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Author Topic: The Politics of Health Care  (Read 447383 times)
Power User
Posts: 42527

« Reply #300 on: July 26, 2009, 04:09:45 AM »

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.
Power User
Posts: 42527

« Reply #301 on: July 26, 2009, 06:00:34 AM »

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!
« Last Edit: July 26, 2009, 07:04:54 AM by Crafty_Dog » Logged
Power User
Posts: 9481

« Reply #302 on: July 26, 2009, 10:42:50 AM »

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?
Power User
Posts: 9481

« Reply #303 on: July 26, 2009, 10:46:05 AM »

One more shot at the Obama/Democrat House healthcare chart.  I found it as an image rather than a pdf this time:

« Last Edit: July 26, 2009, 10:49:41 AM by DougMacG » Logged
« Reply #304 on: July 26, 2009, 02:17:35 PM »

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.
Power User
Posts: 42527

« Reply #305 on: July 26, 2009, 08:51:28 PM »

Does anyone offer insurance that does not allow cancelation?
« Reply #306 on: July 26, 2009, 09:20:16 PM »

I've a guess. I presume you have the answer?
« Reply #307 on: July 27, 2009, 12:49:45 PM »

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.
« Reply #308 on: July 27, 2009, 01:30:38 PM »

2nd Post.

July 27, 2009
Speculators Bet Reform Won’t Hurt Industry
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 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.
« Reply #309 on: July 28, 2009, 09:00:43 AM »

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.
« Reply #310 on: July 28, 2009, 12:53:18 PM »

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: at July 28, 2009 - 01:50:16 PM EDT
« Reply #311 on: July 29, 2009, 12:25:47 PM »

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 -
« Reply #312 on: July 30, 2009, 01:51:50 PM »

Obama’s Great Health Scare
The president resorts to the politics of fear.

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.
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« Reply #313 on: July 30, 2009, 05:53:01 PM »

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.

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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Posts: 7838

« Reply #314 on: July 31, 2009, 10:04:26 AM »

"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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Posts: 513

« Reply #315 on: July 31, 2009, 12:26:50 PM »

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.
« Reply #316 on: August 02, 2009, 04:31:19 PM »

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

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:
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Posts: 9481

« Reply #317 on: August 04, 2009, 10:00:00 AM »

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:

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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« Reply #318 on: August 04, 2009, 11:38:00 PM »

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. 
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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Posts: 74

« Reply #319 on: August 05, 2009, 06:13:29 PM »

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!!!   grin

« Reply #320 on: August 05, 2009, 08:40:09 PM »

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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Posts: 103

« Reply #321 on: August 05, 2009, 09:10:56 PM »

Democrats Decline to Listen to Unhappy Constituents, Decide to Label Them Nuts Instead


« Reply #322 on: August 06, 2009, 10:42:00 AM »

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: at August 06, 2009 - 11:39:57 AM EDT
« Reply #323 on: August 06, 2009, 11:50:55 AM »

2nd post.

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
« Reply #324 on: August 06, 2009, 08:02:20 PM »

3rd post.

How to Fix the Health-Care ‘Wedge’
There is an alternative to ObamaCare.

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
Power User
Posts: 7838

« Reply #325 on: August 07, 2009, 10:27:55 AM »

***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.

Power User
Posts: 7838

« Reply #326 on: August 08, 2009, 09:34:45 AM »

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?***

Power User
Posts: 15533

« Reply #327 on: August 08, 2009, 03:59:26 PM »

At least the left is willing to have an honest debate.  rolleyes
Power User
Posts: 7838

« Reply #328 on: August 10, 2009, 10:14:17 AM »

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.
« Reply #329 on: August 10, 2009, 12:51:30 PM »

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: at August 10, 2009 - 01:49:53 PM EDT
Power User
Posts: 7838

« Reply #330 on: August 10, 2009, 01:06:30 PM »

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.


Power User
Posts: 9481

« Reply #331 on: August 10, 2009, 02:04:58 PM »

CCP: "They should not harp on just the cost issue..."

I think this piece by T. Sowell goes beyond cost:

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."
Power User
Posts: 7838

« Reply #332 on: August 10, 2009, 02:30:48 PM »

 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.

Power User
Posts: 9481

« Reply #333 on: August 10, 2009, 03:37:51 PM »

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...

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.
Power User
Posts: 15533

« Reply #334 on: August 10, 2009, 07:03:17 PM »

Gotta love the Chicago politics that have been brought to the national level. Obama's Purple Shirts are attacking and threatening Obamacare protesters.
« Reply #335 on: August 10, 2009, 10:32:36 PM »

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.;featuredPost-PE
« Reply #336 on: August 12, 2009, 05:48:17 PM »

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 -
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« Reply #337 on: August 12, 2009, 08:48:22 PM »

Obama and fearmongering.
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« Reply #338 on: August 12, 2009, 10:20:15 PM »

A proud Obama supporter!
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« Reply #339 on: August 13, 2009, 06:59:10 PM »

The IBD editorial in question was previously quoted in this thread.  Here is a frontal challenge which seems to make sense.  Comments?

More from

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.
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?
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
U.S. House. "H.R. 3200." (as introduced 14 Jul 2009.)
Collins, Sara. Interview with 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.
« Reply #340 on: August 13, 2009, 08:55:57 PM »

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.
« Last Edit: August 14, 2009, 09:04:24 AM by Crafty_Dog » Logged
« Reply #341 on: August 13, 2009, 10:37:42 PM »

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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« Reply #342 on: August 14, 2009, 03:04:26 PM »

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.
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« Reply #343 on: August 15, 2009, 07:28:31 PM »

The Whole Foods Alternative to ObamaCare
Eight things we can do to improve health care without adding to the deficit.


"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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« Reply #344 on: August 16, 2009, 08:38:02 AM »

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?
« Reply #345 on: August 16, 2009, 02:28:04 PM »

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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« Reply #346 on: August 16, 2009, 03:08:55 PM »

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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« Reply #347 on: August 16, 2009, 07:42:05 PM »

GM:  How do YOU think those questions should be answered?

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

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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Posts: 42527

« Reply #348 on: August 17, 2009, 09:23:42 AM »

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:

Saving Grandma
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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A new blog from The New York Times that tracks the health care debate as it unfolds.

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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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Posts: 7838

« Reply #349 on: August 17, 2009, 10:43:05 AM »

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
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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