way to keep it out is to be very tough on it all the time. And, of course, the government isn't very good at that."
Munger's comment came two days after he addressed some 40,000 attendees at Berkshire's annual meeting in Omaha, Nebraska.
On Thursday, the House narrowly passed a bill to replace the Affordable Care Act, better known as Obamacare. House Republicans had made a series of last-minute amendments to appease both moderate and conservative lawmakers. The bill faces an uphill battle in the Senate.
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This country can't run the VA or IHS well. let's add everyone! That should fix it!
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What is the IHS?
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What is the IHS?
Ihs.gov
The Indian Health Service
Known as the leading cause of death on the reservation.
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Every now and then I see an ad in medical journals for jobs posted for IHS. Don't know much about it or anyone here who has worked for them.
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http://thehill.com/policy/healthcare/334620-divisions-emerge-in-the-senate-on-pre-existing-conditions
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Every now and then I see an ad in medical journals for jobs posted for IHS. Don't know much about it or anyone here who has worked for them.
http://azdailysun.com/underfunded-indian-health-service-means-rationed-care-malpractice/article_7b6fc67f-be14-5fde-b10c-0d45b3a26f3a.html
What single payer looks like.
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http://thehill.com/policy/healthcare/335000-cbo-obamacare-repeal-bill-would-leave-23m-fewer-people-with-insurance
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http://thehill.com/policy/healthcare/335000-cbo-obamacare-repeal-bill-would-leave-23m-fewer-people-with-insurance
Your medical bills are yours, not mine. Get your hand out of my pocket.
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Correct, but politically inadequate.
How about:
a) Of course the number goes up--that is what happens when purchase is not compelled by law;
b) CBO must use the numbers given it-- hence "non-partisan" :roll: Here the numbers assume Obamacare levels across the time frame (10 years?) when Obamacare is insolvent now (e.g. rates have doubled since inception in 2013-- project that forward etc etc)
Also, note that apparently because the CBO says the House bill reduces the deficit, it remains eligible for reconciliation (i.e. majority, not 60 votes)
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The federal government can't do VA healthcare right, how can they do it for the whole country? Let California do single payer, and watch the collapse.
Correct, but politically inadequate.
How about:
a) Of course the number goes up--that is what happens when purchase is not compelled by law;
b) CBO must use the numbers given it-- hence "non-partisan" :roll: Here the numbers assume Obamacare levels across the time frame (10 years?) when Obamacare is insolvent now (e.g. rates have doubled since inception in 2013-- project that forward etc etc)
Also, note that apparently because the CBO says the House bill reduces the deficit, it remains eligible for reconciliation (i.e. majority, not 60 votes)
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Don't repeal-replace Obamacare? 330 million people will lose their healthcare!
Real and Replace - CBO!
If you like your Bankrupt Country, you can keep your Bankrupt Country.
CBO is Wrong - As Always!
Crafty said sound bite, not bumper sticker.
Today's headline says 'House GOP’s health bill would leave 23 million more uninsured, CBO says'
Political show host asks generic Republican lawmaker to respond. We write the answer...
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CBO is wrong. This is a false choice. The wrongly named Affordable Care Act is falling on its own weight, losing insurers, losing choices, losing states, accelerating costs, losing people and losing money. CBO has consistently overestimated ACA enrollment and underestimated its costs.* You can't make a 10 year comparison to something that won't last 10 months.
The Republican bill scored by CBO is one part of a 3 part plan. It can't be meaningfully 'scored' by itself. If that was the whole plan, we would vote against it too.
Any people 'losing' healthcare are doing so by choice as a result of repealing the admittedly unconstitutional individual mandate. (They put it through the Supreme Court as a tax.) In reality, the simplification of plans, removal of artificial minimums in coverage, removal of penalties, and introduction of more competition and choices will make more insurance and better healthcare available to all.
* http://www.commonwealthfund.org/publications/issue-briefs/2015/dec/cbo-crystal-ball-forecast-aca
http://www.cbo.gov/sites/default/files/03-30-healthcarelegislation.pdf
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Good post.
"CBO is wrong. This is a false choice. The wrongly named Affordable Care Act is falling on its own weight, losing insurers, losing choices, losing states, accelerating costs, losing people and losing money. CBO has consistently overestimated ACA enrollment and underestimated its costs.* You can't make a 10 year comparison to something that won't last 10 months."
This is good talking point statement.
"The Republican bill scored by CBO is one part of a 3 part plan. It can't be meaningfully 'scored' by itself. If that was the whole plan, we would vote against it too."
This too is good talking point statement.
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WaPo quoting CBO:
The CBO projects that the number of uninsured Americans would jump by 14 million in the first year after the House bill became law. Direct quote from the report: “Although the agencies expect that the legislation would increase the number of uninsured broadly, the increase would be disproportionately larger among older people with lower income—particularly people between 50 and 64 years old with income of less than 200 percent of the federal poverty level."
"-- 850 percent: “That's the CBO's estimate of how much insurance premiums would rise for elderly, poor people over the next decade if the second version of this Republican bill became law,” Amber Phillips notes. “In a report filled with brutal numbers for Republicans, this may be the most brutal. (Just like it was in the first estimate.) Republicans said their bill will make health insurance cheaper. Except, they'll have to figure out a way to explain why, under Obamacare, 64-year-olds making $26,500 a year are on track to pay $1,700 in annual premiums in 2026. And under the GOP bill, they would pay anywhere between $13,600 to $16,100." Here’s a breakdown:"
"-- One-in-six Americans could lose coverage for pre-existing conditions: “Amendments in the bill allow states to opt out of key ACA provisions such as protections for people with preexisting conditions. The CBO predicts that states accounting for about half the U.S. population would take advantage of these, and similar, opportunities to roll back the ACA,” Kim Soffen and Kevin Uhrmacher report. “As part of those changes, states would be able to change what benefits marketplace insurance plans must offer. Under the ACA, these ‘essential health benefits’ range from covering hospitalizations to mental-health care to prescription drugs. One-sixth of the population resides in states that the CBO expects to drastically alter the preexisting-condition requirement. Predictably, in states that shrink or eliminate that requirement, insurance plans are expected to provide narrower coverage. In other words, the value of insurance, measured as the percentage of a person’s medical expenses that are covered by insurance, would go down.”
"Mitch McConnell has begun to temper expectations, telegraphing that a big bill might never materialize. “I don’t know how we get to 50 [votes] at the moment, but that’s the goal,” the Senate Majority Leader told Reuters earlier in the day. “Exactly what the composition of [our legislation] is, I’m not going to speculate about because it serves no purpose.”
MARC: Politically, this is unmitigated disaster!
Sen. Lindsay Graham: With today's news, the 'Collapse and Replace' of Obamacare may prove to be the most effective path forward.
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Thank you Crafty. Regarding talking points, first shoot down the false premise question and then pivot to where the focus of a good healthcare system must be. Minimize third party pay. Maximize patient and plan choices. Unleash competition and innovation. Force costs down for all but the most experimental of leading edge treatments.
Having the young pay for the old by penalty of law is not a healthcare plan for the young. Having the Secretary of HHS make the most important decisions is not choice. Killing off growth in the economy and in incomes to pay for healthcare is wrongheaded. Subsidizing does not equal affordability as costs and pricing explode. Giving subsidies to people making 400% of the poverty line for basic living expenses is unsustainable. For a country $19 trillion in debt to pour more and more hundreds of billions of borrowed money into collapsed 'risk corridors' is bankrupting.
People living in a free country should not be forced into a government healthcare system. Obamacare was sold on lies and designed to fail. The voters have already voted it down in the House, Senate and Presidential elections. The Supreme Court also should have shot it down. This 3-part plan is the best we have to replace it. 'If you, the liberal media and politicians, have a better plan that accomplishes these objectives, now would be the time to bring it forward!' The ACA wasn't it and every honest observer knows it.
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The CBO projects that the number of uninsured Americans would jump by 14 million in the first year after the House bill became law. Direct quote from the report: “Although the agencies expect that the legislation would increase the number of uninsured broadly, the increase would be disproportionately larger among older people with lower income—particularly people between 50 and 64 years old with income of less than 200 percent of the federal poverty level."
Again, they figure off of a budget reconciliation bill without figuring in ANY of the improvements contained in the 3-part plan. False and meaningless numbers, unless your goal is to shoot down any attempt to rid ourselves of a horribly failed system.
No mention or apology by CBO of their previous errors, or the 36 million that Obamacare left behind, even with a mandate? Did they mention what the cost will be for millions more Americans to continue switching from working to not-working, from full time to part time work and from private to government paid healthcare until there is no one left to pull the wagon?
Was this Newt's biggest failure, along with baseline budgeting, to leave a failed CBO to score all new reforms under static economic rules? We are reforming healthcare so that costs will go down and so that we can grow the economy and incomes, tax reform too, but they cannot figure in reduced costs or increased incomes in a 10 year BS analysis of affordability.
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Valid points all AND politically, this is unmitigated disaster!
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It's not worthless, it's a valuable, deceptive, political product.
http://www.powerlineblog.com/archives/2017/05/the-cbos-analysis-of-the-gops-health-care-bill-is-worthless.php
MAY 25, 2017 BY JOHN HINDERAKER IN HEALTH CARE
THE CBO’S ANALYSIS OF THE GOP’S HEALTH CARE BILL IS WORTHLESS
Yesterday the Congressional Budget Office released an analysis of the current version of the House health care bill that was trumpeted by Democrats because it projected that 23 million people would “lose” their health insurance if the law went into effect. However, as Guy Benson points out, https://townhall.com/tipsheet/guybenson/2017/05/25/no-the-republican-healthcare-bill-would-not-cause-23-million-people-to-lose-insurance-n2331434 this claim is false, since “the large bulk of those who are said to be ‘losing’ coverage do not currently have coverage.” Further, to the extent that some who currently are forced to buy health insurance by Obamacare decide it isn’t worth the cost to them, and choose not to purchase it, that is rightfully their decision.
Then, too, there is the fact that the CBO’s predictions about Obamacare have been ridiculously bad, as illustrated by this graphic:
(http://i2.wp.com/www.powerlineblog.com/ed-assets/2017/05/Screen-Shot-2017-05-25-at-8.51.01-PM.png)
Why should we believe an agency on a topic where its past projections have been wildly off the mark?
There is another, more subtle reason why the CBO’s analysis is worthless. As far as I know, it has been pointed out only by my colleague at Center of the American Experiment Peter Nelson, one of the country’s top health care experts. Peter points out that the CBO has uncritically relied on articles by a former Obama administration official who apparently failed to read the GOP bill and existing regulations carefully. Peter writes:
[T]he CBO appears to have relied on a couple of articles posted on the Brookings Institution website to analyze the impact of allowing states to waive certain Obamacare regulations. The articles were written by Matt Fiedler, former Chief Economist of the Council of Economic Advisers in the Obama Whitehouse. One article focused on how waiving the essential health benefit (EHB) requirement could impact protections against catastrophic losses for people enrolled in large employer plans. The other article assessed how waiving community rating regulations—the regs that restrict insurers from pricing premiums based on health status—for people who failed to maintain continuous coverage would impact individual insurance markets.
The Brookings analysis of the EHB waiver is flat out wrong and Fiedler’s analysis on waiving community rating, to say the least, exaggerates the possibilities. Nonetheless, the CBO touts the same two positions without any qualification.
Here’s what the CBO says about how a state waiving EHBs could lower protections against catastrophic losses:
For the large-group market, which generally consists of employers with more than 50 employees, current regulations allow employers to choose the EHB benchmark plan of any state in which they operate. Because of those regulations, a large employer operating in multiple states, including one that elected an EHB waiver, could base all of the plans it offers on the EHB requirements in a state with the waiver. That decision could allow annual and lifetime limits on benefits not included in the state’s EHBs.
Wrong. If a state chose to specify its own EHBs under a waiver, that choice would not be available to a large employer under current regulations. Presently, a state may choose an EHB from among a set of benchmark plans. While this gives states a choice, it also sets a minimum standard for the federal EHB across the country. Also under current regulations, for the purposes of the annual and lifetime dollar limit restrictions, a large employer may choose from among “one of the base-benchmark plans selected by a State.” Nothing in the regulations suggests an employer could choose from anything but a benchmark plan. Thus, an employer could not choose from an EHB specified by a state under a waiver. It would not be a benchmark plan.
The second issue, relating to state waivers of community rating, is more complicated and is hard to excerpt. You should read it all, but here is the key conclusion:
This scenario the CBO imagines for one-sixth of the population is, well, preposterous. At its core, the CBO believes that a state waiving community rating will allow healthy people to choose from one of two insurance pools, the community rated pool and the underwritten pool. Given the freedom, a healthy person will always choose to base his premium on his health underwriting and, thus, leave less healthy people behind in the community-rated pool.
Why is this scenario preposterous? If a state went the direction the CBO imagines, it would be the state’s choice. The waiver gives states the freedom to choose several different directions. Why would the CBO assume a state would choose this direction when no state ever chose this type of regulatory structure before Obamacare? Why choose this direction when, as the CBO points out, there are such obvious pitfalls?
Moreover, while the language of the bill could be much more clear, it’s also reasonable to read the House bill to limit the application of underwriting to only high-risk people, which would stop healthy people from choosing the underwritten pool…. This reading makes much more sense in the context of allowing states to establish different ways to cover people with pre-existing conditions that don’t burden the rest of the nongroup market with their high costs. That certainly appeared to be the intent of the waiver.
The Congressional Budget Office is generally touted as “non-partisan,” which is technically true. But non-partisan does not equal reliable. With respect to both Obamacare and the House bill that would repeal and replace it, the CBO’s work product has been shoddy and unreliable.
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https://mises.org/blog/lower-health-care-costs-try-freedom
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https://mises.org/blog/lower-health-care-costs-try-freedom
No opportunities for graft and rent-seeking with freedom. That's why politicians frown on it.
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Dropping at a rate of 4 million per year. Dropping faster left in place than CBO predicted under repeal.
http://freebeacon.com/issues/1-9-million-obamacare-cancellations/
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Dropping at a rate of 4 million per year. Dropping faster left in place than CBO predicted under repeal.
http://freebeacon.com/issues/1-9-million-obamacare-cancellations/
They had to pass it to find what's in it.
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Making the House Health Bill More Conservative
By Bobby Jindal
President Trump has finally achieved unity and consensus in our nation’s capital. Pundits, Republican and Democrat members of Congress, and the media all seem to agree that everything must stop so that we can endlessly speculate on Russia, special counsels, the FBI, the last election, and criminal charges. Nonsense. Voters elected President Trump and the Republican majorities in Congress to drain the swamp, i.e., to make big and fundamental changes in the direction of our country. Let Mueller, and the appropriate Congressional committees, talk to Comey, Flynn, and even Putin if they want, but in the meantime, do not let Democrats run out the clock. Our country faces too many dire challenges, thanks in large part to the Obama years, that must be addressed now. Congress is, despite its earned reputation, actually capable of walking and chewing gum at the same time. I have a radical idea – why don’t our political leaders do what they promised when they asked for our votes just a few months ago? They could start by actually repealing and replacing Obamacare.
Now that the House has finally passed its health care legislation, attention turns toward the Senate. House leadership claimed certain popular provisions could not be added, e.g., allowing the sale of insurance across state lines, and other unpopular provisions could not be removed, e.g., the special treatment for Members of Congress and their staff, to ensure rapid Senate approval of the House legislation. Despite these assurances and compromises, Republican Senators are now talking about writing their own legislation. While the House compromise that allows states the option to apply for a federal waiver to repeal many of Obamacare’s regulations disappointed conservatives wanting a full repeal, early indications from the Senate are their changes will be to make the legislation less and not more conservative. (Indeed, why not at least require states to apply to keep, rather than to replace, Obamacare’s regulations?)
Senate Republicans should adopt as their guideposts the conservative goals of reducing federal spending, dependence on subsidies, and government intrusion. President Obama’s unprecedented Medicaid expansion to cover millions of able bodied adults violates all three. It wasn’t that long ago when Republicans were in near unanimous agreement that reducing welfare rolls, through policies like time limits and work requirements, was a positive thing. A safety net should be provided for the neediest amongst us, but it should be temporary, targeted, and locally governed.
Senate Republicans should strengthen the House bill’s provisions by giving states even more flexibility to design and run their Medicaid programs. Multi-year federal grants for states should be tied to some measures of eligibility, but not simply to enrollment. Just as states currently benefit when they reduce their welfare rolls, they should not be rewarded for keeping people on Medicaid longer than necessary or punished for encouraging individuals to afford private coverage. States should also have the flexibility and financial incentives to design wrap-around coverage or premium assistance plans rather than one size fits all benefits packages that often crowd out private coverage. Current rules technically allow but actually discourage states from pursuing such policies. A beneficiary with employer provided or individual coverage might require targeted assistance, for example, affording prescription drugs or cost sharing, but should not have to choose between keeping their private coverage and getting help.
Just as the House bill gives states the option to manage their own individual insurance marketplaces, as they did before Obamacare, so should the Senate give states the ability to manage their own Medicaid programs. States should no longer have to come begging to Washington to design benefit packages, cost sharing provisions, or eligibility requirements that meet the unique needs of their constituents. Washington can and should require accountability through overall performance measures, to ensure states are focused on improving health outcomes and not just complying with complicated rules, and special protections for the most vulnerable populations, e.g., the elderly and disabled.
A second conservative change would be for the Senate to transform the House’s refundable tax credit into a tax deduction. This would have to be accompanied by funding for state designed programs to assist needy individuals who do not earn enough income to pay taxes and benefit from the deduction, but at least this subsidy would be explicitly identified as spending and could thus be managed, rather than hiding a new federal entitlement program in an increasingly complicated tax code. A deduction would incentivize consumers to buy health care more efficiently, as they would keep the savings, and insurers and providers to compete to reduce costs. Independent scoring of this provision previously has shown it to be one of the more effective ways to “bend the cost curve down.”
Conservatives have waited many years to repeal and replace Obamacare. Perhaps it is too ambitious to hope the Senate improves the House legislation, rather than merely playing defense and trying to minimize the ways they will make it worse. However, President Obama himself campaigned on the promise to be transformational and not merely incremental – surely, we should aim no lower.
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https://www.youtube.com/watch?v=UIXK2cjcbPg
http://www.cbsnews.com/news/los-angeles-veterans-affairs-hospital-patients-died-waiting-for-care/?ftag=CNM-00-10aab8a&linkId=39052106
Nearly 100 patients died waiting for care from Los Angeles VA
LOS ANGELES -- President Trump signed a bill today giving top-ranking officials at the department of Veterans Affairs more power to fire incompetent workers and protect whistle-blowers. The agency has struggled to provide health care and other services to military veterans.
The legislation was prompted by a 2014 scandal at the Phoenix VA medical center, where many veterans died while waiting months to see a doctor.
The problem was even worse at the Los Angeles VA hospital, CBS News correspondent Melissa Villarreal reports.
A new report by the VA inspector general shows 43 percent of the 225 patients who died between October 2014 and August 2015 at the Los Angeles VA were waiting for appointments or needed tests they never got. However, the report does not conclude these patients "died as a result of delayed consults."
Susan and Allen Hoffman were happily married for 43 years -- but Allen, a U.S. Navy veteran, was living in pain.
"He had an enlarged prostate and they just kept saying it's not a problem you know, whatever, and then, it started to get worse," Susan says.
He was scheduled to see a specialist in May 2013, but she says that didn't happen.
"She said, 'No, you're here just for a consult. You have to understand people have cancer and he doesn't,'" Susan Hoffman says. "I think we were there for 15 minutes."
Four months later, Hoffman was diagnosed with stage IV prostate cancer.
Dr. Christian Head is a surgeon at the Los Angeles VA. He says 140,000 patient consults were deliberately deleted.
"The number of patients waiting for care, the deletion of consults, and the wait list were much more significant here than at Phoenix," Head says.
"I first noticed an unusual number of patients who are presenting with delay in diagnosis, meaning that they present into the system, they disappeared for a number of years and then they presented late with advanced cancers. Those consults were being deleted, literally removed from the system," Head says.
Allen Hoffman died a year and a half after he was diagnosed. The VA has settled out of court with his widow.
"Was there any doubt in your mind that they were responsible for your husband's death?" Villarreal asked.
"Definitely they were," Susan Hoffman says.
The VA would not comment about Hoffman's case or Head's allegations, but Los Angeles' hospital director admits the problems in the report are serious.
To fix them, they've hired new leadership, are retraining employees and now posting wait times on-line.
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About as good as the rest of the promises, you can keep your doctor, your plan, costs will go down $2500 per family, insured 24 million fewer than CBO predicted, "won't add one dime to the deficit", will not raise taxes on the middle class. etc.
'Can we all say it together - Unexpectedly!'
http://www.beckershospitalreview.com/finance/er-visits-by-medi-cal-patients-up-75-under-aca-data-says.html
ER visits by Medi-Cal patients up 75% under ACA, data says
Written by Alia Paavola | June 12, 2017
Despite predictions that the ACA would ease the strain on emergency rooms, the number of ER visits by Medi-Cal patients rose 75 percent over five years, according to data released by California's Office of Statewide Health Planning and Development.
ACA advocates argued ER visits would decrease once people received health coverage since they could afford to see primary care physicians instead. However, ER visits by California's Medicaid population jumped from 800,000 in the first quarter of 2012 to 1.4 million in the final quarter of 2016, according to the data.
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Also see:
http://www.dailywire.com/news/14725/7-key-promises-obamacare-broke-aaron-bandler#
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"you're going to be able to choose your doctor and not have to go through some network in an emergency situation as a consequence of these rules."
"What happens is, you don't have health insurance, you go to the emergency room. You weren't getting a checkup; something that might have been curable with some antibiotics isn't caught. By the time you get to the hospital, it's much more expensive. The hospital cares for you because doctors and nurses, they don't want to just turn somebody away. But they've got to figure out how do they keep their doors open if they're treating all these people coming into the emergency room."
"that's not fair, because all the rest of us are going to be paying for those folks when they go to the emergency room"
- President Barack Obama, September 22, 2010
http://www.presidency.ucsb.edu/ws/?pid=88480
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Among the howls and yowls over the Senate bill about cutting Medicare blah blah I discovered some fascinating factoids.
*Actual Medicare spending will go UP 18%. The purported "cuts" are but baseline cuts.
*As we here already know, it is a serious misnomer to define the decrease in enrollee numbers as a matter of people being kicked out of coverage. In point of fact many/most are returning to what they did before Obamacare compelled them to join. Furthermore, because the CBO must use the data fed to it (GIGO=Garbage In Garbage Out) apparently it is required to assume 7 million more enrollees than are actually there?!? (Don't have citation for this). Anyway, in this vein, here is this: http://www.nationalreview.com/article/448991/senate-health-care-bill-will-reduce-coverage-15-million-good
No doubt there is much more malarkey of this sort out there , , ,
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https://www.wsj.com/articles/senators-urge-trump-to-back-wholesale-obamacare-repeal-if-gop-bill-fails-1498825462
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Remember, you belong to the state. Don't get any funny ideas...
https://pjmedia.com/parenting/2017/06/29/baby-charlie-denied-life-by-british-health-system-eu-courts/
Baby Charlie Denied Life by British Health System, EU Courts
BY JEFF REYNOLDS JUNE 29, 2017 CHAT 155 COMMENTS
On June 27, the parents of 10-month-old Charlie Gard lost their final appeal to travel to the United States to have him treated for a rare brain disorder. The European Court of Human Rights (EHCR) denied the appeal of London parents Chris Gard and Connie Yates, which means that his life support will be removed and, at some point, he will be allowed to die.
Charlie's parents raised over £1.4million in private donations via GoFundme to pay for the treatment and their travel expenses. Charlie Gard suffers from a mitochondrial disease that causes muscle weakness and brain damage. His parents wanted to bring him to the United States for experimental nucleoside treatment, but the administrators and doctors at Great Ormond Street Hospital for Children denied the request. Their alternative? Withdraw life support, administer palliative care, and let Charlie "die with dignity."
Let that sink in a minute: This treatment would have come at no cost to the hospital or the National Health Service (NHS), and would have been covered completely by private donations. They denied the parents their right to determine care for their own child.
Notably, nucleosides are prevalent in breast milk, but in an interview, the couple said they had been denied the ability to give Charlie breast milk while in hospital:
YouTube @YouTube
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LG @laurakinz
Nucleosides are abundant in unpasteurized breast milk but Charlie isn't allowed it https://youtu.be/wHROVTovpo0 #charliesfight #breastisbest
1:46 PM - 22 Jun 2017
27 27 Retweets 30 30 likes
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That's right. The hospital refused to allow the mother to breast feed her child and refused to allow them to seek alternative treatment on their own dime, at no cost to taxpayers.
Chris and Connie filed appeal after appeal, all the way up to the Supreme Court. The courts sided with the doctors and hospital administrators each time.
The parents are reportedly "utterly distraught." Social media reactions to the decision were heart-wrenching.
27 Jun
Evening Standard ✔ @standardnews
European court rejects Charlie Gard parents' plea to intervene in case http://www.standard.co.uk/news/london/charlie-gard-european-court-rejects-parents-plea-to-intervene-in-battle-to-save-terminally-ill-baby-a3574436.html …
Follow
Catholic State Org. @LaCatholicState
@standardnews very evil people.....$entencing a child to death! What an anti-child pagan $ociety we are. I pray for #CharlieGard!
9:34 AM - 27 Jun 2017
91 91 Retweets 138 138 likes
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Bev @bevvyboo22
@Fight4Charlie his amazing parents couldn't have fought any harder - a system that has lost its soul should be ashamed of this decision
9:48 AM - 27 Jun 2017
25 25 Retweets 77 77 likes
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TomDUK @TomDUK1
The #CharlieGard case is terrible. Shame on the UK judges allowing him to die, shameful, terrible decision.
9:34 AM - 27 Jun 2017
126 126 Retweets 230 230 likes
The decision by the EHCR was as cold as it was final:
Today the European Court of Human Rights has by a majority endorsed in substance the approach by the domestic courts and thus declared the application inadmissible. The decision is final.
The case concerned Charlie Gard, a baby suffering from a rare and fatal genetic disease.
In February 2017, the treating hospital sought a declaration from the domestic courts as to whether it would be lawful to withdraw artificial ventilation and provide Charlie with palliative care.
Charlie's parents also asked the courts to consider whether it would be in the best interests of their son to undergo experimental treatment in the US.
The domestic courts concluded that it would be lawful for the hospital to withdraw life sustaining treatment because it was likely that Charlie would suffer significant harm if his present suffering was prolonged without any realistic prospect of improvement, and the experimental therapy would be of no effective benefit.
The domestic court decisions had been meticulous, thorough and reviewed at three levels of jurisdiction with clear and extensive reasoning giving relevant and sufficient support for their conclusions; the domestic courts had direct contact with all those concerned.
The domestic courts had concluded, on the basis of extensive, high-quality expert evidence, that it was most likely Charlie was being exposed to continued pain, suffering and distress and that undergoing experimental treatment with no prospects of success would offer no benefit, and continue to cause him significant harm.'
Did you notice that? High-quality experts meticulously determined that staying alive would offer no benefit and would continue to cause Charlie significant harm. His parents were removed from the equation entirely by a single-payer health care system -- the NHS -- and bureaucrats who know better.
Of course, we already know that the bureaucrats who know better are motivated as much by fiscal concerns as medical concerns. I've written many times about QALY -- Quality Adjusted Life Years -- the model that helps bureaucrats determine how many healthy, taxpaying years a patient has left so that they can pay back into the system. It's basically a determination of the return on investment on providing care. If you don't show enough ability to pay back into the system over a prolonged lifetime, care is denied.
Hospital administrators insisted that their decision was humane -- to allow Baby Charlie to "die with dignity." One wonders, however, if in the bowels of the bureaucracy it was determined that the poor boy was likely to suffer from permanent brain damage, and thus become too heavy a burden on society.
Another similar case is playing out in Liverpool. Alfie Evans is a 13-month-old baby in a coma. He's been unconscious since December, and his parents now believe they will face a similar legal fight just to keep their baby alive. No diagnosis has happened, and no prognosis for the future has been offered. The baby showed signs of delayed development, but doctors dismissed him as a late bloomer. He subsequently suffered seizures and slipped into a coma and has been unconscious ever since.
The doctors are applying increasing pressure on Alfie's parents to turn off life support.
Death panels have been operating in Great Britain for some time, and reports indicate that the quality of care is further deteriorating in the NHS. It's incumbent upon every member of our society to determine what we're going to do about this -- both in Great Britain and in America. The Independent Payment Advisory Board (IPAB) is Ezekiel Emanuel's creation that brings health care rationing to America under Obamacare. Should we fail to act, these ghoulish horrors are what await us too.
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https://www.americanactionforum.org/research/update-obamacares-impact-small-business-wages-employment/
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http://www.nationalreview.com/article/449296/ted-cruz-mike-lee-obamacare-repeal-amendment-sound-policy
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http://www.nationalreview.com/article/449296/ted-cruz-mike-lee-obamacare-repeal-amendment-sound-policy
It looks good to me.
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https://pjmedia.com/trending/2017/07/13/doj-arrests-hundreds-in-largest-combined-health-care-fraud-case-in-history/
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https://www.conservativereview.com/articles/freedom-and-the-gop-are-dying-under-leader-mcconnell
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Crafty Dog post
Frankly the doctors who are involved in these schemes have always been obvious to those of us in the healthcare field
https://pjmedia.com/trending/2017/07/13/doj-arrests-hundreds-in-largest-combined-health-care-fraud-case-in-history/
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http://ace.mu.nu/archives/370663.php
July 14, 2017
Judge to Allow US Specialist to Examine Charlie Gard
As Ed Morrissey notes, Time magazine (but are they really a magazine?) either credits, or blames, conservatives with pushing this issue out from under the smother blanket of leftwing media embargo.
I don't like that just one guy is being asked his opinion -- I'd rather have two - and I would like it less if, as I'd assume, the Judge, who seems to have a nearly personal stake in this dispute, didn't get to pick the expert here.
Per Time magazine (???), here is how one of Britain's many worthless #FakeChurch clergymen responded:
Thomas Williams, an Auxiliary Bishop for the British city of Liverpool, questioned the motives of some external actors. “It’s a terrible situation for both the family and the hospital,” he told TIME. “I’ve always accepted, as a priest and a hospital chaplain, that people need to be allowed to die and sometimes nature needs to take its course. The right-wing element of these evangelicals, I’m afraid I’m not down that line at all… I can’t read their minds, but I do think that people will stand on soapboxes when situations arise.”
Here's my take:
I am not a strong sentimentalist, though I do have some sentimentalism in me. I am not a life-absolutist -- there are many cases in which I'd say a life isn't worth fighting for. If the person is in pain, and his death is inevitable -- I'd say it's a justifiable position to pull the plug.
But note the very large difference between a "justifiable" decision and a mandatory one. If the people who the law has previously put in charge of these decisions -- the people closest to the stricken patient, who usually have the most love and affection for him -- made this choice, I wouldn't agree with that choice, but only because I would not have even heard of this choice -- such decisions are made every single day, and no one hears about them, and no one judges them much either way.
But in this case, the parents -- who are the most physically, emotionally, and spiritually conntected to Charlie Gard -- have expressed their strong desire to fight for the kid's life, and it's a bunch of disinterested beancounters and bureaucrats, and one judge who really seems to take "playing God" as the ultimate in judgecraft -- who are deciding he must die. Or, as the National Laughingstock would say, "must be permitted to die," as if Charlie Gard is desperately fighting for his right to die in dignity, and his square bullying parents are fighting him over this.
I doubt many people have illusions about Charlie Gard's ultimate fate: He will almost certainly die, whether by state mandated euthanasia or the natural (and often cruel) betrayals of biology, and even if he lives, it will not be for long, and even if he lives, the chances of him having much of a functioning mind are quite low.
That's my opinion. That's the opinion of the NHS and this judge.
We all have opinions. As the man said, they're like assholes. We've all got 'em, and most of them stink pretty foully.
But we are not the people to make this decision. We are not the people whose opinions count.
The opinions that count belong to this kid's flesh-and-blood parents, the ones who made him, the ones who have cared for him and suffered with him since birth.
What is the irreversible harm that will occur if Charlie Gard is permitted a few more days in this world, which may be -- for a nonbeliever like myself -- the only world he will ever exist in?
Is he in great pain? They seem to be saying he's in vegetative state; how then would he feel pain?
Death is irreversible. Unlike a reporter manufacturing news and getting stories 100% wrong, there is no Free Pass for death. There's no coming back from it.
My general instinct is that you give hope a chance.
Hope is often a silly thing. And hope often leads to hearbreak.
And yet, without hope, there is no humanity. Literally. I don't mean that metaphorically -- I mean that hope is a key component of the human survival instinct.
What does a man do without hope? Why would he carry on in a world that is usually pretty tough and often sad?
Well, he'd kill himself. Killing himself would be the rational choice for a man without hope.
Hope is often irrational -- but it is the irrational things like love, a desire to have children who you'll have to care for 20 years (or more), and who may, God forbid, die before you do and break your heart harder than you could have ever imagined, and hope for a better tomorrow that has kept this species from not simply committing mass suicide 100,000 years ago.
The parents are choosing hope. The parents are the natural (as the law would say) guardians and custodians of this child. The parents make the decisions for this child, even if disinterested third-parties might disagree with their opinion.
It's their fucking kid, man. What is so hard to grasp about this?
Here's a fact of biology: When a living thing is stricken and can endure no more, it will allow itself to die.
When someone is in critical condition, and family members ask if he'll pull through, doctors will sometimes ask, "Is he a fighter?"
Some will cling to life longer; some will find the anguish too much, and their bodies will just shut down.
I don't see much of a downside in letting Charlie Gard decide how much fight he has in his little stricken body.
I do see an enormous downside in taking such an intensely personal decision out of the hands of the mother -- don't progressives tell us that mothers, and only mothers, may decide if a child shall live or die? -- and hand it over to beancounting bureaucrats and unaccountable politicians-in-robes.
By the way, I don't totally have anything against the hospital bureaucrats for having a different point of view on this than the parents. As hospital workers, they work in -- let's face it -- a place where many people come to die. It's just a sad fact of their profession --they will see many, many people die. They will see more people die than pretty much anyone, even soldiers.
So they have a (useful, and well-earned) professional detachment about death. They do have a kind of hardened wisdom about life-and-death that most of us do not.
I can understand their feeling, as they've felt about a thousand very ill patients before, that there is no hope here, and that it's time for the baby to die.
What I cannot understand is their determination that their feeling should override the parents' feeling.
Okay, NHS: This is your ten millionth death. I understand -- without being negative about it -- that you are not particularly emotional about your ten millionth death.
Can you understand that this is these parents' first death? Certainly the first death of a child!
I'm not religious, but I am pro-human, and to me, that means understanding that human beings are hardwired for hope (otherwise, as I said, the race would have simply chosen to kill itself 100,000 years ago), and that, even to a not-particularly-sentimental-about-such things, nonbelieving, cynical realist, is a precious and fragile thing which is worth rolling the dice on and worth giving a chance.
That's my opinion.
It's also my opinion that they're just delaying the heartbreak, and, by allowing themselves to be filled with hope, they're going to feel even more heartbreak.
Because hope does that. Hope may lift you, but it sometimes lifts you up just so you can fall further and harder.
That's the nature of the thing.
So those are my opinions.
But who gives a shit about my opinions on it?
My opinion doesn't matter.
If the parents chose to take their kid off life support, my opinion still wouldn't matter.
The parents, the only two people in this world who have an elemental and primal and truly emotional attachment to this kid, have decided its in his best interest to give him a chance.
And as long as they're saying that: Who the fuck has so arrogated himself to sit in the throne of God Himself to claim the right to say otherwise?
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watch the feckless Repubs never
get it out of the House or it will die in Senate as soon as McCain gets back.
http://www.newsmax.com/Politics/congress-budget-plan-cuts/2017/07/18/id/802213/
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http://thehill.com/policy/healthcare/343222-what-trump-can-do-to-cripple-obamacare
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http://thehill.com/policy/healthcare/343222-what-trump-can-do-to-cripple-obamacare
Let it burn.
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Brilliant Move By Gop On Health Care Bill
By DICK MORRIS
Published on DickMorris.com on July 25, 2017
Senate Majority Leader Mitch McConnell is pulling a rabbit out of a hat by redefining what constitutes a rabbit and what is a hat.
Everyone assumed that the procedural motion to vote and bring an end to the health care debate was simply a precursor to passing the final bill. But it was McConnell's genius to realize that it is a separate vote with its own momentum and its own context.
He realized that while the Republican Senators could not agree on what was the solution, they all agreed that one was needed. So he floated three different ideas in order to get the Senators to vote to close debate and vote on something:
1. The Full Monty -- A full repeal and replace bill.
2. A Half Monty -- Just repeal.
3. A Bland Monty -- Just repeal the mandate that people have to buy insurance and some of the tax hikes.
With such a broad array of choices, every Republican could find something he could vote for and use that to justify his vote to close debate.
Once the closure motion passes, then the real bargaining will begin. Why will it succeed now?
McConnell is betting, perhaps wisely, that the momentum of the closure vote will carry over and that, at least, the mandate bill (Option 3) will pass.
President Trump and the GOP leaders rightly reckon that the requirement is to pass something and repeal some of Obamacare. Passing anything will give Trump momentum and a reprieve and will give Republicans something to cheer about.
Back in the days when Obama was president, Republicans passed a bill stripping the mandates and leaving the rest of the Obamacare in tact. He killed it with a veto threat, but if it was good enough for the Republicans back then, its good enough now.
Without the mandate, Obamacare cannot survive. People will not pay its outrageous premiums unless they must. 6.5 million taxpayers paid a fine last year -- totaling $3 billion -- for not having health coverage. The average fine was $470. Once the mandate is lifted, those folks are not going to buy insurance and many who have knuckled under an paid for plans they don't want will flock away.
To save the insurance industry, it will then be essential to permit the sale of more limited plans to bring down prices.
Obama always said that if you abandoned the mandate, the whole structure would fall apart. He was and is right.
So, let's do it!
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http://www.speroforum.com/a/FCTILKZKGM55/81414-Mark-Levin-Republican-liars-pulled-biggest-hoax-in-modern-times?utm_medium=email&utm_campaign=KRPZFGZOJH43&utm_content=FCTILKZKGM55&utm_source=news&utm_term=Mark+Levin+Republican+liars+pulled+biggest+hoax+in+modern+times#.WXq2-3okS2A
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Greg Mankiw goes over some of the basics.
https://www.nytimes.com/2017/07/28/upshot/why-health-care-policy-is-so-hard.html
Why Health Care Policy Is So Hard
Economic View
By. GREGORY MANKIW JULY 28, 2017
“Nobody knew that health care could be so complicated.” President Trump said that in February, yielding more than a few chuckles from pundits and late-night comedians.
In fact, anyone who has spent some time thinking about the issue sees its complexity. With the collapse of the Senate health care bills this week, the president has certainly been reminded of it.
But Mr. Trump’s epiphany raises some questions: Why is health care so complicated? How does it differ from most of the other goods and services that the economy produces? What makes health policy so vexing?
In Econ 101, students learn that market economies allocate scarce resources based on the forces of supply and demand. In most markets, producers decide how much to offer for sale as they try to maximize profit, and consumers decide how much to buy as they try to achieve the best standard of living they can. Prices adjust to bring supply and demand into balance. Things often work out well, with little role left for government. Hence, Adam Smith’s vaunted “invisible hand.”
Yet the magic of the free market sometimes fails us when it comes to health care. There are several reasons.
Externalities abound. In most markets, the main interested parties are the buyers and sellers. But in health care markets, decisions often affect unwitting bystanders, a phenomenon that economists call an externality.
Take vaccines, for instance. If a person vaccinates herself against a disease, she is less likely to catch it, become a carrier and infect others. Because people may ignore the positive spillovers when weighing the costs and benefits, too few people will get vaccinated, unless the government somehow promotes vaccination.
Another positive spillover concerns medical research. When a physician figures out a new treatment, that information enters society’s pool of medical knowledge. Without government intervention, such as research subsidies or an effective patent system, too few resources will be devoted to research.
Consumers often don’t know what they need. In most markets, consumers can judge whether they are happy with the products they buy. But when people get sick, they often do not know what they need and sometimes are not in a position to make good decisions. They rely on a physician’s advice, which even with hindsight is hard to evaluate.
The inability of health care consumers to monitor product quality leads to regulation, such as the licensing of physicians, dentists and nurses. For much the same reason, the Food and Drug Administration oversees the safety and effectiveness of pharmaceuticals.
Health care spending can be unexpected and expensive. Spending on most things people buy — housing, food, transportation — is easy to predict and budget for. But health care expenses can come randomly and take a big toll on a person’s finances.
Health insurance solves this problem by pooling risks among the population. But it also means that consumers no longer pay for most of their health care out of pocket. The large role of third-party payers reduces financial uncertainty but creates another problem.
Insured consumers tend to overconsume. When insurance is picking up the tab, people have less incentive to be cost-conscious. For example, if patients don’t have to pay for each doctor visit, they may go too quickly when they experience minor symptoms. Physicians may be more likely to order tests of dubious value when an insurance company is footing the bill.
To mitigate this problem, insurers have co-pays, deductibles and rules limiting access to services. But co-pays and deductibles reduce the ability of insurance to pool risk, and access rules can create conflicts between insurers and their customers.
Insurance markets suffer from adverse selection. Another problem that arises is called adverse selection: If customers differ in relevant ways (such as when they have a chronic disease) and those differences are known to them but not to insurers, the mix of people who buy insurance may be especially expensive.
Adverse selection can lead to a phenomenon called the death spiral. Suppose that insurance companies must charge everyone the same price. It might seem to make sense to base the price of insurance on the health characteristics of the average person. But if it does so, the healthiest people may decide that insurance is not worth the cost and drop out of the insured pool. With sicker customers, the company has higher costs and must raise the price of insurance. The higher price now induces the next healthiest group of people to drop insurance, driving up the cost and price again. As this process continues, more people drop their coverage, the insured pool is less healthy and the price keeps rising. In the end, the insurance market may disappear.
The Affordable Care Act (a.k.a. Obamacare) tried to reduce adverse selection by requiring all Americans to buy health insurance or pay a penalty. This policy is controversial and has been a mixed success. More people now have health insurance, but about 12 percent of adults aged 18 to 64 remain uninsured. One thing, however, is certain: The existence of a federal law mandating that people buy something shows how unusual the market for health care is.
The best way to navigate the problems of the health care marketplace is hotly debated. The political left wants a stronger government role, and the political right wants regulation to be less heavy-handed. But policy wonks of all stripes can agree that health policy is, and will always be, complicated.
N. Gregory Mankiw is the Robert M. Beren professor of economics at Harvard University.
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Only legal to sell to those over 21 yo.
http://www.nationalreview.com/article/450444/food-drug-administration-commissioner-scott-gottlieb-changes-united-states-tobacco-e-cigarette-policy
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(https://si.wsj.net/public/resources/images/BN-UJ793_OCARE__360V_20170721191110.jpg)
Pulitzer Prize winning editorial writer, died at age 34, July 2017
Joe Rago continued:
The Political John Roberts
The Chief Justice again rewrites ObamaCare in order to save it.
June 25, 2015
For the second time in three years, Chief Justice John Roberts has rewritten the Affordable Care Act in order to save it. Beyond its implications for health care, the Court’s 6-3 ruling in King v. Burwell is a landmark that betrays the Chief’s vow to be “an umpire,” not a legislator in robes. He stands revealed as a most political Justice.
The black-letter language of ObamaCare limits insurance subsidies to “an Exchange established by the State.” But the Democrats who wrote the bill in 2010 never imagined that 36 states would refuse to participate. So the White House through the IRS wrote a regulation that also opened the subsidy spigots to exchanges established by the federal government.
***
Chief Justice Roberts has now become a co-conspirator in this executive law-making. With the verve of a legislator, he has effectively amended the statute to read “established by the State—or by the way the Federal Government.” His opinion—joined by the four liberal Justices and Anthony Kennedy —is all the more startling because it goes beyond normal deference to regulators.
Chief Justice Roberts concedes that the challengers’ arguments “about the plain meaning” of the law “are strong.” But then he writes that Congress in its 2010 haste bypassed “the traditional legislative process” and thus “the Act does not reflect the type of care and deliberation that one might expect of such significant legislation.” So because ObamaCare is a bad law, the Court must interpret it differently from other laws.
Opinion Journal: Roberts Saves ObamaCare Again
Editorial Board Member Joe Rago on the Supreme Court decision to uphold ObamaCare subsidies to federal health exchanges in King v. Burwell.
More to the political point, the Chief argues that withdrawing the subsidies would undermine larger ObamaCare goals such as giving “certain people tax credits to make insurance more affordable” and could lead to bad policy consequences like higher costs. “It is implausible that Congress meant the Act to operate in this manner,” he writes.
Even Solicitor General Donald Verrilli didn’t try to convince the Justices to rule in favor of the good intentions of “reforming” one-sixth of the economy. Instead he stressed statutory ambiguity and asked the Court to defer to the IRS. But Chief Justice Roberts goes beyond this and simply substitutes his own version of what he thinks Congress intended. This means that not even a new President with a new IRS could rewrite the subsidy rule because this rule is now what Chief Justice Roberts says it is.
As Justice Antonin Scalia observes in his coruscating dissent, “We [the Court] lack the prerogative to repair laws that do not work out in practice, just as the people lack the ability to throw us out of office if they dislike the solutions we concoct.” (See more Scalia nearby.) The framers made the judiciary the least accountable branch and vested all legislative power in Congress to protect the accountability necessary for durable self-government.
Justice Scalia quips acidly that “we should start calling this law SCOTUScare,” but the better term is RobertsCare. By volunteering as Nancy Pelosi’s copy editor, he is making her infamous line about passing the law to find out what’s in it even more true than she knew at the time.
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Beware the Obamacare industrial complex
Its litany of lies are resurfacing, and consumers will pay the price
http://m.washingtontimes.com/news/2017/aug/13/obamacare-lies-resurfacing/
By Stephen Moore -
Sunday, August 13, 2017
ANALYSIS/OPINION:
The danger of a Republican bailout of Obamacare is mounting with every passing day. A group of “moderate” Republicans calling themselves the Problem Solvers Caucus is quietly negotiating with Democratic leaders Nancy Pelosi and Chuck Schumer to throw a multi-billion dollar life line to the Obamacare insurance exchanges.
This bailout, of course, would be an epic betrayal by a Republican Party which has promised to repeal and replace the financially crumbling Obama health law.
Republicans who are “negotiating” this bipartisan deal, such as Sen. Lamar Alexander of Tennessee, object to the term “bailout” for this rescue package. The left prefers the euphemism “stabilizing the insurance market.” The Washington Post’s left-wing fact checker, who just can’t seem to get his facts straight, says “bailout” is misleading pejorative language. The Post claims this is merely a payment to low income families to help pay for the escalating premiums under Obamacare. These payments were allegedly always part of the law as passed.
The hypocrisy here is towering. These are the same people who told us over and over again that Obamacare was going to “bend the cost curve of health care down.” These are the same people who promised that Obamacare was going to “save” the average family $2,500 a year in lower insurance premiums. (If Obamacare were lowering insurance costs not raising them, there would be no need for these bailout funds in the first place.)
These were also the same people who swore to us that Obamacare wasn’t going to raise the federal deficit by a dime. Oh really. Where is the $10 to $20 billion to pay for this new federal subsidy going to come from? Pixie dust?
Incidentally, is there even one single promise of Obamacare that has been kept after seven years?
So why is everyone suddenly rallying for an Obamacare bailout? Why aren’t they demanding more consumer choice, an end to the odious individual mandate, repeal of the tax increase, and expanded health savings accounts? The answer is simple. The new health law has given rise to an Obamacare industrial complex. The health system is now like a cocaine junkie hooked on federal payments.
This addiction explains why the insurance companies are lobbying furiously for these funds alongside their new found friends at left-wing interest groups like Center for American Progress. The irony of this alliance is that the left-wing allies the insurers have united with hate insurance companies and want to abolish them. The insurance lobby is selling rope to their hangman.
Hospital groups, the American Medical Association, the AARP and groups like them are on board too. They are joined by the Catholic Bishops and groups like the American Heart Association and the American Lung Association. (If you are donating money to any of these groups you might want to think again.) This multi-billion dollar health industrial complex has only one solution to every Obamacare crack-up: more regulation and more tax dollars.
For example, the Obamacare industrial complex argues that there was an innocent mistake in the Obamacare law as written (imagine that, maybe next time they will read the bill before they vote on it) and that these bail-out funds to Obamacare were intended to be automatic entitlement payments that would not have to be appropriated by Congress.
The Obamacare lobby is salivating over that idea. Every year the insurance companies would get fatter and fatter checks from the government no matter how much Obamacare costs escalate. Is this what the “Problem Solvers” in Congress really want? Financial accountability would be thrown out the window and Obamacare would become an appendage of Medicaid with exploding costs and a blank check from taxpayers.
This year the best estimate is that Obamacare will need at least $10 billion more to keep the system solvent. The death spiral in the program is getting more dire with every passing month, so it’s highly predictable these costs will ratchet up to $20 billion next year and more in the years that follow.
You can call this a bailout or just a swindle of taxpayers who were fed a litany of lies about Obamacare’s virtues from the very start. Either way taxpayers get shafted (again) and the Obamacare industrial complex gets fat and happy. If Republicans are partners to this fiscal crime, they are as culpable as the Democrats who passed this turkey in the first place and they certainly don’t deserve to be the governing party.
• Stephen Moore is a senior fellow at The Heritage Foundation and an economic consultant with Freedom Works.
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ie: government control over all of out countries healthcare and eventually expanded to the world government:
https://www.healthcare-now.org/blog/obama-for-single-payer-before-he-was-against-it/
Obama care was never expected to succeed. It was *always* one step closer to the end game for the progressives.
Moore is all correct :
" the irony of this alliance is that the left-wing allies the insurers have united with hate insurance companies and want to abolish them. The insurance lobby is selling rope to their hangman."
absolutely - cash in while they can. They know the game.
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A lot is still speculative.
yet we are being led to believe that anyone who had a concussion is destined to turn out like Glen Campbell:
http://www.amjmed.com/article/S0002-9343(17)30482-5/fulltext
we see lots of football player working as sport analysts who don't seem punch drunk... but I digress
Interesting the author puts this in the body of the article:
" In Lithuania, where litigation after an accident does not exist, studies have revealed that the incidence of post-concussion symptoms 3 months after a concussion is no different than in a sex- and age-matched control group that did not suffer a head injury."
Not to downplay head inruies in sports but .........
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I would love to see Denny S get more involved on more of our threads here. I recall a collection posted at GilderTech called Denny's Pearls that is worthy of its own thread.
In this piece dated April 2, 2017 he lays out some factors I had not thought of and articulates other ones better than I have seen previously. It is very difficult to put the magic of the free market to words; only a few people have been able to do it. Mostly we just see the damage done by its absence. I hope it is okay that I post this... I would like to also put this in Economics - Science thread as the principles in play are not unique to healthcare.
A different article recently pointed out that healthcare inflation should be compared with our service economy, not goods, but still the question remains, why does an aspirin cost $10 apiece or a hospital room thousands per day while the price of computer power and so many other things keeps falling? We are treating more afflictions with more new treatments all the time but why are no cost saving innovations being made to older, established treatments? Something is wrong and missing because of our tampering, skewing and destroying of the free market.
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How (Healthcare) Markets Work, by Denny Schlesinger
http://softwaretimes.com/files/how+healthcare+markets+wor.html
At a forum I frequent I was challenged to explain why a universal healthcare system is more expensive and less efficient than a free market one. The challenge was posed by an anesthesiologist at a small town clinic.
What if I could convince you that universal health care made economic sense...that if might actually save you/us money?
Adam Smith knew that markets worked but he didn't know how or why so he invented the "invisible hand" to account for it. In the 240 years since The Wealth of Nations we have learned about the workings of markets. The things that we discovered include that markets are complex systems meaning they are not predictable in detail but we do know the kinds of effect that inputs have on prices and availability of goods and services.
What do you think happens when someone without insurance (or the ability to pay out of pocket) gets appendicits? Do you think they just stay home and die?
Think again. They come into the hospital, get taken care of, and then they don't or can't pay their bill. The hospital and staff "eats" the expense. Next time you look at your hospital bill and see the $10 charge for aspirin, you'll understand why. The hospital needs to meet their expenses.
In other words, you are already paying for their care through your higher insurance rates needed to cover those who didn't pay.
Now think about it: if no one had to avoid getting care because of money, they would get their health problems taken care of early, and at less expense. I promise you, waiting until things are unavoidable (like not getting your blood pressure treated until you show up with a stroke) is vastly more expensive than pre-emptive care.
Your example is just one data point -- anecdotal to boot because you don't know the costs involved -- insufficient to come to a definitive conclusion. It also contains a conjecture (bolded by me) that I will show to be false.
(http://softwaretimes.com/images/governor-200.jpg)
Rotating governor used with steam enginesSystems are governed (controlled, moderated, regulated) by feedback, positive and negative. The easiest to understand "negative feedback" mechanism is the rotating governor
The faster spin pushes the weights outward and slower spin lets them drop. This movement is used to control the fuel supply keeping the machine at a constant speed.
An easy to understand "positive feedback" is the screeching of audio systems when the mike is placed too close to the speakers. The mike picks up the increasing volume feeding it right back into the amplifier and out the speakers.
Every input to the market is either positive or negative feedback. If I don't buy something today that's negative feedback, please lower the price if you want me to buy. If the government gives a subsidy that's positive feedback designed to amplify production. Once you think in terms of feedback you understand how the invisible hand works. This is how the law of supply and demand works. The law of supply and demand is the market governor.
What seems miraculous about supply and demand is how millions of independent transactions filter through the system to set prices. I doubt anyone has yet been able to model how that happens, but it happens in every free (independent transactions) market system. The end result is the optimum distribution of scarce goods and services from a cost point of view. The problem is that this distribution might not be socially acceptable and society will insert new feedback to change the shape of the distribution. No matter how noble the intentions, the end result is a less cost effective market.
In an unregulated market the feedback comes from millions of independent transactions. Add extraneous feedback and the economic efficiency drops. I've been pondering for years why the American healthcare system is so expensive. Blaming it on price gougers is not a good answer even if it is part of the answer. One has to dig deeper, search for the causal feedback gone amok. My observations lead me to believe that paternalistic employers were at least part of the problem (see link below). By improving their worker's lot they changed the feedback entering the market creating unexpected distortions one of which was to reduce the efficiency of the market, in other words, by making stuff more affordable for their own workers they shifted the burden to the rest of the market participants.
My first employer, IBM, gave me free healthcare insurance. I didn't have to worry or even think about healthcare costs. My bit of negative feedback disappeared! I want the best, let the free insurance deal with it. With changes in the economy and in the labor market, paternalistic packages (except for higher management) became too expensive. By this time, since the cost of healthcare was basically unknown, the visible culprit of high healthcare costs was the insurance industry. In fact, the healthcare insurance industry itself had been derailed. The purpose of any insurance is to protect wealth. Fire insurance can't protect a home from fire, it can only protect the owner from the cost caused by the fire. Healthcare insurance originally was designed to protect against the cost of unexpected medical care under the assumption that the ordinary health maintenance costs were to be included in the ordinary household budget like rent and other services. Unfortunately the insurance coverage morphed from the transfer of risk of high cost medical treatment to prepaid medical care. That is clearly not the purpose of insurance but it sure makes premiums go up and is highly profitable for insurance companies. But is also alters the feedback the market receives as the payer is not the patient but the insurer.
One easy remedy for the broken healthcare insurance industry is high deductibles which cause the patients to inject feedback into the healthcare industry, feedback that has been sorely lacking for years. Everybody should be a payer!
... (more at the link)
Now let's put it all together: Insurance morphs into prepaid healthcare, angiograms go from when-needed to standard of care. More business for doctors, more business for hospitals, more business for the pharma industry, more business for insurance companies and, from what I have read, there is no payback in extended lifespans. On the other hand, if the standard of care procedure is not done, it's a good reason for a malpractice suit. This is what happens when your health is not in your hands but in the hands of experts.
Here again high deductibles are your friend, they force you to make a better evaluation of your situation, they give you back control over your health, over your body.
In general terms, market regulation is negative feedback designed to even out the playing field while incentives and subsidies are positive feedback. A free market advocate should accept a minimum of necessary regulation and the least amount of incentives and subsidies. The government has enough venues to provide incentives and subsidies such as the Manhattan Project, DARPA's Internet, the Interstate Highway System, and the Moon landing project to keep industry on the leading edge. The rest should be left to the free market.
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https://www.firstthings.com/web-exclusives/2017/08/its-a-culture-war-stupid
IT'S A CULTURE WAR, STUPID
by George Weigel
8 . 22 . 17
Those who persist in denying that the Church is engaged in a culture war, the combatants in which are aptly called the “culture of life” and the “culture of death,” might ponder this June blog post by my summer pastor in rural Québec, Father Tim Moyle:
Tonight I am preparing to celebrate a funeral for someone (let’s call him “H” to protect his privacy) who, while suffering from cancer, was admitted to hospital with an unrelated problem, a bladder infection. H’s family had him admitted to the hospital earlier in the week under the assumption that the doctors there would treat the infection and then he would be able to return home. To their shock and horror, they discovered that the attending physician had indeed made the decision NOT to treat the infection. When they demanded that he change his course of (in)action, he refused, stating that it would be better if H died of this infection now rather than let cancer take its course and kill him later. Despite their demands and pleadings, the doctor would not budge from his decision. In fact he deliberately hastened H’s end by ordering large amounts of morphine “to control pain” which resulted in his losing consciousness as his lungs filled up with fluid. In less than 24 hours, H was dead.
Let me tell you a bit about H. He was 63 years old. He leaves behind a wife and two daughters who are both currently working in universities toward their undergraduate degrees. We are not talking here about someone who was advanced in years and rapidly failing due to the exigencies of old age. We are talking about a man who was undergoing chemotherapy and radiation treatments. We are talking about a man who still held onto hope that perhaps he might defy the odds long enough to see his daughters graduate. Evidently and tragically, in the eyes of the physician tasked with providing the care needed to beat back the infection, that hope was not worth pursuing.
Again, let me make this point abundantly clear: It was the express desire of both the patient and his spouse that the doctor treat the infection. This wish was ignored.
Canada’s vulnerability to the culture of death is exacerbated by Canada’s single-payer, i.e. state-funded and state-run, health care system. And the brutal fact is that it's more “cost-effective” to euthanize patients than to treat secondary conditions that could turn lethal (like H’s infection) or to provide palliative end-of-life care. Last year, when I asked a leading Canadian Catholic opponent of euthanasia why a rich country like the “True North strong and free” couldn’t provide palliative end-of-life care for all those with terminal illnesses, relieving the fear of agonized and protracted dying that’s one incentive for euthanasia, he told me that only 30 percent of Canadians had access to such care. When I asked why the heck that was the case, he replied that, despite assurances from governments both conservative and liberal that they’d address this shameful situation, the financial calculus had always won out—from a utilitarian point of view, euthanizing H and others like him was the sounder public policy.
But in Canada, a mature democracy, that utilitarian calculus among government bean-counters wouldn’t survive for long if a similar, cold calculus were not at work in the souls of too many citizens. And that is one reason why the Church must engage the culture war, not only in Canada but in the United States and throughout the West: to warm chilled souls and rebuild a civil society committed to human dignity.
Then there is the civic reason. To reduce a human being to an object whose value is measured by “utility” is to destroy one of the building blocks of the democratic order—the moral truth that the American Declaration of Independence calls the “inalienable” right to “life.” That right is “inalienable”—which means built-in, which means not a gift of the state—because it reflects something even more fundamental: the dignity of the human person.
When we lose sight of that, we are lost as a human community, and democracy is lost. So the culture war must be fought. And a Church that takes social justice seriously must fight it.
George Weigel is Distinguished Senior Fellow of Washington, D.C.’s Ethics and Public Policy Center, where he holds the William E. Simon Chair in Catholic Studies.
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First, please read or re-read the previous post by G M in this thread. Canada wouldn't treat a bladder infection because the guy was going to die anyway. People (on the left or in a dream world) think we can remove money from healthcare by making it free but scarce resources get allocated one way or another. The question isn't just right or wrong but WHO should make that decision. If private citizens and their families make those choices with their own resources, the government would have more resources left to help when help is needed. !!!
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One thing we should all agree on where government can play a role is to get healthcare pricing out in the open... How can there ever be anything approaching a free market if we can't ever know prices?
http://www.realclearhealth.com/articles/2017/08/29/health_care_pricing_shouldnt_be_like_nuclear_codes_110717.html
Health Care Pricing Shouldn’t Be Like Nuclear Codes
By Greg Borca
August 29, 2017
Ask just about anyone what the most closely held secret is in America, and odds are they’ll either say the nation’s nuclear codes or the formula for Coca-Cola. Yet running a close third is the actual selling price of pretty much everything in health care.
The health care industry, especially the large players that dominate the landscape today, keep the actual dollars paid for care hidden amongst themselves, often obscured within complex contract language. Yes, there are “published” prices, but they bear little resemblance to the reimbursements providers and payers are agreeing to behind the curtain.
Consumers can see evidence of this moving target for pricing when they offer to pay cash directly to a provider versus going through a payer (aka an insurer) at the negotiated rate(s). The differences in pricing negotiated in contracts between providers and payers can be much greater.
The result of all this secrecy is that the per capita cost of something every single American needs has tripled over the last 20 years, rising to become nearly one-fifth of the gross domestic product. Yet no one seems to understand how to change this trend because if they did they’d be proposing a workable solution.
Worse, as long as there is a lack of financial transparency, it is impossible to take the steps that will create meaningful competition across the health care industry. Without competition, pricing will continue to rise needlessly, exacerbating all the issues that are being discussed in Congress right now.
Here’s why the lack of transparency around provider pricing is so effective at killing competition: When payers enter into negotiations with providers, their biggest bargaining chip is the number of members they can drive to that provider. So if health payer A has 3 million members in the market and health payer B has 1 million members, health payer A may get a contract that includes a much greater reduction off the published prices than health payer B.
Health payer A can then elect to offer slightly lower premiums than health payer B. Since the most important consideration for many consumers in selecting a health plan is their premium cost, health payer A gains a distinct market advantage. Add in a few high-deductible health plan (HDHP) options that shift more of the cost to the patient, and health payer A can gain even more market share.
This system of unknown selling prices is also why passing a law that enables insurers to sell across state lines won’t matter. When an insurance company enters a new market, it must negotiate pricing with local providers. The pricing it is offered is normally based on how many members it can direct to a provider. Since it starts out with zero members, it will pay much higher prices than the established insurers. The result will be higher premium costs. It then becomes a chicken-egg scenario. To secure competitive pricing the insurer must secure a large number of members. It cannot secure a large number of members, however, until it lowers its premiums. The new player is, in effect, locked out of the market.
What’s interesting is that health payers and providers didn’t always work together in such lockstep. Twenty-five years ago, the relationship was much more contentious. It wasn’t uncommon to read news stories about hospital systems that failed to reach an agreement with a particular payer and was thus terminating its contract and dropping out of the network. That is unheard of in this day and age.
It is also why those few startups that do manage to get off of the ground tend to rely on inventive strategies, such as narrow networks for high-cost procedures and broader networks for primary care. This two-tier approach is unorthodox but provides smaller insurers a way to find a foothold in larger markets.
If Congress really wants to bring down the cost of health insurance and spur competition, the solution is obvious: Level the playing field by requiring the health care industry to publish prices and costs and adhere strictly to those benchmarks. If an individual organization offers a discount to any player (including the federal Centers for Medicare & Medicaid Services), that now becomes the new price for everyone.
The creation of this type of price transparency will offer several consumer benefits. With pricing leveled and readily available for review, no single payer will have a huge, hidden cost advantage over the current competition. An equal baseline for pricing will encourage payers to improve efficiency and reduce costs, and increased competition will furthermore help keep premium costs in check.
Level pricing will enable new, more efficient payers to develop, allowing for easier access to health care markets in other states.
Enabling such price transparency will allow consumers to shop for the best combination of quality and affordability; think Travelocity or Progressive, but for the best deal on health care in your area. This will be especially helpful as bundled payments and other value-based care options grow in popularity. Right now, if you call a provider and ask how much knee replacement surgery will cost, they won’t be able to give you a fast answer because it will depend on which insurance you have and which plan you’re on. With set pricing, you’ll be able to look it up online and compare.
Where final pricing is conditional on factors such as the state of the patient’s health, transparent pricing will make it easier for payers to deliver an instant explanation of benefits that will show patients exactly what their costs will be rather than being shocked by the costs months after the appointment or procedure. As more consumers adopt HDHPs, knowing those costs will be invaluable to both the patients and the providers who need to collect from them.
Perhaps the most important benefit, however, will be the freshly invigorated spirit of entrepreneurship that will drive down costs through innovative technologies and health care models we haven’t even imagined yet.
Think about how much cheaper air travel became after deregulation, thanks in large part to Southwest Airlines. Once Southwest started offering direct flights to destinations all over the United States for $39, every other airline had to slash its prices or perish. Consider what car buying is like now that automobile manufacturers publish their prices on the Internet for all to see.
Most of the current health payers are still using legacy green screen computing technologies from the 1980s. Why? Because they can. Startups entering the market using technologies designed for the digital age will create a need to modernize the established payers’ technology systems and processes so they can drive down their internal costs to compete with the startups’ significantly lower premiums.
These competition-driven efficiencies will lead to more options in the health insurance marketplace for consumers at lower costs, finally making affordable health care for all a reality. Not by government edict, but by intelligently harnessing the forces of the free market, which should satisfy all political persuasions.
The current system is unsustainable, but it is fixable. It’s time to quit treating health care pricing like it’s the nuclear codes and instead make real prices transparent to all.
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As I understand it, access to healthcare is either controlled by price, or by rationing.
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As I understand it, access to healthcare is either controlled by price, or by rationing.
Right. But rationing is based on price too. They call it free but that doesn't mean your access isn't based on costs and money. "Free" healthcare has a money cost to the government, to the taxpayer. The doctor has a cost. The room has a cost. The nurse, the equipment, the supplies, the parking lot, everything.
Canada has a 270 day wait for basic orthopedic services. 47 weeks for Neurosurgery!!! See link. How do you know now what Neurosurgery services you might need in 47 weeks??!!
http://globalnews.ca/news/3084366/q-a-how-long-are-medical-wait-times-in-canada-by-province-and-procedure/
Medical wait times in Canada, measured in double digits of weeks, are getting worse, not better. They are a feature, not a bug, of their system. The queue allocates scarce resources - by denying them. Canada could lower wait times and ease their rationing anytime they want to - by spending more money. Hire more doctors, invest in more equipment, build more facilities, serve more patients. But they don't - because of money.
Pittsburgh has more MRI machines than Canada. http://healthcare-economist.com/2008/02/11/pittsburgh-has-more-mri-machines-than-canada/ The southwest suburbs of Minneapolis have more MRI machines than Canada. I could still get a picture taken today, by spending money. Canada knows how to buy more machines and hire more doctors and doesn't. Money IS the limiting factor.
I know this is all obvious to everyone here, but we need to successfully address the liberal argument that it is immoral to allocate something as important as healthcare based on money. There is no way around it. Healthcare costs money. Money is even more of a limiting factor in socialistic systems because their economies produce fewer resources needed to pay for things like healthcare. And as you pursue sameness / equality, you necessarily lower the quality for many or most to accomplish that.
Canada has the advantage of something we will never have, a large, innovative, neighbor country right across the border to go to if and when your own system fails.
Tens of thousands of people come from 50 states and 140 countries every year to visit Rochester Minnesota, home of the Mayo Clinic. The Boston Globe calls them "reluctant tourists". https://www.bostonglobe.com/lifestyle/travel/2015/06/27/rochester-thrives-destination-medical-center-for-reluctant-tourists-flocking-mayo-clinic/i9FTkn3KHbobH5hOo8sqUJ/story.html
No doubt they would rather be treated near home or be on a beach somewhere, but this is how they CHOOSE to spend their time and their money at this point in their lives.
Cost is only one factor in affordable healthcare. The other factor in affordability is income/wealth. Grow the economy stupid (paraphrasing Bill Clinton). Grow economic liberties. Grow incomes and accumulate wealth to pay for things that may come up that are important to you - like medical treatment.
What is the Canadian equivalent of the Mayo Clinic? (crickets)
Mayo has a travel/communications office in Canada: http://www.mayoclinic.org/departments-centers/international/locations/mayo-clinic-offices/canada
How come Presidents Reagan, H W Bush, Saudi King Abdallah, Jordan King Hussein, Iraqi President Jalal Talabani and so many others all came to Mayo. Hugo Chavez went to Cuba; how did that go? None of those who can choose, choose Canada. What would they do there, wait??
Using Canadian or liberal logic, maybe the city of Rochester, MN would make even more on their hotel and restaurant traffic if the wait times were 47 weeks...
https://www.fastcompany.com/3041355/the-65-billion-20-year-plan-to-transform-an-american-city
http://dailysignal.com/2010/02/09/the-canadian-patients%E2%80%99-remedy-for-health-care-go-to-america/
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" ens of thousands of people come from 50 states and 140 countries every year to visit Rochester Minnesota, home of the Mayo Clinic. The Boston Globe calls them "reluctant tourists". https://www.bostonglobe.com/lifestyle/travel/2015/06/27/rochester-thrives-destination-medical-center-for-reluctant-tourists-flocking-mayo-clinic/i9FTkn3KHbobH5hOo8sqUJ/story.html "
Boston must be exceptionally jealous of this with their NEJM , Mass Gen , Bringham Young etc..........
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http://www.huffingtonpost.com/entry/bernie-sanders-single-payer_us_59b7faa7e4b031cc65cd0637?ncid=inblnkushpmg00000009
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http://www.huffingtonpost.com/entry/bernie-sanders-single-payer_us_59b7faa7e4b031cc65cd0637?ncid=inblnkushpmg00000009
MOAR. FREE. SH*T!
I'm sure it will work out well.
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" MOAR. FREE. SH*T! "
Absolutely FREEEE !!!
who would not love this idea????
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" MOAR. FREE. SH*T! "
Absolutely FREEEE !!!
who would not love this idea????
This is a defining moment; let's seize it. Republicans failed to repeal ACA, for one reason, because of the uncertainty about what to replace it with. Obamacare has clearly failed; no one argues that. The 'honest liberal' answer is 'single payer', meaning make all healthcare a government program. This is a serious proposal. Bernie represents the left, the socialist and activist wing of the party and more than half of today's Democrats. Al Franken has joined him.
http://m.startribune.com/senators-seek-bipartisan-fix-to-avoid-premium-hikes-under-affordable-care-act/444064943/
https://www.realclearpolitics.com/articles/2017/09/12/democrats_split_on_sanders_medicare_for_all_plan.html
Pure, unadulterated socialism is on the table. Good. Let's bring it up, debate it and vote on it. Let's get Democrats on the record for either supporting socialism or rejecting it. And let's get some clarity among Republicans on the point of why not. Let's defeat the idea out in the open for young voters and all the other groups to see, that socialism has the answers when it never has. See Venezuela.
More than a quarter of Senate Democrats, including several thought to already be laying the groundwork for 2020 presidential bids, have signed on to co-sponsor the single-payer legislation...
The vast majority of Democratic senators up for re-election next year have also shied away from backing Sanders’ bill. Only Tammy Baldwin of Wisconsin has signed on, endorsing the plan Tuesday and featuring the news on her campaign website. Republicans wasted no time going after her. “A $32 trillion socialist health care system is the last thing Wisconsinites want or need,” said National Republican Senatorial Committee Communications Director
https://www.realclearpolitics.com/articles/2017/09/12/democrats_split_on_sanders_medicare_for_all_plan.html
Good, let's split them, expose them and defeat them.
Free sh*t is first level thinking - like all liberal solutions. Someone (like the President of the United States) needs to tell people why they shouldn't support it and convince them - free shit isn't free. Socialism doesn't work. Economic freedom outperforms big brother every time it's tried. We should not give our most important, life saving industry over to the system known to perform the worst.
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"This is a defining moment; let's seize it."
Agree but do you really think Ryan or McConnell are going to do that?
I have ZERO faith in either
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...do you really think Ryan or McConnell are going to do that?
I have ZERO faith in either
I share the same frustration. I don't take it to the level of hatred that Hannity and Levin seem to have. Didn't Reagan have an 11th commandment and these two commentators in particular worship Reagan. These two are not leaders in this environment and I don't know if this congress is leadable. Herding cats... Ryan and McConnell aren't the problem; they just aren't the solution.
Reagan led by taking his case to the people and putting the pressure on the representatives from that direction. McConnell for sure is not a take-it-to-the-people kind of leader and Ryan seems to have lost what got him there. If not Trump, someone else needs to step up - on all these issues. Maybe Pence needs to step in, put pressure on Murkowski in Alaska, Manchin in WV, etc.
The previous repeal failure was the fault of McCain, Murkowski and the ten Trump-state senate Democrats. Maybe we needed a better bill and maybe this new one (Cassidy) is it. Yet one Senator, Rand Paul, can kill this bill: https://www.bloomberg.com/view/articles/2017-09-13/graham-cassidy-bill-is-the-latest-dim-hope-for-health-reform http://thehill.com/policy/healthcare/350161-paul-new-obamacare-repeal-bill-probably-worse-than-nothing
That furthers smaller government how?
Problem is that they've muddled the bills and the principles and the messaging so badly that people even here don't know which bills we favor or oppose.
Again, zero Dem support even though ten of them serve in states Trump won, some in states Trump won by 30-40 points! Who holds those feet to the fire?
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http://www.investors.com/politics/editorials/the-gops-last-ditch-effort-to-repeal-obamacare-is-surprisingly-good/
The GOP's Last-Ditch Effort To Repeal ObamaCare Is Surprisingly Good
Health Reform: After nine fruitless months, Republicans have finally come up with an ObamaCare replacement plan that is simple and appealing, and that should easily pass the Senate. Will the GOP blow it again?
Put together by Sens. Bill Cassidy and Lindsay Graham, the plan would take the money being spent on ObamaCare's insurance subsidies and Medicaid expansion, and give it to states in the form of fixed block grants.
States would then have wide latitude in how they spend the money — for example, they could use it to set up high-risk pools, reduce out-of-pocket costs, pay providers or subsidize premiums. They'd also be able to get out from under ObamaCare's disruptive and costly market regulations and benefit mandates.
It would repeal ObamaCare's individual and employer mandates, and its tax on medical devices. It would expand Health Savings Accounts and for the first time let those with accounts spend HSA money on insurance premiums. It would reform the rest of Medicaid by replacing the current open-ended matching grant program with fixed per-capita payments. And it would also let states impose work requirements for able-bodied adults enrolled in Medicaid.
Interestingly, while trying to craft legislation that would appeal to Republican moderates in the Senate, Cassidy and Graham have created a plan that is in some ways more conservative than the earlier House and Senate repeal-and-replace bills.
Those plans retained ObamaCare's disastrous "guaranteed issue" and "community rating" regulations and carried over its essential health benefits mandate, replacing one federal ObamaCare subsidy scheme for another. The plans were overly complicated and difficult to defend, but easy to attack.
The Cassidy-Graham bill, in contrast, is comparatively simple and straightforward. It lets states run their insurance markets as they see fit.
This is a welcome return to federalist principles that the GOP had forgotten when crafting their earlier ObamaCare replacement bills.
Is the Cassidy-Graham bill ideal? Of course not. Liberal states could keep ObamaCare in place, or use the money to finance single-payer health care. It concedes that the federal government is responsible for providing massive health care subsidies to the states. And it leaves many other free-market reforms off the table.
But look at the complaints from its critics, and you get a sense of why it's a step worth taking.
The liberal Center on Budget and Policy Priorities, for example, complains that "Cassidy-Graham would … allow states to spend their federal block grant on virtually any health care purpose, not just for health coverage." And states could "devise their own coverage programs."
The horror!
The other complaint from liberal groups is that Cassidy-Graham won't spend as much on health care as ObamaCare would. But if states can use their block money more effectively than ObamaCare, less will mean more.
Of course, the Congressional Budget Office will no doubt say that the bill will cause 20 million or so to "lose" coverage — a prediction that Republicans should ignore since, as we've pointed out in this space, it is based on outdated numbers and ridiculous assumptions.
To be sure, the chances of the Cassidy-Graham bill getting approved in the Senate are slim. The deadline for getting a repeal bill approved is September 30.
Two senators — Rand Paul and Susan Collins — have already come out against it, but John McCain says he'll back this. That means Alaskan Sen. Lisa Murkowski would have to change her previous "no" votes to "yes" if there's to be any hope of passage. (With a 52-seat majority in the Senate, the GOP can only afford to lose two GOP votes.)
Someone needs to remind Murkowski that she ran for election in 2016 repeatedly vowing to repeal ObamaCare. In May 2016, for example, she said on the Senate floor that "I have consistently supported full repeal of the ACA and have voted to do so on several occasions." But those votes, which took place while President Obama was sure to veto any repeal measure, were meaningless.
The question is, will Murkowski vote for repeal now, at the eleventh hour, when it will actually count? If she doesn't, Alaska's voters should replace her at their first opportunity.
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Thank God for McCain
What in tarnation is wrong with Rand Paul?
What good is "principals" if we lose everything by him making some sort of false stand?
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https://conservativetribune.com/sanders-invites-canadian-doctor/?utm_source=facebook&utm_medium=makeamericagreattoday&utm_campaign=can&utm_content=2017-09-18
:-D :-D :-D
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To think McCain was actually the GOP candidate back in '08!
He is now the proud hero of the LEFT.
They will be awarding honorary degrees from Harvard and Columbia before he goes into the sunset in a blaze of glory in his own mind.
Joke on us folks.
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I was having similar thoughts myself today as well.
He would NOT have been a good president.
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The McCain nomination was the beginning of the end for the Republicans.
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Have we given up on healthcare reform? Where is Manchin, Heitkamp on this? Susan Collins, Murkowski?
Rand Paul (and I) might want the federal government to play no role in healthcare but that has no chance of passing. If you want to repeal Obamacare, you have to pass one of these bills favored by at least close to a majority of the (House and) Senate, that the President will sign. Failure to do so is the same as reauthorizing the Pelosi-Obama law. This isn't a thought experiment anymore.
Good Analysis of the Cassidy bill here:
https://www.forbes.com/sites/theapothecary/2017/09/17/take-two-inside-bill-cassidys-plan-to-replace-obamacare/#77eae5741181
Like the Better Care Reconciliation Act, Graham-Cassidy would repeal Obamacare’s individual and employer mandates. Both bills increase annual contributions to health savings accounts. Both bills phase down state-based Medicaid provider taxes that states use to game the federal government into giving them more money than they’re supposed to get. Both bills allow states the ability to frequently cull their Medicaid rolls of ineligible recipients—something they can’t do today.
The bill would institute a per-capita allotment for the legacy Medicaid program that is quite similar to the one in the BCRA. This per-capita approach is essential to ensuring that Medicaid is fiscally sustainable in the future. Both bills allow states to institute work requirements for Medicaid.
One of the most interesting reforms in Graham-Cassidy is that, over time, it ends a significant bias in the Medicaid program toward wealthy states like California, Massachusetts, New York, and Maryland. Medicaid is jointly funded by the federal government and the states; on average, Washington foots about 60 percent of the bill. In theory, the federal government is supposed to foot higher proportions of the bill for poorer states; but because the minimum match is set to 50 percent, a number of very wealthy states receive a lot more money than they should.
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http://www.thelibertyconservative.com/trump-to-back-rand-paul-health-care-proposal/
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http://www.thelibertyconservative.com/trump-to-back-rand-paul-health-care-proposal/
It's a crazy idea, but when all else fails, we could try the free market...
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http://thefederalist.com/2017/10/05/bobby-jindal-as-hhs-chief-is-trumps-best-chance-at-obamacare-repeal/
Jindal’s health-care policy bona fides can’t be overstated. Anyone who’s interviewed him or been present for an open-ended Q&A knows that he can expound at length on, say, the problem of counting hospital uncompensated care as a reimbursable Medicaid expense. Or the ways that federal Medicaid matching funds incentivize states to spend more than they need to. Or any number of arcane aspects of health policy
Jindal had among the most detailed and realistic plans to repeal and replace Obamacare, which he unveiled back in 2014. If anyone could push Congress toward the policies that would have the most effect, and might actually get past a divided GOP Congress, it would be him.
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AGREED!!!
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President Donald Trump signed a new executive order on Thursday that moves health care a step in the right direction.
The executive order instructs the secretaries of treasury, labor, and health and human services to propose regulatory changes that would increase choice and competition in health insurance.
This is the right course of action. In the absence of congressional action to address Obamacare’s damage, Trump is right to seek ways within his power to help those hurt by Obamacare’s skyrocketing premiums and the reduced access to quality plans.
Trump’s executive order addresses three problems that hinder people’s access to the insurance and care they need.
Americans need an alternative to the mainstream media. But this can't be done alone. Find out more >>
First, small business employees and the self-employed are most hurt by Obamacare. The percentage of workers at small firms receiving coverage through their employer has declined from nearly half in 2010 to about one-third in 2017. They face skyrocketing premiums and reduced choice in plans.
One challenge small businesses face is that, under current interpretations of a federal employee benefit law, they are limited in their ability to band together and secure coverage similar to plans offered by larger employers.
Obamacare exacerbated that problem by imposing costly new benefit mandates on small employer plans, but not on large employer plans. Thus, Trump is right to ask the Department of Labor to help by exploring ways to update this interpretation.
A change of this sort could allow small businesses and the self-employed to escape Obamacare’s costly benefit mandates and access new options run by associations that they have a stake in.
It could also help more small employers offer coverage to their workers. Newly enrolled individuals could save money—up to 20 to 50 percent on the cost of their insurance—by taking advantage of the tax break for employer-provided health insurance.
Second, President Barack Obama’s administration sharply reduced access to a low-cost option known as short-term, limited duration insurance.
These plans are often one-third of the cost of the cheapest Obamacare plans, yet typically feature broad provider networks and high coverage limits. That makes it harder than it should be for people between jobs to access a low-cost insurance plan.
As a result, people between jobs face suboptimal choices such as buying Obamacare’s heavily regulated and expensive plans, or going on Medicaid.
To address this, Trump rightly asks the departments of the Treasury, Labor, and Health and Human Services to consider reversing Obama’s decision.
Third, the Obama administration issued regulations limiting the ability of businesses to offer their employees coverage through “Health Reimbursement Arrangements,” in order to force such plans to comply with Obamacare’s standardized, one-size-fits-all benefit design.
Yet the whole point of those plans is to give businesses and workers a tool for customizing their health benefits according to their own needs and preferences.
Thus, Trump has rightly asked the departments of the Treasury, Labor, and Health and Human Services to explore ways to revise those regulations so that employers and workers have more flexibility and choices for health benefits.
While Trump’s executive order on health care is a step in the right direction, he needs Congress to get back to work in order to more fully improve our health system. The administration can only do so much, as it has to work within the confines of exiting law, including Obamacare.
For instance, the administration likely has sufficient authority to revise the regulations on health reimbursement arrangements so that employers have new options to give workers tax-free contributions to buy the individual market coverage of their choice.
But the potential benefits of that policy change will remain largely unrealized, so long as the law prevents insurers from offering anything other than Obamacare’s limited menu of standardized, overregulated, overpriced individual market plans.
Thus, Congress needs to do its job, fully undo Obamacare’s damage, and offer broader relief to all Americans struggling with rising premium costs and reduced choice of plans.
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http://thehill.com/opinion/judiciary/355374-on-cutting-obamacare-funding-trump-has-the-law-on-his-side
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and I pay subscriptions has become a branch outlet of the Huffington Post:
http://www.acpinternist.org/archives/2017/10/why-acp-must-speak-out-against-discrimination.htm
What the hell does this have to do with health care or representing my interests ?
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and I pay subscriptions has become a branch outlet of the Huffington Post:
http://www.acpinternist.org/archives/2017/10/why-acp-must-speak-out-against-discrimination.htm
What the hell does this have to do with health care or representing my interests ?
Nothing at all. The left does to organizations what a virus does to a healthy cell.
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The ObamaCare ‘Sabotage’ Meme
The solution for illegal health subsidies is a bipartisan trade.
Sens. Patty Murray and Lamar Alexander in Washington, Jan. 18.
Sens. Patty Murray and Lamar Alexander in Washington, Jan. 18. Photo: Andrew Harrer/Bloomberg News
By The Editorial Board
Oct. 13, 2017 7:10 p.m. ET
369 COMMENTS
By our deadline Friday the world had continued to spin without interruption—planes taking off and landing; men and women commuting home after another week at work—and if you’re reading this then you survived the ObamaCare subsidy apocalypse of 2017. We’re referring to the political meltdown over the Trump Administration’s decision to end extralegal payments to insurers.
The White House leaked Thursday night that the government will stop making “cost-sharing” payments, which are ObamaCare subsidies for insurers that defray the cost of deductibles or co-pays for some folks below 250% of the poverty line. President Trump unloaded on Friday in one of his predawn tweets that “The Democrats ObamaCare is imploding” and “subsidy payments to their pet insurance companies has stopped.” Why he chose to swamp his Thursday health-care executive order with this fresh controversy is a mystery.
In any event, first order of business: The payments are illegal. The Affordable Care Act leaves the subsidies contingent on an annual appropriation, but since 2014 Congress has declined to dedicate the funding. The Obama Administration wrote the checks anyway, and the House of Representatives sued. Federal Judge Rosemary Collyer last year ruled that the Obama Administration had violated the Constitution, and an appeal is pending.
Mr. Trump continued the payments on the hope that Republican health-care reform would repeal ObamaCare and moot the subsidy dispute. That did not happen. Now the Administration has decided to follow the Constitution, and fidelity to the law should trump the policy merits or political risks.
The left is accusing Mr. Trump of—this is a partial list—sabotaging the Affordable Care Act; conspiring to harm the poor; sending a wrecking ball into the American health-care system; killing people. One frequent citation is a Congressional Budget Office report from August that predicted premiums would increase if the subsidies ended, which is true.
Yet CBO also noted that the added expense would be covered by subsidies for individuals that increase with premiums. The market would continue to be stable by CBO’s report, and the change won’t invite the ObamaCare death spiral that Democrats would love to pin on Republicans. More generous individual subsidies mean the insurers now predicting Armageddon will still get paid.
But more uncertainty and turmoil could still drive some users from the exchanges, and the solution is straightforward: Congress can appropriate the money in a legal fashion. Republicans have an incentive to compromise, lest they have to take responsibility for rising premiums. Democrats could in exchange agree to liberalize the insurance markets—e.g., by repealing the individual or employer mandates, or allowing more flexibility on state waivers.
Republican Senator Lamar Alexander has tried to work a deal with Democratic Senator Patty Murray, but Democrats have refused to allow states any running room to experiment, aside from de minimis paperwork exemptions. Chuck Schumer has said for months that he’d negotiate once repeal was off the table, and now we’ll find out. If Democrats really care about the poor—and fixing a problem they helped create by violating the separation of powers—then they’ll compromise.
Meantime, the insurers will uphold the great American tradition of litigation and try to force the government to fork over the money. Mr. Trump deserves credit for upholding the Constitution, but this messy episode is one more consequence of the GOP’s failure in Congress to replace the Affordable Care Act.
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http://www.telegraph.co.uk/news/2017/10/17/nhs-provokes-fury-indefinite-surgery-ban-smokers-obese/
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and they had a national health care system to tell us all what to do.
But they have no problem taxing cigarettes in Britain like here
Why not make them illegal and put smokers in jail?
Why not tax those with BMIs over 30 and those over 40 double tax and those over 50 -> jail.
What about all the drunks in England and Ireland? Refuse them care if they don't stop drinking.
I suppose gender re assignment surgery is covered.
What about all the people spreading STDs? Talk about irresponsible behavior. (can't blame it on Reagan he's dead)
I could think of other examples
Make it LAW -> 1) all people must exercise for 30 minutes a day for 6 days a week
2 ) Sweets banned
3) limit red meat to 8 oz per week per person
4 ) you must prove you are eating your greens and fruit and nuts daily
Otherwise your labeled a deplorable and SJW have the right to decide your fate.
(PS my BMI is about 26)
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and they had a national health care system
But they have no problem taxing cigarettes in Britain like here
Why not make them illegal and put smokers in jail?
Why not tax those with BMIs over 30 and those over 40 double tax and those over 50 -> jail.
What about all the drunks in England and Ireland? Refuse them care if they don't stop drinking.
I suppose gender re assignment surgery is covered.
What about all the people spreading STDs? Talk about irresponsible behavior.
I could think of other examples
Make it LAW -> 1) all people must exercise for 30 minutes a day for 6 days a week
2 ) Sweets banned
3) limit red meat to 8 oz per week per person
4 ) you must prove you are eating our greens and fruit and nuts daily
Otherwise your labeled a deplorable and SJW have the right to decide your fate.
Most socialist paradises have been very successful at ending obesity in the general population.
(https://qph.ec.quoracdn.net/main-qimg-8e23ea98102ee38ddc7ce605b53787c5-c)
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GM,
Yes and
Venezuela is a more recent example
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Has nice ring to it to all those who will not have to pay for it much:
http://thefederalist.com/2017/11/06/democrats-finally-admit-real-goal-single-payer-health-welfare/
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Has nice ring to it to all those who will not have to pay for it much:
http://thefederalist.com/2017/11/06/democrats-finally-admit-real-goal-single-payer-health-welfare/
Why don't they call it V.A. for all? Venezuela for all...
Equal requires coercion; it is not the natural state of things.
And if the wait is too long, we go to Canada, Mexico, Haiti?
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*Finally* a concise well written discussion of the political self serving often data driven drivel I am seeing regularly in the medical literature.
This weeks journal of the american [political] medical association
has two more articles about "gun violence" !!!!
What the hell does that have to do with medicine?
http://www.nationalreview.com/article/453676/doctor-screening-not-key-preventing-gun-violence
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https://www.wsj.com/articles/why-didnt-obamacare-work-1513978521?mod=djemBestOfTheWeb
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talking head on MSNBC with the coordinated left wing attack on the tax cuts criticizing them for being not "bipartisan" and making the ridiculous claim that bills that are not bipartisan always fail
My first thought was how come in that case she was not blasting Obamster care!
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***At some point in the future, be it years, decades, or a century hence, the federal government will seek to ban driving. This, I’m afraid, is an inevitability. It is inexorably heading our way. The dot sits now on the horizon. As is common, the measure will be sold in the name of public health. ***
and from same article:
****Our debate will rest largely upon charts. The American Medical Association will find “no compelling reason to permit the citizenry to drive,” and Vox will quote it daily. Concurring in this assessment will be The New England Journal of Medicine, the Center for American Progress, and the newly rechristened Mothers against Dangerous Driving,.. ****
http://www.nationalreview.com/article/455018/autonomous-vehicles-will-spark-government-efforts-ban-driving
Mr Charles Cooke is EXACTLY right that medical organizations have in the past few yrs become propagandist tools for the LEFT radicals. Health care has never been more political .
A recent JAMA (journal of the American [left wing] medical association ) had recent articles about firearms and now this month's Annals of Internal Medicine had half the journal dedicated to LEFT wing propaganda and again telling all doctors it is their duty to discuss guns with all patients and be a force for action (political activism ) for an assault on the Second Amendment .
Check out all these articles just from ONE journal this past month . One could just imagine the authors are from Hollywood, the DNC or from faux - Pochahantus ' family:
http://annals.org/aim/fullarticle/2659346/state-interstate-associations-between-gun-shows-firearm-deaths-injuries-quasi
http://annals.org/aim/fullarticle/2659347/firearm-injury-after-gun-shows-evidence-gauge-potential-impact-regulatory
http://annals.org/aim/fullarticle/2658284/what-you-can-do-stop-firearm-violence
http://annals.org/aim/fullarticle/2658283/health-care-professional-s-pledge-protecting-our-patients-from-firearm
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***At some point in the future, be it years, decades, or a century hence, the federal government will seek to ban driving. This, I’m afraid, is an inevitability. It is inexorably heading our way. The dot sits now on the horizon. As is common, the measure will be sold in the name of public health. ***
and from same article:
****Our debate will rest largely upon charts. The American Medical Association will find “no compelling reason to permit the citizenry to drive,” and Vox will quote it daily. Concurring in this assessment will be The New England Journal of Medicine, the Center for American Progress, and the newly rechristened Mothers against Dangerous Driving,.. ****
http://www.nationalreview.com/article/455018/autonomous-vehicles-will-spark-government-efforts-ban-driving
Mr Charles Cooke is EXACTLY right that medical organizations have in the past few yrs become propagandist tools for the LEFT radicals. Health care has never been more political .
A recent JAMA (journal of the American [left wing] medical association ) had recent articles about firearms and now this month's Annals of Internal Medicine had half the journal dedicated to LEFT wing propaganda and again telling all doctors it is their duty to discuss guns with all patients and be a force for action (political activism ) for an assault on the Second Amendment .
Check out all these articles just from ONE journal this past month . One could just imagine the authors are from Hollywood, the DNC or from faux - Pochahantus ' family:
http://annals.org/aim/fullarticle/2659346/state-interstate-associations-between-gun-shows-firearm-deaths-injuries-quasi
http://annals.org/aim/fullarticle/2659347/firearm-injury-after-gun-shows-evidence-gauge-potential-impact-regulatory
http://annals.org/aim/fullarticle/2658284/what-you-can-do-stop-firearm-violence
http://annals.org/aim/fullarticle/2658283/health-care-professional-s-pledge-protecting-our-patients-from-firearm
There will be a direct and undeniable connection from those trying to take away guns from free people and those would be gun grabbers suffering GSW.
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[I forgot, what is GSW?]
I had the opportunity to drive a friend's top of the line Tesla this past year. Besides accelerating 15-85 in 2 seconds with all wheel drive traction, you tap the cruise control twice and it shifts into 'self drive' mode. Change lanes with the tap of a turn signal and keep a safe distance from the car in front of you - without your attention. This is amazingly cool technology that will soon be reasonably affordable to many new cars and has great safety enhancement possibilities. But I too fear / know that the central planners would love to use this power to stop us from driving, and control who can use our roads, when, at what speed, by what route, etc etc.
When they say switch to driverless vehicles, I say show me that you solved the hacking and cyber warfare issue for good. But even then, this is an issue of liberty. In spite of the dangers and costs, it was and is one of the most liberating moments of your life when you get your own car and can go where you want, when you want. You were now in charge instead of your parents or school bus driver. Therefore, it will be one of the greatest losses possible when they take that away - in the name of 'safety' and 'public health', and then the state is in charge, not you.
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GSW=Gunshot wounds
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This is a major issue on the horizon.
[I forgot, what is GSW?]
I had the opportunity to drive a friend's top of the line Tesla this past year. Besides accelerating 15-85 in 2 seconds with all wheel drive traction, you tap the cruise control twice and it shifts into 'self drive' mode. Change lanes with the tap of a turn signal and keep a safe distance from the car in front of you - without your attention. This is amazingly cool technology that will soon be reasonably affordable to many new cars and has great safety enhancement possibilities. But I too fear / know that the central planners would love to use this power to stop us from driving, and control who can use our roads, when, at what speed, by what route, etc etc.
When they say switch to driverless vehicles, I say show me that you solved the hacking and cyber warfare issue for good. But even then, this is an issue of liberty. In spite of the dangers and costs, it was and is one of the most liberating moments of your life when you get your own car and can go where you want, when you want. You were now in charge instead of your parents or school bus driver. Therefore, it will be one of the greatest losses possible when they take that away - in the name of 'safety' and 'public health', and then the state is in charge, not you.
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Trump To End ObamaCare As We Know It
By DICK MORRIS
Published on DickMorris.com on January 8, 2018
The other shoe in Donald Trump's war on ObamaCare is about to drop. It will end ObamaCare as we know it.
The first step in ending this obnoxious, intrusive program was to end the requirement that everybody must have health insurance coverage. Thanks to deft manuring by a unanimous Senate majority, this diktat was lifted in the Christmas tax cut.
Now, the second step is about to happen: Trump will eliminate the requirement that all ObamaCare policies cover everything -- from psychological counseling to drug addiction therapy to maternity benefits to smoker cessation to sex change operations whether the customer wants it or can afford it or not.
It is this requirement -- enacted at the behest of the various lobbyists representing the provider organizations -- that has forced up the cost of ObamaCare, triggering the need for massive taxpayer subsidy, and putting its premiums and deductibles, even after the federal subsidy, out of reach for many Americans.
But, soon you will be able to buy what coverage you want from ObamaCare without restriction or buy nothing at all.
Eureka!
All of the prodigious efforts of Texas Senator Ted Cruz (R-TX) and others to make these changes by amendment are now being swept up in a massive rule change by the Administration.
With this change, ObamaCare could become just one of the many options consumers have and not a particularly bad one at that.
To make this change work within the current statutory language, Trump will loosen the rules governing small businesses that band together to buy health insurance, through what are known as association health plans. This change, recommended in this column for months, will allow them to circumvent ObamaCare's regulations. Under the new rules, associations will be able to buy cheaper health insurance that won't cover the ten "essential health benefits" mandated in ObamaCare.
Trump is also expected to allow the expansion emergency, short-term health insurance plans, allowing them to last for an entire year and to be renewed. These plans would be exempt from the regulations governing ObamaCare policies, meaning that insurers will be able to charge more for people with pre-existing conditions. (But, don't worry, those with major pre-existing conditions -- that make policies unaffordable -- will still be able to get low cost coverage through the Pre-Existing Conditions Insurance Program (PCIP) created by ObamaCare and unaffected by the current regulations. Currently, over 100,000 people are covered by PCIP.
If, as Democrats contend, President Trump is losing it mentally, he must still have something upstairs to come up with so deft a way of reforming ObamaCare by regulation.
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Trump officials move to allow Medicaid work requirements
The Trump administration on Thursday unveiled guidance allowing states for the first time to impose work requirements in Medicaid, a major shift in the health insurance program for the poor.
The move opens the door for states to apply for waivers to allow them to require Medicaid enrollees to work in order to receive coverage.
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Single-Payer Health Care Isn’t Worth Waiting For
An orthopedic surgeon challenges Canada’s ban on most privately funded procedures.
by Sally C. Pipes
Jan. 21, 2018 3:27 p.m. ET
When Brian Day opened the Cambie Surgery Centre in 1996, he had a simple goal. Dr. Day, an orthopedic surgeon from Vancouver, British Columbia, wanted to provide timely, state-of-the-art medical care to Canadians who were unwilling to wait months—even years—for surgery they needed. Canada’s single-payer health-care system, known as Medicare, is notoriously sluggish. But private clinics like Cambie are prohibited from charging most patients for operations that public hospitals provide free. Dr. Day is challenging that prohibition before the provincial Supreme Court. If it rules in his favor, it could alter the future of Canadian health care.
Most Canadian hospitals are privately owned and operated but have just one paying “client”—the provincial government. The federal government in Ottawa helps fund the system, but the provinces pay directly for care. Some Canadians have other options, however. Private clinics like Cambie initially sprang up to treat members of the armed forces, Royal Canadian Mounted Police officers, those covered by workers’ compensation and other protected classes exempt from the single-payer system.
People stuck on Medicare waiting lists can only dream of timely care. Last year, the median wait between referral from a general practitioner and treatment from a specialist was 21.2 weeks, or about five months—more than double the wait a quarter-century ago. Worse, the provincial governments lie about the extent of the problem. The official clock starts only when a surgeon books the patient, not when a general practitioner makes the referral. That adds months and sometimes much longer. In Novemberan Ontario woman learned she’d have to wait 4½ years to see a neurologist.
Some patients would gladly go to a clinic like Cambie for expedited care, paying either directly with their own money or indirectly via private insurance. But Canadian law bans private coverage for “medically necessary care” the public system provides and effectively forbids clinics from charging patients directly for such services. The government views this behavior as paying doctors to cut in line. Doctors who accept such payments can be booted from the single-payer system.
Dr. Day’s lawsuit aims to overturn these provisions. It alleges that the government’s legal restrictions on private care are to blame for the needless “suffering and deaths of people on wait lists.” Dr. Day argues that the current system violates citizens’ rights to “life, liberty, and security of the person,” as guaranteed by the Canadian Charter of Rights and Freedoms, the equivalent of the U.S. Bill of Rights.
Moreover, Dr. Day claims the government has long tacitly approved of patients paying private clinics out of their own pockets. For decades, he argues, conservative and liberal politicians have offered him quiet praise and encouragement even as they publicly defend the single-payer system. It’s easy to understand why Canada’s leaders would talk out of both sides of their mouths. Private clinics perform more than 60,000 operations a year, saving the public treasury about $240 million.
British Columbia’s lawyers know that Dr. Day could embarrass Canada’s double-talking politicians by naming them at trial. This could explain the endless stream of seemingly deliberate delays that have kept the court proceedings moving at a snail’s pace. Dr. Day and his colleagues were supposed to testify in November but may not take the witness stand until February or March at the earliest.
Canadians have suffered long enough under single-payer waiting lists. There shouldn’t be a waiting list for justice, too.
Ms. Pipes is president and CEO of the Pacific Research Institute and author of “The False Promise of Single-Payer Health Care,” forthcoming from Encounter.
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SANTIAGO, Chile — They killed Tony the Tiger. They did away with Cheetos’ Chester Cheetah. They banned Kinder Surprise, the chocolate eggs with a hidden toy.
The Chilean government, facing skyrocketing rates of obesity, is waging war on unhealthy foods with a phalanx of marketing restrictions, mandatory packaging redesigns and labeling rules aimed at transforming the eating habits of 18 million people.
Nutrition experts say the measures are the world’s most ambitious attempt to remake a country’s food culture, and could be a model for how to turn the tide on a global obesity epidemic that researchers say contributes to four million premature deaths a year.
“It’s hard to overstate how significant Chile’s actions are — or how hard it has been to get there in the face of the usual pressures,” said Stephen Simpson, director of the Charles Perkins Centre, an organization of scholars focused on nutrition and obesity science and policy. The multibillion dollar food and soda industries have exerted those pressures to successfully stave off regulation in many other countries.
Since the food law was enacted two years ago, it has forced multinational behemoths like Kellogg to remove iconic cartoon characters from sugary cereal boxes and banned the sale of candy like Kinder Surprise that use trinkets to lure young consumers. The law prohibits the sale of junk food like ice cream, chocolate and potato chips in Chilean schools and proscribes such products from being advertised during television programs or on websites aimed at young audiences.
Beginning next year, such ads will be scrubbed entirely from TV, radio and movie theaters between 6 a.m. and 10 p.m. In an effort to encourage breast-feeding, a ban on marketing infant formula kicks in this spring.
Still craving Coca-Cola? In Chile, beverages high in sugar include an 18 percent tax, which is among the steepest soda taxes in the world.
The linchpin of the initiative is a new labeling system that requires packaged food companies to prominently display black warning logos in the shape of a stop sign on items high in sugar, salt, calories or saturated fat.
The food industry calls the rules government overreach. Felipe Lira, the director of Chilealimentos, an industry association, said the new nutrition labels were confusing and “invasive,” and that the marketing restrictions were based on a scientifically flawed correlation between the promotion of unhealthy foods and weight gain. “We believe that the best way to approach the problem of obesity is through consumer education that changes people’s habits,” he said in an emailed statement.
PepsiCo, the maker of Cheetos, and Kellogg’s, producer of Frosted Flakes, have gone to court, arguing that the regulations infringe on their intellectual property. The case is pending.
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Venezuela has been very effective in reducing obesity through policy.
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http://dailysignal.com/2018/02/13/new-white-house-budget-bail-obamacare/?utm_source=TDS_Email&utm_medium=email&utm_campaign=MorningBell%22&mkt_tok=eyJpIjoiTURVMlpqQTROMlV6TW1GaCIsInQiOiJDYWFpdytRMzF1SU1wcWpPNWJ1bUNzTkVWcThtemM2RzBzTVwvUGdXYlBBRndKTFFUR1RWcEJ2dWxGaW9oNkxYZVZlN3dzbUc4MjFPV21URjZROFBOMFVIUDk5YjA2ODg3M2hZalcyV2dFanJNSnVNTjQweGxuWU1NWFJXa29OMTNWWk9JSmNrMzhZU1g5bWVBb3drMXpad0ZueEJ2WVFYYXV0ZFNNU0FhV1lFPSJ9
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https://www.westernjournal.com/dick-morris-dc-states-passing-great-new-ideas-health-insurance/?utm_source=email&utm_medium=deepsix&utm_content=2018-02-24&utm_campaign=can
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https://www.forbes.com/sites/johngoodman/2018/02/22/the-trillion-dollar-surprise-in-the-budget-deal/2/#c7779ad4bc93
Came across this article on Alan Reynolds twitter-- hat tip to Doug on his post on the SC&H "Economics" thread.
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https://patriotpost.us/articles/54419-is-obamacare-on-its-last-legal-leg
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Just has to speak out.
Oh, the whole teaching hospital was so depressed when their gal lost :
http://annals.org/aim/article-abstract/2672915/politics-professionalism
I agree about the personal nature of Trump actually is offensive, but the rest is just Democrat Party lamenting drivel.
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It's not often I ask people to read Sparta Report but they published a very worthwhile twitter feed here. The author wrote a long string of tweets that describes the whole ordeal. I have no personal idea of the accuracy of this but it seems to be well informed, linked and documented. The author worked in the past for the NHS.
https://www.spartareport.com/2018/05/alfie-evans-had-to-die/
At the start I didn't know which way the author was going with this. None of us know when the exact right time is to pull the plug on a person who is not recovering. The most important part to me is who should decide. When there is a loving family involved, it is not government that should decide. The only power a health insurer or government agency should have in these cases is to decide when they should not have to expend more of their resources toward what they believe is not a viable cause. At some point they are entitled to have a bed back to treat another patient. That does not mean they should have any power over anyone to not pursue treatment somewhere else at their own expense.
Read through this and decide for yourself. The UK NHS has some say in the matter of care, end of life care(?), because it is a nation of national health care, socialized medicine, and they have scarce resources to treat an abundance of needs. But that was not the issue with little Alfie. The question was whether they would release him to the wishes of his family to pursue treatment somewhere else and on that question they got it horribly wrong.
Alleged by the writer, this facility provides horrible care and they got this horribly wrong because of an arrogance of life ending consequence. Because we can't cure him, no one can. That is unscientific and very likely to be wrong.
What is the harm of trying something different with a terminal patient?
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Doug
this is a really difficult situation
and every one IMHO is unique
I recall reading the case of this little girl it was offered to bring her to US for some other form of treatment.
seems on the face of it to be worth a try.
OTOH if her brain is permanently damaged it is permanently damaged .
I have been doctor to situations where patients are completely brain dead or very brain damaged but on "life" support .
Sometimes the family is not realistic and it is true to say they have lost all objectivity because it is a loved one they cannot in mind and heart let go.
Yet the other TRUTH is it might cost $100s of thousands to keep the patient's heart and lungs and kidneys going with no further hope then just that .
This might sound harsh but I guarantee that in most of these situations the insurance often pays for it all.. IF the family had to shoulder any of the cost their sentiments might change - and fast. That IS a factor like it or not.
I admit I have not studied the case in England that the political "RIGHT" is holding it up as some sort of great example about the slippery slope of someone else deciding about the decision to pull the plug
but I see the opposite side about cost . When a family is in dream world why should everyone else have to pay to keep the essentially brain dead pt with no hope going on life support?
I do remember two specific cases .
One a man in his 40 s who had major irreversible brain damage from a large stroke.
He was on life support for a year and his family refused removing him from breathing machine and tube feeding even though there was zero chance of recovery. In the middle of the night I was the intern "on call" when his nurse called (after she inadvertently pulled out the breathing tube) ; he passed away . I recall calling his designated family member to inform him of the sad news . After I told him what happened I could here
the man on the other end of the phone say to his wife "daddy passed away". And then he added "thank God" .
Another time a loving son and husband would come in daily to hold hands with the women also in her 50 s who also was so brain damaged also from stroke that she couldn't respond to them or even know they existed. For months doctors suggested gently to them to let her go. husband though it reasonable son would not agree.
AFfer long discussions with both and they could over time see she was not getting better and she would get the inevitable infections etc they agreed to stop life support.
After we stopped life support and they had time to grieve they actually thanked me for doing the "right thing" . It was time and they were relieved of their stress.
I believe the Right's holding this little girl's case up as a bona fide good example of the danger of someone else deciding for the family is wrong - just my take -> this is NOT a good example . Again just my opinion and everyone has one about these things.
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http://coldfury.com/2018/04/28/why-do-once-great-nations-crumble-and-fall/
Why do once-great nations crumble and fall?
Posted on 4/28/2018 by Mike
Because they deserve to.
Like the parents of Charlie Gard – another child similarly condemned to death by a preening NHS – Alfie’s parents disagreed with the hospital’s plans to abandon further treatment and remove life support from their son. They began to investigate alternatives for care outside the NHS system, never suspecting that the state-run system would see their love for their child as a threat to the NHS and would respond with ferocity.
Alder Hey’s physicians have been unrelenting in their abandonment of this child, having decided more than a year ago, in February of 2017, that Alfie should quit embarrassing them by surviving in spite of receiving no treatment and get on with the business of the afterlife.
Since making that decision, the hospital has refused to perform even the most common of procedures for a patient with Alfie’s needs, such as a tracheostomy to facilitate easier breathing or a gastrostomy feeding tube for nutrition and medication.
For all this time, Alfie has been fed through a nasal tube, never intended as a permanent solution, but rather as a stopgap (weeks, not months) designed to be used until a g-tube can be placed.
The medical treatment Alfie has received is abominable, as a direct result of the hospital’s decision, and subsequent criminal obstinacy toward anyone suggesting that their prognosis might be in error.
To hear the barristers for Alder Hey wax poetic about the “first class care” given Alfie by the NHS (parroted by judge after judge in court proceedings) is indeed revolting – the British equivalent of Baghdad Bob. In truth, they have made no attempt to diagnose Alfie’s condition, preferring instead to place him on heavily sedating anti-seizure medications, then claiming that his lethargy is further evidence of his irreversible decline.
The world is witness to slow-motion murder. The perpetrators are the NHS, and the motive is not pecuniary, but rather a perverse form of institutional vanity.
Italy has conferred citizenship to Alfie, and there is a medical air ambulance standing by at the request of the pope to fly Alfie to the Vatican’s children’s hospital, Bambino Gesù, where Alfie can be treated.
But while socialism requires citizen confidence to operate, it will settle for coercion to gain compliance. This is why Alder Hey refuses to release Alfie. Should the boy survive outside NHS care, their “infallibility” would be shattered, and (gasp!) the sheep may begin to question their shepherd.
Collectivist schemes of medicine are no more sustainable (or just!) than collectivist schemes of societal order. Both require submission, even unto death.
The only “life unworthy of life” is that of the arrogant, self-congratulatory medical murderers of the NHS and their judicial enablers. May God’s judgment be realized in the fullest.
Amen to that. The decree refusing to allow the child to be flown to Italy for treatment at precisely no cost to anybody is what shifts this from typical bureaucratic heartlessness and obstinacy into the realm of purest evil. No caring person—no healer worthy of the designation—would ever countenance being party to such an atrocity.
But these are neither caring people nor healers. We’re talking here about monsters, abominations. To grant them an indulgence they in no way deserve by calling them “human” besmirches the word itself.
Yet instead of being righteously cast out of decent society as they should be—shunned to grub about its margins in wretched disgrace and deprivation—they’re running the damned place. Astoundingly, incomprehensibly, it gets even worse (see the attached threatening Tweet from the Merseyside Police for that). Perhaps worse still, the Facebook post linked in the Tweet is chock-full of nitwit statements of support for the NHS posted by Old Blighty’s bleating sheeple.
Maybe it would be better after all if little Alfie winds up succumbing to England’s inhuman savagery and indifference in the end and passes on to a better place. It might be better than living out his life in such a place, forced to acknowledge such contemptible curs as his countrymen.
May the perpetrators of this repulsive display of wanton cruelty burn in the hottest fires of Hell for all eternity.
And yeah, when the day comes that America’s government-(mis)run health-care system has attained this summit of degeneracy, I think everyone here will agree that it is DEFINITELY time to start shooting the bastards.
Update! The cold, hard truth:
If you don’t understand why the NHS and British courts refused, you don’t get socialized medicine. It is not, nor has it ever been, about health care. It’s about power. Once a government — any government — takes control of your health care, they own you and your children. Alfie’s parents and the British public had for months demanded Alfie’s release just to seek treatment by doctors competent enough to figure out what was wrong with him. But, for a socialized system, that’s dangerous. It implies that an individual Brit has rights not bestowed by the state.
In a social “democracy” like Great Britain, the state isn’t there for the purpose of serving the people — sick or otherwise. The people are there for the purposes of the state. If the state can hold your child hostage in a hospital whose doctors are too incompetent to arrive at a diagnosis — yet may terminate his life without your permission — neither you nor your child are “free” in any meaningful sense of the word. And this doesn’t stop at health care, of course. Remember Brexit? What happened when the voters of Great Britain made their wishes known regarding the European Union? The will of the British electorate was ignored.
Likewise, the wishes of Alfie’s parents never meant anything. Nor did the overwhelming public support they received. It is the “interests” of the state that matter in Perfidious Albion, and they have little or nothing to do with those of the “free people” who populate that benighted isle. There is only one way that Alfie is ever going to escape the clutches of the state apparatus they call, with no intentional irony, the National Health Service. The NHS and Alder Hey Children’s Hospital was always going to have the final word on Alfie’s fate.
The most chilling thing about all this has little to do with Britain or its inhabitants; the people of Europe have for centuries been perfectly willing to subject themselves to despotism, oppression, and abuse by tyrants—nor have they ever suffered a shortage of would-be dictators willing to step up and take the job. It’s that here in America, a substantial percentage of our own population demands that we walk down this exact same ruinous road ourselves.
Which in turn is why, in my more pessimistic moments, I’m convinced that either a conflagration or a breakup is inevitable. How can people who cherish liberty and self-determination peacefully coexist for long with grasping, megalomaniacal fools and still call themselves free?
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Thanks ccp. Great points.
"I see the opposite side about cost . When a family is in dream world why should everyone else have to pay to keep the essentially brain dead pt with no hope going on life support?"
I agree with you on that. I understand that a financial decision has to be made at some point no matter who is paying. But in this case, the 'state' took custody to prevent family from trying something else, somewhere else. It was about power, not resources. The agency's only interest should have been to end their efforts, not to prevent other options.
"if her brain is permanently damaged it is permanently damaged "
Yes, and keyword, if. That is exactly right all the time - except when they're wrong. A more difficult ethical question is what is the value of a life with a partially damaged brain if they do recover. My cousin came out of 6 month coma; he is a burden but has a reasonable life. A great guy in a wheelchair, he requires permanent care. Were they wrong to keep him alive? Probably an unanswerable question.
We treat or cure things every day, every year, that used to be untreatable, incurable. My guess is that they would have failed with this British kid at the next place too, but somebody might have learned something that helps the next person. And the parents would believe they tried everything they could.
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My own chip on my shoulder isn't perfectly analogous, they weren't going to put me down. I was hit by a 50 mph car as a pedestrian at age 17, hit and run, left to die below the highway in freezing cold rain, discovered by luck or fate, rescued, then told not likely to walk again, quite dis-spiriting for a teenager. All those different doctors and all their different opinions during college years is the short story. At 21 I canceled my appointment at Mayo Clinic to have my leg re-broken and tried my luck on my own ever since not to see a doc again until colonoscopy age. Slow recovery but fun proving them wrong. I missed the college tennis of my peers but by my 50s and now 60s have accumulated city, state and USTA section titles and wins over guys who won NCAA championships while I was in handicapped parking. I play hockey with former olympians and extreme skiing at 61 with 20 year olds. I still have pain, a lift and a limp but it beats the alternatives.
I respect doctors and all they face. You see them get things wrong too, I imagine. God, fate, luck and imperfect information have a role in it.
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all good points
that is why I suggested each case is unique and needs its own separate evaluation with input from all sides
I am not sure why England did not let the patient go to the States whether political or other. Could they have absolutely prevented the family from taking him in some sort of air ambulance?
expensive to be sure but maybe crowdfunding would have helped
" I was hit by a 50 mph car as a pedestrian at age 17, hit and run, left to die below the highway in freezing cold rain, discovered by luck or fate, rescued, then told not likely to walk again, quite dis-spiriting for a teenager. "
unbelievable story. I take it the driver who hit you was never found?
no doubt we doctors are not always right!!!
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ccp, No they never caught the hit-and-run driver. Never really investigated, it wasn't a felony then.
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"Never really investigated, it wasn't a felony then"
I didn't remember it wasn't . Unless it was different in NJ.
Extreme skiing!
Well I do lots of extreme surfing. Channel surfing :lol:
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"Never really investigated, it wasn't a felony then"
I didn't remember it wasn't . Unless it was different in NJ.
Extreme skiing!
Well I do lots of extreme surfing. Channel surfing :lol:
You watch MSLSD, that's something too extremely nausea inducing for me to handle. :-D
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"Extreme skiing!"
Yes, it's a crucial part of my health care plan. ) One place we went this year was Valhalla, British Columbia in January where they take you by helicopter, or snowcat in our case, to continuous runs all day, untracked in 14 feet of fresh powder, steep, deep, cliffs, chutes and through the trees. 20 people share a mountain 6 times the area of Whistler Blackcomb, Canada's largest ski resort. Guides work non-stop to manage the avalanche risk. Medical evacuation insurance is included. https://www.valhallapow.com/
https://www.youtube.com/watch?time_continue=53&v=0NjNeZzgoI8
The A - Z Chutes at Big Sky Montana, what could possibly go wrong?
https://www.youtube.com/watch?v=Z1LlvwF-y9Q
My Vail season pass shows "1,217,974" vertical feet tracked. A typical day equals about three parachute descents.
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This does not sound very free market oriented , , ,
http://www.dickmorris.com/cut-drug-prices-ban-tv-advertising-lunch-alert/?utm_source=dmreports&utm_medium=dmreports&utm_campaign=dmreports
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John Spooner, Rosanna Jimenez
Augmented reality (AR) and virtual reality (VR) are technologies whose terms are often used interchangeably and thought of strictly as enhancements for entertainment or equipment maintenance. However, they are getting new attention in healthcare across a range of use cases, most often as tools for treating patients and training doctors.
AR is showing early promise in treating PTSD (post-traumatic stress disorder) and substance abuse disorders. VR is also showing similar spark for a range of training and assistance use cases, just as it has in manufacturing, where it is a key assistant in training and performing machine maintenance.
451 Research defines VR as a 'completely immersive replication of the user's world.' The ability to create a controlled immersive environment makes it possible to design new kinds of therapies for patients, ranging from those battling substance abuse and serious injury as well as chronic pain to those suffering from PTSD and aging.
Albert Rizzo, director for medical virtual reality at the University of Southern California's Institute for Creative Technologies, called the use of VR in treating PTSD among soldiers "hard medicine for a hard problem." As part of its effort to treat PTSD, the university's Bravemind project is applying VR technology to re-immerse soldiers in battlefield situations then provide them with immediate therapy.
The 451 Take
The use of AR and VR technologies in healthcare is still nascent. But there is potential for the technologies, used individually or in combinations, to transform the traditional ways patients are treated, particularly for pain, paralysis and psychological trauma.
When applied in clinical trials, AR technology has shown positive results in enhancing some treatments, such as for PTSD; replacing some others, such as opioids for chronic pain; and in creating certain new therapies, such as achieving some level of mobility for victims of paralysis. The collective results show that AR holds promise for new ways of treating patients, while VR shows promise in training and assisting doctors.
Despite initial progress, a wide range of additional clinical trials and government approvals are needed to secure the technology's place in approved methods of treatment within patient care plans. As with most applications of technology in directly treating patients in healthcare, testing will take time and vendors must show both clinical success and provide a return on investment without forcing clinicians to become IT experts.
That testing, along with approvals by regulatory bodies such as the US Food and Drug Administration (FDA), will take years and cost millions. Vendors are already getting started through a broad range of partnerships with healthcare providers and payers.
Clinicians' Challenges
Clinicians generally see promise in using AR and VR, sometimes together, in reinventing how patients are treated, particularly for pain and psychological trauma. The use cases for AR and/or VR in healthcare generally fall into three buckets.
First is the creation of new treatments for chronic conditions and mental health problems, such as post-traumatic stress, which favor AR. Second are training and assistance, especially for complicated procedures, which favor VR. Third is the augmentation of existing medical treatment procedures for alleviating physical injuries that result in chronic pain or paralysis and assist aging patients in managing cognitive decline.
These are mainly focused on AR but can use elements of both technologies. The challenge for clinicians is in proving the clinical impact of these technologies so they can be considered viable replacements for traditional treatments, such as prescribing opioids for pain. Whether AR-focused, VR-focused or using some combination, putting these technologies to work for patients requires close partnerships between technology vendors and clinicians.
Many such partnerships are underway; for example, Dell Technologies working with the USC Institute for Creative Technologies and supporting its Bravemind program and Samsung working with appliedVR and Cedars-Sinai for pain management. The vendors are supporting these efforts with a range of assets from providing hardware and software as well as platforms to providing technical assistance and funding. Dell pledged a $100,000 grant to Bravemind in May.
Vendors' Opportunities
Although costly to prove as a means of treatment, there is much potential opportunity for AR and VR vendors. The technology is applicable across treatments provided by the spectrum of healthcare institutions including outpatient clinics, long-term care facilities and hospitals, while addressing the range of patient populations from young and relatively healthy to the chronically ill and aging.
Vendors are pursuing AR and VR adoption through continued product development and providing support for applicable medical content, plus investment in supporting a broad range of clinical trials that test AR and VR across the range of treatments previously described in this report. Samsung, for one, has supported several medical studies using its Gear VR device for pain management, treating paralysis, diagnosing macular degeneration and even diagnosing and treating concussions.
The following are examples of several AR and VR vendors applying the technologies to a range of healthcare use cases.
VR for Treatment
Samsung Electronics has partnered broadly and is one of the most active VR providers in healthcare. In one partnership, with appliedVR and Cedars-Sinai, the company is supporting the study of VR for pain management and opioid replacement.
In another treatment example, Limbix VR enables therapists to provide a guided VR experience for mental health, addressing problems such as phobias. By placing a patient in a realistic but controlled VR environment built of images and videos, clinicians can gradually expose patients to situations that cause distress while maintaining safety.
Oculus VR, known for going from Kickstarter to a $2bn acquisition by Facebook, is using its Oculus Rift VR headset in a range of applications, including investigating treatments for conversion disorder, in which mental stresses are converted into physical symptoms.
AR for Medical Training
Surgical Theater, of Mayfield, Ohio, says it applies fighter jet simulation technology to neurosurgery. The company's Precision VR merges 2-D brain scans to create patient-specific VR reconstructions that help surgeons better study and treat neurological problems.
Evena Medical offers an AR approach to phlebotomy training, by using its headset to depict a patient's vascular system to offer digitally mediated support for those less skilled in the practice or save time for those who are.
Oculus VR is also pursuing medical training use cases, including partnering with Children's Hospital Los Angeles in 2017 to build a VR simulation for medical training.
Benefits to Providers and Patients
The increasing use of AR and VR technologies in treatment, especially, and training follows a general trend toward applying information technology and IoT technology-enhanced treatments, specifically, to address healthcare market trends.
Providers and payers are looking to lower costs and also treat larger numbers of patients by making treatments more readily available via telemedicine and remote monitoring. This trend has healthcare providers and payers collaborating to move along the path to proactive outpatient-based treatment and monitoring, performed remotely, for a larger population.
In theory, the shift toward proactive outpatient care, away from a reactive inpatient treatment model, can reduce costs for payers and patients by focusing on leveraging technology to monitor and treat patients at home.
This keeps patients at home for longer, reducing hospital admissions or readmissions, driving down costs. At the same time, increasing the number of patients that can be monitored or evaluated by a given clinician in a given day has potential to bolster revenue for providers by allowing them to follow, treat and thus bill for more patients. AR and VR technologies would become part of these processes.
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At the time Obamacare was passed without a single Republican vote, Republicans had already conceded they would support pre-existing conditions in a plan, really the only popular part of Obamacare. With Obamacare going down in flames now, we are back to square one.
There HAS to be a catch with pre-existing conditions coverage or else everyone would wait for their 'pre-existing' condition to materialize in order to buy coverage, ending the entire concept of insurance.
In 2017, R's tried hard to repeal and replace Obamacare. The effort failed when not all Republicans got on board. As an serious, private sector based proposal needs to, there were curtailments on pre-existing coverage and they were hammered on that in the liberal press.
This needs to be solved actuarially and this needs to be solved politically by republicans or else the public will turn to the other side for their 'solution'.
Republicans need to go on the offensive SOON with new laws that open up all kinds of new plans at lower prices and steal this issue back from the party that brought us the last Obamination abomination, Unaffordable healthcare Act.
https://www.cbsnews.com/news/pre-existing-conditions-coverage-at-risk-more-than-thought-obamacare/
https://www.politico.com/story/2018/06/07/obamacare-trump-administration-court-case-texas-606930
[2017]
https://www.theatlantic.com/business/archive/2017/06/ahca-senate-bill-preexisting-conditions/531375/
https://www.huffingtonpost.com/entry/gop-senate-health-care-bill-preexisting-conditions_us_5967b4c6e4b03389bb15e1fe
https://www.usatoday.com/story/news/politics/2017/07/13/new-health-bill-offers-plan-flexibility-pre-existing-conditions/475308001/
https://www.cnn.com/2017/04/30/politics/trump-health-care-pre-existing-conditions/index.html
https://www.cbsnews.com/news/is-trump-right-that-pre-existing-conditions-are-covered-in-the-gop-health-care-bill/
GOP Health Bill Leaves Many 'Pre-Existing Condition' Protections Up To States
https://www.npr.org/sections/health-shots/2017/05/08/527415655/gop-health-bill-leaves-many-pre-existing-condition-protections-up-to-states
Maybe that is the right answer.
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Excellent and timely post Doug.
For the record, my thoughts:
*PRICES MUST BE KNOWN IN ADVANCE OF SERVICE/CONSUMPTION
*Insurance is for extreme events, not everyday matters: Fire, Flood, Car Accidents, Cancer, Heart Surgery, etc.
*Dr. Ben Carson's Health Savings Accounts Plan!!!
*Interstate competition
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I will add this to our government programs thread and Trump accomplishments too but if you believe the news on the face of it, people were becoming disabled in America under Obama at an EPIDEMIC rate.
Disability claims skyrocket: Here's why
CNN April 11, 2013:
http://money.cnn.com/2013/04/11/news/economy/disability-payments/index.html
Cured by Trump somehow.
Disability Applications Plunge as the Economy Strengthens
https://www.wral.com/disability-applications-plunge-as-the-economy-strengthens/17639836/
What did Eddie Murphy say in Trading Places? "I can see!!"
It's as if they didn't have disabilities at all.
ccp and I and a few others knew. The epidemic was in people not working by choice, doctor shopping, and taking a check from the government to do nothing. If anyone believed this was a health crisis, the Obama Surgeon General would have been all over it. He or she wasn't.
"the number of Americans who are on disability has skyrocketed"
https://apps.npr.org/unfit-for-work/
NPR continued:
The federal government spends more money each year on cash payments for disabled former workers than it spends on food stamps and welfare combined. Yet people relying on disability payments are often overlooked in discussions of the social safety net. The vast majority of people on federal disability do not work.[1] Yet because they are not technically part of the labor force, they are not counted among the unemployed.
In other words, people on disability don't show up in any of the places we usually look to see how the economy is doing.
In Hale County, Alabama, nearly 1 in 4 working-age adults is on disability.[2] On the day government checks come in every month, banks stay open late...
...
"Just out of curiosity, what is your disability?" the judge asked from the bench.
"I have high blood pressure," the man said.
"So do I," the judge said. "What else?"
"I have diabetes."
"So do I."
There's no diagnosis called disability. You don't go to the doctor and the doctor says, "We've run the tests and it looks like you have disability."[/i]
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Health Savings Accounts for Everyone
Congress should make HSAs universal and raise the cap to $7,350, which would drive competition.
By Scott W. Atlas
June 19, 2018 7:05 p.m. ET
270 COMMENTS
Despite failing to repeal and replace ObamaCare fully, health-care reform is progressing under President Trump. The individual mandate is nullified. The administration has permitted more low-cost “limited duration” insurance plans, and more small businesses now have access to association health plans. The next step should be to expand and improve health savings accounts.
Health savings accounts allow people to set aside money tax-free to pay for health expenses, but their fundamental purpose is not simply to cushion the blow of costly care. HSAs put consumers directly in charge of their health-care purchases. This drives competition, which leads to lower prices for everyone.
ObamaCare, and most of the proposals that followed, stressed making insurance more affordable, mainly through subsidies. Subsidizing premiums artificially props up coverage that typically minimizes out-of-pocket payment. This is counterproductive. Patients with such coverage don’t think of themselves as paying for services. This shields medical providers from competing on price.
Instead of subsidizing premiums, policy should focus on reducing the cost of medical care itself by generating competition for patients. That is the most effective pathway to affordable, high-quality care. The market should be reformed to encourage patients to consider the price of the medical care they consume and to equip them with the tools to do so.
Outpatient nonemergency care, which forms the bulk of health expenditures, is amenable to price-conscious purchasing. Almost 60% of all health expenditures for privately insured adults under 65 and almost 40% of the elderly’s expenses are for outpatient care, according to a 2012 report from the IMS Institute for Healthcare Informatics. Prices rapidly decrease when patients pay out-of-pocket for procedures like Lasik corrective vision surgery and MRI or CT screening. Data from MRI and outpatient surgery confirm that prices fall almost 20% when patients are motivated to shop around.
Health Savings Accounts for Everyone
Illustration: Barbara Kelley
Because HSAs reward saving, they are particularly effective at putting downward pressure on prices. Spending reductions averaged 15% annually, according to a 2015 National Bureau of Economic Research working paper, when workers were given high-deductible plans and personal medical accounts. When HSAs were added to high-deductible plans, savings increased to up to double the savings that high-deductible plans alone produced. More than one-third of the savings reflected price-conscious decision-making. Corroborating prior studies, these reductions occurred without harming patients’ health.
By increasingly choosing HSAs when given the opportunity, American consumers are approving their value. By the end of 2017, there were at least 22 million health savings accounts in the U.S., up 11% year-over-year. This isn’t a tax benefit for the rich: Median household income for HSA holders is $57,060, and two-thirds earn less than $75,000 a year. The challenge now is to expand HSA use and fully leverage its power to reduce health-care prices.
Congress should pass legislation making HSAs universally available. These accounts should not be connected to specific insurance deductibles, a counterproductive requirement that limits the possibility of HSAs with tailored- or direct-payment plans. To maximize consumer power on prices, Congress should remove restrictions on full HSA participation by seniors on Medicare. Motivating seniors, the biggest users of health care, to seek value is crucial to driving prices down.
Congress should raise the maximum allowable HSA contribution to match total possible out-of-pocket spending under ObamaCare—$7,350 for individuals in 2018. Account holders should be allowed to use their HSA funds to pay for the care of elderly parents. And the accounts should be fully owned by individuals. This means abolishing more restrictive variants tied to employers and eliminating expiration or forfeiture due to arbitrary “use it or lose it” deadlines. When account holders die, they should be allowed a tax-sheltered rollover of their HSA funds to all surviving family members, not only spouses.
HSAs have also been a valuable vehicle through which employers offer effective wellness programs and medical screening. Yet ObamaCare limits financial incentives from employers, like deposits into employee HSAs. Congress should abolish this rule.
Legislators can also change the tax code to encourage more people to sign up for HSAs. Today’s unlimited income exclusion for employer-sponsored health benefits is harmful, because consumers are rewarded for spending more on health care. This reduces concern for price and value. Beyond capping any total health expense deduction or exclusion, the tax code should also limit eligibility to HSA contributions and catastrophic coverage premiums.
Increasing the supply of medical care by eliminating anticompetitive barriers would make HSAs even more effective, as patients need enough choices to compare. Despite widely recognized doctor shortages, scope-of-practice limits on nurse practitioners and physician assistants prevent competition with doctors for simple primary care. Archaic nonreciprocal state licensing restricts telemedicine. State certificate-of-need requirements limit competitive technology. Scandalous contractual gag clauses prohibit pharmacists from telling patients that medication may be cheaper if purchased outside insurance.
Health savings accounts are not appropriate for every patient. But they represent a powerful tool to lower prices and improve access to quality care for everyone. And those are goals that everyone can share.
Dr. Atlas, a physician, is a senior fellow at Stanford University’s Hoover Institution and author of “Restoring Quality Health Care: A Six Point Plan for Comprehensive Reform at Lower Cost” (Hoover, 2016).
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IN between articles about firearms diatribes and women deserve "better health care"
was this summary of an article on the safety of abortions:
"The rate of abortions performed for U.S. women aged 15 to 44 years has decreased by half since 1980, from 29.3 per 1000 women to 14.6 per 1000 women in 2014 (1–3). With 926 190 abortions reported in 2014, abortion remains a common medical intervention and, as is standard for most medical interventions, should be assessed periodically for safety and quality. The Institute of Medicine last evaluated abortion services in 1975 (4). Many advances and improvements in available technologies have occurred since then. As such, the National Academies of Sciences, Engineering, and Medicine (NASEM) was asked by a group of sponsors to answer a series of questions on the appropriate use of different abortion services, associated physical and mental health risks, safety and quality of care, necessary facility requirements, health care provider skills, safeguards for different interventions, safe provision of pain management, and research gaps in providing care. This paper provides a synopsis of the resultant report: “The Safety and Quality of Abortion Care in the United States” "
abortions down - good (more birth control - obviously not chastity !)
the timing of this is NO accident . We will soon see follow up articles about back room abortions and the lack of safety of such . We know the rest................
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The subject here is one I have been pounding on the table for a long time-- the need for price transparency:
You Can’t Put a Price on a Hip Replacement, and That’s a Problem
Andrew Cuomo’s FAIR Health was supposed to make costs transparent. It hasn’t worked out.
You Can’t Put a Price on a Hip Replacement, and That’s a Problem
Photo: Getty Images/iStockphoto
By Steve Cohen
July 13, 2018 6:45 p.m. ET
13 COMMENTS
How much does a new hip cost in New York? The answer isn’t at all clear, despite Gov. Andrew Cuomo’s efforts to improve price transparency. Confusing insurance deductibles and balance billing mean that the actual amount patients pay can vary widely and unexpectedly, often with a painful shock.
That’s what happened to Michael Frank, a 52-year-old Westchester County executive who had his left hip replaced in 2015. The Manhattan hospital charged roughly $140,000. The insurance company paid a discounted rate of about $76,000, and his share—a 10% copay, plus a couple of uncovered expenses—was a bit more than $8,000. Mr. Frank, an actuary, was outraged. The hospital, he was sure, had inflated his bill, and then his insurer had negotiated a lower rate. That smacked of collusion.
Mr. Frank called me because my name had appeared in the media regarding a lawsuit against a different insurer. After hearing his story, I told Mr. Frank what I thought was an odd twist: I’d recently had two hips replaced, six months apart, at the same hospital that had treated him.
“What did they cost you?” Mr. Frank asked.
“Just my deductible,” I answered.
But then he asked what the total price had been, and I had to admit, sheepishly, that I didn’t know.
My policy didn’t have a 10% copay, like Mr. Frank’s, so I didn’t pay much attention to the overall cost. But I told him I’d check. Eventually I learned that the hospital had charged $175,000 for my right hip and $180,000 for the left. The insurance company had paid discounted rates of $75,000 and $77,000.
That should have been the end of the story, save for my momentary guilt knowing that healthy young people’s premiums were paying to replace my decaying baby-boomer parts. But I wondered: If I were facing a 10% copay, would I have been so quick to get into the operating room? Would I have shopped for a lower-cost alternative? What is the real market price for a hip replacement?
This last question should have been relatively easy to answer. In 2009, New York’s then-attorney general, Andrew Cuomo, announced the creation of a nonprofit organization called FAIR Health. Its mandate is to provide consumers accurate pricing information for all kinds of medical services.
I found the FAIR Health website and queried its database. It reported that the out-of-network price for a hip replacement in Manhattan was $72,656, close to what Mr. Frank’s and my insurance companies had paid. The problem: We were both in-network, and FAIR Health estimated that cost as only $29,162.
Something didn’t make sense, so I called FAIR Health. “Maybe you had complications,” the spokesperson suggested. Happily, I hadn’t. I was discharged from the hospital each time in under 24 hours, with no issues and no need for a home health aide. How many data points did FAIR Health use to calculate its price estimate? I was told “4,500 in Manhattan over the last six months.” Who submitted these prices? “The insurance companies.”
I never did figure out the reason for the difference in pricing—but somebody ought to. Giving consumers predictability in health-care costs is a smart idea, and although FAIR Health is trying, clearly there’s a disconnect. Rather than relying on insurers, it might be more effective if FAIR Health collected pricing information directly from hospitals and doctors. That way the data would be less susceptible to selective reporting or massaging. That’s what happened in the early 2000s, when class-action lawsuits revealed the main pricing database was being manipulated to the advantage of insurance companies.
Along with prices, FAIR Health should report the number of procedures performed by each hospital and physician’s practice. Together, these data would give consumers real comparative shopping power. Knowing whether a hospital is performing a particular procedure regularly or only occasionally would help patients make informed decisions about where to seek treatment.
Many policy experts believe transparent pricing is central to any attempt at controlling health-care costs. Nationwide, more than 300,000 people a year undergo hip replacements. If a fraction of them have an experience similar to Mr. Frank’s and mine, that’s a lot of confusion and inefficiency clogging up the system. Real change won’t come until patients have better information—data that are both accurate and granular.
How much does getting a new hip cost in New York? I’ve spent months trying to figure that out. Best I can tell, nobody really knows.
Mr. Cohen is an attorney at Pollock Cohen LLP in New York
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https://www.nationalreview.com/2018/07/trump-administration-targets-prescription-drug-costs/
With regards to rebates negotiated by Pharmacy Benefits Managers (PBMs) it is my understand from a review of this in one of the medical journals (I don't remember which one - probably JAMA)
that these negotiations are all done in secrete between the pharm companies the the pharm benefits managers and the all the so called rebates is taken by the PBMs and no given to consumers.
The article did not necessarily state the negotiations are bad but there is zero transparency . It is all done behind scenes and the public and consumers are all kept in the dark.
So if these negotiations must not really be on the up and up.
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https://www.bostonglobe.com/business/2018/06/22/buffett-bezos-dimon-health-care-firm-likely-start-with-modest-digs/ejjJVt0Pb4WlYKvoLLqw2J/story.html
where else but Harvard : of course.
so we can already surmise what socialized legislation will come down the pike.
if they can really lower the cost curve down without making themselves big profit out of it then great and do it where it benefits all I am all for it.
I just don't want THEM to become, themselves the middleman. I am suspecting this is what will be proposed though
recent article in medical journal questions all this too.
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I am not allowed to read this without giving up my privacy.
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I read but couldn't copy it. It says they (Bezos, Buffet, etc) are starting small, not leasing very much office space for the headquarters in Boston. They don't give away much of what they are up to. The impact and expectation is big just because of the players involved.
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Thank you.
Those are some smart people, it will be interesting to see if they come up with something intelligent and reality based.
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*******Annals of Internal Medicine Logo
Starving the Hungry Tapeworm: How Businessmen May Reform Health Care Cost
Laurence F. McMahon Jr., MD, MPH; Vineet Chopra, MD, MSc
In 2016, U.S. health care spending reached $3.3 trillion, a figure representing 17.9% of the nation's gross domestic product. Sadly, the skyrocketing cost of health care is not headline news. Rather, as aptly summarized by Warren Buffett, “The ballooning costs of health care act as a hungry tapeworm on the American economy” (1). Like a tapeworm, our health care cost problem degrades the overall vitality of our economy. Therefore, news that the CEOs of Amazon, Berkshire Hathaway, and JPMorgan Chase are coming together to combat health care cost has been met with anticipation and skepticism (1): anticipation—because these business giants may help solve what ails our health system—but also skepticism—because what do highly successful entrepreneurs, investment bankers, and money managers know about health care? Could blindness to the usual approaches to reducing health care cost be a strength?
After all, it's not as if health care costs have been ignored. The health system has been subjected to several innovations focused on decreasing the cost of care. We have seen the rise of HMOs (now ACOs [accountable care organizations]) with incentives for health systems to lower cost and improve outcomes. Likewise, efforts have been undertaken to identify and target patients who receive costly—and sometimes unnecessary—interventions. Even changing how we pay for services, from diagnosis-related groups to resource-based relative value systems for hospital and physician payment, has not bent the cost curve. Furthermore, studies, including a recent analysis by the Congressional Budget Office, have highlighted how all these approaches have failed (2, 3).
In contrast, a principal strength of the collaboration among Buffett, Jeff Bezos, and Jamie Dimon is that these 3 highly successful businessmen operate outside the health care delivery structure. Thus, their decisions do not come with the inherent conflict of those who are subject to the results of those decisions. We do not yet know what tactic they will use to address health costs. On one hand, they may wield their collective influence or market power merely to gain discounts for their employees or to promote products they wish to develop. If they do so, they will only become part of the problem, because obtaining price discounts is rampant, from Medicaid to Blue Cross plans. Fortunately, reports suggest that this will not be the case; rather, the new partnership will not seek to profit from health care, as many others have done (4). What, then, might their approach look like?
Health care expenses may be quantified simply by multiplying the cost of a service by its volume. To decrease health care cost, one has to decrease the price of a service, the volume of the service, or both. Thus, regardless of the approach, the end result must affect price or volume (3). We anticipate that these industry leaders will use a business strategy to address this deceptively simple equation. One such method might be Six Sigma (5).
In brief, Six Sigma is a structured, stepwise approach to improve a process: define, measure, analyze, improve, and control. The first step is to define the structure of the health care cost problem. In doing so, several truths are revealed, one of which is that cost is not evenly distributed. For example, we learn that 5% of patients consume 50% of health care cost (6). The second step in Six Sigma is measurement. During this phase, we learn that patients individually are not the problem. In fact, efforts concentrating on individual patients to control cost have never succeeded. Rather, “high-cost” patients are consumers of high-cost services (such as major surgery, cancer treatment, and trauma care). The third step, analysis, focuses on quantifying the value of a service. For example, for some patients, a service may be life saving (for example, a cardiac stent for a patient with acute myocardial infarction). In contrast, for patients with stable angina, the same procedure has substantially less clinical value. Any businessperson would recognize that paying the same for these services with disparate clinical value makes little sense. We expect this will be a key change in the next phase, improvement. We believe that these business pioneers will push for either a decrease in specific services or “repricing” of services that are of low clinical value.
After all, this approach mirrors the structure commonly seen in the consumer marketplace and is most familiar to these business leaders. The creation of a market structure built around relative clinical value has the net effect of both directly affecting the price component of the health care cost equation and, by lowering the price point, sending a signal to decrease the volume of the service. To follow through with the cardiac stent example, the price of the less efficacious use of the service in patients with stable angina would be set lower than its most efficacious use in the setting of acute myocardial infarction. Thus, hospitals and health systems would focus on redirecting resources to higher-margin activities and not invest where they lose payment. In the final Six Sigma step, control, we expect an emphasis on ensuring that the price and volume of low–clinical value services do not increase to offset the price-based savings. Such control will probably require a multifaceted approach, including interfacing with Medicare and private payers to promote similar messages.
How may these changes be executed through a Six Sigma–like process? We expect that these corporate leaders will turn to disruptive technologies to help keep costs low. Just like Amazon dabbled with drones to lower package delivery costs and JPMorgan Chase revolutionized banking through apps, many processes in health care are ripe for innovation. For example, annual health checks (which are controversial given their dubious value) (7) might be automated through publicly available health kiosks that measure blood pressure and blood sugar, and then dispense medications or make referrals if warranted. This is hardly science fiction. Indeed, technology-heavy kiosks that do all this and more are currently available (8). Likewise, virtual consultation with physicians (through an Uber for Doctors–like app) might improve access and wait times while reducing costs—doing to health care facilities what Uber did to taxis. In addition, gaming strategies to promote healthier eating and living (á la Pokémon, which already has been shown to improve activity among sedentary populations) (9) are just a few examples of changes that may be emphasized by these visionaries. Of importance, all these concepts will focus on controlling (and reducing) health care costs—bending the supply-and-demand curve that currently relies on large hospitals and health systems.
Business leaders of the caliber of Bezos, Buffett, and Dimon, who are not steeped in the biases of health care pundits, can provide a fresh look at our cost problem. We believe their use of a business approach will ultimately lead to the repricing of much of what we do in health care. Just as an item with a 1-star rating on Amazon or a poorly performing mortgage product from JPMorgan Chase is quickly removed or repriced, so too could such a business value system change the health care cost problem. Although Medicare is moving to a “value-based” payment system, the pace of that movement is too timid and slow. Moreover, the current political climate (and that of Medicare itself) guarantees incremental not revolutionary progress. The business focus has fewer constraints and has the necessary bottom-line paradigm to be effective. If we do not focus on prices and value (10), we will not be able to starve our hungry tapeworm—and that, quite simply, is bad medicine.
References
Wingfield K, Thomas K, Abelson R. Amazon, Berkshire Hathaway and JPMorgan team up to try to disrupt health care. The New York Times. 30 January 2018. Accessed at www.nytimes.com/2018/01/30/technology/amazon-berkshire-hathaway-jpmorgan-health-care.html on 8 February 2018.
McWilliamsJMChernewMELandonBEMedicare ACO program savings not tied to preventable hospitalizations or concentrated among high-risk patients., Health Aff (Millwood), 2017, vol. 36 (pg. 2085-93)CrossRefPubMed
McMahonLFJrChopraVHealth care cost and value: the way forward., JAMA, 2012, vol. 307 (pg. 671-2)CrossRefPubMed
Bomey N. How Amazon, JPMorgan, Berkshire could transform American health care. USA Today. 25 February 2018. Accessed at www.usatoday.com/story/money/2018/02/25/amazon-jpmorgan-berkshire-health-care/350625002 on 18 April 2018.
de MastJLokkerbolJAn analysis of the Six Sigma DMAIC method from the perspective of problem solving., Int J Prod Econ, 2012, vol. 139 (pg. 604-14)
CrossRef
MitchellEConcentration of Health Expenditures in the U.S. Civilian Noninstitutionalized Population, 2014. Statistical Brief no. 497. Medical Expenditure Panel Survey.RockvilleAgency for Healthcare Research and Quality, 2016
Society of General Internal Medicine. Choosing Wisely: general health checks for asymptomatic adults. 2017. Accessed at www.choosingwisely.org/clinician-lists/society-general-internal-medicine-general-health-checks-for-asymptomatic-adults on 20 April 2018.
Wicklund E. Potential for healthcare kiosks in improving care delivery. mHealth Intelligence. 2018. Accessed at https://mhealthintelligence.com/features/potential-for-healthcare-kiosks-in-improving-care-delivery on 20 April 2018.
BarkleyJELeppAGlickmanEL“Pokémon Go!” may promote walking, discourage sedentary behavior in college students., Games Health J, 2017, vol. 6 (pg. 165-70)CrossRefPubMed
PapanicolasIWoskieLRJhaAKHealth care spending in the United States and other high-income countries., JAMA, 2018, vol. 319 (pg. 1024-39)CrossRefPubMed
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Not sure that I am persuaded here, but certainly quite relevant:
Trump’s Drug Price Bust
HHS follows the Obama method: set policy first, find statute later.
188 Comments
By The Editorial Board
Oct. 18, 2018 7:24 p.m. ET
Trump’s Drug Price Bust
Photo: David Goldman/Associated Press
One thing Americans rightly hate about health care is that no one knows the true price of a service. How much did your last X-ray cost? Why are you suddenly paying more for a statin? The Trump Administration tried to address this frustration this week with a new rule requiring price disclosure on prescription drugs, but its cure is worse than the problem.
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Health and Human Services has proposed a regulation that will force pharmaceutical companies to include the list price of a drug in television advertisements, and the rule applies to any drug paid for by Medicaid and Medicare that runs more than $35 a month. HHS says this is no different from forcing companies to disclose medical side effects and warnings, nothing but sensible transparency that might shame companies into lowering list prices.
This is misleading political advertising. Almost no one pays the “list” price at the pharmacy after insurance and discounts. Nearly nine in 10 prescriptions are generic, an identical version of the product that is a fraction of the cost. A unit of generic Prilosec costs about eight cents versus $3.31 for the branded heartburn medicine. Medicaid patients have co-pays as low as a couple bucks, though they won’t know that from watching an ad that says the medicine costs $50 or $200 a month.
The more important problems are legal. One sleight of hand is that HHS is promulgating the rule through the Centers for Medicare and Medicaid Services, not the Food and Drug Administration, which regulates safety and efficacy disclosures in drug advertisements.
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HHS openly concedes in the rule that “Congress has not explicitly provided HHS with authority to compel the disclosure of list prices to the public.” But it invokes sections of the Social Security Act that direct the agency to operate Medicaid and Medicare programs efficiently. That looks like a throwback to the Obama years: Select a desired policy and then hunt for a broad statute to justify it.
Pharmaceutical companies will almost certainly challenge the rule as compelled speech that violates the First Amendment, and they’re right to do so. Courts must apply the highest standard of review (“strict scrutiny”) on measures that burden content and speaker. This regulation singles out pharmaceutical companies for punishment, but not, say, hospitals. The price details hardly meet the legal exception for purely factual and noncontroversial information, especially given that HHS’s expressed motive is to embarrass companies into lowering their prices.
By the way, the pharmaceutical trade group PhRMA said this week that its member companies will voluntarily include in ads directions to a website where consumers can find what they’re likely to pay. Details include: list price, out-of-pocket costs and information about financial assistance programs.
HHS Secretary Alex Azar called this “a small step in the right direction,” but he is deploying his own rule anyway. That’s a tip that this is more of a political exercise than a good faith effort to offer customers information.
Another clue: HHS says that “we anticipate” the rule’s enforcement mechanism will be private lawsuits alleging unfair competition from misleading advertising. As if blowing money on lawsuits that enrich trial lawyers will lower drug prices.
More broadly, drug costs are roughly 14% of health spending but absorb about 99% of public attention. Much of the debate is driven by an increasingly bitter fight between pharmaceutical manufacturers and supply-chain negotiators known as pharmacy benefit managers. If this continues, the losers may be the rest of us.
Pharmaceutical companies are annoyed that the middlemen drive steep rebates and pocket some of the difference. The benefit managers complain that pharmaceutical companies are villains with huge profit margins. Congrats, you’re both wrong.
Benefit managers have in many cases put downward pressure on prices by negotiating bulk discounts as in any other business. Express Scripts reports that per person prescription drug spending grew a mere 1.5% for commercial plans in 2017. As for pharmaceutical companies, they need high profit margins as a return on capital in a business where most innovations fail. Between 1998 and 2014, some 167 lung cancer drugs failed in trials. Only 10 made it to market.
The Trump Administration is waddling into this debate so it can appear to be doing something—anything—about drug prices. Yet the White House’s policy blueprint offered many worthier ideas: cracking down on anti-competitive behavior from drug companies; reforming a dysfunctional Medicaid price system, and more. Those reforms are better than its simplistic and probably illegal attack on Big Pharma’s advertising.
Appeared in the October 19, 2018, print edition.
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To my knowledge pharm companies don't advertise generics
they advertised patented drugs that cost a bundle
and to simply show the cost to the patient is misleading
as the insurance if it covers or medicare could be paying a huge amount
so the above article is misleading too.
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Newt knows how to win-- too bad the Patricians of the Stupid Party do not.
A Proposed Republican Pledge on Health Care
Originally published at Fox News
The 2018 midterm elections are less than two weeks away, and many polls show there is a sizable bloc of independent voters who have not yet made up their minds. At the same time, health care remains the number one issue for the American people. The best way for Republicans to earn the votes of these undecided voters – and honor commitments to the Republicans who already support them – is to clearly articulate how they would fix our broken health care system.
This is an example of what that plan should be:
Republicans are Creating a Better Health System and Pledge to Do More
Republican Principles for America’s Health and Health Care System
• We believe every American should have the opportunity to live a long and healthy life, supported by a health system that is simple to use, innovative, and affordable.
• We believe that every American should have his or her choice of doctors and insurance that meet his or her specific needs.
• We believe the health system should be transparent about health care costs and quality of treatments options and that this information should be available to every American in a simple, understandable way so patients can make better decisions about their own health.
• We believe in protecting patients with pre-existing conditions so that they can obtain affordable health insurance coverage.
• We believe in the importance of American medical innovation that leads to breakthroughs that dramatically improve health outcomes while significantly lowering costs.
• We believe that the doctor-patient relationship is at the center of an effective health system, and it should not be disrupted by micromanagement from public and private bureaucracies.
• We believe American seniors have earned their health care benefits; and that they, their families, and their doctors should make their own medical decisions – not unelected government boards, bureaucrats, or private third-party payers and middlemen.
• We believe in a competitive health care market where private sector innovation works to strengthen public programs. One-size-fits-all government-controlled health care interferes with doctor-patient relationships, kneecaps new medical breakthroughs, provides less access to treatments, and leads to long wait times for critical care.
• We believe that the current health care system in America is far too expensive. While it is very good at treating people when they become sick, it is much less effective at helping Americans remain healthy – which is equally as important.
• We believe the goal of health reform should be to build on what’s working and fix what’s not. Destroying what’s good about our health system in an attempt to fix what’s bad is not an acceptable step toward a better future.
Republican Accomplishments in Improving America’s Health and Health Care System
Consistent with these principles, Republicans have taken several steps to improve the simplicity and affordability of America’s health and health care system. So far, the Trump administration and the Republican-led Congress have:
• Passed legislation to eliminate the Obamacare individual mandate penalty.
• Passed legislation to end pharmacy “gag” clauses so patients can find the lowest prices for drugs.
• Passed Right-To-Try legislation.
• Passed $6 billion dollars in new funding to fight the opioid epidemic.
• Passed the historic VA Mission Act, which replaced the troubled Veterans Choice Program and passed the VA Accountability and Whistleblower Protection Act to make sure VA employees are held accountable for bad behavior and bad service.
• The Trump administration is providing more affordable health care options for Americans through association health plans and short-term limited-duration plans.
• In the first year of the Trump administration, the Food and Drug Administration approved more affordable generic drugs than ever before in history. Thanks to its efforts, many drug companies are freezing or reversing planned price increases.
• The Trump administration reformed the Medicare program to stop many hospitals from overcharging seniors on their drugs – saving seniors hundreds of millions of dollars this year alone.
• The Trump administration cut high-dose opioid prescriptions by 16 percent during its first year in office. This year, President Trump signed the SUPPORT for Patients and Communities Act to direct even more resources to fighting addiction and crack down on dangerous synthetic drugs that are killing tens of thousands of Americans a year.
• Under the Trump administration, the VA expanded telehealth services, walk-in clinics, same-day urgent primary and mental health care, and launched the promised 24-hour White House VA Hotline.
The Republican Promises for Additional Improvements to America’s Health and Health Care System
If the American people re-elect Republicans to a majority in the House and Senate, we pledge to enact a series of practical and specific changes, based on what works in the public and private sectors, to build a better health system. This system will keep people healthy and provide effective treatments and economic security for those who get sick. These legislative changes will:
1. Protect patients with pre-existing conditions with an alternative approach to the Washington-knows-best method of Obamacare, which doubled premiums in the individual marketplace. We will do so by committing the resources necessary for states to try new approaches, like high risk pools and reinsurance, so everyone – regardless of medical history – has access to affordable insurance.
2. Further reduce the cost of prescription drugs by requiring additional transparency and accountability across the entire prescription drug supply chain (from manufacturers, to pharmacy benefit managers, to health insurers); making sure patients receive the benefits of drug manufacturer discounts and rebates; changing FDA rules to accelerate the release of new and generic drugs to market; and creating incentives to give more patients affordable access to new, highly-effective treatments that cure diseases and save money over time but have large up-front costs that create short-term challenges for public and private payers.
3. Lower premiums for individuals and small businesses by eliminating the health insurance tax; reducing Washington mandates that limit choices and drive up the cost of insurance; allowing the self-employed and small businesses to band together to purchase insurance so that they can have the same negotiating power as big businesses; and making it easier for smaller companies to self-insure.
4. Strengthen Medicare by protecting Medicare Part D patients from excessive out-of-pocket costs for drugs; protecting the market competition model of Medicare Part D, which has kept premiums low for seniors; eliminating unelected boards and bureaucrats that have decisions over treatments; and protecting Medicare as a program for seniors by opposing government-run health care, which would strain resources and limit availability and access to health services.
5. Maximize medical innovation by fully funding National Institutes of Health research that leads to new cures and treatments; creating incentives for private sector research dollars to flow into national health priorities, such as Alzheimer’s disease; repealing the medical device tax; reforming the FDA to give patients access to breakthrough treatments faster and at lower costs; and applying pressure on foreign countries to pay their fair shares for U.S.-developed drugs.
6. Make health care simpler by passing additional legislation to make the price and quality of health care providers visible and useful to patients; insist on patient rights to ownership and portability of their medical records; liberate primary care physicians to practice their craft with minimal interference from government and insurer bureaucracies – including expanding patient access to direct primary care options; and reduce or modify federal mandates, which increase administrative overhead, incentivize waste, and interfere with the kind of doctor-patient relationship that keeps people healthy for the long term.
7. Fight the opioid crisis by reducing the use of opioids to treat pain; enhancing border security to stop the flow of deadly fentanyl into our communities; investing in research to create non-addictive painkillers; and improving access to evidence-based treatment – including medication-assisted treatment.
8. Address the underlying costs of health care by focusing on treating chronic disease; shifting to payment models based on value and long-term health outcomes; passing medical liability reform to reduce unnecessary and duplicative testing; fighting health care fraud through public and private investment in information technology that the credit card industry uses successfully; and emphasizing public investment in improving the social determinants of health status, such as access to public transportation, affordable housing, and healthy food options.
This is the type of contract on health Republicans should be willing to sign – and deliver – to the American people so that we can all live longer, healthier, more productive, and more enjoyable lives.
Your Friend,
Newt
P.S. I hosted a Facebook Live on Thursday to discuss the need to uphold the rule of law and ensure that any person who engages in violence — against any party — is prosecuted to the fullest extent. Watch here>>
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No one understands the Make America Great Again effort with more insight and more experience than Newt Gingrich. He knows what it is like to fight the Washington swamp and challenge the establishment – he has done it his entire career. In his New York Times bestselling book, Trump's America, Gingrich illustrates how our nation’s 45th President is leading our country’s great comeback. From the fight of over the Southern Border Wall, to the Republican tax cuts, to the swamp’s unending efforts to undermine and oppose the President, Trump’s America lays out the truth about the Trump presidency – the truth the mainstream media won’t tell you.
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THE FIRST AMERICAN
Watch Instantly on Prime Video
George Washington is central to understanding America’s founding. He was the crucial figure in winning the American Revolution, in creating the Constitution, and in establishing the precedents for effective self-government as our first president. The First American, an award-winning documentary film, will help ensure that the legacy of George Washington continues to inspire future generations of Americans.
Watch here>>
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Sweet Land of Liberty
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rather then just health care:
https://www.usatoday.com/story/news/nation-now/2018/10/29/same-sex-couple-carries-same-baby-ivf-fertility-treatment-first/1804554002/
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Trump’s Health-Care Progress
The Administration is improving the individual market by expanding insurance choices.
85 Comments
By The Editorial Board
Nov. 4, 2018 5:41 p.m. ET
Americans say health care is a leading concern in Tuesday’s election, and voters say they trust Democrats over Republicans by double-digit margins. Yet the Trump Administration has put together an impressive suite of reforms that allow consumers more freedom and personal choice, not that you’ll read about it anywhere else.
Last month the Trump Administration rolled out a rule on health-reimbursement arrangements that would allow employers to offer workers tax-exempt dollars to buy insurance in the individual market. The Obama Administration banned this via regulation as part of the Affordable Care Act.
The Administration’s thinking is that these arrangements will be most attractive to small firms that lack the economies of scale that make offering insurance affordable. About 30% of workers at firms with three to 24 employees are covered by employer health benefits, down from 44% in 2010, according to Kaiser Family Foundation data. Eight in 10 companies with fewer than 200 employees offer only one plan.
Health reimbursements would be a cheap and easy option for, say, startups. This is also a way to offer more individuals the tax break on health care that employer insurance receives. Ending this economic distortion for everyone would be preferable, but equal treatment is a step forward.
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The reflexive response from Democrats is that this is another effort to undermine the Affordable Care Act, but they need a new script. The rule will draw more young and healthy workers into the individual market, which currently skews toward the sick or those poor enough to be eligible for tax-credit subsidies. Reimbursements should make the ObamaCare exchanges more stable, which is what Democrats claim to want.
The rule includes guardrails to prevent employers from dumping sick employees onto the exchanges, and to prevent a person from getting both employer contributions and public subsidies. The Administration expects that some 800,000 employers will provide reimbursement arrangements to more than 10 million employees. Some three million will have been buying coverage on the individual market, meaning the rule should save the fisc money on increasingly expensive tax credits.
By failing to repeal ObamaCare, Republicans can’t address all of its dysfunctions. But at the margin by expanding choices they are making the individual market better, not worse, even as Democrats accuse them of sabotaging ObamaCare. Other new Trump options include short-term plans and association health plans. And unlike ObamaCare, the government isn’t coercing you to buy these products.
Trump’s Health-Care Progress
Photo: iStock/Getty Images
Speaking of association plans, the returns are coming in on the Democratic claim that allowing employers to band together to offer coverage is “junk insurance.” The plans are still nascent, but look at what the Las Vegas Metro Chamber of Commerce is offering: nine plan choices; dental, vision and life coverage available; pre-existing conditions covered; and more, with premium rates locked in for two years.
This is no surprise. The selling point of association plans is that businesses can pool risk and cut overhead costs. Businesses want to offer generous coverage that helps to attract workers in a tight labor market.
There may also be more relief ahead with the recent announcement that Health and Human Services rescinded a 2015 guidance for Section 1332 waivers. This is the Affordable Care Act’s waiver process for states to opt out of parts of the law. But Democrats designed the waivers to ensure that only progressive fantasies like single payer in Vermont could win approval. The Obama crowd then restricted the statute further in regulation.
The law stipulates that waivers must show the state plan provides coverage that is at least comprehensive and at least as affordable to comparable number of residents. Oh, and make it budget neutral.
The Trump Administration will interpret this in more rational ways, versus Obama guidance that applied the standards down to how plans would affect subpopulations in the state. The guidance was so prescriptive that most states didn’t bother coming up with ideas. The question now is how many enterprising Governors will decide they can do better than the status quo even within the restrictions.
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You haven’t heard about all this because Democrats want to define the election as a choice between them and Republicans who supposedly want to deny insurance to people with lung cancer. But political control of health insurance is not the only way to care for the sick. The GOP tends to favor block grants for high-risk pools that subsidize those who need help paying for expensive treatments.
ObamaCare set up an interim high-risk pool to cover anyone with pre-existing conditions who had been denied coverage, at least until the exchanges went live. Peak enrollment: 115,000, even as Democrats claim now that 130 million people have pre-existing conditions and are at risk from Republican policy.
The GOP’s incremental progress on health-care freedom would have been hard to imagine a year ago when it failed to repeal and replace ObamaCare. Repeal is still desirable given the law’s fundamental flaws. But the Administration is working within the law’s limits to allow as much freedom as possible. If these products prove to be popular, Democrats may find it harder to eliminate the choices to stand up single payer
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Lan
https://www.breitbart.com/politics/2018/11/02/winning-land-o-lakes-offers-health-plans-nearly-50-cheaper-than-obamacare/?fbclid=IwAR08n9HsOnpLfrjYCCeg1ePZy-udNX59MuZnbSBfP2AkMwYxzp5h_xcXfRM
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Texas ObamaCare Blunder
A judge’s ruling will be overturned and could backfire on Republicans.
138 Comments
By The Editorial Board
Dec. 16, 2018 4:40 p.m. ET
Texas Attorney General Ken Paxton
Texas Attorney General Ken Paxton Photo: Tony Gutierrez/Associated Press
No one opposes ObamaCare more than we do, and Democrats are now confirming that it was designed as a way-station to government-run health care. But a federal judge’s ruling Friday that the law is unconstitutional is likely to be overturned on appeal and may boomerang politically on Republicans.
Judge Reed O’Connor ruled for some 20 state plaintiffs that the Affordable Care Act’s individual mandate is no longer legal because Republicans repealed its financial penalty as part of the 2017 tax reform. Recall that Chief Justice John Roberts joined four Justices to say ObamaCare’s mandate was illegal as a command to individuals to buy insurance under the Commerce Clause. “The Framers gave Congress the power to regulate commerce, not to compel it,” he wrote.
Yet the Chief famously salvaged ObamaCare by unilaterally rewriting the mandate to be a “tax” that was within Congress’s power. Never mind that Democrats had expressly said the penalty was not a tax. Majority Leader Roberts declared it to be so.
Enter Texas Attorney General Ken Paxton, who argues in Texas v. U.S. that since Congress has repealed the mandate, the tax is no longer a tax, and ObamaCare is thus illegal. Judge O’Connor agreed with that logic, and he went further in ruling that since Congress said the mandate is crucial to the structure of ObamaCare, then all of ObamaCare must fall along with the mandate.
We’ll admit to a certain satisfaction in seeing the Chief Justice hoist on his own logic. But his ruling in NFIB v. Sebelius was in 2012 and there is more at issue legally now than the “tax” issue in that opinion. One legal complication is that Congress in 2017 repealed the financial part of the individual mandate, not the structure of the mandate itself. Republicans used budget rules to pass tax reform so they couldn’t repeal the mandate’s express language.
The Affordable Care Act has also been up and running since 2014, which means so-called reliance interests come into play when considering a precedent. Millions of people now rely on ObamaCare’s subsidies and rules, which argues against judges repealing the law by fiat.
Judge O’Connor breezes past this like a liberal Ninth Circuit appeals judge handling a Donald Trump appeal. He’s right that Democrats claimed the individual mandate was essential to the Affordable Care Act. But when Congress killed the financial penalty in 2017 it left the rest of ObamaCare intact. When judging congressional intent, a judge must account for the amending Congress as well as the original Congress.
In any case, the Supreme Court’s “severability” doctrine calls for restraint in declaring an entire law illegal merely because one part of it is. Our guess is that even the right-leaning Fifth Circuit Court of Appeals judges will overturn Judge O’Connor on this point.
As for the politics, Democrats claim to be alarmed by the ruling but the truth is they’re elated. They want to use it to further pound Republicans for denying health insurance for pre-existing conditions if the law is overturned. Democrats campaigned across the country against Mr. Paxton’s lawsuit to gain House and Senate seats in November, and they will now press votes in Congress so they can compound the gains in 2020.
President Trump hailed the ruling in a tweet, but he has never understood the Affordable Care Act. His Administration has done good work revising regulations to reduce health-care costs and increase access, but the risk is that the lawsuit will cause Republicans in Congress to panic politically and strike a deal with Democrats that reinforces ObamaCare. This is what happens when conservatives fall into the liberal trap of thinking they can use the courts to achieve policy goals that need to be won in Congress.
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"The Affordable Care Act has also been up and running since 2014, which means so-called reliance interests come into play when considering a precedent. Millions of people now rely on ObamaCare’s subsidies and rules, which argues against judges repealing the law by fiat."
With all due respect, I say ... bull sh*t. They have this completely upside down.
How about the precedent that the federal government does not have this power and the Framers never envisioned it.
The mandate can no longer be deemed a tax no matter how you stretch it.
The "precedent" was that Obamacare was constitutional only because of the tax. The Court has never upheld the power of the federal government to mandate a private purchase. Where in the constitution is that power granted? The legislative branch knew that full well when they repealed the tax. No Democrats supported the repeal. The intent and effect of repeal of the penalty was to repeal the entire law - by taking literally what the Chief Justice of the Supreme Court wrote when he cast the deciding vote in that case sending it back to the legislative branch for action, or inaction. Taking literally what the Supreme Court wrote is what they are supposed to do! It took 5 years and 3 election cycles but this was the legislative response to the guidance given by the Court.
The Supreme Court now has two choices as I see it. Stay consistent with their previous action which means strike the whole law down, or they can contort like a pretzel, again, go against their own previous ruling and rule against the new will of the people expressed through their legislative representatives who responded to the previous ruling by repealing the relatively small tax upon which the constitutionality of the whole mess rested.
The mandate is constitutionally defective, unconstitutional. It was ruled constitutional only if deemed a tax. THAT is the precedent. See Robert in Sebelius. They didn't have a 5th vote then without that and they didn't likely gain one since, though we don't know the Gorsuch or Kavanaugh view on this yet.
The law is a whole made up of interrelated parts. The risk pools for example don't work without the mandate. The law stands or folds as a whole, not a menu of parts for the Court to legislate from.
Major legislation often includes what’s known as a “severability clause,” to prevent courts from invalidating entire laws when they find that small sections of those laws violate the Constitution. The ACA does not include such a clause.
https://talkingpointsmemo.com/dc/the-glitch-that-allows-the-supreme-court-to-throw-out-all-of-obamacare
They could no longer fix that alleged defect when discovered because they lost the 60 vote majority in the Senate after the special election in Massachusetts. In July 2009 Al Franken finished his stealing of the 60th Senate seat making Obamacare possible without a single Republican vote. One month later Ted Kennedy died and Republican Scott Brown won that seat BECAUSE of Obamacare. In 2010 Republicans won the House. In 2014 the Senate and in 2016 the White House.
The tricks supporters used to deem this passed and contortions used to rule it constitutional with one so-called conservative vote have now come back to bite the supporters and the legislation.
The original legislation came from only one party. The repeal came from only the other party after power had switched in the ensuing elections. Now the federal government is divided. They can either enact new legislation or a legislative fix that is bipartisan or they can send it back to the states [where it belongs].
Passing all-encompassing federal legislation that changes the private lives and private decisions of everyone in the country and expands the power and reach of government is hard - JUST LIKE THE FRAMERS INTENDED.
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https://www.nationalreview.com/2019/02/bernie-sanders-health-care-rhetoric-rights/?fbclid=IwAR1MLhCEWuyRB3hX2j2oxRNPS6a147rh_vZebAG_fLZk-LWAysgymUT5C38
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https://www.nationalreview.com/2019/02/bernie-sanders-health-care-rhetoric-rights/?fbclid=IwAR1MLhCEWuyRB3hX2j2oxRNPS6a147rh_vZebAG_fLZk-LWAysgymUT5C38
In the 1850s, the southern dems had a right to cotton.
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https://www.westernjournal.com/hermancain/policy-change-trump-doj-now-asking-supreme-court-throw-obamacare-entirely/?utm_source=push&utm_medium=westernjournalism&utm_content=2019-03-26&utm_campaign=manualpost
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White House working on secret healthcare plan with three conservative think tanks
https://www.washingtonexaminer.com/news/white-house-working-on-secret-healthcare-plan-with-three-conservative-think-tanks?utm_source=Examiner%20Today_04/01/2019&utm_medium=email&utm_campaign=WEX_Examiner%20Today
"The analyst said the administration has been “having conversations” on healthcare policy and has reached out to numerous think tanks, including the Heritage Foundation, the Mercatus Center, and the Hoover Institute."
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My fingers are crossed. The next Trump or Republican proposal needs to be acceptable politically, functionally and doesn't unnecessarily or egregiously violate the principles of free market economics.
BTW, the Obamacare people should have consulted with these three groups too.
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A trial balloon I heard this morning is to "Leave it to the laboratory of democracy-- the fifty States-- to find a way including for preexisting conditions with the Feds giving block grants."
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Credit John Hinderaker for writing what I was thinking about Mick Jagger's health care. With US healthcare the worst in the world according to the Left and the National Health Service in Britain the leader in national healthcare, how come people who have choice keep coming here?
https://www.powerlineblog.com/archives/2019/04/annals-of-government-medicine-27.php
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Oct 2018 Survey:
https://www.studyfinds.org/survey-half-doctors-consider-leaving-medicine-insurance-company-headaches/
https://aimedalliance.org/wp-content/uploads/2018/10/Aimed-Alliance-Primary-Care-Survey-Report.pdf
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https://www.medicareinteractive.org/get-answers/medicare-basics/medicare-coverage-overview/differences-between-medicare-and-medicaid
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When Bernie and the gang talk about "Medicare for all", can we just start calling it Medicaid for all?
Medicare as I understand it is a program where they take from your paycheck all your working life in order to pay for healthcare when you are older, over 65.
WE ALREADY HAVE MEDICARE FOR ALL. To repeat, it is the program where you pay in and then collect.
What Bernie et al is saying is, 'elect me and someone else will pay for your healthcare'. To the poor that means free sh*t; to the taxpayers that means beware! In government-speak, the program where you collect without paying in is called Medicaid. The poor in America have had free healthcare since 1965. What the Left is saying is, let's make this program available to all.
Just posted on Cog Diss of the Left thread is a New Yorker article. On healthcare they point out that the ACA, a so-called subsidized market-based approach "leaves Americans paying more for worse coverage than any other advanced nation." Next paragraph begins, "supporters of the A.C.A. would contest this characterization." But there are no supporters of the ACA. The right wants it gone, the left wants it gone and the center doesn't like it either.
"Medicare for all" is not a proposal because it is not Medicare and no one proposing has accurately forecasted the cost or proposed how to pay for it.
If socialized medicine is a better economic system than market economics, charge people for their share of it. Charge all the able-bodied people their full cost of it, and even that doesn't pay for it because half the people currently pay in nothing.
The "explicit implication" that someone else will pay for it is bullsh*t rubbish. Raising tax rates further only on the rich does not bring in more dollars at all and most certainly doesn't bring in additional tens of trillions of dollars.
We know that having government run something makes it more expensive and less efficient, cf. everything they have touched so far. If you switch to government healthcare, you will pay all your healthcare dollars to the government instead of to your provider AND your taxes will go up to help cover the one or two hundred million who will not be paying their fair share. Only then can you enjoy the 270 day wait times they have in Canada and the quality of heart care that drove the Rolling Stones to the USA.
Candidate Barack Obama was shown that raising rates on capital does not increase tax revenue and he famously responded he would do it anyway out of "fairness".
https://taxfoundation.org/obama-and-gibson-capital-gains-tax-exchange/
Unlimited free healthcare for all would more than double the current cost of the federal government, cost more than $4 trillion per year and escalate rapidly. Symbolic rate increases that don't bring in more revenue doesn't get you there. "Static" increases that don't accurately measure the revenue degradation of changed behavior caused by greater disincentives to produce and report income do not get you there. Frankly nothing gets you there short of closing up all other government spending and shifting it to healthcare. We could have no defense, no payments on the debt, no social security, no food stamps, no court system, no executive or legislative branches, no EPA, and it still wouldn't get you there because you would have no IRS and no enforcement, no prison system to lock up the non-payers.
The Left lives in a dream world and most of us don't share their dream.
And they lie. They tell us we should all be able to have the healthcare of the rich and then they offer us all the healthcare of the poor.
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The articulation of the reality that what is being proposed is Medicaid for All and why that difference matters is a matter of tremendous importance.
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now coming North
expect the political correct not medically correct comments from them:
https://www.delawareonline.com/story/news/health/2019/04/23/remember-kissing-bug-cdc-confirms-one-found-delaware/3548857002/
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Interesting point, but I am unable to see the article. Any other citation?
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With regards to truvada , one could argue people are dying because it's cost too high , but really it is that they continue to have unprotected sex indiscriminately.
truvada allows people to have sex with hiv + people and not get it.
https://www.yahoo.com/news/aoc-asks-pharma-ceo-why-171300682.html
we can't even cure the common cold but we are close to curing HIV , and it can be kept at bay.
so it is not like no one is doing anything AOC .
Maybe she should work for 74 K not 174K
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https://issuesinsights.com/2019/06/04/586-billion-later-health-care-in-bigger-state-of-crisis-thanks-obama/?fbclid=IwAR3xPnFCbGApoVrE6upzOV1I6AQIGdW0kgPkB3UMtHgTJ0fJKrc-NcFCqVI
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https://www.huffpost.com/entry/medicare-for-all-poll-democrats_n_5d08264de4b0886dd15db364?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuaHVmZnBvc3QuY29tLw&guce_referrer_sig=AQAAADmW1PJjngfg-biVDmh6BWXEVoYO_485zyULM1xhCIYxwWfcdrIM_E24PF7Nxselzz1kN0DkbEbGH87pD6tzxnR-kK6Tn7WRPIkgsuFgyvwKGRhTAD4-UzW_29w5laT3dc1-dVS0fD64H1Wx2_Ps06efVn4BQtcSFipbJ82nVzeC
actually it is really very simple
everyone is forced into a government led bureaucracy that controls 1/7 more of the economy and dictates what health care we get or don't gt
and those who make money pay more into it and those that don't will get it for free courtesy of taxpayers
it will expand the Democrats control over all of us and reduce our freedom of choice to none.
unless like in Britain where the super rich can get pay for outside care.
End of story
Complicated - no not really
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"Democratic Voters Don’t Actually Understand ‘Medicare For All,’ New Report Says?
No they don't. If the media polling companies were honest and sought clarity they would ask it more this way:
1) Do you favor banning all private health care and trust everyone's health care to the government?
2) Do you want the healthcare system here that they have in Venezuela where all healthcare is free and provided by the government but they can't give you as much as a band aid because the system is bankrupt?
3) Do you favor banning the entire private sector in all industries and turning everything over to the government?
If you answered no to any of these, vote 'R'.
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up front for basic tests:
https://www.yahoo.com/finance/news/trump-order-seeks-disclosure-hospital-142157856.html
Seems like good idea to me but the anti Trump media is pointing out insurers and hospitals are skeptical and mostly not for it.
Suddenly the news media is on the side of hospitals and insurers :roll: rather then patients
That said I am not sure it will make any difference in costs at all.
Patients I have found do not care what the cost of anything is as long as someone else or the insurance cover it.
I recall telling patients about scams to have them driven to distant hospitals to have procedure done that could have easily been done nearby within their network.
Doctors did this so they could charge several multiples for the same service
Patients respond every freakin time => so what do I care the insurance covered it.
So it will only make a dent if the patient gets the bill is the bottom line.
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a) Do large deductibles motivate patients still in the deductible zone?
b) Would non-motivation be solved by Dr. Carson's HSA proposal?
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a) Do large deductibles motivate patients still in the deductible zone?
b) Would non-motivation be solved by Dr. Carson's HSA proposal?
From my point of view, yes and yes, those are both important steps in moving away from third-party pay to a market system. Everyone should pay the part they can afford out of their own pocket, and as we get more prosperous that should be a larger and larger share of healthcare instead of the other way around as it has been. Then insurance or catastrophic insurance can cover the unexpected or the unaffordable. Government needs to pay less and less, not more and more.
The problem with the large deductibles now is that the price of what you are paying out of your pocket has been driven out of sight by the system of third party and government pay. It is not just the high deductible but what we need is the mindset for most people their health care, like food, clothing, shelter, transportation, entertainment, is among the things you pay for out of your pocket and treat them with that kind of care and choice.
When only a very few are paying out of pocket, the pricing gets based on the government and insurance third party system.
Senator Phil Gramm said, give me 3rd party pay at the grocery store and I'd eat more steak and so would my dog. But that misses half of it. The stake would no longer be 10 or $20 a pound it might be a hundred or $1,000 a pound because no one cares what it costs.
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https://www.nytimes.com/2019/07/08/health/drug-prices-tv-ads-trump.html
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On Drug Prices, Trump Should Heed Reagan’s Advice: “Bold Colors” not “Pale Pastels”
In Friday's column, I explained why the President and Republicans are on their way to a stunning victory in 2020. I predicted that a big factor in this victory will be the clear juxtaposition between the President’s methodical, step-by-step approach to lower health care costs with more transparency, choice, and accountability and the Democrats’ calls for radical change that would throw people off of their private insurance and replace it with a government-run monopoly.
In today’s column, I want to sound a warning about how things could go wrong, particularly when it comes to the President’s efforts to lower prescription drug prices.
Until a few days ago, I would have argued confidently that the President and Republicans were well situated to win on the issue of drug prices in 2020.
A record number of generic drugs were approved by the FDA in 2017, saving consumers nearly $16 billion with lower priced alternatives. The Republican Congress also passed, and the President signed, a bill lifting the pharmacy “gag clauses” that prevented pharmacists from informing patients if they could pay less for a medicine by paying cash instead of going through insurance (some generic drugs are so cheap that they can cost less than a co-pay).
This early progress has led to a stunning result: for the first time in nearly 50 years, the consumer price index for prescription drugs is falling.
With a proof of concept that increasing transparency and consumer choice can lower drug costs, the President and Republicans could point to even bigger reforms being developed using the same strategies. This record of results using common sense, market-oriented reforms would provide a positive contrast with the Democrats’ calls for big government price controls that would lead to rationing of care and fewer medical breakthroughs like gene therapy, which would both cure diseases and create an economic boom in America (click here to learn more).
Unfortunately, the administration's efforts have hit several roadblocks in recent days. Worse, it appears some in the administration are abandoning market-oriented reforms that are working in favor of a more left-wing approach which would be a disaster.
Last week, a judge ruled that the administration could not require the prices of prescription drugs to be disclosed in direct-to-consumer advertising. This was a blow to efforts to use transparency and market forces to put downward pressure on drug prices.
Worse, the administration announced that due in part to misguided budgetary concerns, it was dropping its development of a rule in Medicare Part D to require all discounts and rebates given to pharmacy benefit managers (PBMs) to be passed directly to patients at the pharmacy counter.
This decision is incomprehensible. As I have explained before, this reform would have removed a huge incentive for drug manufacturers to constantly raise their prices in order to provide bigger discounts to PBMs. It is also a reform which would save seniors money in their out-of-pocket costs, making it easier for patients to follow their drug regimes, improving their health. Coupled with the fact that seniors would have started saving money in 2020, an election year, the decision to abandon the rule is both bad medicine and bad politics.
In an even more worrying development, reports are that some in the administration are considering embracing Nancy Pelosi’s plan to impose price controls on drugs in Medicare by tying the rate of drug price increases to inflation. Unlike the rebate rule, using price controls to standardize the rate of price increases won’t reduce the amount seniors pay for their drugs. In fact, drug manufacturers will likely respond by increasing their initial prices. In addition, in Pelosi’s plan, the penalty for raising prices faster than inflation is a tax, which would go to the federal treasury, not to seniors. So instead of reducing seniors’ drug costs, Pelosi’s plan would grow government.
The danger President Trump is in is best summed up by this headline: ‘Trump leaning on Sanders-style ideas to save his drug plan’.
President Trump should heed Ronald Reagan’s advice for conservatives: raise a banner of “bold colors,” no “pale pastels.”
Embracing watered-down, left-wing ideas to get something done on drug prices will not help American patients, who will face rationing and be robbed of future medical breakthroughs made possible through the free market, and it certainly won’t help politically in 2020. The Democratic nominee for president will always be able to go further to the left than a Republican president offering “pale pastels” of liberal ideas.
Instead, President Trump should stick to “bold colors.” He should announce that the rebate rule will be implemented as scheduled; fight for more transparency in drug prices in the courts; and make clear that while he is open to bipartisan legislation on drug prices, he is not going to adopt price controls that would ruin the innovation base making the drug breakthroughs possible in the first place.
Combined with President Trump’s other positive reforms in health care, this would be a “bold colors” health care platform that would win in 2020.
Your Friend,
Newt
P.S. There’s another potential solution to America’s health care crisis. I’ve been working passionately for years to advance it, and I believe we’ve finally reached a tipping point. It has to do with a miraculous scientific breakthrough that could save and improve lives, as well as the finances of our country. I’ll be discussing all the behind-the-scenes details during The 2019 American Health & Wealth Summit Thursday, July 18th at 1pm ET. It'll be online and is free to attend - click here now to register.
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100 yrs after discovery:
https://www.vox.com/science-and-health/2019/4/10/18302238/insulin-walmart-relion
and their prices seem to be in tandem.
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Hospitals would have to disclose the discounted prices they negotiate with insurance companies under a Trump administration rule that could upend the $1 trillion hospital industry by revealing rates long guarded as trade secrets. Hospitals that fail to share the discounted prices in an online form could be fined up to $300 a day, according to the proposal. The price-disclosure requirements would cover all the more than 6,000 hospitals that accept Medicare, as well as some others, and is likely to face fierce industry opposition.
https://www.wsj.com/articles/trump-proposes-forcing-hospitals-to-disclose-discount-rates-negotiated-with-insurers-11564431303?mod=itp_wsj&mod=&mod=djemITP_h
Winning.
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https://fortune.com/longform/medical-records/
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https://www.yahoo.com/news/diabetic-27-dies-taking-cheaper-113810916.html
the story is not complete
not clear how someone who used insulin his entire life would die from a different brand or type exactly
that said there is price fixing
oh yeah the insulin makers may not get together in a back room and agree to all sell at a similar price
they just do it .
no doubt about it.
as for why this guy did not have other insurance
or exactly what happened I dunno.
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https://www.marketwatch.com/story/the-us-can-slash-health-care-costs-75-with-2-fundamental-changes-and-without-medicare-for-all-2019-08-15?fbclid=IwAR1ZJxuQIreQ9WQfph15w6K9ULaS03c5rYG1xWsEAm5G2vYrS36X6J4LJzY
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blasting medical community for under prescribing pain medicines circa 2003
fast forward to now:
regulators now watching every single prescription for pain meds and law firms suing pharmaceutical companies
https://academicworks.cuny.edu/cgi/viewcontent.cgi?article=1147&context=clr
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https://pjmedia.com/trending/trumps-sudden-e-cig-crack-down-raises-questions-did-melania-catch-barron-vaping/
good political move . - Donald is protecting our children and should put smiles on all the suburban babes.
That said I think vaping is good for people who cannot otherwise quit cigarettes though I don't like the flavored shtick
The epidemic of teens using it for fun social reasons and to be cool is not good
at all.
However why ban vapes but not cigarettes?
And suddenly CBD and marijuana is ok?
No real consistency in policy .
:|
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https://www.wsj.com/articles/take-two-aspirin-and-call-me-by-my-pronouns-11568325291
The above is the reason I no longer a member of the American College of Physicians after over 30 yrs for the past ~ 2 yrs
I am tired of reading and hearing about gun control, women make 5 % less than men in healthcare
abortion access BCP access crazy definitions of gender , woke this woke that , climate change affecting menstrual cycles male erectile function and everything any researcher can dream of to make money publish BS and the increasing numbers of woke foreigners, females etc
some of whom seem to think all this is necessary
forcing it down the communication outlets to an every increasing degree.
I can turn on MSLSD to here the same dogma.
I don't need to pay for membership for more of the same.
I can get education updates for free without it.
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“Finland's government resigns over failed healthcare reform - BBC News”
https://www.bbc.com/news/world-europe-47496326
Finland's entire government has resigned over its failure to achieve a key policy goal on social welfare and healthcare reform.
[Too bad our liberals don't have this level of integrity.]
As an increasing number of people live longer in retirement, the cost of providing pension and healthcare benefits can rise. Those increased costs are paid for by taxes collected from of the working-age population – who make up a smaller percentage of the population than in decades past.
Mr Sipila's government also famously experimented with a guaranteed minimum income scheme – giving €560 (£480) a month to 2,000 unemployed people as a basic income with no conditions attached. Initial results suggested the pilot scheme left people happier, but still unemployed.
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"Initial results suggested the pilot scheme left people happier, but still unemployed"
so that is how the Scandinavians become so happy! :-P
the Dems want to make our unemployed even happier to be # one in the world.
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too complicated for me to understand and I don't know the numbers to crunch
but here is a summary :
https://www.conservativereview.com/news/house-republicans-release-health-care-plan-aims-finally-end-insurance-nightmare/
Hopefully this gives Pres Trump something to run with ........
if anyone could promote it he is the man.
I can just imagine Fareeeeed Zakaria is already (with Sanjay) looking for ways to tear this apart to please the Big Zucker.
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https://wilderwealthywise.com/free-speech-not-if-you-want-healthcare/
Good thing that couldn't happen here!
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https://www.marketwatch.com/story/the-us-can-slash-health-care-costs-75-with-2-fundamental-changes-and-without-medicare-for-all-2019-08-15?fbclid=IwAR2U68z6A5Jo6nIwhvvIAzgMtfI-0qqeW702tTb1AF4UlZJaWVZsm_aZ7bo
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https://www.marketwatch.com/story/the-us-can-slash-health-care-costs-75-with-2-fundamental-changes-and-without-medicare-for-all-2019-08-15?fbclid=IwAR2U68z6A5Jo6nIwhvvIAzgMtfI-0qqeW702tTb1AF4UlZJaWVZsm_aZ7bo
Great ideas.
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Yes they are; very much like Dr. Ben Carson's IIRC.
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Trump Administration Releases Transparency Rule in Hospital Pricing
Plans to propose similar requirement for insurers; legal challenges are likely
Prices charged for health-care procedures such as magnetic-resonance imaging vary widely. PHOTO: KEITH SRAKOCIC/ASSOCIATED PRESS
By Stephanie Armour
Updated Nov. 15, 2019 2:52 pm ET
Hospitals and insurers would be forced to disclose their secret negotiated rates for the first time under a far-reaching plan released Friday by the Trump administration.
Administration officials said the final rule will compel hospitals in 2021 to publicize the rates they negotiate with individual insurers for all services, including drugs, supplies, facility fees and care by doctors who work for the facility.
The administration proposed extending the disclosure requirement to the $670 billion health-insurance industry. Insurance companies and group health plans that cover employees would have to disclose negotiated rates, as well as previously paid rates for out-of-network treatment, in file formats that are computer-searchable, officials said.
The insurers, including Anthem Inc. and Cigna Corp. , would have to provide a transparency tool to give cost information to consumers in advance, senior administration officials said.
The requirements are more far-reaching than many industry leaders had expected and could upend commercial health-care markets, which are rife with complex systems of hidden charges and secret discounts. The price-disclosure initiative has become a cornerstone of the president’s 2020 re-election health strategy, despite threats of legal action from the industry.
“Right now, there is too much arbitrage in the system,” a senior administration official said in an interview Thursday with The Wall Street Journal. “There are a ton of vested interests who will oppose this. We expect to get sued. We’re really goring people’s oxes.”
SHARE YOUR THOUGHTS
How could information from insurers and hospitals be helpful to you if this plan goes into effect? Join the conversation below.
Hospitals and insurers typically treat specific prices for medical services as closely held secrets, with contracts between the insurers and hospital systems generally bound by confidentiality agreements. Policy makers, employers and patients are often unable to see clearly which hospital systems and doctor practices are driving high costs.
The proposal covering insurers is the newest part of the price-disclosure initiative, and it would include the private-employer market, where about 158 million people get their health insurance. Insurers and group health plans would have to put the negotiated rates into a file that third-party developers could incorporate into shopping tools.
Insurers would also have to create a web-based tool for beneficiaries that discloses the list price, the negotiated rate, cost sharing and the amount left on a plan deductible, as well as allowable out-of-network rates, officials said. There will be a 60-day public comment period on the proposal.
The requirements for the negotiated-rate file could cost insurers an estimated $200 million to build based on projections in the proposal.
Other costs include an estimated $64 million to $161 million for three years to implement and maintain posting about cost sharing.
The proposal also states that “price transparency may have the opposite effect because in some markets where pricing is very transparent, pricing can narrow and average costs can increase.”
Studies show consumers are often required to pay more out of pocket when they don’t have the price information they need to comparison shop. Employer health-plan deductibles are outpacing wage growth and have risen to an average $1,655 for a single plan, according to a September survey by the Kaiser Family Foundation. Workers on average pay $6,015 toward the cost of their coverage.
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Drug pricing is complicated and secretive. WSJ explains how the flow of money, drugs and rebates behind the scenes may drive up the price of prescription medicine for consumers. Illustration: Mallory Brangan
On the final rule covering hospitals, facilities will have two obligations. First, they will have to provide insurer-specific negotiated rates in a computer-readable file.
Second, hospitals will have to post negotiated charges online for 300 specific services for which patients typically shop around. Seventy of those services, including vaginal birth, colonoscopy and joint-replacement surgery, are stipulated in the rule, according to senior administration officials. Hospitals can select the other 230 services they post online.
Hospitals face fines of up to $300 a day if they don’t comply with sharing negotiated rates.
The requirements would cost hospitals more than $23 million annually in 2016 dollars, according to an estimate in the rule. Annual costs range from $38.7 million to $39.4 million in 2019 dollars.
Taken together, the price-disclosure initiatives could reshape the $3.5 trillion health-care industry.
Prices charged for health care vary widely depending on whether a provider is in or out of the patient’s insurance network and on the insurer’s undisclosed price agreements with hospitals. A magnetic resonance image of the lower back costs $141 at an imaging center in Jefferson, La., but $7,646 at a hospital in Torrance, Calif., according to data from Clear Health Costs, which publishes information on health costs.
Hospitals, insurers and others in the industry have spent the past nine months since the idea was floated by the White House denouncing the proposal and gearing up for a pitched legal battle.
The industry is also likely to argue in any legal challenge that negotiated rates are proprietary and include confidential contractual agreements. Industry groups have also said the proposal runs counter to the First Amendment.
Pharmaceutical companies prevailed with a similar argument when the Trump administration said they had to disclose list prices for drugs in television ads. A federal judge in July ruled that the requirement overstepped regulatory authority.
“It’s actually worse than we expected,” said Tom Nickels, executive vice president of the American Hospital Association. “They have additional requirements. It’s additional data that I don’t know is particularly helpful for consumers.”
If rates are public, health-care companies say, some hospital systems might push for payment rates that match their crosstown rivals’.
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Proponents of the proposal argue it would bring costs down. Out-of-network doctors could try to compete with in-network negotiated rates. Health systems that charge higher negotiated rates could lose business if they don’t match competitors’ rates or justify the reasons for their steeper costs. And employers could press their insurers to include hospitals with lower negotiated rates in their networks.
Employers and patients are often unable to see which hospital systems and doctor’s offices are driving prices upward. Some health-care economists argue that the secrecy is a factor in why the U.S. spends more per resident on health care than any other developed nation.
The administration’s vision is to arm patients with information needed to make health-care decisions much like shopping for other consumer services. Rates potentially could be posted on public websites, where consumers would check the negotiated price of a service before they pick a provider.
The White House push on price disclosure comes as President Trump seeks to close the gap with Democrats, who hold an advantage on health care in public polling.
“You’ll see some results that are incredible in terms of costs coming down,” Mr. Trump said Friday, adding, “We’re taking on the insurance companies and the special interests.”
Mr. Trump has stated that under his health-care plan, Americans will get better care at a lower cost than they currently pay. About three in 10 adults are very or somewhat confident that the president will deliver on his promise, while 62% say they aren’t too confident or not at all confident, according to an October poll by the Kaiser Family Foundation.
The White House is prepared to defend the rule and the proposal covering insurers from lawsuits, a senior administration official said. Officials said authority for the requirements stems from the Public Health Service Act.
“You’ll be able to negotiate all over the place,” Mr. Trump said in an October speech in Florida. “And you’ll be able to pick everything you want, from the hospital to the doctor. And it’s going to save you a tremendous amount of money.”
Write to Stephanie Armour at stephanie.armour@wsj.com
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https://www.wsj.com/articles/hospitals-turn-to-courts-as-lobbying-fails-to-block-price-transparency-proposal-11575551412?fbclid=IwAR2ghXAhPq161SFzi92lozlq1jdaSR6XZt4b1dUMYOUdTBVvQ7uMIxGF9kk
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https://www.facebook.com/SurgeryCenterOK/?hc_location=ufi
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https://www.thetimes.co.uk/article/cancer-patient-delays-worst-on-record-hospital-shortages-5wntk7qbr
“Cancer patients face record wait.”
Cancer patients are being forced to endure the worst waiting times since records began, official figures reveal.
***
In total, 168,390 patients were not seen or treated within the specified times. The figure is up 24% on the same period in 2018-19. Staff shortages, lack of equipment and beds filled by patients needing social care were to blame.
***
In September, 76.9% of patients with suspected cancer began treatment within two months of an urgent referral from a GP.
“Urgent” isn’t what it once was. Delays in obtaining treatment often lead to poor outcomes:
Last year, for the first time, the NHS carried out more than 2m checks. It says cancer survival is at an all-time high, yet Britain is near the bottom of international league tables for cancer survival and is lagging years behind some countries for some types of the disease.
-----------------------
I wondered if these problems are limited to the UK. Switching to Canada:
https://nationalpost.com/news/canada/canada-ranks-low-in-international-comparison-of-patient-wait-times-report
Canada’s health-care wait times get failing grade in survey of 11 industrialized countries
https://www.ctoam.com/precision-oncology/why-we-exist/standard-treatment/treatment/wait-times-in-canada/
Wait Times for Cancer Treatment in Canada
Long wait times are part of the problem, with Canada having the "the highest proportion of patients with long delays to see specialists." (56% of patients wait more than four weeks; the international average is 36%.) Needing to wait this long for diagnosis and treatment results in many cancer patients not getting the treatment they need in time.
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The low point for support for private health care on the Gallup time line happens to be the day Democrats took the House.
(https://content.gallup.com/origin/gallupinc/GallupSpaces/Production/Cms/POLL/dhl9uknhqkweri1m5hcw8a.png)
54% prefer private system; 42% support government-run system
Two-thirds of Democrats favor a government-run system
Independents have been closely divided in recent years, but in 2019 tilt more toward a private (50%) than a government-run (45%) system.
https://news.gallup.com/poll/268985/americans-favor-private-healthcare-system.aspx
---------------------------------------------------
Too bad we don't have a private health care system for people to evaluate.
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https://townhall.com/columnists/janerobbins/2019/12/15/medical-associations-embrace-propaganda-not-science-n2557967
"Under AAP policy, any position statement is drafted by a small committee (usually 10-12 members, and maybe as few as seven) and then voted on by the roughly 12-member board of directors. The broader membership has no direct input into the statement and would generally learn of it only after it’s issued. So the only thing the AAP policy tells us is that less than 0.05 percent of the pediatricians who are still members of AAP believe in experimenting medically on gender-confused children."
This is what I see in the adult medical organizations
A bunch of academic libs direct the their positions and declarations
I have never had any one of them reach out and ask for my opinion.
or take a survey etc
It is the academic self appointed elites - again .
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An ObamaCare Judicial Morass
Democrats get new ammunition as an ill-fated lawsuit drags on.
By The Editorial Board
Dec. 20, 2019 7:10 pm ET
SAVE
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TEXT
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A sign on an insurance store advertises Obamacare in San Diego, October 2017. PHOTO: MIKE BLAKE/REUTERS
Even as Democratic presidential candidacies implode over Medicare for All, Republican state attorneys general and the Trump Administration are handing the left a political lifeline with an overbroad attack on ObamaCare in the courts. On Wednesday the Fifth Circuit Court of Appeals ensured this will drag on as it struck down the individual mandate and asked a district-court judge to determine if other parts of the law have to go too.
The finding that the mandate is unconstitutional is straightforward though it should have little impact. Chief Justice John Roberts in 2012 upheld the Affordable Care Act’s (ACA) command that everyone purchase insurance on grounds that it was a “tax” on failing to buy insurance. In 2017 the GOP Congress set the penalty for failing to buy insurance at $0. If it doesn’t collect revenue, the Fifth Circuit now says, it can’t be a tax.
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That’s a clever legal twist, but states and the Trump Administration want to go further. They say the mandate’s illegality means that much or all of the rest of ObamaCare’s regulations and subsidies must also be dismantled. A district court judge agreed.
The Fifth Circuit panel didn’t affirm this view but also didn’t repudiate it. The judges appear open to the idea that big parts of the law need to fall with the mandate. Most vulnerable would be ObamaCare’s “community rating” and “guaranteed issue” provisions that regulate insurance prices and require companies to cover pre-existing conditions.
The legal issue is called “severability.” The test is whether removing the unconstitutional part would blow up the functioning of rest of the law, as well as the thornier question of whether “Congress would have preferred no ACA at all to an ACA without the mandate.” We’ve opposed ObamaCare’s baleful effects as much as anyone, but there’s little doubt the mandate is severable.
The confusion comes from the misjudgment of the law’s drafters. They said the mandate would cause healthy people to buy insurance and create a thriving individual health-insurance market. If that had happened, then the mandate may have been difficult to sever.
Yet the mandate turned out not to be much of an inducement for people to buy health insurance they couldn’t afford. Congress’s elimination of the penalty in 2017 hasn’t resulted in higher insurance premiums. And the same Congress kept the rest of the law in place. The Fifth Circuit judges seem to want an open-ended inquiry into the “intent” of two different Congresses making complex policy decisions in light of different facts. The simpler solution is to defer to the most recent Congress.
ObamaCare created an entitlement through subsidies and Medicaid; the mandate was mostly superfluous in practice. If conservatives declare that the mandate is an inextricable part of ObamaCare, they would ironically vastly overstate the law’s success in an attempt to sink it.
Millions of people now rely on the law, and “reliance interests” will also doom this challenge if it ever reaches Chief Justice Roberts. He’s unlikely to be amused that other judges are using his saving construction for the law to overturn it today. Yet the GOP will be battered politically in the interim.
Speaker Nancy Pelosi said in response to the ruling that “Republicans have taken every opportunity to dismantle” coverage for Americans with pre-existing conditions. The GOP would do better to develop a health agenda that candidates can defend politically rather than use the judiciary as a legislature of last resort.
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https://www.forbes.com/sites/theapothecary/2016/07/28/overwhelming-evidence-that-obamacare-caused-premiums-to-increase-substantially/#6b312b315be7
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Trump kept "pre existing conditions"
https://www.newsmax.com/t/newsmax/article/950533/1
my opinion - one of 7 billion - is whoever works health care wins 2020.
:-)
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"whoever works health care wins 2020."
Trump should partner up right now with House Republicans and all the best minds of conservative think tanks and hold real policy talks (alongside the impeachment hearings) and propose more moves toward market solutions that they can run on in the fall. More consumer choices, more deregulation, more details on disclosures of prices, and so on.
How about a 10 point (conservative) Contract with America on Health Care that will pass the House if the nation elects them? Build it, perfect it and put it on the ballot.
ccp is right. Silence on health care will cost them (another) election. They better have a plan and it better be a good one.
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Call in Dr. Ben Carson! Sen and Doctor Rand Paul too!
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"How about a 10 point (conservative) Contract with America on Health Care that will pass the House if the nation elects them? "
Now that is a good idea!
put that up against "free Medicare for All" that would bankrupt this country and make everyone debt poor for the next 100 yrs!
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I miss the posts from Venezuela and have wondered where Denny has gone. I see he is still active at Motley Fool discussion board:
https://boards.fool.com/LastPosts.asp?limit=10&uid=95826397
Here is a comment I like, with apologies to our own fully certified MD:
"I have read that part of AMA's unspoken mission is to restrict the number of doctors which is typically the function of all professional and artisan guilds. It's a form of restraint of trade to benefit the current guild members. Then, of course, the blame is placed on the "free" market which is not free from manipulation by the guilds (a. k. a. labor unions -- AMA being the US medical labor union).
Imagine deregulating medicine! ;) "
- (our) Denny S ?
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Sounds like how he sees things :-)
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" body mass index (BMI) is discriminatory to gender nonbinary students." WHAT??????????
https://www.foxnews.com/health/california-gavin-newsom-moves-pause-student-fitness-tests-citing-bullying-concerns
:-o :-(
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" body mass index (BMI) is discriminatory to gender nonbinary students." WHAT??????????
https://www.foxnews.com/health/california-gavin-newsom-moves-pause-student-fitness-tests-citing-bullying-concerns
:-o :-(
Forget about discrimination, what is a "gender nonbinary" student? The ones who don't know which bathroom to use?
"Hey Joe (Biden), How many genders are there?" "I know there are at least two. Wait, is that a trick question?"
Back to BMI, did anyone think there was a perfect number for everyone? We can't even judge by credit score or criminal background anymore.
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https://thehill.com/policy/healthcare/482437-doctors-group-breaks-from-health-care-industry-with-support-for-medicare
Well I cancelled my membership 1 to 2 yrs ago
I don't recall ever being surveyed as to my opinion
They take all these political positions always siding with the political correct crowd .
and then suggest we all agree with it.
From climate change, to abortion, to me too, to trans gay, to anti Republican anything , and on and on and on
Doherty was never elected. He is just there for many years pretending he speaks for me .
Well since i am no longer a member, he doesn't.
I was not from my memory politically activist until the last maybe 10 yrs........?
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and how we foot the bill for the rest of the world
where insulin sells for 10 times less
and despite insulin being around since 1921
the cost keeps going endlessly higher even for basic insulins
and how the pharmacy benefits managers , drug companies are ripping off the patients and their insurances:
https://www.mayoclinicproceedings.org/article/S0025-6196(19)31008-0/fulltext
There is no possibility there is not some form of collusion and price fixing .
Even if not a direct agreement it is an unsaid fact that all the drug companies are keeping their prices high in tandem.
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and how we foot the bill for the rest of the world
where insulin sells for 10 times less
and despite insulin being around since 1921
the cost keeps going endlessly higher even for basic insulins
and how the pharmacy benefits managers , drug companies are ripping off the patients and their insurances:
https://www.mayoclinicproceedings.org/article/S0025-6196(19)31008-0/fulltext
There is no possibility there is not some form of collusion and price fixing .
Even if not a direct agreement it is an unsaid fact that all the drug companies are keeping their prices high in tandem.
I remember after Katrina oil prices spiked with the closing of refineries and shipping lanes and a Dem leaning friend commented on the greed of the oil companies. But in fact, oil company greed was the only factor that held constant during that supply interruption and price spike up and back down.
The economics of insulin is simple, same as every other commodity or manufactured good or service - UNLESS something is standing in the way of market forces working.
When the price and profits go up, the incentive to produce more goes up and the new supply and competition brings down the price. I can only guess why that isn't happening, government interference in the market, probably at every step and every level.
I know nothing about insulin but one crazy idea would be to legalize it.
-------------------
From the Mayo Clinic article:
Reasons for the High Cost of Insulin
"The number 1 reason for the high cost of insulin is the presence of a vulnerable population that needs insulin to survive (Table 1). This population, which numbers in the millions,14 is willing to pay anything to have access to a lifesaving drug. The desperate need for a lifesaving product allows insulin to be priced at high levels because it is not a luxury item that one can forego. The manufacturers of insulin know that patients who need it will spend whatever it takes to acquire it, regardless of price. It is a matter of life and death."
- No, that isn't the reason insulin isn't a plentiful, affordable medicine in the year 2020.
Back to Mayo reason list:
1 • Vulnerable population who is willing to pay high costs to have access to a lifesaving drug
2 • Virtual monopoly/oligopoly
3 • Patent abuse and evergreening
4 • Barriers to biosimilar entry
5 • Pharmacy benefit managers and other middlemen who benefit from a high list price
6 • Lobbying power of insulin manufacturers
Note the 2nd, 4th and 6th reasons. Virtual monopoly. Why? Barriers to entry. Why? Lobbying power? No, it's not the "lobbyists", it's the government they are lobbying.
If the government is failing you, why not get them out of the business, turn the quality certification over to something non-government such as the American Diabetes Assn, diabetes.org.
The only barrier to entry should be you need to have a safe, pure, effective product.
I'm not diabetic but I would be happy to have a Mayo Clinic certification on a med if the government is too slow, too stupid or too corrupt to do the job. Why is the answer to bungled government always more government or complete government takeover? It makes no sense to me.
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Very good points Doug
If we take the position that the companies will go ahead and "abuse the system "
because they can, and this is consistent will human behavior in general
then
the problem must be the system is broken (like at the Copyright Office)
this the system needs to fixed. so the greedy cannot manipulate the system to their benefit
removing barriers of entry seems like it would help.
however I am not sure it is just this.
Even the biosimilars still seem to charge a lot .
only somewhat less then the ibg monopoly players according to this article.
one interesting thing is Walmart has availability of one type of insulin at low cost
because of their purchasing power.
the pharmacy benefits managers are supposed. to have the same effect
but while they may save some insurers money NONE of that saves patients money.
I thinks some wholesale prescription plans have tried to break the strangle hold but I am not sure if any really successful
I don't think I can say it is due to regulations.
I think price collusion is clearly a factor
Just like market forces have not really been able to break the stranglehold of the big tech companies that control most of the market in on line ads and data etc.
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Thanks ccp.
"I think price collusion is clearly a factor"
Yes, price collusion between near monopoly players is broken only with new supplies entering the market. They don't have to talk to each other to collude. They just do market price studies like everyone does.
"Just like market forces have not really been able to break the stranglehold of the big tech companies that control most of the market in on line ads and data etc."
Ever since the rise of Microsoft, these big companies can't be beat because of their low price and high functionality. Google and Facebook are mostly "free" to the user with massive functionality. There are no barriers to entry to sell (most) products on the internet without a middleman for less, just the challenge of getting costs down and getting the word out.
Back to Insulin, something or somebody is stopping more supplies and new suppliers from entering the market. Mayo Clinic pointing the finger at "Lobbying power of insulin manufacturers" makes me wonder... Lobby whom? To do what? Government. To block new supplies and suppliers, I presume.
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https://getpocket.com/explore/item/why-europeans-don-t-get-huge-medical-bills
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https://stateofreform.com/news/2020/03/an-actual-bipartisan-plan/?mkt_tok=eyJpIjoiT0dFM05tSTVaalJtTXpsaCIsInQiOiIzdmU3TG9tM1dyTytRSEo3UzBcL1NqZHE2TFlud2RSemhOdEI2TURZZkZMa0FMbmdIRnZEQ3I3aFJTMHgwdTJhU3JQWkwyemJBdEp6RndVeFJuS2FMcFZTdktoajZQeFpKSU9OYzBBU3lNaUhxYWgyTWJHVkZObUo0ODFDWmpuZisifQ%3D%3D
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https://mises.org/wire/markets-vs-socialism-why-south-korean-healthcare-outperforming-italy-covid-19
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https://time.com/5806312/coronavirus-treatment-cost/
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https://www.nytimes.com/2020/03/25/upshot/coronavirus-health-insurance-faq.html?campaign_id=29&emc=edit_up_20200326&instance_id=17080&nl=the-upshot®i_id=77793356&segment_id=22938&te=1&user_id=34fbda3e017f320f29cec6e86f4891a4
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https://citylimits.org/2017/01/04/hospital-closures-and-medicaid-shifts-took-toll-on-nycs-health/
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https://citylimits.org/2017/01/04/hospital-closures-and-medicaid-shifts-took-toll-on-nycs-health/
Funny how they missed covering the impact of illegal aliens on the healthcare system.
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Just the thought of "Congress" overseeing the 2 trillion "bailout " is nauseating.
I am not sure I could trust Minuchin though completely either.
https://pjmedia.com/trending/trump-resisting-congressional-oversight-of-corporate-bailout-program/
fraud waste nepotism - we all know will be rampant.
from top to bottom
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https://www.nationalreview.com/corner/joe-biden-coronavirus-adviser-ezekiel-emanuel-wants-to-die-at-75/
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What a kook - crazy eccentric person. Was he 12 when he wrote that? Did he wish his grandparents dead? I would hire him for NOTHING. Instead the leading opponent makes him lead adviser, in charge of healthcare rationing - for people over 75.
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https://www.breitbart.com/politics/2020/04/15/jimmy-carter-distressed-over-trump-halting-who-funding/
US fund to WHO 500 million and the Chinese 40 million
yet the WHO leader covers up for the Chinese
he must be getting cash under the table - must be
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https://www.gingrich360.com/2020/05/heres-a-multi-trillion-dollar-stimulus-that-wont-cost-taxpayers-a-penny/
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https://www.usatoday.com/story/news/health/2020/06/26/u-s-doctor-shortage-worsens-especially-black-and-latino-groups/3262561001/
Why be like Ben Carson when you can be Lebron?
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I never heard of anything like this assuming it is true
A Board of Medicine investigating a doctor/senatore (Rep. of course) because of some public comments - which are almost certainly true.
https://www.minnpost.com/glean/2020/07/minnesota-state-senator-says-he-is-being-investigation-by-board-of-medical-practice-over-covid-19-comments/
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The Federal Program That Keeps Insulin Prices High
Middlemen pocket discounts while forcing patients, employers and Medicare to pay more.
By Adam J. Fein
Sept. 10, 2020 7:10 pm ET
Perhaps the biggest flashpoint in the political debate about prescription drug prices is the cost of insulin. This summer an executive order from President Trump required low prices for some patients, and Eli Lilly last week announced new measures to make insulin more affordable for diabetics. Yet many aren’t aware that a federal program is goosing the price of insulin and other treatments, and keeping the prices high for patients who need these drugs.
Over the past few months the little-known 340B Drug Pricing Program has become the source of intense jockeying over who should benefit from the deep drug discounts—sometimes as much as 100%—that manufacturers provide to hospitals and their pharmacy partners. Drug manufacturers Sanofi, Merck and Novartis are demanding transparency to ensure that their discounts aren’t diverted.
Congress created the 340B Drug Pricing Program in 1992 with the vague goal of helping providers “stretch scarce federal resources” by requiring manufacturers to offer steep drug discounts to certain “safety net” hospitals. But the program includes no clear mandate on how the rebates should be spent. Good intentions have been swamped by middlemen that pocket discounts while forcing patients, employers and the Medicare program to pay more for prescription drugs.
For 18 years, 340B remained a minor, generally uncontroversial part of the U.S. health-care system. But shortly after the Affordable Care Act passed in 2010, the Obama administration announced an expansion: Hospitals could purchase and dispense discounted drugs through an unlimited number of external (or contract) commercial pharmacies.
For years I’ve been studying the economics of the complex and opaque intersection of the 340B program and the pharmacy industry. My analysis has found that since 2010 the 340B program has grown by almost 500% and is approaching the size of the nation’s Medicaid outpatient drug market. The number of external pharmacies in the 340B program has also skyrocketed, from fewer than 1,300 in 2010 to 28,000 in 2020. That means almost half the U.S. pharmacy industry now profits from the 340B program, which was designed as a narrow support to certain hospitals.
Profit margins of up to 100% allow hospitals to pay inflated fees to their pharmacy partners, which can earn margins well above what the patient’s insurance company usually pays. Public companies such as Walgreens, CVS, Walmart, Cigna, UnitedHealth Group, and Kroger have rushed into the 340B business. A booming industry of consultants and technology companies helps hospitals and commercial pharmacies profit from this aspect of the 340B program.
Patients don’t benefit from these discounts. Instead, they are expected to pay their health plans’ full out-of-pocket costs. A patient with a high-deductible health plan must pay the full list price for his medicine. The same sad math applies to seniors in the Medicare Part D program. Seniors taking many expensive specialty therapies must pay 5% of their prescription’s price without discounts—even when the manufacturer has practically given the product away.
Unlike Medicaid, the pharmacy component of 340B doesn’t have—and has never had—a regulatory infrastructure. That’s because the Obama administration’s 2010 notice bypassed the usual rule-making and comment procedures. Consequently, there’s no requirement that hospitals appropriately use the billions in 340B pharmacy discounts, no fair-market-value standards for pharmacies’ fees, and zero transparency around the profits earned by the billion-dollar public companies that dominate 340B pharmacy networks.
Even worse, multiple government watchdogs have found that hospitals often don’t provide discounted drug prices to uninsured low-income patients who filled prescriptions at a hospital’s 340B contract pharmacy. The Government Accountability Office discovered that in a sample of 28 hospitals, 16 (57%) didn’t provide discounted drug prices to needy patients at 340B pharmacies.
Manufacturers can find themselves paying a Medicaid rebate and a 340B discounts for the same prescription. Such double dipping occurs because there is a lack of transparency into claims data that would allow states and manufacturers to apply payment policies correctly. Health and Human Service’s Inspector General in a report last month identified this lack of transparency as one of its top unimplemented recommendations to the agency.
Manufacturers understandably oppose paying 200% in discounts while others in the system make money. Hospitals and pharmacies have fought requests for data that manufacturers need to verify or track 340B discounts.
Congress needs to clean up this mess. The health-care system has changed a lot in the 28 years since the discount program was introduced. The 340B program needs to be modernized so that it benefits seniors and other patients—while supporting the genuine safety-net services of health-care providers. In the absence of sensible regulations, manufacturers will struggle to make sure that patients benefit from discounts on prescription drugs.
Mr. Fein is CEO of Drug Channels Institute.
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they screwed up big time the corona virus pandemic
but we need to be teaching the evils of white people ?
:-(
https://www.newsmax.com/politics/cdc-critical-race-theory-racism-colorism/2020/09/15/id/987084/
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Pre-Existing Condition Fiction
Biden repeats the same false claims about ObamaCare that Democrats use every election.
By The Editorial Board
Sept. 30, 2020 7:19 pm ET
Joe Biden claimed at Tuesday’s debate that “100 million people who have pre-existing conditions” will lose insurance if the Trump Administration wins an Affordable Care Act case at the Supreme Court. Democrats have terrified voters with this fiction for years, and Republican confusion has helped keep the fear alive. So let’s explain the reality one more time.
Stipulate first that the GOP attorneys general asking the court to strike down the Affordable Care Act are committing political malpractice. As we wrote Monday, Chief Justice John Roberts’s Court is not about to strike down the entire law, and Democrats know it. But the Trump Administration’s support of the lawsuit has handed Democrats a potent line of attack.
Yet on the merits, the left overstates the problem of pre-existing conditions to justify political control of health care. Mr. Biden’s 100 million figure may come from an estimate of how many Americans have a condition but aren’t enrolled in Medicare or Medicaid. Those two programs cover about one-third of the U.S. population, including seniors and the poor who have pre-existing conditions. Another roughly 160 million Americans have employer-sponsored insurance, where rules on pre-existing conditions date to 1990s privacy law.
The question is not how many Americans have a health condition, but how many Americans buying insurance in the individual insurance market have a condition that makes them difficult to insure at prices they can pay. Keep in mind that the Affordable Care Act set up a subsidized transitional plan for anyone with pre-existing conditions denied insurance in the individual market. Peak enrollment: about 115,000 in 2013.
The White House in an executive order last week noted that, by the Obama Administration’s own report, a mere 2.7% of an estimated roughly 130 million people with pre-existing conditions gained access to health insurance through the Affordable Care Act.
One of the biggest political cons of the past decade is the left’s claim that only ObamaCare could keep these Americans from being deprived of health care. In fact the law’s regulations and mandates have often resulted in narrow networks and high out-of-pocket costs for patients who most need good and affordable care.
Take a 2018 survey that found more than 90% of National Cancer Institute-designated cancer centers are “out of network for some or all health exchange carriers in their state.” The survey notes that coverage mandates may have “accelerated the use of narrow networks to control health plan costs” on the exchanges.
As health experts John Goodman and Devon Herrickhave noted, Houston’s MD Anderson Cancer Center doesn’t accept “a single private health insurance plan sold on the individual market in Texas.” Having an insurance card is no comfort to cancer patients shut out from top hospitals and doctors.
The theory of the 2017 GOP ObamaCare repeal effort was that it would be better to defray the health costs of these patients directly through high-risk pools. That would also reduce high premiums for the healthy. The GOP plan would have allowed states relief from some of the Affordable Care Act’s rules, as long as states availed themselves of billions in funding to subsidize those with pre-existing conditions.
The Galen Institute’s Brian Blase pointed out last week that the Affordable Care Act is on track to cost taxpayers $1.8 trillion over the next decade, and too much of that goes to pay insurance companies for “healthy enrollees who need massive subsidies to afford the coverage that the ACA made much more expensive.” Republicans should run with this line of thinking: $1.8 trillion could be better deployed, particularly in directly helping the seriously ill.
President Trump deserves credit for his efforts to expand insurance options like health-reimbursement arrangements that allow workers to buy a plan with pretax dollars. And it’s a pity that his rule allowing more small businesses to band together to offer insurance (association health plans) has been ensnared in a court fight. Mr. Trump says he supports protecting those with pre-existing conditions, and his health-care executive order last week included several discrete good ideas.
But voters want a larger plan for how he’d help Americans in tough times pay their medical bills while allowing everyone else more portability and choice. The media trope that the right has no ideas on health care is false. But too few Republican politicians have the discipline to learn the details and the political courage to sell reform to voters.
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Great explanation of the issue.
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https://www.nationalreview.com/2020/10/trumps-abdication-on-health-care/
I like Mark Levin's answer when asked what is the policy on health care:
"it is called the private sector"
Nonetheless Republicans seem unable to come up with something that helps private sector cover pre existing conditions ( guarantee ),
or better help people who can't get coverage etc.
And this is the third biggest concern people have as Rich points out.
Trump's only addresses costs of medicines. I am not sure if costs are down or not .
Not easy to tell.
Certainly the deluge of newer biotech meds that cost a lot to get approved, long patent lives, and pharm gaming the legal system to extend patent lives unethically to prevent cheaper generics, and generic companies not reducing costs much lower than brand , I have not seen big difference in prices anectodely.
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ccp:
I like Mark Levin's answer when asked what is the policy on health care:
"it is called the private sector"
--------------------------------
In 2019 you could call it the 90% solution. 90% of America does not live in poverty (pre-covid) and should be able to afford their own insurance and expenses.
As we generously take care of those among us less fortunate, and we do, we should be careful no to screw up the system for the 90%. Markets and competition are the only things that bring down costs. Markets and competition are the only things that drive up incomes. Health care affordability is the ratio of cost to the income available to pay those costs.
Democrat plans address the 10% problem by screwing it all up for the 90%.
Pre-existing conditions? Didn't we already solve that? I thought Obamacare took care of it. And was NOT repealed, see voting records of John McCain, Susan Collins and Lisa Murkowski.
https://www.nbcnews.com/politics/congress/senate-gop-effort-repeal-obamacare-fails-n787311
Were we oversold? Don't you have to admit it failed in order to propose a bigger government program?
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as we all know obama care was designed as first step towards single payer
or maybe some form of private insurance but with total centralized government control
so of course Zeke and crew are already working to implement the plans they have for next step:
https://www.breitbart.com/clips/2020/11/12/klain-biden-will-take-executive-action-fixing-some-of-the-flaws-in-aca-trump-caused/
I am not sure why health stocks are so loved
this is a huge threat to them
to me it is like the gas industry
forced secular decline
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"I am not sure why health stocks are so loved
this is a huge threat to them, "
------------
Big regulation tends to thwart innovation, thwart competition, block new entrants to the market, and benefit the already entrenched players.
The need for healthcare is going up. The money going into Healthcare is going up. The number of choices is going down - except for that great 'public option' coming. Public option probably means giving giant public money going to existing 'market' giants to provide worse and worse service to more and more people. Gotta like that - if you are United Health Group.
More subsidy in the industry means prices go up - for everyone. Econ 101. cf. college tuitions.
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"public option probably means giving giant public money going to existing 'market' giants to provide worse and worse service to more and more people. Gotta like that - if you are United Health Group."
agree that is phase 2
phase 3 eventually will be "medicare for all"
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(https://westernrifleshooters.us/wp-content/uploads/2020/11/8d8e4f54df1cae53.jpeg)
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Would love to be able to post that elsewhere. Is there a URL?
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Would love to be able to post that elsewhere. Is there a URL?
https://gab.com/system/media_attachments/files/059/793/658/original/8d8e4f54df1cae53.jpeg
BTW, Dump FaceHugger and move to Gab.com
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Pelosi who blocked any bill with Republicans will of course now push for massive spending
with billions for favored Democrats
and when Senate balks she and MSM will of course go all out explaining how Repubs are letting people starve and die
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Albert Bourla
CEO of Pfizer
a Greek Jew
with a degree in Veterinary medicine
https://en.wikipedia.org/wiki/Albert_Bourla
they should add democrat to his wikipedia bio
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https://justthenews.com/nearly-50000-doctors-and-scientists-630000-citizens-have-signed-global-anti-lockdown-proclamation
listen to the scientists and doctors - :wink:
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President Donald Trump speaks to the press in the James Brady Press Briefing Room at the White House on Nov. 20.
PHOTO: TASOS KATOPODIS/GETTY IMAGES
Congratulations to drug companies for their tremendous work developing Covid-19 vaccines and therapies in record time. Their reward from the Trump Administration is a new regulation imposing drug price controls, which will make it easier for Joe Biden to go further next year.
The Department of Health and Human Services on Friday finalized a “most-favored nation” rule requiring drug makers to give Medicare the lowest price they charge comparable developed countries. This means the feds will refuse to pay more for medicines than government-run health systems in Europe. Didn’t Mr. Trump campaign against socialism?
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While Medicare pays more for medicines than most countries, Americans also get earlier access to more life-saving treatments. According to the Galen Institute, 96% of new cancer therapies are available in the U.S. compared to 73% in Germany, 66% in France and 54% in Japan. Mr. Trump’s penny-pinching will result in fewer breakthrough treatments.
Most drugs fail in clinical trials, including some 97% of oncology treatments. The rare successes finance research and development into new medicines. It doesn’t take a brain surgeon to understand that drug makers will spend less on new medicines if government cuts their return on investment.
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HHS is rushing out the rule without seeking public comment under its authority to test new payment models to reduce federal spending and improve patient care. Such tests typically are voluntary and involve a small patient or hospital population. The most-favored nation rule will be imposed by fiat nationwide.
A President Biden will no doubt run with Mr. Trump’s legally dubious precedent. Mr. Biden has proposed requiring drug makers to charge even private insurers the same price as Medicare, and his regulators could use Mr. Trump’s same flawed administrative edict to impose it.
Politico reported this week that Mr. Trump pushed HHS to jam through the most-favored nation rule because he is angry that Pfizer didn’t publicly disclose that its Covid-19 vaccine was 95% effective until after the election. “Pfizer and others even decided to not assess the results of their vaccine, in other words, not come out with a vaccine, until just after the election. That’s because of what I did with favored nations and these other elements,” President Trump said Friday, more or less confirming the Politico story. But perhaps Pfizer’s delay was because the data wasn’t available.
The new rule is likely to be blocked in court, but it will tarnish the Administration’s record of accelerating drug approvals, Covid vaccines and therapies. Industry experts expect the next Congress to pass some form of drug price legislation. Maybe it’s good the pandemic hit before politicians could do more damage to pharmaceutical innovation.
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"Politico reported this week that Mr. Trump pushed HHS to jam through the most-favored nation rule because he is angry that Pfizer didn’t publicly disclose that its Covid-19 vaccine was 95% effective until after the election. “Pfizer and others even decided to not assess the results of their vaccine, in other words, not come out with a vaccine, until just after the election. That’s because of what I did with favored nations and these other elements,” President Trump said Friday, more or less confirming the Politico story. But perhaps Pfizer’s delay was because the data wasn’t available."
If true this is no way to run a country.
He did promise lower drug prices but this may stifle innovation
I personally am in favor of stopping the patent expiration shenanigans the Pharma do.
Like buy off generic competitors
find bullshit excuses to extend patents lives
like make a drug slightly different etc.
There are generic drugs that are NOT cheap
not enough competition
there is no question unwritten price fixing
such as with insulins - it is as obvious as that there was clearly fraud in this election (as well in past elections)
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can't post the entire article as I do not subscribe to the political rag Journal of the American Medical Association
but they send me their journals for free
I guess to further force feed me political correct articles
this one seem worse than usual as they name a Supreme Court Justice and of course Trump by name
as threatening birth control the unaffordable care act and the usual LEFTIst propaganda
this came out in Dec 1 issue
other articles in JAMA this week, Dec 8 if loaded with "trust" in healthcare
with mentions of misinformation on social media and of course digs at Trump
It all fits with tony faucet recently telling America that our problem as a country is our freedom and independent spirit
yes , elites would love to control us and tell us how to live
remember when he told us masks do not work?
rights of unborn are NEVER, EVER put forth , never in 35 yrs have a read anything that supports that.
EVER
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October 27, 2020
Health Policy in the Supreme Court and a New Conservative Majority
Lawrence O. Gostin, JD1; Wendy E. Parmet, JD2; Sara Rosenbaum, JD3
Author Affiliations
JAMA. 2020;324(21):2157-2158. doi:10.1001/jama.2020.21987
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Within 8 days of the death of Ruth Bader Ginsburg—a pioneer of women’s rights and a liberal icon—President Trump nominated Judge Amy Coney Barrett to fill her seat. Her elevation to the Supreme Court will have profound consequences for health care and policy.
Justice Barrett opposed the Supreme Court’s 2012 decision upholding the Affordable Care Act (ACA). In California v Texas,1 to be argued on November 10, the Court will decide whether legislation zeroing-out the ACA’s “shared responsibility” tax penalty renders the individual mandate unconstitutional and if so, whether the entire law must be invalidated. If the Court strikes down the law, insurance safeguards will be eliminated, including protection against preexisting condition exclusions. Invalidating the ACA could cause 20 million people to lose subsidized coverage, with the number of uninsured increasing to 50 million people. With the coronavirus disease 2019 (COVID-19) pandemic and rising unemployment, the consequences could not be greater.
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Surprise! A Health Lobby Cage Match
Insurers and providers duke it out, and politicians take credit.
By The Editorial Board
Dec. 30, 2020 6:35 pm
It will take months to digest everything in the Covid relief bill rammed through Congress and signed by President Trump over the weekend. Both parties are hailing an end to “surprise” medical billing, though a word about this cage match between doctors and insurers.
Here’s what we mean by surprise billing: Say you have surgery at a hospital that participates in your insurance network. Unknown to you, the anesthesiologist who puts you under isn’t part of the network. Later this provider bills your insurer for her services, at high prices without a negotiated plan discount. Then the provider sticks you with whatever the insurer refuses to pay. Surprise!
Awful stories abound: a family billed $50,000 for a neonatal intensive care unit stay at a hospital in their insurance network. A 2019 analysis in JAMA Internal Medicine found that 39% of more than 13 million visits to an in-network emergency room between 2010 and 2016 ended in an out-of-network bill, frequently for services like radiology.
Other evidence suggests the practice is concentrated among a small number of hospitals. A subset of physician staffing agencies seems to have figured out it can be lucrative to leave networks and bill patients directly—a nice little arbitrage game on an opaque, third-party payment system. No one with chest pains looks up his doctor network before dialing 911.
Congress has debated intervention that would shield consumers from the damage by limiting them to paying their typical network cost-sharing. As for the rest of the charges, insurers favored a “benchmark” that would reimburse providers at the median rate of in-network services. This is government dictation of what providers can charge. Hospitals and doctors preferred arbitration that would allow a supposedly neutral party to divine the proper price of the service. In other words, both want to club the other with price controls. It’s a pity they couldn’t both lose.
The deal in Congress tries to hold patients harmless for emergency care and some non-emergencies, and erects an arbitration process to settle payment fights. Health-care experts Doug Badger and Brian Blase have pointed out that arbitration, which we support in other contexts, exists for parties who have entered a contract. Here the doctor and insurer have declined to do so. Most distortions in health care derive from price setting in Medicare and Medicaid, and you can expect this political response to surprise billing to cause more surprise complications.
Congress could have penalized insurers who advertise a facility as “in network” if many of the doctors aren’t, or put the onus on hospitals to align the doctors they employ with the insurance networks they join. It would have been better to stop at banning this form of billing patients—and tell hospital systems and insurers to sort out their own problems through the rough and tumble of negotiation.
But both Republicans and Democrats were eager to claim credit for doing something, and the hope is that this will at least help some consumers who were collateral damage in a fight between doctors and insurers. A parting word to the private health industry: Begging government to resolve your internecine wars will make the public more sympathetic to a single-payer system that puts you out of business.
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upersizing ObamaCare Subsidies
The Covid bill hides a major expansion of the Affordable Care Act.
By The Editorial Board
Feb. 24, 2021 6:42 pm ET
We’ve been telling readers about the progressive policy priorities hitching a ride on Congress’s “Covid relief” bill. That includes shoveling billions into the Affordable Care Act, with the goal of making government insurance a middle-class entitlement on the way to Medicare for All.
Provisions of the $1.9 trillion bill moving through the House make Affordable Care Act subsidies more generous and available even to the affluent. Buying an ObamaCare policy makes sense if a subsidy shields you from fearsome premiums and out-of-pocket costs; more than 85% of enrollees receive such a subsidy. But those who earn too much to qualify for government subsidies have been fleeing the exchanges. The Centers for Medicare and Medicaid Servicessaid last fall that unsubsidized enrollment dropped 45% between 2016 and 2019.
Instead of making the underlying product better or less expensive, Democrats now want to pass more of the cost onto taxpayers. More low-income buyers would pay little to nothing for insurance. Democrats would also remove the income cap for receiving subsidies, which is 400% of the poverty line, and reduce a person’s maximum contribution to 8.5% of income from 10%.
The ObamaCare “subsidy cliff” is poor policy that punishes Americans for working and earning more, but now government will spend scarce resources on those who don’t need help. Brian Blase of the Galen Institute has pointed out that a family of four headed by a 60-year-old earning $240,000 could qualify for a nearly $9,000 subsidy. These are not the folks hit hard by the pandemic, many of whom are eligible for Medicaid.
The supersized subsidies would cost $34 billion over two years but that is merely the beginning. The politics are such that the benefit will never be revoked. The more generous subsidies will be captured by insurers, who will continue to raise premiums, and the specter of high costs will push lawmakers to intervene again. Rinse, repeat. Smaller businesses may move their workers onto the exchanges instead of offering their own insurance.
The House bill also offers a temporary five-percentage-point increase in federal funding to states that decide to expand Medicaid to childless, prime-age adults above the poverty line. This has nothing to do with Covid relief.
Texas, Florida and 10 other states declined to expand Medicaid as part of the Affordable Care Act, and that decision looks smart in retrospect. States have spent more money on more enrollees, without improving emergency room visit rates or other health outcomes, while burning a hole in state budgets. State legislators will have to tie themselves to the mast amid interest-group demands to take advantage of “free” money from the feds.
Oh, and would you like to pay more at the counter for your prescription drugs? Democrats have you covered. Here’s how: Drug manufacturers are required to offer steep discounts to Medicaid, and these discounts are capped at 100% of the average manufacturer price of the drug. House Democrats would remove that cap.
Some companies could end up paying state Medicaid programs to take their drugs. The cost of such Medicaid dysfunction is spread across commercial markets, raising drug prices elsewhere, and it is one reason some diabetics pay too much for insulin.
Democrats will talk all of this up as merely helping struggling Americans get health coverage. The true plan is to continue to chip away at private health insurance, creating more market dysfunction that they will later claim to solve with more government insurance.
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Becerra’s confirmation, which all but one Republican opposed, came as expected after Sen. Susan Collins (R-ME), the sole Republican yes-vote, and Sen. Joe Manchin (D-WV), a moderate Democrat, came out in support of the confirmation last week.
https://www.breitbart.com/politics/2021/03/18/senate-confirms-california-attorney-general-xavier-becerra-as-health-secretary-ultrathin-margin/
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https://patriotpost.us/articles/78565-medicare-insolvency-is-only-a-matter-of-time-2021-03-22?mailing_id=5706&utm_medium=email&utm_source=pp.email.5706&utm_campaign=digest&utm_content=body
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feminist liberal USA today and the usual leftist doctors:
1). Florida spring break BAD for corona
2) Illegals coming in by tens or thousands - IGNORE
https://www.yahoo.com/news/potential-exponentially-spread-spring-break-100055598.html
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https://www.yahoo.com/huffpost/fauci-trump-shocked-him-093852117.html
funny
I don't think I heard Fauci speak out against all the BLM protests last summer
strangely silent about that , isn't he?
watching all the protesters was not a "punch to the gut"
and having CNN and other lib outlets and KHarris promoting them was not.a punch to the gut ?
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Yes. He's a smart guy with a strong background in the field but he's also a propagandist and a partisan loaded with bias.
He underestimated the virus. He overestimated it. He told us we didn't need masks, then that we need a double layer after vaccination, and still he makes the most of anyone in government and has people following his every word. Yes he might cringe at some things Trump said, and we cringe on his words, causing schools to close for no good reason, blocking evictions, the enforcement of the most basic contract, shutting down jobs and industries, causing immeasurable damage. Can't criticize CDC or China because we need their cooperation. Now he needs Trump's cooperation to get people to take the vaccine but that's different. Criticizing Trump elevates himself, and ego is science?
Under Fauci, science has become a synonym for bullshit, and mixing truth in with it is the most dangerous type.
Forget masks for the virus at BLM protests, I'd like to know which 'scientist' of the Left spoke out against the air pollution from burning 1600 buildings in our town. The silence is deafening.
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At its current pace, Medicare will go bankrupt in 2026 (the same as last year's projection) and the Social Security Trust Funds for old-aged benefits and disability benefits will become exhausted by 2035.
The Democrats are here so never fear and they are to the rescue:
https://www.wsj.com/articles/democrats-look-at-lowering-medicare-eligibility-age-in-healthcare-package-11617109207
OMFG
could the Dems drive this country into the ground any faster?
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They are going as fast as they can.
At its current pace, Medicare will go bankrupt in 2026 (the same as last year's projection) and the Social Security Trust Funds for old-aged benefits and disability benefits will become exhausted by 2035.
The Democrats are hear so never fear and are to the rescue:
https://www.wsj.com/articles/democrats-look-at-lowering-medicare-eligibility-age-in-healthcare-package-11617109207
OMFG
could the Dems drive this country into the ground any faster?
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https://www.mercatus.org/publications/healthcare/proposed-legislation-increases-openness-and-access-healthcare-maine
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https://washingtontimes-dc.newsmemory.com/?token=f70dc69f9e153a38f5dc80dec6891e87_60b78589_6d25b5f&selDate=20210602
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Texas Provides a Model for Conservative Healthcare Reform
Republicans passed a package of market-friendly laws to expand access and increase competition.
By Bobby Jindal
July 23, 2021 6:02 pm ET
The Supreme Court ruled in 2012 that the federal government couldn’t force states to expand Medicaid as part of the Affordable Care Act. Ever since, Democrats and hospital lobbyists have looked for ways to push state legislators to let able-bodied adults earning up to 138% of the federal poverty level into Medicaid. In the last Covid relief bill, Democrats tried to give states more temporary money to expand Medicaid. Now they are considering legislation to allow Democratic cities in Republican states to expand Medicaid on their own. But Texas Republicans have modeled a better way to get Americans affordable healthcare.
Unfortunately, the Lone Star State is in the minority. Thirty-eight states and the District of Columbia have expanded or approved expansion of their programs. Democrats complain the other 12 states are turning down billions of “free” federal dollars while leaving millions uninsured. As a candidate, Joe Biden proposed creating a government-run plan for low-income people in states that don’t expand Medicaid.
Republicans resisting expansion argue that taxpayers end up paying for “free” federal dollars. State governments receive federal funding for a portion of each dollar they spend on Medicaid, but must provide matching funds from their own coffers. Expansion costs states billions in match requirements.
Conservative Texans who oppose Medicaid expansion point to the explosion in spending in states that have expanded their programs. More than half of Texas doctors said in 2016 they wouldn’t accept all new Medicaid patients due to low reimbursement and increased paperwork.
Medicaid isn’t well run and increasing dependence on government should be avoided. Oregon expanded Medicaid in 2008 using a lottery system, allowing for randomized selection, and a Harvard T.H. Chan School of Public Health study showed no significant improvements in physical health outcomes.
Unfortunately, some GOP states that initially held their ground against Medicaid expansion have surrendered in recent years. As recently as mid-April, Texas seemed poised to relent. Nine Republican state representatives joined Democrats to co-sponsor H.B. 3871, giving Medicaid expansion enough votes to pass the 150-member House, but conservatives acted quickly to present a bipartisan package of bills called Healthy Families, Healthy Texas. In June, Gov. Greg Abbott signed into law this better, more targeted and market-friendly way to help Texans access the care they need.
The Healthy Families, Healthy Texas legislative package includes a law to expand access to telehealth services, on which regulations had been temporarily loosened during the pandemic. Telehealth especially benefits rural and medically underserved areas. The law also increases access to preventive and behavioral healthcare, reduces unnecessary emergency room use, and reduces “no-show” appointment rates.
A second new law makes it easier for doctors to work with patients across state lines and entered Texas into the Interstate Medical Licensure Compact, streamlining the process for physicians to practice in multiple states. Physicians in other compact states can receive expedited licenses to practice in Texas. Increasing the supply of providers will help underserved areas.
A third law extends Medicaid coverage for pregnant women from 60 days after delivery to six months. A biennial state report indicated black women and Medicaid enrollees were more likely to die from pregnancy-related complications and that a majority of such deaths are preventable. A fourth law makes children continuously eligible for Medicaid by reducing the number of midyear reviews from four to one. Many eligible children have been losing coverage and access to primary care because of these reviews, leading to expensive—and preventable—emergency treatments.
A fifth law creates a prescription-drug program allowing a private pharmacy benefit manager to offer rebates to uninsured Texans. A sixth law builds on President Trump’s executive order requiring hospitals to provide price transparency. This is intended to encourage comparison shopping by patients and competition among providers.
A seventh law allows the Texas Mutual Insurance Co. to offer alternative healthcare-coverage products that are technically not insurance. The Texas Mutual was created by the Legislature in 1991 to provide affordable workmen’s compensation insurance, and the law will expand benefits to rural residents, small-business employees, and others. An eighth law allows the nonprofit Texas Farm Bureau, an advocacy group for the state’s agriculture interests, to offer health benefits to its members. Both the Texas Mutual and Farm Bureau plans would be exempt from many state insurance regulations. These plans won’t be the right choice for every Texan, but they will increase competition and offer lower cost options to many.
While liberals moaned about the “free” federal money Texas was missing out on, conservatives found ways to reduce the cost of prescription drugs and health plans, increase access to providers, and improve outcomes for women and children. These new laws may not all work as intended, and Democrats will keep pressing for Medicaid expansion, but the legislative fight in Texas shows Republicans can’t simply avoid the healthcare debate. They can win by offering their own ideas.
Mr. Jindal was governor of Louisiana, 2008-16, and a candidate for the 2016 Republican presidential nomination.
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https://www.westernjournal.com/humiliation-biden-stopped-trumps-insulin-executive-order-now-scrambling-make-things-right/
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https://broadandliberty.com/2021/08/13/john-murawski-medicine-is-getting-major-injections-of-woke-ideology/
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It is in American Journals too
my first thought was the same,
what does this have to do with health care
their are even lectures and classes on how doctors can be warriors for social change.
https://www.breitbart.com/europe/2021/10/11/delingpole-bmj-urges-doctors-to-cut-back-on-treatment-because-climate-change/
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https://www.theepochtimes.com/mkt_breakingnews/biden-administration-hikes-medicare-premiums-blames-drug-costs-and-pandemic_4102350.html?utm_source=newsnoe&utm_medium=email&utm_campaign=breaking-2021-11-13-2&mktids=355ed26e410bb31595f4071c831a6167&est=rUICamt41g0hD4%2BqkJmrpHtqAMaZ66ZP7d3ttroyP3DOqID9Yk8xAQMMnTn2JLk%2BnW8O
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Luckily, everything else is costing more as well!
https://www.theepochtimes.com/mkt_breakingnews/biden-administration-hikes-medicare-premiums-blames-drug-costs-and-pandemic_4102350.html?utm_source=newsnoe&utm_medium=email&utm_campaign=breaking-2021-11-13-2&mktids=355ed26e410bb31595f4071c831a6167&est=rUICamt41g0hD4%2BqkJmrpHtqAMaZ66ZP7d3ttroyP3DOqID9Yk8xAQMMnTn2JLk%2BnW8O
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https://www.washingtontimes.com/news/2021/dec/13/bidens-big-bill-cuts-hospital-funds-poor-red-state/?utm_source=Boomtrain&utm_medium=subscriber&utm_campaign=morning&utm_term=newsletter&utm_content=morning&bt_ee=d5rMZYdtUugJPipkPozkYU056cvahCrvlbRCtIy%2BEDAe5re7RpOBvU84ZL9UYvyq&bt_ts=1639478716016
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Federal Involvement in Health Care Drives Treatment Choices
'Doctors cannot question the federal government. That's how health care works in the United States right now.'
By Beth Brelje December 21, 2021 Updated: December 21, 2021 biggersmaller Print
Around the United States, in numerous cases, hospitalized COVID-19 patients have asked for Ivermectin but were denied the drug, and then sought a court order forcing the hospital to provide the requested medication. Ivermectin, which has been used safely in humans since 1985, has shown promise in treating the virus, especially when taken early. Although it is an off-label use and not guaranteed to work every time, it is legal for doctors to prescribe Ivermectin for COVID-19, and many patients, some desperate and dying, want to give it a try.
Why are so many hospitals opposed to trying safe, inexpensive Ivermectin? The answer is tied to the complicated financial house of cards covering the entire health care system.
This isn’t a story about Ivermectin; it’s about what COVID-19 exposed in America’s health care system. The federal government, pharmaceutical, and insurance companies hold the reins on what care hospital administrators can offer. They never looked at your chart, but have a say in your treatment, and doctors who stray from administrative protocol can kiss their careers goodbye.
Here is a look at the many forces driving health care decisions outside the doctor-patient relationship.
Sick People Are Profitable
Indiana-based Dr. Dan Stock is a family medicine physician connected to America’s Frontline Doctors, a medical freedom organization promoting treatments such as Ivermectin for COVID-19. He says finances guide much of today’s health care landscape.
“Almost no one pays for direct care anymore,” Stock told The Epoch Times. “You pay for your care as you give your money to the federal government through taxes, or to an insurance company through premiums.”
The insurance company or the government buys the service for you as a third party. That’s a problem, Stock says, because “The federal government never has paid its bills. Every doctor and every hospital lose money on every Medicare and Medicaid patient who comes in the door.” And to make up the loss, he says, the cost of health care is inflated for those with private insurance.
A 2017 fact sheet produced by the American Hospital Association said the annual shortfall borne by hospitals is $57.8 billion, and privately insured patients and others make up the difference.
Nonprofit hospitals are federally required to accept Medicare, Medicaid, retired military insurance, Indian Health Services, and all federal insurance programs.
This cost-shifting caused inflation of medical prices and that sparked increases in private health insurance premiums.
“Employers started screaming about it, people started dropping their private insurance because it just wasn’t worth the money anymore, so that’s why the Affordable Care Act got passed,” Stock said. “The idea was, look, market forces won’t make you join in and buy through the third-party payment scheme to keep Medicare and Medicaid afloat. Hospitals are screaming ‘we’re going to go bankrupt.’ So the Affordable Care Act comes out, which says that everybody in the country has to buy insurance, and if you’re an employer, you have to buy it for your employee. You’re not allowed to say no. If you do, we give you a great big tax.”
That kept Medicare and Medicaid funded, stock says.
“But there was a problem with the Affordable Care Act. They have this thing called Medical Loss Ratio,” Stock said. “Somebody talked to these idiots in our federal government into saying hey, if you’re a private insurance company, you have to spend 80-85 percent of the premiums you take in on medical supplies and services. Only 15-20 percent of it can be given to the stockholders or be used to pay administrative fees.”
With this rule, insurance companies are more profitable when patients stay sick.
For example, let’s say the insurance company plans to cover 100 patients with high blood pressure, and it plans to buy a certain blood pressure drug. It estimates the dose these patients will use and negotiates a price with the drug company.
“I’m not going to try and negotiate a low price. I want the price to be high because I’m going to get to keep 20 percent of whatever I buy for them,” Stock said. “The drug company is like, fine, I’ll sell you the high price. Now let’s say two of those 100 patients start eating better food and get rid of their high blood pressure. They don’t need the drug anymore.” The insurance company budgeted to earn based on everyone staying sick. With two people off the drug, the company loses 2 percent of its anticipated profit, in this example.
“The insurance company would have made more money if the population would have stayed sicker and bought more stuff. Let’s take the flip side,” Stock said. “Let’s say 100 percent of those patients see their blood pressure get worse. Now they need to take an additional medication. I’m going to lose money because let’s say 90 percent of the premium I’ve collected has to go buy drugs for high blood pressure patients. Now I’m not going to make as much profit. So, the insurance industry has become a pre-payment scheme for health care services and the way they maximize their income is, don’t buy at low prices, buy at high prices and then force everybody to stay on budget.”
Electronic records, developed around 20 years ago, helped doctors track patient data such as sodium level, blood sugar, and kidney function. About five years later the government realized hospitals and independent doctors were tracking that information but couldn’t share data with each other because of privacy rules associated with the HIPAA Law.
That is why, in 2012, Accountable Care Organizations (ACO) were formed. Doctors and hospitals that join an ACO are now working for one big employer.
Medicare and Medicaid said anybody who is not part of an ACO would have their reimbursement cut by 3 percent. It also offered a 2 percent increase to those who did join an ACO, Stock said.
“You’ve got to know that the margins in medicine are really narrow. Most hospitals have a one or two percent margin,” Stock said.
“The federal government then said, to get that 2 percent and to maintain your reimbursement, there are two other things you have to do,” Stock said.
First, ACOs became obligated to use an electronic medical record system and report data back to the feds and insurance companies.
The data doesn’t drill down to the level of “John Smith has asthma,” but it does tell what percentage of coronary artery disease patients are on a statin drug, or what percent of people with COVID-19 are being treated with respirators.
To enter the information into the computer system, doctors must link a treatment to a diagnosis. They must link a Current Procedural Terminology (CPT code) with an International Classification of Diseases (ICD diagnosis code).
“For instance,” Stock said. “I’m not allowed to just go write somebody a prescription for Losartan. I have to write a prescription for Losartan and link it to a diagnosis, in this case blood pressure, so they can tell what I did.”
If a doctor were to link a treatment like Ivermectin to an off-protocol diagnosis, such as COVID-19, the ACO will be financially punished and the doctor would face consequences, Stock said. To change the diagnosis code to a government acceptable code but use the medicine for something else would be fraud. The prescription must match the diagnosis in the protocol.
Here’s the second thing the government said you had to do to maintain your 2 percent reimbursement: the government and insurance companies came up with a Pay for Performance plan, also known as value-based programs.
“These programs reward health care providers with incentive payments for the quality of care they give to people with Medicare,” the Centers for Medicare and Medicaid Services (CMS) website says. “Our value-based programs are important because they’re helping us move toward paying providers based on the quality, rather than the quantity of care they give patients.”
The CMS website lists “quality improvement organizations” that develop and implement these programs, including the National Quality Forum; the Joint Commission of the Accreditation of Health Care Organizations; the National Committee for Quality Assurance; the Agency for Health Care Research and Quality; the American Medical Association. Some of these groups are led by former insurance, pharmaceutical or CMS executives.
Now the government, advised by insurance and drug companies, defines what good medicine is, Stock says. Doctors must make a diagnosis and provide the protocol code of care.
CMS bases reimbursements on how well health care systems meet these guidelines.
Like a social credit score, individual health care providers are being scored by their performance.
“Every doctor, nurse practitioner, and physical therapist is a cost center for the hospital and the ACO knows exactly how many referrals and how many lab tests they contracted, and they know how much profit individuals are getting from the insurance company,” Stock said. “They’ll come and tell you verbally, they won’t put it down on paper, but administrators will show you exactly how much money the ACO is making on you, how much you’re doing, and if you’re not profitable they’ll get rid you.”
New doctors can come out of college with $350,000 in debt. Older doctors may have kids in college. They sign a contract with a restricted clause that says if the ACO fires them, they must move 10-15 miles away from their practice or from all properties in the ACO.
“You have to stay away for a year, sometimes two years, you’re not allowed to advertise within that exclusionary area, you’re not allowed to tell your patients where you’re going, you’re not allowed to take a copy of your charts with you. For every provider in medicine, our business is our patients’ faith in us and our advice, and now the ACO owns that, which means they own your business capital and they can bankrupt you,” Stock said. “And if they fire you because you’re not profitable, no other ACO wants you because they know you’re not profitable.”
Training the Next Generation
The federal government has a program for new doctors with college debt. Work 10 years at a non-profit ACO and your loans are forgiven. That means 10 years of following the protocols.
“If the doctors aren’t following it, the hospital and the ACO takes a financial hit. An ACO can bankrupt easily because the margins are small and so they control what the doctor can go study,” Stock said. “Now the doctor comes to work every day with a financial gun to his head. ‘If I don’t follow these protocols made by the federal government and the insurance companies, I may end up getting fired, then my family doesn’t make money. I’ve got to go study what the government and insurance company tells me to go study for continuing education. I don’t get to think on my own.’ They’re talking over the entire profession. They have been doing this for 15 years. These doctors are unable to think on their own. Doctors cannot question the federal government. That’s how health care works in the United States right now.”
Beth Brelje
Beth Brelje
REPORTER
Following
Beth Brelje is an investigative journalist covering Pennsylvania politics, courts, and the commonwealth’s most interesting and sometimes hidden news. Send her your story ideas: Beth.brelje@epochtimes.us
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https://www.city-journal.org/mount-sinai-blueprint-for-woke-medicine
how about teaching treat all humans the same
plain and simple
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U.S. Is Open as Canada Shuts Down. The Difference? Their Health Care Systems
U.S. free-market system has more surge capacity than Canada’s
Omicron exposes a trade-off of government-run health care
Hospitals Jammed, But ICUs Less Crowded: Johns Hopkins
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Hospitals Jammed, But ICUs Less Crowded: Johns Hopkins
ByBrian Platt and Kevin Orland
January 6, 2022, 10:30 AM ESTUpdated onJanuary 6, 2022, 12:21 PM EST
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As omicron sweeps through North America, the U.S. and Canadian responses couldn’t be more different. U.S. states are largely open for business, while Canada’s biggest provinces are shutting down.
The difference partly comes down to arithmetic: The U.S. health care system, which prioritizes free markets, provides more hospital beds per capita than the government-dominated Canadian system does.
“I’m not advocating for that American market-driven system,” said Bob Bell, a physician who ran Ontario’s health bureaucracy from 2014 to 2018 and oversaw Toronto’s University Health Network before that. “But I am saying that in Canada, we have restricted hospital capacity excessively.”
The consequences of that are being felt throughout the economy. In Ontario, restaurants, concert halls and gyms are closed while Quebec has a 10 p.m. curfew and banned in-person church services. British Columbia has suspended indoor weddings and funeral receptions.
The limits on hospital capacity include intensive care units. The U.S. has one staffed ICU bed per 4,100 people, based on data from thousands of hospitals reporting to the U.S. Health and Human Services Department. Ontario has one ICU bed for about every 6,000 residents, based on provincial government figures and the latest population estimates.
Covid Crunch
Ontario has the most residents per hospital bed of Canada's provinces
Sources: Canadian Institute for Health Information, Statistics Canada.
Of course, hospital capacity is only one way to measure the success of a health system. Overall, Canadians have better access to health care, live longer than Americans and rarely go bankrupt because of medical bills.
Canada’s mortality rate from Covid-19 is a third of the U.S. rate, a reflection of Canada’s more widespread use of health restrictions and its collectivist approach to health care.
Still, the pandemic has exposed one trade-off that Canada makes with its universal system: Its hospitals are less capable of handling a surge of patients.
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The situation is especially stark in Ontario. Nationally, Canada has less hospital capacity than the U.S. has, as a proportion of the population. But even among Canadian provinces, Ontario fares the worst. It had one intensive-care or acute-care bed for every 800 residents as of April 2019, the latest period for which data is available, according to the Canadian Institute for Health Information. During the same period, the average ratio in the rest of Canada was about one bed for every 570 residents. (The state of New York has about one inpatient hospital bed per 420 residents.)
That leaves the province’s health care system in a precarious position whenever a new wave of Covid-19 arrives.
“The math isn’t on our side,” Ontario Premier Doug Ford said Monday as he announced new school and business closures this week to alleviate pressure on the province’s hospitals. The province has nearly 2,300 people hospitalized with Covid-19.
No Surge Capacity
On Wednesday, after Brampton Civic Hospital in the Toronto suburbs declared an emergency because of a shortage of beds and workers, Brampton’s mayor, Patrick Brown, tweeted: “We need a national conversation on inadequate health care capacity and staffing.”
Ontario Premier Doug Ford Speaks At The Economic Club Of Canada
Ontario Premier Doug FordSource: Bloomberg
The biggest bottleneck in the system is the staffing required by acute care, particularly in the emergency departments and intensive care units, Bell said. The personnel crunch becomes extreme during Covid waves when large numbers of staff are forced to isolate at home because of infection or exposure.
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“We haven’t done an adequate job of developing capacity that will serve the needs of Ontarians,” Bell said. “There’s just no surge capacity available.”
Stephen Archer, head of the medicine department at Queen’s University in Kingston, Ontario, about three hours east of Toronto, spent two decades working in hospitals in Minneapolis and Chicago. He said he believes strongly that the Canadian system is better and provides more equitable care.
Still, he called it “embarrassing” to see Toronto’s hospitals having to transfer virus patients to smaller hospitals around the province, as happened last year. The Kingston Health Sciences Center, where he works, took in more than 100 Covid patients from Toronto earlier in the pandemic, which was no surprise, Archer said, because Ontario’s hospitals get overwhelmed even by a busy flu season.
“I think a very fair criticism of the Canadian system and the Ontario system is we try to run our hospitals too close to capacity,” he said. “We couldn’t handle mild seasonal diseases like influenza, and therefore we were poorly positioned to handle Covid-19.”
Diverging Outcomes
The U.S. death rate from Covid-19 is three times Canada's
Source: Johns Hopkins University
Beyond hospital capacity, Archer and Bell cited other reasons for the disparity in the way that the U.S. and Canada respond to new outbreaks. Canadians put more trust in their government to act for the larger collective good, and they won’t tolerate the level of death and severe disease that America has endured from Covid, they said.
David Naylor, a physician and former University of Toronto president who led a federal review into Canada’s response to the 2003 SARS epidemic, said hospital capacity probably plays a bigger role in Canadian decision-making than in the U.S. because Canada’s universal system means “the welfare of the entire population is affected if health care capacity is destabilized.”
But he also argued that focusing only on hospital capacity could be misleading. “Both Canada and the U.S. have lower capacity than many European countries,” he wrote by email.
The major difference between the two countries’ responses to Covid outbreaks is cultural, Naylor argues. In Canada, more than the U.S., policy is guided by a “collectivist ethos” that tolerates prolonged shutdowns and other public health restrictions to keep hospitals from collapsing.
“America’s outcomes are almost inexplicable given the scientific and medical firepower of the USA,” Naylor said. “With regret, I’d have to say that America’s radical under-performance in protecting its citizens from viral disease and death is a symptom of a deeper-seated political malaise in their federation.”
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https://patriotpost.us/articles/87167-unhappy-birthday-obamacare-turns-12-2022-03-24?mailing_id=6554&utm_medium=email&utm_source=pp.email.6554&utm_campaign=digest&utm_content=body
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https://www.breitbart.com/politics/2022/04/28/american-academy-of-pediatrics-guide-teaches-kids-girl-erections/
this org used to be one of the few sane ones left...
I don't know how 7% of the population is able to FORCE their agenda on the rest of us
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https://www.city-journal.org/the-corruption-of-medicine
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near impossible to read a journal without there being something about racism or something woke
recent JAMA had Harvard lawyer authored article about the burden placed on doctors about the Roe/wade decision
as always IT IS NEVER ABOUT THE RIGHTS OF THE UNBORN.
if interested (I only glanced over it ):
https://www.cnn.com/2022/08/03/politics/kansas-abortion-midterm-election-what-matters/index.html
Political Bottom line (in a round about way)
Republicans bad
Democrats good
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And virtually nothing about making sick well, making successful remedies more available and affordable to more people, nothing about lowering the ratio of bureaucracy to care. But racial injustice, omg...
Time to break the AMA monopoly.
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https://www.newsmax.com/newsfront/republicans-senate-insulin/2022/08/07/id/1082103/
along with endless mass media
megaphoning this 24/7 !
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Inflation Reduction Act breaks prescription-drug pipeline
Price controls are a massive risk for little-to-no reward
By Dr. Tom Price
The pharmaceutical-innovation pipeline, which recently delivered the life-saving COVID-19 vaccines in record time, may be irrevocably broken.
The so-called Inflation Reduction Act, which was passed by the U.S. House of Representatives on Friday, allows the government for the first time to enact price controls on some prescription drugs in Medicare. Artificially lowering prescription drug prices by government fiat will reduce the revenues needed to fund the next generation of cures.
The dynamic U.S. prescription drug industry has helped Americans live longer and healthier lives. New medications are responsible for around half the increase in U.S. life expectancy over the past 30 years.
The IRA’s price controls threaten this progress. They effectively transfer nearly $300 billion from the productive pharmaceutical industry to the unproductive green energy complex. This wealth transfer will meaningfully reduce the nearly $100 billion, or about 28% of revenues, drugmakers spend yearly on research and development.
The nonpartisan Congressional Budget Offi ce projects this bill will result in 15 fewer medications arriving on the market. But this is almost certainly an underestimate. “I would be shocked if the impact of this bill doesn’t result in 15 fewer medicines from Eli Lilly and Company alone,” said Eli Lilly CEO David Ricks. “Right now, 40% of our portfolio are small molecules. We’ll need to reevaluate every single one of those projects for viability.”
According to one consulting firm, the 12 drug companies responsible for the 20 medications likely to be subject to price controls will lose more than $80 billion of revenues as a result of this legislation.
Price controls, no matter the industry — from energy to real estate to prescription drugs, scare away needed investments and ultimately hurt consumers. Capital is flighty and demands a return on investment.
The kicker here is that price controls are a solution in search of a problem. For all the talk of “skyrocketing” drug prices, costs have actually fallen over the last few years when drug rebates and other concessions are considered. Yet patients often don’t see these price declines at the pharmacy counter because rebates are diverted by distortionary prescription drug middlemen known as pharmacy benefit managers.
As I explained recently in The Wall Street Journal, one of the best indications of medication price deflation is the low costs at the new Cost Plus Drug Company, which obviates inflationary drug-supply-chain middlemen such as pharmacy-benefit managers.
A better way to make medications more affordable while protecting the innovation pipeline is by reforming this rebate system to direct rebate savings straight to patients. A Health and Human Services rule finalized in November of 2020 did exactly this. But in an added insult to patients, the IRA effectively scraps this rule so it can redirect the savings meant for patients to pay for climate activism. Finally, it’s not at all clear that price controls will save patients or the health care system money. To the extent medications keep patients out of expensive hospitals, they reduce rather than grow health expenditures. Medicines only account for 12% of U.S. health care spending, but they save the system far more in reduced hospitalizations.
Consider, for instance, how the recent hepatitis C cure has prevented thousands of enormously expensive liver transplants.
Or how COVID-19 vaccines prevented hundreds of thousands of extended hospitalizations. Fewer new medications, as projected by the CBO and numerous independent scholars, therefore likely mean higher costs over the long term. Drug companies will also try to recoup price controlinduced losses in Medicare by raising their prices in the commercial market. They will likely follow the same playbook as hospitals, which overcharge commercial patients to make up for artificially low Medicare prices.
Prescription drug price controls are a massive risk for little-to-no reward. They will result in fewer cures and treatments for rare diseases you’ve never heard of.
They will set back progress in the fight against Alzheimer’s, Parkinson’s and cancer. And they will slow vaccine development when the next pandemic comes.
Tom Price, a former secretary of Health and Human Services and a former member of Congress, is a senior health care policy fellow at the Job Creators Network
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Dr Price
who was a failed HHS secretary
and did nothing to reverse Obamster care
I disagree
I do think Medicare should negotiate prices down
and I do think pharma takes advantage of prices
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Remember how Trump wanted to cap insulin prices which are totally outrageous
then Biden comes in day one or two and reverses :
https://www.policymed.com/2021/10/biden-administration-rescinds-trump-administration-insulin-pricing-rule.html
NO MEDIA mention how Biden took this away
NOW THE BULLSHIT ARTIST DEMS AND THEIR ACCOMPLICES IN THE MEDIA
are tooting around they are EXPANDING HEALTH CARE BY REDUCING INSULIN PRICES
nothing political here
all the while pharm and WS backing of pharm is spreading their money around screaming how
these restrictions will restrict drug development and we will all die and NO innovation and the same bullshit every time this comes up.
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https://www.spectator.co.uk/article/why-is-canada-euthanising-the-poor-
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A young 30s man reported to us yesterday about his health checkup and minute with the doctor. Not much about health issues but definitely wanted to know his pronouns.
In a simpler world of old, a doc who has seen the patient's penis already knows (his) pronouns.
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"A young 30s man reported to us yesterday about his health checkup and minute with the doctor. Not much about health issues but definitely wanted to know his pronouns."
I both laugh and cry at this.
I send people messages about their lab results
and I have always called them Mr. or Ms. (so I don't offend the women with Mrs. or Miss)
now when I do this I have to think twice and worry would Mr or Ms offend this person
totally annoying and just stupid nonsense
yet we have this construct on every chart
asking patient which pronoun do you want to be called
I am still waiting for building or ship or human being or cat etc.....
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https://www.spectator.co.uk/article/why-is-canada-euthanising-the-poor-
https://www.foxnews.com/world/canadian-soldier-suffering-ptsd-offered-euthanasia-veterans-affairs
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https://www.spectator.co.uk/article/why-is-canada-euthanising-the-poor-
https://www.foxnews.com/world/canadian-soldier-suffering-ptsd-offered-euthanasia-veterans-affairs
https://www.dailymail.co.uk/news/article-9374291/Scandal-500-care-home-patients-given-DNR-orders-without-consent.html
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https://www.politico.com/news/2022/08/28/hackers-have-laid-siege-to-u-s-health-care-and-a-tiny-hhs-agency-is-buckling-under-the-pressure-00053941
the criminals run wild
while ordinary citizens get little protection .
what else is new
:roll:
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https://www.spectator.co.uk/article/why-is-canada-euthanising-the-poor-
https://www.foxnews.com/world/canadian-soldier-suffering-ptsd-offered-euthanasia-veterans-affairs
https://www.dailymail.co.uk/news/article-9374291/Scandal-500-care-home-patients-given-DNR-orders-without-consent.html
https://www.cbc.ca/news/canada/manitoba/medically-assisted-death-could-save-millions-1.3947481
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increased monitoring period from 42 to 60 days:
https://nypost.com/2022/09/12/it-seems-clear-dems-pressured-the-fda-to-delay-the-covid-vaccine-to-hurt-trump/
Same people who stated they would not take the vaccine before the election pushed it after the election .
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https://www.youtube.com/watch?v=-dAjCeMuXR0
increased monitoring period from 42 to 60 days:
https://nypost.com/2022/09/12/it-seems-clear-dems-pressured-the-fda-to-delay-the-covid-vaccine-to-hurt-trump/
Same people who stated they would not take the vaccine before the election pushed it after the election .
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The Inflation Reduction Act has eight provisions intended to reduce future drug prices. Some observers were surely pleased that Congress gave the Centers for Medicare and Medicaid Services new powers to negotiate with pharmaceutical companies. They shouldn’t have been. The Inflation Reduction Act won’t noticeably reduce inflation and it will do little or nothing to lower the cost of healthcare. Forcing drug companies to charge lower prices will likely lead to fewer new drugs.
Virtually no products are more valuable than the modern medicines produced by the biopharmaceutical industry. They cure diseases and extend lives. We’ve all heard that Americans pay higher drug prices than people in other countries. That’s true, but only when comparing retail prices of brand-name drugs. Very few Americans pay retail prices; most pay a fraction—a copay dictated by their insurance plan. Most country-to-country comparisons also leave out generics. Nine of 10 prescriptions in the U.S. are filled with generic drugs priced lower than in most other countries.
In many countries, the government is the sole purchaser of pharmaceuticals. For a new drug to be used, the government must buy and distribute it. If the government declines, the drug won’t be available. These governments negotiate with a take-it-or-leave-it attitude. Drug companies often take it, because once research and development costs are covered, some money is better than no money.
Except in rare cases, pharmaceutical companies develop drugs for the U.S. market. For drugs that make it in America, potential sales in Europe, Japan, Canada, China and elsewhere are gravy. Drugs that can’t make it in the U.S. are scuttled. Probable success in America is a necessary and sufficient condition for the development of new drugs. There are four main reasons for this:
First, the U.S. is a relatively large country. Second, the U.S. is a wealthy country; Americans are 46% richer than the British, 59% richer than the French, and 36% richer than the Germans as measured by per capita gross domestic product. Third, negotiating prices with government bureaucrats takes time, resulting in one to two years of lost sales. Fourth, prices in the U.S. are somewhat more influenced by market forces and, until the Inflation Reduction Act, weren’t determined by negotiations with the government.
Where CMS is concerned, “negotiations” is a “Godfather”-esque euphemism. If a drug company doesn’t accept the CMS price, it will be taxed up to 95% on its Medicare sales revenue for that drug. This penalty is so severe, Eli Lilly CEO David Ricks reports that his company treats the prospect of negotiations as a potential loss of patent protection for some products.
Drug research and development involves enormous fixed costs. As of 2013, the cost per new drug approved by the Food and Drug Administration was $2.9 billion. Historically, these fixed costs have doubled in real terms every nine years. So in 2022, the inflation-adjusted fixed cost per approved drug is close to $7 billion.
That huge cost must be spread out over a small fraction of the world’s population during a limited period of marketing exclusivity. Without wealthy American consumers and insurers who pay retail or close to it for brand-name drugs, some drugs won’t be developed at all. While it’s true that foreign governments mostly free-ride on the enormous investments in R&D made by the U.S., it’s also true that somebody has to pay. If nobody pays, many treatments that would improve and extend people’s lives won’t exist.
Research by Columbia University economist Frank Lichtenberg suggests that 73% of the increase in life expectancy that high-income countries experienced between 2006 and 2016 was due solely to the adoption of modern drugs. He also found that the pharmaceutical expenditure per life-year saved was $13,904 across 26 high-income countries and $35,817 in the U.S. Most Americans would pay $36,000 to live an extra year.
Even though the U.S. shoulders the lion’s share of global pharmaceutical R&D costs, Americans get a great deal. New drugs are a fantastic investment for humanity, and Americans benefit as much as everyone else. Whether to accept that deal and get a good outcome or reject the deal and get a worse outcome should be an easy decision. Before Congress attacks drug prices again, it should account for the tremendous value of the products that originate from this amazing yet maligned industry and consider the possibility that the U.S. will be shooting itself in the foot if it tries to imitate more-restrictive governments.
Mr. Hooper is president of Objective Insights, a life-science consultancy, and author of “Should the FDA Reject Itself?” Mr. Henderson is a research fellow with Stanford University’s Hoover Institution and was senior health economist with President Reagan’s Council of Economic Advisers.
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second
Biden’s Cancer ‘Moonshot’ Contradiction
His new price controls might have killed Amgen’s breakthrough drug for lung cancer
By The Editorial Board
Sept. 14, 2022 6:33 pm ET
President Biden this week gave a speech promoting his Cancer Moonshot initiative and a new government health agency that he says will drive treatment breakthroughs. As usual, he gave no credit to drug makers that are producing game-changing treatments such as Amgen’s Lumakras for lung cancer.
Lung cancer kills more Americans than any other cancer. The five-year survival rate is a mere 18.6% and 5% for advanced forms. Treatments targeting particular protein or gene mutations have improved survival odds for breast, melanoma and some other cancers. But cancers driven by a mutation in the KRAS gene have eluded these breakthroughs, and lung cancer is one of them.
The KRAS gene regulates cell growth and division, and mutations are found in many tumors, including 32% of lung and 90% of pancreatic cancers. Yet the KRAS protein has long been considered “undruggable” because its small size and smooth surface are difficult for drug molecules to block. Amgen’s Lumakras pill proves it can be done.
The Food and Drug Administration last May approved Lumakras under its accelerated approval pathway for patients with advanced non-small lung cancer bearing a particular KRAS gene mutation. Results from early trials showed promise and this week were borne out by a late-stage trial that showed more than twice as many patients responded to the drug than they did to chemotherapy.
A quarter of patients receiving Lumakras lived at least a year without their cancer getting worse compared to 10% who received chemotherapy. Survival benefits were hard to assess since a third of the chemotherapy patients received Lumakras after their disease progressed. Amgen also announced results from a separate small trial this week showing Lumakras may help patients with metastatic colorectal cancer.
The drug is by no means a cure, but progress occurs at the margin and some patients who had what amounted to a death sentence now have hope to live. Lumakras is also much less brutal than chemotherapy.
Yet the drug might not have been developed had the Medicare take-it-or-leave-it negotiations that Democrats recently enacted been in effect earlier. Their price controls will penalize in particular small-molecule drugs like Lumakras that have the potential to help large numbers of patients. Within six years, Lumakras could be targeted by bureaucrats for price controls and the payoff on Amgen’s investment could vanish.
Mr. Biden’s price-control policy contradicts his desire to promote faster cancer cures. The damage will come in slower therapies and patients who might have been saved
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and content :
***Firearms and Violence Theme Issue
Editorial: The Unrelenting Epidemic of Firearm Violence
Viewpoint: The Epidemiology of Firearm Injuries in the US: The Need for Comprehensive, Real-time, Actionable Data
Video: Firearms and Violence***
https://www.google.com/search?rlz=1C5GCEM_enUS1001US1001&source=univ&tbm=isch&q=latest+JAMA+cover&fir=tQtd6H0NmSANzM%252CgNrLWyn--DCbTM%252C_%253BuB52sni6hocxkM%252CduImVRs6-PeyeM%252C_%253BFDHOu3IkwvVrWM%252CduImVRs6-PeyeM%252C_%253Bi4l3_iCT94QqYM%252C1qfK-q_3xeR3TM%252C_%253BhsbFekwvGH0W7M%252C1qfK-q_3xeR3TM%252C_%253BdcC6EzJn7jsSjM%252CpdYZgh6WLSGO4M%252C_%253B_lidx8TVNn-QNM%252CnMBtjOuC5N__EM%252C_%253B6yQQs7_iNc5wuM%252CiMnS-jkakrLwmM%252C_%253BP3qfDK0nMyE_cM%252CiMnS-jkakrLwmM%252C_%253Bk0RLskfgB1eZQM%252CeGjGn7XG1kTcdM%252C_&usg=AI4_-kTnOm3B5DrTbn376_KDGEVmoJcN2A&sa=X&ved=2ahUKEwiVmM7Rxrf6AhWxGlkFHUmNAIMQjJkEegQIBBAC&biw=1440&bih=789&dpr=2#imgrc=k0RLskfgB1eZQM
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I don't subscribe - they send to me free. I am not a member or I would quit immediately.
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Did they mention deaths from fentanyl coming across the open southern border up 70% * ?
*. 70% is the increase in Colorado in one year. Here is a 40%increase in North Carolina:
https://www.ncdhhs.gov/news/press-releases/2022/03/21/north-carolina-reports-40-increase-overdose-deaths-2020-compared-2019-ncdhhs-continues-fight-against
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overdose deaths are seven times higher than they were in 1999.
https://www.realclearinvestigations.com/articles/2022/09/28/opioids__work_hidden_scourge_sapping_the_economy_855616.html
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More than 1o0,000 young Americans died from drug overdoses last year, more than have ever been killed by terrorists, with almost 70 percent of the American dead coming from fentanyl, that cheap, deadly synthetic opioid shipped from smiling China, spruced up by the drug lords of Mexico, and delivered as poison across Biden’s wide-open border to kill American young people of all races and creeds, of all backgrounds.
Yet for the next several days, the nation’s eyes won’t be on the open air drug markets of San Francisco, the Southern border where the fentanyl and millions of illegal immigrants cross almost at will.
https://johnkassnews.com/political-lies-on-the-wide-open-southern-border-cant-cover-deadly-poisoning-of-americas-young/
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".Did they mention deaths from fentanyl coming across the open southern border up 70% * ?"
excellent point!
I have never seen the academics take a political side like they have been the past few yrs, but when they do it is ALWAYS from the point of view of Democrats - always .
never pro life
always on side of rationing care
now all racial
wokism
and recently taking up anti sec amendment agenda
I am sick of it but this is academia today
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I just tried to link to the link in my 9/28 post
and it was an image of the Journal of the American Medical Association
with an image of a 45 caliber handgun
It seems image no longer available on the Web
though I have the journal in my bathroom where I read them .
funny - did they flack back and take down the image ?
In any case
check out the whole issue set up by the libs :
https://jamanetwork.com/collections/5650/firearms
5 in September 27,2022 and some previous ones just prior
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From last months Cleveland Clinic Journal:
https://www.ccjm.org/content/89/9/501
Another journal I get for free
:x
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From last months Cleveland Clinic Journal:
https://www.ccjm.org/content/89/9/501
Another journal I get for free
:x
Know the difference between black drug dealers and white prison gang members in jails/prisons?
Most white prison gang members haven't killed a black person.
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I cannot read that article without being totally insulted
why is it ok for Black people to insult me?
no I don't agree it was Reagan's fault blacks were killing each other with drugs in the 80s.
what bull
and to use Jay Z as some sort of example is a joke
the guy has more money than nearly everyone in the country
boy is this nation racist or what?
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https://www.spectator.co.uk/article/why-is-canada-euthanising-the-poor-
https://www.foxnews.com/world/canadian-soldier-suffering-ptsd-offered-euthanasia-veterans-affairs
https://www.dailymail.co.uk/news/article-9374291/Scandal-500-care-home-patients-given-DNR-orders-without-consent.html
https://www.cbc.ca/news/canada/manitoba/medically-assisted-death-could-save-millions-1.3947481
https://twitter.com/TPostMillennial/status/1582708189979721728
What a slippery slope!
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https://www.spectator.co.uk/article/why-is-canada-euthanising-the-poor-
https://www.foxnews.com/world/canadian-soldier-suffering-ptsd-offered-euthanasia-veterans-affairs
https://www.dailymail.co.uk/news/article-9374291/Scandal-500-care-home-patients-given-DNR-orders-without-consent.html
https://www.cbc.ca/news/canada/manitoba/medically-assisted-death-could-save-millions-1.3947481
https://twitter.com/TPostMillennial/status/1582708189979721728
What a slippery slope!
https://media.gab.com/cdn-cgi/image/width=1050,quality=100,fit=scale-down/system/media_attachments/files/118/396/661/original/249da7ad50ba35b1.jpg
(https://media.gab.com/cdn-cgi/image/width=1050,quality=100,fit=scale-down/system/media_attachments/files/118/396/661/original/249da7ad50ba35b1.jpg)
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more training for doctors on opioid prescribing $
treatment
blah blah blah
endless going after doctors
spending more money
FOR GOD'S SAKES JUST CLOSE THE DARN BORDER
STOP THE CCP FROM SENDING AS FENTANYL
STOP THE MEXICAN CARTELS - DECLARE WAR ON THEM
WHAT THE HELL IS SO HARD ABOUT THIS
https://www.thecentersquare.com/new_jersey/new-jersey-lawmakers-opioid-bill-targets-education-training/article_572d89d0-489e-11ed-a9a1-03b69fa98cf7.html
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Amen!
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Strange New Organ Transplant Methods Raise Urgent Questions
New techniques use organs from partially resuscitated people and look toward genetically modified pigs
FEATUREDBIOTECHNOLOGY
Martha Rosenberg
Martha Rosenberg
Nov 12 2022
If you or a loved one has needed an organ transplant, you know the problem firsthand: There are not enough organs for those who need them and there is a long waiting period.
That desperate need, and potential profits, have fueled a Frankenstein-like effort to find or create organs to give recipients a longer lease on life.
The need for organs can be a matter of life or death. In the United States, more than 105,000 people sit on the national waiting list, and every nine minutes, a new name is added. Seventeen people die every day while waiting for an organ transplant in the United States, according to the government’s organ donor website.
The most common transplant operations are for hearts, kidneys, livers, pancreases, lungs, bone and bone marrow, skin, and intestines; some such transplants come from living donors, but most are obtained after a donor is deceased.
Different organs remain viable for different amounts of time after the patient has died, or after the organ has been taken from the deceased.
According to Donor Alliance, the liver can remain viable for transplant for up to 12 hours, and kidneys for up to 36 hours. But for other organs, such as the heart or lungs, that window is much shorter, in the range of 4 to 6 hours.
With so few organs available for so many in need, there’s tremendous pressure on scientists and industry to push the boundaries of medical ethics with products and procedures that can sound like mad science.
These vanguard developments raise fundamental questions about human life, the commodification of the human body, and the very definition of “human.”
Let’s put aside the obvious horrors of forced organ harvesting from prisoners of conscience in China, including Tibetans, Uyghurs, and, most notably, Falun Gong practitioners, “the primary victims of this cruel practice,” according to the U.S. Human Rights Commission.
Everyone can agree that this practice is abhorrent, but there are other new practices that raise more complex questions, including a new practice that some fear is being used to curb the dead donor rule.
That rule requires that a patient be dead, and often for several minutes, before their organs are taken. This ensures organs only come from the deceased.
Reviving the Dead—Partially
Doctors are using a relatively new procedure called NRP-cDCD (“normothermic regional perfusion with controlled donation after circulatory death”) to widen the window on organ transplants and make more organs available.
In this procedure, terminal patients are allowed to die and then be partially resurrected. Their blood is circulated with the help of machines that warm it, but the arteries that feed the brain are clamped off and starved.
Writing in the journal Cureus in 2022, pro-NRP researchers say that the method “is an emerging technology, a cost-effective alternative in donation after circulatory death (DCD), and will increase the pool of donors in heart transplantation.”
Among other advantages, NRP “restores heart function” and allows “continuous warm blood perfusion,” the researchers write.
Until now, transplant surgeons wouldn’t remove the organs of patients who are not brain dead, even if they couldn’t survive without life support. The procedure raises questions about what can be done with the body after death and how “death” itself is defined. Other procedures challenge the definition of the human body.
Transplants from Genetically Modified Animals
Scientists are in a race to develop genetically humanized animals for their organs. For example, scientists are currently trying to grow human organs in genetically altered pigs and other animals, and in 2017, the creation of what’s claimed to be the first part-human, part-pig hybrid was announced.
Xenotransplantation—using animal organ donors—is far from new. The first pig-to-human corneal transplant, for example, was performed in 1838, according to the journal EMBO Reports, but xenotransplantation was beset with failures until recently.
With the advent of CRISPR gene editing (clustered, regularly interspaced, short palindromic repeats) and stem cell science, an otherworldly new form of “chimeric” animals boasting human organs has made xenotransplantation viable.
Doctors had all but given up on such procedures after too many experiences like Dr. Keith Reemtsma’s in the 1960s. Reemtsma, a transplant surgeon at Tulane University, inserted rhesus monkey and chimpanzee kidneys into humans, but the transplants all failed.
“An infant known as Baby Fae received a baboon heart at the Loma Linda University Medical Center in California in 1984 but died of rejection 21 days later,” wrote Dr. Joshua Mezrich, a transplant surgeon writing in The Wall Street Journal.
After more mishaps, transplant doctors stopped work with animal organs altogether, Mezrich wrote, and “only implantation of inert tissue from animals, such as heart valves, continued.”
A major risk with transplantation is the human immune system attacking and rejecting the newly transplanted organ as foreign.
According to the government health site MedlinePlus, “all [organ] recipients have some amount of acute rejection,” and if anti-rejection medicines are not used—risky unto themselves—”the body will almost always launch an immune response and destroy the foreign tissue.”
When transplants come from pigs—a preferred animal donor over primates because of size, breeding time, and public acceptance of their use—their intrinsic protein, alpha-gal, leads to rapid human rejection.
In 2020, the FDA approved a pig without alpha-gal, the first intentional genomic alteration. Some researchers and medical scientists want to use pigs that are genetically altered to prevent rejection of their organs in humans.
Issues With Transplantation Research
As the human body becomes more manipulatable by surgeons and scientists, the extent to which transplant research requires “living” human bodies also increases. This can complicate the mourning process for family members or play on the emotions of the organ recipients themselves.
In one example, earlier this year, scientists at NYU Langone Health in New York City announced the plan to study pig kidney behavior in brain-dead individuals for two to four weeks.
After a pig heart was transplanted into Alva Capuano, who was brain dead, as part of a study at Langone medical center, her husband, Richard Capuano, told The Wall Street Journal that the decision “was monumentally hard on the entire family.”
“Even though we realized she had already died and wasn’t coming back, there is still a respirator on and there is still a heartbeat. Psychologically it plays a game with you,” he said.
Many remember the recent saga of 57-year-old David Bennett, the first human recipient of a pig heart, who died weeks after his transplant, apparently from porcine cytomegalovirus (though human herpesvirus 6, which may cross-react with cytomegalovirus, was also found in Bennett).
According to a study published in The New England Journal of Medicine, the pigs used in recent failed human heart transplants at Langone, were significantly altered.
“The genetic modifications of the donor pig (including its heart) fell into two categories: those that inactivated pig genes and those that introduced human genes. In total, 10 different modifications were introduced, most to prevent graft rejection by the human immune system,” noted the journal.
The pig heart recipient, Bennett, had a criminal history and was denied a human heart because he was known to not follow medical guidance, raising other transplantation questions.
Scientific and Ethical Experts Weigh In
While many applaud scientific breakthroughs that allow more organs for human transplants (and these developments can certainly be lucrative), others question the direction in which we are going. In a 2021 statement, the American College of Physicians (ACP) raised serious concerns about NRP-cDCD.
The procedure, it said “is more accurately described as organ retrieval after cardiopulmonary arrest and the induction of brain death. It raises significant ethical concerns and questions regarding the dead donor rule, fundamental ethical obligations of respect, beneficence, and justice, and the imperative to never use one individual merely as a means to serve the ends of another, no matter how noble or good those ends may be.”
ACP is the largest medical-specialty society in the world, with 160,000 members internationally.
‘Humanized’ Animals
In a 2018 paper in the journal Embo Reports, authors worry that human stem cells transplanted into genetically altered pig embryos “will migrate to the animal’s brain and alter its behavior or cognitive state.” While such a brain presence could propel Alzheimer’s and Parkinson’s disease research, “there is no consensus on accurately assessing what it means to possess a human-like cognitive state,” wrote the researchers.
“Should personhood be defined as the percent of human brain cells expressed in a human-animal chimera…?” ask the researchers.
The U.S. National Institutes of Health has refused to support the transplantation of human-animal chimeras for this reason.
Moreover, could the advanced genetic technology we have today be used on “healthy human embryos to create designer babies for behavioral or cosmetic enhancements?” they asked.
Nita Farahany, a professor of law and philosophy at Duke Law School, agrees about the slippery slope that genetic engineering allows, she said in a recent interview with The Wall Street Journal. Scientists still don’t have a grasp on how insertion of human genes through gene editing affects animals’ cognitive capabilities, so “you’re starting to blur the line essentially between humans and non-human animals,” she says.
Disease Transmission
Research in the magazine Philosophy Now raises another ethical question: The possibility of disease transmission and future pandemics occasioned by transplantation.
“Diseases like HIV, Ebola, Hepatitis B, and, most recently, bird flu, originated in animals,” wrote co-author Laura Purdy in the magazine. “Pigs, where current xeno research is now focused, are thought to have been the vector of the devastating 1918 influenza epidemic.”
Known and unknown viruses are embedded in pigs’ DNA as they are in all mammals, says Purdy, and “currently harmless organisms, like the E. coli that lives in our guts, could pick up new, possibly harmful traits from the micro-organisms that came along for the ride on pig organs.”
Whether extreme NRP-cDCD surgery or the creation of pig-human chimeras, the race to harvest new organs has a dark side, according to experts.
“In some ways, the legal determination of death and medical practice are starting to diverge in ways that raise complex ethical and legal challenges we will increasingly face as a society,” Farahany of Duke University told The Epoch Times.
Beyond the moral issues of giving further intelligence to genetically modified pigs, or the health issues of inserting animal organs into people, there are fundamental questions about how we are commodifying the body and what it will mean for the sanctity of the body for future generations.
In a time when people can be fired or censured for not getting injected with a relatively new and unverified mRNA vaccine, which some describe as a gene therapy, these questions take on particular urgency.
And given that many of these organ failures are driven by preventable lifestyle factors, such as stress, diet, and a lack of natural movement, one has to wonder if we are putting scientific and commercial interests ahead of the human beings they are supposed to serve.
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It seems to me medical ethics used to put some kind of limits on what modern medicine could and should do in the manipulation of God's creation.
Now if you oppose genital removal of a minor you are a transphobe and if you oppose chopping the head off a fully developed fetus in the womb, you are a threat to 'women's rights'.
I don't claim to know where the limits should be but there ought to be some kind of limits on what we do with science and 'medicine' as our capabilities keep expanding.
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Drug Prices Reach New High—in the Millions
Several new drugs, most of them gene therapies, promise to cure or treat diseases in one course, but their price tags will test the health-insurance system
The most recent gene therapy approved in the U.S. set a price record: $3.5 million for CSL’s Hemgenix, a treatment for hemophilia B.
PHOTO: DARRIAN TRAYNOR/GETTY IMAGES
By Peter Loftus
Dec. 26, 2022 8:00 am ET
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A new era of expensive drugs has arrived: medicines priced in the millions of dollars a patient.
Since August, U.S. or European health regulators have approved four new products intended as one-time treatments for rare genetic diseases that carry list prices of at least $2 million a patient, including two from Bluebird Bio Inc.
The most recent one approved in the U.S. set a price record: $3.5 million for CSL Ltd.’s Hemgenix, a treatment for the blood disorder hemophilia B.
The price tags mark a new high for medicines, which drugmakers were once reluctant to charge more than six figures for but whose prices have been heading upward. The companies say the cost reflects the drugs’ potential to help patients in a single dose, but paying for it could challenge patients and health insurers.
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“It’s an innovation freight train headed toward an inflexible insurance wall,” said Steven Pearson, president of the Institute for Clinical and Economic Review, a nonprofit drug-pricing watchdog group. “The payers are not in a position to say no because there will be no other alternatives” for patients, he added.
Most of the multimillion-dollar treatments are gene therapies, a groundbreaking type of treatment that involves injecting a functional gene into a person to correct a faulty, disease-causing one.
Bluebird’s Skysona gene therapy for a rare neurological disease affecting children costs $3 million, while its Zynteglo for an inherited blood disorder is priced at $2.8 million.
Novartis AG’s Zolgensma gene therapy treating a muscle-wasting condition costs $2.1 million.
Drugmakers say gene therapies can make a difference to patients with rare genetic diseases, by either curing them or providing yearslong benefits through delivering a correct copy of a faulty gene, though there have been some safety concerns over the class.
Some of the new therapies could produce long-term savings, the companies say, by sparing patients from having to take older treatments repeatedly for the rest of their lives. Most of the gene therapies approved to date are for diseases with small patient populations, limiting their overall cost to health insurers’ budgets despite high per-patient prices.
A syringe containing Novartis’s genetic treatment Zolgensma, priced at $2.1 million.
PHOTO: PA WIRE/ZUMA PRESS
Yet health insurers say they aren’t set up to handle such big payouts. They are accustomed to paying for older, chronic treatments on a recurring basis over time, rather than paying a high price for a single treatment that could have lasting benefits.
The introduction of more high-price gene therapies could raise healthcare costs, especially once the drugs target bigger patient populations, health insurers say. That could lead to higher insurance premiums, before any long-term savings kick in.
McKinsey & Co. estimates that about 30 new gene therapies could be introduced in 2024 alone.
“When you think about hundreds of gene therapies under development, if we’re fortunate enough that they all work, there’s a concern about the collective budget impact,” said Michael Sherman, chief medical officer of Point32Health, which administers health-insurance plans primarily in New England. “Each time we see a new gene therapy they are at a higher price point.”
One-time therapies are on the horizon for diseases with bigger patient populations, including a more common form of hemophilia, as well as another blood disorder known as sickle-cell disease.
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to my knowledge there are no new classes of oral antibiotics being researched
occasionally an intravenous one for hospitals that can cost a lot
but nothing for most everyday use
as bacterial increasingly mutate to more resistant forms we are slowly running out of options
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The West’s Drug-Price Self-Sabotage
A lesson from Europe for America on how price controls reduce access to treatments and cures.
By The Editorial BoardFollow
Jan. 23, 2023 6:35 pm ET
Democrats and even some Republicans want to import Europe’s drug price controls. So it’s worth observing how Europe’s raid on drug makers to bolster its ailing national health systems is reducing pharmaceutical investment and access to treatments.
The latest alarm came last week when AbbVie and Eli Lilly said they’re pulling out of a “voluntary” agreement with the U.K. government aimed at reducing drug spending. An AbbVie executive said the government’s policies are harming “our ability to operate sustainably in the UK.”
The British National Health Service (NHS) imposes price controls on drugs that reduce their cost on average by 60% versus America. U.K. law also requires drug makers to pay a 24.4% rebate on revenue from branded drugs. This levy on top of the NHS price controls discourages drug makers from selling treatments in the U.K.
The government and companies struck a deal in 2019 aimed at increasing access to innovative treatments, but this has turned out to be even more punitive. The agreement capped the government’s annual drug spending growth at 2%. Drug makers must pay the government rebate equal to their revenue above the cap.
Government spending on drugs has nonetheless continued to rise at a faster rate owing to Covid and delayed care for diseases such as cancer. As a result, companies this year must pay the government 26.5% of their brand drug revenue (about $4 billion), up from 15% last year and 5% in 2021. In short, drug companies are dunned more because more Brits are sick.
Eli Lilly and AbbVie last week withdrew from the 2019 agreement, and Bristol Myers Squibb has warned that the U.K. levies might cause it to divert investment. An executive at Germany’s Bayer last week said it is reducing its U.K. footprint and “deprioritising Europe to some degree.”
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Governments across the continent are making it difficult for drug makers to earn a return on investment. Germany last fall increased mandatory drug discounts to 12% from 7% and extended a 2010 price freeze through 2026 that was supposed to expire in 2022.
Hard to believe, the U.K. and Germany are also still trying to attract pharmaceutical investment. But as Bayer’s pharmaceutical head Stefan Oelrich recently explained, “European governments are trying to create incentives for research investments, but they are making our lives miserable on the commercial side.” While Europe boasts a handful of pharmaceutical powerhouses, venture capital is flowing into biotech startups in the U.S. and China.
The result for Europe will be less investment and access to life-saving treatments. About 85% of new medicines launched between 2012 and 2021 were available in the U.S., compared to 61% in Germany, 59% in the U.K. and 52% in France and Italy. Bluebird bio in 2021 said it was unwinding operations in Europe and withdrawing gene therapies for rare diseases, citing the challenges of “achieving appropriate value recognition and market access.”
Generic drug firms also say Europe’s price controls, onerous regulation and rising energy costs are contributing to shortages of medicines and driving more production to China and India. Germany in December eased price controls on pediatric drugs in short supply because manufacturers were prioritizing countries with higher reimbursements.
According to a European Public Health Alliance survey in 2019, nearly half of patients reported that they or a family member couldn’t get a drug they needed. In France, 2,446 drug shortages were reported in 2020, up from 868 in 2018 and 44 in 2008. Two in three French oncologists say shortages of anti-cancer medicines can reduce survival odds.
But European governments refuse to pay more to ensure their citizens have access to treatments. Bureaucrats in Brussels are therefore now considering legislation that would reduce intellectual property protection for drugs that don’t launch in nearly all European Union markets. Such a deal: Accept price controls, or Europe will hand IP to the Chinese. Dealing with the Italian mob is easier.
***
The U.S. has drawn more pharmaceutical investment amid Europe’s war on drug makers, but this may not continue as progressives pound the industry. Democrats last year limited the price growth for drugs in Medicare to the rate of inflation and required the feds to dictate lower prices for dozens of drugs to finance climate spending.
Democrats also want the Health and Human Services Department to abrogate patents for higher-cost drugs such as prostate cancer treatment Xtandi that benefitted in part from government research. This would discourage cooperation between private industry and government, which helped produce life-saving Covid vaccines and therapies.
Pfizer CEO Albert Bourla warned last week that attacks on drug makers would leave the West more vulnerable to the next pandemic. “What was the big lesson from Covid? It was that thank god there was a thriving life-sciences industry that was predominantly fueled privately, but also supplemented by academia,” he said.
The novel mRNA vaccines didn’t turn out to protect as well against Covid infection as hoped, but they did save lives and helped the world return to normal. It makes no sense for governments to try to kill companies that came to their rescue.
Appeared in the January 24, 2023, print edition as 'The West’s Drug Self-Sabotage'
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from previous CD post :
"The West’s Drug-Price Self-Sabotage
A lesson from Europe for America on how price controls reduce access to treatments and cures.
By The Editorial BoardFollow
Jan. 23, 2023 6:35 pm ET"
of course WSJ thinks only of "profits "
but this is the down side of drug companies ripping us off. in the US :
https://www.nytimes.com/2023/01/28/business/humira-abbvie-monopoly.html
I am for price controls that the market itself would take
ie : competition
2 things bother me:
price fixing among drug companies - not clear they actually collude per se
but they do not seem to compete on pricing
when a similar drug comes out it seems to be priced like the earlier drug from another company
they see what the competition charges then charge the same but claim their drug is better (usually marginally etc ) and sell on that basis
but do not cut cost for consumers
the other problem is this legal patent scam
they make tiny differences in their drug
and patent them to prevent competition
or as noted in the article simply pay off the generic manufacturer to not make the drug
THIS IMO needs regulation
folks we are being ripped off
I am telling everyone
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Some of what you describe is the inherent behavior of oligopolistic markets.
There is also the matter of markets dominated by insurance.
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hey CD
CD responded with :
"Some of what you describe is the inherent behavior of oligopolistic markets.
There is also the matter of markets dominated by insurance. "
implying what ?
it is all ok and we should not confuse predatory behavior with free market forces ?
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No, just seeking a good starting point for good diagnosis.
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"No, just seeking a good starting point for good diagnosis."
I am thinking
diagnosis is human nature
which is sadly placing profit over morality .
Not inevitable but all too common .
I am not a regulation kind of guy
but sometimes protecting consumers and reducing health costs is legitimate cause for intervention
pros vs cons
IMveryHO
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FWIW my starting orientation:
In the absence of coercion, the Free Market is most harmonious with human nature.
Insurance exists for good and proper reasons but has the consequence of separating the consumer and payor; the consumer is not constrained by price. Once the insurance modality exceeds a certain portion of the market, the dynamics of a healthy free market are subverted.
IMHO Dr. Ben Carson had a serious proposal when he was running for President that I saw as being a very realistic and plausible way of returning the price mechanism to the health care market while still allowing for insurance for the cases that people could not be reasonably be held to be financially capable.
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PBM are used as middlemen between companies, insurances , to "negotiate " prices for drugs from the pharmaceutical companies
the top 3 control 80 to 90 % of all drug plans in the nation
and the top 10 control 97%
detailed inspected in recent Jama article recently. I can't post as I am not member of AMA - but I get the magazine free.
Bottom line
they are more profitible then the pharm companies
while at the same time there is ZERO transparancy to the public
the government allowed them to continue and merge with the health plans and drug stores
United Health Care , Humana, CVS Aetna etc
thinking they this would lower prices .
However, it seems the academics who research this cannot tell if they do this
[certainly does not seem likely with the cost of medicines today ]
or how they and the drug companies seem to be getting fantastically rich while the insurers stock prices at or near at all time highs.
The big pharma are cutting deals with the PBMs to use their drugs as preferred
but paying the BPMs off at the same time
Somehow everyone gets rich - except the consumers who seem to paying more and more for prescriptions
anytime back room wheeling and dealing occurs and is kept from outside inspection and oversight we KNOW it ain't good .
Without a doubt we will be hearing more about people trying to crack this complex maze of of shenanigans .
We must.
I am near certain US consumers are getting screwed
-
anytime back room wheeling and dealing occurs and is kept from outside inspection and oversight we KNOW it ain't good .
PBM are used as middlemen between companies, insurances , to "negotiate " prices for drugs from the pharmaceutical companies
the top 3 control 80 to 90 % of all drug plans in the nation
and the top 10 control 97%
detailed inspected in recent Jama article recently. I can't post as I am not member of AMA - but I get the magazine free.
Bottom line
they are more profitible then the pharm companies
while at the same time there is ZERO transparancy to the public
the government allowed them to continue and merge with the health plans and drug stores
United Health Care , Humana, CVS Aetna etc
thinking they this would lower prices .
However, it seems the academics who research this cannot tell if they do this
[certainly does not seem likely with the cost of medicines today ]
or how they and the drug companies seem to be getting fantastically rich while the insurers stock prices at or near at all time highs.
The big pharma are cutting deals with the PBMs to use their drugs as preferred
but paying the BPMs off at the same time
Somehow everyone gets rich - except the consumers who seem to paying more and more for prescriptions
anytime back room wheeling and dealing occurs and is kept from outside inspection and oversight we KNOW it ain't good .
Without a doubt we will be hearing more about people trying to crack this complex maze of of shenanigans .
We must.
I am near certain US consumers are getting screwed
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Joe Biden’s Insulin Fictions
He peddles nonsense about prices that almost no one paid.
By The Editorial BoardFollow
March 1, 2023 6:41 pm ET
The drug maker Eli Lilly said Wednesday that it will cut the sticker price of some insulin products by 70%, and Democrats are taking a victory lap. Well, yes, government coercion can work. But the supposed pricing triumph here is far less than meets the press releases, and the truth is worth noting for the future of drug innovation for Americans with diabetes and other diseases.
“Insulin has been around for 100 years,” President Biden said Tuesday in Virginia Beach, and he says the drug costs $10 to make. “But you’ve been paying three, four, five hundred dollars a month for that. But Big Pharma has been unfairly charging you that—record profits. Not anymore.” The Inflation Reduction Act capped insulin out-of-pocket costs at $35 a month for Medicare, and Mr. Biden wants to extend his price control on insulin into private insurance markets.
This bedtime story also appeared in Mr. Biden’s State of the Union address, and it’s pure fiction. The insulin of a century ago came from animals like pigs and cattle, hardly comparable to today’s products. Long-acting forms can regulate blood sugar for up to 24 hours. Only those who don’t have to inject themselves with needles all day could fail to see the value of an inhaled insulin.
And despite the intoning about profits, net insulin prices have been flat or declining for years. The few patients who struggle to afford the drug are dealing with distortions in insurance and benefit design, not corporate greed. Not everyone benefits from the discounts negotiated by pharmacy-benefit managers.
Mr. Biden said Wednesday that Eli Lilly’s price cut was “a big deal,” but the best industry analysis suggests three in four patients pay less than $30 out of pocket for insulin. Eli Lilly noted in its press release that, same as before, anyone who doesn’t have insurance can “immediately download” an online coupon for $35 a month insulin, and all the major manufacturers offer such help.
Drug makers know they’re on the political menu and are responding to the pressure. Drug makers will probably spread the costs of cheaper insulin in other products they sell. The Biden Administration sees insulin as a convenient political wedge to sell controls on all drugs, and the politics of lower prices now beats the promise of therapies that may never be discovered because of price controls.
Republicans have been under deep cover on healthcare since they failed to repeal the Affordable Care Act, but there is an opening for a politician willing to make the case that the U.S. is the world’s premiere medicine cabinet. A dynamic economy can make drugs more available now without crushing the capital and ingenuity that eventually produce cures to brutal diseases like diabetes.
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"Mr. Biden said Wednesday that Eli Lilly’s price cut was “a big deal,” but the best industry analysis suggests three in four patients pay less than $30 out of pocket for insulin. Eli Lilly noted in its press release that, same as before, anyone who doesn’t have insurance can “immediately download” an online coupon for $35 a month insulin, and all the major manufacturers offer such help."
75 % pay $30 or less
but not clear to me how much the insurance foots the bill
which we all pay for
and the newer insulins are far more expensive usually
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https://www.ncbi.nlm.nih.gov/books/NBK22944/
*The federal Anti-Kickback Statute (AKS) (See 42 U.S.C. § 1320a-7b.) is a criminal statute that prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of business reimbursable by federal health care programs.*
https://www.nationalreview.com/corner/did-fauci-and-collins-receive-royalty-payments-from-drug-companies/
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https://www.ncbi.nlm.nih.gov/books/NBK22944/
*The federal Anti-Kickback Statute (AKS) (See 42 U.S.C. § 1320a-7b.) is a criminal statute that prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of business reimbursable by federal health care programs.*
https://www.nationalreview.com/corner/did-fauci-and-collins-receive-royalty-payments-from-drug-companies/
https://www.revolver.news/2023/03/video-the-hidden-real-reason-why-fauci-lied-to-you-about-hcq-ivermectin/
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https://www.zerohedge.com/markets/code-red-downplaying-academic-excellence-med-school-admissions
The doctors of tomorrow will be DIVERSE!
And stupid!
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"Dr Anthony Fauci, the Biden COVID advisor who retired from the government last year, has said he still believes it was likely a natural occurrence"
but he included unnatural cause as being natural cause
if a scientist is out in the woods and brings an animal to the lab and gets corona from that animal that is in the mind of tony a "natural occurrence "
:roll:
what a BS artist this guy is .
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There is nothing more natural than a PLA Biowarfare lab!
"Dr Anthony Fauci, the Biden COVID advisor who retired from the government last year, has said he still believes it was likely a natural occurrence"
but he included unnatural cause as being natural cause
if a scientist is out in the woods and brings an animal to the lab and gets corona from that animal that is in the mind of tony a "natural occurrence "
:roll:
what a BS artist this guy is .
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https://acecomments.mu.nu/?post=403547
There is nothing more natural than a PLA Biowarfare lab!
"Dr Anthony Fauci, the Biden COVID advisor who retired from the government last year, has said he still believes it was likely a natural occurrence"
but he included unnatural cause as being natural cause
if a scientist is out in the woods and brings an animal to the lab and gets corona from that animal that is in the mind of tony a "natural occurrence "
:roll:
what a BS artist this guy is .
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https://www.msn.com/en-us/health/medical/the-collapse-of-britain-s-national-health-service-the-crown-jewel-of-socialized-healthcare/ar-AA18E8kR?ocid=entnewsntp&pc=U531&cvid=3260631adc7d4dffb2d102aa31e30f02&ei=29
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I didn't know it was that bad there
my nephews first wife was a brit
her father was discussing US vs Brit health care with me
explaining why theirs is better and why don't we want it here.
my short answer was called "freedom" to choose .
I think I caught him off guard.
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I didn't know it was that bad there
my nephews first wife was a brit
her father was discussing US vs Brit health care with me
explaining why theirs is better and why don't we want it here.
my short answer was called "freedom" to choose .
I think I caught him off guard.
We are the last place where freedom matters, and we are losing ground.
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Which is why we fight by speaking and searching for Truth here.
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https://www.breitbart.com/politics/2023/04/02/joe-biden-moves-cut-medicare-advantage/
probably the reason is here :
https://jamanetwork.com/journals/jama/fullarticle/2801097
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If Health Care Is So Expensive, Why Are Hospitals Closing Their Doors?
On the menu today: It’s time to take a look at one of those looming national problems that is not sexy and unlikely to get a lot of attention in the presidential race but that is a problem nonetheless: We’re used to seeing hospitals claim they’re running out of money and need more government assistance. What we’re not used to seeing is hospitals actually going ahead and closing their doors, and not necessarily those in the most rural, far-out places. Somehow the U.S. government went on an unprecedented spending binge during the pandemic, with much of that spending focused on health care, and yet hospitals, particularly rural hospitals, contend they’re just scraping by. Meanwhile on Capitol Hill, lawmakers have noticed that Medicaid reimburses hospitals at a much higher rate than private practices for the same procedures and care, and they are taking a serious look at “site-neutral payments” — perhaps the only proposal to reduce Medicaid spending that is plausible and that won’t automatically get demagogued to death.
The High Costs of Health Care and the Falling Fortunes of Hospitals
How can it be that health care in the U.S. is so expensive — hey, remember when Obamacare and moving to electronic health records were supposed to fix all that? — while at the same time many hospitals claim they are in dire straits?
Some of these claims clearly were not exaggerated: Hospitals have closed or are in the process of closing. In San Antonio, Texas Vista Medical Center permanently closed this week. The hospital’s parent company, Steward Health Care Network, issued a statement to local news reporters blaming the closure on a combination of insufficient support from local government and an unsustainable rate of patients who could not afford to pay their bills:
Twenty-five percent of the patients treated at TVMC do not pay for their care. Without Steward’s commitment, TVMC would have closed years ago. As a physician-led company, Steward has been very reluctant to close TVMC and stayed the course throughout the pandemic. Steward sought partners and many avenues to avoid closing TVMC. However, in the absence of much needed and denied assistance from Bexar County, Steward can no longer keep it open. Very few companies can give away 25 percent of its product and remain viable.
(For anyone preparing their “this is because of tight-fisted Republicans who won’t pay for health care” arguments, note that Bexar County is a heavily blue county where the Democrats swept almost all of the local and county offices last year, Beto O’Rourke carried 57 percent of the vote in last year’s governor’s election, and in 2020, Biden carried 58 percent of the vote.)
In March, Madera Community Hospital and its three rural clinics in Madera, Calif., closed. Madera is not a terribly small town; its population is about 66,000, and it’s smack in the middle of the San Joaquin Valley, just up the road from Fresno. The county is home to 160,000 people.
Last year, Mississippi’s only burn center closed, and the Delta region’s only neonatal-intensive-care unit closed. Things don’t look better next door in Alabama, the sixth-poorest state in the country:
Over the last three years, hospitals in the state have lost $1.5 billion compared to pre-pandemic levels. The reason? Everything costs more—from contract labor which grew by 450 percent, to the cost of medical supplies which has risen by $82 million across the state. Drug expenses are also up 14 percent.
At the beginning of the year, the Center for Healthcare Quality and Payment Reform identified “631 rural hospitals — more than 29 percent nationwide — [that] are either at immediate or high risk of closure. Those at high risk either have low financial reserves or high dependence on nonpatient service revenues such as local taxes or state subsidies.”
And yet, it is unlikely that anybody who has been to a hospital lately will tell you that the experience was cheap. Yes, the pandemic imposed all kinds of new and unexpected costs on hospitals, and the burnout rate among staff was high. Runaway inflation after the pandemic clearly raised operating costs as well. But the U.S. government also spent utterly unprecedented sums on health care during the pandemic, in all kinds of ways — the Provider Relief Fund, American Rescue Plan rural funds, delayed reductions in Medicare payments, and a 20 percent increase in Medicare payments for inpatient Covid-19 admissions during the declared emergency — with much of that funding going to hospitals. Medicare paid $40 to administer each dose of a Covid-19 vaccine. The U.S. government was throwing money at hospitals across the country; how can so many hospitals be going broke?
In that article about Alabama above, a pediatrician argues that the hospitals would be in better shape if the state expanded Medicaid; Alabama is one of eleven states that hasn’t expanded eligibility for the program since the passage of the Affordable Care Act.
A quick refresher: Medicaid covers pregnant women, individuals with disabilities, children in low-income households, some of the poorest elderly, and parents meeting specific income thresholds, generally those at or below the federal poverty level — $14,580 per year for an individual, or $30,000 per year for a family of four. (Children above the threshold for Medicaid can qualify for a separate program, the Children’s Health Insurance Program; North Dakota’s CHIP program covers children up to 175 percent of the poverty level, and New York’s goes up to 405 percent of the poverty level.) States are allowed to impose a usually small copayment on Medicaid recipients for nonemergency care, also determined by income level. In Virginia, “most adults in Medicaid have small copayments for some services. The copayments are usually $1 to $3 for each service. There copayment for inpatient hospitalization is $100.”
Most hospitals insist they lose money — a lot of money — on Medicaid patients. Last year, the American Hospital Association pointed to data from the Medicare Payment Advisory Commission, finding that “hospitals experienced a –8.5 percent margin on Medicare services in 2020, and it projects that margin will fall to –9 percent in 2022. Combined underpayments from Medicare and Medicaid to hospitals were $100 billion in 2020.”
Some studies argue the opposite, and you can find Republicans who argue that the transparency, accountability, and oversight of Medicaid spending are so minimal that hospitals are making money and then telling the world that they’re covering Medicaid patients at a terrible financial loss.
Getting the remaining eleven states to expand Medicaid would mean they’d be switching from one program that loses money to a different program that loses money, hopefully at a slower rate. If expanding Medicaid were a magic wand to help hospitals, we wouldn’t see hospitals closing in places like California.
One of the ideas on the table to control costs moving forward is “site-neutral payments.” Under Medicaid, medical care administered at a hospital-owned outpatient department is reimbursed at a higher rate than care administered at sites that are independent or owned by clinicians. In the anecdote of one doctor, the reimbursement rates are wildly and unjustifiably different:
Hospitals convinced Medicare to pay hospital-owned physicians in outpatient settings at nearly twice the rate that they pay independent physicians. I know of two internists who practiced internal medicine in the same office. Both were trained at the same institution. Both were board certified. One was owned by a hospital, and one practiced independently. Medicare paid the hospital-owned physician nearly double the rate of the independent physician for both an office visit and complete physical exam. There is no valid reason for this. It’s a classic example of corporate welfare.
The Blue Cross Blue Shield Association argues that moving to site-neutral policies would save Medicaid $471 billion over ten years. Because so few members of Congress are willing to touch entitlements in any serious way, enacting site-neutral policies might be one of the very few realistic ways of reducing spending on Medicaid. Congress could credibly argue that it isn’t cutting aid for anyone, just insisting on the same lower payment rate for all care providers.
Unsurprisingly, hospitals hate this proposal. The American Hospital Association contends that hospitals get reimbursed at a higher rate under the law because they do so much more than private practices do:
Americans rely heavily on hospitals to provide 24/7 access to care for all types of patients, to serve as a safety net provider for vulnerable populations, and to have the resources needed to respond to disasters.
However, these roles are not explicitly funded; instead, they are built into the overall hospital cost structure and supported by revenues received from providing direct patient care. Hospitals are also subject to more comprehensive licensing, accreditation and regulatory requirements than other settings.
The Federation of American Hospitals argues, “Blunt site-neutral payment policies, such as the current reduction for clinic services performed in hospital provider-based departments, ignore fundamental functional and cost structure differences between hospitals and physician offices, among other settings, and the unique, mission-critical services communities rely on hospitals to provide.”
But there’s a surprisingly broad coalition endorsing site-neutral payments. On the left, there’s the Progressive Policy Institute; in the middle-ish, there are the Brookings Institution and Committee for a Responsible Federal Budget; and on the right, there are the American Legislative Exchange Council, Americans for Prosperity, and Americans for Tax Reform.
If Congress were to pass legislation requiring site-neutral payment polices and Biden signed it into law, it would represent one of the most unlikely of policy victories — an entitlement reform that saved money, had minimal if any impact on care, and got Republicans and Democrats to agree. The House Energy and Commerce Committee is taking a hard look at this idea. Will it get off the drawing board?
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Believes Fauci should win Nobel Peace Prize
https://redstate.com/bonchie/2023/05/15/biden-nominates-an-absolute-nightmare-to-lead-the-nih-n746103
this, and thus she is a woman assures her the nod
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from the Journal of the American Medical Association
(JAMA)
May 9,2023 pg 1549-50
volumE 329 #18
ABSTRACT:
A fundamental shift in the Supreme Court was set in motion in 2020 with the death of Ruth Bader Ginsburg. President Trump appointed Amy Coney Barrett as his third appointee, forming a conservative 6-3 supermajority. The Supreme Court’s jurisprudence is having a profound effect on public health, safety, and environmental policy. This Viewpoint looks back at the Supreme Court’s 2021 and 2022 terms and forward to the 2023 term and beyond.
Rather than deferring to scientific decisions during the COVID-19 pandemic, the Supreme Court often struck them down. The justices invalidated New York and California’s restrictions on religious gatherings (eTable in the Supplement) despite considerable evidence that congregate settings pose a high transmission risk. The Supreme Court similarly overturned the Centers for Disease Control and Prevention eviction moratorium despite findings that evictions contribute to the spread of SARS-CoV-2.
I cannot post the whole article now without subscription but it is written by 2 Georgetown lawyers Lawrence O. Gostin, JD and Sarah Wetter, JD, MPH
https://en.wikipedia.org/wiki/Larry_Gostin
https://www.linkedin.com/in/sarah-wetter-a81b74107?original_referer=https%3A%2F%2Fwww.google.com%2F
IT BASHES THE SUPREME COURT AND CONSERVATIVE JUSTICES on all woke issues claiming it is harming health (specifically mentioning "with the death of PBG and Trump appointing Barrett").
1) that challenges to the Medical establishment powers CDC moratorium , OSHA edicts and overturning powers by SCOTUS
2) Free speech - "false and misleading scientific information "
3) Environmental "health" SCOTUS putting more guardrails on EPA tyrannical edits
and rules
4) Firearm "safety
5) Abortion "rights" ; like I said babies never count in the Universities etc
6) LBGTQ + "rights"
7) and of course Health "equity"
This is the very most blatant partisan publication since I started reading journal somewhere ~ 1982 or 1984.
AMA
JAMA
now the DemocraticSocialistMedicalJournal
or maybe JAMSNBC
disgusting
I would think more than half of doctors are outraged yet will not either say or be allowed to say anything
perhaps there will be letters to the editor but I doubt they will express the necessary outrage or counter points well enough.
even though I get for free I am thinking of still cancelling
but once in a while they do have some article and very rarely a study that concerns
my area of practicing medicine so I feel it best to keep getting . OTOH I have closer insight into what is going on .
I can only imagine the medical schools or training programs with DEI LBGTQ*+*
classes and brainwashing now.
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https://www.spectator.co.uk/article/why-is-canada-euthanising-the-poor-
https://www.foxnews.com/world/canadian-soldier-suffering-ptsd-offered-euthanasia-veterans-affairs
https://www.dailymail.co.uk/news/article-9374291/Scandal-500-care-home-patients-given-DNR-orders-without-consent.html
https://www.cbc.ca/news/canada/manitoba/medically-assisted-death-could-save-millions-1.3947481
https://twitter.com/TPostMillennial/status/1582708189979721728
What a slippery slope!
https://media.gab.com/cdn-cgi/image/width=1050,quality=100,fit=scale-down/system/media_attachments/files/118/396/661/original/249da7ad50ba35b1.jpg
(https://media.gab.com/cdn-cgi/image/width=1050,quality=100,fit=scale-down/system/media_attachments/files/118/396/661/original/249da7ad50ba35b1.jpg)
https://www.theburningplatform.com/2023/05/22/one-third-of-canadians-support-killing-the-homeless-modern-eugenics/
Canadian nice!
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https://www.yahoo.com/news/congress-trying-tackle-rising-prescription-182927024.html
I doubt this :
"he trade association representing PBM’s is called the Pharmaceutical Care Management Association. The group’s President and CEO, JC Scott, said they weren’t invited to share their perspective for this hearing.
In a statement, Scott said the committee risks “fundamentally misconstruing the role of pharmacy benefit companies and playing right into the hands of Big Pharma, which wants nothing more than to weaken this one check on big drug companies’ otherwise unlimited pricing power and avoid accountability for their egregious abuse of the patent system that blocks competition and keeps prices high.”
IF THIS WERE SO TRUE THEN WHY ARE ALL THE PBMs BUSINESS DEALINGS TOTALLY NON TRANSPARENT.
Hard to believe they too mild the system beyond what big pharma does
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mild= milk?
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1https://jewishworldreview.com/0823/shapiro083023.php
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as expected Ben Shapiro does what the pharma wants:
reduced innovation
kill profits
opening pandora's box
of endless price limits
the end of the pharma industry
I don't buy it
sell more drugs at lower prices and thus profits are preserved.
maybe change the patent time to being longer though drug companies already have schemes to extend it.
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**** harvard psychiatrist ****
on Trump , of course:
https://www.msn.com/en-us/news/politics/harvard-psychiatrist-fears-trump-s-mental-state-has-crossed-into-dangerous-new-terrain/ar-AA1klDIz
and this from the leftist charlatan:
https://www.psychiatrictimes.com/view/dealing-american-psychiatrys-gag-rule
gag rule for doctors diagnosing people they have never interviewed should be lifted for Trump.
how about psyhoanalysis of Obama or Biden or yourself.
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Biden, Trump and ObamaCare
Democrats distort the issue, but the GOP offers no alternative.
By
The Editorial Board
Follow
Nov. 29, 2023 6:49 pm ET
Donald Trump handed his opponents another gift over the weekend by vowing to “terminate” ObamaCare—or at least that’s how Democrats are translating his blunderbuss comments. Democrats are distorting the issue as ever, but they know Mr. Trump has no plan of his own.
“The cost of Obamacare is out of control, plus, it’s not good Healthcare,” Mr. Trump wrote Saturday on Truth Social. “I’m seriously looking at alternatives. We had a couple of Republican Senators who campaigned for 6 years against it, and then raised their hands not to terminate it. It was a low point for the Republican Party, but we should never give up!”
His comments were responding to our editorial (“Elizabeth Warren Has an ObamaCare Epiphany”) about complaints from the Massachusetts Senator that insurers are exploiting the law’s profit cap and driving healthcare costs higher. Thanks for reading, sir, but it would help if there were an idea behind your impulse.
Democrats seized on his post, warning that 40 million Americans could lose health coverage if Mr. Trump wins again. In 2024 “the Affordable Care Act and all its transformational benefits will be on the ballot,” Nancy Pelosi declared. “The American people will need to know that if Donald Trump wins next year, he’s coming for your health care.”
On Tuesday President Biden told donors that “if Trump gets his way, it’s all gone.” Democrats successfully ran on protecting ObamaCare in 2018 and 2020, and they are trying to make it a three-peat. Bidenomics isn’t selling with voters, so why not run on the tried-and-true strategy of scare-mongering about losing health coverage?
Recall that Republicans failed to repeal and replace ObamaCare in 2017 despite controlling both houses of Congress. John McCain’s opposition ultimately killed the GOP’s last reform bill, but Mr. Trump’s unwillingness to understand the policy arguments was the bigger problem. His inability to marshal a case to rally public opinion contributed to its failure and the GOP’s losses in the midterms.
Democrats are again making false claims about ObamaCare that Mr. Trump and Republicans seem incapable of refuting. Mr. Trump later attempted to clarify that he merely wants to “replace” ObamaCare with “MUCH BETTER HEALTHCARE,” though he again missed the mark by suggesting that other countries’ socialized health systems are superior to America’s private care.
The reality is that ObamaCare has increased healthcare costs while producing few tangible benefits for patients. As we recently pointed out, the law’s de facto profit cap has driven industry consolidation, resulting in higher costs for patients and taxpayers. Insurers have pocketed subsidies while increasing premiums and deductibles.
The share of Americans with insurance increased by about five percentage-points in the six years after the law’s Medicaid expansion and health exchanges took effect. This resulted in about 17 million Americans gaining health coverage. But most newly insured are young, healthy adults on Medicaid. They could have afforded “skinny” plans more appropriate for their age and health risks, but the Biden Administration is restricting those plans.
Medicaid spending was growing at an unsustainable 9% a year even before its pandemic expansion. Taxpayers are shelling out $90 billion this year for ObamaCare subsidies—$6,324 per household—which Democrats sweetened in 2021 to offset surging premiums for middle- and upper middle-income Americans.
Meantime, insurance provider networks have become narrower while out-of-pocket costs increase for patients. Democrats have no plan to deal with these problems or soaring government healthcare spending other than drug price controls or rationed care. But neither do most Republicans, who more or less stopped thinking about healthcare after their 2017 failure. The policy chops of former Reps. Paul Ryan or Tom Price are nowhere to be seen in the current House majority.
Republicans could start by educating voters about ObamaCare’s regulatory distortions, such as the de facto cap on insurer profits, rigid plan designs, and benefit mandates that increase costs while limiting choice. They could also propose giving states more flexibility to manage Medicaid in a way that offers better patient care while imposing work requirements for the young and healthy, among other ideas.
There are other ideas, but they require doing some homework and honing a message. If Republicans have nothing more to say than Mr. Trump does, they’re better off ducking the subject lest they lead with their chin.
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https://www.yahoo.com/finance/news/cvs-shaking-drug-pricing-thank-110038889.html
Not clear how this will affect the prices we pay for drugs
I do not like behind the scenes wheeling and dealing by the PBMs.
Do they save or cost us money? I have no idea.
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This bears watching!
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This I can't agree with:
https://www.politico.com/news/2023/12/06/biden-admin-authority-seize-certain-drug-patents-00130452
However I do wonder if it is right for Drug companies to shyster the duration of patents by changing the drug a tad with slightly different version to keep out generics or they buy out the generic company
and make it themselves. Something odd all around going on.
Note Biden will emphasize health care, and of course keep reminding us all how Trump will end Obamacare and everyone will die.
we will see if Trump can truly come up with any kind of replacement. Not holding my breath. Better be better then we can pump more oil and sell to the world to reverse 33 trillion in debt and at the same save Medicare and Social Security
as though money will flow from the heavens into our treasure chest like manna.
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DeSantis Is Right About Medicaid
North Carolina becomes the 40th state to join the expansion, which harms taxpayers and existing beneficiaries alike.
By Brian Blase
Dec. 17, 2023 4:08 pm ET
North Carolina has become the 40th state to succumb to federal cash and adopt ObamaCare’s Medicaid expansion for able-bodied working-age adults. A new study from the Paragon Health Institute shows there is little to celebrate. Overall health is unlikely to improve despite this massive increase in public welfare.
We now have 10 years of data on ObamaCare’s Medicaid expansion. The evidence against the policy is overwhelming: Expansion leads to a surge in spending but reduces healthcare access for traditional Medicaid enrollees such as low-income children and people with disabilities. And it doesn’t improve health.
The Paragon study contains specific estimates for Florida, one of the most populous states that have resisted the policy. If Florida expands Medicaid, some 2.5 million people would newly enroll in the program. Three in 10 Floridians would be on Medicaid, and there would be only 1.5 workers for every Medicaid enrollee. Among people who join Medicaid, 65% would replace private coverage.
The cost of expansion to Florida’s state taxpayers would reach $2 billion by the end of the decade. To pay for that, the state would need to raise its sales tax from 6% to 6.4% or significantly cut other public priorities such as education.
Expanding Medicaid also leads to much higher federal deficits. Florida’s decision to reject ObamaCare’s Medicaid expansion has already saved American taxpayers nearly $50 billion.
After ObamaCare’s Medicaid spending surge, federal officials found that more than 20% of payments nationwide were improper—mainly payments to health insurers for ineligible recipients. A much bigger Medicaid program hasn’t improved health. In the first four years of Medicaid expansion, mortality trends were worse in expansion states.
Medicaid expansion reduces healthcare access for traditional program enrollees. After expansion, Medicaid enrollees were one-third less likely to secure doctor appointments, driving more people into emergency rooms. A Mercatus Center study found that Medicaid spending stagnated for children and people with disabilities and significantly increased for able-bodied working-age adults in expansion states.
Part of a state’s calculus should be how vulnerable it would be to a change in federal Medicaid financing that lowers the ObamaCare reimbursement rate to the traditional enrollee rate, which is 30 percentage points lower for Florida. This policy change passed the House in 2017 and will undoubtedly be on the table when Washington next pursues deficit reduction. If Florida decides to expand and the enhanced match rate ends, the state’s extra costs will exceed $40 billion over the next decade, according to my estimates. North Carolina’s decision to expand creates fiscal risk for the state exceeding $10 billion over the next decade.
Leaders in 10 states have kept Medicaid a priority for those who most need it, and saved Americans from higher taxes that don’t improve health. That is the correct approach—and a courageous one, given enormous pressure from the healthcare industry and the left to expand the program.
Mr. Blase, who served as a special assistant to President Trump at the National Economic Council, is president of Paragon Health Institute and a co-author of “Resisting the Wave of Medicaid Expansion: Why Florida is Right.”
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https://www.bizpacreview.com/2023/12/22/bidens-signature-law-was-supposed-to-lower-drug-prices-but-its-doing-just-the-opposite-1422144/?utm_campaign=bizpac&utm_content=Newsletter&utm_medium=Newsletter&utm_source=Get%20Response&utm_term=EMAIL
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https://patriotpost.us/opinion/103221-confession-of-a-public-health-expert-2024-01-01
we all questioned at some point early on was the prescription written by the Medical experts worse then the disease itself.
answer in retrospect - yes.
I don't know if there is any good way to handle such a respiratory viral epidemic that has relatively high death rates - once it is out.
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So where is the healthcare spending delta to be found? It’s going to fraud:
https://blog.independent.org/2024/01/24/healthcare-spending-pandemic/?utm_source=rss&utm_medium=rss&utm_campaign=healthcare-spending-pandemic
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Currently enduring far fewer regulations imposed on the health industry by Obamacare, Biden seeks to eliminate this workaround, impacting a half million Americans along the way:
https://www.cato.org/policy-analysis/biden-short-term-health-plans-rule-creates-gaps-coverage#introduction
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https://www.msn.com/en-us/news/us/the-doctor-will-ask-about-your-gun-now/ar-BB1kTixP
The only time I would/have ask(ed) a patient if they own a gun is when they are contemplating suicide.
Otherwise in my opinion it is not anyone's damn business.
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Let's see, we have a right of privacy, sort of, and we have a right to bear arms, sort of, but we don't have a right of privacy as it relates to our exercise of the (first or) second amendment.
Informing the government of all the privately owned guns would defeat the purpose of having those guns in the event they are needed to stand up against a rogue, tyrannical government.
Or does someone think the government won't get your "health" records if they want them? And whose idea was it to merge government and healthcare?
The second amendment wasn't about hunters' rights.
[Same might apply to the right or privacy relating to bitcoin purchases (or gold). The right to wealth. The purchase of bitcoin is not a taxable event. The sale of it is. Why do you have to disclose your purchases? They don't have a constitutional right to tax wealth, why do they have the right to track it. Doesn't a right of privacy apply up to the point where it becomes any of their business?]
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Let's see, we have a right of privacy, sort of, and we have a right to bear arms, sort of, but we don't have a right of privacy as it relates to our exercise of the (first or) second amendment.
Informing the government of all the privately owned guns would defeat the purpose of having those guns in the event they are needed to stand up against a rogue, tyrannical government.
Or does someone think the government won't get your "health" records if they want them? And whose idea was it to merge government and healthcare?
The second amendment wasn't about hunters' rights.
[Same might apply to the right or privacy relating to bitcoin purchases (or gold). The right to wealth. The purchase of bitcoin is not a taxable event. The sale of it is. Why do you have to disclose your purchases? They don't have a constitutional right to tax wealth, why do they have the right to track it. Doesn't a right of privacy apply up to the point where it becomes any of their business?]
More than one doctor—particularly pediatricians when my kids were younger—got an earful when they started reading from the gun script. Likely would have stained their britches were they aware of what all was on my person at the time.