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Politics, Religion, Science, Culture and Humanities => Politics & Religion => Topic started by: Crafty_Dog on September 18, 2007, 07:07:13 AM

Title: The Politics of Health Care
Post by: Crafty_Dog on September 18, 2007, 07:07:13 AM
Woof All:

There are two health related threads already on the SC&H forum, so I pause before starting a third one here.  That said, I do start this thread here because it is obvious that health care is going to be a major theme in the Presidential campaign. 

We kick the thread off with Karl Rove :evil:


Republicans Can Win on Health Care
A market-based system can give us freedom, innovation and health security.

Tuesday, September 18, 2007 12:01 a.m. EDT

All around America, families are grappling with health-care concerns. They wonder if they'll have insurance at a price they can afford. They worry about how much out-of-pocket health costs take from the family budget. They question if they'll be able to pick their own doctor. Some feel trapped in jobs they don't like out of fear of losing their health insurance.

As the latest government-heavy plan announced by Hillary Clinton yesterday once again shows, the answers politicians offer on health care highlight the deep differences between liberals and conservatives. This is a debate Republicans cannot avoid. But it is one we can win--if we offer a bold plan. Conservatives must put forward reforms aimed at putting the patient in charge. Increasing competition will ensure greater access, lower costs and more innovation.

Liberals see the concerns of families as a failure of private insurance, and want the U.S. to move toward a government-run, single-payer model. This is a recipe for making problems worse. Socialized medicine inevitably leads to poor quality, inefficiency, rising taxes and rationing. The waiting lines and poor care that cause people from other countries to come here for treatment are not the answer.

Government can help poorer and older Americans get quality health care without sacrificing what everyone wants--the ability to choose their own doctor and health coverage that meets their family's particular needs. What reforms will do that?
• Level the tax playing field. People who work for companies get a tax break on the health insurance they get from their employer. Many small business employees, farmers and the self-employed are unable to benefit from the same tax advantage, because they or their employers can't afford health insurance. It's not fair or wise to penalize people who have to pay for health insurance out of their own pockets. They should benefit from the same tax advantage employees from bigger companies get.

The mortgage interest deduction made it easier for people to own a home and all America benefited. Similarly, every worker should get a deduction for health-insurance premiums. This would ease the burden on working families and make it possible for millions more Americans to own health insurance. Some Republicans in Congress support a tax credit rather than a deduction: that's reasonable, too. A deduction or a credit puts patients in charge by helping them get private coverage that meets their needs.

• Tax-free savings for health costs. We are encouraged to save tax-free for retirement and college; we should make it easier to save tax-free for out-of-pocket medical expenses, too. Tax-free savings accounts, paired with low-cost catastrophic health insurance, make coverage affordable for working families. For example, a youth minister told me his Health Savings Account (HSA) gave his family peace of mind because they now had insurance coverage for big emergencies and could save tax-free for everyday health expenses.

That's why, in less than three years, more than 4.5 million families have set up HSAs. Some Democrats want to rein in HSAs because they fear HSAs put the individual--not government--in charge and once someone gets to pick a plan that meets their needs, they won't like being dictated to by government.

And when people see they can save money by eating better, exercising and making healthy lifestyle choices, guess what? They do. I met with workers at Wendy's Headquarters in Ohio who were eagerly taking steps to lead healthier lives because it saved them money.

• Portability. When you change jobs, you don't have to change auto insurance, but you may have to change your health insurance and even your doctor. That's important in a world where young Americans are likely to have 10 jobs before they are age 36. Too many people are locked into jobs they don't like out of fear they'll lose health coverage. The solution is obvious: People should be able to take their health insurance with them when they change jobs.

• Arming consumers through more competition. Rep. John Shadegg (R., Ariz.) argues that people should be able to buy health insurance issued by a company based in another state. Lack of interstate competition helps to explain why the same health policy costs $8,334 in North Dakota but $10,312 in South Dakota. If consumers in South Dakota could buy that North Dakota policy, prices for health insurance would go down.

• Pool risk, lower costs. Large companies get purchasing power and savings because they share risk across large numbers of employees. Sen. Mike Enzi (R., Wyo.) and Rep. Sam Johnson (R., Texas) believe small businesses should be able to join together to pool risk, too. It would mean more competition and lower costs, and more people able to afford coverage.

• Greater transparency.Today, patients rarely know what a procedure will cost or how good a clinic or hospital is, except by reputation and word of mouth. For example, a study of metropolitan hospitals found prices for services varied widely--by as much as 259%--even after controlling for geographic variations in the cost of doing business. Putting information about cost and quality in the hands of patients would lower the cost and improve the quality of health care. Patients making informed choices would create market pressures for lower prices and better care.

• Stop junk lawsuits. I've heard sad stories from doctors and patients. The doctor who had to close her clinic in her hometown and move across the state to work at a hospital that would pay her rising liability insurance premiums. The head trauma specialist afraid that when he retired, his community in one of the poorest regions in the country couldn't attract a replacement. The pregnant woman who drove 80 miles from home in Las Vegas to get prenatal care.

Communities are losing talented health-care professionals who simply can't afford the bigger liability premiums caused by frivolous lawsuits. More than 48% of all counties in the U.S. have no ob-gyn physicians. Hospitals are finding it tougher to provide obstetrics, emergency room care or neurosurgery because of frivolous lawsuits. And doctors, afraid of lawsuits, practice "defensive medicine," ordering unnecessary tests and procedures which add to the cost of health care.

Whose interest does that really serve? If we want richer trial lawyers, let them keep filing junk lawsuits we all pay for. If we want better health care, curb frivolous lawsuits.

• Build on the progress already made by putting patients in charge and letting competition work. When Congress considered prescription drug coverage under Medicare, Democrats tried to have government set prices and deliver the drugs. When the Congressional Budget Office estimated the first year's monthly premium for seniors would be $35, Democrats tried to lock in that price.

Republicans disagreed, arguing competition would lower prices and provide more choices. They were right: Competition led to more options and an average monthly premium of around $23--an annual savings of $144 in the first year. Competition continues to save seniors (and taxpayers) money. When the bill passed, independent actuaries estimated the monthly premium for 2008 would be $41. Recently, Medicare officials announced that the 2008 average monthly premium will be around $25. Seniors would have paid over $4 billion more in prescription drug premiums the first two years of the program had Democrats mandated a $35 monthly premium. Taxpayers are saving also: This past January, the actuaries projected that the prescription drug benefit will cost $113 billion less over the next 10 years than estimated the previous year, primarily because of competition and low bids.

In short, the best health reform proposals will be those that recognize and build on the virtues of our market-based medical system. Sick people around the world come here because they can't get quality care in their home countries. Many health-care professionals come here to practice, leaving behind well-meaning health-care systems where government is in charge, bureaucrats make the decisions, and where the patient doesn't have the choice he or she does in the U.S.
Mrs. Clinton may think Americans want to trade freedom and innovation for the illusory security of government regulation and surrender control of their health decisions to government bureaucrats. My bet is 2008 will teach us something different if Republicans make health care a centerpiece issue.

Mr. Rove recently left the White House, where he was an adviser to President Bush.

Title: Re: The Politics of Health Care
Post by: Crafty_Dog on September 18, 2007, 10:21:19 AM
Chattels of the Nanny State

The Democratic battle of health plans has begun in earnest now that Hillary Clinton has promised "universal" coverage. Meeting with Iowans a few weeks ago, John Edwards probably told voters more than they wanted to hear about what it means when government controls your health care: Under his proposed scheme, Americans could be punished for not going to the doctor for preventive care.

Mr. Edwards made clear that a government big enough to give you health care is big enough to take it away. "You have to go in and be checked and make sure that you are OK," he said. For example, women would be required to have regular mammograms or presumably lose their right to coverage.

Mr. Edwards could almost be channeling David Cameron, leader of Britain's opposition Tory party, who recently came up with his own scheme to deny free National Health Service treatment to those who fail to follow a healthy lifestyle. "Heavy smokers, the obese and binge drinkers who were a drain on the NHS could be denied some routine treatments such as hip replacements until they cleaned up their act," reports the London Standard.

Small wonder that Michael Ancram, a former deputy leader of the Conservative Party, has taken Mr. Cameron to task in a manifesto calling for a return to the party's core principles of lower taxation, skepticism about the European Union and tough anti-crime measures. He urged the party leadership to stop "trashing" the legacy of Margaret Thatcher and downplay its trendy embrace of gay unions and draconian economic curbs on carbon emissions.

Would that some brave Democrat might step forward to criticize Mr. Edwards for going further than almost anyone has in the U.S. to link government's provision of health services with the direct policing of personal behavior. In a free health-care market, personal responsibility and healthy habits would be encouraged through lower insurance premiums and other incentives. It's when the government pays the bill and controls the entire system that you can expect the heavy hand of the state to directly control your lifestyle.

-- John Fund

Title: Re: The Politics of Health Care
Post by: Crafty_Dog on September 19, 2007, 06:08:33 AM
HillaryCare's New Clothes
Different means but the same political destination.

Wednesday, September 19, 2007 12:01 a.m. EDT

Hillary Clinton has been blasted for months by her Democratic Presidential rivals because, until Monday, she hadn't delivered her formal campaign promises for "universal" health care. But John Edwards and Barack Obama were unfair. She beat them to the punch by at least 13 years.

The former first lady's 1993-94 health-care overhaul ended disastrously. Still, it poured the philosophical and policy foundations of the current health-care debate. As she unveils HillaryCare II, Mrs. Clinton likes to joke that it's "deja vu all over again"--and it is, unfortunately. Her new plan is called "Health Choices" and mentions "choice" so many times that it sounds like a Freudian slip. And sure enough, "choice" for Mrs. Clinton means using different means that will arrive at the same end: an expensive, bureaucratic, government-run system that restricts choice.

Begin with the "individual mandate." The latest fad after Mitt Romney's Massachusetts miracle, it compels everyone to have insurance, either through their employers or the government. Not only would this element of HillaryCare require a huge new enforcement bureaucracy, it is twinned with a "pay or play" tax on businesses that don't, or can't afford to, provide health insurance to their employees.
The plan also creates a new public insurance option, modeled after Medicare, and open to everyone, regardless of income. To keep insurance "affordable," HillaryCare II offers a refundable tax credit that limits cost to a certain percentage of income. Yet the program works at cross-purposes, because coverage mandates always drive up the price of insurance. And if the "pay or play" tax is lower than a company's current health insurance costs, a company will have every incentive to dump its employee plan and pay the tax.

Meanwhile, the private insurance industry would be restructured with far more stringent regulations. Mrs. Clinton would require nationally "guaranteed issue," which means insurers have to offer policies to all applicants. She would also command "community rating," which prohibits premium differences based on health status.

Both of these have raised costs enormously in the states that require them (such as New York), but Mrs. Clinton says they are necessary nationwide to prevent "discrimination" that infringes "on the central purposes of insurance, which is to share risk." Not quite. The central purpose of insurance is to price, and hedge against, reasonably predictable risks. It does not require socializing every last expense and redistributing wealth.

No liberal reform would be complete without repealing the Bush tax cuts of 2001 and 2003; Mrs. Clinton would foot the bill for her plan with this tax increase. The rest of the estimated $110 billion per year in new government spending would be achieved by "modernizing" health-care delivery and "promoting wellness," though this $35 billion in savings is speculative, if not fanciful. Further tax hikes would be required: That $110 billion is a back-of-the-envelope calculation, and Team Hillary is keeping the specifics in its pocket.

Given how poorly "universal" policies fared the last time around, who can blame them? Mrs. Clinton and Ira Magaziner headed a health-care task force with more than 500 members that eventually produced 1,342 numbing pages of proposals. It's hardly surprising this boondoggle died without so much as a Congressional vote.
Yet Mrs. Clinton insisted that the public had been spooked by Rush Limbaugh, an article in a marginal political journal and advertising campaigns such as "Harry and Louise." In other words, the lessons she learned were political, not substantive. She thought she had overreached with too-sweeping changes. So she and her husband began to slice their universal health-care ambitions into smaller initiatives like the 1997 State Children's Health Insurance Program (Schip).

This is her strategy now. HillaryCare II is designed to cause minimal disruptions to current private insurance coverage in the short run, while dressing up the old agenda with slightly different mechanisms and rhetoric. Rather than fight small business, this time she is trying to seduce it with tax credits for small companies that provide insurance. Only later when costs rise will the credits shrink or other taxes rise. To court large manufacturers, like the auto and steel industries, she'll offer another, "temporary" tax credit to subsidize their health-care liabilities. Her plan, in short, is HillaryCare I in better clothes--a transitional platform to shift people to the default option, which is government insurance.

What's striking about all this is how little new thinking there is. Like the other Democratic proposals, HillaryCare II would mark another major government intrusion into health care. It would keep all of the system's current problems, most of them created by government policies, and entrench and expand them. The creativity is all in the political repackaging.

Title: Re: The Politics of Health Care
Post by: Crafty_Dog on September 22, 2007, 07:15:07 AM
This article from today's NY Slimes could easily have gone in the Media thread as an example of liberal media bias-- witness the repeated efforts to blur the distinction between illegal and legal immigrants.  It could also have gone in the immigration thread as an example of the consequences of illegal immigration.  And it fits here-- this has all the makings of a political football.

Immigrants’ Emergency Care Is Limited by U.S. Rule


Published: September 22, 2007
The federal government has told New York State health officials that chemotherapy, which had been covered for illegal immigrants under a government-financed program for emergency medical care, does not qualify for coverage. The decision sets the stage for a battle between the state and federal governments over how medical emergencies are defined.

The change comes amid a fierce national debate on providing medical care to immigrants, with New York State officials and critics saying this latest move is one more indication of the Bush administration’s efforts to exclude the uninsured from public health services.
State officials in New York and other states have found themselves caught in the middle. The New York dispute, focusing on illegal immigrants with cancer — a marginal group of unknown size among the more than 500,000 people living in New York illegally — has become a flash point for health officials and advocates for immigrants in recent weeks.

Under a limited provision of Medicaid, the national health program for the poor, the federal government permits emergency coverage for illegal immigrants and other noncitizens. But the Bush administration has been more closely scrutinizing and increasingly denying state claims for federal payment for some emergency services, Medicaid experts said.

Last month, federal officials, concluding an audit that began in 2004 and was not challenged by the state until now, told New York State that they would no longer provide matching funds for chemotherapy under the emergency program. Yesterday, state officials sent a letter to the federal Medicaid agency protesting the change, saying that doctors, not the federal government, should determine when chemotherapy is needed.

Federal health officials declined to discuss chemotherapy or the New York claims. But Dennis Smith, director of the Center for Medicaid and State Operations at the federal Centers for Medicare and Medicaid Services, said in a statement, “Longstanding interpretations by the agency have been that emergency Medicaid benefits are to cover emergencies.”

The federal statute that defines an emergency under Medicaid makes it clear that routine care for illegal immigrants and nonresidents, including foreign students and visitors, is not covered. But the only procedures it specifically excludes from reimbursement are organ transplants, leaving to the states the task of further defining an emergency. States and courts have grappled with the question for years, yielding no clear definition.

Some states have maintained that any time a patient is able to schedule an appointment — as opposed to showing up at an emergency room — the condition would not be considered an emergency. Others, including New York, have defined an emergency as any condition that could become an emergency or lead to death without treatment.

“There are clearly situations that we consider emergencies where we need to give people chemotherapy,” Richard F. Daines, the New York State health commissioner, said in an interview late yesterday. “To say they don’t qualify is self-defeating in that those situations will eventually become emergencies.”

Dr. Daines said that for every effort in the state to use Medicaid “creatively” to cover the uninsured, “the Bush administration, at every chance, is pushing it back.”

The state estimated that the federal government denied $60 million in matching funds for emergency Medicaid from 2001 to 2006, including $11.1 million for chemotherapy. Medicaid costs are typically split evenly between the state and the federal government.

It is unclear how many other states are providing chemotherapy to illegal immigrants, because all emergency services are generally lumped together in state Medicaid reports. But others have also been challenged on emergency Medicaid claims.

In Washington State, where illegal immigrants are entitled to Medicaid coverage for a month or more after treatment in an emergency, officials said a federal audit of their emergency Medicaid claims was under way, and the state has asked the federal government to provide a definition of emergency services.

“The awkward position state Medicaid programs are in is trying to figure out what kinds of medical care should be available for emergency conditions,” said Douglas Porter, assistant secretary for the Washington Health and Recovery Services Administration.

Washington and other states have also fought the federal government over Medicaid for infants born to illegal immigrants, an issue reflected in the ferocious debate over the national children’s health insurance program.

In the wake of stricter federal rules, New York, New Jersey, Connecticut and 20 other states have extended full Medicaid coverage, using only state money, to some immigrants who do not qualify for federal aid. Under federal law, proof of citizenship is required for full Medicaid coverage, but not for emergency coverage.


(Page 2 of 2)

But some states with growing immigrant populations, like Georgia and Arizona, have themselves moved to limit coverage under emergency Medicaid, leading to intense opposition from immigrant health advocates.

Advocates for breast cancer patients said they were particularly concerned about the denial of coverage after lobbying the federal government for years to provide breast cancer screening to uninsured women. Under a program offered to underinsured and uninsured women, the Centers for Disease Control and Prevention provides free or low-cost screening.

“To allow women to be diagnosed with breast cancer and then create an obstacle for them to get treatment is a horrendous policy,” said Donna Lawrence, executive director of Susan G. Komen for the Cure in New York.

In New York City, cancer kills 15,000 residents a year. It is the second leading cause of death among both the native- and the foreign-born, according to a 2006 survey by the city’s health department, with lung, breast and colon cancer the top killers.

The state had initially accepted the federal finding that New York was not entitled to federal reimbursement for chemotherapy under the emergency Medicaid program. But until last month, state health officials had not informed medical providers that the treatment would no longer be covered by either state or federal funds.

That provoked a pitched outcry from immigrant health advocates over the last few weeks, and state health officials reversed their position this week, saying Medicaid should cover the treatment.

State officials said they were challenging the federal decision on the grounds that chemotherapy treatment qualifies as an emergency under the federal government’s own rules. Certain conditions, including diseases of the brain, spinal cord and bone marrow disease, could require immediate chemotherapy.

The state’s letter also said that chemotherapy can be used to “cure cancer, control cancer and/or ease cancer symptoms,” and that if that the measures typically used to treat cancer were not available to patients, their health could be in serious jeopardy — one of the federal criteria in determining an emergency.

The cost of emergency Medicaid is still a relatively small portion of state Medicaid budgets, experts said, and a majority of the money is spent on care for pregnant women, labor and delivery. But the demand for it rising quickly as the immigrant population balloons.

Health advocates say that many illegal immigrants who need and qualify for emergency care are afraid to seek help, and that emergency Medicaid is underused.

A recent study of emergency Medicaid services in North Carolina found that spending, largely devoted to pregnant women, increased by 28 percent from 2001 to 2004; still, the emergency costs accounted for less than 1 percent of total Medicaid expenditures.

New York City public hospitals, which serve 400,000 uninsured patients a year, among them illegal immigrants, would continue to provide the cancer treatment no matter what, said officials from the Health and Hospitals Corporation. But if there is no reimbursement from Medicaid, they said, they will have to look elsewhere for financial support.
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on September 22, 2007, 09:55:07 AM

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HillaryCare Flops in California
September 22, 2007

SACRAMENTO, Calif. -- Hillary Clinton is patting herself on the back for proposing a health-care plan that is much more politically astute than her 1993 Rube Goldberg effort. She told an audience in New York this week: "I think I have successfully thought through all of the objections and pre-empted them."

She may want to think again. Last January, California Gov. Arnold Schwarzenegger proposed an eerily similar plan using the same rhetoric and even the same slogan adopted by Mrs. Clinton to describe hers: "Shared Responsibility."

That's no coincidence. Both ArnoldCare and HillaryCare 2.0 are the product of the same advisers. But despite all of its clever political compromises, ArnoldCare is bogged down in trench warfare in California's liberal Democratic legislature. If anything passes, it will likely be only a shell of a bill without any financing component. Legislators will hope voters approve a general tax increase to pay for it in November 2008.

The two plans have many features in common. ArnoldCare's $12 billion-a-year price tag represents about a 10th of Mrs. Clinton's estimate for the costs of her plan, roughly in line with California's share of the national economy. Both include mandates to buy health insurance, a ban on premium differences based on health status, Medicaid expansion, and a requirement that insurers have to offer policies to all applicants.

All of this is the brainchild of Laurie Rubiner, who directed health-care issues at the liberal New America Foundation until she left in 2005 to become Mrs. Clinton's Senate legislative director. She was replaced by Len Nichols, who in 1993 served as the liaison between President Bill Clinton's budget office and Mrs. Clinton's health-care task force. Ms. Rubiner isn't taking direct credit for selling Mr. Schwarzenegger on her plan, but aides to the governor confirm her role. Steve Clemons of the New America Foundation acknowledges that Ms. Rubiner "incubated and hatched" the ideas at the heart of the governor's plan. Ms. Rubiner declined to respond to a request for an interview.

Given the similarities, here are some political lessons that ArnoldCare might teach us about how Mrs. Clinton's plan might be received:

• The claim that no new bureaucracies are created will be challenged. Like Gov. Schwarzenegger, Mrs. Clinton envisions requiring everyone to prove they have health insurance. But she's vague on the details: "At this point, we don't have anything punitive that we have proposed." You can bet she will have some ideas.

Even so, making certain people have insurance is easier said than done. California has had a law mandating that drivers have car insurance since 1970 and has required physical proof of insurance to register a car for a decade. Even so, the Insurance Research Council says 25% of the state's drivers remain uninsured.

• Illegal aliens and their access to health insurance will be controversial. Mrs. Clinton promises health care for all, but is punting on the issue of whether the illegal aliens who often use emergency room services will be covered. Ms. Rubiner admits it's a "huge issue," but says "that's one we're going to have to think through a little bit."

Criticism of the governor's plans to cover illegal aliens forced him to drop the idea, but this week he fumed at those who raise such "Mickey Mouse"-type concerns. Mrs. Clinton's plan could be caught between populist forces opposing health care for illegal aliens and liberals who will insist on it.

• Hoping for bipartisan support isn't the same thing as getting it. Gov. Schwarzenegger sincerely believed he could convince Republicans to support his plan. In the end, he couldn't find anyone from either party to push his plan in the legislature. It was too tax-heavy for Republicans (his effort to call proposed tax hikes "loans" flopped) and not nearly interventionist enough for Democrats.

"The governor got significant parts of the business community to sign on, from Safeway to the Los Angeles Chamber of Commerce," one adviser to the governor told me. "But that didn't move the anti-tax Republican base."

• Nothing big passes Congress these days without bipartisan support. "The lesson from California is just how difficult it is to deal with so many players that have such disparate demands," says Dan Walters, a columnist for the Sacramento Bee. "The governor's original plan had the doctors opposing the fees it imposed on them and the nurses' union upset because it wasn't single-payer. Having all the first responders who dress in white opposing your plan isn't politically healthy."

Sen. Clinton claims she now realizes she'll need actual votes to pass something. But traces of the old Hillary remain. "I wish it were possible to just wave a magic wand and say from the White House, 'Here's what I want.' But that's not the way it works," she told the Associated Press.

The real test may be her willingness to accept some market-oriented GOP proposals such as tax-free savings accounts for health care and a curb on frivolous liability lawsuits as the price for the bipartisan support she now claims to want. Now that really would be a New Hillary.

Mr. Fund is a columnist for
Title: Re: The Politics of Health Care
Post by: G M on September 23, 2007, 10:27:41 AM
September 23, 2007, 0:00 a.m.

Tough Days for Freedom
The heart of the matter.

By Mark Steyn

Our theme for today comes from George W Bush: “Freedom is the desire of every human heart.”

When the president uses the phrase, he’s invariably applying it to various benighted parts of the Muslim world. There would seem to be quite a bit of evidence to suggest that freedom is not the principal desire of every human heart in, say, Gaza or Waziristan. But why start there? If you look in, say, Brussels or London or New Orleans, do you come away with the overwhelming impression that “freedom is the desire of every human heart”? A year ago, I wrote that “the story of the western world since 1945 is that, invited to choose between freedom and government ‘security,' large numbers of people vote to dump freedom — the freedom to make your own decisions about health care, education, property rights, seat belts and a ton of other stuff.”

This week freedom took another hit. Hillary Rodham Clinton unveiled her new health-care plan. Unlike her old health-care plan, which took longer to read than most cancers do to kill you, this one’s instant and painless — just a spoonful of government sugar to help the medicine go down. From now on, everyone in America will have to have health insurance.


And, if you don’t, it will be illegal for you to hold a job.

Er, hang on, where’s that in the constitution? It’s perfectly fine to employ legions of the undocumented from Mexico, but if you employ a fit 26-year-old American with no health insurance either you or he or both of you will be breaking the law?

That’s a major surrender of freedom from the citizen to the state. “So what?” say the caring crowd. “We’ve got to do something about those 40 million uninsured! Whoops, I mean 45 million uninsured. Maybe 50 by now.” This figure is always spoken of as if it’s a club you can join but never leave: The very first Uninsured-American was ol’ Bud who came back from the Spanish-American War and found he was uninsured and so was first on the list, and then Mabel put her back out doing the Black Bottom at a tea dance in 1926 and she became the second, and so on and so forth, until things really began to snowball under the Bush junta. And, by the time you read this, the number of uninsured may be up to 75 million.

Nobody really knows how many “uninsured” there are: Two different Census Bureau surveys conducted in the same year identify the number of uninsured as (a) 45 million or (b) 19 million. The (a) figure is the one you hear about, the (b) figure apparently entered the Witness Protection Program. Of those 45 million “uninsured Americans”, the Census Bureau itself says over nine million aren’t Americans at all, but foreign nationals. They have various health-care back-ups: If you’re an uninsured Canadian in Detroit and you get an expensive chronic disease, you can go over the border to Windsor, Ontario, and re-embrace the delights of socialized health care; if you’re an uninsured Uzbek, it might be more complicated. Of the remaining 36 million, a 2005 Actuarial Research analysis for the Department of Health and Human Services says that another nine million did, in fact, have health coverage through Medicare.

Where are we now? 27 million? So who are they? Bud and Mabel and a vast mountain of emaciated husks of twisted limbs and shriveled skin covered in boils and pustules? No, it’s a rotating population: People who had health insurance but changed jobs, people who are between jobs, young guys who feel they’re fit and healthy and at this stage of their lives would rather put a monthly health tab towards buying a home or starting a business or blowing it on booze ‘n’ chicks.

That last category is the one to watch: Americans between the ages of 18 and 34 account for 18 million of the army of the “uninsured.” Look, there’s a 22-year old and he doesn’t have health insurance! Oh, the horror and the shame! What an indictment of America!

Well, he doesn’t have life insurance, either, or homeowner’s insurance. He lives a life blessedly free of the tedious bet-hedging paperwork of middle-age. He’s 22 and he thinks he’s immortal — and any day now Hillary will propose garnisheeing his wages for her new affordable mandatory life-insurance plan.

So, out of 45 million uninsured Americans, nine million aren’t American, nine million are insured, 18 million are young and healthy. And the rest of these poor helpless waifs trapped in Uninsured Hell waiting for Hillary to rescue them are, in fact, wealthier than the general population. According to the Census Bureau’s August 2006 report on “Income, Poverty and Health Insurance Coverage,” 37 percent of those without health insurance — that’s 17 million people — come from households earning more than $50,000. Nineteen percent — 8.7 million people — of those downtrodden paupers crushed by the brutal inequities of capitalism come from households earning more than $75,000.

In other words, if they fall off the roof, they can write a check. Indeed, the so-called “explosion” of the uninsured has been driven almost entirely by wealthy households opting out of health insurance. In the decade after 1995 — i.e., since the last round of coercive health reform — the proportion of the uninsured earning less than 25,000 has fallen by 20% and the proportion earning more than 75 grand has increased by 155%. The story of the last decade is that the poor are getting sucked into the maw of “coverage” and the rich are fleeing it. And, given that the cost of health “insurance” bears increasingly little relationship to either the cost of treatment or the actuarial reality of you ever getting any particular illness, it’s entirely rational to say: “You know what? I’ll worry about that when it happens. In the meantime, I want to start a business and send my kid to school.” Freedom is the desire of my human heart even if my arteries get all clogged and hardened.

I was glad, at the end of Hillary Health Week, to see that my radio pal Laura Ingraham’s excellent new book Power To The People has shot into the New York Times Bestseller List at Number One. It takes a fraudulent leftist catchphrase (the only thing you can guarantee about a “people’s republic” is that the people are the least of it) and returns it to those who mean it - to those who believe in a nation of free citizens exercising individual liberty to make responsible choices.

Do you remember the so-called “government surplus” of a few years ago? Bill Clinton gave a speech in which he said, yes, sure, he could return the money to taxpayers but that we “might not spend it the right way”. The American political class has decided that they know better than you the “right way” to make health-care decisions. Oh, don’t worry, you’re still fully competent to make decisions on what car you drive and what movie you want to rent at Blockbusters. For the moment. But when it comes to the grown-up stuff best to leave that to Nurse Hillary.
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on October 01, 2007, 02:27:33 PM
“[T]he so-called ‘explosion’ of the uninsured has been driven entirely by wealthy households opting out of health insurance. In the decade after 1995—i.e., since the last round of coercive health reform—the proportion of the uninsured earning less than $25,000 has fallen by 20 percent, and the proportion earning more than 75 grand has increased by 155 percent. The story of the past decade is that the poor are getting sucked into the maw of ‘coverage,’ and the rich are fleeing it. And, given that the cost of health ‘insurance’ bears increasingly little relationship to either the cost of treatment or the actuarial reality of you ever getting any particular illness, it’s entirely rational to say: ‘You know what? I’ll worry about that when it happens. In the meantime, I want to start a business and send my kid to school.’ Freedom is the desire of my human heart even if my arteries get all clogged and hardened.” —Mark Steyn

“Governments are not empowered to grant rights; governments can only limit, or extinguish rights. Governments can, however, bestow gifts upon its citizens. But in order to do so, governments must first take resources from those who have earned them, and redistribute those resources to others. Hillary-care, Obama-care, Edwards-care, and every other form of socialized medicine, is inherently fraught with fraud, abuse, and corruption... If the federal government is to be involved in health care, it should be looking toward encouraging, and providing incentives for private medical care that is determined between the patient and provider. The problem is complex, and cannot be solved by any government program. Health care is certainly one of the primary areas where the principles of freedom should be observed and advanced. Any candidate, or politician, who thinks government can solve the problem better than a free market, should be rejected.” —Henry Lamb
Title: Re: The Politics of Health Care
Post by: Maxx on October 03, 2007, 01:21:55 PM
Here is a nice one from Mister Bush  :roll:

Bush vetoes child health insurance plan

President, Congress battle over $30 billion coverage difference
WASHINGTON - President Bush, in a sharp confrontation with Congress, on Wednesday vetoed a bipartisan bill that would have dramatically expanded children's health insurance.
It was only the fourth veto of Bush's presidency, and one that some Republicans feared could carry steep risks for their party in next year's elections. The Senate approved the bill with enough votes to override the veto, but the margin in the House fell short of the required number.
Senate Majority Leader Harry Reid, D-Nev., decried Bush's action as a "heartless veto."
"Never has it been clearer how detached President Bush is from the priorities of the American people," Reid said in a statement. "By vetoing a bipartisan bill to renew the successful Children's Health Insurance Program, President Bush is denying health care to millions of low-income kids in America. "
The White House sought little attention, with Bush casting his veto behind closed doors without any fanfare or news coverage. He was discussing it later Wednesday during a budget speech in Lancaster, Pa.
Socialized medicine?
The State Children's Health Insurance Program is a joint state-federal effort that subsidizes health coverage for 6.6 million people, mostly children, from families that earn too much to qualify for Medicaid but not enough to afford their own private coverage.
The Democrats who control Congress, with significant support from Republicans, passed the legislation to add $35 billion over five years to allow an additional 4 million children into the program. It would be funded by raising the federal cigarette tax by 61 cents to $1 per pack.
The president had promised to veto it, saying the Democratic bill was too costly, took the program too far from its original intent of helping the poor, and would entice people now covered in the private sector to switch to government coverage. He wants only a $5 billion increase in funding.
Bush argued that the congressional plan would be a move toward socialized medicine by expanding the program to higher-income families.
Democrats deny that, saying their goal is to cover more of the millions of uninsured children and noting that the bill provides financial incentives for states to cover their lowest-income children first. Of the over 43 million people nationwide who lack health insurance, over 6 million are under 18 years old. That's over 9 percent of all children.
Veto override considerations
Eighteen Republicans joined Democrats in the Senate, enough to override Bush's veto. But this was not the case in the House, where despite sizable Republican support, supporters of the bill are about two dozen votes short of a successful override.
House Majority Leader Steny Hoyer, D-Md., said Democrats were imploring 15 House Republicans to switch positions but had received no agreements so far.
House Minority Whip Roy Blunt, R-Mo., said he was "absolutely confident" that the House would be able to sustain Bush's expected veto.
Senate Minority Whip Trent Lott, R-Miss., said Congress should be able to reach a compromise with Bush once he vetoes the bill. "We should not allow it to be expanded to higher and higher income levels, and to adults. This is about poor children," he said. "But we can work it out."
It took Bush six years to veto his first bill, when he blocked expanded federal research using embryonic stem cells last summer. In May, he vetoed a spending bill that would have required troop withdrawals from Iraq. In June, he vetoed another bill to ease restraints on federally funded stem cell research.
Bush's letter to Congress on insurance bill veto
War between the states over health insurance
  In veto math, the magic number is 146
Bush veto: A blessing or curse for Republicans?
New York Times Politics

In the case of the health insurance program, the veto is a bit of a high-stakes gambit for Bush, pitting him against both the Democrats who have controlled both houses of Congress since January, but also many members of his own party and the public.
The Democratic Congressional Campaign Committee launched radio ads Monday attacking eight GOP House members who voted against the bill and face potentially tough re-election campaigns next year.
And Gerald McEntee, president of the American Federation of State, County and Municipal Employees union, said a coalition of liberal groups planned more than 200 events throughout the nation to highlight the issue.
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on October 04, 2007, 06:09:45 AM
I support President Bush's veto.

We need to read beyond the title of the bill.  It was not about "supporting poor children"-- it expanded coverage FAR beyond that.  This bill was simply another shot fired in the Democrats attack on the remaining vestiges of the private sector in our health care.

Title: Re: The Politics of Health Care
Post by: Maxx on October 04, 2007, 09:28:19 AM
The problem is that as far as I am aware P. Bush veto's anything that comes to Poor children or Poor folk's in general. I don't think in the past 8 year's he has shown that much Concern for the well being of the poor. Maybe I am wrong here in the fact that he has gone out of his way to better the lives of poor Americans and if he has then I must be reading the wrong report's and watching the wrong poll's

Either way a Pres. must be aware that his first duty is the duty to his people..Health, Education and Protection and none of these seem to be on any Politicans mind lol!
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on October 04, 2007, 09:37:29 AM

"Bush veto's (sic) anything that comes to Poor children or Poor folk's (sic) in general."

This simply is factually wrong.  This is only the second veto of Bush's presidency.   Please forgive my bluntness, but the rest of your post is mostly at variance with the facts as well.  Spending under Bush has gone up massively across the board-- including to "the poor".  This is not to say he doesn't have especially soft places in his heart for certain corporate interests, but the mob has been feeding at the public trough with little restraint during his presidency.

Title: Re: The Politics of Health Care
Post by: Maxx on October 04, 2007, 10:29:31 AM
Like I said, I could be wrong but I just go off of what I read and why his rating's are at record low's and even how he is not very popular in his own Party because of the choices he makes. Be it War choices, Public choices or whatever choices the man makes they don't always seem to be the best ideas on where to put money.

I am neither a Republican nor a Democrate..I have never voted the party and only the issue , so my views are never based off I am a democrate and I must hate republican's or the other way around.

And what about Bush Housing Plan did that ever go though?

And ya..I voted for CONAN errr Arnold.  :mrgreen:

Title: Re: The Politics of Health Care
Post by: Crafty_Dog on October 04, 2007, 11:05:09 AM
As noted in the Media thread, much of what we are given to read is not honest-- due diligence is a must!  Bush's popularity and lack thereof has much to do with Iraq-- and worth noting is that Congress's ratings are distinctly worse than his!!!

Here's this:

Schip Hits the Fan

The crocodile outrage flowed fast and deep yesterday after President Bush's promised veto of the Schip bill that would have vastly expanded a federal subsidy for children's health care.

Ted Kennedy called it "the most inexplicable veto in the history of the country." Barack Obama decried a "callousness of priorities." Nancy Pelosi flirted with the edges of self-parody, saying: "President Bush used his cruel veto pen to say 'I forbid 10 million children from getting the health benefits they deserve.'"

Of course, the veto will not actually deprive any current enrollees (10% of whom are adults) of medical care. President Bush made sure of that when he signed a continuing resolution funding the program until an accommodation is reached. Count on this fact remaining little noticed amid the current political circus.

Democrats believe they have a strong shot at overriding the veto, but will wait a week or two to continue milking the controversy and to solidify a campaign issue for 2008. Of the eight House Democrats who opposed the expansion and three others who didn't vote, the leadership has already rolled five of them. That means at least 14 Republicans need to turn over as well, out of 151 in the opposition.

To that end, lobbying groups including Families USA,, AARP, SEIU and AFSCME, as well as the Democratic Party, are mounting an advertising campaign targeting vulnerable Republicans, mainly in swing districts. No doubt we'll see more of the same end-of-days hysteria.

Harry Reid in particular has been trying to shame Republicans by name, singling out Rep. Roscoe Bartlett of Maryland, the only member of his delegation to vote nay. In response, Mr. Bartlett thanked Mr. Reid "for recognizing that I cast the only correct vote about Schip in the state of Maryland.... Democrats are demanding that Schip be expanded to have government-controlled, taxpayer-paid health care for millions of children who already have private health coverage."

In a soundbite, Mr. Bartlett has exactly described what the battle is all about.
Political Journal WSJ
Title: Health Care needs an Internet Revolution: Bill Gates
Post by: Crafty_Dog on October 05, 2007, 09:43:29 AM
Health Care Needs an Internet Revolution
October 5, 2007; Page A17

We live in an era that has seen our knowledge of medical science and treatment expand at a speed that is without precedent in human history. Today we can cure illnesses that used to be untreatable and prevent diseases that once seemed inevitable. We expect to live longer and remain active and productive as we get older. Ongoing progress in genetics and our understanding of the human genome puts us on the cusp of even more dramatic advances in the years ahead.

But for all the progress we've made, our system for delivering medical care is clearly in crisis. According to a groundbreaking 1999 report on health-care quality published by the Institute of Medicine (the medical arm of the National Academy of Sciences) as many as 98,000 Americans die every year as a result of preventable medical errors. That number makes the health-care system itself the fifth-leading cause of death in this country.

Beyond the high cost in human life, we pay a steep financial price for the inability of our health-care system to deliver consistent, high-quality care. Study after study has documented the billions of dollars spent each year on redundant tests, and the prolonged illnesses and avoidable injuries that result from medical errors. The impact ripples through our society, limiting our ability to provide health care to everyone who needs it and threatening the competitiveness of U.S. businesses, which now spend an average of $8,000 annually on health care for employees.

At the heart of the problem is the fragmented nature of the way health information is created and collected. Few industries are as information-dependent and data-rich as health care. Every visit to a doctor, every test, measurement, and procedure generates more information. But every clinic, hospital department, and doctor's office has its own systems for storing it. Today, most of those systems don't talk to each other.

Isolated, disconnected systems make it impossible for your doctor to assemble a complete picture of your health and make fully informed treatment decisions. It also means that the mountain of potentially lifesaving medical information that our health-care system generates is significantly underutilized. Because providers and researchers can't share information easily, our ability to ensure that care is based on the best available scientific knowledge is sharply limited.

There is widespread awareness that we need to address the information problem. In 2001, the Institute of Medicine issued a follow-up report on health-care quality that urged swifter adoption of information technology and greater reliance on evidence-based medicine. In his 2006 State of the Union address, President Bush called on the medical system to "make wider use of electronic records and other health information technology."

But increased digitization of health-care information alone will not solve the problems we face. Already, nearly all procedures, test results and prescriptions are recorded in digital form -- that's how health-care providers transmit information to health insurers so they can be paid for their work. But patients never see this data, and doctors are unable to share it. Instead, individuals do their best to piece together the information that they think their caregivers might need about their medical history, the medications they take and the tests they've undergone.

What we need is to place people at the very center of the health-care system and put them in control of all of their health information. Developing the solutions to help make this possible is an important priority for Microsoft. We envision a comprehensive, Internet-based system that enables health-care providers to automatically deliver personal health data to each patient in a form they can understand and use. We also believe that people should have control over who they share this information with. This will help ensure that their privacy is protected and their care providers have everything they need to make fully-informed diagnoses and treatment decisions.

I believe that an Internet-based health-care network like this will have a dramatic impact. It will undoubtedly improve the quality of medical care and lower costs by encouraging the use of evidence-based medicine, reducing medical errors and eliminating redundant medical tests. But it will also pave the way toward a more important transformation.

Today, our health-care system encourages medical professionals to focus on treating conditions after they occur -- on curing illness and managing disease. By giving us comprehensive access to our personal medical information, digital technology can make us all agents for change, capable of pushing for the one thing that we all really care about: a medical system that focuses on our lifelong health and prioritizes prevention as much as it does treatment. Putting people at the center of health care means we will have the information we need to make intelligent choices that will allow us to lead healthy lives -- and to search out providers who offer care that does as much to help us stay well as it does to help us get better.

The technology exists today to make this system a reality. For the last 30 years, computers and software have helped industry after industry eliminate errors and inefficiencies and achieve new levels of productivity and success. Many of the same concepts and approaches that have transformed the world of business -- the digitization of information, the creation of systems and processes that streamline and automate the flow of data, the widespread adoption of tools that enable individuals to access information and take action -- can be adapted to the particular requirements of health care.

No one company can -- or should -- hope to provide the single solution to make all of this possible. That's why Microsoft is working with a wide range of software and hardware companies, as well as with physicians, hospitals, government organizations, patient advocacy groups and consumers to ensure that, together, we can address critical issues like privacy, security and integration with existing applications.

Technology is not a cure-all for the issues that plague the health-care system. But it can be a powerful catalyst for change, here in the U.S. and in countries around the globe where access to medical professionals is limited and where better availability of health-care information could help improve the lives of millions of people.

Mr. Gates is chairman of the Microsoft Corporation.

Title: Re: The Politics of Health Care
Post by: nasigoreng on October 05, 2007, 03:22:53 PM
John Stossel: 20/20 Sick In America

profits drive accountability. accountability improves service. Improving service increases customer satisfaction.
when a government apparatus is put in place without viable free market alternatives, there is no incentive to improve services and satisfy customers. Case in point: America's public schools:

Title: Death as a Positive Feedback Mechanism
Post by: buzwardo on October 13, 2007, 03:20:00 PM
The NHS wins when its patients die

By Charles Moore
Last Updated: 12:01am BST 13/10/2007

 Have your say      Read comments

Florence Nightingale's famous Notes on Nursing, published in 1859, state that "the greater part of nursing consists in cleanliness". In my edition, the foreword points out that much of Miss Nightingale's writing, excellent though it is, is now out of date. In particular, the need for cleanliness is well understood. That foreword was written in 1946.

Now it is 2007, and we learn that nurses in the hospitals run by the Maidstone and Tunbridge Wells NHS Trust told patients suffering from diarrhoea to "go in their beds". Between 2004 and 2006, 90 patients treated in those hospitals died from Clostridium difficile, and the disease was a factor in the death of a further 241.

Were it not for bad nursing, bad medical attention and bad administration, none of these patients need have died. Indeed, they would not have contracted C. difficile at all unless they had gone into hospital. So, after 150 years' advance of education, technology, prosperity and science, we have lost what Florence Nightingale taught.

It was the distressing subject of diarrhoea, indeed, that provoked Miss Nightingale to one of her most trenchant footnotes. She gave the example of how, if a bedpan with a lid were changed only once a day ("As well might you have a sewer under the room"), by a maid rather than a nurse, the problem might go undetected. he bedpan must be changed frequently, inspected, and all of it, including its lid, properly cleaned.

I notice that the Healthcare Commission's report on Maidstone says that stool charts, i.e. recorded inspections of the diarrhoea, were made in fewer than 15 per cent of cases.

Florence Nightingale adds: "If a nurse declines to do these kinds of things for her patient, 'because it is not her business', I should say that nursing is not her calling." It is a "waste of power", she says, for nurses to do things such as scouring floors, but if it needs doing, they must do it: "the true nurse-calling" puts "the good of their sick first, and second only the consideration what is their 'place'?".

The testimony of the families from the Maidstone area is that their relations who died were often humiliated, left in filth, and ignored. The weakest — the old — were treated the worst. It was a failure of systems, yes, but also of individual professionals and of common humanity.

Every year, as a journalist, I go to party conferences and hear politicians of all parties make speeches about how wonderful the National Health Service is. Gordon Brown got all weepy this year about how it saved one of his eyes.

Last year, David Cameron said that where Tony Blair had spoken of three words — "Education, education, education" — he would emphasise three letters — "N-H-S".

The point our leaders are constantly making is not medical, but moral. It is that the NHS embodies organised altruism. It proves that we, as a nation, care for one another. It makes us "the envy of the world", and it makes us good.

One naturally wants to agree. We all like to think that matters of life and death are well looked after. And most of us will have direct experience of NHS nurses and doctors who have treated us with great kindness, care and skill.

Nevertheless, the basic proposition is not true. The National Health Service is not, morally, or in any other way, the best system of healthcare in the world. Indeed, it is morally defective at its very root, because it does not — cannot — put the sick first. Until this is recognised, it cannot be reformed.

The NHS is, with our state school system, the last major survival in this country of the idea of the 1940s that government can decide what is best for us and make sure that it is done. Aneurin Bevan, who invented the thing, once said that not a bed-pan (that object again) should fall to the ground without the minister knowing about it.

A colleague of mine, who investigated alternative healthcare systems when the extreme dirtiness of many British hospitals first became an issue, went to France to compare. In hospital after hospital, he found floors so clean that you could have eaten your lunch off them. Did the Health Minister order them to clean them, he asked an administrator.

He was met with a look of incredulity. "Of course not. We run ourselves. Patients have a choice of hospital. If they do not choose us, we get no money. No hospital can survive if it is not clean."

Two weeks ago in Bournemouth, Gordon Brown was on to the subject of C. difficile, babbling about ordering "deep clean" and more than doubling the number of hospital matrons to 5,000.

"Bring back matron" has become a party conference cry, like "Bring back the rope" used to be. But matron will be only a name so long as Mr Brown (or whoever is Prime Minister) ultimately decides who should have what where.

We all know that a Minister for Industry could not possibly decide how many computers we produce or how many investment banks we should have. We all know that a Minister for Food could not wisely decree what vegetables should be sold in which shops.

But we cling to the idea that a single organisation employing 1.4 million people, with the GDP of an entire Scandinavian country, run by politicians, can meet our health needs.

Suppose Sainsbury's cold meat counter was found to have helped kill more than 300 people, would the company survive? Yet the NHS sails on, dealing death. According to a report four years ago by Professor Karol Sikora, we could save 10,000 deaths a year from cancer, just by hitting the European average; but we don't, and nobody takes the blame.

The boyfriend of the chief executive of the death-dealing Maidstone trust tells the press: "No way is she going to talk to you. Why should she?" The trust has arranged her severance pay of £250,000.

We all complain about the "target culture" that made administrators in Maidstone ignore actual human suffering before their eyes. But if you have a top-down system of healthcare, targets are the inevitable response to whatever is the latest disaster.

In this case, one of the targets was to cut waiting times in Accident and Emergency to four hours (four hours! You wouldn't put up with that to buy a cinema ticket, yet we have been brainwashed into thinking that it's not too bad for your child with a broken arm). In this world without choice, each claim of need jostles against another: either faster A&E, or cleaner bed-pans, but not both.

This is all, morally, wrong. It turns the patient from being the entity for which the service exists into a nuisance. Each new patient is just an added cost and each dead patient is an administrative convenience.

Under systems of social insurance, such as exist in Germany, Belgium or France, many problems remain, but this most basic one disappears. Money goes with each patient, who can choose who treats him. Therefore every doctor, hospital and nurse wants patients.

Our system also turns the nurse and doctor away from their duty, and therefore attacks their moral sense. It tells them to ignore "the habit of observation", which, said Florence Nightingale, was the key skill of nursing, in favour of through-put or targets or — for human nature reasserts its worse side when badly led — sneaking off home exhausted and disillusioned.

The NHS is run from top to bottom, and therefore, from top to bottom, it is bad.;jsessionid=5BRUDBCNSKWZ5QFIQMGCFFOAVCBQUIV0?xml=/opinion/2007/10/13/do1302.xml
Title: The Health Cost Myth
Post by: Crafty_Dog on November 13, 2007, 04:20:02 AM
The Health Cost Myth
November 13, 2007; Page A25

'As major employers, we are engaging in one of the most crucial domestic policy debates of our time -- fixing our nation's health-care crisis, reducing out of control costs, and ensuring every American has affordable health care," said CEO Steve Burd of Safeway, a supermarket chain, earlier this year.

He's not alone. Several American business leaders have come to believe that the American health-care system is not only bad for our health but also for national competitiveness. In the automotive industry, General Motors claims that it spends about $1,600 per car on health care. In Japan, according to GM, Toyota's per automobile healthcare expenditure is just $110.

Some politicians and executives have concluded that the "solution" to this problem is universal, government-run health care. They must be onto something, right?

Health coverage is indeed becoming more expensive for businesses. Over the past eight years, the percentage of firms offering health benefits to employees has dropped significantly, to 60% from 69%.

This decline, however, is almost completely accounted for by businesses with fewer than 10 employees.

These firms find health benefits unaffordable because states have laid a massive burden of over-regulation on small-group health insurance since the early 1990s, making it increasingly expensive. In the face of this, the freedom to contract employment without health benefits provides a valuable option for American entrepreneurs and workers. Only in the U.S. can they opt out of the government-regulated health "system," if it allows them to be more competitive.

But what about the share of Gross Domestic Product (GDP) spent on health care, a metric of health system performance and value that some consider definitive? The United States leads the pack in this regard, spending far more on health than other countries. Surely this puts the U.S. at a competitive disadvantage, doesn't it?

No: It's the other way around. America's high productivity gives us the ability to spend more on health care, especially the latest treatments and technologies, than other developed nations that labor under forms of socialized health care.

Robert L. Ohsfeldt and John R. Schneider of the American Enterprise Institute have determined that health spending increases at a constant rate of about 8% for every $1,000 increase in GDP per capita. For example, if GDP rises from $30,000 per capita to $31,000, health spending increases by $232. But if GDP per capita rises from $40,000 to $41,000, health spending increases by $500.

Thus, because Americans earn so much more than people in other countries, it naturally follows that we spend more on health care.

Consider four countries whose health-care systems are often held up as admirable alternatives: Canada, Germany, France and Great Britain. Certainly, the U.S. spends significantly more on health care than those countries do, but these nations also earn significantly less income per person.

Look at it this way: Even after paying for our health care, Americans have far more money left over than their neighbors to spend on other goods and services. It works out to about $8,000 more than the average German or Frenchman, and about $4,000 more than the average Canadian or Briton.

Of course, averages obscure many harsh realities and hide the fact that many Americans are unable to afford health care.

To improve the state of American health care and lighten the burden on business and workers, policy leaders should push for portability of health benefits, transparent pricing for health services, tort reform and more competition among both insurers and providers.

Crusaders for "universal" health care allege that America's unique lack of government-mandated coverage is a handicap to the nation's competitiveness. Given America's superior economic performance, however, it is a uniqueness we should not rush to abandon.

Mr. Graham is the director of health care studies at the Pacific Research Institute.
Title: Newt and John Kerry together!
Post by: Crafty_Dog on November 16, 2007, 09:12:11 AM

November 16, 2007; Page A20

In 1799, doctors likely hastened the death of George Washington by draining a third of his blood to treat a bacterial infection. Bleeding was a common practice in those days, it dates back to the Greeks and Romans.

But nowadays, if a doctor used bloodletting he would be barred from practicing medicine. In the age of the Internet, is it any less inexcusable that we have yet to modernize and transform our health-care system?

We have talked long enough about using technology to cut costs and improve the quality of care. Now is the time to act -- and the place to start is preventable medication errors.

According to the Institute of Medicine, Americans average one medication mistake for every day spent in a hospital, accounting for more than 1.5 million injuries each year. Medication errors will kill at least 7,000 Americans this year. Of the more than three billion prescriptions written each year, doctors report nearly one billion require a follow-up between providers and pharmacies for clarification. The cost to our health-care system is in the billions.

One reason for this mess is that 95% of prescriptions are transmitted using 5,000-year-old technology: pen and paper.

That is unacceptable. The deaths and inefficiencies of paper prescriptions can be nearly entirely eliminated if we use the same technology we that use in other aspects of our lives. Electronic prescriptions can replace handwritten, misread and mismatched prescriptions with online, automated and expert technology.

The benefits are clear and compelling. When a doctor "writes" an electronic prescription, a computer can warn of potentially dangerous interactions with other medications or allergies and thereby prevent thousands of unnecessary hospitalizations each year. E-prescribing can also let a physician know whether a drug is covered by a patient's insurance or whether an alternative generic is available at a fraction of the cost. One initiative led by Chrysler, General Motors and Ford to encourage doctors to write e-prescriptions in the Detroit region has generated more than one million prescription alerts that have saved lives and money.

The benefits of e-prescribing are so important that the Institute of Medicine has called for every doctor and nurse to prescribe electronically by the year 2010. Business and labor leaders, health insurers and consumer advocates are unanimous in their support of this common-sense initiative.

Doctors also know that e-prescribing is vital for our health-care system. One recent study of 400 physicians found that 85% of physicians think e-prescribing is a good idea; 81% say it would reduce medication errors; and 65% say it would save time. They like a system that reduces their liability and allows them to focus on providing care, not filling out paperwork.

The problem is that very few doctors use the technology. Of those 400 physicians polled, only 7% actually transmit prescriptions electronically. And 63% say implementing the technology is not a priority. Why? It's not always in their immediate financial interest to do so.

That must change.

The federal government can lead by requiring that doctors who do business with Medicare convert to e-prescribing. This can be done by using market forces and the federal government's purchasing power to align financial incentives.

First, offer bonus payments to Medicare doctors who already prescribe electronically or who adopt the technology. Such payments will help doctors, especially those with small practices without many patients, to pay for startup costs. Private insurers, like WellPoint, are already using this strategy to drive adoption of e-prescribing.

If a majority of doctors don't e-prescribe a few years down the road, the government should require all doctors to adopt e-prescribing or face financial penalties. E-prescribing should become a condition of doing business with Medicare. This is no different than the requirements other suppliers expect to see when they negotiate with customers.

A new study by the Department of Health and Human Services estimates that if 18% of doctors in Medicare adopt e-prescribing, the government will save $4 billion and nearly three million adverse drug events can be prevented over five years.

This is something Republicans and Democrats can agree on. While we continue to debate how to cover the uninsured, improve quality, and lower costs, there is too little being done to modernize health care. E-prescribing for Medicare is just the beginning of the modernization and digitization our ailing health-care system urgently needs. A high-tech, healthier future is within our grasp. We just need creative leadership bold enough to reach for it.

Mr. Kerry, a Democrat, is a senator from Massachusetts. Mr. Gingrich, a Republican, is former speaker of the House and founder of the Center for Health Transformation. Chrysler, GM, Ford and WellPoint are members of the center.

Title: Re: The Politics of Health Care
Post by: Crafty_Dog on November 19, 2007, 11:15:00 AM
Foreign Health Affairs
November 19, 2007; Page A18

America, a nation prone to love at first sight with seductive health-care fixes, is now falling for the systems of the Netherlands and Switzerland. Their representatives recently displayed their dowry in D.C., and U.S. Health and Human Services Secretary Michael Leavitt personally checked out the potential brides earlier this month.

Beware: The last time we fell in love, it was with managed care, as exemplified by California's Kaiser Permanente. But the Kaiser model proved difficult to replicate outside of California, even for Kaiser itself. The version of managed care we got was of the "Just Say No" variety: "No" to enrollee requests and provider referrals. It has made a mess of our health-care system.

Though media accounts lump the systems of Switzerland and the Netherlands together, they are profoundly different. There are things to be learned from each, though neither presents a complete model the U.S. should emulate.

The Swiss and Dutch systems share one terrific feature -- universal coverage. Americans increasingly want this. Both achieve universal coverage using private sector insurers, at far lower cost than the U.S. -- 12% of GDP for Switzerland and 10% for the Dutch, versus a staggering 15% for the U.S. in 2003. They also have far better health outcomes than the U.S., even when Switzerland is compared to socio-demographically similar U.S. states such as Connecticut and Massachusetts. The sick in both countries can afford to buy health insurance, and also pay the same price. Yet private insurers compete in the market because they are paid more for sick enrollees through various risk-adjustment systems.

But the devil is in the details.

The Swiss are required to buy health insurance themselves, using their own money -- they account for 65% of health care expenditures. If individuals cannot afford it, most Cantons transfer funds to them. There are neither employer nor government health-insurance programs for the poor or elderly. The Swiss government accounts for only a quarter of the health-care spending versus nearly 50% for the U.S.

The Swiss system is consumer-driven because consumers themselves pay for their purchases. The Dutch government, in contrast, funds consumers to purchase their own health insurance to a much greater extent -- five million people in the country are on some sort of government dole. Thus, when the Dutch buy their insurance, they may think they are using other people's money.

The results? The Swiss have lower health-care inflation -- 2.8% versus 4.1% for the Dutch and the U.S. from 1996-2003 -- and substantially more in the way of health-care resources. And Switzerland tops the world in most measures of user satisfaction.

The 93 private insurance companies that compete in Switzerland dwarf the 41 in the Netherlands. Swiss providers also compete because, in addition to paying for their health insurance, the Swiss pay for nearly 32% of their health-care services out of their own pockets, as compared with only 8% for the Dutch. Yet even with its limitations, Dutch health-care inflation fell from the time when Dutch employers bought health care, and waiting lists have reportedly tumbled.

Nevertheless, the Swiss system is hardly perfect. On the demand side, the government limits insurance competition with requirements for extensive minimum benefit packages and considerable micromanagement of prices. Imagine a car market in which the government designs the vehicles and stringently oversees distributors' prices. Pretty soon all the cars would come with features we do not necessarily want -- heated seats -- at a price we do not want to pay.

Even worse is the Swiss government's micromanagement of medical care suppliers. Unwisely adopting the U.S. government's Medicare payment system, it not only dictates medical care prices but also specifies the bundles of care for which it will pay. This kind of micromanagement discourages innovation. For example, when Duke Medical Center lowered the costs of treating congestive heart patients by 40% in only one year with innovations that improved health status, it lost nearly all the savings it created. The U.S. government pays only for activities like hospital stays and doctor visits. Perversely, medical innovators who improve health and reduce hospital visits, lose money.

So before we latch on to the Dutch or Swiss models, let's be careful. Yes, the consumer-driven health care of these two nations is clearly the better model for implementing universal coverage. But their governments' micromanagement of the prices of insurers and providers should be avoided, not emulated. Instead, government should help lower-income people, enforce transparency, prosecute fraud and abuse -- but otherwise get out of the way.

Ms. Herzlinger is professor of business administration at Harvard Business School and a senior fellow at the Manhattan Institute. She is the author of "Who Killed Health Care?" (New York: McGraw-Hill, 2007).
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on December 22, 2007, 07:31:11 AM
I am left wondering if PC cowardice accounts for this article's failure to mention the role of illegal aliens in overwhelming emergency departments.  Notice how most/all of the examples given are from places like Tucscon AZ.

Seriously ill suffer as relationship between physician and hospital unravels
By Christopher Lee
The Washington Post
updated 12:39 a.m. MT, Fri., Dec. 21, 2007
Hospital emergency departments across the United States, already struggling with overcrowding and growing patient loads, are increasingly unable to find specialists to help treat seriously injured and ill patients, according to medical experts.

Crucial minutes, hours and even days can go by as patients suffering from trauma, strokes, broken bones and other maladies await evaluations by neurologists, orthopedic surgeons and other specialists because hospitals are having difficulty getting them to serve 24-hour emergency "on-call" shifts.

"It can mean death," said Linda Lawrence, president of the American College of Emergency Physicians and a practicing emergency department doctor in California. "Patients have died in transport, or waiting to find a neurosurgeon, or getting to a heart center for a cardiologist."

A nationwide survey by the American College of Emergency Physicians in 2005, the most recent available, found that of the 1,328 emergency department directors who responded, 73 percent said they had a problem with inadequate on-call coverage by specialists, including neurosurgeons, orthopedic surgeons and obstetrician/gynecologists. That was up from 67 percent in 2004.

Stretched to breaking point

The shortage comes at a time when emergency rooms at many hospitals are routinely stretched to the breaking point. The annual number of visits to emergency departments rose 18 percent, to 110 million, from 1994 to 2004, according to the Centers for Disease Control and Prevention. At the same time, the number of hospitals operating 24-hour emergency departments fell by 12 percent.

The shortage of specialists is the result of a fear of malpractice lawsuits, a reluctance to go without pay when seeing uninsured patients, and a growing intolerance for the disruption in their personal lives and private practices, the experts say. Many specialists are also decreasing their work for general hospitals.

Retiree Mary Jo McClure, 74, experienced the problem firsthand one Friday afternoon in January when she fell down some concrete steps, tearing large chunks of flesh from one leg. The plastic surgeon on call for Tucson Medical Center refused to leave her private-practice patients to come to the emergency department to treat McClure, who has health insurance. The doctor said instead she would see the injured woman in her office the next Monday.

But over the weekend, the specialist telephoned the family to say that she could not treat McClure after all because she performs only cosmetic procedures and is not trained to handle severe wounds, McClure said.

"What was she doing on the roster?" asked McClure, who searched for six days before finding a plastic surgeon at another hospital who would see her. "Do they expect you to walk in for a face-lift? . . . That was a very bad day, because you are hurt and you're in pain, and you always feel like the hospital will help you."

'A constant issue'

Judy Rich, the hospital's executive vice president and administrator, said the plastic surgeon later acknowledged that she should have seen McClure.

"It's a constant issue, our emergency room coverage," Rich said. "We count on the medical staff to come in when they are called. . . . There's too many patients and not enough specialists many times in communities, and Tucson, I think, is pretty typical of the kind of dilemma that we have."

In the Washington area, specialists are generally available, but emergency room patients sometimes must be transferred to get the expert care they need, said Eric Glasser, assistant chief of the emergency department at Georgetown University Hospital.

"At Georgetown, we take referrals from the whole region, because some hospitals can't find a neurosurgeon," said Glasser, president of the D.C. chapter of the emergency physicians' group. "They have to be transported long distances when minutes count. And that, in turn, impacts overcrowding in our hospitals."

For the most part, the dearth of specialists nationally arises not from a numerical shortage but from the growing unwillingness of many specialists to take on-call duty, said Ann S. O'Malley, a physician and senior researcher who co-authored a new study of the issue for the District-based Center for Studying Health System Change.


Traditionally, many specialists agreed to pull on-call duty in exchange for admitting privileges and use of a general hospital's facilities to perform operations and other procedures as part of their regular practice, O'Malley said. But the rise of physician-owned specialty hospitals and outpatient surgical centers over the past 15 years has reduced doctors' reliance on the general hospital.

"The historic relationship between physicians and hospitals is unraveling," O'Malley said.

Another factor is the rising number of the uninsured, with specialists complaining that they often do not get paid for treating patients they see in the emergency room. Moreover, rising malpractice insurance costs and the threat of lawsuits have made more physicians reluctant to see such patients, with whom they have no established professional relationship. Because taking on-call duty can require trips to the emergency department at any hour, it can disrupt doctors' personal lives and force them to reschedule appointments or elective surgeries for their regular, paying patients.

"It's our responsibility to take care of these patients, because that's what we do. That's part of our inherent fiber of being an orthopedic surgeon," said Leon S. Benson, a hand surgeon near Chicago who is active in the American Academy of Orthopaedic Surgeons, a professional association. "But there's no question that as the inconvenience and fatigue and poor compensation and difficulty in having appropriate resources to take care of patients build up, you get this perfect-storm effect where more and more people are thinking, 'Gee, I don't know if I want to do that anymore.' "

Benson, 47, an associate professor of clinical orthopedic surgery at Northwestern University, takes emergency department on-call duty every other day, but he acknowledged that he is the exception these days.

'System is being pressured'

"I can understand nationally why this is becoming a bigger issue, because the system is being pressured," he said. "More volume is getting through a pipe that's getting smaller in diameter. And then what you actually do while you're on call gets to be more and more painful."

Some hospitals have taken steps such as hiring specialists full time or on contract, covering professional fees for doctors who see uninsured patients, and paying physicians daily or monthly stipends for on-call duty, said O'Malley, the analyst. That helps, Benson said, but hospitals might impress physicians more by setting aside trauma rooms and teams of people to assist the on-call specialist in a timely, efficient way when an emergency arises.

The shortage of on-call specialists is so dire at Covenant Medical Center in Lubbock, Tex., that the hospital sometimes has to haul out telemedicine equipment that enables neurologists in faraway cities such as San Antonio to evaluate possible stroke victims through a video link, said Juan Fitz, associate director of the emergency department.

Sarah Thompson, 29, an emergency medical technician at Covenant, said she had to be admitted to the hospital for six days in September before doctors could find an oral surgeon to evaluate a swelling in her jaw and neck. It turned out to be cat-scratch fever that caused swollen lymph nodes and a secondary infection, not an abscessed tooth, as doctors first suspected, she said.

"They had an oral surgeon on call, but he wouldn't come to see me," said Thompson, who was pregnant. "He was supposed to be taking call. And then they called him, and they said he was out of town. It was a big mess-up. . . . All of our doctors were very frustrated with the situation. They tried their best."

Lawrence, the president of the emergency physicians' group, said that legislation introduced this year on Capitol Hill -- but not yet considered in committee -- would create a bipartisan national commission to study challenges related to the provision of emergency medical services, including the on-call specialist problem.

"Something people don't understand is that even if you have insurance, if I don't have an on-call orthopedic surgeon, I can't help you," Lawrence said. "It's an issue that affects everybody, insured and uninsured. If there's no bed available, there's no bed available."

Title: Re: The Politics of Health Care
Post by: Crafty_Dog on February 04, 2008, 04:22:48 AM
Equity and Health Care
February 4, 2008; Page A14
Democrats, and even a few Republicans, are in a populist mood, and fair enough. But if they really want the tax code to be more "progressive" -- i.e., from each according to his means -- they ought to forget the Bush tax cuts and address the way the government subsidizes health insurance. On the advice of our doctors, we're not holding our breath.

According to the Democratic consensus, too many people lack health insurance, and the liberal remedy is to protect the status quo while expanding public programs for the uninsured. That's the opposite of a rational health policy: Not only does the current system cause unnecessary problems for the insured, but many of the gaps in coverage owe to the way tax subsidies shortchange the uninsured, particularly working-class and middle-income families.

If such inequality and unfairness existed anywhere other than health care, the Democrats would be raising hell. Instead, they're silent -- which is politically telling.

The core problem is that people who get insurance through their employers pay no income or payroll taxes on the value of the benefit. The Treasury defines this as a "tax expenditure," meaning it's revenue the government forgoes to encourage certain behavior. If these losses were converted to the equivalent of direct spending, the tax exemption would have cost more than $208 billion in 2006. The only federal programs that cost more are Social Security, Medicare and national defense. But all that money props up only employer-provided insurance. Individuals who buy policies don't get any tax breaks and pay with after-tax dollars.

If the purpose of health-care reform is to decrease the ranks of the uninsured, these job-related tax breaks are poorly targeted, even regressive. The more generous the employer health plan, the more the subsidies increase. On average, lower-wage workers have more limited coverage as part of their compensation, usually from small- or medium-sized businesses. Estimates show that the subsidy is worth more than $3,000 for upper-income families (with higher marginal tax rates), and less than $1,000 for those on the lower income rungs.

These aren't new insights, and economists have recommended changing these incentives for decades. What's hard to believe are the convenient blind spots of the Democratic Presidential candidates. Hillary Clinton, queen of the wonks, includes in her health-care proposal an undefined cap on the deduction for "high-income Americans," but all of her emphasis is on larger spending subsidies. Barack Obama doesn't even mention it. Neither did John Edwards.

They're uncharacteristically missing a chance to effectively raise taxes on "the rich." Curbing these subsidies could generate billions for their elaborate "universal" health programs. More to the point, this is a simple matter of equity, usually Democratic terrain. If the government is going to support health insurance, then those subsidies ought to apply regardless of a person's income, where they work, or how they purchase their insurance.

So why the Democratic silence? Perhaps it's because they think such a change would interfere with their main policy goal, which is slow but steady progress toward government control of the health-care market. Or possibly it's because many of the most generous tax-subsidized health plans come from union-negotiated contracts. Or maybe Democrats simply don't want to concede that President Bush has a point.

In his 2007 State of the Union address, Mr. Bush suggested redistributing the government's health subsidies. His proposal would sever the link between insurance and employment, shifting the deduction to individuals and capping it at $15,000 a year for a typical family. About four-fifths of the country would do better than they do now, while the rest currently have the most gold-plated employer coverage and would still have plenty of options.

Not only would this be a relatively cost-effective way to increase coverage. It would also address the major market distortions that the employer-exclusive deduction causes, with individuals essentially prepaying for routine costs through third-party insurance companies. If Republican candidates came to their senses, they'd recognize an opportunity to poach a traditionally Democratic issue -- as well as an opening to address middle-class anxiety without demagoguing business or "the rich." Individual policies would also be portable when workers are between jobs, reducing risk and uncertainty.

But the big questions are for the Democrats, who claim to believe that health-care reform is as much a moral as an economic issue. Whatever their other ambitions, how can they stand by a system that offers the least assistance to the working class and nothing at all to the uninsured?

Title: The Wages of HillaryCare
Post by: Crafty_Dog on February 07, 2008, 07:07:34 AM
The Wages of HillaryCare
February 7, 2008
Hillary Clinton and Barack Obama agree on most policy issues, but that makes their rare differences all the more revealing. To wit, their running scrap over Mrs. Clinton's "individual mandate" for health care, which Mr. Obama has now had the nerve to expose for its inevitable government coercion.

Mrs. Clinton's proposal requires everyone to buy health insurance, along with more insurance regulation, a government insurance option for everyone and tax hikes. Mr. Obama likes all that but his mandate would only apply to children. He argues that the reason many people aren't insured is because it's too expensive, not because they don't want it. Mrs. Clinton counters that coverage can't be "universal" without a mandate.

But then Mr. Obama had the impudence to defend his views. His campaign distributed a mailer in key primary states that claimed the Clinton plan "forces everyone to buy insurance, even if you can't afford it." It also featured an image of an anxious couple at a kitchen table. The Clinton apparat went apoplectic, claiming the flyer evokes the famous "Harry and Louise" commercials. A common article of liberal faith is that this "smear campaign" doomed HillaryCare in 1994 -- as opposed to, say, its huge cost and complexities. But never mind.

Yet if Mrs. Clinton's plan is better because it has a mandate, how does it work in the real world, where some people still won't be able to afford insurance, or would decline to acquire it? At a recent debate, the Illinois Senator drove the point home, asking Mrs. Clinton, "You can mandate it but there will still be people who can't afford it. And if they can't afford it, what are you going to fine them? Are you going to garnish their wages?" And in an interview with ABC's George Stephanopoulos on Sunday, Mrs. Clinton conceded that "we will have an enforcement mechanism" that might include "you know, going after people's wages."

Well, well. In other words, HillaryCare II isn't all about "choice," but would require financial penalties for people to pay attention, including garnishing wages. To put it more accurately, the individual mandate is really a government mandate that requires brute force plus huge subsidies to get anywhere near its goal of universal coverage.

Mitt Romney's mandate program in Massachusetts is already expected to reach $1.35 billion in annual costs by 2011, up from $158 million today. And that's with only half of the previously uninsured currently enrolled; no less than 20% didn't qualify for subsidies and were granted exemptions because the costs were too much of a hardship.

Most experts calculate that a national mandate with subsidies like Mrs. Clinton's would enroll about half to two-thirds of the uninsured, less for a voluntary plan and subsidies alone. But such guesswork is pointless without the basic enforcement assumptions, which Mrs. Clinton refuses to provide. She's more interested in wielding what she calls "a core Democratic principle" against Mr. Obama. "My opponent will not commit to universal health care," she said Saturday.

The logic of Mr. Obama's approach is that policy makers should target those who are priced out of coverage. The Census Bureau says 38% of the uninsured earned more than $50,000 in 2006, 19% above $75,000. They aren't a major public policy problem -- except that a big reason they lack coverage is because it is more expensive than it needs to be thanks to government market interference. And 29% earn under $25,000, which means they probably qualify for existing subsidy programs like Medicaid or Schip but haven't enrolled.

The news here is that all of this is being exposed now, and by a fellow Democrat. Many Americans are uncomfortable with the coercion of the mandate -- and not all of them are Republicans. The California health-care overhaul was recently done in by liberals concerned about its consequences for the working poor.

The political lesson that Mrs. Clinton learned in 1994 wasn't about compromise or market forces. It was that a government health-care takeover can only be achieved gradually and by stealth. Her individual mandate is an attempt to force everyone to buy into a highly regulated and price-controlled system where government redistributes income and dictates coverage. We assume the McCain campaign is paying attention.

Title: Re: The Politics of Health Care
Post by: Crafty_Dog on February 20, 2008, 06:43:16 AM

Health Questions for the Candidates
February 20, 2008; Page A15

On March 4, voters in the Texas Democratic primary will choose between Hillary Clinton and Barack Obama. The battle is shaping up to be a health-care Alamo. Twenty five percent of people living in the Lone Star state are uninsured, according to the U.S. Census. That's the highest rate of any state.

Sen. Clinton has issued the challenge, telling Sen. Obama "I'll see you in Texas." She promises to provide health coverage for "every single one of the nation's 47 million uninsured," and she accuses Sen. Obama of offering a "band aid" solution that would leave about a third of those 47 million uncovered.

In preparation for the Texas showdown, Sen. Clinton and Sen. Obama will debate this Thursday night in Austin -- and both candidates have called for less oratory and more specifics. With that in mind, here are some of the questions they should be asked:

- Sen. Clinton: When you pledge to cover every one of the 47 million uninsured, do you include recent and future newcomers to the United States, legal and illegal?

The recent rise in the uninsured is due primarily to new arrivals and their U.S.-born children, and it is happening mostly in the five border states, according to the Center for Immigration Studies and U.S. Census data. In Texas, the cost of caring for these newcomers and children has been paid by local and state taxes, with little help from the federal government. For example, 39% of babies born in Parkland Hospital in Dallas are children of illegal immigrants. County taxpayers foot the bill.

At the University of Texas Medical Branch at Galveston, doctors are thrust into an ethical crisis. The hospital provides charity care to all. Its budget is at breaking point, and the hospital has had to lay off workers. In December, the hospital proposed that doctors triage cancer patients based on immigration status rather than medical need. But Galveston doctors say they are bound by their oath to heal, and that border control is Washington, D.C.'s problem.

Texas, as a border state, has specific problems, but also some typical ones. Of the nine million children in the U.S. considered "uninsured," six million are already eligible for government programs such as Medicaid or Schip, but their parents have not signed them up.

- Sen. Obama: You have said that you will require all parents to have health insurance for their children. What will you do to enforce this law?

In Texas, 850,000 children are eligible but not enrolled. The available programs provide check-ups, prescription drugs, hospital care, and dental care. The state runs radio ads, hands out brochures in several languages, and partners with community organizations to inform parents about these programs, but parents still fail to act.

- Sen. Clinton: a question about young adults. They think of themselves as invincible and are not apt to buy insurance. Your "mandate" would force them to do so, and more than that, to pay the same premium as middle aged people whose health care needs generally are much greater. You defend the one-price rule as "shared responsibility," but isn't it an unjust, hidden tax on the younger generation?

Today in Austin, Texas a 25-year-old man can buy a $1,000 deductible policy for $70, according to A 55-year-old man pays $270 for the same policy. In nearly all states, young adults currently get price breaks, and for good reason. They need, on average, about $1,500 a year in health care. Your health plan bars insurers from giving these price breaks to the young.

- Sen. Obama: You have pledged to make health insurance "affordable." Texas lawmakers have made insurance less affordable by requiring that every plan include in vitro fertilization, acupuncture, marriage counseling and some 50 other features. This is like passing a law saying that the only car you're permitted to buy is a fully loaded luxury sedan.

Would you allow Texans (and all of us who live in states with similarly costly insurance requirements) to shop for cheaper insurance outside our own state?

- Sen. Clinton: You promise that "everyone who is already insured will be able to keep the coverage they have today." Yet your proposal says all health plans must cover services "experts deem necessary."

About 4.5 million people have high-deductible insurance, because it costs less and allows them to make their own decisions about where and when to get medical care. But when Massachusetts passed mandatory health insurance, people with high-deductible plans were forced to switch to more expensive medical policies to meet that state's definition of insurance.

Will that also happen under your proposal?

- Sens. Obama and Clinton: Some doctors and hospitals are worried about your plans to make electronic record-keeping compulsory. What will be the penalty for a doctor who doesn't get computerized?

In the California primary debate, Sen. Clinton claimed a Rand study shows that savings due to information technology could pay for half of her $110-billion-a-year universal health coverage plan. What the Rand study actually says is that information technology will produce savings, estimated at $77 billion a year, but not until year 15 -- and not necessarily for the thousands of doctors and hospitals who are forced to spend $125 billion (Rand's estimate) up front for the equipment.

- Sens. Obama and Clinton: Both your proposals call for limits on the profit margins of insurance companies. Attacking the most unpopular industry in America may sound politically attractive, but if profit margins are legally capped, investors will flee to other industries and private insurance could become a thing of the past. That would leave only a government-run health-care system.

Do you believe the nation should take that risk?

Ms. McCaughey, a former lieutenant governor of New York, is an adjunct senior fellow at the Hudson Institute.
Title: Re: The Politics of Health Care
Post by: ccp on February 20, 2008, 05:01:44 PM
***- Sens. Obama and Clinton: Some doctors and hospitals are worried about your plans to make electronic record-keeping compulsory. What will be the penalty for a doctor who doesn't get computerized?

In the California primary debate, Sen. Clinton claimed a Rand study shows that savings due to information technology could pay for half of her $110-billion-a-year universal health coverage plan. What the Rand study actually says is that information technology will produce savings, estimated at $77 billion a year, but not until year 15 -- and not necessarily for the thousands of doctors and hospitals who are forced to spend $125 billion (Rand's estimate) up front for the equipment.***

I can tell you now that the cost of going electronic is a lot for many physicians including myself.   It is not even feasable.
Additionally, I have yet to see anywhere wherein it produces any savings, cost efficiencies, extra income, or much of any other benefit to providers who will soon be forced to do it.

It is obviously too much to ask before an election why we can't just stop illegals from coming here and having babies at the expense of citizens.  It ain't just in Texas.  I see it all the time here in Jersey.   I would not be surprised to find out that a large percentage of the 47 million number we hear about is simply this.  That said I have people born here who can't afford care because of pre-existing conditions, or they earn too little.  Yet instead of helping them we have people waltzing into the country and getting free hospital care.
Title: NYT: Free healath care kills in UK
Post by: Crafty_Dog on February 21, 2008, 05:43:05 AM
LONDON — Created 60 years ago as a cornerstone of the British welfare state, the National Health Service is devoted to the principle of free medical care for everyone. But recently it has been wrestling with a problem its founders never anticipated: how to handle patients with complex illnesses who want to pay for parts of their treatment while receiving the rest free from the health service.

Although the government is reluctant to discuss the issue, hopscotching back and forth between private and public care has long been standard here for those who can afford it. But a few recent cases have exposed fundamental contradictions between policy and practice in the system, and tested its founding philosophy to its very limits.

One such case was Debbie Hirst’s. Her breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist’s support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment.

By December, she had raised $20,000 and was preparing to sell her house to raise more. But then the government, which had tacitly allowed such arrangements before, put its foot down. Mrs. Hirst heard the news from her doctor.

“He looked at me and said: ‘I’m so sorry, Debbie. I’ve had my wrists slapped from the people upstairs, and I can no longer offer you that service,’ ” Mrs. Hirst said in an interview.

“I said, ‘Where does that leave me?’ He said, ‘If you pay for Avastin, you’ll have to pay for everything’ ” — in other words, for all her cancer treatment, far more than she could afford.

Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.

Patients “cannot, in one episode of treatment, be treated on the N.H.S. and then allowed, as part of the same episode and the same treatment, to pay money for more drugs,” the health secretary, Alan Johnson, told Parliament.

“That way lies the end of the founding principles of the N.H.S.,” Mr. Johnson said.

But Mrs. Hirst, 57, whose cancer was diagnosed in 1999, went to the news media, and so did other patients in similar situations. And it became clear that theirs were not isolated cases.

In fact, patients, doctors and officials across the health care system widely acknowledge that patients suffering from every imaginable complaint regularly pay for some parts of their treatment while receiving the rest free.

“Of course it’s going on in the N.H.S. all the time, but a lot of it is hidden — it’s not explicit,” said Dr. Paul Charlson, a general practitioner in Yorkshire and a member of Doctors for Reform, a group that is highly critical of the health service. Last year, he was a co-author of a paper laying out examples of how patients with the initiative and the money dip in and out of the system, in effect buying upgrades to their basic free medical care.

“People swap from public to private sector all the time, and they’re topping up for virtually everything,” Dr. Charlson said in an interview. For instance, he said, a patient put on a five-month waiting list to see an orthopedic surgeon may pay $250 for a private consultation, and then switch back to the health service for the actual operation from the same doctor.

“Or they’ll buy an M.R.I. scan because the wait is so long, and then take the results back to the N.H.S.,” Dr. Charlson said.

In his paper, he also wrote about a 46-year-old woman with breast cancer who paid $250 for a second opinion when the health service refused to provide her with one; an elderly man who spent thousands of dollars on a new hearing aid instead of enduring a yearlong wait on the health service; and a 29-year-old woman who, with her doctor’s blessing, bought a three-month supply of Tarceva, a drug to treat pancreatic cancer, for more than $6,000 on the Internet because she could not get it through the N.H.S.

Asked why these were different from cases like Mrs. Hirst’s, a spokeswoman for the health service said no officials were available to comment.

In any case, the rules about private co-payments, as they are called, in cancer care are contradictory and hard to understand, said Nigel Edwards, the director of policy for the N.H.S. Confederation, which represents hospitals and other health care providers. “I’ve had conflicting advice from different lawyers,” he said, “but it does seem like a violation of natural justice to say that either you don’t get the drug you want, or you have to pay for all your treatment.”

Page 2 of 2)

Karol Sikora, a professor of cancer medicine at the Imperial College School of Medicine and one of Dr. Charlson’s co-authors, said that co-payments were particularly prevalent in cancer care. Armed with information from the Internet and patients’ networks, cancer patients are increasingly likely to demand, and pay for, cutting-edge drugs that the health service considers too expensive to be cost-effective.

“You have a population that is informed and consumerist about how it behaves about health care information, and an N.H.S. that can no longer afford to pay for everything for everybody,” he said.

Professor Sikora said oncologists were adept at circumventing the system by, for example, referring patients to other doctors who can provide the private medication separately. As wrenching as it can be to administer more sophisticated drugs to some patients than to others, he said, “if you’re a doctor working in the system, you should let your patients have the treatment they want, if they can afford to pay for it.”

In any case, he said, the health service is riddled with inequities. Some drugs are available in some parts of the country but not in others. Waiting lists for treatment vary wildly from place to place. Some regions spend $280 per capita on cancer care, Professor Sikora said, while others spend just $90.

In Mrs. Hirst’s case, the confusion was compounded by the fact that three other patients at her hospital were already doing what she had been forbidden to do — buying extra drugs to supplement their cancer care. The arrangements had “evolved without anyone questioning whether it was right or wrong,” said Laura Mason, a hospital spokeswoman. Because their treatment began before the Health Department explicitly condemned the practice, they have been allowed to continue.

The rules are confusing. “It’s quite a fine line,” Ms. Mason said. “You can’t have a course of N.H.S. and private treatment at the same time on the same appointment — for instance, if a particular drug has to be administered alongside another drug which is N.H.S.-funded.” But, she said, the health service rules seem to allow patients to receive the drugs during separate hospital visits — the N.H.S. drugs during an N.H.S. appointment, the extra drugs during a private appointment.

One of Mrs. Hirst’s troubles came, it seems, because the Avastin she proposed to pay for would have had to be administered at the same time as the drug Taxol, which she was receiving free on the health service. Because of that, she could not schedule separate appointments.

But in a final irony, Mrs. Hirst was told early this month that her cancer had spread and that her condition had deteriorated so much that she could have the Avastin after all — paid for by the health service. In other words, a system that forbade her to buy the medicine earlier was now saying that she was so sick she could have it at public expense.

Mrs. Hirst is pleased, but up to a point. Avastin is not a cure, but a way to extend her life, perhaps only by several months, and she has missed valuable time. “It may be too bloody late,” she said.

“I’m a person who left school at 15 and I’ve worked all my life and I’ve paid into the system, and I’m not going to live long enough to get my old-age pension from this government,” she added.

She also knows that the drug can have grave side effects. “I have campaigned for this drug, and if it goes wrong and kills me, c’est la vie,” she said. But, she said, speaking of the government, “If the drug doesn’t have a fair chance because the cancer has advanced so much, then they should be raked over the coals for it.”
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on May 05, 2008, 05:27:50 AM
Obama's Health Care Record
May 5, 2008; Page A15

Laughing gas can be useful during complicated dental procedures, but should every health plan be required to cover it and should health insurance cost more because of it?

Barack Obama thinks so. As a state senator in Illinois, he voted to require that dental anesthesia be covered by every health plan for difficult medical cases. Today, the requirement is one of 43 mandates imposed by Illinois on health insurance, according to the Illinois Division of Insurance. Other mandates require coverage of infertility treatments, drug rehab, "personal injuries" incurred while intoxicated, and other forms of care.

By my count, during Mr. Obama's tenure in the state Senate, 18 different laws came up for a vote and passed that imposed new mandates on private health insurance. Mr. Obama voted for all of them.

As a presidential candidate, Mr. Obama says people lack health insurance because "they can't afford it." He's right. But he is also partly responsible for why health insurance is too expensive. A long list of studies show that mandates like the ones Mr. Obama has championed drive up the cost of insurance for the very people priced out of coverage.

A 2008 study by an insurance-industry supported research organization, the Council for Affordable Health Insurance (CAHI), estimates that mandates increase the cost of basic health coverage by 20% to 50%, depending on the state. Average policies in high-mandate New Jersey cost about $4,000 according to a 2004 insurance survey, much more than the $1,200 charged in low-mandate Wyoming.

CAHI estimates that there are 1,961 state-mandated benefits across the country. It's not just specific products and services that get mandated, but also whole categories of providers like chiropractors and psychologists. By one count, states have enacted about 500 laws mandating coverage for 25 different types of providers.

States also mandate new categories of eligibility that force small businesses to cover additional dependents. One popular measure is the "slacker mandate," which extends coverage to unmarried dependents under the age of 30.

Not all mandates are equally expensive. Drug rehab, for example, increases a plan's premiums by 9% on average, according to America's Health Insurance Plans (AHIP). Coverage for psychologists adds 12% to premiums. But in total, in some states mandates increase the cost of insurance from 10% to 20%, according to AHIP.

These increased costs aren't shared equally among all who have health insurance. People who are covered through self-insured employers (usually large corporations) are shielded from state mandates because of the federal Employee Retirement Income Security Act (ERISA), which prevents states from enacting controls on plans that cross state lines.

The burden of paying for state mandates is usually borne by individuals who buy their own insurance, small employers and others not covered by ERISA. In total, about half of the people who have insurance bear the brunt of the cost of state mandates. And, as it turns out, individuals who do not work for large corporations are much more likely to be uninsured. AHIP calculates that between 20%-25% of uninsured Americans can't afford coverage because of the increased cost of providing mandated care.

It doesn't have to be that way. If insurers were allowed to offer "bare-bones" plans – which would be cheaper because they would cover just essential care – many consumers who are priced out of health insurance now would likely buy these plans instead of living without insurance.

State mandates even hurt those who have insurance because they prompt insurers to cut back on coverage for catastrophic illnesses. This undermines the purpose of insurance by turning policies into prepaid health care rather than security from the economic consequences of serious medical problems. And because many mandates define the duration and scope of specific benefits, they lock in treatment standards that grow outdated as knowledge advances. That can diminish incentives to find more effective ways of delivering medical care.

Why, then, do we have mandates?

For the simple reason that each mandate has a powerful constituency – be it chiropractors, dentists or other groups – who benefit when their services are included on the list of mandated care. These groups pressure lawmakers to expand the list of mandates and, over time, the list grows to be very long and expensive. Often the care that is being mandated is for minor medical problems because small, routine ailments are suffered by more people and therefore have broader political constituencies.

One way to make insurance more affordable is to extend the benefits of the ERISA exemption to people who buy insurance on their own, putting them on a level playing field with those who get coverage through large employers by freeing them from expensive state insurance laws.

Most insurance plans would still cover important health-care items such as prenatal HIV testing or routine colon cancer screening or bone density tests – three additional mandates Mr. Obama helped enact in Illinois. But without government mandates, plans would also have the flexibility to offer lower-priced insurance options.

Better still, Congress could pass legislation that has long languished in the House allowing people to purchase health plans across state lines. People could choose which state regulations to buy into, creating a market for the insurance mandates. This would give states more incentives to fix local problems that have helped make health insurance expensive in the first place. It's a fair bet that there would be an exodus of policyholders from higher-cost, higher-mandate states like New Jersey and even Illinois (which has more expensive mandates than about half of the other states).

Mr. Obama says people need more options to purchase insurance outside the workplace. He also says he can draw on his experience as a state legislator to lead a reform of the kinds of special interests that pursue these mandated benefits. Right now Mr. Obama's health-care proposal, like Hillary Clinton's plan, does the opposite by adding federal regulations on top of state laws.

"My plan emphasizes lowering costs," Mr. Obama says. If that is really what he wants to do, he can start by freeing consumers from forced subsidization of the pricey state mandates. Given a choice between the lower costs he promises and subsidized dental anesthesia he has delivered, some would opt for the affordable health insurance and make do with some extra Novocain.

Dr. Gottlieb is a resident fellow at the American Enterprise Institute.
Title: WSJ: Medicaid Money Laundering
Post by: Crafty_Dog on May 19, 2008, 07:59:00 AM
Medicaid Money Laundering
May 19, 2008; Page A14
Every politician moans that entitlement spending is out of control, so it ought to be easy at least to stop blatant fraud and abuse. Evidently not: Congress is currently resisting an attempt to rein in even a Big Con that everyone acknowledges.

The scene of this crime is Medicaid, the open-ended program that provides health coverage for about 59 million low-income people, with the rolls expanding every year. States determine eligibility and what services to cover, and the feds pick up at least half the tab, though the effective "matching rate" is as high as 83%. Now it turns out that states have been goosing their financing arrangements to maximize their federal payouts and dump more of their costs onto taxpayers nationwide.

The swindle works like this: A state overpays state-run health-care providers, such as county hospitals or nursing homes, for Medicaid benefits far in excess of its typical rates. Then the federal government reimburses the state for "half" of the inflated bills. Once the state bags the extra matching funds, the hospital is required to rebate the extra money it received at the scam's outset. Cash thus makes a round trip from states to providers and back to the states – all to dupe Washington.

The Government Accountability Office and other federal inspectors have copiously documented these "creative financing schemes" going back to the Clinton Administration. New York deposited its proceeds in a Medicaid account, recycling federal dollars to decrease its overall contribution. So did Michigan. States like Wisconsin and Pennsylvania fattened their political priorities. Oregon funded K-12 education during a budget shortfall.

The right word for this is fraud. A corporation caught in this kind of self-dealing – faking payments to extract billions, then laundering the money – would be indicted. In fact, a new industry of contingency-fee consultants has sprung up to help states find and exploit the "ambiguities" in Medicaid's regulatory wasteland. All the feds can do is notice loopholes when they get too expensive and close them, whereupon the cycle starts over.

The Bush Administration did just that. In 2003, it began audits that resulted in 29 states dialing back the practice. In 2007, officials tried to make the reforms permanent through formal rules changes, saying federal Medicaid dollars would only pay for Medicaid services received by Medicaid beneficiaries.

Naturally, the states were furious. All 50 Governors were (and are) opposed, while pressure groups like AARP and their media collaborators chime in with horror stories about "cuts" to the social safety net. Congress promptly forbade enforcement of the new regulations. That moratorium, which was slipped into last year's Iraq war funding bill, expires at the end of this month.

Now Congress wants to extend it until President Bush leaves office. The House passed a bill – 349-62 – but Harry Reid was unable to whisk it through the Senate unnoticed. Wavering GOP Senators are trying to strike a deal with the Bush Administration, which is threatening a veto, mostly with offers to beef up the $25 million allocated to "combat" Medicaid fraud and abuse. Of course, these antifraud troops only fight after state schemes have paid out. And should the moratorium stick around, states will merely revert to their con artistry, knowing they are no longer being watched.

A reform alternative would be for the government to distribute block grants, rather than a set fee for every Medicaid service. That would amputate Washington from state accounting and insulate taxpayers from these shakedowns. States would have an incentive to spend more responsibly, and also craft innovative policies without Beltway micromanagement. But we can dream.

In the short term, Congress could – but probably won't – allow the Administration to close this case. No one really knows how much the state grifters have already grabbed, though the Congressional Budget Office estimates that the Administration remedies would save $17.8 billion over five years and $42.2 billion over 10.

We realize this is considered a mere gratuity in Washington, but Medicaid's money laundering is further evidence that Congress isn't serious about spending discipline.
Title: WSJ: the New Big Dig
Post by: Crafty_Dog on May 21, 2008, 05:57:15 PM
The New Big Dig
May 21, 2008
Mitt Romney's presidential run is history, but it looks as if the taxpayers of Massachusetts will be paying for it for years to come. The former Governor had hoped to ride his grand state "universal" health-care reform of 2006 to the White House, but his state's residents are now having to live with what he and the state's Democratic Legislature passed. As the Boston press likes to say, it's "the new Big Dig."

The showpiece of RomneyCare was its individual mandate, a requirement that all Massachusetts residents obtain health insurance by July of last year or else pay penalties. The idea was that getting everyone into the insurance system would eliminate the "free-rider" problem of those who refuse to buy insurance but then go to emergency rooms when they're sick; thus costs would fall. "Will it work? I'm optimistic, but time will tell," Mr. Romney wrote in these pages in 2006.

Well, the returns are rolling in, and the critics look prescient. First, the plan isn't "universal" at all: About 350,000 more people are now insured in Massachusetts since the reform passed. Federal estimates put the prior number of uninsured at more than 657,000, so there was a reduction. But it was not secured through the market reforms that Governor Romney promised. Instead, Massachusetts also created a new state entitlement that is already trembling on the verge of bankruptcy inside of a year.

Some two-thirds of the growth in coverage owes to a low- or no-cost public insurance option. Called Commonwealth Care, it uses a sliding income scale to subsidize coverage for everyone under 300% of the federal poverty level, or about $63,000 for a family of four. Commonwealth Care also accounts for 60% of statewide growth in individual insurance over the last year, and the trend is expected to accelerate, perhaps double.

One lesson here is that while pledging "universal" coverage is easy, the harder problem is paying for it. This year's appropriation for Commonwealth Care was $472 million, but officials have asked for an add-on that will bring it to $625 million. For 2009, Governor Deval Patrick requested $869 million but has already conceded that even that huge figure is too low. Over the coming decade, the expected overruns float in as much as $4 billion over budget. It's too early to tell how much is new coverage or if state programs are displacing private insurance.

The "new Big Dig" moniker refers to the legendary cost overruns when Boston rebuilt its traffic system. Now state legislators are pushing new schemes to offset RomneyCare's runaway expenses, including reductions in state payments to doctors and hospitals, enlarged business penalties, an increase in the state tobacco tax, and more restrictions on drug companies and insurers.

Mr. Romney's fundamental mistake was focusing on making health insurance "universal" without first reforming the private insurance market. The "connector" that was supposed to link individuals to private insurance options has barely been used, as lower-income workers flood to the public option. Meanwhile, low-cost private insurers continue to avoid the state because it imposes multiple and costly mandates on all policies.

Hailed at first as a new national model, the Massachusetts nonmiracle ought to be a warning to Washington. Barack Obama and Hillary Clinton are both proposing versions of RomneyCare on a national scale, with similar promises that covering everyone under a government plan will reduce costs. Mr. Obama at least argues that more people would be covered were insurance more affordable. But his solution is Massachusetts on steroids – make insurance less expensive for policyholders by transferring the extra costs onto the government. Mrs. Clinton likes that but also wants the individual mandate, despite the mediocre results so far.

The real problem in health care is the way the tax code and third-party payment system distort incentives. That's where John McCain has been focusing his reform efforts – because that really does have the potential to reduce costs while covering more of the uninsured – and Republicans ought to follow his lead.

In this respect paradoxically, we can be thankful that Massachusetts ignored the cost problems that doomed other recent liberal health insurance overhauls in California, Pennsylvania, Wisconsin and Illinois. The Bay State is showing everyone how not to reform health care.

See all of today's editorials and op-eds, plus video commentary, on Opinion Journal.
Title: WSJ: The Florida Revelation
Post by: Crafty_Dog on May 29, 2008, 05:16:58 AM
The Florida Revelation . . .
May 29, 2008; Page A16
Republicans in Congress may be out of gas, but that doesn't mean conservative ideas aren't percolating elsewhere, and even on the supposedly Democratic stronghold of health care. Take the news from Florida, where GOP Governor Charlie Crist succeeded last week in moving an innovative reform through the state legislature.

The Sunshine State has about 3.8 million people without insurance, or about 21% of the population, the fourth-highest rate in the country. The "Cover Florida" plan hopes to improve those numbers by offering access to more affordable policies. As even Barack Obama says, the main reason people are uninsured isn't because they don't want to be; it's because coverage is too expensive.

But the Florida reform, which both houses of the legislature approved unanimously, renounces Mr. Obama's favored remedy: It nudges the government out of the health-care marketplace. Insurance companies will be permitted to sell stripped-down, no-frills policies exempted from the more than 50 mandates that Florida otherwise imposes, including for acupuncture and chiropractics. The new plans will be designed to cost as little as $150 a month, or less.

Mr. Crist observed that state regulations increase the cost of health coverage, and thus rightly decided to do away with at least some of them. It's hard to believe, but this qualifies as a revelation in the policy world of health insurance. The new benefit packages will be introduced sometime next year and include minimum coverage for primary care and catastrophic expenses for major illness.

Critics are already saying that, without mandates, the plan won't guarantee quality of care. That's purportedly why the states have imposed more than 1,900 specific-coverage obligations. But invariably mandates are the product of special-interest lobbying. Health-care providers – not consumers – are always asking for tighter regulation, because they profit from making everyone subsidize generous plans that cover, say, podiatry or infertility treatment. Given the choice, consumers might choose policies that cover some services but not others.

These government rules are imposed without regard for how much they will cost and who will bear the burden. In practice, the costs are disproportionately carried by lower- and middle-income workers, who already on average have more limited insurance coverage as part of their compensation, or none at all. When prices rise because of mandates, the less affluent are often forced to make an all-or-nothing choice between "Cadillac coverage," which involves just about everything, or going uninsured. In other words, they're prohibited from buying the lower-cost options that might be better suited to their needs.

Governor Crist is to be credited for removing this artificial, regressive floor on plans. It's a simple matter of equity. And though the plan will only enroll those who have gone without coverage for six months, it also creates a clearinghouse that will let small businesses that can't afford coverage offer their employees a variety of similar policies.

Despite his often populist brand of politics (such as on hurricane insurance), Mr. Crist also avoided the typical liberal health-care response of expanding public programs. Mitt Romney should have taken this route in Massachusetts, but fell instead for the siren song of "universal coverage," even if provided by the government. Florida is already having a tough fiscal year, but such state-level expansions are often pushed anyway.

Some 13 states currently offer bare-bones policies on a full or trial-run basis. While not a cure-all, they're movement in the right direction – especially as the states can't do anything about the continuing tax bias for employer-provided health insurance. That kind of much-needed change can only come from Washington, as John McCain is proposing.

The Florida success also shows the political benefits when Republicans talk seriously about health care. Mr. Crist has made increasing consumer choice a signature issue. When Mr. McCain talked up his health-care reforms earlier this spring, he did so in Tampa. He chose the right state.
Title: Re: The Politics of Health Care
Post by: ccp on May 29, 2008, 06:56:37 AM
"including for acupuncture and chiropractics"

Insurers will pay for these but they won't pay for treatment of people who are overweight or obese.  Those are considered "cosmetic".

I don't have answers on how to fix health care but I am really not thrilled at more government intrusion into our lives.  It is out of control already.
Title: Universal Health Care
Post by: ccp on June 13, 2008, 06:19:53 AM
I have mixed feelings about *universal* health care.  Of course the idea of world class health care for everyone that is paid for by x is a wonderful thought.  Who isn't for that?  But we all know it isn't that simple.

As one who pays for health care for myself and an employee I have many different thoughts and conerns from different directions but I don't have the answers.  The only thing I can say is that for any universal coverage to not bankrupt the system there would *have* to be some form of rationing.  Most Americans don't understand this and on an individual basis refuse to except this.  And as a doctor  I don't want to be the one in the middle who is the person who tells the patient they cannot have that MRI on day #1 for a shoulder or back sprain.  Yet the business guys with the HMOs have put us in that spot.  There better be strict guidelines set up in a way so I can refer this to the patient.  "No, you can't have this test because you don't qualify by national guidelines until these steps are followed".

Everyone cannot scour the country like Ed Kennedy shopping for all sorts of experimental care and expect others to pay for it.
BTW I wonder about his care.  Why is it he couldn't get the care in Massachussetts where there is world class health care?  Ever here of Mass General?  What is that guy at Duke and their University trying to sell?  There is to me an *obvious* self promotional aspect to their offering experimental stuff to a famous wealthy guy.  It is a sales decision - no more and no less.

Anyway here is some thoughts on universal care:   

***Senators Clinton’s and Obama’s split over mandating coverage distinguishes them from one another, but does that difference matter?

From the June ACP Internist, copyright © 2008 by the American College of Physicians.

Stacey ButterfieldBy Stacey Butterfield

In the seemingly endless Democratic primary, Sens. Hillary Clinton and Barack Obama have expended a lot of effort trying to distinguish themselves from one other. She stands for experience, he stands for change, and so on.

They both stand for health care reform and have acknowledged that they propose very similar plans for covering the uninsured. But their plans do have one difference—mandates for coverage—and there doesn’t seem to be any consensus on whether that is a big, important difference or a small, insignificant one.

Both plans require insurers to offer coverage to everyone, and use federal funds to make the coverage affordable for consumers. However, Mrs. Clinton’s plan will require all Americans to purchase coverage or face as-yet-unspecified penalties. Mr. Obama’s plan requires mandatory insurance only for children; for adults, coverage will be optional.

Proxies explained their candidates’ proposals at the 2008 World Health Care Congress (WHCC) in Washington, D.C., where one of the keynote addresses featured representatives of the three major presidential campaigns. Since my last column focused on Mr. McCain’s proposals, I’ll stick to the discussion between Mrs. Clinton’s and Mr. Obama’s campaigns.

Democrats’ health plans not much help to undecided votersU.S. Representative Jim Cooper of Tennessee, who represented Mr. Obama, said the mandate issue has been overplayed. “I think that’s much ado about a technical subject,” he told the audience of health care leaders in April. “The health care plans of Hillary Clinton and Barack Obama are almost identical. We are for universal coverage.”

He also offered an explanation for Mr. Obama’s policy decision. “An upfront, individual mandate will probably get zero Republican co-sponsors in Congress,” Mr. Cooper said.

That’s not true, argued Chris Jennings, the political strategist who represented Mrs. Clinton at the WHCC. “There already is [bipartisan support],” he said. He noted that mandatory coverage legislation has been proposed by Sen. Ron Wyden (D-OR) and Sen. Robert Bennett (R-UT), and two Republican governors, Mitt Romney and Arnold Schwarzenegger, have been the driving forces behind state efforts to mandate insurance.

“The reason why we want everyone to be in the system is to make it work rationally,” Mr. Jennings said. If consumers can wait until they are sick to purchase health insurance, it would raise the premiums of those who buy insurance as well as drawing intense protest from health insurers, he explained.

Obviously, the most likely to opt out under the non-mandatory plan would be the young and healthy whose premiums would typically subsidize the cost of covering the less healthy, more expensive patients. Mr. Obama’s advocates argue that if health insurance is made affordable, almost everyone would choose to buy it, but there’s no way to prove that without enacting a plan.

The Obama plan does have the advantage of being less expensive. Analysts have calculated that his plan would cost taxpayers 50%-80% of what the Clinton plan would. Since either plan would cost the government tens of billions of dollars a year, it’s somewhat difficult for laypeople to really grasp the price difference.

So what is the priority in creating a new health care coverage system? Gaining bipartisan support? Ensuring that everyone is within the system? Limiting cost?

Attendees at the WHCC, who were mostly health care industry executives, seemed to be thoroughly divided about the answers to these questions. After the representatives from the two Democratic campaigns and a spokesperson for Mr. McCain had presented their candidates’ proposals for health reform, the audience voted on their perceptions of feasibility and cost.

The votes were just about even. Mrs. Clinton’s plan got slightly positive ratings, with about 54% of the group finding it feasible and 51% saying it would help with costs. The voters were exactly split on the feasibility of Mr. Obama’s plan and slightly favorable (54%) on cost. The evaluation of Mr. McCain’s plan was slightly negative, with 45% voting yes on feasibility and 46% on cost.

With that mixed evaluation from the health care experts, it’s no wonder that the American voters are still undecided about who they want to lead health care reform.***
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on June 13, 2008, 04:42:45 PM
"If you think health care is expensive now, wait until the government makes it free."  PJ O" Rourke.
Title: An article on McCain's health prescription
Post by: ccp on June 15, 2008, 04:21:29 PM


One might think because I am a doctor I would have some strong opinions one way or the other regarding what is *best* for health care, but I don't.  I'm just trying to pay my bills like everyone else.  I don't endorse McCain or the others based on their health care opinions except to the extent that I don't want even more regulation, strangulation, and an even more gigantic government in any shape or form.

I thought those who read this board might find this helpful.

John McCain touts his plan for the U.S. health care system

From the May ACP Internist, copyright © 2008 by the American College of Physicians.

Jessica Berthold By Stacey Butterfield

Despite the importance of health care in the 2008 presidential campaign, relatively little attention has been paid to the plans that the Republican nominee Sen. John McCain has proposed for the U.S. health care system.

Part of that is because Sen. McCain himself has spent less time talking about the issue than his Democratic opponents. His reticence makes sense, given that Republican voters rank health care as a less important issue (fourth) than do Democrats (second), a Kaiser Foundation poll found. But Sen. McCain has released some proposals to reform health care, and although his plans are not fully fleshed out, they represent a dramatic change from both the current status quo and Democratic proposals.

Unlike the Democrats, cost, rather than access, is the focus. “The problem is not that most Americans lack adequate health insurance,” Sen. McCain told an audience in Des Moines, Iowa. “The biggest problem with the American health care system is that it costs too much.”

John McCain touts his plan for the U.S. health care systemThe centerpiece of his plan to tackle cost is to change the tax code, which would eliminate the incentives for employer-sponsored health coverage and offer individuals a $2,500 tax credit ($5,000 per family) for purchasing their own insurance. Under his plan, which also encourages health savings accounts and cost transparency, patients will have substantially more responsibility for making their own health care and coverage determinations, and would be less likely to choose the most expensive and often unnecessary options, he said in the same speech.

To foster nationwide competition and thereby reduce cost, Sen. McCain also proposes eliminating state-by-state divisions of insurance marketing and physician practice.

Although states would lose some control over insurance regulation and medical licensing, they would take on the new responsibility of finding coverage for high-risk, high-cost patients. States should develop methods for providing additional assistance to families who face unusually high premiums, Sen. McCain said. “The federal government can help fund this effort, but in exchange states should allow Medicaid and SCHIP funds to be used for private insurance,” he explained.

Sen. McCain envisions substantial changes to private insurance as a result of his encouragement of competition. “Insurance should be innovative, moving from job to home, job to job, and providing multi-year coverage. Allow individuals to get insurance through any organization or association that they choose,” his Web site states.

Of concern to internists, he favors eliminating lawsuits against physicians who follow clinical guidelines and adhere to protocols, payments for coordinated care and nonpayment for preventable errors.

Although he hasn’t provided details, Sen. McCain has also expressed opinions on some other hot-button health care issues. He supports walk-in clinics as an alternative/addition to physician offices and emergency rooms. He opposed Medicare Part D because of the cost of providing drug benefits to senior citizens who could afford to pay for their medications, but he favors re-importation of drugs and faster introduction of generics to lower drug expenditures.

Some responsibility for lowering the expense of the U.S. health care system also will fall onto the general public under the McCain plan. He mentions obesity, diabetes and high blood pressure specifically as areas where individual efforts could reduce disease incidence.

A discussion of autism recently caused some controversy for Sen. McCain. According to the New York Times, he recently told a Texas audience that “strong evidence” indicates that vaccine preservatives are causing rising autism rates. His comment drew heat from host of experts who cited strong evidence to the contrary.

Sen. McCain is the underdog in convincing voters to support his plan for reform. A March Wall Street Journal poll conducted by Harris Interactive after the Ohio and Texas primaries found that 45% of voters would trust Democrats to lead health reform while only 25% said they would trust Republicans. Among the three remaining candidates, 44% of those polled said they would trust Sen. Hillary Clinton with overhauling health care, compared with 40% for Sen. Barack Obama and 30% for Sen. McCain.

Presumably, as the campaign moves forward, Sen. McCain will release more details. For information on his opponents’ plans, check back next month, when the Campaign Trail will conduct a similar analysis of the Democratic candidates’ health care platforms.

© Copyright 2008 American College of Physicians. All Rights Reserved.
190 North Independence Mall West, Philadelphia, PA 19106-1572

Title: pharmaceutical studies
Post by: ccp on June 18, 2008, 05:28:43 AM
There is a reason patients are not paid a lot of money to participate in pharmaceutical studies.  Ethics experts and institutional review boards composed of religious, business, legal medical and other lay people decide that offering too much money clouds the judgement of people into participate in these studies.  In fact I had conducted some of these myself and it would have been *a lot easier* to offer a lot more money and have more participants then we would need rather than be able to offer a pittence and take forever to find subjects.  Additionally IRB approve the informed consent, advertising, and to suggest that these veterans or anyone else is just thrown into these studies without their complete and explicit consent is bogus publicity.  These are not Nazi experiments.  The patient know full well they are in experimental studies and know full well there are risks.

Again as I said before a one in a million reaction to chantix is hardly some sort of scandal.  I think Obama dumba should have to spend a month taking care of the millions of patients dying of cancer, and emphysema because they couldn't stop smoking - that SOB.
***VA testing drugs on war veterans
Experiments raise ethical questions
Audrey Hudson (Contact)
Tuesday, June 17, 2008

UPDATE: Obama's office sent a letter Tuesday to James Peake, secretary of the Department of Veterans Affairs, on the issue. You can read the full text of the letter here.

UPDATE II: Sen. John Cornyn, Texas Republican, issued his own letter to Peake as well. You can read it here.

The government is testing drugs with severe side effects like psychosis and suicidal behavior on hundreds of military veterans, using small cash payments to attract patients into medical experiments that often target distressed soldiers returning from Iraq and Afghanistan, a Washington Times/ABC News investigation has found.

In one such experiment involving the controversial anti-smoking drug Chantix, the Department of Veterans Affairs (VA) took three months to alert its patients about severe mental side effects. The warning did not arrive until after one of the veterans taking the drug had suffered a psychotic episode that ended in a near lethal confrontation with police.

ROD LAMKEY JR./THE WASHINGTON TIMES Veteran James Elliott arrives at the Veterans Affairs Medical Center in Washington for his scheduled substance-abuse class in April. Mr. Elliott, a chain smoker, served 15 months in Iraq as an Army sharpshooter and suffers post-traumatic stress disorder.

ROD LAMKEY JR./THE WASHINGTON TIMES Iraq war veteran James Elliott opted for a government clinical trial for a smoking-cessation drug for $30 a month, starting in November. Two weeks later, the FDA informed the VA of serious side effects.

ROD LAMKEY JR./THE WASHINGTON TIMES STILL SMOKING: Iraq war veteran James Elliott smokes on his porch in Silver Spring as he talks about his experiences in war and dealing with post-traumatic stress disorder. Mr. Elliott suffered a psychotic episode while taking the anti-smoking drug Chantix.

James Elliott, a decorated Army sharpshooter who suffers from post-traumatic stress disorder (PTSD) after serving 15 months in Iraq, was confused and psychotic when he was Tasered by police in February as he reached for a concealed handgun when officers responded to a 911 call at his Maryland home.

For photos, video of James Elliott, official FDA documents and more, visit the interactive site for the Disposable Heroes report.

Mr. Elliott, a chain smoker, began taking Chantix last fall as part of a VA experiment that specifically targeted veterans with PTSD, opting to collect $30 a month for enrolling in the clinical trial because he needed cash as he returned to school. He soon began suffering hallucinations and suicidal thoughts, unaware that the new drug he was taking could have caused them.

Just two weeks after Mr. Elliott began taking Chantix in November, the VA learned from the Food and Drug Administration (FDA) that the drug was linked to a large number of hallucinations, suicide attempts and psychotic behavior. But the VA did not alert Mr. Elliott before his own episode in February.

In failing to do so, Mr. Elliott said, the VA treated him like a "disposable hero."

"You're a lab rat for $30 a month," Mr. Elliott said.***
Title: So how is Romney's plan in Massachussets doing?
Post by: ccp on June 26, 2008, 07:08:55 AM
From the New England Journal of Medicine which does carry of leftist flavor when it comes to politics and health care.  (Well they do reside in Massachussetts. :wink:)

I don't know why Hollywood shouldn't pay for our health care needs with a windfall profits tax.  Maybe athletes and sports team owners should pay a windfall tax too  (who still weasel public money for their stadiums.).  And my well known favorite industry - the music industry.

This is what we will see from Bo on a national scale.  It is a very complicated situation so I have no real opinion one way or another and am just sitting helplessly on the sidelines anyway so what ever will be - will be....

****The New England Journal of Medicine
Volume 358:2757-2760      June 26, 2008      Number 26

Health Care Reform in Massachusetts — Expanding Coverage, Escalating Costs
Robert Steinbrook, M.D.

The far-reaching health care reforms that Massachusetts enacted in April 2006 are often cited as a model for other states.1 After 2 years, the good news is that the new programs have ramped up rapidly, the number of people without health insurance has been substantially reduced, and overall public and political support remains broad. Early data suggest that access to care has improved, especially among low-income adults; there have also been "reductions in out-of-pocket health care spending, problems paying medical bills, and medical debt."2 As of May 2008, about 350,000 residents — 5.5% of the state's population — were newly insured (see figure). About half of them are enrolled in Commonwealth Care, a subsidized insurance program for adults who have no access to employer-sponsored insurance, Medicare, Medicaid, or veterans' or student insurance programs and who earn no more than 300% of the federal poverty guidelines. About a third have purchased private insurance or gained employer-sponsored coverage, and the rest have enrolled in Medicaid. About 72% of the approximately 25,000 people with new individual policies have purchased them through Commonwealth Choice, an unsubsidized offering of private health plans approved by the Commonwealth Health Insurance Connector Authority, which administers many aspects of the reforms. In addition, the individual and small-group insurance markets have been merged, markedly reducing the cost of individual premiums.

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     Growth in Health Insurance Coverage in Massachusetts after Health Care Reform.

Panel A shows the health insurance coverage among the 352,170 Massachusetts residents (5.5% of the 2007 state population of 6.4 million) who are newly insured. An estimated 550,000 to 715,000 residents (8.6 to 11.2%)1 were without health insurance before reform. Data for Commonwealth Care enrollees are from the Commonwealth Connector as of May 1, 2008. Medicaid data are from MassHealth as of February 29, 2008. Data for private insurance are from the Massachusetts Association of Health Plans, representing the increase in the number of people enrolled in commercial insurance between January 1, 2007, and January 1, 2008. New private-insurance enrollment includes coverage through Commonwealth Choice, an unsubsidized offering of approved private health plans that has been available through the Commonwealth Connector since July 2007; as of May 1, 2008, a total of 18,122 people had purchased insurance through Commonwealth Choice. Panels B and C show the numbers of residents enrolled in Commonwealth Care and Commonwealth Choice, respectively.

Not all the news is good, however. Perhaps 5% of the state's population — the exact figure is a matter of conjecture and may be higher — is still uninsured, the financial burden of the reforms is increasing, and the challenges of sustaining the subsidized program have been exacerbated by the economic downturn. The features of plans that decrease the cost of premiums also increase out-of-pocket costs for those who obtain care. Although adults reported lower levels of health care needs that remained unmet because of cost in the fall of 2007 than in the previous year, those with low incomes reported increased difficulty in getting appointments or in finding a doctor or other provider who would see them.2 And the state ultimately decided that not all residents must actually carry health insurance, as the legislation originally intended: exemptions are available for adults who make too much money to enroll in the subsidized insurance program but are deemed unable to afford policies in the private market; others can be exempted on religious grounds or when unusual financial circumstances arise. If more residents were eligible for subsidized insurance, fewer would qualify for hardship exemptions, but such an approach would further increase the cost of the new programs. Already, enrollment in Commonwealth Care is growing faster than was projected. Annual state spending would be $1.08 billion for fiscal year 2009 if 255,000 residents are enrolled, an increase of about 80,000 enrollees from the current number.3 If 225,000 residents enroll, as an earlier estimate suggested, spending would be $869.4 million. By comparison, spending for Commonwealth Care was $132.9 million in fiscal year 2007 and is projected to be $647.4 million in fiscal year 2008. Moreover, as compared with the national average, the per-capita cost of medical care in Massachusetts is high.

"To maintain public and financial commitment to the new programs, controlling costs is 110% of the challenge for the next several years," according to Jon Kingsdale, executive director of the Commonwealth Connector. The monthly cost per member in the subsidized insurance program is $352.43, which is about what was budgeted and considerably less than the median cost of employer-sponsored coverage in the state. There are no monthly premiums for adults earning less than 150% of the federal poverty guidelines (in 2008, $15,612 for an individual and $31,812 for a family of four); premiums for those who earn 150 to 300% of the federal poverty guidelines are set according to a sliding scale, with a maximum premium for an individual of $105 a month. About 70% of those who have signed up pay no premiums. People who are eligible for Commonwealth Care are deemed to have access to affordable coverage; Medicaid covers the children of adults enrolled in Commonwealth Care.

The requirement to carry insurance is enforced through the state income-tax return. In general, the Massachusetts Department of Revenue uses the affordability schedule adopted by the Commonwealth Connector and other financial and insurance information to verify the self-reported information on tax returns and to determine eligibility for hardship exemptions. In 2008, the maximum penalty for not having insurance is $912. In 2007, it was $219. Revenue from this penalty is expected to be $8.5 million for fiscal year 2008.3

In June 2008, the Department of Revenue released preliminary data about the health insurance information reported on 2007 tax returns, covering 86% of the tax filings that are eventually expected. Of the taxpayers required to file insurance information, only 1.4% failed to comply. About 168,000 of 3.34 million adults (5.0%) reported that they did not have health insurance coverage at the end of the year. On the basis of the affordability schedule, about 97,000 were deemed "able to afford" insurance — 86,000 who paid the penalty and 11,000 who have appealed it. About 62,000 were deemed "unable to afford insurance" and are thus eligible for an exemption. In addition, about 9,000 taxpayers claimed a religious exemption, and about 200 had already obtained a "certificate of exemption," for financial reasons, from the Commonwealth Connector. About 10% of residents either do not file tax returns or are not accounted for as dependents on the returns of others, so the actual number without health insurance is probably higher.

As of January 1, 2009, people with health insurance must have plans that provide "minimum creditable coverage." Among other requirements, such plans must cover at least three doctor visits for an individual or six for a family before charging any deductible, and they must offer prescription-drug coverage (with a limit on any separate deductible of $250 for an individual and $500 for a family). However, annual deductibles (capped at $2,000 for an individual and $4,000 for a family) and out-of-pocket spending (capped at $5,000 for an individual and $10,000 for a family) can be very high.

In 2008, health insurance in Massachusetts is considered affordable — regardless of the premium — for individuals with incomes above $52,501, for couples with incomes above $82,501, and for families of any size with incomes above $110,001, according to the Commonwealth Connector. For people with lower incomes, the affordability schedule, which is revised annually, is used to determine whether residents can pay for health insurance, regardless of whether it is obtained through the Commonwealth Connector or directly from an insurer. According to the 2008 schedule, affordable policies typically require no more than 7.5% to 10.6% of income to be paid for premiums; the percentages vary according to income and type of household. People with preexisting medical conditions are not charged more for individual policies. However, because premiums increase with age, people with incomes below the affordability thresholds are considered to have no affordable private insurance options after a certain age — currently, 55 years for individual coverage, 50 years for couple coverage, and 30 years for family coverage. Income-based categorical exemptions apply mostly to adults who are not offered employer-sponsored insurance. Until a more detailed analysis of tax returns is completed, state officials will not know how many of the people deemed unable to afford health insurance fall into these categories. And, of course, people who use medical care have additional expenses for copayments, deductibles, prescription charges, and other out-of-pocket costs.

Premiums for the unsubsidized Commonwealth Choice program will increase by an average of 5% for fiscal 2009, which begins on July 1. Government payments for premiums in Commonwealth Care will increase by an average of 9.4%. The state's cost for Commonwealth Care is partially offset by federal reimbursement — projected to be at $268.3 million in fiscal year 2008 and for $360.6 million in fiscal year 20093 — and a decrease in payments to community health centers and hospitals that treat the uninsured, which has caused difficulties for some centers and hospitals. Other revenues are limited. Revenue from the "fair share contribution," an annual per-employee charge of $295 paid by businesses that have 11 or more full-time–equivalent employees but do not provide or contribute to health insurance, is projected to be $6.7 million in fiscal 2008, as compared with the $50 million per year that was estimated when the reform was enacted.1,3 The difference could reflect inaccurate or incomplete reporting or an inaccurate initial estimate of the number of employers that would be subject to the assessment. More people, including low-income adults, have employer-sponsored insurance than did before the reform.

Massachusetts has thus far avoided legal challenges to its reforms that might have been brought under the federal Employee Retirement Income Security Act, which prohibits states from setting plan standards for self-insured employers. Possible explanations are that the requirement for maintaining a minimum standard of coverage is placed on individuals rather than employers, that businesses largely support the reform,4 and that their obligations are modest. An employer's requirements are met if at least 25% of its workers enroll in the company health plan or if it offers to pay at least one third of the premium for individual coverage. Employers are not required to provide health insurance to part-time employees. So far, employers have blocked efforts to make them pay more of the costs of the reform.

Health care reform in Massachusetts is not a panacea for the many shortcomings of the health care system.5 It is worth remembering that California, for example, has more people without health insurance (6.7 million) than Massachusetts has residents (6.4 million) and that the financing and delivery of medical care have not changed.1 Having health insurance is not having health care.5 There are still many difficulties with access to primary care and other services. However, Massachusetts has made some strides, and given sufficient resources, more can be done. This includes identifying and reaching people who are still uninsured and helping them gain coverage, expanding employer-sponsored insurance, and improving the options for part-time employees, for low-paid workers who are offered insurance by their employers but who earn less than 300% of the federal poverty guideline and cannot afford it, and for others with hardship exemptions. The state legislature is considering new cost-control measures, and there is interest in a plan from Blue Cross–Blue Shield of Massachusetts, the largest carrier in the state, which pays doctors and hospitals according to a combination of capitation and pay-for-performance approaches. As a practical matter, the improvements in health insurance coverage can continue indefinitely as long as public and political support remain strong and the state is willing — with the substantial help of the federal government through the renewal of a Medicaid waiver agreement — to keep paying the ever-increasing bill.

Dr. Steinbrook ( is a national correspondent for the Journal.


   1. Steinbrook R. Health care reform in Massachusetts -- a work in progress. N Engl J Med 2006;354:2095-2098. [Free Full Text]
   2. Long SK. On the road to universal coverage: impact of reform in Massachusetts at one year. Health Aff (Millwood) 2008;27:W270-W284.
   3. The Commonwealth of Massachusetts. Information statement. April 16, 2008. (Accessed June 6, 2008, at
   4. Gabel JR, Whitmore H, Pickreign J. Report from Massachusetts: employers largely support health care reform, and few signs of crowd-out appear. Health Aff (Millwood) 2008;27:w13-w23. [Free Full Text]
   5. Angell M. Health reform you shouldn't believe in. The American Prospect. April 21, 2008.

The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved.****
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on July 22, 2008, 08:07:54 AM
American Cancer Care Beats the Rest
July 22, 2008; Page A19

"Your accomplishment of [universal access] is the envy of every U.S. citizen who understands what you've done," Sen. Edward Kennedy (D., Mass.) told a Canadian audience in 1996. This week, a major international study confirms that Mr. Kennedy is right to stay at home for his own cancer care: U.S. medicine bests the cancer treatment available to people in 30 other countries.

The Concord study compares five-year cancer survival rates for several malignancies: breast cancer in women; prostate cancer; colon and rectal cancer in women and men. Combining the efforts of some 100 researchers, drawing data from almost two million cancer patients in 31 countries, the study, to be published in the August issue of The Lancet, is groundbreaking.

Who's on top? Arguably Cuba, which records the best overall outcomes for breast cancer and colorectal cancer (in women), and seems to beat U.S. health care in three out of the four categories. The study's authors -- who apparently hold higher standards than filmmaker Michael Moore -- disregard these results owing to data quality issues.

The study finds that the U.S. leads in the field of breast and prostate cancer. France excelled in women's colorectal cancer and Japan in men's colorectal cancer. The news isn't all good here: great discrepancies exist between white and African-Americans. That said, the United States clearly leads other nations in overall survival.

These results aren't completely surprising. Though international comparisons are hard to make, Lancet Oncology published last August a comparison of American and European care, and the U.S. fared better in 13 of the 16 cancers studied.

Americans don't usually hear good news stories about health care. Mr. Moore favorably reviewed British, French and even Cuban health care in the movie "Sicko," showing satisfied patients and happy, chic docs. Paul Krugman wrote last year in the New York Times that: "there's very little evidence that Americans get better health care than the British."

Cancer care there is different than here. Take for instance the country whose health-care system Mr. Krugman likes so much. The Lancet Oncology study finds that five-year survival rates for cancer in men, for example, are 45% in England (slightly higher in Wales, lower in Scotland) but 66% in the U.S.

Why do the British lag behind American survival rates? Screening standards are different. In the United States, internists recommend that men 50 and older get screened for colon cancer; in the National Health Service in the United Kingdom, screening begins at 75. And British patients wait much longer to see specialists. A Clinical Oncology study of British lung cancer treatment found in 2000 that 20% "of potentially curable patients became incurable on the waiting list." Novel drugs offered here often aren't available there; for instance, Avastin, a drug for advanced colon cancer, is prescribed more often in the U.S. than in the UK, by some estimates as much as ten-fold more.

A drug called Temodal is the U.S. standard of care for Sen. Kennedy's type of brain cancer. In Britain, a government body charged with funding decisions -- the euphemistically named NICE, or National Institute for Health and Clinical Excellence -- ruled in 2001 that Temodal wasn't worth the money as a first-line treatment; in 2007, they partially lifted the prohibition. Patients can still get the drug, they just need to pay out of pocket -- for all their cancer care. The National Health Service recently ruled that if patients opt out of one type of care (say by getting Temodal), they opt out of all publicly funded care.

Two cheers, then, for American health care and better cancer outcomes. Rising costs, however, threaten to undermine the economy. Not surprisingly, our debate is shifting to a discussion of getting better value from our health dollars. Just last week, the U.S. House of Representatives held hearings on this topic (full disclosure, I was a witness). Former Sen. Tom Daschle and his co-authors speak at length about "value" in their new book, "Critical: What We Can Do About the Health-Care Crisis." Given his potential role in a future Democratic administration, the book may lay out the first outline of ObamaCare.

What's to be done? Mr. Daschle talks up the idea of a federal health-care board charged with "recommending coverage of those drugs and procedures backed by solid evidence. It would exert influence by ranking services and therapies by their health and cost impacts." The inspiration? Mr. Daschle cites Britain's NICE. The Congressional Budget Office is slated to release a paper on this topic later this year.

Given the Concord results, the CBO may want to hold off on that effort. Value -- like in the other five-sixths of the economy -- will come from competition and choice, not a government committee. But the federal government can take a leadership role in promoting competition. How? By creating greater transparency of prices, releasing more Medicare information on complications and outcomes, encouraging hospitals and clinics to standardize their health records, and slashing regulations that discourage competition. Together, these efforts would make it easier for American patients to seek out excellence. And that seems as American as apple pie and good cancer care.

Dr. Gratzer, a physician, is a senior fellow at the Manhattan Institute. His most recent book, "The Cure: How Capitalism Can Save American Health Care" (Encounter Books, 2006), is now out in paperback.

See all of today's editorials and op-eds, plus video commentary, on Opinion Journal.
Title: WSJ: The Price of Romney Care
Post by: Crafty_Dog on July 29, 2008, 07:50:40 AM
I have been leaning towards favoring Romney as Veep for McC, in great part because, unlike McC, he can articulate free market economics pretty well-- but then there is the coming clusterfcuk of Romeny Care-- which will make it hard for McC to challenge BO's promised socialization.

The Price of RomneyCare
July 29, 2008; Page A16
Gearing up for 2009, liberals are eager to claim Massachusetts as a Valhalla of health reform. Their enthusiasm is apparently evidence-proof.

Even Mitt Romney, who should know better, took to these pages recently to proclaim, "Health-care reform is working in Massachusetts." Shortly after Mr. Romney's self-tribute, Governor Deval Patrick wheeled out a new $129 million tax plan to make up for this year's health spending shortfalls. Yet partisans are cheering the cost overruns as a sign of success.

Supporters are exultant because 350,000 people are newly covered since former Governor Romney's parley with Beacon Hill Democrats in 2006; this cuts the state's uninsured rate by about half. That's not the promised "universal" system, but never mind. The ominous news is that only about 18,000 people -- or 5% of the newly insured -- have taken advantage of the "connector," which was supposed to be the plan's free-market innovation linking individuals to private insurers.

Most of this growth in coverage has instead come via a new state entitlement called Commonwealth Care. This provides subsidized insurance to those under 300% of the poverty level, or about $63,000 for a family of four. About 174,000 have joined this low- or no-cost program, a trend that is likely to speed up.

As this public option gets overwhelmed, budget gaskets are blowing everywhere. Mr. Patrick had already bumped up this year's spending to $869 million, $144 million over its original estimate. Liberals duly noted that these tax hikes are necessary because enrollment in Commonwealth Care is much higher than anticipated. But of course more people will have coverage if government gives it to them for free. The problem is that someone has to pay for it.

Thus the extra tab of $129 million, which may need to go higher because it relies on uncertain federal funds from Medicaid. For now, Mr. Patrick wants one-time (yeah, right) charges of $33 million on insurers and $28 million on providers, plus some shuffling of state funds. The balance comes from an estimated $33 million boost in the state's "pay or play" tax: If businesses don't offer "fair and reasonable" insurance to their employees, they get hit.

This is a textbook example of how business taxes evolve into "pay or pay," the first recourse of state-funded health systems. Politicians love levies on business because they disguise the overall bill from voters. But such taxes are merely passed along to workers in the form of reduced take-home pay, since all health costs are part of compensation.

The main reason people are uninsured is because coverage is too expensive. Massachusetts didn't have many options for reforming the way health dollars are laundered in the third-party payment system created by the federal tax code. But it could have helped make insurance cheaper by reforming its private market before defaulting to public programs.

The Bay State has long served up coverage-specific insurance mandates, such as for fertility treatments, which raise costs. Yet in a just-deserts twist, Massachusetts health planners are now reviewing ways to trim mandates because the state is footing more of the bill, even if they didn't care when imposing them on individuals and small business. A state-sponsored study shows that total spending on mandates was $1.32 billion in 2005, or 12% of premiums. The study is devastating despite its pro-mandate slant.

Not that such practical lessons have stopped liberals from joining the Massachusetts parade. They have to gussy up the state's model because the extravagant claim that led to its creation -- that health care will be less expensive if everyone is covered -- is being relentlessly discredited. It's the same claim they want to make when they try to pass a similar plan for the whole country in next year's Congress.

See all of today's editorials and op-eds, plus video commentary, on Opinion Journal.

And add your comments to the Opinion Journal
Title: WSJ: Pulling the Trigger
Post by: Crafty_Dog on August 02, 2008, 10:13:51 AM
Pulling the Trigger
August 2, 2008; Page A10
Let's hope Capitol Hill never catches fire. Congress would switch off the alarm and pretend there were no flames. That, at least, was the policy message sent by Speaker Nancy Pelosi and her health-care enforcers when the House voted last week to deactivate a warning that entitlement spending is running amok.

Everybody has known forever that Medicare's spending trend is untenable. The program soaked up 3.2% of GDP and 16% of all federal spending in 2007, and it is expected to grow by 7.4% or more a year over the next decade. The Tom DeLay Republicans made the problem worse with their 2003 prescription drug benefit, but in doing so they felt a twinge, a flicker, a memory flash of fiscal conscience. So as a token gesture Republicans added a "trigger" that was supposed to force some future Congress to address the program's long-term insolvency.

The trigger kicks in if Medicare's Trustees project, for two years in a row, that the program will draw more than 45% of its funding from general government revenue -- instead of from payroll taxes, or premiums and co-pays from beneficiaries. That has happened for the last two years, and probably will every year for the foreseeable future. And when it does, the White House is required to write up "corrective" legislation. Under special procedures, the White House proposal is guaranteed an up-or-down vote in the House, though not the Senate.

The trigger doesn't actually require any cost-saving, much less real discipline. All it does is oblige the political class to nod at Medicare's deteriorating finances. But even that minor annoyance is too much for Democrats, so the House voted 231-184 last Thursday to change the rules to avoid considering President Bush's proposal.

Not that the Administration's proposal is ambitious. It would merely slow the rate of spending growth enough to shut off the 45% trigger. Provisions include moving toward electronic health records and a microincrease in prescription drug premiums for 1.5 million wealthy seniors. The horror!

Congress was free to reject any of this. But a vote might draw attention from the otherwise sleepy Capitol Hill press corps, and Democrats objected even to having the discussion. Liberal health-care maharishi Pete Stark wailed about "a political ploy to foster an unfounded panic," while Majority Leader Steny Hoyer called the trigger "completely arbitrary."

Democrats have tried repeatedly since 2006 to abolish the trigger because it gets in the way of their health-care agenda, even if only a little bit. Barack Obama has plans for a slow-motion roll toward "Medicare for all," the ultimate goal of Democratic health policy. The trigger reminds people of how spendthrift and taxing the budget for Medicare already is -- even when it's reserved only for seniors.

The House vote stalls action until the next Administration, when Democrats will almost certainly dump the trigger entirely.

Title: BO
Post by: Crafty_Dog on September 16, 2008, 06:17:08 AM
For those of us who have had quite enough of lipsticked pigs and the politics of personality, here is an effort at discussing the issues from BO's team posting at the WSJ

Why Obama's Health Plan Is Better
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The big threat to growth in the next decade is not oil or food prices, but the rising cost of health care. The doubling of health insurance premiums since 2000 makes employers choose between cutting benefits and hiring fewer workers.

Rising health costs push total employment costs up and wages and benefits down. The result is lost profits and lost wages, in addition to pointless risk, insecurity and a flood of personal bankruptcies.

APSustained growth thus requires successful health-care reform. Barack Obama and John McCain propose to lead us in opposite directions -- and the Obama direction is far superior.

Sen. Obama's proposal will modernize our current system of employer- and government-provided health care, keeping what works well, and making the investments now that will lead to a more efficient medical system. He does this in five ways:

- Learning. One-third of medical costs go for services at best ineffective and at worst harmful. Fifty billion dollars will jump-start the long-overdue information revolution in health care to identify the best providers, treatments and patient management strategies.

- Rewarding. Doctors and hospitals today are paid for performing procedures, not for helping patients. Insurers make money by dumping sick patients, not by keeping people healthy. Mr. Obama proposes to base Medicare and Medicaid reimbursements to hospitals and doctors on patient outcomes (lower cholesterol readings, made and kept follow-up appointments) in a coordinated effort to focus the entire payment system around better health, not just more care.

- Pooling. The Obama plan would give individuals and small firms the option of joining large insurance pools. With large patient pools, a few people incurring high medical costs will not topple the entire system, so insurers would no longer need to waste time, money and resources weeding out the healthy from the sick, and businesses and individuals would no longer have to subject themselves to that costly and stressful process.

- Preventing. In today's health-care market, less than one dollar in 25 goes for prevention, even though preventive services -- regular screenings and healthy lifestyle information -- are among the most cost-effective medical services around. Guaranteeing access to preventive services will improve health and in many cases save money.

- Covering. Controlling long-run health-care costs requires removing the hidden expenses of the uninsured. The reforms described above will lower premiums by $2,500 for the typical family, allowing millions previously priced out of the market to afford insurance.

In addition, tax credits for those still unable to afford private coverage, and the option to buy in to the federal government's benefits system, will ensure that all individuals have access to an affordable, portable alternative at a price they can afford.

Given the current inefficiencies in our system, the impact of the Obama plan will be profound. Besides the $2,500 savings in medical costs for the typical family, according to our research annual business-sector costs will fall by about $140 billion. Our figures suggest that decreasing employer costs by this amount will result in the expansion of employer-provided health insurance to 10 million previously uninsured people.

We know these savings are attainable: other countries have them today. We spend 40% more than other countries such as Canada and Switzeraland on health care -- nearly $1 trillion -- but our health outcomes are no better.

The lower cost of benefits will allow employers to hire some 90,000 low-wage workers currently without jobs because they are currently priced out of the market. It also would pull one and a half million more workers out of low-wage low-benefit and into high-wage high-benefit jobs. Workers currently locked into jobs because they fear losing their health benefits would be able to move to entrepreneurial jobs, or simply work part time.

In contrast, Sen. McCain, who constantly repeats his no-new-taxes promise on the campaign trail, proposes a big tax hike as the solution to our health-care crisis. His plan would raise taxes on workers who receive health benefits, with the idea of encouraging their employers to drop coverage. A study conducted by University of Michigan economist Tom Buchmueller and colleagues published in the journal Health Affairs suggests that the McCain tax hike will lead employers to drop coverage for over 20 million Americans.

What would happen to these people? Mr. McCain will give them a small tax credit, $5,000 for a family and $2,500 for an individual, and tell them to navigate the individual insurance market on their own.

For middle- and lower-income people, the credits are way too small. They are less than half the cost of policies today ($12,000 on average for a family), and are far below the 75% that most employers offering coverage contribute. Further, their value would erode over time, as the credit increases less rapidly than average premiums.

Those already sick are completely out of luck, as individual insurers are free to deny coverage due to pre-existing conditions. Mr. McCain has proposed a high-risk pool for the very sick, but has not put forward the money to make it work.

Even for those healthy enough to gain coverage in the individual insurance market, the screening, marketing and individual underwriting that insurers do to separate healthy from sick boosts premiums by 17% relative to employer-provided insurance, well beyond the help offered by the McCain tax credit.

The immediate consequences of the McCain plan are even worse. The McCain plan is a big tax increase on employers and workers. With the economy in recession, that's the last thing America's businesses need.

Finally, Mr. McCain does nothing to bend the curve of rising health-care costs downward. He does not fund investments in learning, rewarding and preventing. Eliminating state coverage requirements will slash preventive service availability.

The high cost-sharing plans he envisions will similarly discourage preventive care. And as he does nothing about the hidden costs of the uncovered -- expensive ER visits, recurring conditions resulting from inadequate follow-up care.

Everyone agrees our health-care financing system must change. But only one candidate, Barack Obama, has real change we can believe in.

Mr. Cutler is professor of economics at Harvard and an adviser to Barack Obama's presidential campaign. Mr. DeLong is professor of economics at University of California, Berkeley. Ms. Marciarille is adjunct law professor at McGeorge School of Law.
Title: Re: The Politics of Health Care
Post by: ccp on September 16, 2008, 07:11:53 AM
Well here is that Cutler guy again.   Does one find it interesting he is a 'Harvard economist' advising how health care should be distributed?  I am sure he is a die hard political neutral (sarcasm emphasized).  From New England Journal on Cutler and the rest of the "experts".   BTW, remember "prevention" is not always synonomous with lower costs.   

***Volume 359:1085-1087  September 11, 2008  Number 11
Speaking Truth to Power — The Need for, and Perils of, Health Policy Expertise in the White House

Jacob S. Hacker, Ph.D.
 President Harry Truman once famously wished for a one-handed economist, because the ones advising him were forever saying, "On the one hand . . . but on the other hand. . . ." President George W. Bush went one appendage further: "If [these economists] had three hands they'd say, on the one hand, on the other hand, and then on the third hand."1 Yet presidents keep coming back to economists and other policy experts, especially in the fiendishly complex field of health care. Democratic presidential candidate Barack Obama leans on Harvard economist David Cutler; his larger stable of health advisers includes Austin Goolsbee and Jason Furman, both economists. Republican John McCain relies on economics Ph.D. Gail Wilensky, as well as on the former director of the Congressional Budget Office, Douglas Holtz-Eakin, another economist.

Economists are not, of course, the only experts to which presidents and presidential aspirants turn. On health care, Obama and McCain are advised by lawyers, doctors, holders of public-policy degrees, and the occasional noneconomist social scientist. What remains constant is the role these advisers occupy, a role awash in ambiguity, opportunity, and risk. The adviser is the president's ally — in the lingo of organizational economics, an "agent" serving the interests of a "principal." Yet as a bearer of specialized knowledge, the adviser is also responsible to a larger profession, to its values and commitments, and ultimately to the ideal of expertise itself.

The adviser, in short, must both "speak truth to power" and aid in the exercise of power, both offering unbiased intelligence and acting as a very biased assistant. It is fashionable to pretend these two roles are the same, but they are not. An expert adviser has special knowledge, training, and skills — all of which are needed more than ever in the White House. The question is whether these talents can really be used, or be useful, in the bare-knuckles world of American politics — and, more important, whether the values they embody can be upheld when science, advocacy, and democracy collide.

Consider the travails of noted health policy expert Len Nichols. As Hillary Clinton battled for the Democratic nomination, Nichols joined a conference call for reporters set up by her campaign. The topic was an Obama advertisement charging that Clinton would force people to buy insurance "even if they can't afford it." On the call, Nichols likened the ad to "having Nazis march through Skokie" — a depiction the Clinton campaign immediately disavowed. Shortly thereafter, Nichols apologized for letting his "passions" overwhelm him. The head of the New America Foundation, where Nichols works, declared his comments "regrettable," not least because the foundation "does not endorse or advise any campaign in an official capacity."2

Nichols's sin — besides the obvious rhetorical offense — was to cross the line between expert and partisan. Politics is about power more than truth, about winning more than being right. But expertise is about truth more than power, and being right is the whole point. The authority of the expert cannot survive long when expert judgment is seen to hinge on grudges or biases. The abiding concern of the expert adviser is how to maintain independence while acting as a faithful ally and advocate — how to make power serve truth while still serving the principal.

Yet the greater, and more vexing, problem is far less recognized: the limits of expertise itself. When the Clinton administration's health plan died in 1994, many dismissed its health policy advisers as naive. And yet the closest of these advisers were not just highly regarded health policy experts, they were some of the most knowledgeable the White House has ever seen. Paul Starr, who had masterfully dissected the past failure of national health insurance, left Princeton to help write the plan. Scores of other experienced policy gurus — including Len Nichols — lent their wisdom. Even Ira Magaziner, the much-maligned policy wonk who oversaw the president's gargantuan health care task force, had more than a passing familiarity with health and economic policy. All of them had studied the lessons of history — and ended up repeating them anyway.

The modern presidency demands expertise. The rise of a massive, interconnected executive branch, the ever-increasing complexity of public policy, the "permanent campaigns" of contemporary elections, with their endless issues, talking points, and proposals — all make the president's job as much about fostering and managing competing information streams and creating communities of allied expertise as about fulfilling the authoritative role President Bush evocatively termed "the decider." Contemplating Dwight Eisenhower's arrival, Harry Truman foresaw the challenge for the former general as presidential impotence: "He'll sit here, and he'll say, `Do this! Do that!' And nothing will happen."3 But the more basic challenge may be to decide what to do on issues as varied and complex as global warming and stem-cell research, health care financing and financial-market regulation. Here expertise is invaluable, unavoidable — and sometimes, as the failure of the Clinton plan reminds us, perilous.

Health policy experts can do more sophisticated analyses than ever, and there are more of them than ever, too — in policy schools, departments of economics, schools of public health, think tanks, private foundations, and government. But the progress in quality of expertise has not been matched by progress in thinking about the role of the expert or about how policy advice can and should be adapted to the political realities that those receiving advice inevitably confront. Policy experts are brilliant when it comes to designing proposals but often horrible at thinking through the ways in which their proposals will be refracted through the political prism. Subtle visions of policy are wedded to crude caricatures of politics, and, not surprisingly, those visions all too often either fail to become reality or fail to work.

Worse, the expert's claim to authority can undercut the more important wellspring of democratic leadership: the demands and wishes of the people. Experts are habitually disdainful of what ordinary citizens believe. People have opinions; experts have facts. When a well-regarded economist complains that democratic policy choice should be restricted because "irrational" voters endorse all sorts of harmful nostrums — whether trade protection or farm price supports (he might have added health insurance with low deductibles, drug price controls, and free choice of doctors) — he may be out on a limb.4 But the tree is one that many policy experts climb.

Ironically, then, the failure of the Clinton administration's plan was made more, not less, likely by the amount of policy expertise poured into its design. The Clinton advisers sought the ideal policy synthesis. Though aware of political realities, they treated them as problems of policy design, to be managed within the confines of the president's blueprint rather than incorporated into a political strategy that would make the president's goals and ideals, not a 1342-page bill, the guiding light of congressional debate. And the advisers designed the proposal knowing full well that many of its elements, such as greater emphasis on tightly managed health plans, were at odds with what most of the public professed to want. That was a problem for the political consultants, who would try to figure out how to "sell" Americans on what was good for them. The result was a fiasco — and a cautionary tale about the limits of expert presidential advice in an age that demands it.

This time around, health policy advisers — whatever their formal background, and whether two-handed or more Vishnu-like — would do well to take a different tack. We badly need health care experts in the White House who offer advice based on evidence and analysis, not prejudice. But even the best experts need to know when to defer to the political process, to see the purpose of their craft as facilitating democratic debate rather than providing final answers once Americans have decided on the questions.

Winston Churchill once said that "scientists should be on tap, not on top."5 That is a good starting point. But sometimes presidential policy experts should also have the good sense to get out of the way.

Dr. Hacker reports receiving advisory board fees from Pfizer and speaking fees from America's Health Insurance Plans, both of which he reports donating to charity. No other potential conflict of interest relevant to this article was reported.

Source Information

Dr. Hacker is a professor of political science at the University of California at Berkeley, codirector of Berkeley Law School's Center on Health, Economic, and Family Security, Berkeley, CA, and a fellow at the New America Foundation, Washington, DC.


President Bush discusses economy, trade. Washington, DC: The White House, May 2, 2008. (Accessed August 22, 2008, at
Melber A. Clinton surrogate compares Obama ad to Nazi march [updated]. The Nation. February 1, 2008. (Available at
Neustadt RE. Presidential power: the politics of leadership. New York: Wiley, 1960.
Caplan B. The myth of the rational voter: why democracies choose bad policies. New Haven, CT: Yale University Press, 2007.
Rose N. Churchill: an unruly life. New York: Simon & Schuster, 1994.

Title: The WSJ compares McC and BO
Post by: Crafty_Dog on September 16, 2008, 07:22:44 AM
Studies Detail Contrasts in Rivals' Health-Care Plans
Obama's Proposal Would Insure More but at Higher Cost
WASHINGTON -- Republican presidential candidate John McCain's health-care plan would make only a small dent in the ranks of the uninsured, at best covering about five million more people, two new reports conclude.

Democratic nominee Barack Obama would cover more people -- eventually adding about 34 million, according to one of those reports, by the nonpartisan Tax Policy Center.

Barack Obama
Sen. Obama's plan would be costly, the center concluded: $1.6 trillion over 10 years. Sen. McCain's would cost nearly as much: $1.3 trillion over the same span. The center doesn't give either campaign credit for initiatives to reduce the cost of health care.

The advantages of the McCain plan, according to the reports, are less government regulation, a more generous tax break and, for many, more flexibility and choice in where to buy coverage.

The Tax Policy Center called its estimates for both plans preliminary because neither campaign has put out enough information to provide a full evaluation.  Similarly, a pair of studies analyzing the candidates' plans, being published Tuesday in Health Affairs, a peer-reviewed policy journal, found many details lacking.  But the campaigns have made clear what direction they would take the health-care system. The differences provide a sharp contrast for voters.

Neither plan would offer universal coverage, though Sen. Obama regularly says his would. Critics of each plan suggest the other would erode the employer-based system that currently covers some 170 million people.

The reports shed new light on the potential and the problems of each plan.

Sen. Obama would give consumers more options, but he would increase federal regulations.

He would create a new government-run plan as well as an "exchange" in which private companies would offer insurance to compete with the government plan. New rules would require that insurance companies provide coverage to everyone, at consistent prices, even those with existing ailments. Parents would be required to cover their children, and large employers would be required to cover their workers or pay a fine.

It amounts to a significant amount of new regulation, health experts Joseph Antos, Gail Wilensky and Hanns Kuttner write in Health Affairs.

"Each of these [new rules] extends the control of government over health insurance, imposing new requirements that will drive up the cost of insurance," they write.

The government-run plan would set a minimum standard for benefits that private plans would have to meet, they explain. Politically, there will be pressure to include generous benefits, they say, and that will lead to high premiums, leaving few options for those who want cheaper, more basic coverage.

 It is likely that companies would be required to offer the same generous benefits to their workers, they say -- another increase in government regulation.  Still, the impact on the uninsured is significant. Overall, the Tax Policy Center predicts that the Obama plan would reduce the number of uninsured by 18 million people in the first year and by 34 million in 10 years.

Sen. McCain would reduce both state and federal regulations and give consumers more choices about where to buy health insurance.

Current law offers a tax break only to those who get insurance through their jobs. The McCain plan would give a refundable tax credit to all who find coverage: $2,500 per person or $5,000 per family. In trade, workers would pay income taxes on the value of health insurance as part of their compensation.

But, unlike a similar plan put forth by President George W. Bush last year, health benefits still would be exempt from the payroll tax paid by workers and employers, and that is why the McCain plan is more expensive than Mr. Bush's, said Len Burman, director of the Tax Policy Center.  Because people could buy insurance on their own, some would leave the employer-sponsored system, especially young and healthy people who can get a better deal on their own. Older, sicker people are likely to face problems buying coverage.

Overall, the Tax Policy Center and the four academics writing in Health Affairs project that about 20 million would leave employer-sponsored coverage, while about 21 million people would be newly covered on the open market. That is a net increase of about one million insured people.

"Many employers would be quick to drop health benefits in response to a major policy change, such as the McCain plan, that greatly altered the business case for offering benefits," the article concludes. The Tax Policy Center projects that the number of newly insured Americans could climb in future years and perhaps reach five million people before dropping again.

The Health Affairs article, whose lead author is Thomas Buchmueller of the University of Michigan, finds other problems with the McCain plan. Because administrative costs are higher on the open market, where insurers evaluate customers individually, he predicts that coverage would be more expensive but less generous.

The McCain plan would allow consumers to buy insurance across state lines. That would give people more choices, but it also would undermine state laws that mandate certain benefits and provide various consumer protections.

Write to Laura Meckler at

Title: Re: The Politics of Health Care - case against socialized medicine
Post by: DougMacG on September 16, 2008, 08:25:10 PM
"According to an August 2008 study published in Lancet Oncology, the renowned British medical journal, Americans have a better than five-year survival rate for 13 of the 16 most prominent cancers when compared with their European and Canadian counterparts.

With breast cancer, for instance, the survival rate among American women is 83.9 percent. For women in Britain, it’s just 69.7 percent. For men with prostate cancer, the survival rate is 91.9 percent here but just 73.7 percent in France and 51.1 percent in Britain.

American men and women are more than 35 percent more likely to survive colon cancer than their British counterparts."
Is the grass greener with socialized medicine?

By Sally C. Pipes
Special to the Examiner | 8/23/08 7:35 PM With Democrats convinced 2008 is their year, the campaign trail is awash with promises to make universal health care a reality by the end of the next president’s first term.

The basic argument of those who support a government takeover of the health care system is familiar. As New York Times columnist Paul Krugman once put it, “America’s health care system spends more, for worse results, than that of any other advanced country.”

Krugman’s line has been repeated so often it’s considered gospel truth in most public debates — people rarely check to see if it matches the facts. As the American humorist Josh Billings quipped, “the problem with the world ain’t ignorance, it’s the things people know that just ain’t so.”

If they did, they’d probably be surprised. Socialized health care isn’t all it’s cracked up to be.

Take the much-vaunted Canadian system. More than 825,000 Canadian citizens are currently on waiting lists for surgery and other necessary treatments. Fifteen years ago, the average wait between a referral from a primary-care doctor to treatment by a specialist was around nine weeks. Today, that wait is over 16 weeks.

That’s almost double what doctors consider clinically reasonable. As Canadian physician Brian Day explained to The New York Times, Canada “is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years.”
In part, these waits are due to a doctor shortage. According to the Organization for Economic Cooperation and Development, Canada ranks 24th out of 28 countries in doctors per thousand people.

Why so few doctors? Over the past decade, about 11 percent of physicians trained in Canadian medical schools have moved to the United States. That’s because doctors’ salaries in Canada are negotiated, set and paid for by provincial governments and held down by cost-conscious budget analysts. Today, in fact, the average Canadian doctor earns only 42 percent of what a doctor earns in the United States.

Canada also limits access to common medical technologies. When compared with other OECD countries, Canada is 13th out of 24 in access to magnetic resonance imagings, 18th of 24 in access to computed tomography scanners, and seventh of 17 in access to mammograms.

The problems plaguing Canada are characteristic of all universal health care systems.

In Britain, more than 1 million sick citizens are currently waiting for hospital admission. Another 200,000 are waiting just to get on a waiting list. Each year, Britain’s National Health Service cancels around 100,000 operations.

Britain even has a government agency explicitly tasked with limiting people’s access to prescription drugs. Euphemistically called the National Institute for Health and Clinical Effectiveness, the agency determines which treatments the British health care system covers. More often than not, saving money takes priority over saving lives.

In 2008, for instance, NICE refused to approve the lung cancer drug Tarceva. Despite numerous studies showing that the drug significantly prolongs the life of cancer patients — and the unanimous endorsement of lung cancer specialists throughout the United Kingdom — NICE determined that the drug was too expensive to cover relative to its effectiveness. As of August 2008, England is one of only three countries in Western Europe that denies citizens access to Tarceva.

Britain’s behavior is typical — every European government rations drugs to save money. Eighty-five new drugs hit the U.S. market between 1998 and 2002. During that same time period, only 44 of those drugs became available in Europe.

The evidence clearly indicates that patients under socialized medicine are suffering. Why, then, do countries with government-run health care consistently outrank the United States on international quality surveys?

It’s not because the American health care system is inferior. It’s because these surveys use deeply flawed metrics that don’t reflect health care quality.

Case in point: The World Health Organization rankings of overall health system performance placed the United States 37th out of 191 countries. That’s behind not only Canada, Britain and France, but even countries like Costa Rica, Morocco and Cyprus.

Life expectancy accounted for 25 percent of a nation’s WHO ranking. But life expectancy is the function of a variety of factors. Medical care is just one of them. Just as important are a nation’s homicide rate, the number of accidents, diet trends, ethnic diversity and much more.

Another factor accounting for 25 percent of a nation’s ranking was “distribution of health,” or fairness. By this logic, treating everyone exactly the same is more important than treating people well. So long as everyone is equal — even if they’re equally miserable — a nation will do quite well in the WHO rankings.

In measuring the quality of a health care system, what really matters is how well it serves those who are sick. And it’s here that America really excels.

According to an August 2008 study published in Lancet Oncology, the renowned British medical journal, Americans have a better than five-year survival rate for 13 of the 16 most prominent cancers when compared with their European and Canadian counterparts.

With breast cancer, for instance, the survival rate among American women is 83.9 percent. For women in Britain, it’s just 69.7 percent. For men with prostate cancer, the survival rate is 91.9 percent here but just 73.7 percent in France and 51.1 percent in Britain.

American men and women are more than 35 percent more likely to survive colon cancer than their British counterparts.

It’s no wonder then that foreign dignitaries living in countries with socialized health care systems routinely come to this country when they need top-flight medical treatment.

When Italian Prime Minister Silvio Berlusconi needed heart surgery in 2006, he traveled to the Cleveland Clinic — often considered America’s best hospital for cardiac care. When Canadian Member of Parliament Belinda Stronach, who had denounced a two-tier health care system for Canadians, needed breast cancer surgery herself in 2007, she headed to a California hospital and paid out of pocket.

So much for the “free” health care they could have received at home.

As for the supposed cost advantages of socialized medicine? Those are illusory, too. True, other developed nations may spend less on health care as a percentage of gross domestic product than the United States does — but so does Sudan. Without considering value, such statistical evaluations are worthless.

And one of the primary reasons health care costs more in America is that we are a wealthy country that demands the best. And, we’re investing a lot more in medical research.

The United States produces over half of the $175 billion in health care technology products purchased globally. In 2004, the federal government funded medical research to the tune of $18.4 billion. By contrast, the European Union — which has a significantly larger population than the United States — allocated funds equal to just $3.7 billion for medical research.

Between 1999 and 2005, the United States was responsible for 71 percent of the sales of new pharmaceutical drugs. The next two largest pharmaceutical markets — Japan and Germany — account for just 4 percent each.

While no one can deny that there are significant problems in the American health care system, overall it provides exceptional value. The ideologues who claim we’d be better off under socialized medicine are massively wrong. Government-run health care has proven to be heartless and uncaring — and the inferior treatments it provides come with a very steep price tag.
Title: Re: The Politics of Health Care
Post by: tankerdriver on September 18, 2008, 08:50:48 PM
Crafty I suppose you are self employed, do you have any health insurance tips for someone looking to buy their own health insurance. The policy I have through work sucks, so I am looking around, to see if I can do better on my own.
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on September 18, 2008, 09:06:22 PM
About all I can offer is that by being a corporation, I can deduct the cost of my health insurance, rather than pay for it with after tax dollars. 

Also, I would give a VERY serious look at Health Savings Accounts.  HSAs have a lot to recommend them.

Title: Re: The Politics of Health Care
Post by: Jonobos on October 03, 2008, 10:13:05 PM
I have a question:

Lets say I don't have health care because I can't afford it. Would socialized health care be better or worse for me?

Title: Re: The Politics of Health Care
Post by: DougMacG on October 04, 2008, 07:13:37 AM
"Lets say I don't have health care because I can't afford it. Would socialized health care be better or worse for me?"
Free lunch may taste good, but in the long view, I think you are worse off.  Just my opinion.  It really depends on how you feel about mandating someone else to pay your basic living expenses.

'Can't afford it' has two components, income and the (artificially) high cost of health care.  Poor people in America already have free health care.  It's amazing to see how they use the money they save on other things.

Why are health care expenses artificially high?  Third party pay.  There is a disconnect between the user of the service and the payer of the service that removes market spending discipline. Price is the most efficient way of allocating a scarce resource.  Unfortunately, the more important the resource the more we turn to less efficient methods.
Title: Re: The Politics of Health Care
Post by: Jonobos on October 04, 2008, 07:25:58 AM
In the long run you are right Doug... but I don't think many people consider that.

I am a single guy, with no dependents... and I bring in a good wage... I am already paying for plenty of other peoples basic living expenses so I feel you there as well. I am not sure that poor people are really capable of saving money. If they could they would not really be poor would they? I guess that is a little off topic...
Title: Re: The Politics of Health Care
Post by: JDN on October 05, 2008, 12:57:10 PM
Crafty I suppose you are self employed, do you have any health insurance tips for someone looking to buy their own health insurance. The policy I have through work sucks, so I am looking around, to see if I can do better on my own.

In a previous life, I was an Employee Benefit Consultant for a very large Employee Benefit Consulting Firm.  Mostly large to very large clients, but for buying health insurance, the concept is the same.  I guess Tankerdriver the question is, "Are you healthy?"  No one can predict the future, but today, are you healthy?  And, given your genes, are you healthy?  And finally, it depends on age.  But let's assume you are healthy and reasonably young (under 40) then Crafty is right, an HSA is the way to go.  Why?  You can save a lot of money tax deferred (don't forget to put away the money for a rainy day), you can buy a "quality" medical plan" and it's portable.  Portable is important.  The plan you belong to, your employer's plan, you must remember it isn't yours. Yes, if you quit or a laid off, you have COBRA for 18 maybe 36 months, but after that you have zero; not good if you have a heart attack, cancer, etc.  After COBRA runs out, if you are healthy, fine, but if not, you can't buy health insurance at any price when you really need it.  The counter argument is that your employer's plan usually offers pretty good low deductible benefits (maybe you have a choice of plans?) and it is free (employer paid) or minimal cost to you.  If you truly have job security, i.e. police, fire, government employee, etc. maybe that is the way to go, but...

I have an excellent quality, albeit expensive HSA.  I must pay the first $2400.00 out of my own pocket (an incentive to stay healthy) but that is ok because overall I have been blessed with good health.  I rarely need to go to the doctor.  And I am self employed.  And if something happens I want to go to the "best" doctors and hospitals, not the ones on a limited list. But if I were you and had an ongoing or chronic problem, then I might consider joining a group plan if I had that choice.  Also, note, as you get older, you HSA premium will rise becoming much more expensive than a group plan.  I pay a small fortune for a plan I (almost) never use yet I don't consider being without it.  You never know and while I can afford $2400.00 I can't afford $500,000+ for a serious illness. It happens. 

As for "poor people in America already have free health care" that is true, albeit a very poor substitute for quality care.  Many/most doctors, especially your top tier will not treat non pay patients.  And many top hospitals will reject that patient.  And you might get the CT Scan, but they will say you really don't need the MRI (too expensive is what they mean) and you want the new cancer drug, well forget it, it's too expensive.  The quality of care is second class, no third class or worse.  it's not only my opinion, although from personal experience I have been treated different when they thought I didn't have but later found out I did have good coverage, but numerous studies and books show the disparity of quality care.  Is that right?  Is that fair?  I don't know, I guess it's a different subject.
Title: Re: The Politics of Health Care
Post by: G M on October 05, 2008, 02:59:36 PM
Does everyone deserve the same level of healthcare?
Title: Re: The Politics of Health Care
Post by: Jonobos on October 05, 2008, 03:24:27 PM
My inclination is that No, not every deserves the same level of healthcare... but I say that with caution. Although some people are no doubt in the situation they are in by choice, you can't choose who your parents are, and your parents more or less determine what type of healthcare you get as a child.

That waitress that works 60 hours a week to raise her kids might not be able to afford the best healthcare... but does that mean she deserves it less than a wealthy banker? What about a convicted felon?
Title: Re: The Politics of Health Care
Post by: DougMacG on October 05, 2008, 09:24:37 PM
"Does everyone deserve the same level of healthcare?"

Of course that could mean does everyone deserve mediocre care or does everyone deserve the health care of royalty, free back massages, tummy tucks, costly experimental meds, you name it.  And do they deserve it to be free or paid by someone else.

To make the answer - yes - I would ask it differently, does everyone in this country deserve the right to choose and purchase health care from the same menu of choices and costs?

Does everyone deserve to live in the largest mansion?  Does everyone deserve oceanfront property? Does everyone deserve to dine in the same restaurant? Every night of the week?  No, you have to earn, save and choose the best. Or you can make other choices.  Some would rather live a block from the ocean and put the rest of the money toward something else.   Does everyone deserve admittance to the best college?  Does every golfer deserve Tiger's winnings? Does every man deserve to sleep with the planet's most beautiful woman?

We guarantee 'same' level of health care only by banning above average care. How does that make us better off?

Health Care is more equal in Europe but survival rates for the most likely ailments you could face are far worse:
"Survival was significantly higher in the United States (than Europe) for all solid tumors, except testicular, stomach, and soft-tissue cancer, the authors report. The greatest differences were seen in the major cancer sites: colon and rectum (56.2% in Europe vs 65.5% in the United States), breast (79.0% vs 90.1%), and prostate cancer (77.5% vs 99.3%),
Title: Re: The Politics of Health Care
Post by: JDN on October 06, 2008, 07:43:43 AM
I suppose it depends upon the definition of "same level of healthcare". 

Are you entitled to the same rich (low deductible, little out of pocket, PPO choice) benefit plan? I don't think so; that is what I think DougMacG was alluding to. Are you entitled to a short wait, fast service, and the very best doctors; probably not. But are you entitled to an MRI when your knee looks like a pretzel?  Are you entitled to stay one more day in the hospital if you can't even stand up?  Are you entitled to that expensive drug that may save you life or at least take away the pain?   Are you entitled to a plastic surgeon after  a car accident?  A respected Orthopedic surgeon versus a resident?  I don't know the answer, but if you don't have insurance in this country, too bad, you lose.

As for survival rates, DougMacG was a bit disingenuous. America, as it concerns very high cost treatment items like cancer is superb where star war technology rules.  However, if you look at overall rankings of America's Health Care we are rarely in the top 10 and often are not even in the top 20 among industrialized nations.  Plus on any chart our morbidity and mortality rankings are quite low.  Yet we spend, by far, the greatest amount per capita on heath care.  Still, the survival rates for the most likely ailments you could face are far worse in America.

Yes, if you are very rich, America is the place to be.  Unfortunately, we are not all rich.  And God help the person who had a good corporate medical plan, but was laid off and now cannot buy insurance.  He'll soon be joining the poor after he sells his house and all his belongings.
Title: McCain Health Plan
Post by: Body-by-Guinness on October 07, 2008, 09:05:25 AM
Healthy Line of Attack
By the Editors

In recent days, Barack Obama’s campaign has intensified its attacks on John McCain’s proposal for reform of our health-insurance system. Based on a spate of recent radio and television ads, and on the line Joe Biden took in last week’s vice-presidential debate, McCain should expect some sharp attacks against his bold proposal in this tonight’s debate. He should be ready to respond, because the attacks are either false or grossly distorted, and his plan deserves to be defended and touted.

The McCain plan begins by addressing the fundamental health-care concern of the middle class: that insurance is too expensive, too rigid, and too insecure. Rising premiums are pushing down take-home wages, the choice of insurance plans is made by the company and not by the family, and leaving a job means losing coverage in uncertain times. The solution, McCain argues, is to put more control in the hands of families rather than holding them hostage to their employers’ plans.

Today, most Americans have only as many insurance options as their employer provides — which is usually one, take it or leave it. This is largely a function of bad government policy. Federal law says that if your employer buys your insurance, the money he spends (which is taken out of your wages) is not counted as part of your income, and so is not taxed. But if you buy your insurance yourself, you do pay taxes on the money you use. For six decades, this has provided an enormous incentive to opt for employer-provided health insurance and has kept a real market for individually purchased coverage from developing. This is an enormous disadvantage for those who don’t have the option of employer-based coverage or who have needs that aren’t met by their employer-based plans.

The McCain plan begins by erasing the distinction between employer-provided and individually purchased health insurance. It replaces the existing tax deduction with a tax credit of $2,500 per person (or $5,000 per family) offered to everyone, regardless of whether their employer offers health coverage.

If you now get insurance from work and want to continue to do so, what your employer pays for your coverage will now count as income, but the credit will more than cover your additional taxes — you keep your coverage, and even end up with a little more money in your pocket at tax time. If you now get insurance from work but would rather choose a different plan — or if are dropped from your current coverage — the wages your employer now takes out for insurance would become regular cash wages, and together with the new tax credit will let you buy the insurance you want independently. Again, you end up with more options and more money at the end of the day. If you don’t have insurance today, or are getting it on your own, the tax credit will help you better afford it. In every case, you end up with more money, more options, and more control over your own health insurance.

Meanwhile, the McCain plan also seeks to vastly increase options and reduce costs by allowing competition in the insurance industry across state lines, which would allow many who are now uninsured to get private coverage. It would help protect vulnerable patients with preexisting conditions by expanding risk pools and by providing subsidies for private coverage for those with low incomes.

The Obama campaign’s attacks on the plan have been astoundingly dishonest. In last week’s debate, Sen. Biden claimed McCain’s plan would raise taxes on middle-class families, when every independent assessment has shown it would lower their tax burden. He argued it was tantamount to what has sent Wall Street into a tailspin — but the more accurate analogy to the mess in our housing market is the Obama health-care plan, which would have the government compete with private insurers and distort the market by confusing politics with economics just as Fannie Mae and Freddie Mac have done.

Indeed, the Obama campaign’s increasingly fervent attacks serve mostly to take attention away from the details of their own health-care proposals, which would price private insurers out of business, subsidize a government-run alternative, levy a heavy new tax on employment, and misspend many hundreds of billions of dollars just as we are entering difficult economic times.

Long-term, Obama’s plan amounts to putting the whole country on Medicare, which would reduce the quality of care, empower bureaucrats over doctors and patients, and, quite possibly, bankrupt the federal government. McCain’s plan envisions instead a competitive market for health insurance, which would give patients more options and more control, leave taxpayers with more money in their pockets, and ensure our thriving biomedical research industry an opportunity to keep developing new treatments and technology.

The McCain plan deserves a defender and champion this week, and John McCain should finally step up and become one in tonight’s debate.

National Review Online -
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on October 08, 2008, 12:04:28 PM
For someone running as the tribune of "change," Barack Obama showed again in last night's debate that he sure is comfortable with the status quo on health care. He continued his recent assaults on John McCain's health reform even though it is precisely the kind of plan that someone of Mr. Obama's professed convictions ought to support.

APThe attacks include swing-state TV spots and Joe Biden's multiple distortions, though the most over-the-top come from the candidate himself. Over the weekend, Mr. Obama called the McCain plan "radical," "out of line with our basic values" and, in case he wasn't clear, "catastrophic for your health care." Since Mr. McCain offered only a once-over-lightly defense of his plan, allow us to give it a try.

Perhaps Mr. Obama is so agitated because Mr. McCain's proposal is highly progressive. The Republican wants to readjust the subsidies that Congress channels into health coverage for business so that lower- and middle-wage workers aren't shortchanged, as they are now. Currently, people who get insurance through their employers pay no income or payroll taxes on the value of the benefit. This is revenue the government forgoes to encourage certain behavior. If those losses were direct spending, the tax exemption would have cost more than $246 billion in 2007.

But all that money props up only employer-provided insurance. For reasons of historical accident and lobbying clout, individuals who buy policies get no tax benefits and pay with after-tax dollars. Mr. McCain is proposing to make the tax benefits available to everyone, regardless of how they purchase their insurance.

He would offer a refundable tax credit of $5,000 for families, $2,500 for individuals, and the benefit isn't dependent on where people work or what they earn. Some would stick with their current job-based coverage. Given the option, others -- especially the uninsured, armed with new health dollars -- would decide to buy coverage on their own. That in turn would stimulate a market for more affordable insurance.

Mr. Obama doesn't want to let people make this choice. He even claims it would amount to "taxing your health-care benefits for the first time in history," which is a wild distortion. His point seems to be that because companies wouldn't have to pay for health care, they could raise wages and thus taxes would also increase for workers on those higher incomes. But doesn't Mr. Obama want higher wages?

All in all, workers would come out ahead with the McCain plan. According to the left-leaning Tax Policy Center, the average taxpayer would see his tax bill drop by $1,241 in 2009. On average, lower-wage workers have more limited coverage as part of their compensation, mostly from small- or medium-size businesses. But the more generous the employer health plan, the more the tax subsidies increase. According to the Joint Committee on Taxation, the current employer benefit is only worth between $600 and $3,000 for people making under $100,000. The upper-income brackets save between $4,000 and $5,000.

The most affluent -- i.e., the top quintile of earners -- would be slightly worse off after 2013 under the McCain plan, though they'd still have plenty of options. Even as he routinely promises to raise taxes on "the rich," Mr. Obama is leaping to their unlikely defense here only to frighten everyone else. The McCain plan is fairer than the status quo, which subsidizes the most expensive employer (and union) insurance plans.

But don't take our word for it. Mr. Obama's chief economic adviser agrees with the McCain critique of the current system, or at least he once did. "This massive program of tax breaks is ineffective and regressive, wasting money on those who have health insurance while doing little for those who can barely afford it and nothing at all for those without it," wrote Jason Furman in 2006 in the journal Democracy. Before he joined the Obama campaign, Mr. Furman championed a health reform that relied on many of the same tax tools as Mr. McCain's.


In contrast to Mr. McCain, the Obama plan is all about expanding government health care. Mr. Obama is proposing a "public option" that is similar to Medicare but open to everyone of any age. With this new taxpayer-funded entitlement, private insurers would be crowded out as the government gradually paid all of the country's health-care costs.

Yet according to the Congressional Budget Office, federal spending on Medicare and Medicaid already takes up 4% of GDP today and will rise to an unsustainable 9% over the next two decades. Mr. Obama wants to add even more costs to this taxpayer balance sheet. The inevitable result as spending explodes would be price controls and rationing.

On choice, portability, quality and especially equity, the McCain health plan is far superior to Mr. Obama's. The Democrat is merely offering Canada on the installment plan.

Please add your comments to the Opinion Journal forum.
Title: Re: The Politics of Health Care
Post by: G M on October 17, 2008, 07:58:53 AM

"If you think healthcare is expensive now, just wait until it's free."
Title: Re: The Politics of Health Care
Post by: JDN on October 21, 2008, 08:23:29 AM
Something needs to be done...

A good article in this morning's paper.,0,6869686.story
Title: BO health plan
Post by: Crafty_Dog on October 27, 2008, 09:06:53 AM
Its the NY Times so caveat lector:

Businesses Wary of Details in Obama Health Plan
Published: October 26, 2008
AGAWAM, Mass. — Dave Ratner, owner of Dave’s Soda and Pet City, is pretty sure he is about to get “whacked” by the new state law that requires employers to contribute to health care benefits for their workers or pay a $295-per-employee penalty. In order to avoid thousands of dollars in fines, Mr. Ratner is considering not adding part-time workers at his four pet supply stores in Western Massachusetts.

But the penalty in Massachusetts is picayune compared with what some health experts believe Senator Barack Obama, the Democratic presidential nominee, might impose as part of his plan to provide affordable coverage for the uninsured. Though Mr. Obama has not released details, economists believe he might require large and medium companies to contribute as much as 6 percent of their payrolls.

That, Mr. Ratner said, would be catastrophic to a low-margin business like his, which has 90 employees, 29 of them full-time workers who are offered health benefits.

“To all of a sudden whack 6 to 7 percent of payroll costs, forget it,” he said. “If they do that, prices go up and employment goes down because nobody can absorb that.”

Writ large, that is one of the significant concerns about Mr. Obama’s health plan, which like this state’s landmark 2006 law would subsidize coverage for the uninsured by taxing employers who do not cover their workers. And it is a primary reason that so-called play-or-pay proposals have had an unsteady history for nearly two decades.

With Mr. Obama’s plan, business leaders say, the devil will be in the unknown details.

Mr. Obama would prohibit insurers from rejecting applicants because of medical conditions, require health insurance for children and create a new federal health plan to provide comprehensive coverage to the uninsured. Those beneath certain income levels would be granted tax credits to make premiums affordable, and small businesses would be offered tax credits to provide benefits.

The tax credits are projected to cost at least $110 billion. Mr. Obama has said he would pay for it primarily by raising income taxes on those making more than $250,000 and by reducing health spending. But when he announced the plan in May 2007, he emphasized that employers would share in the cost.

“We will ask all but the smallest businesses who don’t make a meaningful contribution today to the health coverage of their employees to do so by supporting this new plan,” he said.

Left undefined has been what size firms would be exempted, what constitutes a “meaningful contribution,” and how much noncompliant businesses would be required to pay. Senator John McCain, the Republican nominee, badgered Mr. Obama in two of their debates to define the penalty, but Mr. Obama did not rise to the bait.

“We made a decision even before the plan was rolled out not to decide,” said David M. Cutler, a Harvard economist who speaks for the campaign on health care. “It’s not that there’s a decision out there that we’re not telling. It’s literally that we’ve decided not to decide.”

That may be smart politics. But it makes business groups nervous that Mr. Obama might impose an unmanageable burden. They also worry that any time his health plan faces a shortfall, businesses will be asked to up their ante, as has happened in Massachusetts.

“Play-or-pay can become a blank check to an already overcapitalized health care system,” said Helen B. Darling, president of the National Business Group on Health, which represents 300 companies.

Business groups also have concerns that Mr. McCain’s plan to change the tax treatment of health benefits would erode employer-sponsored insurance.

Mr. Cutler said the Obama campaign regarded play-or-pay less “as a revenue raiser” than as a way of “leveling the playing field.” It would hold accountable those employers whose uninsured workers might seek treatment in emergency rooms or enroll in government insurance plans, with costs subsidized by others through higher premiums and taxes. Mr. Cutler said the expense to businesses would be offset by savings from Mr. Obama’s proposals to reduce health spending, though that is an uncertain prospect.

Several econometric models have assumed that Mr. Obama would have to set his penalty near 6 percent of payroll (Mercer, a benefits consulting firm says that large employers typically pay 15 percent). Recent play-or-pay proposals in California and Pennsylvania put the figure at 3 or 4 percent, and both failed in part because of business opposition.


Page 2 of 2)

Hawaii is the only state that requires employers to provide health benefits, while Vermont, like Massachusetts, gently fines those who do not. Several other states have enacted similar laws over the last two decades, but they have been repealed, rejected by voters or challenged in court.

Economists believe the cost of health benefits is ultimately shifted to employees through lower wages. When wages cannot be lowered, layoffs may result. Katherine Baicker of Harvard and Helen G. Levy of the University of Michigan have projected that play-or-pay might push 224,000 workers into that category.
When negotiating their health plan, Massachusetts lawmakers rejected a payroll tax and instead set a “fair share contribution” that was low enough to appease businesses. The amount also was kept low to steer clear of the 1974 federal law prohibiting states from regulating multistate group insurance plans. Companies with 10 or fewer full-time equivalent employees were exempted.

State officials hoped the penalty would generate a little revenue, but recognized it was not likely to prompt employers to start offering coverage. It raised only $7.7 million in its first year, well under projections. So when a substantial budget gap opened in the $869 million health plan this year, Gov. Deval Patrick asked businesses to help fill the hole.

He compromised on a revised formula that is projected to bring in $30 million by increasing the number and average size of firms that will be penalized. The state expects 1,100 businesses to be fined, up from 855, or about 3 percent of eligible companies.

The deal left business leaders satisfied for the moment. They recognize that the $295 penalty is a fraction of the $4,000 that Massachusetts employers spend to insure an individual worker.

But businesses worry the state will raise their obligation each year. They argue they have already absorbed costs of insuring 159,000 workers with group coverage since the state began mandating insurance (a total of 439,000 have enrolled, giving the state the country’s highest insurance rate).

“You want the system to work,” said Jon Hurst, president of the Retailers Association of Massachusetts. “You just want to make sure there isn’t more cost-shifting to businesses because they are paying their fair share.”

State officials are gratified that — contrary to national trends — the share of employers offering health benefits has increased slightly. One fear about play-or-pay is that if the penalty is too low employers will stop offering coverage and pay the fines instead, shifting workers to government insurance programs.

But leaders here also are sensitive to the possibility that further increases in the penalty might stymie wage and job growth.

“In this day and age,” said Dr. JudyAnn Bigby, the state secretary of health and human services, “it wouldn’t take much of a change in policy to push some entities over the brink.”
Title: Re: The Politics of Health Care
Post by: ccp on October 27, 2008, 09:27:26 AM
"offset by savings from Mr. Obama’s proposals to reduce health spending"

Cutler and there is another Massachussetts liberal type - his name eludes me now - are getting everyone covered first and figuring about how to pay for it later.  Right or wrong I don't know but they are not being honest with all the ramifications of what they advocate.  But what else is new with liberals?

Health spending will not be reduced by expanding coverage to all without increasing people's personal responsibility for the costs as well.  I don't hear them say anything about this.  Not one iota.  Amazing isn't it?

The fastest way to reduce the costs of health care is to transfer costs to patients.  You would be surprised how quickly people will refuse tests not absolutely necessary or opt for generics as soon as they learn they will have to pay more.

But there is some blame for all.  The insurers, the providers (doctors and hospitals), administrators, politicians, pharmaceuticals, device makers, acadamia, lawyers, cottage industries and more.
Title: Re: The Politics of Health Care
Post by: DougMacG on October 27, 2008, 10:59:18 AM
CCP: "The fastest way to reduce the costs of health care is to transfer costs to patients."

VERY well put, yet the more we see a cost problem the more we move in the opposite direction.

Same goes for college tuition. 
Title: Re: The Politics of Health Care
Post by: ccp on October 27, 2008, 01:41:11 PM
yet the more we see a cost problem the more we move in the opposite direction.

Yes your so right.  The "government" fix will exponentially increase costs not reduce them IMO.
The "fix" is in.

You think we have illegals crossing the border now? 
Title: Re: The Politics of Health Care
Post by: taoist-engineer on November 06, 2008, 06:24:49 AM
Crafty just curious as man with children

I am a bit baffled by your contempt for universal health care

I think Americans call these entitlements . I'm canadian so the concept of being turned away at a hospital for monetary reasons
is completely foreign to me.  Over crowding yes but not for lack of cash 

Do you think your personal wealth should dictate whether your child should live or die?

I find this odd in that The Dog Brother culture is based on the community of the tribe or  is it a pack

As a tribe you work together to become stronger you protect the little ones so that they have a chance to grow up to become productive members of the pack

You protect the elderly and infirm because they are your source of knowledge

Even in a pack wolves they protect the young and an older less able pack member is left at the den to guard the pubs or so I' told

Universal health care is not an "entitlement" it is a community decision to look after one another

The US is the only G8 country that does not provide some form of universal health care

I make a good wage and pay a boat load of taxes much more than it would cost for my once yearly trip to the doctor

but when accidents happen like when i tore the cartilage in my knee competing in  Bjj in Brazil.

The system was there for me. I saw my GP took a weeks to get in. He refered me to a specialist
took 3 months to see him . Sent me for a MRI 6 weeks, another consultation with the specialist and he booked me for surgery in 6 weeks
got fixed, got some physio, went back to brazil the following july and won.
Total cost to me 0 becuse my employer pays for more health care insurance.
Other wise a couple of 100 for meds, physio and a chiropractor.
Now if that would have happened in the US in lets say the 1980 during the recession when i was an unemployed student
and both my parents had lost there jobs. I would be still limping today.
I can tell you similar stories about the various broken finger, concussions and nasty infections
that were dealt with before they become serious because as an unemployed student all I had to do was go to the local medical clinic and wait my turn

I was told in the US I could have had done in two weeks for 5000. If you are rich no need to wait your turn?

I consider myself a libertarian not interested in being surveilled, counted or have the government telling what to read or who to associate with,
who i can marry or what substance in can put in my body.
I don't want the government listen to my phone calls, reading my mail or seeing what crazy things i look up on the interweb or seeing how i spend my money

But what about my community.

Do my taxes benefit the community?

I say yes because if i had to make a choice between my daughter getting medical attention that would save her life and committing a crime
I think i would be a criminal and crime is an act against the community.

 I see universal health care as a decision to strengthen your community
is Canada's system perfect hell no its rationed health care but if you are rich you can always go to the US

I think with Mr Obama you are about to find your community

Best Regards

Title: Re: The Politics of Health Care
Post by: Crafty_Dog on November 06, 2008, 10:24:42 AM
Woof TE:

I am about to OD on forum matters so I will be a bit briefer than your question deserves:

No one is talking about letting someone without money die from car accidents etc.

I would draw attention to your apparent notion that it is morally superior to turn people away for overcrowding as versus turning people away for insufficient money.   What is your reasoning here?

Denial of service due to overcrowding--due to virtually unlimited demand and diminished supply-- is precisely what happens when a good such as health is made "free"-- which in part is what is meant when we say "If you think health care is expensive now, just wait until the government makes it free." (PJ O'Rourke)  At the moment, in Canada you do not suffer the full consequences of your course of action precisely because you live next door to us.

Let me tell you a story of an experience of mine:

In 1992 I had a freak BJJ accident wherein the ACL, PCL, and Lateral Collateral Ligaments of my left knee were snapped in half.  Thanks to the wonders of modern medicine, what 5 to 10 years previous to that would have left me seriously gimp for life was fixed during the course of three surgeries which replaced the snapped ligaments with tendons from cadavers.  INCREDIBLE!   The cost was nearly $50,000 (remember this was 1992-93 dollars)  Because I bought health insurance, I was out of pocket $5,000 and the insurance company paid the other $45,000. 


OTOH, if Hillary Clinton and her health care program had been in charge, they probably would have decreed that there were too many specialists making too much money (this was a favorite point of hers) and there probably would not have been the specialists and the technology capable of saving my knee--- and my life in martial arts.


Furthermore, I used to be a lawyer in Washington DC, so I have a very visceral sense of the human beings who would be the bureaucrats deciding whether I was allowed to get a particular treatment are.  They are slow, vapid, and basically don't give a fcuk.  As a free man in a free country, giving such people control over how I pursue my health is a bitter anathema.

IMHO it is important to understand that the clusterfcuk we have now is NOT the free market and most of its undesirable features can be traced rather directly to government intervention.

That's all I have time for right now.  I hope it helps explain my perspective.


Title: Re: The Politics of Health Care
Post by: G M on November 06, 2008, 10:34:15 AM
Growing up, my health/dental care came courtesy of the IHS (Indian Health Service). It operated with the efficiency of the post office and the compassion of the IRS.  :-D

A running joke on the reservation goes "What's the leading cause of death on the rez? IHS."
Title: Mandate BMWs and we're Lucky to Get Yugos
Post by: Body-by-Guinness on November 18, 2008, 09:18:19 AM
Shocking News! State Mandates Increase the Cost of Health Insurance!

Ronald Bailey | November 18, 2008, 11:36am

Researchers at Brigham Young University, the National Bureau of Economic Research and the Brookings Institution have found that health insurance mandates raise the price for everybody. As the press release describing the study explains:

New research shows that the cost of health insurance for a typical family increases about $100 per month when state governments limit price adjustments based on factors like age, health or risky behaviors such as smoking.

The finding by Brigham Young University economist Mark Showalter is one of several examples of how one state's set of rules can result in widely different prices than what's found in the state next door. Perhaps the most eye-opening contrast exists in Trenton, New Jersey, where premiums cost about twice as much as those sold across the Delaware River in Pennsylvania...

Seven states prevent insurers from adjusting prices based on one or more factors like age, health status or risky behavior. The researchers found such rules - known as community ratings - increased family premiums between 21 and 33 percent.

The rule is intended to promote equity but may consequently make insurance too expensive for healthy people. The study found New Jersey's strict form of community ratings responsible for premiums set two to three times higher than if the requirement were not in place.

Who knew that 1800 federal and state mandates would boost the price of health insurance? Well, actually, lots of analysts do. For example, Harvard business school professor Regina Herzlinger told reason:

"It's like I'm shopping for a car and my state mandates that all cars have heated seats," says Herzlinger. Car buyers would not long stand for a heated car seat mandate that raises the price of a car by $1,000, and similarly individual health insurance shoppers would object to unnecessarily expensive insurance mandates.

It is very likely that legislators rarely consider the costs of such mandates to consumers, so the good news is that the study now quantifies them so that these trade-offs can be made explicitly. Whole press release for the study is available here.
Title: Mandates Impact Price
Post by: Body-by-Guinness on November 18, 2008, 09:24:47 AM
The piece referred to above.

Health Insurance Premiums Rise Up To 33 Percent With State Pricing Rule, USA

18 Nov 2008   

New research shows that the cost of health insurance for a typical family increases about $100 per month when state governments limit price adjustments based on factors like age, health or risky behaviors such as smoking.

The finding by Brigham Young University economist Mark Showalter is one of several examples of how one state's set of rules can result in widely different prices than what's found in the state next door. Perhaps the most eye-opening contrast exists in Trenton, New Jersey, where premiums cost about twice as much as those sold across the Delaware River in Pennsylvania.

"Establishing the actual costs of specific state regulations informs discussion of how to make health insurance more affordable," Showalter said. "It helps present a picture of what would happen if consumers were allowed to buy insurance from other states."

Showalter began the research during an appointment as a senior economist for the U.S. Council of Economic Advisers. He co-authored the new study with Amanda Kowalski of the National Bureau of Economic Research and William Congdon of The Brookings Institution. Their report will appear later this month in the academic journal Forum for Health Economics & Policy.

The researchers analyzed prices offered state-by-state for the estimated 26.5 million Americans who purchase directly from insurers rather than through an employer.

Seven states prevent insurers from adjusting prices based on one or more factors like age, health status or risky behavior. The researchers found such rules - known as community ratings - increased family premiums between 21 and 33 percent.

The rule is intended to promote equity but may consequently make insurance too expensive for healthy people. The study found New Jersey's strict form of community ratings responsible for premiums set two to three times higher than if the requirement were not in place.

University of Minnesota health economist Roger Feldman, who was not involved with the study, is funded by the U.S. Department of Health and Human Services to figure out how an interstate market might reduce the number of uninsured Americans.

"This study enables us to predict the effect of allowing consumers to shop for insurance across state lines," said Feldman. "Those kinds of simulations would not be possible without this study."

The researchers also found that health insurance premiums rise 10 percent or more when a state government makes insurers accept all doctors, hospitals or pharmacies instead of steering customers to an exclusive network of providers.

Twenty-one states have laws that require insurers to allow a patient to buy prescription drugs from any pharmacy they choose. Seven of those states force insurers to offer the same flexibility with choosing a doctor or hospital. According to the study, these laws result in a typical family paying about $30 more per month for health insurance.

Data for Showalter's study came from two major health insurers that do business nationwide. The analysis took into account factors that vary by location, such as the cost of health care, state taxes and consumer demographics.

"All of the regulations we studied have presumed benefits," Showalter said. "Our goal was to quantify the costs so that policymakers can better weigh the two."

A BYU alumnus, Showalter received a Ph.D. from the Sloan School of Management at the Massachusetts Institute of Technology. In 1991 he joined the BYU Economics Department faculty and has since published many journal articles on health and education.

Birgham Young University
Article URL:
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on November 20, 2008, 12:57:55 AM
The Obama Health Plan Emerges Article
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"Universal" government-run health care proved too ambitious even for FDR, who stripped it out of the Social Security Act of 1935. Lyndon Johnson settled for Medicare and Medicaid. Now liberals think the political moment has finally arrived to achieve what has eluded every other Democratic President from Harry Truman to Bill Clinton.

APOne signal is yesterday's news that Barack Obama has selected Tom Daschle, the very liberal former Senate warhorse, to head the Health and Human Services Department. But a even clearer sign was last week's release by Montana Senator Max Baucus of a policy blueprint that closely resembles the one Mr. Obama campaigned on for 17 months. The plan is significant not only because its author is Chairman of the powerful Finance Committee, which oversees taxes and about half of all government spending. Mr. Baucus is also one of the more moderate, and cautious, senior Democrats.

If the Obama White House decides that reorganizing the 17.1% of the economy that the U.S. is likely to spend on health care in 2010 is a first-year priority, then Mr. Baucus's bill will be the place they start. Americans need to learn what they'd be paying for.

First, Democrats want the government to create a national insurance exchange, or marketplace, in which all comers could buy into a range of heavily regulated private policies at group rates. These private plans would then "compete" with a new public insurance option, i.e., a program managed by the government and modeled after Medicare. Lower-income earners would get subsidies to make coverage "affordable." Businesses that didn't cover their employees would pay a tax on some portion of their payroll.

The last cog is the "individual mandate." This requirement that everyone buy coverage has grabbed most media scrutiny of the Baucus plan, because Mr. Obama opposed it during the campaign. But the many moving parts don't work together unless the young and healthy foot the bill for care of the older and sicker -- one reason Hillary Clinton kept nagging Mr. Obama about the individual mandate during the primaries.

The irony is that the public option -- not the mandate -- is far and away the most radical part of the plan. Green eyeshade objections are obviously out of favor in modern Washington, but the reality is that the Baucus-Obama plan would be extraordinarily expensive as it slowly but relentlessly grew the government's share of health spending. The draft doesn't include an exact cost, though casually notes the ballpark "investment" could run as high as $150 billion a year.

Even those huge outlays are likely conservative, considering that subsidies would go to families earning up to 400% of the federal poverty level. According to the Census Bureau, that would apply to 61.5% of the American population, or about 184 million people -- less those already on Medicare and Medicaid.

Some financing will come from the "pay or play" tax on businesses, but because Mr. Baucus is no more omniscient than anyone else, the tax rate is left undefined. If it is too low, companies will have every incentive to "cash out" their employee liabilities and pay the tax instead. Then workers will flood the public option.

The Baucus plan expects to make up more of the money with nips like better health technology and tucks such as "a national focus on wellness." But those don't come close to adding up to $150 billion -- or the health system would have made them already. As for the claim that centralizing health spending will lead to more "efficiency" . . . well, that is the triumph of hope over evidence.

 Over the past 40 years, per capita health spending has grown an average of 2.1 percentage points faster than the economy. The dominant U.S. insurer -- Medicare -- has had no success in mitigating this climb, despite valiant attempts. Since the 1980s, Medicare has actually controlled the prices that physicians and hospitals are paid for thousands of billable services. In 2007, the program spent some $425 billion according to these arbitrary guesses. Because of its huge purchasing power, and because many private plans adopt its reimbursement rates, Medicare significantly shapes all health-care financing and delivery.

Now the Democrats want to double down with the public option, apparently on the theory that the bureaucracies fail only when they're too small. Even without the new program, Medicare and Medicaid costs are rising substantially both as a share of the economy and the federal budget. The nearby chart tracks the historical behavior of government health spending and the Congressional Budget Office's post-2007 fiscal scenario in the absence of reform. Today, health entitlements account for 4% of GDP but will rise to 7% in 2025 and about 15% in 2062.

Not that the current level of benefits will ever be paid. According to the Medicare trustees, the program's excess costs over the next 75 years -- that is, the difference between expected outlays and revenues -- is more than $36 trillion, which even they acknowledge is several trillion too low given current trends. Even if Congress doubled all individual and corporate tax rates, it still wouldn't raise enough revenue to pay for Medicare and Medicaid.

The Obama-Baucus solution to this slow-motion catastrophe is to add tens of millions more people to the federal balance sheet. Because the public option will enjoy taxpayer sponsorship, it will offer generous packages to consumers that no private company could ever afford or justify. And because federal officials will run not only the new plan but also the "market" in which it "competes" with private programs -- like playing both umpire and one of the teams on the field -- they will crowd out private alternatives and gradually assume a health-care monopoly.

Many proponents of plans similar to Mr. Baucus's openly cite this as one of their goals. Eventually, the public option will import Medicare's price controls into the private sector as it tries to manage the inevitable cost overruns. When that doesn't work, Congress will deal with the problem by capping overall spending and rationing care through politics (instead of prices) -- like Canada does today.

Either Senator Baucus and President-elect Obama are making promises that can't possibly be kept. Or they're not being honest about their plans for U.S. health care.

Title: Re: The Politics of Health Care
Post by: ccp on November 21, 2008, 06:39:57 AM
Unfortunately, the grim picture this article paints is all too true.

***the public option will import Medicare's price controls into the private sector as it tries to manage the inevitable cost overruns. When that doesn't work, Congress will deal with the problem by capping overall spending and rationing care through politics (instead of prices) -- like Canada does today***

Medicare's price controls?  Is some cases Medicare is preferred by providers as opposed to some of the commercial carriers.

***The Baucus plan expects to make up more of the money with nips like better health technology and tucks such as "a national focus on wellness." But those don't come close to adding up to $150 billion -- or the health system would have made them already. As for the claim that centralizing health spending will lead to more "efficiency" . . . well, that is the triumph of hope over evidence.***

The idea that converting to electronic recods will cut the necessary inefficiencies out to the extent we are saved is a fantasy.

I got to laugh when Newt and others sit in front of the camera and say all we need to do is centralize the information and costs will stop increasing.  While I agree it is a good idea and must be done in some way I beg to differ that it will save the future of medical care.

As for "wellness" - there are some preventative things that are done that save long term costs and there are others that actually drive up long term costs.

Without rationing health care costs will continue to skyrocket.  Specialists who do procedures are whing because they can't charge the exorbitant fees they were bilking form the system for years. and those specialists who don't preform procedures have trouble paying bills.  As for primary care folks like me - well the whole field is collapsing.  You all may very well be seeing nurses instead of primary doctors from now on.

I spoke to one physician recently who was praying for total nationalization of health care.  He feels anything is better than dealing with multiple insurances, patients without coverage etc.  One national medical organization I know was ecstatic that Tom Daschle is picked for Sec of HHS.  They feel he is on their side with regards to saving primary care which may soon be as obsolete as GM,Ford,Chrysler.

I am still not for nationalization.  But the public I am afraid is not facing the truth about rationing.  They still want everything possible especially as long as someone else covers it.
Title: Coming Soon to a Health Care System Near You
Post by: Body-by-Guinness on November 21, 2008, 07:49:20 PM
10,000 Britons die needlessly every year as GPs with out-of-date training miss vital cancer symptoms

By Daniel Martin
Last updated at 1:32 AM on 21st November 2008

GPs often do not send enough patients for tests
More than 10,000 people die needlessly each year because their cancers are not diagnosed in time, a study says.

The charity Cancer Research UK found GPs too often miss symptoms or do not send enough patients for tests.

In some cases their training is simply out of date. The report says some people are deterred from seeking treatment by the difficulty of getting an appointment.

And there is too little public awareness about cancer symptoms, meaning many victims do not see their GP until it is too late to save their lives. The result is that Britain's survival rates for cancer are still the worst in Western Europe, despite the billions poured into the Health Service by Labour.

Only 53 per cent of women and 42 per cent of men with cancer survive for more than five years.

Of 14 major countries compared by the charity, Britain came 11th for women and 12th for men, alongside Poland and Slovenia. If our rates were as good as the best in Europe, the report says, there would be 10,744 fewer deaths a year.

Lead researcher Professor Michael Coleman said: 'We know many cases are being diagnosed too late and this is a major reason for our poor survival rates.'

He said many GPs were not up to date on cancer treatment, and family doctors with an average practice size saw only around eight new cancer cases a year.

'Some GPs would benefit from guidance on identifying patients more successfully,' he said.

Another problem was access, said Professor Coleman. 'Patients find it difficult to make appointments or park their cars, and many are worried about taking time off work and losing money.'

Only a half of GP practices see patients outside working hours  -  and even these open for an average of only three more hours a week.

Survival rates
The failure of GPs comes despite their pay soaring by more than 50 per cent  -  to over £100,000  -  since a new contract was agreed in 2004.

They are also working fewer hours a week.

Better survival rates in Europe are partly due to the fact that patients in many countries can have direct access to a specialist, while in Britain they must go through their GP.

The Government's cancer 'czar', Professor Mike Richards, said: 'We want to work with GPs to find out which patients and which symptoms they are most likely to miss. They need to be more alert and send people for tests much earlier.'

Britain's poor record has also been blamed on drug rationing by NICE  -  which can take up to 18 months to decides whether the NHS should fund new treatments  -  and low spending on cancer drugs, £76 a head a year, compared to £143 in Germany and £121 in France.

Professor Karol Sikora, professor of cancer medicine at London's Imperial College, said last night the low survival rates were a failure of the whole NHS, not just GPs. He said: 'People have to wait too long for scans and biopsies. There is undercapacity in radiography and chemotherapy.

'We don't get access to the drugs they get in Europe. Huge amounts of money have been thrown at cancer over the past decade so it is surprising to see these problems are still here.

'The main culprit is the NHS itself  -  it's a bureaucratic monolith.'
Title: Re: The Politics of Health Care
Post by: ccp on November 22, 2008, 07:01:10 AM
The article points out that cancer is being diagnosed too late in Britain but it is not at all clear why.
Are patients getting their screening tests?  Are they being offered?  Is it the delay in confirmatory testing and eventual referral to specialist?

Many studies also show that more screening does not equate to better care or longer survival.  In fact many studies show that more screening makes for more problems.  There are relatively few screening test that are clearly supported by evidence of having net benefit.  For every total body scan one might want to do to look for a lurking cancer we will find two dozen other things that will warrant more tests, biopsies, anxiety and money that would never have been a problem.
We could also do screening up the wazoo till the nation goes bankrupt.  There is a balance.

Access to specialists is important and should be easy.  Yet patients who run to different speicalists do wind up getting more tests (especially if the specialist has the test in their office and can bill for it - usually reasonable but clearly overdone at times) get fragmented care. 

In this country nurses are replacing primary care doctors so one could argue there will be more opportunity for diagnoses to be missed.  But some simple care they probably could do.  I notice patients of mine who go to local walk in clinics for colds are invariably getting antibiotics though invariably it is uncommon they really need them.  I try to talk my patients out of it.  In these clinics that are more concerned for generating customer satisfaction they are all getting antibiotics because the patients think they need it.  They are now contributing to further use of antibiotics and the problem of resistance.

But I digress.

Title: WSJ: Jindal'
Post by: Crafty_Dog on November 24, 2008, 12:08:48 AM
Bobby Jindal, Louisiana's prodigy Governor, has been arguing lately that only policy innovators will break a path out of the GOP's political wilderness -- and he is leading by example. Mr. Jindal recently announced a major renovation of the way his state provides health coverage to the poor and uninsured, thus taking up a topic for which most Republicans require a shot of epinephrine just to pay attention.

Gov. Bobby Jindal
Name any health criteria, and Louisiana is probably scraping bottom. According to one national ranking, the state was 49th in health outcomes in 2007 and worst overall in 2006. Even though about a quarter of the population is enrolled in Medicaid, another quarter is uninsured. Even though the federal government's "matching rate" pays out 71% of state Medicaid costs, state spending has doubled to 16% of the general budget over just the last two years. That share is projected to rise to 22% by 2011, swallowing funding for schools, police and other priorities.

Governor Jindal plans to steer working-poor Medicaid recipients out of the current "fee for service" program, where the state pays a set rate for all health-care charges (some 54 million this year). Instead, they'd choose among private managed-care plans, with Louisiana paying a fixed per-patient amount, adjusted for health risks. Essentially, Mr. Jindal wants to use Medicaid dollars to fund something like private insurance. That way, physicians and hospitals will be compensated for outcomes -- rather than volume of visits and procedures -- and get incentive payments for good performance.

Such a "defined contribution" plan is one way to wrestle run-amok health costs back under control and spend more responsibly. It isn't a new idea, but it is a good one. Congressional Republicans passed a similar reform in 1995 for Medicare, which Bill Clinton vetoed -- only to have his own bipartisan commission endorse it in 1999.

In today's Opinion Journal

Secretary of BailoutsJindal's MedicineThe Sidwell Choice


The Americas: Election Fraud in Nicaragua
– Mary Anastasia O'GradyInformation Age: When Even Good News Worsens a Panic
– L. Gordon Crovitz


The Fed Is Out of Ammunition
– Christopher WoodWhat a Single Nuclear Warhead Could Do
– Brian T. KennedyChange Our Public Schools Need
– Terry M. MoeBush Does the Right Thing for Darfur
– Kenneth RothSince Louisiana will increase the value of its Medicaid dollars and free up other funding, it will also be able to expand eligibility. The initiative will start with about 380,000 people in New Orleans, Baton Rouge and two other regions, with the rest of the state integrated over the next five years. The hope is that by integrating fee for service's separate silos and realigning incentives, the quality of the delivery system will also improve.

Medicaid allows states the flexibility to experiment like Mr. Jindal, but it requires a federal waiver. Currently, Louisiana's negotiations are hung up on $771 million that the feds claim the state owes, much of it in alleged "overpayments." States often game the system to filch federal money they don't deserve, courtesy of national taxpayers. But in this case, Louisiana ought to get credit for good behavior, especially considering that Mr. Jindal inherited the problem. In any event, the state only wants to pay back Medicaid over a longer term while producing savings compared to the status quo.

The Bush Administration's go-ahead is also a matter of urgency. If the talks aren't wrapped up soon, Mr. Jindal will be forced to start over with Barack Obama's team, which will be hostile to reforms that bank on the private sector. Either way, just the transition itself could delay things for six months or a year or more.

Congress is currently considering a state Medicaid "bailout" as part of its second stimulus package, in which Washington would pay for an even greater share of state health spending. That would reward the most spendthrift states. Mr. Jindal's proposal is a far better idea.

Title: Re: The Politics of Health Care
Post by: ccp on November 24, 2008, 07:33:58 AM
Agree with Jindal about innovation.  We need more like him.  Romney sounded good over the weekend talking about Detroit.
We don't need more pundits like Laura Ingram - *my way or the highway*.

***physicians and hospitals will be compensated for outcomes -- rather than volume of visits and procedures -- and get incentive payments for good performance***

There is ongoing research on this model now by many groups.  Many different interests from providers, insurers, government, vendors, pharma, pharmacies, patients, cottege industries.
Its premature to say how this is going to work.  In theory there are pros and cons, but I like the idea and hope it will have value to all.  Early results suggest it will.
Title: Re: The Politics of Health Care
Post by: DougMacG on November 24, 2008, 08:10:01 AM
"physicians and hospitals will be compensated for outcomes -- rather than volume of visits and procedures"..."There is ongoing research on this model now by many groups.  Many different interests from providers, insurers, government, vendors, pharma, pharmacies, patients, cottege industries. Its premature to say how this is going to work.  In theory there are pros and cons, but I like the idea..."

My daughter's orthodontia (braces) is set up this way.  One lump sum / payment plan all specified up front, includes the full program.  Excludes certain things especially any service needed from others such as the dentist or oral surgeon.  No additional charge for minor follow up visits scheduled or unscheduled.  Somehow they cover it out of the first six grand.  You don't ever have to second guess motives on how often to come in.  And they don't get started in a service that isn't financed to completion - like a house.

For all my whining about the cost I have my (14yo)daughter considering orthodontics as a profession.

Title: Re: The Politics of Health Care
Post by: ccp on November 24, 2008, 10:18:34 AM
Hi Doug,
Bundling the service for a health problem into one overall cost irregardless of number of visits, phone calls, etc is part of it.
I am just going by experience and my study of the situation but am not an expert:

There are different ways of bundling.   Surgeons are usually bundled by procedure - say they get a lump sum that includes visits and procedure for hernia repair.  Others are capitated - that is they get a lump sum from the insurer to provide all care to a patient.  I am not in favor of this because the financial incentive is for providers to do as little as possible since they earn the same either way.
Another would be boutique medicine wherein a doctor provides all care (availability, visits, hospital, etc) to a patient for a specified monthly or yearly fee billed directly to a patient.

The main concept of *outcomes*, is bonus pay in getting patient to their target goals based on national standards. Say more pay for physicians if there patients blood pressures are where they should be and not over the goal for example.  Other outcomes I guess could be patient satisfaction, screening tests recommended as per national guidlines, preventative care etc.

The idea is to base reimbursement partly on measured performance rather than just on how many patients or procedures one does.
Reimbursement for quality and not just quantity I guess would be another way to put it.

As of right now those doctors who do procedures are compensated far more than doctors who do cognitive types of care whether specialist or primary.

Title: WSJ: The BO Health Care Express
Post by: Crafty_Dog on December 08, 2008, 09:52:13 PM
A charismatic Democratic President takes office promising to extend health insurance to all Americans. His party enjoys majorities in Congress, and the GOP is at sea. The press corps finds policy a bore and instead files stories that draw facile analogies to the heyday of FDR.

APYes, all that will be true next year -- but it was also true in January 1993. Fewer than two years later, the grand health-care ambitions of Bill and Hillary Clinton were reduced to tatters. No one is more attuned to this memory than today's Democrats, who aren't about to let history repeat itself. And since the lessons they learned from the HillaryCare fiasco are political, and not substantive, they are already moving full-speed ahead.

This mentality is nicely captured by Tom Daschle, the former Senate Majority Leader who Barack Obama has tapped to run Health and Human Services. "I think that ideological differences and disputes over policy weren't really to blame," he writes of 1994 in his book "Critical," published earlier this year. Despite "a general agreement on basic reform principles," the Clintons botched the political timing by focusing on the budget, trade and other priorities before HillaryCare.

President-elect Obama will not make the same mistake. Congressional Democrats are already deep into the legislative weeds, while Mr. Daschle is organizing the interest groups and a grassroots lobbying effort. Mr. Obama may be gesturing at a more centrist direction in economics and national security, but health care is where he seems bent on pleasing the political left.

According to Mr. Daschle, because of the Clintons' hesitation, "reform opponents succeeded in confusing and even frightening Americans about what change might mean," and this time the Democrats mean to define the debate. Consider the December 2 letter to us from Senator Max Baucus, who is upset that a recent editorial on his health-care plan did not use his favorite terms of art (his style being surrealism). "It will require affordability, but premiums will not be set," he writes. So the government will merely determine "affordability" -- which might as well be the same thing.

Much as Mrs. Clinton insisted that her health bureaucracies were "alliances," Mr. Baucus says his new entitlement "will not be 'managed by the government,' but by an independent council of Presidentially appointed health-care experts." The Senate Finance Chairman wants us to believe that a government commission to determine benefits and subsidies will somehow be above politics.

Shrewder moves are being made to co-opt should-be opponents. The Clintons decided to go to war with "proponents of the status quo," as Mrs. Clinton put it in a bare-knuckled speech in May 1993. This meant vilifying business, especially insurance companies guilty of "unconscionable profiteering" and even drug makers like Merck, which Mr. Clinton had courted during his campaign. This time, Democrats are trying to seduce business with subsidies and other bribes.

They may succeed, which is no surprise given that many corporations would be only too happy to dump their health liabilities on the government. The "Divided We Fail" coalition, which advocates "universal" coverage, includes not only usual suspects like unions and AARP but also the Business Roundtable and the National Federation of Independent Business, the small-business lobby that led the charge against HillaryCare.

America's Health Insurance Plans, the industry trade group, recently said its members would accept all comers regardless of health status or previous illness -- i.e., guaranteed issue -- but only if the government requires everyone to buy insurance. The individual mandate will expand their business in the short term, but it won't be long before Congress is also regulating premiums, cost-sharing and administrative expenses. Dr. Faustus, call your internist.

In today's Opinion Journal


The Obama Health-Care ExpressFight Racism, U.N.-StyleLet Ford Save Ford


Main Street: Now for an Honest Debate on Gitmo
– William McGurnGlobal View: Obama's Team of Conformists
– Bret Stephens


Getting Out of the Credit Mess
– Harvey GolubRestore the Uptick Rule, Restore Confidence
– Charles R. SchwabHolding CEOs Accountable
– Jonathan MaceyAnother opening for Democrats is the new director of the Congressional Budget Office, a post vacated when Peter Orszag joined the Obama Administration. CBO totes up the official cost of legislation and thus is one of those obscure Beltway outfits that frames the political argument. A "score" that is too costly make a bill harder to pass.

In the 1990s, CBO director Robert Reischauer knee-capped HillaryCare by pointing out its true costs and giving little credit to claims it would generate savings. With good reason: Putative cost "offsets" never seem to materialize when Congress tries to plan the insurance markets. Now Democrats will try to install a CBO director who can be more easily rolled.

Most disturbingly, Democrats are talking up "budget reconciliation" to pass a health overhaul. This process was created in 1974 and allows legislation dealing with government finances to be whisked through Congress on a simple majority after 20 hours of debate. In other words, it cuts out the minority by precluding a filibuster. Mr. Daschle writes that reform "is too important to be stalled by Senate protocol," and Mr. Baucus has said he's open to the option.

Any taxpayer commitment this large ought to require a social consensus reflected in large majorities, but Democrats are determined to plow ahead anyway. They know that a health-care entitlement for the middle class will never be removed once it is in place; and that government will then dominate American health-care choices for decades to come. That's all the more reason for the recumbent GOP to get its act together.
Title: soda tax
Post by: ccp on December 15, 2008, 07:36:14 AM
The soda tax does not make much sense.  There is ZERO evidence that people who stop drinking soda alone will lose weight.  There is even some evidence (in animals) that the calorie free sodas with the artificial sweeteners actually cause weight gain.

Leave it to a crat to lay awake at night to dream up ways to rip us off.  As for the health care cuts it wouldn't hurt if we get rid of the illegals who contribute to putting hospitals out of business by usuing ER services.  No mention of that of course.
How about taxes on political contributions?  How about windfall profits taxes on the incomes of any politician above whatever it was before they took office?

How about a tax on all white men?  That would be fair.  How about taxes from government employees unions?

How about a luxury tax on all cosmetic procdures?

New taxes, cuts in budget plan
Paterson sees $404M tax on non-diet soda; higher levies on health care 
By JAMES M. ODATO, Capitol bureau
Click byline for more stories by writer.
First published: Sunday, December 14, 2008
New taxes, deep cuts to education and health care, and a restructuring of the state's economic development programs will be hallmarks of Gov. David Paterson's first budget plan to be released in two days, according to interviews of people briefed on components.
The plan will come with a host of revenue raisers — increased taxes on hospitals and insurance policies, for instance — and at least one new assessment, a so-called obesity tax on non-diet soda to raise $404 million. The governor also is contemplating requiring new license plates to raise cash, reviving sales tax on clothing purchases, removing the tax cap on gasoline and threatening to require Indian retailers to collect taxes on sales to non-Indians by signing into law a bill passed earlier this year by the Legislature.

Paterson will unveil the spending plan, aimed at closing a $12.5 billion deficit for next year, on Tuesday. The total size of the Paterson budget is unknown.

There is no word on Paterson's plans for the state work force, although he has said he will adhere to a strict hiring freeze while looking to consolidate some components of government.

The cuts will be across the board and will build upon a deficit reduction plan Paterson proposed in November as he attempted to close the $1.5 billion shortfall in the $120 billion budget negotiated for this year. The plan was inherited from the executive budget introduced last January by Gov. Eliot Spitzer.

The health industry will be particularly upset, although Paterson's cuts will raise blood pressure throughout. He will call for about $3.53 billion in health care cuts, not including federal share of matching Medicaid dollars, which could be another $2 billion in cuts.

The biggest hits will be to insurance companies, which will be asked to come up with about $855 million in extra assessments. Those amount to more taxes on health insurance plans, increased sales tax on hospital discharges and more shifting of general fund costs to the Insurance Department so that insurance companies pay for programs such as Timothy's Law, the mandated coverage of mental health treatments.

Further, the governor also will propose a new tax on some physician services to raise $50 million.

The bottom line will be a net increase in costs that ultimately get paid by subscribers, thereby increasing the cost of coverage at a time that most upstate insurers are struggling.

Hospital cost saving initiatives will amount to $700 million next year and $50 million this year. Some of that will come from a 0.7 percent tax on gross receipts and Medicaid rate reductions. Graduate medical education funds will be redirected to save $141 million and another $23 million will be cut through reforming reimbursement.

Nursing homes will be cut by $4.2 million this year and $420 million next year. Home care will be cut $190 million next year.

A number of other public health programs will come with savings by, for instance, taxing non-diet sodas under an "obesity tax" that will raise $404 million. Prescription drug costs, a hit on pharmacies and drug makers, will cut by $111 million.

Among the reductions in education spending, public colleges will be directed to raise tuitions. But despite the cuts, Paterson will try to make it easier for SUNY schools to partner with private developers who want to build on campus property. The public/private initiative is seen as a way to stimulate construction of private housing for campus residents.

The Empire Zone program will be cut by at least 50 percent, saving the state tens of millions by not extending benefits as liberally.

The budget will come a day after Senate Republicans vote on a bill to stimulate the economy by phasing out the Empire Zone program through 2011 and using the savings as tax breaks for companies.

The governor has contemplated instituting a different pension system for new employees, but the so-called Tier 5 program may not make it to the budget. He is also expected to reiterate a call for greater health care payments from retirees and the closure of some juvenile detention facilities.

James M. Odato can be reached at 454-5083 or by e-mail at
Title: Re: The Politics of Health Care, soda tax etc.
Post by: DougMacG on December 15, 2008, 09:20:36 AM
"The soda tax does not make much sense.  There is ZERO evidence that people who stop drinking soda alone will lose weight.  There is even some evidence (in animals) that the calorie free sodas with the artificial sweeteners actually cause weight gain." 

 - And if there was a study proving the soda/weight connection, how about we publicize the information instead of changing the tax code.  My understanding is that there is a reverse correlation in that skinny people tend to drink the real soda and heavier people more likely tend to choose the diet version.

"How about taxes on political contributions?  How about windfall profits taxes on the incomes of any politician above whatever it was before they took office?...
How about a tax on all white men? ...How about a luxury tax on all cosmetic procedures?"

Very funny.  It's all tempting.  Tax everything we don't like when it's our turn to be in power.  They tried the most obvious one - luxury tax on new yachts.  It lasted about a minute.  Turned out that most rich yachters already had a perfectly good boat and the Democrat leader of the Senate (Mitchell D-Maine) was from a yacht building state...

Call me old fashioned but how about we tax each dollar of income the same no matter the source and each dollar of consumption the same no matter the destination, i.e. equal treatment under the law.  People might have a different view of demanding or tolerating free services if they didn't believe someone else was paying for it. 
Title: wsj: BO will ration
Post by: Crafty_Dog on December 30, 2008, 08:01:45 AM
People are policy. And now that President-elect Barack Obama has fielded his team of Tom Daschle as secretary of Health and Human Services and Melody Barnes as director of the White House Domestic Policy Council, we can predict both the strategy and substance of the new administration's health-care reform.

The prognosis is not good for patients, physicians or taxpayers. If Mr. Daschle meant what he wrote in his book "Critical: What We Can Do About the Health-Care Crisis," Americans can expect a quick, hard push to build more federal bureaucracy, impose price controls, restrict medicines and technology, boost taxes, mandate the purchase of health insurance, and expand government health care.

In his book, Mr. Daschle proposes a National Health Board to regulate the way health care is provided. This board would have vast powers in regulating the massive federal health-care system -- a system that includes Medicare, Medicaid, and other programs. Under Mr. Obama, it is likely that that system will be expanded and that new government insurance for the nonelderly, nonpoor will be created.

Given the opportunity, Mr. Daschle would likely charge the board with determining which treatments and drugs are cost effective and therefore permissible to use for patients covered by the government. And because the government is such a big player in the health-care market (46% of health-care spending comes from the government), the board would effectively set parameters for private insurers.

It is nearly certain that the process of determining which drugs and which treatments would be approved for use would be quickly politicized. The details of health-care policy may not be kitchen table conversation, but the fact that a Washington committee can deny grandma a hip replacement due to her age, or your sister a new and expensive drug, is. Health care is personal and voters will pressure lawmakers on access to care.

Liberal experts, Mr. Daschle included, believe that America needs to ration new technology and drugs. In his book, Mr. Daschle complains about overuse of new technology and praises the United Kingdom's National Institute for Health and Clinical Excellence (NICE), a rationing system that controls government costs. NICE's denial of care is legendary -- from the arthritis drug Abatacept to the lung cancer drug Tarceva. These drugs are effective. It's just that the bureaucrats don't consider them cost effective.

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Americans will not put up with such limits, nor will our elected representatives. Mr. Daschle himself proves this. He punts the hard decisions about rationing to an unelected board. Yet his main proposals are not only about expanding subsidized programs to cover more people but about adding the massively expensive benefit categories of mental health, which has a strong lobby behind it, and long-term care, which is important to the broad middle class.

One of the great myths in health care is that the uninsured are responsible for driving up private premiums by shifting costs. Uncompensated care certainly shifts some costs to private payers. Yet these costs are actually quite manageable in the aggregate, akin to what retailers lose due to shoplifting. The major cost shift is from government programs -- Medicare and Medicaid -- to private plans. The government pays doctors to treat Medicare and Medicaid patients. But the rates it pays, on average, are less than the cost for providing care to these patients. This is why Medicaid patients, and increasingly Medicare patients, struggle to find doctors. Putting more people on these programs will destabilize the remaining private system and create a coalition for price and wage controls.

Americans will never tolerate this. Remember our managed-care experiment in the 1990s. It succeeded in its main goal of controlling costs without an aggregate reduction in health quality. But in asking Americans to limit their choices, it prompted a bipartisan act of Congress to provide patients with a Bill of Rights. Now Mr. Daschle proposes nothing less than a giant HMO with a federal bureaucracy setting the benefit plan.

Mr. Daschle's model is Massachusetts. But Massachusetts's plan is an unfolding disaster and demonstrates how Mr. Daschle's private/public model is merely a stalking horse for government-dominated health care.

In Today's Opinion Journal


The Wizards of OilThe Philanthropy ShakedownYou Are Your Record


Global View: Hamas Know One Big Thing
– Bret StephensMain Street: New Jersey Is the Perfect Bad Example
– William McGurn


Samuel Huntington's Warning
– Fouad AjamiWhy Detroit Has an Especially Bad Union Problem
– Logan RobinsonObama Will Ration Your Health Care
– Sally C. PipesThe FDA Is Killing Crohn's Patients
– Gideon J. Sofer
The headline claim is that the program has signed up 442,000 more people for health insurance. The reality is that 80,000 of these were simply put on Medicaid and 176,000 more on the taxpayer-subsidized plans. Costs have exploded, requiring additional tax hikes and the entire system is only possible due to sizable transfers from the federal government. The plans are so unaffordable that in 2007, 62,000 people were exempted from the individual mandate. So much for universal coverage.

The only way the Massachusetts plan will survive is with continued and increasing federal subsidies -- that is, tax revenue from the residents of other states. The only way Mr. Daschle's proposed plan would survive is with massive deficit spending -- that is, with taxpayer money from future Americans, many of whom are not yet born.

Mr. Daschle and the Democrats have spent years developing both the policy and political strategy to make the final push for taxpayer-financed universal health insurance. They have the players on the field, a crisis providing a sense of urgency, and a playbook filled with lessons learned from years of health policy reform disasters -- most recently that of HillaryCare in 1994.

The big questions for believers in private medicine are at this point political and strategic. With employers and most insurers reportedly on board with the new administration's desire for radical overhaul, who will step in to ask the tough questions? Will these issues get raised in time to provoke a meaningful, fact-based debate? Americans could easily find that Mr. Obama's 100-day honeymoon ends with a whole new health-care regime they hadn't quite bargained for.

Ms. Pipes, president and CEO of the Pacific Research Institute, is the author of "The Top Ten Myths of American Health Care: A Citizen's Guide" (Pacific Research Institute, 2008).

Title: Full government take over of health care is here
Post by: ccp on January 09, 2009, 08:45:42 AM
Interesting he is introduced by Bob Dole.

This statement is humorous:

***I want to take politics out of it as much as possible and allow scientists to do their job."***

You can't take politics out of health care.  How will scientists do their job with the government regulating every inch of our system?

***Daschle Makes Case for Appointment to HHS Post
By Emily P. Walker, Washington Correspondent, MedPage Today
Published: January 08, 2009
WASHINGTON, Jan. 8 -- Tom Daschle, picked by President-elect Barack Obama to be Health and Human Services secretary, said medical trainees should have school loans forgiven and receive other incentives to choose careers in primary care.
Daschle told senators at his confirmation hearing today he wants to send a message to medical students: "If you take this route, we're going to find ways to ensure that you have the financial wherewithal to become that front-line provider that we need."

Daschle testified before the Senate Health, Education, Labor, and Pensions (HELP) Committee, chaired by Edward Kennedy (D-Mass.).

Senate approval is expected for the well-liked ex-senator from South Dakota. Republicans on the committee gave him a friendly reception at the hearing, and Orrin Hatch (R-Utah) announced he would support Daschle's nomination.

Daschle told the committee he has been laying the groundwork for a healthcare reform plan, which he said cannot be dictated from the White House and Congress.

He advocated a more grassroots approach and said he's taken ideas from Obama's transition Web site, which has received tens of thousands of comments, and from local community health forums in the last several months.

Daschle said the Centers for Medicare and Medicaid Services should save money by moving to a medical-home care model and steering its focus toward prevention and wellness rather than paying for disease treatment.

The CDC should better utilize community-based prevention efforts, like smoking cessation and weight loss programs, Daschle said. He said he would "revitalize" CDC's ability to detect and investigate health threats and focus on better coordination between public and private entities.

Daschle promised to restore trust in the FDA, citing a survey that found nearly two-thirds of Americans don't believe that the agency can ensure drug safety and effectiveness.

"Ensuring the food we eat and the medications we take are safe is a core protection that American people deserve and a core responsibility of government," Daschle said.

Daschle said all the agencies he would oversee need to operate with fewer political motivations.

"I want to reinstate a science-driven environment," he said. "I want to take politics out of it as much as possible and allow scientists to do their job."

Daschle said the National Institutes of Health budget is so limited that only 10% of grant applications are funded.

"I will work to strengthen NIH, with leadership that focuses on the dual objectives of addressing the healthcare challenges of our people and maintaining America's economic edge through innovation," he said.

Although the HELP committee traditionally holds confirmation hearings for the HHS post, the Finance Committee will hold its own hearing and have final say on whether to advance Daschle's nomination to the Senate floor. That hearing has not been scheduled yet.

The HELP committee's senior Republican Michael Enzi (R-Wyo.) said the last two HHS secretaries were confirmed within two weeks of their appearances before the HELP committee.

Daschle served three terms in the Senate and was minority leader from 2001 to 2004, when he lost a re-election bid. He joined the Center for American Progress, a Democratic think tank, as a senior fellow and has advised the lobbying firm Alston & Bird.

He published a book on health care in 2008, Critical: What We Can Do About the Health-Care System. Enzi said he had recommended it to all his staff.

Today's hearing was also notable for the appearances of Kennedy, who appeared healthy and fit despite his recent bout with malignant glioma, and Robert Dole, the former GOP senator from Kansas.

Dole introduced Daschle, saying Congress and the public appear ready to address healthcare reform.

Dole, as leader of Senate Republicans in the early 1990s, had engineered the defeat of the Clinton administration's reform proposal.

He now works with Daschle at Alston & Bird.***
Title: Re: The Politics of Health Care
Post by: DougMacG on January 09, 2009, 10:08:02 AM
CCP: Thank you for your opposition to government run health care!

One note on the Daschle appointment with Bob Dole introducing, I thought Obama was promising a lobbyist-free administration:

"Daschle ... advised the lobbying firm Alston & Bird...Dole introduced Daschle...He now works with Daschle at Alston & Bird."

Daschle's wife was/is also a HUGE lobbyist so maybe 99% of the family income comes from lobbying?  Makes Obama look a lot like Bill Clinton - say anything you want to any audience at any time and have enough charm to pull it off.  It's not the lobbying; it's the obvious deception that disgusts me.

Not mentioned, Daschle was the ringleader of the blocking of appointments to the judiciary by the minority in the senate, so he went from winning re-election by 30 points to losing in his own state.
Title: Re: The Politics of Health Care
Post by: ccp on January 09, 2009, 11:54:18 AM
Not mentioned, Daschle was the ringleader of the blocking of appointments to the judiciary by the minority in the senate, so he went from winning re-election by 30 points to losing in his own state.

He was voted out so BO who is just another party hack turns around and rewards him with this.

And the pols in DC are all getting rich anyway with their lobbying and such.

Even the supposedly honorable Dole is on the dole - and from Daschle no less.  Gives a new meaning to bipartisanship doesn't it.

I guess his viagra plug makes him an expert in health care. :x :-(
Title: BO-Daschle control over health care
Post by: ccp on January 19, 2009, 08:04:58 AM
For those of us who want to see what's in store for US health care we should probably read Daschle's book.  We are going down the road of gigantic federal control, expansion, redistribution, and subtle (politically covered) rationing.  There will be a board which will oversee and control one seventh of our economy:

Visions for Change in U.S. Health Care — The Players and the Possibilities

John K. Iglehart
 Under the incoming presidential administration, U.S. Democratic leaders are determined to achieve a long-elusive goal: securing "affordable, accessible health care for every single American," as President-elect Barack Obama put it recently. Recognizing the blunders that doomed the reform effort of President Bill Clinton 16 years ago, the new administration is working closely with Congress to craft a bill that will attract sufficient support to ensure enactment.

Although some critics argue that we can ill afford the costs of expanded coverage and other reforms with the economy in recession and an ever-growing federal deficit, Obama counters that these are pocketbook issues, integral to recovery efforts. At a December news conference, when he introduced Tom Daschle as his choice for secretary of Health and Human Services, Obama said a major health care initiative "has to be intimately woven into our overall economic recovery plan. It's not something that we can put off because we are in an emergency. This is part of the emergency."

The new administration's proposal for health care reform will not be part of the large stimulus package that Democratic legislators plan to enact in early January. Though the proposal is a work in progress, its central tenets are well known and, in some key respects, resemble the plan enacted in Massachusetts — which, in 2 years, has reduced the state's uninsured to 2.4% of its population (the lowest in the country), according to a 2008 report by the Urban Institute.

Obama's proposal would enable people with employer-sponsored health insurance coverage to retain it, if they prefer, and would require large employers either to offer their workers "meaningful coverage" or to contribute a certain percentage of their payroll to support a new public plan. The proposal would also create an insurance exchange through which people without employer coverage could select private coverage or the public plan at rates similar to those offered through large employers. Obama has pledged to "lower costs by taking on anticompetitive actions in the drug and insurance companies," to support disease prevention and health promotion efforts, and to invest $50 billion over the next 5 years to accelerate adoption of health information technology.1

A number of health-related items are being considered as elements of the early stimulus package, largely to prevent people who lose their jobs from losing their coverage and to begin investing in the infrastructure for a more efficient delivery system. These items include increased federal support to states to maintain or expand their Medicaid enrollment, reauthorization of and increased funding for the State Children's Health Insurance Program, grants to states to speed adoption of health information technology, and expansion of the Consolidated Omnibus Budget Reconciliation Act (COBRA) to give certain laid-off workers the right to temporarily continue insurance coverage at group rates.

Democrats' fortunes improved dramatically in November when Obama swept to a historic victory over Republican Senator John McCain. Thanks to the unpopularity of President George W. Bush and Obama's coattails, Democrats also increased their majorities in both houses of Congress — to margins of 257 to 178 in the House and 58 to 42 in the Senate (if Democrat Al Franken of Minnesota wins the seat), including two independents who caucus with the Democrats. (The retirement of Obama and Democrats Hillary Clinton and Ken Salazar from the Senate leaves open seats in Illinois, New York, and Colorado, and the race in Minnesota is undecided.) Republicans — if their caucus can maintain tight discipline — will still wield considerable influence in the Senate, where it takes 60 votes to overcome a filibuster.

Determined to avoid the mistakes that brought down the Clinton reform plan, Obama demonstrated in his early appointments the importance he attaches to maintaining close ties between Congress and the White House. He selected Rahm Emanuel, a powerful congressman from Illinois, as chief of staff, and former Senate Majority Leader Daschle as secretary of Health and Human Services and director of a new White House Office of Health Reform. Daschle has set out his own ideas for reform in a recent book, calling for all Americans to purchase coverage and for the creation of a federal health board (modeled after the Federal Reserve Board) that would have sweeping powers to mandate policies for all federal health programs.2 Peter Orszag was named Obama's director of the Office of Management and Budget, a powerful agency that prepares the government's annual budget. Since 2007, Orszag has been the director of the Congressional Budget Office, where he has placed a heavy emphasis on health-related issues.

Democratic congressional leaders will also play influential roles in promoting the administration's health reform agenda and urging Republican legislators to join as cosponsors. House Speaker Nancy Pelosi (D-CA) is a dominant figure who ranks health care reform among her highest priorities. Senate Majority Leader Harry Reid (D-NV) may have more difficulty maintaining discipline within his ranks because in the Senate there is disagreement on the shape reform should take. For example, Senators Ron Wyden (D-OR) and Robert Bennett (R-UT) have persuaded 15 other senators to cosponsor a bill that the authors assert reflects an "ideological truce" between the parties: "Democrats are correct in saying that universal coverage is necessary to fix health care," they write. "Republicans are correct in saying that market forces play an important role in health care by promoting competition and innovation. The Healthy Americans Act strikes a balance between these ideals."3

Five congressional committees will be instrumental in refining any reform plan. Three of Pelosi's California colleagues, all liberal Democrats, hold leadership positions on the three key House panels: Henry Waxman is the new chair of the House Energy and Commerce Committee, George Miller chairs the House Education and Labor Committee, and Pete Stark chairs the House Ways and Means Subcommittee on Health. The relevant Senate committees are the Finance Committee, chaired by Max Baucus (D-MT), and the Health, Education, Labor, and Pensions Committee, chaired by Edward Kennedy (D-MA).

The House Ways and Means Committee is generally considered the most influential panel in Congress because of a constitutional requirement stipulating that all tax legislation must originate there. It also oversees Medicare Part A (which covers hospitals), public welfare, Social Security, trade, and unemployment compensation. Although Representative Charles Rangel (D-NY) chairs the committee, he often defers to Stark on health issues, and his standing has been weakened by ethics problems currently under investigation. Stark recently told reporters that once reform legislation is introduced, consideration of it would probably consume most of 2009, with enactment possible in early 2010. Stark has long supported "Medicare for all" as his preferred approach to expanding coverage; he opposes privatizing the program. He was a lead sponsor of the Children's Health and Medicare Protection Act (CHAMP), a measure the House approved in August 2007 on a vote of 225 to 204 that would have replaced the formula on which Medicare's physician fees are set. The bill, which died in the Senate, would also have placed greater emphasis on primary care and preventive services covered by Medicare by allowing physician payments in these areas to grow at a rate 2.5% faster than that of the gross domestic product (GDP), whereas payments for all other physician services would be limited to the GDP's growth rate.

Waxman established a reputation as an adroit legislator during the 15 years he chaired the House Energy and Commerce Subcommittee on Health (1979 to 1994). His most significant legislative accomplishment during a period that included the presidency of the conservative Ronald Reagan was pressing Congress to vastly expand Medicaid.4 In recent weeks, Waxman demonstrated his political acumen by securing enough votes in the House Democratic caucus to wrest the chairmanship of the Energy and Commerce Committee from John Dingell (D-MI), who in February will become the longest-serving House member in history, with 53 years of service. The practical Waxman recently noted that the "best approach to reform is what we can pass . . . that secures the goal of universal coverage, sensible controls on cost, and assurance of quality care." But he also said he would work to bring generic versions of biologic products to the market and to restore the effectiveness of the Centers for Disease Control and Prevention and the Food and Drug Administration.

Baucus's Senate Finance Committee oversees Medicare, Medicaid, public welfare, Social Security, taxes, trade, and unemployment insurance. Baucus is a moderate who occasionally upsets his liberal colleagues by casting votes more reflective of Montana conservatism than his party's activism. In mid-2008, however, he came out strongly in favor of ambitious health care reform and has since released an 89-page "call to action" that embraces a commitment to strengthening the employer-based insurance system, bolstering the role of primary care, and reexamining Medicare's graduate medical education policies.5 Baucus also outlined an approach to reforming Medicare's physician payment system that resembles the model in CHAMP.

Senator Kennedy, for his part, is determined to top his many health policy accomplishments by winning enactment of universal coverage. In September, Kennedy, who is undergoing treatment for brain cancer, directed his staff to organize roundtable discussions among representatives of disparate interests (large and small businesses, community health organizations, consumers, health plans, hospitals, labor, physicians, and others) to identify issues on which there is broad agreement or conflicting opinion and strive to build support for reform. One purpose of these ongoing discussions is to neutralize opposition to the ambitious reform designs that Democrats hope to enact. One participant, Karen Ignagni, chief executive officer of America's Health Insurance Plans (the new incarnation of an organization that helped to bring down Clinton's reform plan with its devastating "Harry and Louise" ads), said of the roundtable: "You see a range of diverse stakeholders trying to work together to achieve health care reform."

Congressional Republicans have been slow to engage Democrats on health care issues. They have developed no alternative proposals, and no armies of grassroots supporters or well-financed private organizations seem poised to do battle against reform. This situation could change rapidly once proposals are introduced, hearings commence, and winners and losers are clearly identified. Republicans' greatest concerns seem to be the creation of a new public plan, which many fear is a backdoor approach to a single-payer system; the possible creation of a federal health board with sweeping new powers over benefit packages, which might stifle innovation; and the long-term financial implications of providing near-universal coverage.

President-elect Obama faces a daunting set of challenges as his grand vision for change comes into closer contact with the realities of U.S. politics. Obama has acknowledged that hundreds of billions of dollars will be added to the federal deficit as he pursues economic recovery, but he has also vowed to scour the budget in search of wasteful spending to offset these new costs. This exercise, in which Congress will undoubtedly participate, will provoke many a pitched battle and is certain to affect Americans' reaction to the new president's definition of "change."****

Source Information

Mr. Iglehart is a national correspondent for the Journal.

An interactive graphic on key players in health care reform is available at


Obama B, Biden J. Barack Obama and Joe Biden's plan to lower health care costs and ensure affordable, accessible health coverage for all. (Accessed December 22, 2008, at
Daschle T, Greenberger SS, Lambrew JM. Critical: what we can do about the health-care crisis. New York: Thomas Dunne Books, 2008.
Wyden R, Bennett B. Finally, fixing health care: what's different now? Health Aff (Millwood) 2008;27:689-692. [Free Full Text]
Iglehart JK. Medicaid revisited -- skirmishes over a vast public enterprise. N Engl J Med 2007;356:734-740. [Free Full Text]
Baucus M. Call to action: health reform 2009. Washington, DC: Committee on Finance, 2008. (Accessed December 22, 2008, at

Comments and questions? Please contact us.

The New England Journal of Medicine is owned, published, and copyrighted © 2009 Massachusetts Medical Society. All rights reserved.
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on January 20, 2009, 10:07:21 PM
The House made its first down payment on President Obama's health-care plans last week, passing 289-139 a major expansion of the State Children's Health Insurance Program. The Senate is scheduled to take it up soon and pass it easily as well. These days tens of billions in new spending is a mere pittance, but Schip is also the Democratic model for a quantum jump in government health care down the line.

The bill became a liberal Pequot after President Bush repeatedly vetoed it in 2007 (while supporting a modest expansion). The GOP has no hope of stopping it now, so Schip will more than double in size with $73.3 billion in new spending over the next decade -- not counting a budget gimmick that hides the true cost. The program is supposed to help children from working-poor families who earn too much to qualify for Medicaid, but since it was created in 1997 Democrats have used it as a ratchet to grow the federal taxpayer share of health-care coverage.

With the new bill, Schip will be open to everyone up to 300% of the federal poverty level, or $63,081 for a family of four. In other words, a program supposedly targeted at low-income families has an eligibility ceiling higher than the U.S. median household income, which according to the Census Bureau is $50,233. Even the 300% figure isn't really a ceiling, given that states can get a government waiver to go even higher. Tom Daschle's folks at Health and Human Services will barely read the state paperwork before rubberstamping these expansions.

The political purpose behind Schip has always been to capture the middle class. Every time the program grows, it displaces private insurance. Even before Democrats struck down rules limiting crowd out, research indicated that for every 100 children signed up -- now more than 7.1 million -- there is a reduction in private coverage for 25 to 50 kids. Exactly the same thing will happen if Messrs. Obama and Daschle end up introducing a "public option," a government insurance program modeled after Medicare but open to anyone of any income. As with Schip, any net increase in insurance coverage will come by having taxpayers gradually supplant the private system.

Schip money is delivered as a block grant, which states are supposed to match, though national taxpayers end up paying 65% to 83% of the total cost. When states make health-care promises they can't afford -- such as New York, which expanded the program to 400% of poverty -- the feds always step in with, yes, a bailout. The House bill creates a "contingency fund" precisely for that purpose, and also allots bonus payments to states that boost Schip enrollment, so Governors will be further rewarded for overspending. All this is propped up by a permanent increase in the tobacco tax, which will rise to $1 a pack from the current 39 cents -- thus financing a permanent and growing entitlement with a declining corps of smokers.

Lately Mr. Obama has been making noises about the necessity of entitlement reform. This is no way to start.
Title: Entitlement Stimulus
Post by: Crafty_Dog on January 29, 2009, 10:15:55 AM
The more we dig into the pile of spending and tax favors known as the "stimulus bill," the more amazing discoveries we make. Namely, Democrats have apparently decided that the way to gun the economy is to spend even more on health care.

This is notable because if there has been one truly bipartisan idea in Washington, it's that the U.S. as a whole spends too much on health care. President Obama has been talking up entitlement reform as a way to free up the money for his other social priorities. But it turns out that Congress is using the stimulus as cover for a massive expansion of federal entitlements.

Only the bill's $20 billion or so devoted to electronic health records can be reasonably called an investment. More typical is the $87 billion that will go to Medicaid, which -- silly us -- we underestimated by about $6 billion in our stimulus editorial yesterday. This pot of money will be used to blow out the federal matching rate by 4.9 percentage points across the board. Medicaid is nominally a joint state-federal program, but the feds pick up 57% of the Medicaid bill on average and are willing to go as high as 82% in some states. In other words, Democrats want to bail out the states that make unaffordable health-care promises and haven't tried to control costs. This latest rescue will give Governors more incentive to do so, given that the more they spend, the more Congress pays.

National taxpayers will also fund a new program allowing some laid-off workers receiving unemployment checks to enroll in Medicaid. For the first time ever on a large scale, the federal government will pay 100% of the costs they incur, and states are explicitly prohibited from means-testing this benefit. Supposedly the $11 billion plan will expire in 2010, but the word "temporary" does not exist in the entitlement world -- and Democrats will fight furiously to extend these benefits before they sunset.

Another damaging inspiration is the plan to throw $30.3 billion at Cobra insurance plans. The unemployed are currently allowed to keep their work health benefits for 18 or 36 months since 1986. While they search for a new job, they must pay 102% of the full insurance premium, including the employer's share. But Democrats now plan to subsidize these plans to the tune of 65%.

Are they making Cobra a new entitlement? Cobra was never intended as an option to assist the long-term unemployed -- considering that adverse selection means Cobra enrollees cost businesses about 145% as much as covered employees. Since Democrats want to boost participation by propping up Cobra use, that will result in less capital to invest in new jobs in the middle of a recession. It will also mean adding another disincentive (in addition to unemployment insurance) to get a new job. When you subsidize people not to work, you get more nonworkers.

Not for nothing did Democratic heath-care commissar Pete Stark tell the New York Times that "We accomplished more today than in the last eight years" after his committee approved the Medicaid and Cobra pieces of the stimulus. In one swoop Democrats will make employer-sponsored health care even more expensive and expand opportunities for an anxious public to join, or remain on, the welfare rolls. The pretext of "stimulus" is being leveraged to capture ever more of the private health-care market and transfer those costs onto government.

But don't forget that everyone agrees that health spending is already too high. So the stimulus also devotes $1.1 billion to create a new bureaucracy called the Federal Coordinating Council for Comparative Effectiveness Research. A billion dollars isn't nearly enough to conduct the rigorous clinical studies needed to provide more information on what medical treatments result in the best outcomes. But Democrats want to get this "health-care Fed" on the books now so it's around when they pass the next entitlement expansion -- for the entire middle class.

When government finances start to buckle under that subsidy, the comparative effectiveness outfit will start to ration care to control costs, much like the United Kingdom's National Institute for Clinical Excellence (NICE). The draft report accompanying the House portion of the bill notes that procedures and drugs "that are found to be less effective and in some cases, more expensive, will no longer be prescribed."

In sum, what we are really getting in this stimulus bill are several more steps in the gradual government takeover of the health-care market.
Title: WSJ: The Canadian experience
Post by: Crafty_Dog on February 08, 2009, 07:34:42 PM
President Obama and Congressional Democrats are inching the U.S. toward government-run health insurance. Last week's expansion of Schip -- the State Children's Health Insurance Program -- is a first step. Before proceeding further, here's a suggestion: Look at Canada's experience.

Martin KozlowskiHealth-care resources are not unlimited in any country, even rich ones like Canada and the U.S., and must be rationed either by price or time. When individuals bear no direct responsibility for paying for their care, as in Canada, that care is rationed by waiting.

Canadians often wait months or even years for necessary care. For some, the status quo has become so dire that they have turned to the courts for recourse. Several cases currently before provincial courts provide studies in what Americans could expect from government-run health insurance.

In Ontario, Lindsay McCreith was suffering from headaches and seizures yet faced a four and a half month wait for an MRI scan in January of 2006. Deciding that the wait was untenable, Mr. McCreith did what a lot of Canadians do: He went south, and paid for an MRI scan across the border in Buffalo. The MRI revealed a malignant brain tumor.

Ontario's government system still refused to provide timely treatment, offering instead a months-long wait for surgery. In the end, Mr. McCreith returned to Buffalo and paid for surgery that may have saved his life. He's challenging Ontario's government-run monopoly health-insurance system, claiming it violates the right to life and security of the person guaranteed by the Canadian Charter of Rights and Freedoms.

Shona Holmes, another Ontario court challenger, endured a similarly harrowing struggle. In March of 2005, Ms. Holmes began losing her vision and experienced headaches, anxiety attacks, extreme fatigue and weight gain. Despite an MRI scan showing a brain tumor, Ms. Holmes was told she would have to wait months to see a specialist. In June, her vision deteriorating rapidly, Ms. Holmes went to the Mayo Clinic in Arizona, where she found that immediate surgery was required to prevent permanent vision loss and potentially death. Again, the government system in Ontario required more appointments and more tests along with more wait times. Ms. Holmes returned to the Mayo Clinic and paid for her surgery.

On the other side of the country in Alberta, Bill Murray waited in pain for more than a year to see a specialist for his arthritic hip. The specialist recommended a "Birmingham" hip resurfacing surgery (a state-of-the-art procedure that gives better results than basic hip replacement) as the best medical option. But government bureaucrats determined that Mr. Murray, who was 57, was "too old" to enjoy the benefits of this procedure and said no. In the end, he was also denied the opportunity to pay for the procedure himself in Alberta. He's heading to court claiming a violation of Charter rights as well.

These constitutional challenges, along with one launched in British Columbia last month, share a common goal: to win Canadians the freedom to spend their own money to protect themselves from the inadequacies of the government health-insurance system.

The cases find their footing in a landmark ruling on Quebec health insurance in 2005. The Supreme Court of Canada found that Canadians suffer physically and psychologically while waiting for treatment in the public health-care system, and that the government monopoly on essential health services imposes a risk of death and irreparable harm. The Supreme Court ruled that Quebec's prohibition on private health insurance violates citizen rights as guaranteed by that province's Charter of Human Rights and Freedoms.

The experiences of these Canadians -- along with the untold stories of the 750,794 citizens waiting a median of 17.3 weeks from mandatory general-practitioner referrals to treatment in 2008 -- show how miserable things can get when government is put in charge of managing health insurance.

In the wake of the 2005 ruling, Canada's federal and provincial governments have tried unsuccessfully to fix the long wait times by introducing selective benchmarks and guarantees along with large increases in funding. The benchmarks and the guarantees aren't ambitious: four to eight weeks for radiation therapy; 16 to 26 weeks for cataract surgery; 26 weeks for hip and knee replacements and lower-urgency cardiac bypass surgery.

Canada's system comes at the cost of pain and suffering for patients who find themselves stuck on waiting lists with nowhere to go. Americans can only hope that Barack Obama heeds the lessons that can be learned from Canadian hardships.

Mr. Esmail, based in Calgary, is the director of Health System Performance Studies at The Fraser Institute.

Title: Daschle's loss to BO
Post by: ccp on February 09, 2009, 10:40:25 AM
Dashcle was felt to be in position with his influence peddling contacts and experience to be able to push through heatlh reform.  Whether or not we would like his reforms is open to debate.  For those who have no insurance they would likely be pleased.  For those with existing medicare, they would likely get rationed care.  And for those who pay for commercial insurance they would get screwed most likely.  That said the system is broken and something has to change but what I don't know:

Losing Daschle Hurts, but Won't Kill Health Plans
Posted Feb 3, 09 4:13 PM CST in Science & Health,  Opinion,  Politics 
(Newser) – The loss of Tom Daschle is a blow to President Obama’s plans for health-care reform, but the administration still has the resources to get the job done, Jonathan Cohn writes in the New Republic. Daschle was not only to head the Department of Health and Human Services, but also a White House office on health reform—which is where his political know-how would’ve come in handy.

“Daschle had a combination of talents not easy to find in one person,” Cohn writes. “But that doesn’t mean you can’t replace those skills, particularly if you’re willing to find several people instead of one.” While number of current or former governors could take over the cabinet position, Cohn pushes scholar Jeanne Lambrew for the reform office: “In fact, based on things I’ve heard, she’s been doing much of it for a while.”
Source: New Republic

Title: Slipping one into the Stimulus Package. . . .
Post by: Body-by-Guinness on February 09, 2009, 04:00:58 PM
Ruin Your Health With the Obama Stimulus Plan: Betsy McCaughey
Email | Print | A A A

Commentary by Betsy McCaughey

Feb. 9 (Bloomberg) -- Republican Senators are questioning whether President Barack Obama’s stimulus bill contains the right mix of tax breaks and cash infusions to jump-start the economy.

Tragically, no one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department.

Senators should read these provisions and vote against them because they are dangerous to your health. (Page numbers refer to H.R. 1 EH, pdf version).

The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.”

Keeping doctors informed of the newest medical findings is important, but enforcing uniformity goes too far.

New Penalties

Hospitals and doctors that are not “meaningful users” of the new system will face penalties.  “Meaningful user” isn’t defined in the bill. That will be left to the HHS secretary, who will be empowered to impose “more stringent measures of meaningful use over time” (511, 518, 540-541)

What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment? The vagueness is intentional. In his book, Daschle proposed an appointed body with vast powers to make the “tough” decisions elected politicians won’t make.

The stimulus bill does that, and calls it the Federal Coordinating Council for Comparative Effectiveness Research (190-192). The goal, Daschle’s book explained, is to slow the development and use of new medications and technologies because they are driving up costs. He praises Europeans for being more willing to accept “hopeless diagnoses” and “forgo experimental treatments,” and he chastises Americans for expecting too much from the health-care system.

Elderly Hardest Hit

Daschle says health-care reform “will not be pain free.” Seniors should be more accepting of the conditions that come with age instead of treating them. That means the elderly will bear the brunt.

Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council (464).

The Federal Council is modeled after a U.K. board discussed in Daschle’s book. This board approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit. Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis.

In 2006, a U.K. health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye. It took almost three years of public protests before the board reversed its decision.

Hidden Provisions

If the Obama administration’s economic stimulus bill passes the Senate in its current form, seniors in the U.S. will face similar rationing. Defenders of the system say that individuals benefit in younger years and sacrifice later.

The stimulus bill will affect every part of health care, from medical and nursing education, to how patients are treated and how much hospitals get paid. The bill allocates more funding for this bureaucracy than for the Army, Navy, Marines, and Air Force combined (90-92, 174-177, 181).

Hiding health legislation in a stimulus bill is intentional. Daschle supported the Clinton administration’s health-care overhaul in 1994, and attributed its failure to debate and delay. A year ago, Daschle wrote that the next president should act quickly before critics mount an opposition. “If that means attaching a health-care plan to the federal budget, so be it,” he said. “The issue is too important to be stalled by Senate protocol.”

More Scrutiny Needed

On Friday, President Obama called it “inexcusable and irresponsible” for senators to delay passing the stimulus bill. In truth, this bill needs more scrutiny.

The health-care industry is the largest employer in the U.S. It produces almost 17 percent of the nation’s gross domestic product. Yet the bill treats health care the way European governments do: as a cost problem instead of a growth industry. Imagine limiting growth and innovation in the electronics or auto industry during this downturn. This stimulus is dangerous to your health and the economy.

(Betsy McCaughey is former lieutenant governor of New York and is an adjunct senior fellow at the Hudson Institute. The opinions expressed are her own.)

To contact the writer of this column: Betsy McCaughey at

Last Updated: February 9, 2009 00:01 EST
Title: Hold the Pickle, Lettuce, and, Uh, Beef
Post by: Body-by-Guinness on February 10, 2009, 06:07:12 AM
What If ‘Comparative Effectiveness’ were applied to cheeseburgers?
D.C. Examiner Op-Ed
By:  Sally C. Pipes

The Examiner (Washington, D.C.), February 6, 2009
A shocking new provision was discovered today in the $825 billion stimulus package recently passed by the House of Representatives. Hidden half-way down page 538 is a clause that would provide $1.1 billion to help government bureaucrats compare the effectiveness of various cheeseburgers.

The provision was discovered by a congressional aide, who is also accusing his boss of torture for making him read the 647-page bill in its entirety.

As it turns out, the language of the “cheeseburger effectiveness” clause is virtually identical to a better-known provision in the bill that applies to medicine. The only apparent difference between the two clauses is that one uses the word “cheeseburgers” throughout, whereas the other uses terms like “medical treatments.”

Congressional watchdogs quickly linked the cheeseburger clause to Rep. Norman Busybody, whose family owns Planet Taco, the third-largest fast-food chain in Texas.

“Many restaurants routinely pressure consumers into ordering a more expensive newfangled burger, even when it doesn’t represent a clear improvement in flavor over previous burgers."

Rep. Busybody insists that his cheeseburger effectiveness provision will solve this crisis – just as the comparative effectiveness provision will help solve the healthcare crisis.

“There are too many burgers on the market. Patrons are confused by all the choices out there,” he says. “They anguish over whether they should order a Big Mac or a Whopper. Soon after my law is passed, there will be only one burger on all fast-food menus. It will be made from tofu and taste horrible, so people will probably just eat tacos instead.”

Under the new program, government researchers will be charged with testing new sandwiches in three classes – chicken, fish, and beef – before they hit the marketplace. They'll check for such features as flavor, texture, general aesthetic appeal, possible side-effects, and nutritional value. Tacos will be exempt from all testing.

Fast-food restaurants worry the government-funded research will put billions of dollars from the sales of their newest and most lucrative sandwiches in jeopardy. They fear the research will be followed by regulation that would ban most cheeseburgers from the market as part of a congressional effort to lower overall food costs.

Rep. Busybody says their fears are warranted. His staff is currently working on follow-up legislation that would ban the three most problematic types of burgers:

1) ‘Me-too’ burgers, which have fancy names, but are no better tasting than other cheeseburgers already on the market;

2) Marginally-improved burgers, like the Triple-Decker, which costs a dollar more than the Double Quarter Pounder, but is only slightly more satisfying;

3) Frequently ineffective burgers, like the Fish-and-Pickles, which some people love, but many find disgusting.

Many in Congress have already come out in support of the cheeseburger measure within just hours of its discovery.

“If comparative effectiveness research can save the country money for medicine, then why not apply it to cheeseburgers, as well?” says Rep. Stanley Toetheline, who last week paid $200,000 in backtaxes upon his nomination to the House Ethics Committee.

Some consumers disagree. “Most days I order a Chicken Cheddar. But sometimes I want a Biggie Bacon,” says Joe Hartattak, a fork-lift operator from Kansas who eats fast food five times a week. “Some of my friends prefer the Double Trouble. We’re all different – so choice is important to us.”

Rep. Busybody disagrees. “People like Hartattak are just country bumpkins – the kind of fools who actually pay their taxes. They need smart government bureaucrats – people like me – to micromanage their lives.”

Other supporters say the research will help protect consumers like Hartattak from buying cheeseburgers that may not be worth the extra money.

Federal officials are already exploring a scheme to make findings from the studies binding by prohibiting “Travel & Entertainment” tax deductions for the purchase of unapproved burgers.

"If we're to get profiteering burger-companies under control, this comparative-effectiveness research effort has to have some teeth," says the administration’s newly appointed Burger Czar Ron Machater. "The tax penalty will ensure that restaurants can't rip off consumers with overpriced products.”

Backers of the research provision say restaurants don't have the incentive to compare their burgers with those of competitors. "Consumers are in the dark when it comes to figuring out which burger tastes best. Clearly, only the government has the resources and objectivity necessary to make an effective selection between the Big Mac and the Whopper,” says Machater, who admits to being a vegetarian.

In fact, Machater believes that fast-food television commercials – also known as “direct-to-burger-eater advertising” – should be banned altogether. “These ads hypnotize unsuspecting couch-potatoes into making late-night trips to White Castle.”

The burger effectiveness legislation is modeled after Britain’s National Institute for Health and Clinical Effectiveness (NICE) – an agency that evaluates medical treatments and then decides which ones the British health care system will cover.

Critics argue that in its zeal to save money, NICE often denies patients access to life-saving medicines. Last year, for example, NICE was widely criticized after it announced that four breakthrough drugs would not be covered for people with kidney cancer. As of today, only one of those drugs has been approved and it was just recently. Not surprisingly, Britain dramatically trails the United States in cancer survival rates.

Rep. Busybody says that Britain’s nightmare experience with “comparative effectiveness” doesn’t worry him. “Just because this model has been an abject failure in Britain doesn’t mean it won’t work here,” he says. “We’re on untrodden territory here – no one has ever tried this with cheeseburgers before.”
Sally C. Pipes is president and ceo of the Pacific Research Institute. She is the author of The Top Ten Myths of American Health Care: A Citizen’s Guide.

This information was found online at:
Title: Re: The Politics of Health Care
Post by: ccp on February 10, 2009, 08:16:45 AM
***One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446).***

Well yes.  Of course.
Electronic medical records will also be used to store, centralize data, and have all this at the government's fingertips to so they can find ways to reduce costs by rationing care.

Nurses will replace doctors by simply following algorithms, cheaper and sometimes less effective drugs will be preferred, more services will not be paid as deemed inappropiate, patients will be forced to do preventative care (with financial incentives) and maybe even their habits, such as cigarettes, diets, exercise patterns will be tracked and their rates adjusted "accordingly".

I don't like it.  But the system is totally out of control.  Without some form of rationed care we will go bankrupt.

I believe the best hope is actually the pharmaceutical industry to find drugs that actually work to combat obesity and cancer and arthiritis that keeps as healthier and only in that way can we get what we want.  Otherwise its rationed care or we all go bankrupt.

Offering health care to illegals doesn't help but that is probably only a small part of the problem.
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on February 10, 2009, 09:46:09 AM
Well, tragically it certainly looks to be going that way.  The present system slandered as being free market, is actually bureaucratic madness.  We of free minds and free markets need to make the case.
Scott Grannis

Stealth Healthcare in the stimulus bill
Tom Daschle didn't make it to the HHS post, thanks to being a tax cheat, but he has left us his legacy in the form of significant legislation buried in the new stimulus bill. Read all about it here if you haven't already. It boils down to creating a new national medical database that will keep track of everyone's medical records, so that eventually a National Coordinator of Health Information Technology can ration healthcare.

Any effort by the government to implement something like single-payer or universal healthcare will inevitably result in rationing and shortages. That's just simple economics: if people don't have to pay for their own health care, costs will rise, health care services will be in short supply, and the whole system will become inefficient. To wish it would happen otherwise is fanciful.

The urge to move us to universal healthcare is based on the belief that a modern, advanced society has an obligation to ensure that everyone receives healthcare treatment; it would be unconscionable to deny anyone treatment. Well, consider what would happen if we felt the same way about food: surely no one should be allowed to starve in this age of abundance ...

If the government paid for everyone's food, imagine the consequences. Filet mignon would fly off the shelves; home refrigerators would be stocked to capacity, spoiled food routinely chucked in the trash can; competition to produce better and cheaper products would become a quaint vestige of the past; hamburger meat would pile up; food quality would decline; complaints would skyrocket. It wouldn't take long before the government created an entire bureacracy to monitor and "regulate" prices. Any mistakes in setting prices would resort in shortages or abundancies. Sound familiar?

Call your Senator now and tell him to vote against this bill!
Title: Re: The Politics of Health Care
Post by: Chad on February 10, 2009, 10:07:37 AM
Call your Senator now and tell him to vote against this bill!

I doubt Klobuchar would change her mind (she's co-sponsor of S1). Both Franken and Coleman would be on board, so pretty much don't count on MN.  :oops:
Title: Re: The Politics of Health Care
Post by: ccp on February 10, 2009, 10:16:28 AM
***Well, consider what would happen if we felt the same way about food:***

Well the Dems have already decided that owning a home is an entitlement.  Thanks to them and the Republicans that were afraid to stand up to them because essentially they are the minority party in the US today and were afraid of upsetting those who would benefit from the give aways, we are going broke.

It is happening with health care.  It is the most massive social engineering we have ever seen.  And the Dems keep increasing their constituent base that would benefit from this and would love to have the minority who pay for it continue to do so and to an even larger extant.

Michelle BO is ashamed of our country.  So I guess now she can be proud that we are turning to socialism.
That's what she and BO wanted all along.  Even with all their constituancies they are only getting it because of the impending collapse of the economy.  That is remarkable to me.  That most Americans still would not support them if it were not for the crash of banks.
Title: WSJ: Yet another Trojan horse
Post by: Crafty_Dog on February 11, 2009, 12:36:47 PM
The "stimulus" is the bill that keeps on giving, not least for journalists. Health-care providers and patients may have a different reaction, however, when they learn that Democrats are using the bill to create a health information monopoly that will help centralize government control of the health-care market.

In theory, electronic medical records are among the few stimulus ideas that might do some actual good. Democrats and Republicans agree that exchanging the paper files we mostly use now for digital versions will lower costs, cut down on medical errors, and maybe cure the common cold.

The Opinion Journal Widget
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Both the House and Senate stimulus bills include about $20 billion in incentive payments (mainly through Medicare and Medicaid) to encourage the digitization of medical records. Fair enough. But one of the reasons only an estimated 17% to 29% of doctors use health IT is because there are still many technical issues to work out. Different systems must be compatible so doctors can communicate with each other, coordinate care and share information -- and they don't want to invest in a platform that could become as obsolete as HD-DVD.

Democrats have decided that the way to jump this gap is for government simply to pick the next Blu-Ray. Instead of building on a voluntary public-private standard-setting body created by the Bush Administration, the stimulus bill codifies it as a federal office and gives it broad new powers if private companies are not "substantially and adequately" meeting the needs of doctors and hospitals. The health IT outfit will soon be deciding which platforms are up to code and shutting down competitors.

This will certainly muffle innovation, given that high-school dropouts have been known to scam U.S. health bureaucrats out of millions of dollars that should be preventable with off-the-shelf auditing software. Anyway, what's the rush? Democrats give the game away by mandating that most medical providers who aren't linked into the government-approved health information network after 2016 will start to be penalized. Their real political goal is to make a down payment on national health care.

The stimulus actually makes it harder for doctors, hospitals and pharmacies to use health IT, under the guise of "privacy." This is especially dishonest. Insurers already know the health condition of millions of Americans from claims information, which list diagnoses, prescriptions, procedures, etc. The government does too, because it pays so many medical bills through the entitlement programs.

In its pure form, the primary purpose of health IT is to organize all this data in a useful way, so we can get a better sense of health trends and outcomes. Large insurers like Kaiser Permanente and others are starting to do just that on their own, as well as creating the data-based tools that could give consumers a better value for their health dollars. The plug could get pulled from such efforts because the faux privacy provisions are so onerous.

The true political goal is cost control. For the Pete Stark Democrats whose ambition is Medicare for all -- no exceptions -- giving government exclusive control over electronic health information and reporting is a step toward "comparative effectiveness" research. That in turn will be used to impose price controls and deny some types of medical treatment and drugs. And because government is able to skew the whole health system through Medicare and Medicaid, comparative effectiveness could end up micromanaging the practice of medicine.

If three Republican Senators are going to help pass this stimulus, the least they can do is demand that this stalking horse for government-run health care is out. We need to debate this in the open, not slip it into legislation under false cover.

Title: Politicizing Treatment Options
Post by: Body-by-Guinness on February 17, 2009, 12:04:05 PM
This piece can be read on several levels. With the specter of comparative effectiveness buried in the "stimulus" package looming, the politicization of health care standards is bound to follow, as demonstrated below. Combined with the pathological science trail blazed by global warming zealots, there are a lot of avenues open for politics guised as science to be inserted into all our lives.

Science, Politics, and Values
The Politicization of Professional Practice Guidelines

John D. Kraemer, JD, MPH; Lawrence O. Gostin, JD
JAMA. 2009;301(6):665-667.

The Infectious Diseases Society of America (IDSA) issued updated clinical practice guidelines in 2006 for the diagnosis and treatment of Lyme disease.1 Within days, the Connecticut attorney general launched an investigation, alleging IDSA had violated state antitrust law by recommending against the use of long-term antibiotics to treat "chronic Lyme disease (CLD)," a label applied by advocates to a variety of nonspecific symptoms for which frequently no evidence suggests the etiologic agent of Lyme disease is responsible. The IDSA was forced to settle the claim to avoid exorbitant litigation costs, even though the society's guidelines were based on sound science. The case exemplifies the politicization of health policy, with elected officials advocating for health policies against the weight of scientific evidence.

The Antitrust Investigation of IDSA

Although untreated or inadequately treated Lyme disease can progress to cause neurological complications and arthritis, there is no evidence the disease has a chronic form (except perhaps as sequelae) in the absence of objective clinical or serological evidence of active infection.2 Nevertheless, some patient groups and a small minority of physicians contend Borrelia burgdorferi, the causative agent of Lyme disease, commonly persists in patients after standard antibiotic treatments. They maintain that a constellation of nonspecific symptoms such as fatigue, myalgia, headaches, and chest pain are evidence of chronic infection, and that standard diagnostics are inaccurate.3 Furthermore, some recommend using long-term, high-dose antibiotics—frequently administered intravenously—to treat patients with nonspecific symptoms and no objective evidence of infection.3

The IDSA treatment guidelines strongly disagreed and instead labeled the constellation of symptoms "post-Lyme syndrome"—either sequelae without ongoing infection or unrelated to B burgdorferi. The guidelines state, "There is no convincing biologic evidence for the existence of symptomatic chronic B burgdorferi infection among patients after receipt of recommended treatment regimens for Lyme disease. Antibiotic therapy has not proven to be useful and is not recommended for patients with chronic (6 months) subjective symptoms after recommended treatment regimens for Lyme disease."1 The IDSA guidelines also rejected the use of a variety of alternative diagnostic tests deemed unvalidated by the Centers for Disease Control and Prevention (CDC) and US Food and Drug Administration.

IDSA's guidelines were based on the biological implausibility of B burgdorferi persistence after proper treatment in the absence of objective indications of treatment failure; the high background rates of the subjective symptoms often attributed to chronic Lyme infection; and the absence of benefit from, and the serious adverse effects of, long-term treatment. The CDC4 and National Institutes of Health5 concurred in the judgment that long-term antibiotic use is not justified: "despite extensive study, no clear evidence has emerged to support the contention that CLD results from a past or persistent Lyme disease infection."5 American Academy of Neurology treatment guidelines for Lyme disease affecting the nervous system reached the same conclusion.6

The International Lyme and Associated Diseases Society (ILADS), a CLD advocacy group, immediately protested and asserted the superiority of its alternative guidelines,3 which others have suggested were based on substandard review methods.7 Shortly after, Connecticut Attorney General Richard Blumenthal launched an investigation of IDSA's guideline writing process, alleging it violated state antitrust laws by excluding differing viewpoints from its guideline creation process and including members who had financial interests in, or ties to, Lyme diagnostic and treatment makers.8 IDSA did disclose its panel members' potential conflicts of interest in its published guidelines, even though there is no evidence that any conflicts altered the guidelines' content. Meanwhile, the committee that created the ILADS guidelines included the president of a company that manufactures an alternative Lyme disease diagnostic test9 and multiple physicians whose practices are listed with a CLD advocacy group's patient referral service10—but ILADS did not disclose the conflicts in its guideline document.3

Antitrust laws are designed to ensure legitimate commercial competition and protect against predatory corporate practices due to inappropriate restraints on trade. Professional organizations, such as IDSA, can violate antitrust laws if their standard-setting is an unreasonable attempt to advance their members' economic interests by suppressing competition.11 Applying the antitrust "rule of reason," a challenger must show that the professional organization both possesses substantial market power and that the anticompetitive effects of its standards outweigh patient benefits.12 Even assuming IDSA wielded sufficient market power through its nonbinding guidelines to meet the first part (which is questionable considering that insurers and clinicians can independently choose which treatments to cover and prescribe), the second part of the rule of reason cannot be met because IDSA guidelines substantially advanced patients' interests.

The courts should defer to professional medical associations when standards are set on the basis of valid science aimed at protecting patient health or safety. A precisely on-point federal case (though one that does not bind Connecticut courts interpreting the state antitrust law) upheld the American Academy of Ophthalmology guidelines attaching the label "experimental" to radial keratotomy, a surgical procedure for correcting nearsightedness.13 "Antitrust law is about consumers' welfare," said the court, so ultimately professional guidelines are a "medical not a legal question."13 That truism should decide antitrust cases, so that when a professional organization bases its work on the weight of science there can be no improper restraint of trade.

After spending more than a quarter of a million dollars on legal expenses, IDSA agreed to settle with the attorney general (without admitting any fault), assenting to an ombudsmen-reviewed panel to assess the 2006 guidelines.14 While it is unlikely IDSA's guidelines will change due to the investigation, the daunting potential for litigation by those unhappy with the outcomes of treatment guidelines may well chill the willingness of medical associations to make appropriate scientific evaluations of controversial topics—a development that would significantly threaten patient care and increase medical costs.

Science, Values, and Politics

At the heart of this controversy is the conflict between the positive nature of science and the normative function of value systems and political thought. Science is, and can only be, descriptive and explanatory. Whether a scientific finding is judged to be accurate is dependent on the quality and rigor of the methods used and whether that finding is replicable. The scientific process is not democratic—no amount of desire for different results can establish them—and inconsistent findings create true controversy only when their methods are of comparable validity.

At the same time, the sciences cannot be normative. They can establish context and a factual base for normative discourse, but scientific findings cannot entail any particular normative conclusion without reference to outside systems of thought. Science, for example, cannot resolve the never-ending debate over abortion in the United States. Medical science can describe the maternal health risks of pregnancy, elucidate fetal development, and establish risks of birth defects and complications. Nothing, however, inherently follows from any of these; rather, policy makers must look outside science, to moral, religious, ethical, and legal norms—eg, when aggregated cells become human life or what the relationship between citizens and their government should be. Medical science can, and should, inform these discussions, and in a vibrant and healthy society, such value questions will be vigorously debated.

However, all too often, the normative and positive blend into one another. Positive assertions are presented in a normative light—for example, that the cost of treating a condition surpasses a benchmark of cost-effectiveness, hence it should not be used. This really consists of 3 separate assertions: the cost of treatment equals a particular amount (a positive claim); treatments costing more than a certain amount are not cost-effective; and cost-effectiveness should guide the allocation of health care resources. All these claims may be justifiable, but only the first can be established through scientific methods.

The converse—when normative views are passed off as positive assertions—is even more problematic, such as the well-documented issue of abortion and breast cancer in the Bush administration. Multiple adequately powered and well-designed and analyzed studies investigated the putative association between abortion and breast cancer and found no evidence of its existence. However, from 2002 to 2003, information was placed on the National Cancer Institute Web site suggesting a link between abortion and breast cancer, based largely on older epidemiologic studies that failed to sufficiently control for recall bias.15

The Connecticut attorney general's action against IDSA falls into this latter category. The CLD advocacy community understandably seeks answers for the symptoms attributed to Lyme disease. But when high-quality research repeatedly was inconsistent with the group's hypotheses, the community should have sought other answers. Instead, many advocacy organizations—and the attorney general—insisted (against the weight of evidence) on a link between the symptoms and chronic infection and continued to call for long-term antibiotic treatments. Even this was perhaps defensible—after all, medical studies cannot prove the nonexistence of a phenomenon—although physicians in the CLD community should treat their patients based on the best-available evidence. But when political leaders using the force of law sued IDSA for its appropriate scientific conclusions that differed with the results they desired, they abused the public good.

A wall of separation is needed between science, norms, and politics. Science should inform normative discussions and provide the evidentiary base for political choices. Likewise, values will always be important in deciding how science is applied for human benefit. But neither should be permitted to distort the other—limits on the outer boundaries of what questions each can answer must be respected when making public policy. Medical science, and the health of patients who depend on it, are too important to be subjected to political ideologies.


Corresponding Author: Lawrence O. Gostin, JD, O’Neill Institute for National and Global Health Law, Georgetown University, 600 New Jersey Ave NW, Washington, DC 20001 (

Financial Disclosures: None reported.

Author Affiliations: O’Neill Institute for National and Global Health Law, Georgetown University, Washington, DC.


1. Wormser GP, Dattwyler RJ, Shapiro ED; et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Disease Society of America. Clin Infect Dis. 2006;43(9):1089-1134. FULL TEXT | ISI | PUBMED

2. Feder HM Jr, Johnson BJ, O'Connell S; et al, Ad Hoc International Lyme Disease Group. A critical appraisal of "chronic Lyme disease" [correction published in N Engl J Med. 2008;358(10):1084]. N Engl J Med. 2007;357(14):1422-1430. FREE FULL TEXT

3. Cameron D, Gaito A, Harris N; et al, ILADS Working Group. Evidence-based guidelines for the management of Lyme disease. Expert Rev Anti Infect Ther. 2004;2(1)(suppl):S1-S13. FULL TEXT | PUBMED

4. Lyme disease treatment and prognosis. CDC Web site. Updated October 8, 2008. Accessed January 16, 2009.

5. Chronic Lyme disease. National Institute of Allergy and Infectious Diseases Web site. Updated October 23, 2008. Accessed January 16, 2009.

6. Halperin JJ, Shapiro ED, Logigian E; et al, Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007;69(1):91-102. FREE FULL TEXT

7. Bowie WR. Guidelines for the management of Lyme disease: the controversy and the quandrary. Drugs. 2007;67(18):2661-2666. ISI | PUBMED

8. Connecticut Attorney General's Office. Attorney General's investigation reveals flawed Lyme disease guideline process, IDSA agrees to reassess guidelines, install independent arbiter. Updated May 14, 2008. Accessed January 16, 2009.

9. IGeniX Inc Web site. Accessed January 16, 2009.

10. LDA automated doctor referral system. Lyme Disease Association. Accessed January 16, 2009.

11. Wilk v American Medical Association, 895 F2d 352 (7th Cir 1990).

12. Harris JL. Connecticut attorney general investigating possible anticompetitive impact of practice guidelines. ReedSmith Health Law Monitor. 2007;11(1):2-4. Accessed January 16, 2009.

13. Schachar v American Academy of Ophthalmology, Inc, 870 F2d 397 (7th Cir 1989).

14. Klein JO. Danger ahead: politics intrude in Infectious Diseases Society of America guideline for Lyme disease. Clin Infect Dis. 2008;47(9):1197-1199. FULL TEXT | ISI | PUBMED

15. United States House of Representatives Committee on Government Reform—Minority Staff. Politics and Science in the Bush Administration. 2003. Posted November 13, 2003. Accessed January 16, 2009.
Title: Re: The Politics of Health Care
Post by: ccp on February 26, 2009, 04:39:35 PM

There is simply no way to provide health care to 48 million more people without taking money or benefits from those who already do have paid coverage

How is the 634 billion health care proposal going to be funded?

Much of the money is to be generated from squeezing private insurers who are in the Medicare Advantage program.  They now get more than Medicare alone pays but will soon get no more than 100% thus to make money they will have to cut costs more than Medicare.  This will no doubt result in less benefits, more costs to patients, and much more controlled care.  If yo think your HMO is controlling you now this will be child's play to what we will see. 

The smaller players will fail.  There will be consolidation and the around 15 big players who provide around 70% of it now may stop providing this service to Medicare recipients altogether.  More Hospitals will go out of business. Most are in the red now anyway.
Most physicians will already get further squeezed more than they already are.  As a primary care physician I am one of the few that may get a pitance more (5% is tossed about).  But the big BO gov. will simply find another way to get it back somewhere else so this essentially meaningless raise is just that.   

*****Obama health plan opens tough negotiation
 President Barack Obama's prescription for the nation's ailing health care system comes with Medicare cuts and tax hikes — usually poison pills that doom any overhaul effort in Congress.

But the budget Obama proposed Thursday is not a finished blueprint for overhauling health care. Rather it's the opening bid in a tough negotiation. Anybody who's been in a bargaining session knows you never end up with your opening bid.

Obama is asking Congress: If you're going to cover an estimated 48 million uninsured Americans in the world's costliest medical system, how do you pay for it?

Obama's plan would set aside $634 billion over 10 years in a major effort to cover all Americans — a goal that could cost more than $1 trillion. Half the money would come from tax increases on upper-income earners; the other half from cuts to Medicare and Medicaid. Private insurance plans serving Medicare seniors would take the biggest hit, but hospitals, drug companies and home health agencies also face cuts.

Republicans and fiscally conservative Democrats are sure to disagree with Obama's specifics, but they may quietly applaud his determination to pay for health care reform, instead of adding to the deficit.

"This is a serious effort to get the process moving," said Mark McClellan, a doctor and health economist who ran Medicare for former President George W. Bush. "The specific financing proposals are going to have a very tough time."

Obama's approach is a conscious departure from the path former President Bill Clinton took in the 1990s. Clinton's 1,300-page health care bill tried to answer every question and ultimately went nowhere. Obama is asking Congress to fill in the blanks.

"He's outlining these cuts as examples of places where savings can be accrued," said Christine Ferguson, a health policy professor at George Washington University. "You put those on the table, and if people want to have this discussion, they have to propose alternatives."

Whether that dialogue succeeds depends not just on Obama, but on Congress and interest groups representing insurers and doctors, hospitals and drug companies, consumers and small business.

Clinton's top priority was to get everybody covered quickly. Obama has framed the problem differently, focusing on how to slow rising costs, so that everybody can eventually be covered.

"What the president is doing is bold, but it's not overreaching," said economist Robert Reischauer, president of the Urban Institute research center. "The administration is coming to grips with the reality that this will cost a lot of money, and it's committed to paying for it."

The tricky part is in the details.

For example, more than half of Obama's spending cuts would come from Medicare managed care plans. The private plans cost the government 14 percent more on average than care for seniors in traditional Medicare. That translates into lower out-of-pocket costs for seniors, who in a bad economy have been flocking to the plans, increasing enrollment to about 10 million.

"People are flooding into the program," said Dan Mendelson, president of Avalere Health, an information company serving government and the health care industry. "I don't think cuts of this magnitude ultimately are going to be palatable to Congress."

Obama would replace the current payments with a competitive bidding system estimated to save $177 billion over 10 years. That sent insurance company shares skidding Thursday on Wall Street. But some market analysts said there may be a silver lining: While competitive bidding could decrease profit margins, it might generate higher revenues for insurers if seniors keep signing up.

America's Health Insurance Plans, the insurance industry trade group, wasn't ready to leave the bargaining table.

While warning that Obama's cuts would "jeopardize the health security" of seniors, the group's president, Karen Ignagni, said insurers "are committed to doing our share" to expand coverage.****

Title: Re: The Politics of Health Care
Post by: DougMacG on February 27, 2009, 11:43:10 AM
[the Obama plan] "will no doubt result in less benefits, more costs to patients, and much more controlled care."

Costs paid directly by the consumer and prices yielded directly to the producer comprise the mechanism that allocates resources the most efficiently.  But the more crucial the market, the more we try to use inferior mechanisms to allocate the resources.  In the 1990's the WSJ published an unbelievably complicated flow diagram of how healthcare decisions would be made, almost cartoon-like, taken from the literal text of the Hillary-care proposal.  Congressional staffers and mid-level bureaucrats will be making very important decisions for people they never met.
Scott G wrote this week:  "we could probably solve 80-90% of the healthcare problem by simply changing the tax code so that anyone, not just employers, could deduct the cost of healthcare insurance. This would reintroduce basic market dynamics to the healthcare market, and that is the only thing that can make healthcare cost-effective and widely available."
Title: Re: The Politics of Health Care
Post by: ccp on February 27, 2009, 12:14:41 PM
***Congressional staffers and mid-level bureaucrats will be making very important decisions for people they never met.***

They will be getting their advice from ivory tower New England liberal health care policy types a few are MDs and most are phDs who write the flow charts and policies with the idea of providing as much universal coverage in a cost effective way.  They are looking at populations, and budgets, not individuals.  These people are from Harvard Yale the usual know it all suspects.

Title: All in the Family
Post by: Body-by-Guinness on March 02, 2009, 11:53:48 AM
Perhaps I should have posted under "Cognitive Dissonance" this piece that records Michelle Obama's role in, ah, redirecting, poor patients from the hospital where she was an administrator:

March 02, 2009
Michelle Obama's Patient-Dumping Scheme

By David Catron
The First Lady helped create a notorious program that dumped poor patients on community hospitals, yet the national media ignore the story. Imagine if her husband were a Republican.

The University of Chicago Medical Center has received a good deal of justly opprobrious press over its policy of "redirecting" low-income patients to community hospitals while reserving  its own beds for well-heeled patients requiring highly profitable procedures. Substantial coverage was given to a recent indictment of the program by the American College of Emergency Physicians. ACEP's president, Dr. Nick Jouriles, released a statement suggesting that the initiative comes "dangerously close to ‘patient dumping,' a practice made illegal by the Emergency Medical Labor and Treatment Act, and reflected an effort to ‘cherry pick' wealthy patients over poor."

Oddly absent from most of the unflattering press coverage of UCMC's patient-dumping scheme is any mention of the role our new First Lady played in devising the program. A laudable exception has been the Chicago Sun-Times, which reported last August that "Michelle Obama -- currently on unpaid leave from her $317,000-a-year job as a vice president of the prestigious hospital -- helped create the program."

On the rare occasions when other "news" media have bothered to connect the Urban Health Initiative to its glamorous creator, they have attempted to whitewash this tawdry program. Typical of such disingenuous coverage was a story in the Washington Post, which described it as "an innovative program to steer the patients to existing neighborhood clinics."

But no amount of journalistic lipstick can hide the reality that Mrs. Obama's initiative is a patient-dumping scheme. Such "cherry-picking," as Dr. Jouriles accurately describes it, was, at one time, fairly common. Prestigious institutions like the University of Chicago Medical Center routinely "dumped" Medicaid, uninsured and other unprofitable patients on less mercenary community hospitals. Many patients suffered needlessly, and more than a few actually died, as the result of this practice. So, in 1986, President Reagan signed the Emergency Medical Labor and Treatment Act (EMTALA) into law. EMTALA made such "redirection" illegal, but many high profile hospitals still chafed at being forced to treat poor patients. Enter Michelle Obama, UCMC's "Vice President for Community and External Affairs."

Mrs. Obama first hatched the UCMC program as the "South Side Health Collaborative," which featured a gang of "counselors" whose job it was to "advise" low-income patients that they would be better off at other hospitals and clinics. The program was so successful in getting rid of unwanted patients that she expanded it, gave it a new name, and hired none other than David Axelrod to sell the program to the public. According to the Sun-Times, "Obama's wife and Valerie Jarrett, an Obama friend and adviser who chairs the medical center's board, backed the Axelrod firm's hiring."  Axelrod helped the future First Lady formulate a public relations campaign in which the "Urban Health Initiative" was represented as a boon to the community actuated by the purest of altruistic motives.

The resultant PR campaign was a study in Orwellian audacity. Chicago's inner city residents soon began hearing that UCMC's patient dumping program would "dramatically improve health care for thousands of South Side residents" and that the medical center was generously willing to provide "a ride on a shuttle bus to other centers." Likewise, the people who ran the community hospitals to which these unwanted patients were being shuttled began to read claims in local media to the effect that the Urban Health Initiative was good for them as well. Dr. Eric Whitaker, the Blagojevich crony who succeeded Mrs. Obama as Director of the program, repeatedly assured gullible reporters that the financial impact on these hospitals would be positive: "The initiative actually is improving their bottom lines." The CFOs of those hospitals were no doubt relieved to learn that treating Medicaid and uninsured patients is profitable.

But you just can't please some people. In one of the few frank passages of the Post article, we discover that many members of UCMC's medical staff believe the program is nothing more than an "attempt to ensure that the hospital retains only affluent patients with insurance." And another association of emergency physicians has joined ACEP in denouncing the Urban Health Initiative. The Chicago Tribune reports that Dr. Larry Weiss, president of the American Academy of Emergency Medicine is unhappy about UCMC's failure to consult its own ER physicians before initiating the program: "Not including emergency-room physicians ... would be analogous to changing the way surgery is performed in an operating room without involving any surgeons." Dr. Whitaker assures us, however, that such critics are merely "opposed to change."

Presumably, he would be similarly dismissive of Angela Adams, who brought her son to the medical center's ER after his lip had been partially torn off by a pit bull. As the Tribune puts it, "Instead of rushing Dontae into surgery ... the hospital's staff began pressing her about insurance." Unfortunately for Dontae, he was covered by Medicaid. So, all he got from the UCMC emergency department was a shot, some antibiotics, and instructions to "follow up with Cook County." Angela had to take her son across town to John Stroger Hospital, where he was immediately admitted for reconstructive surgery. Like doctors Jouriles and Weiss, Angela is having trouble seeing the community benefit of the Urban Health Initiative.

Meanwhile, the program's parents, Michelle Obama and David Axelrod, have moved to Washington. As the First Lady and the President's closest advisor, they wield enormous power. Indeed, they may be the most powerful people in the Obama Administration, aside from the President himself. If these two characters were willing to betray their Chicago neighbors -- the South Side's most vulnerable citizens -- with a disgraceful program like the Urban Health Initiative, what sort of mischief will they devise for the hapless denizens of flyover country?

Come to think of it, isn't Obamacare being sold to us in pretty much the same way the Urban Health Initiative was sold to Chicago?

David Catron is a health care finance professional who has spent more than twenty years working for and advising hospitals and medical practices. He blogs at Health Care BS.

Page Printed from: at March 02, 2009 - 02:51:26 PM EST
Title: Venereal Warts & All
Post by: Body-by-Guinness on March 04, 2009, 09:15:22 AM
March 04, 2009
Two Forms of ID and Your Colonoscopy Report, Please

By Carol Peracchio
For the past two years I have been employed in nursing as a medical record reviewer. I've reviewed hundreds of records, the old fashioned handwritten kind, and also the electronic medical record (EMR).

I am not ideologically opposed to EMRs. When done well, they are much more efficient and easier to read and use. However, it can take months to train an office in EMRs. And if the computers are down, everything stops. But overall, EMRs are a net plus. No, what I'm opposed to is Obama's plan to set up a Ministry of Health Information. In Obama's stimulus bill recently signed into law are provisions that will allow Washington unfettered access to every American's health history through the magic known as the EMR.

When I hear Obama and his spokesmen giving us the hard sell about EMRs I am reminded of the Sham-Wow® pitchman. EMRs will cure everything wrong with our health care! Watch as EMRs tackle that long wait to see your doctor! Now you're whisked into the exam room in ten seconds or less! High deductibles your problem? Not with EMRs! Our computerized records will cut overhead by 50%! Are you getting this, Camera Guy?

The problem with their sales pitch is it isn't convincing. After all, no one in the Obama administration has any experience with EMRs or in taking care of sick people. Like many non-medical people, Obama apparently envisions American health care like the television program Gray's Anatomy: chock full of gorgeous physicians who push the gurneys themselves and come up with exotic diagnoses based on high tech data. Every patient is teetering on the edge of calamity. Thank God the EMR has Mr. Patient's every burp recorded and at Dr. McDreamy's fingertips. Otherwise he'll never be able to make the life-saving diagnosis of Mrs. Jane Doe by commercial!

In reality, the vast majority of patients have dull ailments like bursitis and pneumonia. They see the doctor for their diabetes and the surgeon to get their gall bladder out. Most of us see the same doctor for years. If we move, Dr. New's office gets our records from Dr. Old's office. Most people would be stunned to find out how quickly an experienced physician can get "up to speed" on a new patient. We like to think we're complicated, fascinating cases. Most of the time, we're pretty boring.

"But what if the patient is unconscious or otherwise unable to communicate? Won't having everyone's health records in a central location help in that instance?" the Obama team will ask.

This situation does occur. People who take daily medications should carry a list with them. Those who have chronic illnesses or allergies should have medic-alert bracelets. There are solutions to this rare occurrence besides placing 300 million people's medical records in the hands of ACORN Health Information Management.

I recently heard an expert on television claim that gathering everyone's EMRs on one big government server will solve that sterotypical problem -- the doctor with indecipherable handwriting. I have to agree that some of these doctors must be writing with their feet. However, I employed a much simpler remedy than taking steps toward socialized medicine. I called the doctor and asked him what he wrote. True, there are practitioners out there who should not be allowed anywhere near a pen. But if my records are going to be sent to Barack Obama, I'd prefer they remain illegible!

How about the sharing of medical information between institutions? The new administration insists this is another reason they need all your private health records in Washington. Dr A at General Hospital needs a consult from Dr B at Memorial Hospital. In days of yore they would phone, fax or email.  If I remember my geometry correctly, the shortest distance between two hospitals would not include a trip through Nancy Pelosi's office. Ask the mortgage industry how much "help" it is to have Washington in the middle.

In 2003, the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule took effect. Across America millions of health care workers attended numerous inservices to learn how the law "establishes regulations for the use and disclosure of Protected Health Information (PHI)." There would be no more indiscriminate sharing of a patient's status with anyone who called the hospital unit. Nurses were told that all PHI was on a "need to know" basis: if a health care worker didn't have an excellent reason to be in a patient's chart or EMR, that worker could be fired. Patients are now asked to list exactly who can be given information, including their spouse; in other words, the patient should control the dissemination of his PHI. I've heard the complaints that at times we've gone overboard with confidentiality. However, I really don't think we want to go back to the days when Mrs. Jones checked in to the hospital and the news hit the beauty parlor on Main Street before she was in her room.

So why are we now so anxious to hand Obama and the Democrats our most personal health details? Don't tell me my information is safe; I'm sure Jack Ryan felt the same way about his sealed divorce records.  Once your records are cyberwinging their way to Harry Reid, et. al., it's out of your and your doctor's hands. That little STD you had? The results of an HIV test? The fact that your sister carries the breast cancer gene? Who wants to know? That's the 780 billion dollar question.

What has happened to the American liberal? Where are the protestors who felt the Declaration of Independence should be edited to include the right to privacy along with life, liberty and the pursuit of happiness? Suddenly, because a Democrat president and Congress are asking, the Left is lining up at Kinko's to copy and mail their health records to Washington, DC. Wake up! Remember, it is entirely possible that in two years the Republicans may be back in power. Have you thought out that a  Republican Congress would then have access to your EMR? And if you think that you'll ever get the EMR genie back in the bottle, well, you probably also order products from late-night TV.

So since the liberals (and the mainstream media) have swallowed the EMR sales pitch hook line and sinker, I've been wondering if there's anything the rest of us can do to protect our private health information.  And here is where I'd appreciate some expertise from the lawyers who frequent this site:

Do we as individuals have any right to keep private our own Protected Health Information?

If my doctor has to get my permission before leaving lab results on an answering machine, shouldn't he have to get my permission before sending my PHI to Washington DC?  We need another Schechter Poultry, someone who will stand between Obama's New Deal and our medical records and cry "Halt!" Or has the right to privacy gone the way of the house call?

Carol Peracchio is a registered nurse.

Page Printed from: at March 04, 2009 - 12:11:36 PM EST
Title: Re: The Politics of Health Care
Post by: JDN on March 04, 2009, 09:52:25 AM
A friend of mine is an Oncologist.  He has recently converted over to only keeping electronic medical records (EMR).  It's a pain, he had to buy computers for each examining room,
train his staff, etc.  BUT the final result is superior and efficient; he is very happy he made the switch.  More and more doctors are switching voluntarily. 

I don't get the privacy issue here.  The doctor's office will still keep EMR records local; another copy goes to Washington.  For example, my parents are covered under Medicare; a government
single pay plan.  It seems to work pretty well; the doctors are happy overall as are my parents.  As for records, of course the doctor retains his copy, but Medicare (Washington) may
at any time ask for a copy as can the secondary insurance company ask for a copy.  And unless we pay cash at the doctor's office, we all sign a release authorizing the physician to bill and
release medical records to third parties.  HIPPA does not apply if a release has been obtained.

Although implementation would take time; a national EMR plan could/would be more efficient.  That being said, it is not a panacea like the plan being sold to the public.  In the end,
costs will not significantly reduce unless people are willing to make difficult choices.  We want our cake and to eat it too; it doesn't work that way. 
Title: Memory Lapse
Post by: Body-by-Guinness on March 04, 2009, 10:08:01 AM
You don't get a privacy issue with all records being on a central database accessible by sundry federal factotums? You don't recall the unauthorized perusal of BHO's travel records from within the State Department? You don't recall Nixon, Clinton, J. Edgar Hoover, et al using federal resources and records to get leverage over people and bring down foes? You don't remember, as was cited in the piece above, how BHO's senatorial foes had sealed records leaked, thus dooming their candidacy? Do you recall how Joe the Plumber's financial info got released?

If these and doubtless numerous other examples of confidential government information being mishandled don't lead to obvious conclusions than I doubt a productive conversation can ensue.

BTW, your side of the aisle is all about privacy when it comes time to tap a potential terrorist's phone or get someone to an abortion clinic, but those considerations don't apply to medical records? How's that bit of cognitive dissonance reconcile itself?
Title: Re: The Politics of Health Care
Post by: JDN on March 04, 2009, 10:20:57 AM
If you go see a doctor tomorrow, pay attention the paperwork you sign.  One form in the stack will be an authorization to release medical records. 
Only if you pay cash and refuse to sign the form will you be exempt. 

Ergo the government/industry already has access to your medical records, insurance companies have access to your medical records, hospitals do,
other doctors do, etc.  Theoretically, this information cannot be disseminated or  "abused"; yet as you pointed out records are often improperly accessed
and abused.  Another data bank will not significantly change that. 
Title: Re: The Politics of Health Care
Post by: Body-by-Guinness on March 04, 2009, 10:37:16 AM
Horsepuckey. Currently the feds would have to do some pretty serious work to get a hold of my records and leave questionable fingerprints all over the place in doing so. I just transferred my files from one Dr. to another and am not particularly worried some clown in DC can get his hands on all those photocopies. That changes when there is a central repository for reasons I've already stated and that you failed to address.
Title: From the Government and Here for your Health
Post by: Body-by-Guinness on March 04, 2009, 07:00:00 PM
Stealth Care
By INVESTOR'S BUSINESS DAILY | Posted Wednesday, March 04, 2009 4:20 PM PT
Spending: The stimulus provides for the creation of a federal health care bureaucracy not unlike Hillarycare. Decisions that should be made by doctors and patients will belong to bureaucrats deciding cost-effectiveness.
IBD Exclusive Series: Inside The Stimulus

The stimulus bill commits $19 billion to accelerate adoption of Health Information Technology (HIT) systems by doctors and hospitals. It involves the creation of electronic medical records to be stored in a central database. This is said to be for reducing treatment errors and increasing efficiency in the delivery of medical care.
It also authorizes the creation of the Office of the National Coordinator for Health Information Technology — and the appointment of a 15-member board of officials from federal agencies and others — charged with developing this nationwide health information database
It further creates an entity called the Federal Coordinating Council for Comparative Effectiveness Research, which will decide which treatments you should get, whether you should get them, and whether they should even be available. It is modeled after a British board which helps run the notoriously inefficient and bureaucratic National Health Service.
These agencies will monitor treatments to make sure your doctor is caring for you in a way the federal government deems appropriate and cost-effective. Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost-effectiveness standard that would lead to health care rationing. It would determine what medical care should be provided and who should get it.
The U.K. board approves or rejects treatments after dividing the cost of the treatment by the number of years the patient is expected to benefit. Such a formula is found on page 464 of the stimulus bill.
Under these formulas, younger patients likely get treatment for whatever ails them before granny can get her hip replacement. In 2005, the Orwellian-named British National Institute for Health and Clinical Excellence proposed that the National Health Service use age as a measurement of a patient's worthiness for treatment.
In 2006, for example, a U.K board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other. After all, how many years would they be needing two good eyes?
The system that will store everyone's medical records electronically, which was supposed to make health care delivery more efficient, will make it more subservient to government whim by providing a system to monitor doctors' treatment.
Medical treatments should be determined by doctors and patients and not by a bureaucracy that will ration your health care, deciding whether you really need it and are really worth it.
Title: pretend you are one of them and then you will be able to change them
Post by: ccp on March 05, 2009, 02:20:21 PM
The them is us.  it is America as we knew it.  The you is BO and his true agenda.  America just voted the most liberal guy in the Senate to be our leader.  Why people now are so surprised by his leftist leanings I guess comes from the humanistic natural defense mechanism of denial.

Personally I have seen enough.  Lets not be taken by his deception.  This guy will go on to "being open to all ideas and options", and "everything is on the table" etc etc.

This guy's game is now obvious.  "Pretend you are one of them, then can change them."  Thanks to Mark Levin for opening my eyes pre election about what BO is really about and what he is up to.  As he says "it is pay back time".  This is reparations time.  Problem is we will all suffer far more because of this.

Folks, the *plan* for health care reform is already done.  Just like it is for Wall Street, Gas and coal companies, businesses, those at the higher end of the pay scale, Israel, and all the rest.   This is just a dog and pony show to snooker the gullible:

****Obama open to compromise on health care overhaul
         AP – President Barack Obama delivers remarks to the White House Forum on Health Reform, Thursday, March 5, … WASHINGTON – President Barack Obama said the consensus from the White House health care summit is that there is an immediate need for health care reform, and signaled that he's open to compromise on Thursday.

Obama told participants at the end of a health summit that although he offered a plan during last year's campaign, he isn't wedded to that proposal. He told Republicans and Democrats, doctors and insurers — "I just want to figure out what works."

The president said there are some elements that all sides can agree on such as electronic health records that will save lives and money. Other issues — such as his $634 billion down payment for expanded coverage — are certain to create deep divisions.

He said: "We have to keep an open mind."

Obama invited more than 120 people who hold a wide range of views on how to fix the system.

Obama entered the room with Sen. Edward Kennedy of Massachusetts, who is battling a brain tumor. After brief remarks summarizing the participants' observations, Obama called on Kennedy. The veteran Democratic senator said he looked forward to being a foot soldier in the push for health care reform and said: "this time we will not fail."

Kennedy, who recently turned 77, is battling brain cancer and has been in Florida continuing his treatment and physical rehabilitation. He chairs the Health, Education, Labor and Pensions Committee and was a strong Obama backer during the 2008 campaign.****

Title: Press "1" if you need heart surgery
Post by: Body-by-Guinness on March 06, 2009, 02:12:19 PM
Some links that'll give you an idea what waitlists for surgery look like north of the border.

Waiting Lists For Surgery In Canada

British Columbia:

Here's one for Cardiac surgery:

Here's Ontario:

Click in here, and click on "Wait Times In your Area". Then click on "Find By Map Location", and pick out an area at random. See how much time one has to wait for cancer surgery

Here's a site that gives you the average wait times for whatever ails you in Alberta:
Title: The Church of Universal Coverage
Post by: Body-by-Guinness on March 06, 2009, 04:22:42 PM
Interesting exchange about universal health care can be found here:

Contains more formatting than I'd care to replicate and a lot of links.
Title: Re: The Politics of Health Care
Post by: G M on March 06, 2009, 04:31:29 PM
Why wait, let's get rid of free market supermarkets and have government run food centers instead! I'm sure that'll work just as well as Obamacare.
Title: Obama wants vets to pay for treatment
Post by: Chad on March 11, 2009, 08:33:16 PM
Quote from:

On CNN's Political Tracker:

WASHINGTON (CNN) - Veterans Affairs Secretary Eric Shinseki confirmed Tuesday that the Obama administration is considering a controversial plan to make veterans pay for treatment of service-related injuries with private insurance, but was told by lawmakers that it would be "dead on arrival" if sent to Congress...

But it's still under consideration after several lawmakers tried to get ahead of the change:

...No official proposal to create such a program has been announced publicly, but veterans groups wrote a pre-emptive letter last week to President Obama opposing the idea after hearing the plan was under consideration. The groups also noticed an increase in “third-party collections” estimated in the 2010 budget proposal—something they said could only be achieved if the VA started billing for service-related injuries.

Asked about the proposal, Shinseki said it was under "consideration."

"A final decision hasn't been made yet," he said...
Title: Re: Results of Universal Healthcare and Free Everything in Sweden
Post by: DougMacG on March 13, 2009, 04:17:10 PM
Riot/protest video edited out of this topic per moderator directive. I stand by my observation that this unrest is now in Sweden because these people moved there, not for the weather, not for the jobs with 70% unemployed, but for the world's most lavish welfare benefits including universal healthcare. - Doug
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on March 13, 2009, 10:16:29 PM
Interesting footage, but the connection to the subject of this thread is ephemeral at best.  Please repost it in the Isalm in Europe thread.
Extinguishing Physician Conscience
By Mary L. Davenport, MD
The largest generational cohort in American history, the Baby Boomers, will be the first Americans to be denied available effective life-saving treatments for reasons of cost. The seeds for this mass liquidation have already been planted.

Imagine that it is 2016, and you are a 65 year old boomer. You have been admitted to your local community hospital with malaise, fatigue, vomiting and cloudy mental status. You have had blood pressure problems and diabetes for a few years, and have just been diagnosed with renal failure. As you drift in and out of consciousness, you are vaguely aware your old family practice physician, who had taken care of you for 20 years, is not around. A religious man, he quietly retired from medical practice in 2014, after the full force of the Obama administration‘s removal of conscience protection for physicians in February, 2009, came into effect.

You feel vaguely uncomfortable as you are placed in a darkened room in the Comfort Care wing of the hospital. In moments of lucidity, you wonder if you shouldn't have some oxygen, an IV or SOMETHING! But the appropriate therapy, kidney dialysis, is not on the approved list of treatments for patients over 65, having been deemed too expensive. The new regulations from the Department of Health and Human Services were presented just last month to your hospital's Futile Care Committee. It was decided at the highest levels that for those over 65 years of age, renal dialysis would not be a beneficial treatment, that the alternatives of a kidney transplant were too expensive, and that your quality of life on chronic dialysis would be too diminished.

Your children wonder why you are not in an ICU. They are told that you will be placed on a morphine drip to make you more comfortable as you pass away, and that this is the highest standard of care for your diagnosis and age. It is called terminal sedation. You signed an advanced directive indicating that you did not want extraordinary care for a terminal condition, and under the new protocols renal failure, although treatable, qualifies as a terminal condition.

Your children frantically try to find their old family doctor. But your health plan replaced him with a large group of younger physicians, the hospital's Consortium for Health, a private-public foundation that was created to promote efficiency and reduce wasteful spending in medical care. By 2014 when he left, your family doctor was a dinosaur, having been trained in an earlier era. His medical school was one of the last to retain the original Hippocratic Oath.  It affirmed the covenantal relationship between the physician and patient, overseen by God, and that whatever the physician did would be for the patient's benefit.  You had felt safe entrusting your health to Dr. O'Brien's professional judgment.

Not only did the Hippocratic Oath your doctor took decades ago took specifically forbid physician assisted suicide and abortion, it also established patient confidentiality so that your secrets would never be disclosed. That is, until 2012, when physicians participating in the national healthcare system, which included ALL licensed physicians, were mandated to submit your visits to the unified electronic medical record system.  This data base was created in 2003 to coordinate medical care, detect emerging health threats, and exchange clinical information. Your doctor was very uncomfortable with this policy despite reassurances that HIPAA regulations would maintain your privacy.

But forces beyond any individual's control began to erode your relationship with your doctor long before he left the practice of medicine. The insurance companies stopped paying him in the late 1990's for hospital care, preferring to hire "hospitalists" or "intensivists" for greater efficiency in reducing hospital stays. Since office visits were reimbursed at lower and lower rates, your doctor had to see more and more patients in the office to just stay even. So although O'Brien knew you well and was trained to treat conditions such as renal failure or pneumonia, he stopped treating patients in the hospital.

Around 2007 both the hospital and office physicians began to be paid by a formula that rewarded them for saving money on medical care.  When your family doctor was forced to join the Consortium in 2012 because the health plans stopped contracting with individual physicians, a powerful new computer system tracked each doctor's prescribing habits, referrals to specialists, and utilization of expensive lab tests. But your doctor was an "outlier" in this new system, having been brought up in Hippocratic tradition of doing what was necessary for the individual patient, rather than the Greater Good, the newer communitarian ethic followed by the younger doctors. He was financially penalized for doing too much for his patients, since the formulas based 30% of physician income on "efficiency."

Your old doctor could tolerate the erosion of his income, but had trouble with the new regulations that insisted that he discuss and refer for "all legal procedures." Since by 2013 physician assisted suicide was legal in 21 of 50 states, the Consortium enumerated the conditions that mandated the "euthanasia talk", including multiple sclerosis, metastatic breast cancer, and many others. He could never actually bring himself to violate his original Hippocratic Oath that not only forbade assisting his patients in committing suicide but also prohibited even mentioning it. It was impossible to rid himself of the idea that a physician's role was to assist in healing and that medical killing was antithetical to his professional integrity.

Back in 2007, ACOG, the ob/gyn's professional organization, issued Ethics Committee Opinion 385, contending that ob/gyn doctors had the duty to either do abortions or have offices in close proximity to abortion doctors to whom they would refer patients. There was an outcry from professional organizations of pro-life ob/gyns, Catholic physicians,  and other Christian doctors. Especially troubling to many was the assertion in  Committee Opinion 385 that defined conscience as a sentiment, and measured its "authenticity" by the degree to which a provider would suffer "guilt, shame or loss of self esteem" if it were violated. Your doctor and many of his colleagues regarded medical killing as anathema, and were incensed by describing their integrity as a physicians as a "feeling". But by 2013 the protests had died down, and the ethics committee recommendation for ob/gyn's had evolved into a mandate for family practice doctors under new rules enforced by the Department of Health and Human Services.

The final blow came in early 2014. Back in 2008, in Benitez v North Coast Women's Care Medical Group, the California Supreme Court ruled against ob/gyn doctors who did not want to provide intrauterine insemination to a lesbian couple because of their religious beliefs. Although most European nations did not allow the buying or selling of eggs or sperm, and restricted fertility therapies to heterosexual married couples, the California courts not only permitted but required health care providers to cooperate in any reproductive therapies for any patient regardless of sexual orientation or marital status.

Although the birth of octuplets in 2009 with assisted reproductive technology to a single woman with six other children initially created a brief public uproar, ultimately no legislation was passed protecting physicians who did not want to participate in a patient's procreative endeavor. Your physician had a 68 year old bipolar single male patient who wanted to have an heir. The patient requested that your doctor appeal to the Consortium to provide him with a donated egg and surrogate mother for his desired offspring. Since your doctor did not want to be used as a tool in his patient's peculiar agenda and was legitimately afraid of an expensive lawsuit that would decimate his dwindling retirement funds if he refused, he decided at this point to quit medicine altogether and move to a sunny warm state.

Your family doctor had been inspired as a young man by study of the U.S. Constitution and other foundational documents that he thought would forever ensure his liberty. He had studied the same "Rules of Civility" that the young George Washington had encountered in 1747.  One of the most memorable of these maxims was "Labor to keep alive in your breast that little spark of celestial fire called conscience." It was clear to him that conscience here referred to man's innate understanding of moral right and wrong. When the American Founders would later declare independence from Great Britain in 1776, it was by virtue of this "spark of celestial fire" that they would establish the principles of human equality, unalienable rights, and government by consent as the foundations of American constitutional government.

Just before he left for his retirement home, your doctor was deeply disturbed to see the concept of conscience mocked in the New England Journal of Medicine by University of Wisconsin law professor R. Alta Charo in her article "The Celestial Fire of Conscience - Refusing to Provide Medical Care."  Charo's presentation did not acknowledge that many Americans do not believe that abortion, assisted suicide, and embryonic stem cell therapies are legitimate medical care in the first place. Her article also did not distinguish between emergency and elective care, and merely regards the health care provider as a tool for whatever ends the patient wants to achieve. Attorneys such as Ms. Charo claimed the right to take whatever cases they want, but seem deny the same basic right to physicians. Patients can always seek the care of other providers.

Your doctor (and many other Americans) believed that failure to protect physician conscience will destroy the trust and accountability that is essential to the physician patient relationship. If the physician and patient cannot freely collaborate, ultimately another agenda -- that of the health plan or state -- will replace it, to everyone's detriment.

Dr. Davenport is an obstetrician/gynecologist in private practice in El Sobrante, California.
Title: NYT: Obama open to taxing health benefits
Post by: Chad on March 15, 2009, 07:37:40 AM
Proposal problematic for Obama as he denounced similar one in campaign

By Jackie Calmes and Robert Pear
The New York Times
updated 9:31 a.m. CT, Sun., March. 15, 2009
WASHINGTON - The Obama administration is signaling to Congress that the president could support taxing some employee health benefits, as several influential lawmakers and many economists favor, to help pay for overhauling the health care system.

The proposal is politically problematic for President Obama, however, since it is similar to one he denounced in the presidential campaign as “the largest middle-class tax increase in history.” Most Americans with insurance get it from their employers, and taxing workers for the benefit is opposed by union leaders and some businesses.

In television advertisements last fall, Mr. Obama criticized his Republican rival for the presidency, Senator John McCain of Arizona, for proposing to tax all employer-provided health benefits. The benefits have long been tax-free, regardless of how generous they are or how much an employee earns. The advertisements did not point out that Mr. McCain, in exchange, wanted to give all families a tax credit to subsidize the purchase of coverage.

At the time, even some Obama supporters said privately that he might come to regret his position if he won the election; in effect, they said, he was potentially giving up an important option to help finance his ambitious health care agenda to reduce medical costs and to expand coverage to the 46 million uninsured Americans. Now that Mr. Obama has begun the health debate, several advisers say that while he will not propose changing the tax-free status of employee health benefits, neither will he oppose it if Congress does so.

At a recent Congressional hearing, Senator Ron Wyden, an Oregon Democrat whose own health plan would make benefits taxable, asked Peter R. Orszag, the president’s budget director, about the issue. Mr. Orszag replied that it “most firmly should remain on the table.”

Mr. Orszag, an economist who has served as director of the Congressional Budget Office, has written favorably of taxing some employer-provided health benefits and using the revenue savings for other health-related incentives. So has another Obama adviser, Jason Furman, the deputy director of the White House National Economic Council.

They, like other proponents, cite evidence that tax-free benefits encourage what Mr. McCain called “gold-plated” policies, resulting in inefficient and costly demands for health care and pressure on employers to hold down workers’ pay as insurance expenses rise. And, they say, the policy discriminates against those — many of whom are low-income workers — who do not have employer-provided coverage.

When Senator Max Baucus, Democrat of Montana, advocated taxing benefits at a recent hearing of the Finance Committee, which he leads, Treasury Secretary Timothy F. Geithner assured him that the administration was open to all ideas from Congress. Mr. Geithner did, however, allude to the position that Mr. Obama had taken as a candidate.

The administration’s receptivity to the idea is owed partly to the advocacy of Mr. Baucus, whose committee has jurisdiction over tax policy and health programs, and to support from Republicans. There is less enthusiasm among Democrats in the House, though the health debate is at an early stage and no comprehensive plans are on the table.

Also, Mr. Obama’s own idea for raising revenues for health care — limiting the income tax deductions that the most affluent taxpayers claim — has run into opposition not only from Mr. Baucus but also from his counterpart in the House, Representative Charles B. Rangel, Democrat of New York, who is chairman of the Ways and Means Committee.

Mr. Obama’s proposed limit on deductions would raise an estimated $318 billion over 10 years, or half of his proposed “health care reserve fund.” That is a fraction of the revenues that could be raised from taxing employer-provided health benefits.

In the campaign, Mr. McCain estimated that taxing all health benefits would raise $3.6 trillion over a decade — “a multitrillion-dollar tax hike,” one Obama advertisement said.

The Congressional Budget Office says that including health benefits in taxable income could mean $246 billion in additional revenue for a single year. Stopping short of full taxation, as Mr. Baucus and others suggest, would mean less new revenue.

The latest government figures, for 2007, show that 70 percent of the 253 million people with health insurance received at least some of their coverage through employers. Employment-based insurance covers three-fifths of the population under 65.

Those who want to tax benefits in whole or in part make two main arguments. They say the tax exclusion is a generous subsidy that insulates employees from the true costs of health care, leading them to demand more of it and driving up overall costs. Critics also say the policy is unfair because it favors higher-income people. “It’s too regressive,” Mr. Baucus said. “It just skews the system.”

But in a blueprint for health legislation that he issued last November, Mr. Baucus said taking the exclusion on health benefits out of the tax code would go “too far” and “cause widespread disruption in employer-based health benefits.” Mr. Obama has also said he wants to preserve employer-provided coverage. Mr. Baucus, in his paper, cited other options, like taxing benefits above some value, taxing only wealthy employees or both.

However the proposal is devised, advocates will not have an easy time selling it.

Republicans, like Mr. McCain and former President George W. Bush before him, tend to favor taxing the benefits to finance other incentives for people to buy their own insurance. But given Mr. Obama’s use of the issue in his campaign, Republicans are unlikely to support a change unless the president himself proposes it, a senior adviser to Senate Republicans said.

Many Democrats, especially House liberals, are opposed. “It’s a dumb idea,” said Representative Pete Stark of California, chairman of the Ways and Means Subcommittee on Health. “We have to maintain as much as we can of the employer payments.”

Administration officials often say they will not repeat the mistakes of former President Bill Clinton, whose plan for universal health insurance collapsed in 1994. But Frank B. McArdle, a health policy expert at Hewitt Associates, a benefits consulting firm, said, “If President Obama agrees to cut back the tax break for employee health benefits, he will risk repeating one of Mr. Clinton’s errors by disrupting health insurance for people who have it and like it.”

Some big businesses consider nontaxable employment benefits a tool for recruiting and retaining workers. The United States Chamber of Commerce opposes eliminating the exclusion on health benefits, but James P. Gelfand, senior manager of health policy, said the group had not taken a position on limiting it.

Organized labor, a pillar of the Democratic Party base, considers the benefits among the union movement’s historic achievements for the middle class. But a split could be developing between the manufacturing unions, which have negotiated rich benefit packages, and the growing service employees unions, which include many low-wage workers without generous benefits.

Alan V. Reuther, legislative director of the United Automobile Workers, said: “These proposals would represent a tax increase on working families. They would undermine good health care coverage.”

But at the Service Employees International Union, which was an early supporter of Mr. Obama, Dennis Rivera, the coordinator of the union’s health care campaign, said that while his organization was “predisposed not to agree to the taxing of health benefits,” he would wait to pass judgment. The union, Mr. Rivera said, wants to see how any tax changes fit into the overall effort to revamp the health care system. “We need to see the total picture,” he said.

This story, Administration Is Open to Taxing Health Benefits, originally appeared in the New York Times.

Copyright © 2009 The New York Times

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Title: Can They Run it Better than the Bailout?
Post by: Body-by-Guinness on March 18, 2009, 12:56:45 PM
More Reasons Not to Nationalize Health Care

Posted by Doug Bandow

Advocates of a government takeover of the health care system routinely offer up horror stories of American medicine, and no system yet has found a way around the problem of human imperfection, especially when operating in a system with such distorted incentives–most from ill-considered government policies.  Yet the horror stories in nationalized health care systems are manifold and tend to be more intractable since they result from government policy.

For instance, consider the quality of care delivered by hospitals in one region in Great Britain (with a hat-tip to Philip Klein of the American Spectator for finding this story).  According to the Daily Telegraph:

Sir Ian Kennedy, chairman of the Healthcare Commission, said the report is a ’shocking story’ and that there were failures at almost every stage of care of emergency patients. “There is no doubt that patients will have suffered and some of them will have died as a result,” he said.

The investigation of the trust now called the Mid-Staffordshire NHS Foundation Trust, found overstretched and poorly trained nurses who turned off equipment because they did not know how to work it, newly qualified doctors left to care for patients recovering from surgery at night, patients left for hours in soiled bedclothes, reception staff expected to judge how seriousness of patients arriving at A&E, patients left without food or drink, others who received the wrong medication or none at all, blood and faeces left on lavatories and floors, and doctors diverted away from seriously ill patients in order to treat minor ones who were in danger of breaching the four hour waiting time target.

When high mortality rates triggered questions, the trust board of directors ‘fobbed off’ investigators by saying the rates were a result of statistical errors but the Healthcare Commission found this was not that case.

The report said there was a ‘reluctance to acknowledge or even consider that the care of patients was poor’.

The trust was more concerned with hitting targets, gaining Foundation Trust status and marketing and had ‘lost sight’ of its responsibilities for patient care, the report said.

Sir Ian said: “The resulting report is a shocking story. Our report tells a story of appalling standards of care and chaotic systems for looking after patients.”

While Britain tends to be near the bottom in terms of health care system in industrialized states, there are plenty of horror stories elsewhere.  Socialism doesn’t work, whether in health care or elsewhere.  As Investor’s Business Daily reminds us:

The Swedish government system is no better. It also refuses to provide some expensive medication and, inhumanely, refuses to let patients buy the drugs themselves. Why? According to a Journal of American Physicians and Surgeons article, bureaucrats believe doing so “would set a bad precedent and lead to unequal access to medicine.”

Like Canadians, Swedes are subjected to long waits. They also have denial-of-care problems that sometimes lead to death.

A reasonable person would see the record of repeated failures in government-run medicine as evidence that such a system is not sustainable. Yet every central planner thinks he or she — or his or her immediate group — is smart enough to correct the flaws of socialist programs and therefore has the moral authority to force others to participate in his experiments. It is the same thinking that will move a person to say we are the ones we’ve been waiting for.

The Obama administration seems determined to waste a lot of money “stimulating” the economy.  We can replace money lost.  But if the administration succeeds in nationalizing the medical system directly or indirectly, the damage may prove irreversible–and deadly.
Title: WSJ: MA shows what will happen
Post by: Crafty_Dog on March 26, 2009, 09:39:14 PM
Praise Mitt Romney. Three years ago, the former Massachusetts Governor had the inadvertent good sense to create the "universal" health-care program that the White House and Congress now want to inflict on the entire country. It is proving to be instructive, as Mr. Romney's foresight previews what President Obama, Max Baucus, Ted Kennedy and Pete Stark are cooking up for everyone else.

Mitt Romney.
In Massachusetts's latest crisis, Governor Deval Patrick and his Democratic colleagues are starting to move down the path that government health plans always follow when spending collides with reality -- i.e., price controls. As costs continue to rise, the inevitable results are coverage restrictions and waiting periods. It was only a matter of time.

They're trying to manage the huge costs of the subsidized middle-class insurance program that is gradually swallowing the state budget. The program provides low- or no-cost coverage to about 165,000 residents, or three-fifths of the newly insured, and is budgeted at $880 million for 2010, a 7.3% single-year increase that is likely to be optimistic. The state's overall costs on health programs have increased by 42% (!) since 2006.

Like gamblers doubling down on their losses, Democrats have already hiked the fines for people who don't obtain insurance under the "individual mandate," already increased business penalties, taxed insurers and hospitals, raised premiums, and pumped up the state tobacco levy. That's still not enough money.

So earlier this year, Mr. Patrick appointed a state commission to figure out how to control costs and preserve "this grand experiment." One objective is to change the incentives for preventative care and treatments for chronic disease, but everyone says that. It sometimes results in better health but always more spending. So-called "pay for performance" financing models, on the other hand, would do away with fee for service -- but they also tend to reward process, not the better results implied.

What are the alternatives? If health planners won't accept the prices set by the marketplace -- thus putting themselves out of work -- the only other choice is limiting care via politics, much as Canada and most of Europe do today. The Patrick panel is considering one option to "exclude coverage of services of low priority/low value." Another would "limit coverage to services that produce the highest value when considering both clinical effectiveness and cost." (Guess who would determine what is high or low value? Not patients or doctors.) Yet another is "a limitation on the total amount of money available for health care services," i.e., an overall spending cap.

The Institute for America's Future -- which is providing the intellectual horsepower (we use the term loosely) for reforms like those in Massachusetts -- argues that the cost overruns prove the state must cap how much insurers are allowed to charge consumers and regulate their profits. If Mr. Patrick doesn't get there first, that is. He reportedly told insurers and hospitals at a closed meeting this month that if they didn't take steps to hold down the rate of medical inflation, he would.

Even the single-payer cheerleaders at the New York Times have caught on to this rolling catastrophe. In a page-one story this month, the paper reported on the "expedient choice" that Mr. Romney and Democrats made to defer "until another day any serious effort to control the state's runaway health costs. . . . Those who led the 2006 effort said it would not have been feasible to enact universal coverage if the legislation had required heavy cost controls. The very stakeholders who were coaxed into the tent -- doctors, hospitals, insurers and consumer groups -- would probably have been driven into opposition by efforts to reduce their revenues and constrain their medical practices, they said."

Now they tell us. What really whipped along RomneyCare were claims that health care would be less expensive if everyone were covered. But reducing costs while increasing access are irreconcilable issues. Mr. Romney should have known better before signing on to this not-so-grand experiment, especially since the state's "free market" reforms that he boasts about have proven to be irrelevant when not fictional. Only 21,000 people have used the "connector" that was supposed to link individuals to private insurers.

Which brings us to Washington, where Mr. Obama and Congressional Democrats are about to try their own Bay State bait and switch: First create vast new entitlements that can never be repealed, then later take the less popular step of rationing care when it's their last hope to save the federal fisc.

The consequences of that deception will be far worse than those in Massachusetts, however, given that prior to 2006 the state already had a far smaller percentage of its population uninsured than the national average. The real lesson of Massachusetts is that reform proponents won't tell Americans the truth about what "universal" coverage really means: Runaway costs followed by price controls and bureaucratic rationing.

Title: Re: The Politics of Health Care
Post by: ccp on March 27, 2009, 06:17:19 AM
Well for those people who for whatever reason have no health coverage now, rationed care is better than no care.  They will be quite pleased to have someone else pay for their health care - rationed or not.
For the rest of us who will have to foot the bill - we are screwed.
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on March 27, 2009, 06:20:31 AM
Ummm , , , has "no care" actually been the case?
Title: IBD: Surprising Facts
Post by: Crafty_Dog on March 27, 2009, 06:33:23 AM
second post

How U.S. Health Care Really Stacks Up
By INVESTOR'S BUSINESS DAILY | Posted Thursday, March 26, 2009 4:20 PM PT

Facts: A movie has been made solely to criticize it. The left treats it as if it's an invader that must be repelled. Most Americans, however, are satisfied with this object of so much hate — America's health care industry.


Read More: Health Care


Manipulative filmmaker Michael Moore says "we have the worst health care in the Western world" and has offered up Cuba as a paradigm for the U.S. to follow.

Former South Dakota Sen. Tom Daschle, who was nearly named the administration's health and human services secretary, says the "flaws in our health care system are pervasive and corrosive."

Rep. Dennis Kucinich, a former Democratic presidential candidate, called the current health care market "predatory capitalism." Some Democrats go so far as to say the system is racist.

The kindest thing most Democrats will say about health care in the U.S. is that it's broken. Their talking points to back up the claim revolve around costs, America's low position (37th) in World Health Organization rankings and the number of uninsured.

The last is a useless measure, since only a small portion of the uninsured are chronically without coverage. So are the WHO rankings, which can't be trusted because of disparities in how countries compile statistics, demographic and cultural differences, and the WHO's leftist bias.

Which leaves us with the issue of costs.

Yes, with $2.5 trillion expected to be spent this year, health care in the U.S. is more expensive than in any other country, including Great Britain and Canada, whose nationalized, universal care systems are held up as models .

But what we spend isn't thrown down a rathole. The National Center for Policy Analysis has published a study, "10 Surprising Facts About American Health Care," that shows how Americans get something for the extra dollars they lay out. To wit:

• "Americans have better survival rates than Europeans for common cancers." Breast cancer mortality: 52% higher in Germany and 88% higher in the United Kingdom than in the U.S. Prostate cancer mortality: 604% higher in the U.K., 457% higher in Norway. Colo-rectal cancer mortality: 40% higher among Britons.

• "Americans have lower cancer mortality rates than Canadians." Rates for breast cancer (9%), prostate cancer (184%) and colon cancer among men (10%) are higher than in the U.S.

• "Americans have better access to treatment of chronic diseases than patients in other developed countries." Roughly 56% of Americans who could benefit are taking statin drugs. Only 36% of the Dutch, 29% of the Swiss, 26% of Germans, 23% of Britons and 17% of Italians who could benefit receive them.

• "Americans have better access to preventive cancer screenings than Canadians." Nine of 10 middle-aged American women have had a mammogram; 72% of Canadian women have. Almost every American woman (96%) has had a pap smear; fewer than 90% of Canadian women have. Roughly 54% of American men have had a prostate cancer test; fewer than one in six Canadian men have. Almost a third of Americans (30%) have had a colonoscopy; only 5% of Canadians have had the procedure.

• "Lower-income Americans are in better health than comparable Canadians." Nearly 12% of U.S. seniors with below-median incomes self-report being in "excellent" health, while 5.8% of Canadian seniors say the same thing.

• "Americans spend less time waiting for care than patients in Canada and the United Kingdom." Canadians and Britons wait about twice as long, sometimes more than a year, to see a specialist, have elective surgery or get radiation treatment.

• "People in countries with more government control of health care are highly dissatisfied and believe reform is needed." More than seven in 10 Germans, Canadians, Australians, New Zealanders and Britons say their health systems need either "fundamental change" or "complete rebuilding."

• "Americans are more satisfied with the care they receive than Canadians." More than half (51.3%) of Americans are very satisfied with their health care services, while 41.5% of Canadians hold the same view of their system.

• "Americans have much better access to important new technologies like medical imaging than patients in Canada or the U.K." There are 34 CT scanners per million Americans. There are 12 per million in Canada and eight per million in Britain. The U.S. has nearly 27 MRI machines per million. Britain and Canada have 6 per million.

• "Americans are responsible for the vast majority of all health care innovations." The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other single developed nation; the most important recent medical innovations were developed here.

Can the nationalized, universal systems in Britain, Canada or anywhere else improve on this? No, but we can ruin our health care by following the policies of countries where medical treatment is far below the American standard.

Title: Re: The Politics of Health Care
Post by: ccp on March 27, 2009, 08:03:02 AM
I agree with the post but,
I am afraid that one can find statistics that buttresses both sides of the argument. For or against national or single payer care.
I am not for big government care.  But at this point the free market's answer appears unsustainable with regards to costs.
The electronic medical  records may or may not decrease costs - the jury is out - as is the concept that preventative care reduces costs (evidence suggests it increases costs in many cases). 
There is simply no way to insure another 40 mill people and not ration care.
That said we will need to ration care anyway at some point.

People are living longer and the result is more health care needs.  As well of course the baby boom thing.

The best hope in my opinion still comes ironically from the pharmaceutical industry.

For example it is becoming apparent that diabetes 2 is possibly an intestinal disease and bariatric surgery which was used for weight loss results in reversal of diabetes far more than expected for any degree of weight loss.  This seems to have been discovered by accident.  It is also clear that some people who are NOT overweight still will have diabetes reversed by this surgery.
Thus a treatment with goal of cure for this is surgery.  At this time it costs several thousand dollars.  Yet in the long run thses procedures may reduce costs.

If the drug industry can find a real cure or better treaments for obesity and other conditions than costs may actually decrease.

It is all too complicated.  I could work towards a Phd thesis and still not know the answers though I would have a better handle on the problems.
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on March 27, 2009, 08:39:34 AM
"That said we will need to ration care anyway at some point."

The proper mechanism is called "price". :-D
Title: Re: The Politics of Health Care
Post by: ccp on March 27, 2009, 08:54:55 AM
The proper mechanism is called "price".

I don't follow you. :?
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on March 27, 2009, 10:36:05 AM
Sorry for my failed effort at laconic wit  :-)

In a free market, who gets something is determined by price.
Title: Re: The Politics of Health Care
Post by: ccp on March 27, 2009, 11:42:41 AM
Well now you are getting to the question:  is health care a right or a privilege that is earned?

I just tried to look up if there are any polls conducted on the opinions of people on this issue.  I do not find much.
Clearly BO feels it is a right and in conjuction, a responsibility for those who can and do pay to do so for those who can't or won't.
I don't know where the majority of Americans are on this issue.  I suspect most feel it is a right but I could be wrong. 
What do I feel?  Well of course as a doctor I am expected to be kind, thoughtful, and a true humanitarian and philanthropist, and alive and working only for the public good. 
All the while my wife and I are getting stalked and robbed. 
And everyone and their sister has an opinion about how much doctors should or shoudn't make.
So is it a right or a privilege?  Personally I am tired of philosophy and I frankly don't even give a darn.
My thoughts don't mean anything anyway. 

I suspect one reason BO is so popular is because most agree with him.
Title: Re: The Politics of Health Care
Post by: JDN on April 08, 2009, 08:37:03 AM
When it comes to healthcare, the U.S., Britain and Canada are hurting
Healthcare in all three countries has the same problem. They just feel it in different places.
By Ezra Klein

April 7, 2009

When asked by the New England Journal of Medicine to detail his healthcare vision during the campaign, John McCain concluded with a rousing denunciation of "new government bureaucracies that will translate into higher taxes, reduced provider payments and long waiting lines."

Long lines come up frequently in the American healthcare discussion, the symbol of all that is to be feared about a government-run system. And it's true that in Canada and Britain, the two countries most often cited in discussions of what nationalized healthcare might mean, some patients report having to wait months for some elective treatments. Sometimes.

But we've got waiting lines too -- along with 50 million uninsured and a system that costs more than twice as much per person as that of any other country. We've just managed to hide our lines through clever statistical gimmickry.

Britain and Canada control costs in a very specific fashion: The government sets a budget for how much will be spent on healthcare that year, and the system figures out how to spend that much and no more. One of the ways the British and Canadians save money is to punt elective surgeries to a lower priority level. A 2001 survey by the policy journal "Health Affairs" found that 38% of Britons and 27% of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5%. Score one of us!

Well, sort of. American healthcare controls costs in another way. Rather than deciding as a society how much will be spent in the coming year and then figuring out how best to spend it, we abdicate collective responsibility and let individuals fend for themselves. So although Britain and Canada have decided that no one will go without, even if some must occasionally wait, the U.S. has decided that most of those who can't afford care simply won't get it.

When that very same survey also looked at cost problems among residents of different countries, 24% of Americans reported that they did not get medical care because of cost. Twenty-six percent said they didn't fill a prescription. And 22% said they didn't get a test or treatment. Those latter numbers are probably artificially small: If you can't afford to see a doctor, you never know that you can't afford the treatment she would recommend. In Britain and Canada, only about 6% of respondents reported that costs had limited their access to care.

Moreover, surveys conducted by the Organization for Economic Cooperation and Development have found that most countries don't have waiting lines or the uninsured. Not Germany or France or Japan or Sweden, all of which have more of a mix of public and private options. But Canada is next door, and Britain speaks our language, so we tend to spend a lot of time comparing our system with these systems and not a lot of time thinking through the full range of options.

In light of the "Health Affairs" data, smugness about our speedy access to care seems a bit peculiar. If someone can't afford care, we record their waiting time as zero. You don't wait for what you can't have. But a more accurate accounting would record that wait as infinite, or it would record when the patient eventually ends up in the emergency room because the original ailment went untreated. Research like this raises a simple question: Would you rather wait four months for a surgery or be unable to get it altogether?

Just last week, House Republicans expressed their preference for the latter. Their long-awaited budget document was admirably specific about changes to Medicare. They call for "a new Medicare program" in which enrollees are given a check "equal to 100% of the Medicare benefit," which they can then take to the private market to purchase their own care.

This proposal has a purpose beyond dismantling a popular government entitlement program. Currently, Medicare does not abide by a budget. It is not run like the Canadian or British healthcare systems. Instead, it pays whatever is deemed "reasonable and necessary." Because of that, costs are shooting through the roof: The Congressional Budget Office estimates that Medicare spending will more than triple by 2050.

The Republican plan gives Medicare a budget. Costs grow only as fast as the check grows. And because the check grows more slowly than health spending does, the program saves money. But this is, in effect, almost precisely the strategy of Britain and Canada: It is the government imposing an arbitrary budget on its healthcare spending.

The difference is that the British and Canadian governments try to apportion that health spending so that the whole population gets care. That can mean, alongside other cost-saving measures, longer waits for services. The Republican budget simply would give individuals a fixed check. That will mean that patients who exceed that sum and don't have money of their own go without needed care.

So Americans will continue to brag that no one waits, and Canadians and Britons will continue to brag that no one goes without. And somewhere, the French and the Germans and the Japanese and the Swiss and many others will wonder why we insist on choosing between such awful extremes.
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on April 08, 2009, 08:52:49 AM
"Rather than deciding as a society how much will be spent in the coming year and then figuring out how best to spend it, we abdicate collective responsibility and let individuals fend for themselves."

Wow , , ,  :roll:
Title: Re: The Politics of Health Care
Post by: G M on April 08, 2009, 09:06:10 AM
Who thinks that this should be done with food? It's only "fair".....
Title: WSJ: Quality care metrics
Post by: Crafty_Dog on April 08, 2009, 03:05:51 PM
The coming clusterfcuk gathers momentum:

The Obama administration is working with Congress to mandate that all Medicare payments be tied to "quality metrics." But an analysis of this drive for better health care reveals a fundamental flaw in how quality is defined and metrics applied. In too many cases, the quality measures have been hastily adopted, only to be proven wrong and even potentially dangerous to patients.

Martin KozlowskiHealth-policy planners define quality as clinical practice that conforms to consensus guidelines written by experts. The guidelines present specific metrics for physicians to meet, thus "quality metrics." Since 2003, the federal government has piloted Medicare projects at more than 260 hospitals to reward physicians and institutions that meet quality metrics. The program is called "pay-for-performance." Many private insurers are following suit with similar incentive programs.

In Massachusetts, there are not only carrots but also sticks; physicians who fail to comply with quality guidelines from certain state-based insurers are publicly discredited and their patients required to pay up to three times as much out of pocket to see them. Unfortunately, many states are considering the Massachusetts model for their local insurance.

How did we get here? Initially, the quality improvement initiatives focused on patient safety and public-health measures. The hospital was seen as a large factory where systems needed to be standardized to prevent avoidable errors. A shocking degree of sloppiness existed with respect to hand washing, for example, and this largely has been remedied with implementation of standardized protocols. Similarly, the risk of infection when inserting an intravenous catheter has fallen sharply since doctors and nurses now abide by guidelines. Buoyed by these successes, governmental and private insurance regulators now have overreached. They've turned clinical guidelines for complex diseases into iron-clad rules, to deleterious effect.

One key quality measure in the ICU became the level of blood sugar in critically ill patients. Expert panels reviewed data on whether ICU patients should have insulin therapy adjusted to tightly control their blood sugar, keeping it within the normal range, or whether a more flexible approach, allowing some elevation of sugar, was permissible. Expert consensus endorsed tight control, and this approach was embedded in guidelines from the American Diabetes Association. The Joint Commission on Accreditation of Healthcare Organizations, which generates report cards on hospitals, and governmental and private insurers that pay for care, adopted as a suggested quality metric this tight control of blood sugar.

A colleague who works in an ICU in a medical center in our state told us how his care of the critically ill is closely monitored. If his patients have blood sugars that rise above the metric, he must attend what he calls "re-education sessions" where he is pointedly lectured on the need to adhere to the rule. If he does not strictly comply, his hospital will be downgraded on its quality rating and risks financial loss. His status on the faculty is also at risk should he be seen as delivering low-quality care.

But this coercive approach was turned on its head last month when the New England Journal of Medicine published a randomized study, by the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Canadian Critical Care Trials Group, of more than 6,000 critically ill patients in the ICU. Half of the patients received insulin to tightly maintain their sugar in the normal range, and the other half were on a more flexible protocol, allowing higher sugar levels. More patients died in the tightly regulated group than those cared for with the flexible protocol.

Similarly, maintaining normal blood sugar in ambulatory diabetics with vascular problems has been a key quality metric in assessing physician performance. Yet largely due to two extensive studies published in the June 2008 issue of the New England Journal of Medicine, this is now in serious doubt. Indeed, in one study of more than 10,000 ambulatory diabetics with cardiovascular diseases conducted by a group of Canadian and American researchers (the "ACCORD" study) so many diabetics died in the group where sugar was tightly regulated that the researchers discontinued the trial 17 months before its scheduled end.

And just last month, another clinical trial contradicted the expert consensus guidelines that patients with kidney failure on dialysis should be given statin drugs to prevent heart attack and stroke.

These and other recent examples show why rigid and punitive rules to broadly standardize care for all patients often break down. Human beings are not uniform in their biology. A disease with many effects on multiple organs, like diabetes, acts differently in different people. Medicine is an imperfect science, and its study is also imperfect. Information evolves and changes. Rather than rigidity, flexibility is appropriate in applying evidence from clinical trials. To that end, a good doctor exercises sound clinical judgment by consulting expert guidelines and assessing ongoing research, but then decides what is quality care for the individual patient. And what is best sometimes deviates from the norms.

Yet too often quality metrics coerce doctors into rigid and ill-advised procedures. Orwell could have written about how the word "quality" became zealously defined by regulators, and then redefined with each change in consensus guidelines. And Kafka could detail the recent experience of a pediatrician featured in Vital Signs, the member publication of the Massachusetts Medical Society. Out of the blue, according to the article, Dr. Ann T. Nutt received a letter in February from the Massachusetts Group Insurance Commission on Clinical Performance Improvement informing her that she was no longer ranked as Tier 1 but had fallen to Tier 3. (Massachusetts and some private insurers use a three-tier ranking system to incentivize high-quality care.) She contacted the regulators and insisted that she be given details to explain her fall in rating.

After much effort, she discovered that in 127 opportunities to comply with quality metrics, she had met the standards 115 times. But the regulators refused to provide the names of patients who allegedly had received low quality care, so she had no way to assess their judgment for herself. The pediatrician fought back and ultimately learned which guidelines she had failed to follow. Despite her cogent rebuttal, the regulator denied the appeal and the doctor is still ranked as Tier 3. She continues to battle the state.

Doubts about the relevance of quality metrics to clinical reality are even emerging from the federal pilot programs launched in 2003. An analysis of Medicare pay-for-performance for hip and knee replacement by orthopedic surgeons at 260 hospitals in 38 states published in the most recent March/April issue of Health Affairs showed that conforming to or deviating from expert quality metrics had no relationship to the actual complications or clinical outcomes of the patients. Similarly, a study led by UCLA researchers of over 5,000 patients at 91 hospitals published in 2007 in the Journal of the American Medical Association found that the application of most federal quality process measures did not change mortality from heart failure.

State pay-for-performance programs also provide disturbing data on the unintended consequences of coercive regulation. Another report in the most recent Health Affairs evaluating some 35,000 physicians caring for 6.2 million patients in California revealed that doctors dropped noncompliant patients, or refused to treat people with complicated illnesses involving many organs, since their outcomes would make their statistics look bad. And research by the Brigham and Women's Hospital published last month in the Journal of the American College of Cardiology indicates that report cards may be pushing Massachusetts cardiologists to deny lifesaving procedures on very sick heart patients out of fear of receiving a low grade if the outcome is poor.

Dr. David Sackett, a pioneer of "evidence-based medicine," where results from clinical trials rather than anecdotes are used to guide physician practice, famously said, "Half of what you'll learn in medical school will be shown to be either dead wrong or out of date within five years of your graduation; the trouble is that nobody can tell you which half -- so the most important thing to learn is how to learn on your own." Science depends upon such a sentiment, and honors the doubter and iconoclast who overturns false paradigms.

Before a surgeon begins an operation, he must stop and call a "time-out" to verify that he has all the correct information and instruments to safely proceed. We need a national time-out in the rush to mandate what policy makers term quality care to prevent doing more harm than good.

Dr. Groopman, a staff writer for the New Yorker, and Dr. Hartzband are on the staff of Beth Israel Deaconess Medical Center in Boston and on the faculty of Harvard Medical School.

Title: More politics from the liberal rag
Post by: ccp on April 10, 2009, 11:12:16 AM
If one doesn't think the NEJM is a liberal rag this is from the same issue:

Conscientious Objection Gone Awry — Restoring Selfless Professionalism in Medicine

Julie D. Cantor, M.D., J.D.
 A new rule from the Department of Health and Human Services (DHHS) has emerged as the latest battleground in the health care conscience wars. Promulgated during the waning months of the Bush administration, the rule became effective in January. Heralded as a "provider conscience regulation" by its supporters and derided as a "midnight regulation" by its detractors, the rule could alter the landscape of federal conscience law.

The regulation, as explained in its text (see the Supplementary Appendix, available with the full text of this article at, aims to raise awareness of and ensure compliance with federal health care conscience protection statutes. Existing laws, which are tied to the receipt of federal funds, address moral or religious objections to sterilization and abortion. They protect physicians, other health care personnel, hospitals, and insurance plans from discrimination for failing to provide, offer training for, fund, participate in, or refer patients for abortions. Among other things, the laws ensure that these persons cannot be required to participate in sterilizations or abortions and that entities cannot be required to make facilities or personnel available for them. And they note that decisions on admissions and accreditation must be divorced from beliefs and behaviors related to abortion. On their face, these laws are quite broad.

But the Bush administration's rule is broader still. It restates existing laws and exploits ambiguities in them. For example, one statute says, "No individual shall be required to perform or assist in the performance of any part of a health service program or research activity funded" by DHHS if it "would be contrary to his religious beliefs or moral convictions."1 Here the rule sidesteps courts, which interpret statutory ambiguities and discern congressional intent, and offers sweeping definitions. It defines "individual" as physicians, other health care providers, hospitals, laboratories, and insurance companies, as well as "employees, volunteers, trainees, contractors, and other persons" who work for an entity that receives DHHS funds. It defines "assist in the performance" as "any activity with a reasonable connection" to a procedure or health service, including counseling and making "other arrangements" for the activity. Although the rule states that patients' ability to obtain health care services is unchanged, its expansive definitions suggest otherwise. Now everyone connected to health care may opt out of a wide range of activities, from discussions about birth control to referrals for vaccinations. As the rule explains, "an employee whose task it is to clean the instruments used in a particular procedure would also be considered to assist in the performance of the particular procedure" and would therefore be protected. Taken to its logical extreme, the rule could cause health care to grind to a halt.

It also raises other concerns. In terms of employment law, Title VII of the Civil Rights Act, which applies to organizations with 15 or more employees, requires balancing reasonable accommodations for employees who have religious, ethical, or moral objections to certain aspects of their jobs with undue hardship for employers. But the new rule suggests that if an employee objects, for example, to being a scrub nurse during operative treatment for an ectopic pregnancy, subsequently reassigning that employee to a different department may constitute unlawful discrimination — a characterization that may be at odds with Title VII jurisprudence.2 As officials of the Equal Employment Opportunity Commission remarked when it was proposed, the rule could "throw this entire body of law into question."3

Furthermore, although the rule purports to address intolerance toward "individual objections to abortion or other individual religious beliefs or moral convictions," it cites no evidence of such intolerance — nor would it directly address such intolerance if it existed. Constitutional concerns about the rule, including violations of state autonomy and rights to contraception, also lurk. And the stated goals of the rule — to foster a "more inclusive, tolerant environment" and promote DHHS's "mission of expanding patient access to necessary health services" — conflict with the reality of extensive objection rights. Protection for the silence of providers who object to care is at odds with the rule's call for "open communication" between patients and physicians. Moreover, there is no emergency exception for patient care. In states that require health care workers to provide rape victims with information about emergency contraception, the rule may allow them to refuse to do so.

Recently, the DHHS, now answering to President Barack Obama, took steps to rescind the rule (see the Supplementary Appendix). March 10 marked the beginning of a 30-day period for public comment on the need for the rule and its potential effects. Analysis of the comments ( and subsequent action could take some months. If remnants of the rule remain, litigation will follow. Lawsuits have already been filed in federal court, and Connecticut Attorney General Richard Blumenthal, who led one of the cases, has vowed to continue the fight until the regulation is "finally and safely stopped."4

This state of flux presents an opportunity to reconsider the scope of conscience in health care. When broadly defined, conscience is a poor touchstone; it can result in a rule that knows no bounds. Indeed, it seems that our problem is not insufficient tolerance, but too much. We have created a state of "conscience creep" in which all behavior becomes acceptable — like that of judges who, despite having promised to uphold all laws, recuse themselves from cases in which minors seek a judicial bypass for an abortion in states requiring parental consent.5

The debate is not really about moral or religious freedom writ large. If it were, then the medical profession would allow a broad range of beliefs to hinder patient care. Would we tolerate a surgeon who holds moral objections to transfusions and refuses to order them? An internist who refuses to discuss treatment for diabetes in overweight patients because of moral opposition to gluttony? If the overriding consideration were individual conscience, then these objections should be valid. They are not (although they might well be permitted under the new rule). We allow the current conscience-based exceptions because abortion remains controversial in the United States. As is often the case with laws touching on reproductive freedom, the debate is polarized and shrill. But there comes a point at which tolerance breaches the standard of care.

Medicine needs to embrace a brand of professionalism that demands less self-interest, not more. Conscientious objection makes sense with conscription, but it is worrisome when professionals who freely chose their field parse care and withhold information that patients need. As the gatekeepers to medicine, physicians and other health care providers have an obligation to choose specialties that are not moral minefields for them. Qualms about abortion, sterilization, and birth control? Do not practice women's health. Believe that the human body should be buried intact? Do not become a transplant surgeon. Morally opposed to pain medication because your religious beliefs demand suffering at the end of life? Do not train to be an intensivist. Conscience is a burden that belongs to the individual professional; patients should not have to shoulder it.

Patients need information, referrals, and treatment. They need all legal choices presented to them in a way that is true to the evidence, not the randomness of individual morality. They need predictability. Conscientious objections may vary from person to person, place to place, and procedure to procedure. Patients need assurance that the standard of care is unwavering. They need to know that the decision to consent to care is theirs and that they will not be presented with half-truths and shades of gray when life and health are in the balance.

Patients rely on health care professionals for their expertise; they should be able expect those professionals to be neutral arbiters of medical care. Although some scholars advocate discussing conflicting values before problems arise, realistically, the power dynamics between patients and providers are so skewed, and the time pressure often so great, that there is little opportunity to negotiate. And there is little recourse when care is obstructed — patients have no notice, no process, and no advocate to whom they can turn.

Health care providers already enjoy broad rights — perhaps too broad — to follow their guiding moral or religious tenets when it comes to sterilization and abortion. An expansion of those rights is unwarranted. Instead, patients deserve a law that limits objections and puts their interests first. Physicians should support an ethic that allows for all legal options, even those they would not choose. Federal laws may make room for the rights of conscience, but health care providers — and all those whose jobs affect patient care — should cast off the cloak of conscience when patients' needs demand it. Because the Bush administration's rule moves us in the opposite direction, it should be rescinded.

Dr. Cantor reports representing an affiliate of Planned Parenthood in a legal matter unrelated to conscientious objection. No other potential conflict of interest relevant to this article was reported.
Dr. Cantor is an adjunct professor at the UCLA School of Law, Los Angeles.

This article (10.1056/NEJMp0902019) was published at on March 25, 2009.


42 U.S.C.A.  300a-7(d).
Shelton v. Univ. of Medicine & Dentistry of New Jersey, 223 F.3d 220 (3d Cir. 2000).
Pear R. Protests over a rule to protect health providers. New York Times. November 17, 2008:A14.
Press release of the State of Connecticut Attorney General's Office, Hartford, February 27, 2009. (Accessed March 20, 2009, at
Liptak A. On moral grounds, some judges are opting out of abortion cases. New York Times. September 4, 2005.

Title: more health care propaganda
Post by: ccp on April 11, 2009, 07:42:40 AM
Dear Mr. Ricardo Alonso-zaldivar,

They may not be a "lobbying" group but they certainly do have and use a voice - its called voting.  The same for those who pay no income taxes.  They express their "voice" with their votes!  And I don't need a poll to tell me which party they overwhelmingly vote for:

****Associated Press Writer Ricardo Alonso-zaldivar, Associated Press Writer – 1 hr 19 mins ago
WASHINGTON – If the uninsured were a political lobbying group, they'd have more members than AARP. The National Mall couldn't hold them if they decided to march on Washington.

But going without health insurance is still seen as a personal issue, a misfortune for many and a choice for some. People who lose coverage often struggle alone instead of turning their frustration into political action.

Illegal immigrants rallied in Washington during past immigration debates, but the uninsured linger in the background as Congress struggles with a health care overhaul that seems to have the best odds in years of passing.

That isolation could have profound repercussions.

Lawmakers already face tough choices to come up with the hundreds of billions it would cost to guarantee coverage for all. The lack of a vocal constituency won't help. Congress might decide to cover the uninsured slowly, in stages.

The uninsured "do not provide political benefit for the aid you give them," said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. "That's one of the dilemmas in getting all this money. If I'm in Congress, and I help out farmers, they'll help me out politically. But if I help out the uninsured, they are not likely to help members of Congress get re-elected."

The number of uninsured has grown to an estimated 50 million people because of the recession. Even so, advocates in the halls of Congress are rarely the uninsured themselves. The most visible are groups that represent people who have insurance, usually union members and older people. In the last election, only 10 percent of registered voters said they were uninsured.

The grass-roots group Health Care for America Now plans to bring as many as 15,000 people to Washington this year to lobby Congress for guaranteed coverage. Campaign director Richard Kirsch expects most to have health insurance.

"We would never want to organize the uninsured by themselves because Americans see the problem as affordability, and that is the key thing," he said.

Besides, added Kirsch, the uninsured are too busy scrambling to make ends meet. Many are self-employed; others are holding two or three part-time jobs. "They may not have a lot of time to be activists," he said.

Vicki and Lyle White of Summerfield, Fla., know about such predicaments. They lost their health insurance because Lyle had to retire early after a heart attack left him unable to do his job as a custodian at Disney World. Vicki, 60, sells real estate. Her income has plunged due to the housing collapse.

"We didn't realize that after he had the heart attack no one would want to insure him," said Vicki. The one bright spot is that Lyle, 64, has qualified for Medicare disability benefits and expects to be getting his card in July.

But for now, the Whites have to pay out of pocket for Lyle's visits to the cardiologist and his medications. The bills came to about $5,000 last year. That put a strain on their limited budget because they are still making payments on their house and car.

"I never thought when we got to this age that we would be in such a mess," said Vicki, who has been married to Lyle for 43 years. "We didn't think we would have a heart attack and it would change our life forever."

While her own health is "pretty good," Vicki said she suffers chronic sinus infections and hasn't had a checkup since 2007. "I have just learned to live with it," she said.

The Whites' example shows how the lack of guaranteed health care access undermines middle-class families and puts them at risk, but that many of the uninsured eventually do find coverage. Lyle White has qualified for Medicare, even if the couple must still find a plan for Vicki.

Research shows that nearly half of those who lose coverage find other health insurance in four months or less. That may be another reason the uninsured have not organized an advocacy group. At least until this recession, many have been able to fix the situation themselves.

"The uninsured are a moving target," said Cathy Schoen, a vice president of the Commonwealth Fund, a research group that studies the problems of health care costs and coverage.

But even if gaps in coverage are only temporary, they can be dangerous. "Whenever you are uninsured, you are at risk," said Schoen. "People don't plan very well when they are going to get sick or injured."

Indeed, the Institute of Medicine, which provides scientific advice to the government, has found that a lack of health insurance increases the chances of bad outcomes for people with a range of common ailments, from diabetes and high blood pressure to cancer and stroke. Uninsured patients don't get needed follow-up care, skip taking prescription medicines and put off seeking help when they develop new symptoms.

Such evidence strengthens the case for getting everybody covered right away, Schoen said. But she acknowledges the politics may get tough. "It certainly has been a concern out of our history that unorganized voices aren't heard," she said.****


Title: WSJ: The end of private insurance
Post by: Crafty_Dog on April 13, 2009, 09:28:34 AM
Above every other health-care goal, Democrats this year want to institute a "public option" -- an insurance program financed by taxpayers, managed by government and open to everyone, much like Medicare. This new middle-class entitlement is the most important debate in Congress this year, because it really is the last stand for anything resembling private health insurance.

This public option will supposedly "compete" with private alternatives. As President Obama likes to put it, those who are happy with the insurance they have now can keep it -- and if they happen to prefer the government offering, well, gee whiz, that's the free market at work. The reality is far different. Not only will the new program become the default coverage for the uninsured, but Democrats intend to game the system to precipitate -- or if need be, coerce -- an exodus to government from private insurance. Soon enough, that will be the only "option" left.

A public program won't compete in a way that any normal business would recognize. As an entitlement, Congress's creation will enjoy potentially unlimited access to the Treasury, without incurring the risks or hedging against losses that private carriers do. As people gravitate to "free" or heavily subsidized care, the inevitably explosive costs will be covered in part with increased outlays to keep premiums artificially low or even offer extra benefits. Lacking such taxpayer cash, private insurance rates will escalate.

Much like Medicare, overall spending in the public option will be controlled over time by paying less for medical services, drugs and technology. With its monopsony purchasing power, below-market fees will be dictated on a take-it-or-leave-it basis -- an offer hospitals and physicians won't be able to refuse. Medicare's current reimbursement policies pay hospitals only 71% of private rates, and doctors 81%, according to the Lewin Group.

 In a recent analysis, Lewin estimates that enrollment in the public option will reach 131 million people if it is open to everyone and pays Medicare rates. Fully 119 million people will shift out of -- or lose -- private coverage. Everything depends on the payment levels that Congress adopts, as well as the size of the eligible pool. But even if a public option available to all takes the highly improbable step of paying at some midpoint between private and Medicare rates, nearly 68 million people will still be crowded out of private insurance. The nearby table summarizes Lewin's eye-popping findings.

This public option would be the most radical change in the way American health care is financed -- and thus provided -- in at least 44 years, and maybe ever. About 170 million people currently have private insurance, which is already pressured by the price controls of Medicare and Medicaid. A significant share of government underpayments are simply transferred to the private sector, adding tens of billions of dollars every year to consumer health bills.

A 2006 study in the journal Health Affairs concludes that around 17 cents of every dollar in relative reductions in Medicare payments to private hospitals are shifted onto private patients -- and that such cost-shifting accounts for fully 12.3% of the total increase in private payer prices between 1997 and 2001.

This share would be far higher were government payment rates not limited to the elderly and the poor but imposed over the entire system. This will only hasten the flight to government. Meanwhile, employers small and large will have every incentive to dump their plans and transfer their workers to the public rolls. The result will inevitably be a cascade of failures or withdrawals from the market by commercial insurers, with the public option as the only option for the diaspora.

Congress will finish the job with regulatory changes. Under the aegis of a level playing field, all private plans will be forced to offer benefit packages similar to those in the public option. They will also be required to accept all comers, regardless of pre-existing conditions, and also be forced to offer similar rates to all enrollees, ending the ability to manage risk through underwriting. Any private plan will essentially become a public utility where government decides what products it must offer and how much it can charge.

Democrats couldn't be clearer on this point. House baron Pete Stark -- who thought HillaryCare was too moderate and has long favored Medicare for all -- said at a recent hearing that currently "We have no mechanism to directly push the private sector to do delivery system reform and address rising costs." But the public option, he added, would force private insurers to "modernize," which seems to be his term for industrial policy.

Under this model, the annual political warfare over Medicare payment policies would be imported to what is left of the private sector. Once government takes over the majority of U.S. health-care liabilities, it can either provide every service at huge and growing cost, or it can ration services. People who need an MRI or hip replacement or whatever will face waiting lines. Medical innovation will be at the mercy of the price controls hashed out in Washington.

Proponents of a public option point to the Federal Employees Health Benefits Program to dismiss such criticism, but that program is offered only to a discrete population. Mr. Obama's proposal would be open to everyone and necessitate a huge permanent increase in government spending as a share of the economy. Medicare and Medicaid alone account for 4% of GDP today and will rise to 9% by 2035, according to the Congressional Budget Office. CBO estimates that individual and corporate income tax rates would have to rise by about 90% to finance the projected increase in spending through 2050 -- without the new middle-class entitlement.

Proponents will say we are exaggerating, but the consequences we describe are inevitable when government bulldozes into a market. Democrats want to sell their "public option" as a modest and affordable reform that won't affect anyone's private insurance. It isn't true. Republicans, especially those in the Senate who want to cut a deal on health care, should understand that a public option is the beginning of the end of private health insurance.

Please add your comments to the Opinion Journal forum.
Title: Have you seen your doctor?
Post by: Crafty_Dog on April 16, 2009, 10:01:20 PM

Here's something that has gotten lost in the drive to institute universal health insurance: Health insurance doesn't automatically lead to health care. And with more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have.

Consider that the Medicare Payment Advisory Commission reported in 2008 that 28% of Medicare beneficiaries looking for a primary care physician had trouble finding one, up from 24% the year before. The reasons are clear: A 2008 survey by the Texas Medical Association, for example, found that only 38% of primary-care doctors in Texas took new Medicare patients. The statistics are similar in New York state, where I practice medicine.

More and more of my fellow doctors are turning away Medicare patients because of the diminished reimbursements and the growing delay in payments. I've had several new Medicare patients come to my office in the last few months with multiple diseases and long lists of medications simply because their longtime provider -- who they liked -- abruptly stopped taking Medicare. One of the top mammographers in New York City works in my office building, but she no longer accepts Medicare and charges patients more than $300 cash for each procedure. I continue to send my elderly women patients downstairs for the test because she is so good, but no one is happy about paying.

The problem is even worse with Medicaid. A 2005 Community Tracking Physician survey showed that only 50% of physicians accept this insurance. I am now one of the ones who doesn't take it. I realized a few years ago that it wasn't worth the money to file the paperwork for the $25 or less that I received for an office visit. HMOs are problematic as well. Recent surveys from New York show a 10% yearly dropout rate from the state's largest HMO, the Health Insurance Plan of New York (HIP), and a 14% drop-out rate from Health Net of New York, another big HMO.

The dropout rate is less at major medical centers such as New York University's Langone Medical Center where I work, or Mount Sinai Medical Center, because larger physician networks have more leverage when choosing health plans. Still, I am frequently hamstrung as I try to find a good surgeon or specialist to refer one of my patients to.

Overall, 11% of the doctors at NYU Langone don't participate in at least two insurance plans -- Aetna or Blue Cross, for instance -- so I end up not being able to refer my patients to some of our top specialists. This problem, in addition to the mass of paperwork and diminishing reimbursements, is enough of a reason for me to consider dropping out as well.

Bottom line: None of the current plans, government or private, provide my patients with the care they need. And the care that is provided is increasingly expensive and requires a big battle for approvals. Of course, we're promised by the Obama administration that universal health insurance will avoid all these problems. But how is that possible when you consider that the medical turnstiles will be the same as they are now, only they will be clogged with more and more patients? The doctors that remain in this expanded system will be even more overwhelmed than we are now.

I wouldn't want to be a patient when that happens.

Dr. Siegel, an internist and associate professor of medicine at the NYU Langone Medical Center, is a Fox News medical contributor.
Title: NYT
Post by: Crafty_Dog on April 25, 2009, 06:15:26 AM
ama Tactic Shields Health Care Bill From a Filibuster
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LinkedinDiggFacebookMixxMySpaceYahoo! BuzzPermalinkBy CARL HULSE
Published: April 24, 2009
WASHINGTON — At the prodding of the White House, Democratic Congressional leaders have agreed to pursue a plan that would protect major health care legislation from Republican opposition by shielding it from last-minute Senate filibusters.

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The aggressive approach reflects the big political claim that President Obama is staking on health care, and with it his willingness to face Republican wrath in order to guarantee that the Democrats, with their substantial majority in the Senate, could not be thwarted by minority tactics.

While some Democratic senators were reluctant to embrace the arrangement, Mr. Obama made clear at a White House session on Thursday afternoon that he favored it, people with knowledge of the session said.

Mr. Obama has given way in some battles with Congress, but the new stance suggests he may be much less willing to compromise when it comes to health care, his top legislative priority, even if it means a bitter partisan fight.

The no-filibuster arrangement is fiercely opposed by Republican leaders, who say health care is too important to be exempted from the Senate rules that usually mean major bills must win support from 60 senators.

At the White House meeting this week, Mr. Obama told senators from both parties that he did not want a health care overhaul to fail if it came up a vote shy of the 60 needed to break filibusters, the people with knowledge of the session said. Republicans have used the procedure themselves in the past, but Senator Mitch McConnell of Kentucky, the Republican leader, told Mr. Obama in the meeting that that approach was likely to heighten partisan tensions in Congress.

The arrangement is spelled out in a tentative budget agreement reached Thursday night between Congressional leaders and the White House, allowing health legislation that meets budget targets to be approved by a simple Senate majority, under a process known as reconciliation.

Democrats say they intend to use the process as a last resort, and will include a provision in the budget that would not trigger the Senate shortcut until Oct. 15. That would leave the door open for months of negotiations over health care legislation, which the Democrats hope to deliver by the end of the year.

“Virtually everyone who has been part of these discussions recognizes that reconciliation is not the preferred way to write this legislation,” said Senator Kent Conrad, Democrat of North Dakota and chairman of the Senate Budget Committee. “But the administration wants to have a reconciliation instruction as an insurance policy.”

Mr. Conrad said the decision not to invoke the no-filibuster rule until mid-October was intended “as a signal that people are very serious and want this to work through the normal give-and-take.”

But that might not mollify Republicans, who say that once Democrats have the ability to fast-track the measure they will have no incentive to negotiate seriously with Republicans.

Republicans have threatened to use their own procedural weapons to bog down the Senate if Democrats adopt a budget that restricts filibusters on an issue as important as health care.

“The floor of the Senate will become a very untidy place if they start using reconciliation for major policy,” warned Senator Judd Gregg of New Hampshire, senior Republican on the budget panel.

Mr. Conrad and Representative John M. Spratt Jr. of South Carolina, the House Budget Committee chairman, were hammering out final details of the $3.5 trillion budget in talks with the administration that were expected to head into the weekend.

“Most issues have been resolved,” Senator Harry Reid of Nevada, the majority leader, said Friday, “but there are some that have not.”

The Democrats can rely on 58 votes in the Senate, and expected to add a 59th once the courts finish their review of the disputed election in Minnesota. But Mr. McConnell said that using the no-filibuster approach on health care “without the benefit of a full and transparent debate, does a disservice to the American people.”

“It would make it absolutely clear they intend to carry out their plans on a purely partisan basis,” he said.

Mr. Conrad had advised against using reconciliation, saying it did not lend itself to such a complex issue as health care.

But Mr. Conrad came under intense pressure from the White House, his own Senate leadership and the House to include it, to guard against Republicans’ using the filibuster to kill a health care bill. Proponents of reconciliation note that House and Senate Republicans have so far stood almost united against the new administration’s major initiatives.

Besides the agreement to use reconciliation, negotiators were coming to terms on lingering tax issues and the overall level of domestic spending, with the amount originally requested by Mr. Obama expected to be reduced by about $10 billion for 2010. The White House was pushing for final approval of a budget by Wednesday to put a successful coda on the Obama administration’s first 100 days.

The tentative agreement would also apply reconciliation rules to a less-partisan fight over student lending, but does not include filibuster protection for energy or climate-change legislation.

Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee, said Friday that he would prefer not to pursue health legislation through the reconciliation process.

“I think it gets in the way,” Mr. Baucus said, explaining that his goal was to produce a health care bill that could “get significantly more than 60 votes.”

“If we jam something down somebody’s throat, it’s not sustainable,” he said.

But other leading Democrats say they need the ability to circumvent filibusters if Republicans refuse to negotiate. They noted that Republicans often relied on reconciliation when they held power, notably using it to enact President George W. Bush’s tax cuts in 2001 and 2003.

Senate rules give the minority party, in this case the Republicans, ample ability to snarl the legislative process in a chamber where much activity is conducted under agreements between majority and minority leadership.

Republicans could force multiple votes on mundane matters, slow walk administration nominations, force Democrats to spend days teeing up bills for debate and require lengthy bills to be read in full. In 2005, Democrats threatened to bring the Senate to a halt using similar tactics when Republicans said they would strip them of the ability to filibuster judicial nominations. That showdown was averted.

Now, Republicans would run some political risk of being portrayed as obstructing health care and other initiatives sought by a popular new president if they were seen as shutting down the Senate out of pique.

Robert Pear contributed reporting.
Title: Re: The Politics of Health Care
Post by: ccp on April 27, 2009, 07:54:33 AM
It is not so much that there is a shortage of doctors as much as shortage in some areas.  In my area there is too many doctors.
But anyway:

Obama administration concerned about growing shortage of primary-care doctors
by Robert Pear/New York Times Sunday April 26, 2009, 9:59 PM
Washington -- Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the number of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.

The officials said they were particularly concerned about shortages of primary-care providers who are the main source of health care for most Americans.

One proposal -- to increase Medicare payments to general practitioners, at the expense of high-paid specialists -- has touched off a lobbying fight.

Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors -- a difficult argument at a time of huge budget deficits.

Some of the proposed solutions, while advancing one of President Barack Obama's goals, could frustrate others. Increasing the supply of doctors, for example, would increase access to care, but could make it more difficult to rein in costs.

The need for more doctors comes up at almost every congressional hearing and White House forum on health care. "We're not producing enough primary-care physicians," Obama said at one forum. "The costs of medical education are so high that people feel that they've got to specialize." New doctors typically owe more than $140,000 in loans when they graduate.

Lawmakers from both parties say the shortage of health-care professionals is already having serious consequences. "We don't have enough doctors in primary care or in any specialty," said Rep. Shelley Berkley, Democrat of Nevada.

Sen. Orrin G. Hatch, Republican of Utah, said, "The work force shortage is reaching crisis proportions."

Even people with insurance are having problems finding doctors.

Miriam Harmatz, a lawyer in Miami, said: "My longtime primary-care doctor left the practice of medicine five years ago because she could not make ends meet. The same thing happened a year later. Since then, many of the doctors I tried to see would not take my insurance because the payments were so low."

To cope with the growing shortage, federal officials are considering several proposals. One would increase enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants. A third would expand the National Health Service Corps, which deploys doctors and nurses in rural areas and poor neighborhoods.

Sen. Max Baucus, Democrat of Montana, chairman of the Finance Committee, said Medicare payments were skewed against primary-care doctors -- the very ones needed for the care of older people with chronic conditions like congestive heart failure, diabetes and Alzheimer's disease.

"Primary-care physicians are grossly underpaid compared with many specialists," said Baucus, who vowed to increase primary-care payments as part of legislation to overhaul the health-care system.

The Medicare Payment Advisory Commission, an independent federal panel, has recommended an increase of up to 10 percent in the payment for many primary-care services, including office visits. To offset the cost, it said, Congress should reduce payments for other services -- an idea that riles many specialists.

Dr. Peter J. Mandell, a spokesman for the American Association of Orthopaedic Surgeons, said: "We have no problem with financial incentives for primary care. We do have a problem with doing it in a budget-neutral way. If there's less money for hip and knee replacements, fewer of them will be done for people who need them."

The Association of American Medical Colleges is advocating a 30 percent increase in medical school enrollment, which would produce 5,000 additional new doctors each year.

"If we expand coverage, we need to make sure we have physicians to take care of a population that is growing and becoming older," said Dr. Atul Grover, the chief lobbyist for the association. "Let's say we insure everyone. What next? We won't be able to take care of all those people overnight."

The experience of Massachusetts is instructive. Under a far-reaching 2006 law, the state succeeded in reducing the number of uninsured. But many who gained coverage have been struggling to find primary-care doctors, and the average waiting time for routine office visits has increased.

"Some of the newly insured patients still rely on hospital emergency rooms for nonemergency care," said Erica L. Drazen, a health policy analyst at Computer Sciences Corp.

The ratio of primary-care doctors to population is higher in Massachusetts than in other states.

Increasing the supply of doctors could have major implications for health costs.

"It's completely reasonable to say that adding more physicians to the work force is likely to increase health spending," Grover said.

But he said: "We have to increase spending to save money. If you give people better access to preventive and routine care for chronic illnesses, some acute treatments will be less necessary."

In many parts of the country, specialists are also in short supply.

Linde A. Schuster, 55, of Raton, N.M., said she, her daughter and her mother had all had medical problems that required them to visit doctors in Albuquerque.

"It's a long, exhausting drive, three hours down and three hours back," Schuster said.

The situation is even worse in some rural areas. Dr. Richard F. Paris, a family doctor in Hailey, Idaho, said that Custer County, Idaho, had no doctors, even though it is larger than the state of Rhode Island. So he flies in three times a month, over the Sawtooth Mountains, to see patients.

The Obama administration is pouring hundreds of millions of dollars into community health centers.

But Mary K. Wakefield, the new administrator of the Health Resources and Services Administration, said many clinics were having difficulty finding doctors and nurses to fill vacancies.

Doctors trained in internal medicine have historically been seen as a major source of frontline primary care. But many of them are now going into subspecialties of internal medicine, like cardiology and oncology.

Title: Re: The Politics of Health Care
Post by: Crafty_Dog on April 27, 2009, 08:27:01 AM
The folks who ran Katrina now look to takeover the people's remaining medical freedoms.  A giant clusterfcuk comes , , ,  :cry:
Title: Steve Forbes: The Fight over 17% of the Economy
Post by: DougMacG on April 29, 2009, 10:08:43 AM
Crafty: "The folks who ran Katrina..."   or as we say in Mpls, the folks who brought us the bridge...  How come the same liberals demanding government-run healthcare aren't clamoring to move into public housing?

Steve Forbes makes many good points in this piece, also some very specific improvements to the current system that could easily be done now at no cost: "Allow mandate-free insurance policies... Permit people to buy health insurance across state lines... Make it easier for small businesses to buy insurance in a pool... Equalize the tax treatment of premiums... Raise limits on contributions to HSAs and on deductibles.

The Fight

The biggest domestic battle since the Clintons tried to nationalize health care in the early 1990s is about to unfold. Sometime in June the Obama Administration will formally introduce its plan to deal with the problem of the 46 million Americans who don't have health insurance. But the proposal will have far larger--and more ominous--implications for the country than the number of uninsured. This will be President Obama's attempt to do what the Clintons couldn't: truly socialize American health care. Make no mistake: Obama's plan will be the Administration's absolute top priority, trumping new energy taxes and the forced unionization of private-sector workers. Irrevocably sinking Washington's claws deep into an area constituting 17% of the economy is too great an opportunity for this Administration to pass up.

The President will propose that the government set up its own health insurance company, a Medicare-for-everyone system. The purpose, as he puts it, will be to provide competition with the private carriers. But this won't be competition; it will be a de facto government takeover.

The Administration will portray opponents as heartless for not wanting to do something about the uninsured. It will proclaim that private carriers make too much money and spend too much on overhead and marketing and that a nonprofit government insurer can make insurance affordable for those who currently don't get it through their employer or are out of a job.

Health care socialists will declare, "Look at Medicare. Despite its flaws and incomplete coverage it still provides a fantastic, affordable safety net for tens of millions of the elderly. Why can't we do that for everyone?"

Such a scheme would be a disaster. It would destroy innovation and lead to shortages and rationing. All the frustrations we experience with our current higgledy-piggledy system will pale beside the replacement's increasingly subpar care, ever lengthening lines for basic services and ever longer waits for "elective" surgeries.

Let's clear up some of the myths. Both Medicare and Medi-caid are heavily subsidized by privately insured patients, to the tune of $90 billion a year. Federal reimbursement in these two programs is far below cost, which is why an increasing number of doctors are refusing to treat or are substantially cutting back on the number of Medicare and Medicaid patients they see.

Medicare and Medicaid are rife with fraud. Unlike private insurers, the government refuses to spend real resources on routing out the wrongdoing: overbilling, overtesting and charging for visits not made or tests not given.

Obama beat them at presidential politics in 2008. Now he hopes to achieve what they conspicuously didn't do in health care.

The quality of care will decline. Health care "outcomes" for Medicaid patients are substantially below those of similar private-insurance patients. Fees are so low that patients are often treated more like ill, undesirable cattle.

Socialized systems are anathema to innovation. Breakthroughs in medications, diagnostic tools and medical devices require substantial capital investment and entail high risk. In the pharmaceutical industry, barely one in 250 promising compounds ever makes it to the marketplace. In the 1960s western Europe was a font of new medicines. But nationalized medicine put a stop to that. Today most of the breakthroughs come from the U.S. Even when another country invents something, it is in the U.S. that the product is fully developed. For example, the MRI breakthrough was achieved by a Brit, but MRIs are much more widely used in the U.S.

Medicare is no exception to this anti-innovation bias. As health care expert John C. Goodman, CEO of the National Center for Policy Analysis, has noted:

"Almost no one talks to his or her doctor on the phone. Why? Because Medicare doesn't pay a doctor to talk to you on the phone. And private insurers, who tend to follow Medicare's lead, don't pay for phone consultations, either. The same goes for e-mail: Only about 2% of patients and doctors e-mail each other--something that is normal in every other profession.

"What about digitizing medical records? Doctors typically do not do this, which means that they can't make use of software that allows electronic prescriptions and makes it easier to detect dangerous drug interactions or mistaken dosages. Again, this is something that Medicare doesn't pay for. Likewise patient education: A great deal of medical care can be handled in the home without ever seeing a doctor or a nurse--e.g., the treatment of diabetes. But someone has to give patients the initial instruction, and Medicare doesn't pay for that."

A federal government insurance company, with its subsidies, will attract more and more people from private plans. Instead of overtly running providers such as Aetna ( AET - news - people ) and UnitedHealthcare out of business, the federal government will take them over through mandating what they can and cannot do, as well as "reinsuring" private carriers for costs above certain levels. In other words, nongovernment insurance companies will become vassals and virtual subsidiaries of the Washington-run system.

What are the alternatives to this health care nightmare? There are many positive, nongovernment things that could instead be done.

--Allow mandate-free insurance policies. True catastrophic health insurance--not the current dollar-for-dollar coverage--is very affordable.

--Permit people to buy health insurance across state lines. Removing such barriers would sharply increase competition.

--Make it easier for small businesses to buy insurance in a pool, whether through trade associations or other kinds of affiliations.

--Equalize the tax treatment of premiums. Companies get a tax deduction for health insurance premiums, as do the self-employed. Why not give that break to employees who choose to buy their own individual policies? They would get a deduction or a refundable tax credit (meaning if they don't have a tax liability they'd get an actual check from Uncle Sam). Many small businesses offer no insurance, or those that do may offer policies some workers find unsatisfactory. These folks should have the ability to easily get their own alternatives.

--Raise limits on contributions to HSAs and on permissible deductibles.

All of these ideas would substantially cut the number of un-insured. For those truly uninsurable, why not give them the medical equivalent of food stamps and subsidize their catastrophic health insurance premiums through private companies?

President Obama says he wants to make health care affordable for all. Applying free-market principles to health care would do just that. Even with private-sector insurance there isn't a true free market--not when most expenses are covered by third parties. The key is to give consumers, not businesses and government bureaucracies, control of their health care dollars. Having businesses put money into workers' HSAs would be preferable to today's system. Once consumers actually control the money, they will apply pressure to get more value for it. After all, it's theirs.

Free-market dynamics have worked in virtually every other part of the economy, spurring production and innovation and helping us get more for less. Food is even more basic than health care. We don't have a third-party-payer system for food (except for food stamps). Result: Today people spend a smaller portion of their income for food than they did decades ago. And the variety of foods is greater than ever. Free markets can do the same with regard to health care; governments manifestly cannot.
Title: Re: The Politics of Health Care
Post by: JDN on April 29, 2009, 02:06:24 PM
Some good ideas Doug,

But, you said..... and I basically agree.....

Free-market dynamics have worked in virtually every other part of the economy, spurring production and innovation and helping us get more for less. Food is even more basic than health care. We don't have a third-party-payer system for food (except for food stamps). Result: Today people spend a smaller portion of their income for food than they did decades ago. And the variety of foods is greater than ever. Free markets can do the same with regard to health care; governments manifestly cannot."

Except for Medicare, the medical system is basically free market, yet it doesn't work, i.e. people are paying more for medical care than ever before.  Why?

My 2 cents.
People expect the "best".  Yet using food (as you did) for example, some people eat steak and some people eat hamburger.  And the system works.  In medical care everyone wants the newest and the best, but doesn't want to pay for it.  Tough choices need to be made.

Also, ease of entry.  Now, all doctors get paid the same whether they went to Harvard Medical School or Montana Tech.  Lawyers in contrast usually earn more if they went to Harvard versus the joke of a college; why not Medical?  And why not allow easy entry for foreign medical MD's if they pass the medical exam here?  Again, it works for lawyers.  Yet doctors keep a closed community limiting the number of doctors in America to
artificially raise incomes.  Is that right?  Some doctors as you pointed out are declining Medicare patients.  What about the Doctor's oath?

Bottom line, people expect the best, but will not pay for it out of their own pocket.  Tough choices, who gets what procedures, what technologies, what drugs, etc must be made otherwise a competitive system will never work.  America pays more than nearly any other country for their health care, and yes, for the high tech issues like cancer etc it is the best, but for the everyday Joe, our morbidity is not superior to most industrialized countries. 

And then we get back to the issue of whether Medical care is a right, like a Fire Department, Police Department, roads, etc available and equal for all, or is only the best available to the affluent.  Is that right???  Maybe yes, maybe no. 

But something needs to be done, that is a given...
Title: Caged Free Market
Post by: Body-by-Guinness on April 29, 2009, 03:33:13 PM
Except for Medicare, the medical system is basically free market, yet it doesn't work, i.e. people are paying more for medical care than ever before.  Why?

Whoa! Not sure an informed discussion can follow a statement as inaccurate as that. The current US system is a heavily regulated, oddly constructed hodgepodge that spins off perverse incentive with great frequency. Most health insurance is provided through a person's employer, for instance, rather through any free market vehicle hence driving a wedge between the market and the health insurance decision making process. Until recently many health insurance policies did very little to reward good decision making and punish bad decision making on the part of the insured, again divorcing tangible consequences from market forces. Then a given employer's policy wasn't transferable to a new job, which prevents some from making market oriented vocational decisions as they are tied via pre-existing conditions or other situations to their current employer. Then there are the uninsured who receive basic medical services via the ER with those costs passed on to the insured, rules and regs that prevent an insurer in one state from competing in another, duchies and principalities such as Massachusetts passing all manner of regulations meant to insure all that instead drives doctors out of the system, FDA regs, EPA regs, regs that keep the pain ridden and terminally ill from easily accessing narcotic analgesics and so on. And all these examples of non-market oriented mechanism are what leap to mind with a few minutes thought. A little research would doubtless reveal considerably more.

It galls me when the housing crash is called a failure of the free market when massive government intervention, political favor granting, and ill-considered tinkering had much to do with it. Similarly it strikes me that any discussion of the current health care system is doomed to failure if its initial premise is that we are currently operating under a free market system where health care is concerned. Indeed, when attempts at market based reforms are demagogued as they were last election cycle and when nanny state supporters struggle ceaselessly to impose a single payer system I'm surprised the term "free-market" is even raised in this debate as it's clearly not part of the current health care paradigm.
Title: Re: The Politics of Health Care
Post by: Body-by-Guinness on April 29, 2009, 03:37:46 PM
A piece written just prior to the election that speaks to the points made above:
Candidates' competing prescriptions for health care
by Robert E. Moffit, Ph.D.
October 24, 2008 |
[back to web version]
Approximately 47 million Americans lack health coverage. It's a huge problem.

To their credit, both major presidential candidates have both ponied up ambitious plans to deal with it. Their approaches are expansive and expensive. And that's where the similarities end.

When it comes to the future of America's health system, John McCain and Barack Obama hold two very different visions.

The Obama health plan would centralize power in Washington.

Increasingly, federal officials would hold the purse strings and make the decisions on health care delivery.

The McCain plan would decentralize control over health care financing and decision-making, empowering individuals and families. In the public health arena, states would retain authority rather than cede power to the feds.

In the case of both plans, some crucial details are sparse. But it's easy to spot the major differences in approaches taken by the candidates.

To expand coverage, Sen. Obama would take four major steps:

Create a new national health plan. The new government health plan would enroll those without job-sponsored coverage and those not eligible for coverage under existing government health programs, such as Medicaid and SCHIP.
Create a national health insurance exchange. The exchange would be the ultimate regulatory "watchdog," making sure that private health plans competing with the government plan met the same regulatory standards as those applied to the new federal health plan.
Impose a "play or pay" employer mandate. Employers would be expected to offer their workers a level of health coverage set by the government. Those who didn't would have to pay a new federal tax - of an unspecified amount - which would be used to help finance the new government plan.
Embrace new regulatory initiatives governing health care delivery by physicians and other medical professionals, and expand existing government health programs - particularly Medicaid and SCHIP.
Just how much that would entail government control over medical practice is, again, unclear.

No doubt, Obama's approach would take a big bite out of the uninsured problem. But not as much as you might think.

His approach adds millions to the public health rolls by skimming millions from private health plans - especially employer-based plans.

The Lewin Group, the country's most authoritative health econometrics firm, estimates the plan would extend government health coverage to 48.3 million Americans. But nearly half of those (47 percent) are currently insured through their employers. They and their families would "gain" government coverage because the Obama approach makes it economically advantageous for their companies to discontinue their health benefits and dump them into the government-run plan.

The McCain plan calls for three major steps:

Replace federal tax breaks exclusively for employment-based coverage with a universal health care tax credit ($5,000 for a family, $2,500 for an individual). The new health care tax credit would replace the current employees' tax exclusion, not the employer's deduction.
Create a national market for health insurance. Individuals and families could buy state-regulated health insurance plans anywhere in the country, not just in the state where they happen to live.
Implement a "guaranteed assistance program." The feds would give states financial assistance to provide affordable coverage for the 2 million to 5 million Americans considered "uninsurable" due to serious medical conditions. This would be accomplished through state-based high-risk pools or similar mechanisms
Like Obama, McCain would also promote changes in care delivery with an eye toward securing greater value for health care dollars.

Independent analysts generally see McCain's proposal, powered by the universal health care tax credit, as producing a rapid expansion in private health coverage and a reduction in dependency on government programs. The Lewin Group estimates it would extend private insurance coverage to an additional 26.5 million Americans. Millions of Americans on Medicaid, a welfare program, would transition over to private health insurance. The net reduction in the ranks of the uninsured, according to Lewin: 21.1 million.

The most common concern about the McCain plan focuses on its financing.

Some critics imply his proposal to pay for the tax credit by taxing health benefits amounts to a tax increase. In truth, however, this approach would yield a major tax cut to the vast majority of Americans, particularly for the middle class. Analysts at the Urban Institute estimate the change in tax treatment would leave the typical family roughly $1,200 ahead annually.

The financial question pales in comparison to the far larger issue at hand: the direction this country will take in crafting a 21st century health system. Sen. Obama's plan would take us on the path to a government-controlled system. Sen. McCain's approach would shift the reins of health care financing and selection into the hands of individuals and families.

Robert Moffit, is director of the Center for Health Policy Studies at The Heritage Foundation.
Title: Re: The Politics of Health Care
Post by: DougMacG on April 29, 2009, 09:13:08 PM
"Except for Medicare, the medical system is basically free market"

Guinness answered this better, but I was going to say that sure - it's a free market - about like OPEC, lol.  Government based healthcare and government rules and mandates I think are a huge part of the market and as Forbes demonstrates, set the tone for how things are done in the rest of the market.  I would not favor a totally unregulated market in medicine, but if we want control on costs we have to find a way for competition and consumer choices to flourish.

Healthcare was compared with the market for food but high-tech might be a more insightful comparison.  I can buy a computer model that has been proven for a few years and widely available for a few hundred bucks.  Or I can buy the very latest experimental high tech device barely out of the lab for maybe hundreds of thousands.   In every other area we balance those choices with our budget and our circumstances.  Not with other people's money available and life and health choices on the line.  In health care we keep wanting the newest and latest treatment no matter the price or whether or not the performance is proven and we demand that someone else pay for it.

Do you want government to ration these decisions or prices and individual choices to do that?  Neither is perfect, but I prefer leaning toward the price mechanism and free choices over the bureaucracy as much as possible.

Studies show that a lion's share of health care costs, especially the more recent increases, go toward our treatments during our last 6 months of life.  Basically we are denying our own mortality, and then dying anyway.  If you made those treatment choices out of your own saving, and imagine if you had the right to pass your earned, accumulated wealth on to your family, would you still want to pay any price and fight every fight even the ones not winnable while knowing that you are spending the last of your family's inheritance?
Title: Re: The Politics of Health Care
Post by: JDN on April 30, 2009, 08:07:03 AM
Except for Medicare, the medical system is basically free market, yet it doesn't work, i.e. people are paying more for medical care than ever before.  Why?

Whoa! Not sure an informed discussion can follow a statement as inaccurate as that. The current US system is a heavily regulated, oddly constructed hodgepodge that spins off perverse incentive with great frequency. Most health insurance is provided through a person's employer, for instance, rather through any free market vehicle hence driving a wedge between the market and the health insurance decision making process. Until recently many health insurance policies did very little to reward good decision making and punish bad decision making on the part of the insured, again divorcing tangible consequences from market forces. Then a given employer's policy wasn't transferable to a new job, which prevents some from making market oriented vocational decisions as they are tied via pre-existing conditions or other situations to their current employer. Then there are the uninsured who receive basic medical services via the ER with those costs passed on to the insured, rules and regs that prevent an insurer in one state from competing in another, duchies and principalities such as Massachusetts passing all manner of regulations meant to insure all that instead drives doctors out of the system, FDA regs, EPA regs, regs that keep the pain ridden and terminally ill from easily accessing narcotic analgesics and so on. And all these examples of non-market oriented mechanism are what leap to mind with a few minutes thought. A little research would doubtless reveal considerably more.

It galls me when the housing crash is called a failure of the free market when massive government intervention, political favor granting, and ill-considered tinkering had much to do with it. Similarly it strikes me that any discussion of the current health care system is doomed to failure if its initial premise is that we are currently operating under a free market system where health care is concerned. Indeed, when attempts at market based reforms are demagogued as they were last election cycle and when nanny state supporters struggle ceaselessly to impose a single payer system I'm surprised the term "free-market" is even raised in this debate as it's clearly not part of the current health care paradigm.

Let me try...

Albeit some years ago, having worked for William Mercer (Benefit Consultants) for a number of years, representing large 50,000+ee employers, I assure that these employers (the buyers) are interested in reducing costs.  HMO's have become prevalent; deductibles have been raised, higher co-pays were instigated, networks established, etc all with the express purpose of lowering costs.  For a number of years, group plans have rewarded good decision making and punished bad decision making.  As for the market, well the market (competing insurance companies) are the ones who fought for pre-existing clauses.  And large groups, basically self insured likes pre existing clauses as well.  Do you want to hire and employee, pay him 30K but absorb a 500K medical expense?  Market forces have denied these people coverage.  Again, market forces denied the transferability of coverage; who wants a new sick employee?  Better to have a short form medical questionnaire and deny coverage to the uninsured or ill.  It was only the government intervention that COBRA came about.  Better than nothing a lifeline to some.

I agree, the uninsured bog down the ER room.  But again, market forces deny coverage to these people.  It will take the government to intervene to provide coverage. 

As for state regulation, why on other posts is "state's powers " lauded and encouraged?  Yes, a few states implement silly rules, but I doubt if many doctors leave the state because of it.  Nor many employers for that matter; they just suck it up.  And oddly, market force again usually will dictate which rules and regs are passed; employers don't sit on the butt; but rather offer stiff opposition to almost any law increasing costs.  I remember when pregnancy wasn't covered and a few states started to mandate the coverage.  There was a huge fight, market forces wanted to deny coverage, but in the end government intervened.  And I think we are better off.

As for keeping the pain ridden and terminally ill from easily accessing narcotics, well in our litigious society, it is not easy.  You may want your loved one to have these medications, and if they die from the medication and/or become addicted logic your logic (and mine) says you eased their pain.  But someone else may not agree.  And who is to decide? And think about the possible abuse.  Those drugs are cheap; it is not a cost issue, but a safety issue.

Free market?  There are lots of insurance companies competing here in California.  And a doctor is free to choose how to run his practice.  My doctor for example will not take any HMO and only a very few (high paying) PPO's.  He prefers  cash.  A new doctor just out of school to increase their business often will sign up for any HMO that will take him.  Ask at UCLA if the top oncologists will take HMO.  The answer is a resounding "NO".  I know from a friend's personal experience.  That is the free market at work.

In review the issues of transferability, pre-existing conditions, uninsured, etc are essentially denied coverage because of "free market" not in spite of; frankly it's not profitable business; that's easy.  It takes the government to intervene to demand coverage and make a level playing field otherwise why should a business enter a non profitable market?

The issue is choices, hard choices.  As I said before, we want our cake and eat it too.  Frankly, I like and agree with most of Doug's immediately preceding posted comments.  Choices; but America wants the newest and best medical care for everyone and if it isn't offered America is indignant.  Some choices need to be made.  Maybe an insurance company is best, or the government, but individuals?  It's tough to say "no, don't use an MRI (even though it's better) a CT Scan is good enough".  I can choose my computer based upon my financial situation and need, but I want the "best" medical care for my family whether I can pay for it or not.  And I will let you (not personal Doug) decide not to spend the family's inheritance not to keep your wife alive later in life; it's tough... albeit logical.  We are too emotionally attached.

I'm not saying an all government plan is the answer.  I am saying that something needs to be done.  And yes, there is waste.  But the government  needs to mandate that somehow everyone will be insured.  That pre-existing condition clauses don't exist, etc.  Medical care is not buying a new computer, it is a life at stake. 

Title: Re: The Politics of Health Care
Post by: Crafty_Dog on April 30, 2009, 09:06:20 AM
Re transferability:

Doesn't this issue have its roots in the wage and price controls of WW2?  IIRC the govt did allow health insurance to become part of the payments to workers without taxing it-- but if an individual wants to buy insurance on his own, he must do so with after tax dollars.  Yes?
Title: Re: The Politics of Health Care
Post by: DougMacG on April 30, 2009, 09:14:39 AM
"And I will let you (not personal Doug) decide not to spend the family's inheritance not to keep your wife alive later in life; it's tough... albeit logical.  We are too emotionally attached."

Don't worry JDN, nothing personal taken, but you read me wrong.  I am saying that it IS a valid choice to spend your own money on heroic health measures, or mansions yachts and trips around the world instead of leaving a nest egg. But it doesn't work for ALL of us to choose the highest cost solutions on everything and then demand that someone else pay for it - and keep costs down.
Title: Re: The Politics of Health Care
Post by: DougMacG on April 30, 2009, 09:29:14 AM
"Doesn't this issue have its roots in the wage and price controls of WW2?  IIRC the govt did allow health insurance to become part of the payments to workers without taxing it-- but if an individual wants to buy insurance on his own, he must do so with after tax dollars.  Yes?"

Yes, though you can make limited pre-tax HSA contributions (health savings account). 

Sure enough, health care was federalized though the tax code.  JDN makes a good point about states rights.  I will indulge him on that and agree with any move that takes the feds completely out of the health care business, and auto manufacturing, and housing/mortgages, and ...
Title: Re: The Politics of Health Care
Post by: JDN on April 30, 2009, 10:00:45 AM
"And I will let you (not personal Doug) decide not to spend the family's inheritance not to keep your wife alive later in life; it's tough... albeit logical.  We are too emotionally attached."

Don't worry JDN, nothing personal taken, but you read me wrong.  I am saying that it IS a valid choice to spend your own money on heroic health measures, or mansions yachts and trips around the world instead of leaving a nest egg. But it doesn't work for ALL of us to choose the highest cost solutions on everything and then demand that someone else pay for it - and keep costs down.

Glad nothing personal taken.

Yes, It is a valid choice how to spend your own money, however I think people can logically find it rather easy not to buy the mansion, yacht(s) :-) or trip around the world in their late years.  Yet difficult to deny their wife the best care (i.e. most expensive).  I'm not sure you can equate the two.  It's a tough choice, although I concede your logic, such decisions are often made with emotion; logic doesn't enter into it.  "Because it's expensive, "Let them die" or don't do another round of the latest Chemo ($5000 for 10 pills+++) cocktail" is hard to say...  Will/Do people consciously accept a lower level of medical care for lower quality of care in exchange for lower cost?  Especially on the life threatening issues?  I'm not sure...  And is that even right?
Title: Re: The Politics of Health Care
Post by: Body-by-Guinness on April 30, 2009, 10:17:39 AM
Albeit some years ago, having worked for William Mercer (Benefit Consultants) for a number of years, representing large 50,000+ee employers, I assure that these employers (the buyers) are interested in reducing costs.

I certainly assume they are. But they are not the end user of the health product and hence have little impact on the decision making occurring at the time a health service is provided. A system where consumers are insulated from market forces is not a "free-market," and hence should not be indicted as a free market failure.

HMO's have become prevalent; deductibles have been raised, higher co-pays were instigated, networks established, etc all with the express purpose of lowering costs.  For a number of years, group plans have rewarded good decision making and punished bad decision making.

Which is why I said "until recently." Still, in my market and most others there are non-HMO choices that many opt for, as I did recently having grown annoyed with the HMO habit of rationing care via long waits and bureaucratic hoop navigation when seeking anything other than preventative care.

As for the market, well the market (competing insurance companies) are the ones who fought for pre-existing clauses.  And large groups, basically self insured likes pre existing clauses as well.  Do you want to hire and employee, pay him 30K but absorb a 500K medical expense?  Market forces have denied these people coverage.  Again, market forces denied the transferability of coverage; who wants a new sick employee?  Better to have a short form medical questionnaire and deny coverage to the uninsured or ill.  It was only the government intervention that COBRA came about.  Better than nothing a lifeline to some.

As mentioned, non-free market forces such as limiting plans to a given state prevent innovation that might allow folks with ongoing illness to band together and seek specific treatments. My mother had multiple sclerosis and died due to its complications, but was limited throughout her life by the insurance available through my father's employer. There is a very active MS community out there, as there is for many illnesses, and it doesn't take a lot of imagination to envision an entrepreneur who caters to a targeted market creating a plan focussed on a specific set of needs. Throw portable health insurance into the mix and I'm confident innovation would occur. Alas, non-market based interventions prevent this from occurring, necessitating government intervention such as COBRA.

I agree, the uninsured bog down the ER room.  But again, market forces deny coverage to these people.  It will take the government to intervene to provide coverage.

Hmm, I'm having some trouble wrapping my head around this statement. Isn't it market forces that deny this same group yachts? Need we demand government intervention to address this inequity too? I was going to use the example of higher end housing, but in fact the government did intervene on that front, I remember reading somewhere. Remind us how that turned out.

Again, the debate as you framed it is that the free market has failed to provide health care, though as hopefully has been established, the market isn't free so indicting it for failures such as these puzzles me. Moreover, attempts to introduce free market devices such as tax free medical savings accounts that would provide the uninsured with an incentive to save money and participate in something like a High Deductible Low Premium insurance plan are routinely nixed by the very same government officials who favor single payer schemes. Just a coincidence, no doubt. Markets are stifled, then blamed by the political types. Good work if you can get it, I guess.

As for state regulation, why on other posts is "state's powers " lauded and encouraged?

MA is welcome to make all doctors wear pink mohawks and walk around flapping their arms like birds if they'd like, just don't call it an expression of the free market, yes?

Yes, a few states implement silly rules, but I doubt if many doctors leave the state because of it.  Nor many employers for that matter; they just suck it up.  And oddly, market force again usually will dictate which rules and regs are passed; employers don't sit on the butt; but rather offer stiff opposition to almost any law increasing costs.

"Taxachusetts" as some of its residents less than fondly call it is in fact is experiencing contractions in employment and population that predate the recession, is trying to come up with schemes to tax people who live in neighboring states because of the high cost of living those folks live elsewhere but work in MA, is looking at ways to recover sales tax when residents make purchases outside the state to avoid high rates, etc. My very liberal sister the Boston lawyer has even gotten to the point where she is connecting the dots; I'd be very surprised if these same circumstances don't impact medical care.

I remember when pregnancy wasn't covered and a few states started to mandate the coverage.  There was a huge fight, market forces wanted to deny coverage, but in the end government intervened.  And I think we are better off.

Back when I started riding BMW motorcycles we use to say "you can get a Beemer in any color you want as long as it is black." Similarly, you can get any sort of insurance you want, as long as it's offered by your employer. Wish there was a way to lay a wager over what would have happened if portable insurance had been around back then; I'd be willing to bet pregnancy insurance would have come along quicker if it was something people could have easily opted for, but that choice, ie the free market, was disallowed by employers. Indeed, a lot of what you cite in fact refutes the premise that the markets are free. Is this being noted or am I gonna start wondering why I'm participating in a counterproductive loop?

As for keeping the pain ridden and terminally ill from easily accessing narcotics, well in our litigious society, it is not easy.  You may want your loved one to have these medications, and if they die from the medication and/or become addicted logic your logic (and mine) says you eased their pain.  But someone else may not agree.  And who is to decide? And think about the possible abuse.  Those drugs are cheap; it is not a cost issue, but a safety issue.

And so the free market is invoked and trumped in the same paragraph. If we are talking about markets let's talk about markets. If we are talking about morality or whatever let's stick to that. The drug example, however, is a very straightforward one illustrating just how far the medical market is tainted by non-market forces, which again gives lie to your premise.

Free market?  There are lots of insurance companies competing here in California.  And a doctor is free to choose how to run his practice.  My doctor for example will not take any HMO and only a very few (high paying) PPO's.  He prefers  cash.  A new doctor just out of school to increase their business often will sign up for any HMO that will take him.  Ask at UCLA if the top oncologists will take HMO.  The answer is a resounding "NO".  I know from a friend's personal experience.  That is the free market at work.

Wow, I can't find the energy to start unraveling that. Here's a question you can pose to your doctor: does he think he'd see more patients or fewer if everyone had portable insurance unburdened by government regulation? I think the answer is obvious, and if it is what does it say about the rest of your arguments?

In review the issues of transferability, pre-existing conditions, uninsured, etc are essentially denied coverage because of "free market" not in spite of; frankly it's not profitable business; that's easy.  It takes the government to intervene to demand coverage and make a level playing field otherwise why should a business enter a non profitable market?

I trust my responses to this point make it clear that I disagree with your summary, and similar sorts of government interventions like the recent one in the housing market speak for themselves.

I feel an attack of the snarkies coming on so I'm gonna leave it there. I'm not hardwired in a manner that allows me to calmly discuss a premise as its antithesis is cited as evidence. If you are going to persist in identifying the free market while citing examples that are not part of free markets as I understand them, then perhaps it's time to define the term so discussion can proceed sans the cognitive dissonance that starts my acid tongue waggin'.
Title: Re: The Politics of Health Care
Post by: JDN on April 30, 2009, 12:09:59 PM
BbyG said, "Here's a question you can pose to your doctor: does he think he'd see more patients or fewer if everyone had portable insurance unburdened by government regulation? I think the answer is obvious, and if it is what does it say about the rest of your arguments?"

I don't think my doctor worries too much about government regulation slowing down the number of patients visited; he is pretty full 5-6 days a week right now.  His income might be affected by the paperwork, but then free enterprise insurance company's paperwork is much if not more to blame as well.  As for portability, yes, it's a great idea.  Never happened until the government stepped in and demanded COBRA.  Free enterprise is driven by profit; nothing wrong with that.  But actuarially there is little or no profit in portability, or covering people who banded together with MS or Cancer, etc.  Imagine going to an underwriter and say, "Hey, I've got a group of 5000 people diagnosed with cancer or MS or... would you like to cover them?"  Again, it will never happen.  Only the government can intercede. 

And don't forget, if you feel so strongly you can always opt out of your employer's plan and chose an individual plan.  It will cost you, but if you can get covered it's portable.  I like that and that's why I have an individual high medical savings account for many years.  I don't want to ever be left high and dry with a pre-existing condition if my employer decides to close the office.

And it IS a discussion on morality as well; it cannot be avoided.  No one would say buy the biggest and best yacht versus a dinghy if you are are a tight budget; it is a luxury.  But is medical care a "luxury"?
Or a necessity?  And if I never could afford my yacht, one would say "oh well" but if I died because I couldn't afford or obtain insurance, well... something is very wrong...  It's different. And morality IS an issue.
Title: Re: The Politics of Health Care
Post by: Body-by-Guinness on April 30, 2009, 01:00:40 PM
As long as "free-market" and "morality" aren't conflated within a discussion I don't have an issue. Just don't argue one while introducing the other and behaving as though they are one in the same.
Title: A Pipe Dream
Post by: Body-by-Guinness on May 01, 2009, 05:32:00 AM
So last night I had a wan notion: how 'bout if we start a movement to make any health insurance scheme produced by congress and signed by the president be beta tested for an election cycle--4 years--by congress and all federal employees and then have the efficacy of that plan reviewed by the GAO? If it's something they want to foist on the nation then they can prove that it works first.

A pipe dream, I realize, and even if it were to occur congress itself would insert little clauses in line 10,583 that would give them access to the sort of backdoor care patrician a$$holes demand, but they exempt themselves from so much of what they drop on others it'd be nice to see it turned around, for once.
Title: Republicans killed Jack Kemp?
Post by: DougMacG on May 04, 2009, 09:54:57 PM
From 'Rest in Peace' , Sen. Specter blamed the Republican party for the death of Jack Kemp.  My first reaction is just bad manners; sounds like Specter is getting angry and bitter along with growing old. I saw Specter on the shows - he is not senile but getting a little slower and sadly desperate in his cling to power.  For his new party, though, this type of thinking is an accepted pattern.  They said the same things about cures they say should have happened for Christopher Reeves and Michael J. Fox. 

Besides bad manners, one issue with Reeves and Fox is the stem cell issue and the other with Specter, Kemp and cancer is about public spending. (Let's leave stem cell controversy for another day.)

Public spending on medical research is Specter's beef (or maybe he's just rambling because he saw a camera and microphone on - like Biden does).  My view is out of the mainstream, but I think the federal government should be a whole lot smaller, the cost should be a whole lot lower, privately we would be a whole lot wealthier and then our favorite form of charity might be to give money directly to medical research for the ailments that are most likely to strike our families.  Cancer research is certainly at or near the top of anyone's list.

Ironically, prostate cancer might be one of the most likely types many people here might face and the survival rate here is the U.S. under our current, 'failed' system with underfunded research is far higher than in the countries with the national healthcare systems that we strive to emulate.

If we were to slash all the programs out of the budget that aren't called for in the constitution I would hopefully cut medical research last, but I would prefer to see it off of coercion-based funding. That's just me, but I wouldn't put a man on the moon at taxpayer expense either.

One objection I always have is that we measure compassion (and results) in dollars spent.  As some watching the global warming fiasco have noticed, science at major institutions sometimes seems to be more about the funding than about the cure or the truth.  Published results always seem to call for more study needed and more funding.  CCP, you have more real world exposure to the medical research side than most of us so let us know what you see...

Another related point is that in health care we spend a huge portion of the money on the last 6 months of life.  In the federal budget other than medical research we spend zillions on programs that are either counter productive or lower in benefit to cost ratio than crucial medical research.  Setting priorities means putting something AHEAD of something else for funding, not just sending more and more to every feel-good bill that ever passed a previous congress.  Did Specter make clear what we should spend LESS on in order to fund eternal life?

Two ideas for government involvement in research:  a) offer rewards for results instead of funding for study, or b) consider buying up the best patents and then making 'the cures' available everywhere for free, a public good.

MD's here may see it differently but I doubt that there is 'a cure' or elimination for cancer.  I think that we just trudge forward with better preventions, better treatments, better results and longer life expectancies just like we are doing and seeing now.

[If Specter really wanted to save lives and protect the weakest among us, he could change his position on the first issue he mentioned having in common with his new party, pro-choice support for abortion rights.]

CCP and others, your thoughts?
Title: Cargo Cult Science
Post by: Body-by-Guinness on May 05, 2009, 10:06:31 AM
As some watching the global warming fiasco have noticed, science at major institutions sometimes seems to be more about the funding than about the cure or the truth.  Published results always seem to call for more study needed and more funding.

I subscribe to an RSS feed from Eureka Alert, a journal of breaking scientific research, but find myself marking all the items as read when in fact I haven't seen them because most the headlines try to work in some wan relationship to AGW in. It's freaking embarrassing to read piece after piece where some author/committee is so starved for funding/attentions that they come up with crap like "Global Warming Responsible for Lower Rate of Circumcision in Sub-Saharan Africa." The whole AGW boondoggle has turned into a warped funding talisman, a talisman that is diametrically opposed to the values of science. It is downright scary to think that we are raising a generation of scientists who think that cargo cult funding schemes have to be incorporated into every scientific effort; I've little doubt this regimen of perverse incentive will bite us on the fanny down the road.
Title: Re: The Politics of Health Care
Post by: ccp on May 06, 2009, 11:49:12 AM
I am not an expert on cancer research but from what I have read about ongoing research over the years suggests that Specker's remarks are no less ridiculous, absurd, and downright stupid.

There has been more money spent on cancer research than anything as far as I know.

Treating much less curing cancer is simply *that complex* and *that challenging*.  More dollars he implies?  What/who do you throw more dollars to?  There are only so many researchers.  There are only so many avenues that are discovered to explore at any given time.  There is only so much we can learn at a time. It takes *years* if not decades of study to prove anything one way or the other.  Why we haven't even been able to prove if doing a prostate screening blood tes (PSA) is beneficial or harmful after many years of trying to figure it out!

I am not clear how much of the confusion is based on *misunderstanding* by the media, politicians, public, etc.  I am not sure how much of it is grandstanding by scientists themselves who are no less interested in money, politics, power, fame, other agendas than the rest of humanity.  don't let the fact that they research cancer fool you into thinking they are all so noble and pure.  Quite the contrary.  Some of stories I have heard from researchers are not pretty with regards to pettiness.

I am really not sure.  But taken on the face of it, Spector's comments seem totally irresponsible.

As for your two ideas:

***Two ideas for government involvement in research:  a) offer rewards for results instead of funding for study, or b) consider buying up the best patents and then making 'the cures' available everywhere for free, a public good.****

I think the first is a bad idea because most research ends in failure.  *At least* to the tune of 90%.  So I think that will stiffle a lot of research.   Who wants to pay for something that has unusually high risk? 

As to the second, I think it is an *excellent* idea.

Just my two cents.


Title: Another Fine Expression of the Free Market Meeting Patient Needs
Post by: Body-by-Guinness on May 06, 2009, 03:31:33 PM

Tenth Circuit to Hear Arguments Today on the Science Behind Painkiller Prosecutions

Radley Balko | May 6, 2009, 4:12pm

A couple of weeks ago, Jacob Sullum blogged about a case in Kansas where the government seems to be targeting not only Stephen Schneider, a physician specializing in pain treatment and his wife Linda, but also Siobhan Reynolds, who heads up the pain patient advocacy group the Pain Relief Network.

Reynolds has become a sort of shoestring-budgeted PR machine for doctors under investigation whom she believes are getting railroaded. She educates local media on pain treatment, including the sometimes very high doses of medication needed to treat patients who have built up a tolerance to opiods. Her efforts in the Schneider case have resulted in some refreshingly balanced coverage. And that apparently has Assistant U.S. Attorney Tanya Treadway steaming.

As Sullum noted, last year Treadway tried to impose a gag order on Reynolds. She was denied. Several of Schneider's patients who had spoken out on his behalf say shortly after, federal agents forced their way into their homes, in one case confiscating a letter Schneider had written from prison.

So Treadway is now calling Reynolds the "subject" of a grand jury investigation into possible obstruction of justice. Treadway has asked Reynolds to turn over all of her correspondence with pain patients, attorneys, the Schneiders, and just about everyone else in any way associated with the case. Reynolds is fighting the subpoena, and is now represented by the ACLU.

Last year, Treadway also attempted to bar the Schneiders from obtaining court-appointed counsel, citing their considerable wealth. The problem is that everything the Schneiders own is subject to forfeiture, meaning any attorney who agreed to take their case would do so knowing there would be a pretty good chance he'd never get paid. The government essentially argued that the accused couple should have no counsel in court (unless they could find someone to take the case pro bono), and be barred by law from having anyone defend them in public. When all of that failed, they asked for a change in venue, claiming that patients and Reynolds speaking out for the Schneiders had tainted the jury pool.

Treadway's efforts are particularly egregious given that it has become pretty standard practice for U.S. attorneys to issue press releases and sometimes even call press conferences to announce when a physician has been indicted for over-prescribing painkillers—as they did in the Schneider case. The government can work the media and jury pool all it likes. But when a suspect gets an advocate who knows how to work the media, they first try to shut her up with a gag order, then intimidate her with a grand jury investigation.

But Treadway's aggressiveness may well come back to bite her. Her office originally tried to link the Schneiders' practice to 56 alleged patient overdose deaths. U.S. District Judge Monti Belot balked, and threw out all of the deaths but four. He then sternly warned Treadway not to appeal his decision. Belot also instructed the government not to use inflammatory descriptions like "pill mill" in front of the jury, another common tactic in these cases.

Treadway appealed anyway, delaying the Schneiders' trial by months. The interesting thing is that her appeal allowed the defense to file a cross-appeal that will challenge not only Treadway's attempt to link the Schneiders to the four remaining deaths, but also the government's entire methodology of using "red flags" and questionable links to patient deaths to prosecute pain doctors. Reynolds, who has seen a lot of these cases, says it's the first case she can recall where a federal appeals court will hear arguments on whether the government's system of identifying what it says are drug diverting physicians is scientifically sound enough to be admitted into evidence.

One red flag the government uses, for example, is to look for physicians who simply prescribe a raw number of pills that investigators say is too high, a practice pain advocates say has made doctors afraid of engaging in the high-dose opiate therapy course of chronic pain treatment that's been so effective. Other red flags include doctors who spend what investigators say is too little time with patients to make an accurate diagnosis, a problem pain advocates say has become increasingly common not because more doctors are selling scripts to addicts and drug dealers, but because the few doctors who do still treat chronic pain are overwhelmed with patients whose former doctors have been arrested, stripped of their licenses, or run out of business by investigations.

The Schneiders' brief also argues that the government's practice of linking deaths to opioids is problematic because such deaths often include patients who merely had high concentrations of opiates in their systems and died unexpectedly. Several of the patients who died of heart attacks, for example, weren't checked for signs of heart disease. The heart attack plus a high concentration of opiods in their system was enough for the government to link the opiods to the heart attack.

The government's argument that the Schneiders were causing a disproportionately high number of deaths also rests on comparing the number of clinic patients who died to the population at large, instead of to the number of patients undergoing treatment at a clinic not suspected of any wrongdoing. It isn't all that difficult to see how patients undergoing treatment for chronic pain might have a higher mortality rate than the general population.

The federal government has been using these arguments to prosecute doctors for years, but to this point, there has never been a formal hearing to determine if there's any actual science behind them. Pain specialists are skeptical. The general consensus is that red flags are fine for identifying potentially problematic doctors by, say, a medical board, but they're simply not enough to find a doctor guilty of criminal wrongdoing. Pain specialist and pain organizations have also long decried the arbitrariness with which the red flags and ambiguous links to patient deaths are applied. Today, the U.S. Tenth Circuit Court of Appeals will hear their complaints.

There would be some poetic justice here if Treadway's aggressive tactics in the Schneider case were to result not only in a fatal blow to her own cause, but in the Tenth Circuit becoming the first federal appeals court to call into question the very foundation of how the government builds its case against pain physicians.

Prior Reason coverage of the pain issue here.
Title: The Sound of Republican Silence
Post by: Crafty_Dog on May 08, 2009, 08:55:20 AM
Listen. That sound of silence? That's what's known as the united Republican response to President Barack Obama's drive to socialize health care.

The president has a plan, and he's laid it on the table. The industry groups that once helped Republicans beat HillaryCare are today sitting at that table. Unions are mobilized. A liberal umbrella group, Health Care for American Now, is spending $40 million to get a "public option," a new federal entitlement that would kill off private insurance. Democrats passed a budget blueprint that will allow them to cram through that "public option" with just 51 votes.

Republicans? They're trying to figure out what they think.

Well, not all of them. Earlier this week I ended up in the office of Oklahoma Sen. Tom Coburn, where the doctor was hosting North Carolina Sen. Richard Burr. The duo is, for the second time, crafting a comprehensive reform that would lower costs, cover the uninsured, and put Americans in control of their health care. And while the senators decline to talk GOP politics, their bill raises the multitrillion-dollar question: Will the party have the nerve or sense to coalesce behind some such conservative alternative to the Democratic product?

They'd better, because the days of Republicans winning these battles solely by spooking Americans are over. Phil Gramm, Harry and Louise might have scored with that approach in the 1990s, but the intervening years have brought spiraling costs and public unrest. Americans want a fix. Democrats promise one. The GOP can't tank the public option simply by complaining it will kill private insurance. The party has to finally elucidate how it plans to allow the private market to work.

Not that the senators don't think Republicans need to make clear to the country that the public option is, in Mr. Burr's words, "a fast track to a single-payer system." But they are also operating on the belief that Republicans must go beyond Band-Aid solutions to embrace, as Mr. Coburn puts it, a "complete transformation" of a system that is "structurally" flawed.

Their own bill overhauls the tax code, currently stacked in favor of corporate employees, to provide a tax credit to every American to purchase insurance. It expands health-savings accounts. It creates state health-insurance exchanges, where private insurers compete to cover Americans, including the uninsured. (This is partly modeled on the Medicare drug program, which has provided seniors with choice and held down costs.)

More broadly, it seeks to reorient financial incentives so that the system is no longer focused, as Mr. Coburn puts it, on "sick care," but on preventing the chronic diseases that eat 75% of health expenditures. These incentives would be used to lower costs and discourage insurers from cherry-picking patients. The bill also dives into Medicare and Medicaid reform.

Yet no small number of Senate Republicans are biding their time in Max Baucus land, waiting to see what the Democratic finance chairman produces as a "bipartisan" product. (Read: A bill the president wants.) This crowd has taken to heart Mr. Obama's accusation that they are the party of "no," and think it might be easier to be the party of Baucus, or the party of Baucus-lite, or the party of nothing whatsoever.

The White House is targeting folks like Chuck Grassley, Orrin Hatch and other Senate Republicans who back in 1997 voted for the State Children's Health Insurance Program, which was pitched by Democrats at the time as a modest program to help poor kids. It has, of course, become exactly what Democrats always intended it to be: a ballooning federal entitlement that is today transferring middle-class children from private insurance onto the federal rolls. This might be thought of as a teachable moment. But now Republican "moderates" are all ears for the administration's soothing suggestions that perhaps the "public option" can be "structured" so as to protect private insurance. Uh-huh.

Another group of Republicans are still going 50 rounds over taxes -- namely, whether a deduction isn't a more principled and cleaner way than credits to equalize the tax treatment of insurance. This is a legitimate debate, but one that should've been had 10 years ago when Republicans were in the majority. While the GOP fiddled, Democrats focused the argument on "uninsureds," which has made a tax deduction (which would only cover those who pay taxes) even less politically palatable.

Over in the House time runs on, as the Republican leadership and a health-care working group continue to noodle over platforms, policies, egos and timing. Democrats intend to be debating their bill by June.

As for Messrs. Coburn and Burr, they spent a good half hour with me enthusiastically explaining why a competitive market would improve health, provide control and choice, lower costs, and tackle entitlements. It's a good pitch. If only the rest of America could hear the party make it.
Title: WSJ: Reps and the Public Option
Post by: Crafty_Dog on May 11, 2009, 08:49:25 AM
So Democrats have declared their willingness to use a parliamentary tactic to force a far-reaching restructuring of U.S. health care through Congress on a partisan vote. Imagine if Tom DeLay had tried to do that on, say, Social Security. Would Democrats have rolled over?

On the one hand, President Obama and his party say they're hoping to strike a good-faith compromise on health care. On the other, they're threatening this "budget reconciliation" maneuver to coerce Republicans into rubber-stamping liberal policy. And if the GOP won't oblige, Democrats say they'll add a new multitrillion-dollar liability to the federal fisc anyway, using a process that was designed to cut spending and reduce the deficit.

The political game here is that Democrats want to use this threat to peel off a handful of GOP Senators before the bill comes to the floor in June. That would short-circuit this year's health-care debate before it begins. Their targets include the likes of Chuck Grassley, Orrin Hatch, Susan Collins and Olympia Snowe, all of whom bowed to the Democrats in 2007 on expanding the state children's insurance program (Schip). But those were minor stakes compared to this year's battle, especially over the so-called public option for health insurance.

This new entitlement -- like Medicare but open to all ages and all incomes -- would quickly crowd out private insurance as people gravitated to heavily subsidized policies, eventually leading to a single-payer system. So Democrats are trying to seduce diffident Republicans with a Potemkin compromise. A "soft" public option would limit enrollment only to the uninsured or those employed by small businesses, or include promises that the plan will pay market rates. As recently proposed by Chuck Schumer, it would pay claims entirely with premiums and co-pays. But if the plan can't force down reimbursement rates through brute force, and doesn't get taxpayer dollars, why bother to "compete" with private plans?

The truth is Democrats know that any policy guardrails built this year can be dismantled once the basic public option architecture is in place. The White House strategy is to dilute it just enough to win over credulous Republicans. That is what has always happened with government health programs:

When Medicare was created in 1965, benefits were relatively limited and retirees paid a substantial percentage of the costs of their own care. But the clout of retirees has always led to expanding benefits for seniors while raising taxes on younger workers.

In 1965, Congressional actuaries expected Medicare to cost $3.1 billion by 1970. In 1969, that estimate was revised to $5 billion, and it actually came in at $6.8 billion. That same year, the Senate Finance Committee declared a Medicare cost emergency. In 1979, Jimmy Carter proposed limiting benefits, only to have the bill killed by fellow Democrats. Things have gotten worse since, and Medicare today costs $455 billion and rising.

Medicaid was intended as a last resort for the poor but now covers one-third of all long-term care expenses in the U.S. -- that is, it has become a middle-class subsidy for aging parents of the Baby Boomers. Its annual bill is $227 billion, and so far this fiscal year is rising by 17%.

Schip was pitched a decade ago as a safety net for poor kids, and some Republicans helped sell it as a free-market reform. But Schip is now open to families that earn up to 300% of the poverty level, or $63,081 for a family of four. In New York, you can qualify at 400% of poverty.

Any new federal health plan will inevitably follow the same trajectory, no matter how much Republican Senators might claim they've guaranteed otherwise. The Lewin Group consultants estimate that 119 million people who now have private insurance could potentially be captured by the government under the Obama public option. This is on top of the 90 million already in Medicare or Medicaid. This would guarantee a spending explosion that would over time lift federal outlays as a share of GDP into the upper 20% range or higher. Republicans would spend the rest of their days deciding whether to vote for tax increases to finance this, or stand accused of denying health care to the middle class.

This doesn't mean the die is cast. Democrats also know that durable reforms in America have typically passed with bipartisan majorities. They understand that a national health plan that passes on partisan lines could be pared back as unaffordable or unfair, the way the "catastrophic" health plan for seniors was repealed in 1989.

As New Hampshire Republican Judd Gregg recently told us, Democrats also don't want their swing-state Senators to have to defend such a partisan process in the 2010 election. That's why they're eager for even the veneer of bipartisanship that three or four GOP Senators would provide. And that's why they're willing to threaten a procedural bludgeon to intimidate Republicans to provide that veneer.

This health-care debate isn't like the "stimulus" bill, which was largely about short-term spending and deficits. This one is about whether to turn 17% of the U.S. economy entirely and permanently into the arms of the government. For Republicans, this is about whether they still stand for anything at all.
Title: All the interst groups pledge to cut costs.
Post by: ccp on May 11, 2009, 10:12:05 AM
Oh really?  How?
It sounds like special interest group panic at the thought of BO in charge.
All weird to me:

Obama lauds industry offer to contain health costs
WASHINGTON – President Barack Obama has praised health industry groups for coming forward with an offer to reduce the growth of spending by $2 trillion a year to overhaul the system.

Obama appeared at the White House with an array of industry figures, including union representatives, and called it the occasion "historic."

Industry figures pledged that they would voluntarily slow their rate increases over the next 10 years.

Obama said the step the industry took Monday must be carried out as part of "a broader effort" to change the health care system, keep costs under control and provide health insurance for the some 46 million Americans who do not now have it.

He said, "I will not rest until the dream of health care reform is achieved in the United States of America."

THIS IS A BREAKING NEWS UPDATE. Check back soon for further information. AP's earlier story is below.

WASHINGTON (AP) — Health industry groups are promising to reduce the growth of spending by $2 trillion over 10 years by improving coordination, focusing on efficiency and embracing better technology and regulatory reform.

Hospitals, insurance companies, drug makers and doctors have told President Barack Obama in a letter that they'll voluntarily slow their rate increases in coming years. It's a move that government economists say would create breathing room to help provide health insurance to an estimated 50 million Americans who now do not have it.

The industry letter released Monday said "these and other reforms will make our health care system stronger and more sustainable."

It's a change from the time in the early 1990s when then-President Bill Clinton took on health care reform and industry leaders fought back.

Title: Obamacare will stifle your doctor
Post by: Crafty_Dog on May 11, 2009, 10:02:49 PM
At the heart of President Barack Obama's health-care plan is an insurance program funded by taxpayers, administered by Washington, and open to everyone. Modeled on Medicare, this "public option" will soon become the single dominant health plan, which is its political purpose. It will restructure the practice of medicine in the process.

Chad Crowe
 Republicans and Democrats agree that the government's Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama's plan for a centrally managed government insurance program exacerbates Medicare's problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors' financial incentives.

Like Medicare, the "public option" will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. (Medicare pays doctors 20% to 30% less than private plans, on average.) While the public option is meant for the uninsured, employers will realize it's easier -- and cheaper -- to move employees into the government plan than continue workplace coverage.

The Lewin Group, a health-care policy research and consulting firm, estimates that enrollment in the public option will reach 131 million people if it's open to everyone and pays Medicare rates, as many expect. Fully two-thirds of the privately insured will move out of or lose coverage. As patients shift to a lower-paying government plan, doctors' incomes will decline by as much as 15% to 20% depending on their specialty.

Physician income declines will be accompanied by regulations that will make practicing medicine more costly, creating a double whammy of lower revenue and higher practice costs, especially for primary-care doctors who generally operate busy practices and work on thinner margins. For example, doctors will face expenses to deploy pricey electronic prescribing tools and computerized health records that are mandated under the Obama plan. For most doctors these capital costs won't be fully covered by the subsidies provided by the plan.

Government insurance programs also shift compliance costs directly onto doctors by encumbering them with rules requiring expensive staffing and documentation. It's a way for government health programs like Medicare to control charges. The rules are backed up with threats of arbitrary probes targeting documentation infractions. There will also be disproportionate fines, giving doctors and hospitals reason to overspend on their back offices to avoid reprisals.

The 60% of doctors who are self-employed will be hardest hit. That includes specialists, such as dermatologists and surgeons, who see a lot of private patients. But it also includes tens of thousands of primary-care doctors, the very physicians the Obama administration says need the most help.

Doctors will consolidate into larger practices to spread overhead costs, and they'll cram more patients into tight schedules to make up in volume what's lost in margin. Visits will be shortened and new appointments harder to secure. It already takes on average 18 days to get an initial appointment with an internist, according to the American Medical Association, and as many as 30 days for specialists like obstetricians and neurologists.

Right or wrong, more doctors will close their practices to new patients, especially patients carrying lower paying insurance such as Medicaid. Some doctors will opt out of the system entirely, going "cash only." If too many doctors take this route the government could step in -- as in Canada, for example -- to effectively outlaw private-only medical practice.

These changes are superimposed on a payment system where compensation often bears no connection to clinical outcomes. Medicare provides all the wrong incentives. Its charge-based system pays doctors more for delivering more care, meaning incomes rise as medical problems persist and decline when illness resolves.

So how should we reform our broken health-care system? Rather than redistribute physician income as a way to subsidize an expansion of government control, Mr. Obama should fix the payment system to align incentives with improved care. After years of working on this problem, Medicare has only a few token demonstration programs to show for its efforts. Medicare's failure underscores why an inherently local undertaking like a medical practice is badly managed by a remote and political bureaucracy.

But while Medicare has stumbled with these efforts, private health plans have made notable progress on similar payment reforms. Private plans are more likely to lead payment reform efforts because they have more motivation than Medicare to use pay as a way to achieve better outcomes.

Private plans already pay doctors more than Medicare because they compete to attract higher quality providers into their networks. This gives them every incentive, as well as added leverage, to reward good clinicians while penalizing or excluding bad ones. A recent report by PriceWaterhouse Coopers that examined 10 of the nation's largest commercial health plans found that eight had implemented performance-based pay measures for doctors. All 10 plans are expanding efforts to monitor quality improvement at the provider level.

Among the promising examples of private innovation in health-care delivery: In Pennsylvania, the Geisinger Clinic's "warranty" program, where providers take financial responsibility for the entire episode of care; or the experience of the Blue Cross Blue Shield plans in Pennsylvania, Michigan and Virginia, where doctors are paid more for delivering better outcomes.

There are plenty of alternatives to Mr. Obama's plan that expand coverage to the uninsured, give them the chance to buy private coverage like Congress enjoys, and limit government management over what are inherently personal transactions between doctors and patients.

Rep. Nydia Velazquez (D., N.Y.) has introduced a bipartisan measure, the Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (Choice) Act of 2009, that would make it cheaper and easier for small employers to offer health insurance. Mr. Obama would also get bipartisan compromise on premium support for people priced out of insurance to give them a wider range of choices. This could be modeled after the Medicare drug benefit, which relies on competition between private plans to increase choices and hold down costs. It could be funded, in part, through tax credits targeted to lower-income Americans.

There are also measures available that could fix structural flaws in our delivery system and make coverage more affordable without top-down controls set in Washington. The surest way to intensify flaws in the delivery of health care is to extend a Medicare-like "public option" into more corners of the private market. More government control of doctors and their reimbursement schemes will only create more problems.

Dr. Gottlieb, a former official at the Centers for Medicare and Medicaid Services, is a fellow at the American Enterprise Institute and a practicing internist. He's partner to a firm that invests in health-care companies
Title: Re: The Politics of Health Care
Post by: ccp on May 12, 2009, 06:59:53 AM
Isn't this the same Gottleib who wrote a biotech newsletter for Gilder?

"Among the promising examples of private innovation in health-care delivery: In Pennsylvania, the Geisinger Clinic's "warranty" program, where providers take financial responsibility for the entire episode of care;"

This I want nothing to do with.  Do you want your doctor deciding between ordering more care or saving him/herself money at every turn?   This "option" is something that I am reading more and more about and its not a good idea.

"or the experience of the Blue Cross Blue Shield plans in Pennsylvania, Michigan and Virginia, where doctors are paid more for delivering better outcomes."  This is too general a statement.  If he means better BP control, better diabetes control - mabye.

"There are plenty of alternatives to Mr. Obama's plan that expand coverage to the uninsured, give them the chance to buy private coverage like Congress enjoys, and limit government management over what are inherently personal transactions between doctors and patients."

Why in the part above he points to ways that increase insurance carriers management between doctors and patients.  So it winds up being wealthier people can afford to pay off the carriers to not intrude into that relationship.

"Rep. Nydia Velazquez (D., N.Y.) has introduced a bipartisan measure, the Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (Choice) Act of 2009, that would make it cheaper and easier for small employers to offer health insurance. Mr. Obama would also get bipartisan compromise on premium support for people priced out of insurance to give them a wider range of choices. This could be modeled after the Medicare drug benefit, which relies on competition between private plans to increase choices and hold down costs. It could be funded, in part, through tax credits targeted to lower-income Americans."

I don't know.  Lower income Americans already pay little in taxes.  Gottleib actually thinks this will make it easier and cheaper for Small Business to pay for employee health care?  Tax credits to these people?  Isn't the tax code already too complicated?

Folks, Gottlieb makes it sound like its so simple and the answers are staring us in the face.
There really is only one answer that is staring me in the face.  You want to hold down costs, you want to add tens of millions of people to the roles.  Than we have to ration care.   There is no other answer.  Paying providers based on "outcomes" is often a code word for this folks.  It is based on large populations, not an individuals unique medical situation.  You will have liberals in DC and Boston, and New Haven deciding what is  best and that will become the dictum. 
Yes waste can be squeezed out of the system but it will never do enough of what the politians are saying it will without significant rationing of care. 
Title: Re: The Politics of Health Care
Post by: ccp on May 12, 2009, 08:51:45 AM
"and limit government management over what are inherently personal transactions between doctors and patients"

One other thought.

Ther real question is thus should private insurance carriers limit care or government?

That is the "to be or not to be question" at the bottom line.

So who would one rather have limiting or controlling care?  Private insurance administrators or government bureaucrats?

Personally I don't have a fondness for either.
Title: Corporatism Conclave
Post by: Body-by-Guinness on May 12, 2009, 06:47:26 PM

Health Care Corporatism Arrives

Consumers will pay the price if government partners with the health care industry

Ronald Bailey | May 12, 2009

In the past few months, Americans have seen their government essentially seize control of one sector of the economy after another. Federal authorities now tell the automobile, banking, credit card, and insurance industries what products and services to offer, all while hiring and firing industry executives in order to implement government orders.

Health care represents the latest frontier in this drive to centrally manage the American economy. Yesterday, the country's major health care producers, including insurance companies, hospital and physician organizations, pharmaceutical companies, and health care labor unions, promised President Barack Obama they would reduce the growth rate of their future incomes by 1.5 percent over the next ten years. If those cuts actually happened, it would mean that in 2019 health care costs (both government and patient) would be $700 billion lower than current projections, reducing health care spending by $2 trillion over the next ten years.

Why would the industry agree to this preemptive surrender? Because it means the end of competition. Under the proposed agreement, the government would guarantee a certain level of profit for each health care producer. From the industry's point of view, the goal is to get a seat at the table as politicians and government technocrats "reform" health care—which means it will decide who the winners and losers will be.

There's a word for when the government directs the production of goods and services and divides the economic pie: corporatism. The Concise Oxford Dictionary of Politics succinctly defines coporatism as "a system of interest intermediation linking producer interests and the state, in which explicitly recognized interest organizations are incorporated into the policy-making process, both in terms of the negotiation of policy and of securing compliance from their members with the agreed policy."

If the coporativist bargain works out as they plan, both insurers and hospitals expect to profit from the government mandating health insurance coverage for all Americans. Insurers look forward to millions of new customers who will have to buy insurance either individually, through their employers, or through government vouchers. In addition, since the government will set rates and benefits, health insurers won't have to bother with the vexing problem of competition. Of course, state and federal mandates and regulations have already taken us a ways down this road, but corporativist "health care reform" should eliminate any lingering vestiges of consumer choice. For their part, hospitals will have plenty of newly-insured patients to fill their wards and will no longer need to offer uncompensated care to the health care indigent.

As for the pharmaceutical companies, they have experienced rapidly increasing price controls over the years. For example, the Obama administration's 2010 budget lowers what Medicare will pay for drugs from 15 percent below average price to 22 percent below average. In agreeing to the corporativist bargain, those companies hope to get a better deal and to prevent the adoption of cost-benefit tests for the approval of new drugs.

Along similar lines, Medicare and Medicaid price controls have been squeezing doctors' fees for decades. As the federal government either converts private insurance companies into minutely regulated public utilities, creates a rival government health care payment system, or simply adopts a national single-payer (government entitlement) system, doctors rightfully worry that their fees will drop even further as government bureaucrats attempt to slash costs. But with a seat at the health care negotiating table, doctors hope to make the best out of a very bad situation. Interestingly, health care labor unions will probably emerge as the biggest winners in this corporatist arrangement, because they'll be able to extract higher than market wages from politicians dependent on union votes.

In his remarks welcoming the "historic" concessions by the health care industry, President Barack Obama noted that health care "costs are out of control." The goal of corporatist health care reform is to cut those costs. It's a noble aim. The only problem is that the one surefire way to cut costs is completely off the bargaining table: competition. Producers certainly won't reduce costs unless competitors force them to do so. And why would they? Reducing costs means reducing incomes.

Indeed, costs in our current health care system rise faster than the rate of inflation precisely because there is so little competition. The third party payment system, where employers or government agencies pay for insurance, gives consumers few incentives to shop around and bid down prices. On top of that, the federal and state governments have piled so many mandates on insurers that consumers are offered little more than one-size-fits-all policies with similar rates.

It's no secret the current health care system is rife with inefficiencies. But without effective competition, there will be no effective way to discover them and root them out. Competition incentivizes consumers and competitors to eliminate inefficiencies. The notion that wise government regulators can wring them out is beyond laughable.

Consider the recent announcement that a line-by-line review of the federal budget by the Obama administration found just $17 billion in savings from $3.6 trillion budget. That's far less than one half of 1 percent of the total budget. And the constituencies who benefit from that $17 billion are now mobilizing to oppose even those absurdly modest cuts. Just like producers who have no competition, federal agencies have no incentive to improve or to cut their budgets. History shows that the government agencies cut health care "costs" chiefly by imposing price controls on the private sector.

Corporatism represents an ugly deal between governments and producers. The hospitals, doctors, pharmaceutical companies, and health care labor unions hope that the corporativist bargain will guarantee future profits while eliminating competition. Perhaps it will, perhaps it won't. But there's absolutely no question that corporativist health care will increase inefficiencies, stifle innovation, and reduce consumer choice. That's a disastrous deal for the rest of us.

Ronald Bailey is Reason magazine's science correspondent. His book Liberation Biology: The Scientific and Moral Case for the Biotech Revolution is now available from Prometheus Books.
Title: Re: The Politics of Health Care
Post by: G M on May 12, 2009, 07:54:00 PM

Logan's Run, anyone?
Title: Single Payer Cascades
Post by: Body-by-Guinness on May 13, 2009, 10:40:00 AM
How ObamaCare Will Affect Your Doctor
Expect longer waits for appointments as physicians get pinched on reimbursements.

At the heart of President Barack Obama's health-care plan is an insurance program funded by taxpayers, administered by Washington, and open to everyone. Modeled on Medicare, this "public option" will soon become the single dominant health plan, which is its political purpose. It will restructure the practice of medicine in the process.

Republicans and Democrats agree that the government's Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama's plan for a centrally managed government insurance program exacerbates Medicare's problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors' financial incentives.

Like Medicare, the "public option" will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. (Medicare pays doctors 20% to 30% less than private plans, on average.) While the public option is meant for the uninsured, employers will realize it's easier -- and cheaper -- to move employees into the government plan than continue workplace coverage.

The Lewin Group, a health-care policy research and consulting firm, estimates that enrollment in the public option will reach 131 million people if it's open to everyone and pays Medicare rates, as many expect. Fully two-thirds of the privately insured will move out of or lose coverage. As patients shift to a lower-paying government plan, doctors' incomes will decline by as much as 15% to 20% depending on their specialty.

Physician income declines will be accompanied by regulations that will make practicing medicine more costly, creating a double whammy of lower revenue and higher practice costs, especially for primary-care doctors who generally operate busy practices and work on thinner margins. For example, doctors will face expenses to deploy pricey electronic prescribing tools and computerized health records that are mandated under the Obama plan. For most doctors these capital costs won't be fully covered by the subsidies provided by the plan.

Government insurance programs also shift compliance costs directly onto doctors by encumbering them with rules requiring expensive staffing and documentation. It's a way for government health programs like Medicare to control charges. The rules are backed up with threats of arbitrary probes targeting documentation infractions. There will also be disproportionate fines, giving doctors and hospitals reason to overspend on their back offices to avoid reprisals.

The 60% of doctors who are self-employed will be hardest hit. That includes specialists, such as dermatologists and surgeons, who see a lot of private patients. But it also includes tens of thousands of primary-care doctors, the very physicians the Obama administration says need the most help.

Doctors will consolidate into larger practices to spread overhead costs, and they'll cram more patients into tight schedules to make up in volume what's lost in margin. Visits will be shortened and new appointments harder to secure. It already takes on average 18 days to get an initial appointment with an internist, according to the American Medical Association, and as many as 30 days for specialists like obstetricians and neurologists.

Right or wrong, more doctors will close their practices to new patients, especially patients carrying lower paying insurance such as Medicaid. Some doctors will opt out of the system entirely, going "cash only." If too many doctors take this route the government could step in -- as in Canada, for example -- to effectively outlaw private-only medical practice.

These changes are superimposed on a payment system where compensation often bears no connection to clinical outcomes. Medicare provides all the wrong incentives. Its charge-based system pays doctors more for delivering more care, meaning incomes rise as medical problems persist and decline when illness resolves.

So how should we reform our broken health-care system? Rather than redistribute physician income as a way to subsidize an expansion of government control, Mr. Obama should fix the payment system to align incentives with improved care. After years of working on this problem, Medicare has only a few token demonstration programs to show for its efforts. Medicare's failure underscores why an inherently local undertaking like a medical practice is badly managed by a remote and political bureaucracy.

But while Medicare has stumbled with these efforts, private health plans have made notable progress on similar payment reforms. Private plans are more likely to lead payment reform efforts because they have more motivation than Medicare to use pay as a way to achieve better outcomes.

Private plans already pay doctors more than Medicare because they compete to attract higher quality providers into their networks. This gives them every incentive, as well as added leverage, to reward good clinicians while penalizing or excluding bad ones. A recent report by PriceWaterhouse Coopers that examined 10 of the nation's largest commercial health plans found that eight had implemented performance-based pay measures for doctors. All 10 plans are expanding efforts to monitor quality improvement at the provider level.

Among the promising examples of private innovation in health-care delivery: In Pennsylvania, the Geisinger Clinic's "warranty" program, where providers take financial responsibility for the entire episode of care; or the experience of the Blue Cross Blue Shield plans in Pennsylvania, Michigan and Virginia, where doctors are paid more for delivering better outcomes.

There are plenty of alternatives to Mr. Obama's plan that expand coverage to the uninsured, give them the chance to buy private coverage like Congress enjoys, and limit government management over what are inherently personal transactions between doctors and patients.

Rep. Nydia Velazquez (D., N.Y.) has introduced a bipartisan measure, the Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (Choice) Act of 2009, that would make it cheaper and easier for small employers to offer health insurance. Mr. Obama would also get bipartisan compromise on premium support for people priced out of insurance to give them a wider range of choices. This could be modeled after the Medicare drug benefit, which relies on competition between private plans to increase choices and hold down costs. It could be funded, in part, through tax credits targeted to lower-income Americans.

There are also measures available that could fix structural flaws in our delivery system and make coverage more affordable without top-down controls set in Washington. The surest way to intensify flaws in the delivery of health care is to extend a Medicare-like "public option" into more corners of the private market. More government control of doctors and their reimbursement schemes will only create more problems.

Dr. Gottlieb, a former official at the Centers for Medicare and Medicaid Services, is a fellow at the American Enterprise Institute and a practicing internist. He's partner to a firm that invests in health-care companies .
Title: Re: The Politics of Health Care
Post by: ccp on May 15, 2009, 08:19:23 AM
I disagree with most of this.
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on May 15, 2009, 10:10:36 PM
Ok, I'll beg-- please tell us why  :lol:
Title: An Alternative Emerges
Post by: Body-by-Guinness on May 18, 2009, 03:44:29 PM
May 18, 2009, 4:00 a.m.

Alternative to Obamacare
A new plan, courtesy of Richard Burr and Tom Coburn.

By Duncan Currie

Without much fanfare, Sens. Richard Burr (R., N.C.) and Tom Coburn (R., Okla.) have become leading advocates of market-based health reform. This week they will introduce their alternative to Obamacare. It has no chance of passing in the current Congress.

But it does signify progress for GOP health-care reformers, who recognize that if Republicans are to improve their credibility on this issue, they must offer their own proposals for reducing costs and expanding coverage. Among other things, the Burr-Coburn bill would establish an advanceable, refundable tax credit for health insurance, worth nearly $2,300 for individuals and just over $5,700 for families. This would make coverage more affordable for the self-employed, the unemployed, and those whose employers don’t provide health benefits — all of whom lose out under the current employer-based system. It would also help workers who are between jobs or are dissatisfied with their employer-provided insurance.

Meanwhile, the legislation would make Health Savings Accounts (HSAs) more attractive by removing the tax penalty on health-insurance premium payments made with HSA money, and by raising the ceiling on annual HSA contributions. In addition, the bill would let High Deductible Health Plans — which are paired with HSAs — cover preventative services.

HSAs were first introduced as part of the 2003 Medicare Modernization Act. In January, Diamond Management & Technology Consultants reported that, while the recent expansion of the HSA market had been “slower than expected,” HSAs “have become an integral element of the consumer-directed health-care trend.” According to Diamond, HSAs grew at an average annual rate of almost 70 percent between 2005 and 2008. Diamond reckons that the number of HSA accounts will swell to at least 11 million and perhaps as high as 13 million by 2012, at which point those accounts will have $35 billion–$45 billion in total assets.

Burr and Coburn also want to create State Health Insurance Exchanges that would function as marketplaces for consumers. These exchanges would have safeguards to protect patients with preexisting conditions. States would also have the opportunity to form new health-insurance pools.

The bill does not shy away from entitlement reform. It would subsidize the transfer of certain low-income families from Medicaid to private insurance plans, an important step in ensuring that these Americans have ready access to health care. It would also restructure how federal and state governments share the burdens of Medicaid and Medicare; revamp the Medicare Advantage program; establish Medicare Accountable Care Organizations; and force wealthy Medicare recipients to pay more for the services they receive under Medicare Part B.

Nancy Pelosi has declared that the goal of health-care reform is to achieve “quality, affordable, accessible health care for all Americans.” The Burr-Coburn legislation would not guarantee “universal” insurance coverage, but it would make quality health insurance and care more affordable and accessible. Conservative policy wonks will doubtless find nits to pick in the bill, and it’s unclear how many Republicans will embrace the Burr-Coburn approach. In recent years, says former GOP whip Rep. Roy Blunt, “no more than two dozen” Republican House members have been deeply engaged in the health-care issue. That is now changing, thanks in large part to the challenge of defeating Obamacare.

As the debate unfolds, Americans will be swamped with data and projections. Analysts at McKinsey and Co., the consulting giant, have compiled some especially striking numbers. According to Diana Farrell, Eric Jensen, and Bob Kocher, “the United States spends $650 billion more on health care than might be expected given the country’s wealth and the experience of comparable members of the Organization for Economic Cooperation and Development (OECD).” Outpatient care — which now constitutes 65 percent of all American health care, compared with 43 percent in 1980 — accounts for roughly two-thirds ($436 billion) of that $650 billion. Today, U.S. health-care spending represents about 17 percent of GDP. Based on present trends and historic growth rates, Jean Drouin, Viktor Hediger, and Nicolaus Henke estimate that this figure could rise to 30 percent by 2040 and to more than 50 percent by 2080.

As Farrell, Jensen, and Kocher observe, most Americans do not have “any real value consciousness” when it comes to health-care costs, partly because they are heavily insulated from those costs: “In the United States, the ‘average’ consumer of health care pays for only 12 percent of its total cost directly out of pocket (down from 47 percent in 1960), as well as for 25 percent of health-care insurance premiums, a share that has stayed relatively constant for the last decade.” Meanwhile, much of the information about health-care pricing remains inaccessible. The Burr-Coburn bill would set up a new commission designed to make this information more transparent.

Politicians from both parties have warned that soaring health-care spending is unsustainable and could lead to a fiscal and economic disaster. Just last week, a new report from the Medicare trustees announced that the Medicare Part A trust fund will be “exhausted” by 2017. Total Medicare expenditures are projected to reach of 11.4 percent of GDP in 2083, compared with 3.2 percent of GDP today. “Growth of this magnitude, if realized, would substantially increase the strain on the nation’s workers, Medicare beneficiaries, and the Federal Budget,” the report states.

Of course, Democrats and Republicans disagree sharply about how to rein in health-care spending. But Americans could do their part by making certain lifestyle and dietary changes. Farrell, Jensen, and Kocher reckon that the overall decline in the health of the U.S. population from 2003 to 2005 raised medical costs by between $20 billion and $40 billion. A new study published in the peer-reviewed journal PLoS Medicine calculates that in 2005, smoking was responsible for one-third of all deaths from cancer and high blood pressure was responsible for 45 percent of all deaths from cardiovascular diseases.

The Burr-Coburn legislation notes that roughly 75 percent of American health-care expenditures go toward the treatment of five chronic but “largely preventable” diseases, and it would give states new incentives to lower the rates of these diseases. The bill would boost health-education efforts. It would also allocate $50 million a year to make vaccines more widely available and reward states that meet a vaccine coverage target.

The health-care showdown is bound to be fiercely contentious, given its sweeping implications. As countless pundits have remarked, the political terrain looks much different today than it did in 1993 and 1994, when President Clinton took his ill-fated stab at transforming the U.S. health system. Republicans are fighting an uphill battle. But the Burr-Coburn bill indicates that at least some of them are serious about developing their own version of comprehensive reform.

— Duncan Currie is deputy managing editor of National Review Online.
National Review Online -
Title: Re: The Politics of Health Care
Post by: ccp on May 18, 2009, 05:43:17 PM
I really don't have answers and was not playing coy.  It is that complicated.  Gottlieb it seems to me makes a lot of assumptions.
Some of his solutions are experimental.
Some doctors would do better if more people were covered, not worse.
I guess it depends on the saturation of doctors in the area.
Not many doctors could survive on cash only practices. No one would show up.
Or this one, Medicare's incentives are wrong.  Payments increase for those who stay sick.
Well of course.  The more one's legal problems persist the more one pays lawyers.  The more one's house falls apart the more we spend fixing it.
Were talking chronic progressives diseases.  Not problems that can be fixed forever in most instances.
Or pay based on outcomes?  Every human being and every situation is unique.

What about this one:

"The Burr-Coburn legislation notes that roughly 75 percent of American health-care expenditures go toward the treatment of five chronic but “largely preventable” diseases, and it would give states new incentives to lower the rates of these diseases. The bill would boost health-education efforts."

So is this implying if we live healthier 75% of health care costs could go away?

What kind of a statement is this?

Has this guy ever heard of aging?

I don't know.  The more I read about opinions on what should be done the more I think no one has a clue.

Title: Re: The Politics of Health Care
Post by: HUSS on May 18, 2009, 07:02:39 PM
So is this implying if we live healthier 75% of health care costs could go away?

What kind of a statement is this?

Has this guy ever heard of aging?

I don't know.  The more I read about opinions on what should be done the more I think no one has a clue.

You guys sure do have a lot of fat people in the U.S.  Im always disturbed by the amount of fat people riding around on scooters when i go to American walmarts.  I'll bet that if you got rid of obesity your health care costs would go down dramatically.
Title: Re: The Politics of Health Care
Post by: HUSS on May 18, 2009, 07:07:21 PM
My opinion on this topic causes me to be flamed quite a bit here in Canada, but here it goes.  Universal health care should not exist period.  taxes should be lowered and people should be forced to buget.  But that is not going to happen.  The next best thing would see people who are fat, smoke or drink pay a massive sur charge for access to health care.  and before you say it, i have an older brother who is a drunk and one 6pak away from needing a liver transplant.  My thoughts are, if he cant afford to pay for his selfish life style why should i.  Have fun in the next life bro, hope the bar is closed on the other side.  Maybe im cold, but i have grown tierd of seeing selfish people cause others to suffer.
Title: Re: The Politics of Health Care
Post by: G M on May 18, 2009, 07:09:40 PM

Um, every time i've gone to Canada, the population looks pretty.....American.

Aside from Looneys and liters, it's hard to tell i'm in a different country.
Title: Re: The Politics of Health Care
Post by: G M on May 18, 2009, 07:36:56 PM

Rank   Country   %
1.   Nauru   94.5
2.   Micronesia, Federated States of   91.1
3.   Cook Islands   90.9
4.   Tonga   90.8
5.   Niue   81.7
6.   Samoa   80.4
7.   Palau   78.4
8.   Kuwait   74.2
9.   United States   74.1
10.   Kiribati   73.6
11.   Dominica   71.0
12.   Barbados   69.7
13.   Argentina   69.4
14.   Egypt   69.4
15.   Malta   68.7
16.   Greece   68.5
17.   New Zealand   68.4
18.   United Arab Emirates   68.3
19.   Mexico   68.1
20.   Trinidad and Tobago   67.9
21.   Australia   67.4
22.   Belarus   66.8
23.   Chile   65.3
24.   Venezuela (Bolivarian Republic of)   65.2
25.   Seychelles   64.6
26.   Bahrain   64.1
27.   Andorra   63.8
28.   United Kingdom   63.8
29.   Saudi Arabia   63.5
30.   Monaco   62.4
31.   Bolivia   62.2
32.   San Marino   62.1
33.   Guatemala   61.2
34.   Mongolia   61.2
35.   Canada   61.1
36.   Qatar   61.0
37.   Uruguay   60.9
38.   Jordan   60.5
39.   Bahamas   60.4
40.   Iceland   60.4
41.   Nicaragua   60.4
42.   Cuba   60.1
43.   Germany   60.1
44.   Brunei Darussalam   59.8
45.   Slovenia   59.8
46.   Peru   59.6
47.   Vanuatu   59.6
48.   Finland   58.7
49.   Jamaica   57.4
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on May 18, 2009, 08:54:02 PM
"You guys sure do have a lot of fat people in the U.S."

Reminds me of a very international after dinner conversation in Bern, Switzerland.  We were riffing on national stereotypes.  I asked what the stereotype was of Americans.  "Fat people in shorts with white socks" came the answer.  Ouch!!!
Title: Sausage Making 101
Post by: Body-by-Guinness on May 19, 2009, 06:18:40 AM
How Washington Rations
ObamaCare omen: a case study in 'cost-control.'
Try to follow this logic: Last week the Medicare trustees reported that the program has an "unfunded liability" of nearly $38 trillion -- which is the amount of benefits promised but not covered by taxes over the next 75 years. So Democrats have decided that the way to close this gap is to create a new "universal" health insurance entitlement for the middle class.

Such thinking may be a non sequitur, but it will have drastic effects on the health care of all Americans -- and as it happens, this future is playing out in miniature in Medicare right now. Desperate to prevent medical costs from engulfing the federal budget, the program's central planners decided last week to deny payment for a new version of one of life's most unpleasant routine procedures, the colonoscopy. This is a preview of how health care will be rationed when Democrats get their way.

At issue are "virtual colonoscopies," or CT scans of the abdomen. Colon cancer is the second leading cause of U.S. cancer death but one of the most preventable. Found early, the cure rate is 93%, but only 8% at later stages. Virtual colonoscopies are likely to boost screenings because they are quicker, more comfortable and significantly cheaper than the standard "optical" procedure, which involves anesthesia and threading an endoscope through the lower intestine.

Virtual colonoscopies are endorsed by the American Cancer Society and covered by a growing number of private insurers including Cigna and UnitedHealthcare. The problem for Medicare is that if cancerous lesions are found using a scan, then patients must follow up with a traditional colonoscopy anyway. Costs would be lower if everyone simply took the invasive route, where doctors can remove polyps on the spot. As Medicare noted in its ruling, "If there is a relatively high referral rate [for traditional colonoscopy], the utility of an intermediate test such as CT colonography is limited." In other words, duplication would be too pricey.

This is precisely the sort of complexity that the Democrats would prefer to ignore as they try to restructure health care. Led by budget chief Peter Orszag, the White House believes that comparative effectiveness research, which examines clinical evidence to determine what "works best," will let them cut wasteful or ineffective treatments and thus contain health spending.

The problem is that what "works best" isn't the same for everyone. While not painless or risk free, virtual colonoscopy might be better for some patients -- especially among seniors who are infirm or because the presence of other diseases puts them at risk for complications. Ideally doctors would decide with their patients. But Medicare instead made the hard-and-fast choice that it was cheaper to cut it off for all beneficiaries. If some patients are worse off, well, too bad.

Medicare is already the country's largest purchaser of health care. Private carriers generally adopt its rates and policies, and the virtual colonoscopy decision may run this technology out of the marketplace. Now multiply that by the new "public option" that Democrats favor, which would transfer millions of patients to a new insurance program managed by the federal government. Washington's utilitarian judgments about costs would reshape the practice of medicine.

Initially, the open-ended style of American care will barely be touched, if only for political self-preservation. Health planners will adjust at the margins, as with virtual colonoscopy. But scarcity forces choices. As the Medicare trustees note in their report, the tax increases necessary to fund merely the current benefit schedule for the elderly would cripple the economy. The far more expensive public option will not turn into a pumpkin when cost savings do not materialize. At that point, government will clamp down with price controls in the form of lines and rock-bottom reimbursement rates.

Mr. Orszag says that a federal health board will make these Solomonic decisions, which is only true until the lobbies get to Congress and the White House. With virtual colonoscopy, radiologists and gastroenterologists are feuding over which group should get paid for colon cancer screening. Companies like General Electric and Seimens that make CT technology are pressuring Medicare administrators too. More than 50 Congressmen are demanding that the decision be overturned.

All this is merely a preview of the life-and-death decisions that will be determined by politics once government finances substantially more health care than the 46% it already does. Anyone who buys Democratic claims about "choice" and "affordability" will be in for a very rude awakening.
Title: Re: The Politics of Health Care
Post by: JDN on May 19, 2009, 06:55:34 AM
"Nearly everyone wants to limit the costs of rising medical care."
"Nearly everyone wants the newest and best technology"

Unfortunately, these two statements are not congruous.  Choices, difficult choices must be made.

Of course, "Companies like General Electric and Seimens that make CT technology are pressuring Medicare administrators too."
Whether needed or not, that's how GE makes it profits and why it pays it's lobbyists. 

Yet the National Cancer Institute says;
"While there is always room for technological improvements, we need to do a better job of using the current screening technologies. Because, despite their limitations, they have been proven effective in reducing the burden of disease."

Where do you draw the line at costs?

Is a virtual colonoscopy more patient friendly?  Sure.  In most cases does it produce any better results? No.  Does it cost more?  A lot more...

So someone needs to make the tough choices.  Individuals seem to want the newest and best, regardless if the results are the same and regardless of the cost
since they don't individually pay for it.  The "insurance company pays" or "Medicare pays" yet in reality we all pay.
And new technology will continue to be pushed by corporations.  Do you really think they have our best interest at heart?

IF we go to a National Health Care Plan maybe it should offer basic care WITHOUT all the bells and whistles?  Sure you have to wait.  And maybe you don't get
the latest technology.  Or the newest wonder/experimental drugs.  But as a nation, at least everyone would have basic coverage.

And perhaps there is room for supplemental coverage?  My father has Medicare, but he pays a fortune (money well spent) for his excellent supplemental care.  But it is
a choice on the table.

My point is that we cannot have our cake (newest technology) and eat it (affordability) too.  One/We must choose.

Title: Re: The Politics of Health Care
Post by: ccp on May 19, 2009, 07:16:22 AM
JDN - that's it in a nutshell.  Speaking of vitual colonoscopy the imaging lobbyists who were set to make a bundle doing this test were of course outraged it was not approved for reimbursement by Medicare.  Of course it is all in the goal of better patient care.
And of course the gastroenterologist who may (or may not) lose out were delighted in the name of patient care that it was not approved.  Who does one believe?
Bottom line your right.  We either ration care, or we don't provide care to all, or/and we go broke.

And who does Gottlieb work for now?

"Medicare Shoots Down Virtual Colonoscopy Reimbursement (GE, SI)
Posted: May 12, 2009 at 4:26 pm

Today was a big day for the world of colonoscopies and the battle in detecting colon cancer and polyps.  The Center for Medicare and Medicaid Services issued a final decision that Medicare would not cover the reimbursement for virtual colonoscopies.  This is a blow for the medical imaging sector, particularly for leaders such as General Electric Co. (NYSE: GE) and Siemens AG (NYSE: SI).  This is also a blow in the battle for detecting of polyps or early stages of colon cancer.

The CMS noted in its memo, “The evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test….  CT colonography for colorectal cancer screening remains noncovered.”

Whether you have to get a colonoscopy done the old fashioned way or virtually it still requires the material you have to consume to clear out the bowels.  The difference of a virtual or traditional method is rather simple.  The CT machine scan is a relatively non-invasive procedure besides an ingestion of a chemical marker and requires no real sedation followed by a CT/MRI scan.  For the traditional exam, sedation is required and a fiber optic camera on a flexible tube is inserted through the anus and snaked up all the way through your intestine.  Guess which one is more desirable if you are the patient.

Detecting colon cancer while it is a mere polyp or in the very early stages is far better from a cost-basis, a quality of life basis, and on the basis of what is a better use of the medical system.  The belief is that there would be many more colonoscopies conducted if this was approved in a virtual manner, and in theory much fewer colon cancer cases.  The downside to the virtual colonoscopy is that if polyps (or worse are detected, then a traditional colonoscopy and then whatever procedure would be required anyhow.

This is perhaps one of the first tests of what may or may not be coming down the pipe with the new healthcare system, yet this decision may be independent of any of the comparisons between the healthcare system of today versus the system of tomorrow.  Some form of universal healthcare is much more likely than ever.  That will be a welcome wagon for the army of uninsured or underinsured Americans.  For the rest of us we all really want to know what the new system will really be, and what sort of service we can expect.

When it comes to old fashioned colonoscopies versus the virtual colonoscopies, the CMS just said “Up Yours!”… Quite literally in this case."

Title: Teats 'n Wheets
Post by: Body-by-Guinness on May 19, 2009, 08:35:58 AM
Don't have an issue with any of the economic realities being mentioned, though I do have one with some of the pronouns being bandied. Who is this "we" that's gonna determine how health care is rationed? The current debate employs so much smoke and so many mirrors that informed constituencies are hard to find in the first place, and then many of the mechanisms being discussed for use in "solving" health care finance issues are regulatory in nature and hence make it hard to identify lawmakers who can be held accountable when a program fails. There is so much obfuscation employed on all sides of the issue and so many of the mechanisms lay so far beyond the control of most voters that I have a hard time accepting that "we" are much of an actor in this passion play.

My read on the current single payer effort is that it will paint the sunniest face on they type of care it seeks to shill, make all sorts of promises, suck folks into it's system, and then at some point declare "golly gee willikers, we have unfunded mandates that dwarf the $35 trillion deficit projected for Medicare and hence have to ration care." Never heard of a system that adopted single payer going back to a more market based solution--once you get folks suckling at the teat there are too many "wheet wheets" to move 'em off--so a one size fits all single payer system becomes what you're stuck with.

Make all the legiscreatures and their staffs adopt the system they seek to peddle for four years first. If it works then they can try to make the sale.
Title: Re: The Politics of Health Care
Post by: DougMacG on May 19, 2009, 09:13:13 AM
CCP and all , thanks for health care info.  One piece said the virtual was cheaper (assuming no follow up invasion is needed) and I think another said virtual costs more (maybe because of the follow up).  I will be getting quotes soon.  I have only major medical coverage so I will be the ever so rare, cost-conscious patient.  We have family history of colon cancer - I should have done this starting at age 45.  The photo sounds a lot better to me than the snake.  Besides the cost, I think I have snake through anus phobia.  Now at 52 and change I should be a fine candidate for a free one at a medical university (wiulling to travel) - any suggestions? 

As a polical matter, liberals contend that health care is much better in western Europe than the US but then they measure it in percentage insured.  I would measure heath care systems by survival rates of the worst ailments we are most likely to face.  For men here that include prostate and colon cancer (women - breast concer etc.)and I think survival rates are much higher in the US.(?)
Title: Re: The Politics of Health Care
Post by: JDN on May 19, 2009, 10:00:19 AM
Doug, on the medical side (CCP) can do a much better job, but it is my understanding that IF (God forbid) there is a problem or question, and a biopsy is needed,
the regular (up your....) colonoscopy will still need to be done; you pay double.

As for health care being better or worse, I think one needs to look at overall mortality, not just mortality from a select few diseases.  And in doing so you will find that
we lag many industrialized countries.  By the way, I too have a High Deductible Major Medical policy.

Regarding your colon cancer example, yes, our High Technology (think high cost) can often assure a higher mortality rate after cancer has been discovered, BUT as your own article
points out, "Colon cancer survival rates vary throughout the world. Quality of care is one reason, but another is colon cancer screening programs. In general, the earlier colon
cancer is detected, the easier it is to treat."
  Japan (national health care) at much less cost than the USA has an equal or better colon cancer survival rate
than we do. (again see your posted article).  And they definitely do not have any better technology or talent.

So if people simply get a basic colonoscopy, catch it early, the easier it is to treat.  Yet, as you pointed out, cost is a very real issue.  Given you family history, no doubt whatever the cost
you should proceed with the test, but would you pay the money without the family history to wake you up?  I question that...  Yet, if a basic colonoscopy was "free" (no out of pocket)
I bet you might consider doing so and therefore hopefully catch the disease in the early stages. 
Title: Comparative Costs/Survival Rates
Post by: Body-by-Guinness on May 19, 2009, 11:43:16 AM
Please keep in mind that the comparative survival rate data can lead to a lot of apple and oranges conflation. Many industrial nations have far more stringent immigration/citizenry requirements that skew things. If you do your comparisons across similar demographics all of a sudden many of the gaps shorten significantly. Compare immigrant communities, or blacks living at the poverty line across countries and you'll find those numbers similar, though the US has a greater percentage of the population that fits those categories and hence its overall survival rate data skews that direction.
Title: Re: The Politics of Health Care
Post by: JDN on May 19, 2009, 12:00:40 PM
Gee, and I thought France and England were going to $%^& due to their liberal immigration policy and
growing ghetto areas?   :-)

As for Japan (little immigration) they have an aging population which translates into higher morbidity yet
they still have a better mortality rate.

Title: An Acme of Argumentation
Post by: Body-by-Guinness on May 19, 2009, 03:22:52 PM
Gee back at you, how 'bout Sweden, Norway, Holland, Switzerland, Finland, and so on? I'm sure there are many others, but I don't follow this issue as part any health debate, but I do as part of the firearm rights debate where, what do you know, rates of firearms crime stays pretty consistent across ethnic groups in various contiguous countries, which suggest a strong cultural component is involved.

But hey, since you asked the question how 'bout you do some follow up research? The UK already cooks its books where its crime figures are concerned, do they do the same with health outcomes? Are non-citizen immigrants counted among the data? Much of the recent car torching and rioting in France was caused by non-citizen immigrants annoyed about economic opportunities, or the lack thereof, in France; are they counted as citizens in health stats? If not, what would that do to the curve?

BTW, I deal all day with folks who think facile deconstruction of a point is the acme of argumentation, and regularly then hand them their fannies. Doubt you're aware you consistently employ the same tactic and so would like to suggest you add a couple more tools to your rhetorical tool box.
Title: Re: The Politics of Health Care
Post by: JDN on May 19, 2009, 04:32:42 PM
What does firearm rights have to do with health care? :?
By the way, since you brought it up, I am in favor of firearm rights for all adult individuals.

And I didn't ask any health care question...  So no interest in doing additional research.

As for my tool box, it's fine thank you, as is my fanny.  You might check yours though.   
It might be kind of sore lately...
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on May 20, 2009, 03:10:42 AM
Now, now, gentlemen, lets stick to the merits of the subject matter at hand , , ,
Title: Just Another Rift in the Space Time Continuum, Move Along
Post by: Body-by-Guinness on May 20, 2009, 06:03:32 AM
Whoa, parallel universe alert. . . .
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on May 20, 2009, 06:07:44 AM
Title: Reality Rift
Post by: Body-by-Guinness on May 20, 2009, 07:51:47 AM

Sorry for the confusion, it's just on a regular basis when I read one of JDN's responses I feel like I've encountered some sort of rift in space and time.
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on May 20, 2009, 08:21:17 AM
Not that I ever read them, but a HS friend who read the Cliff Notes version told me that in Plato's writings of the conversations with Socrates that there was a member of the group who asked questions seen by most of the rest of the group as foolish.   I wonder how Socrates dealt with his questions?
Title: Re: The Politics of Health Care
Post by: JDN on May 20, 2009, 08:34:44 AM
According to Plato's Apology, Socrates' life was that of being the "gadfly" of Athens.

Sometimes I too feel like I am the Gadfly of this forum.   :-)
Title: Re: The Politics of Health Care
Post by: Body-by-Guinness on May 20, 2009, 10:33:23 AM
Would suggesting "hemlock" be too coarse a response?
Title: Re: The Politics of Health Care
Post by: JDN on May 20, 2009, 12:20:49 PM
Socrates is seen as a wise and benevolent father figure, martyred for his intellectual beliefs.
After Socrates' death opinion in Athens turned against his accusers.
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on May 20, 2009, 10:06:36 PM
Ummm , , , JDN , , , I was thinking of you less in the role of Socrates and more in the role of "a member of the group who asked questions seen by most of the rest of the group as foolish"  :lol:
Title: Re: The Politics of Health Care
Post by: JDN on May 20, 2009, 10:21:22 PM
Ummmm Marc, I somehow got that... I just chose to ignore it  :-)

My final post was to BbyG "Hemlock" comment.  "martyred for his intellectual beliefs".  and, after his death,
the Forum turned against his accusers.  :-)
Title: Re: The Politics of Health Care
Post by: Body-by-Guinness on May 21, 2009, 05:16:07 AM
Now all we gotta see is an intellectual belief, and, with 3 pairs of socks, the shoe might fit.  :evil:
Title: Re: The Politics of Health Care
Post by: JDN on May 21, 2009, 06:19:31 AM
You're like a dog with an old bone; you just can't quit.
BbyG, I'm sorry if your fanny is STILL sore....

But really, you really should take Crafty's advice and "move on"...

And maybe move back to topic...

Title: Film ar 11
Post by: Body-by-Guinness on May 21, 2009, 07:48:45 AM
Pot calls kettle black, film at 11.

Get a million JDNs banging on a million keyboards and not so much as a zit would be raised on my butt.

Feel free to move on when the mood strikes you. Until then, if an inanity hammer is all you got, I guess that's all you'll swing.
Title: Re: The Politics of Health Care
Post by: JDN on May 21, 2009, 07:57:21 AM
 :-o    :-D
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on May 21, 2009, 08:54:18 AM

Let us return to the merits of the subject at hand please!!!

Title: CATO on Health Care "Reforms
Post by: Body-by-Guinness on May 21, 2009, 09:42:26 AM
Summary of new CATO report examining likely aspects of BHO's health care. Entire report, a very long read, available here:

May 21, 2009
Policy Analysis no. 638

Obamacare to Come: Seven Bad Ideas for Health Care Reform

by Michael D. Tanner

President Obama has made it clear that reforming the American health care system will be one of his top priorities. In response, congressional leaders have promised to introduce legislation by this summer, and they hope for an initial vote in the Senate before the Labor Day recess.

While the Obama administration has not, and does not seem likely to, put forward a specific reform plan, it is possible to discern the key components of any plan likely to emerge from Congress:

At a time of rising unemployment, the government would raise the cost of hiring workers by requiring employers to provide health insurance to their workers or pay a fee (tax) to subsidize government coverage.

Every American would be required to buy an insurance policy that meets certain government requirements. Even individuals who are currently insured — and happy with their insurance — will have to switch to insurance that meets the government's definition of "acceptable insurance."
A government-run plan similar to Medicare would be set up in competition with private insurance, with people able to choose either private insurance or the taxpayer-subsidized public plan. Subsidies and cost-shifting would encourage Americans to shift to the government plan.

The government would undertake comparative-effectiveness research and cost-effectiveness research, and use the results of that research to impose practice guidelines on providers — initially, in government programs such as Medicare and Medicaid, but possibly eventually extending such rationing to private insurance plans.
Michael D. Tanner is a senior fellow with the Cato Institute and coauthor of Healthy Competition: What's Holding Back Health Care and How to Free It (2007).

Private insurance would face a host of new regulations, including a requirement to insure all applicants and a prohibition on pricing premiums on the basis of risk.
Subsidies would be available to help middle-income people purchase insurance, while government programs such as Medicare and Medicaid would be expanded.
Finally, the government would subsidize and manage the development of a national system of electronic medical records.
Taken individually, each of these proposals would be a bad idea. Taken collectively, they would dramatically transform the American health care system in a way that would harm taxpayers, health care providers, and — most importantly — the quality and range of care given to patients.
Title: Re: The Politics of Health Care
Post by: ccp on May 21, 2009, 01:46:15 PM
"Private insurance would face a host of new regulations, including a requirement to insure all applicants and a prohibition on pricing premiums on the basis of risk."

Personally I think it is necessary that insurance be available to all regardless of pre-existing conditions.  In reality many of these people go onto disability because that is the only way they can get medical care.  Or those who don't qualify wind up using more care down the road.

I do think that providing insurance to some should also come with the requirement that are partners in keeing costs down.  They follow doctors suggestions, at least make efforts to quit smoking, lose weight, take their medicines.  So I am not as sure that I agree with prohibition of pricing based on risk though - perhaps based on patient contribution to their own health and well being perhaps.

"Subsidies would be available to help middle-income people purchase insurance, while government programs such as Medicare and Medicaid would be expanded."

I dont know enough to commment on the merits of this.  But we all know that some of us will be bearing the extra burden of paying for these things.  Why is that fair?

"Finally, the government would subsidize and manage the development of a national system of electronic medical records."

There are so many vendors with so many products not all of which are compatible.  One size or style or brand is best for all medical practice types or goals.

I am not even sure how cost/benefit ratios work out for these.  But it is as inevitable as the internet is in general.
I am not electronic in my office.  I don't mind the government helping us subsidize this if it must be done.
But like anything the gov grants us it comes with strings attached.  Not least of which has been mentioned - gathering, monitoring, surveillancing health records for multiple imaginable purposes including but limited to control over delivery of care, outcomes data, rationing, delivery and following the adherence to "guidelines" ( to be developed by the big liberals in medical care at Yale and Harvard - many who are PhDs - not MDs), controlling and redirecting payments to providers based on their behavior as deemed appropriate not by them or their patients but by the bamas of the world.
Title: slight corrections to previous post
Post by: ccp on May 21, 2009, 06:04:40 PM
One size or style or brand is best for all medical practice types or goals.

Correction: "is NOT best"

"Not least of which has been mentioned - gathering, monitoring, surveillancing health records for multiple imaginable purposes including but limited to control over

Correction:  "but NOT limited to"

Sorry. Sometimes I post without re reading and checking the language like I should.
Title: Longevity
Post by: JDN on May 23, 2009, 07:47:48 AM
The newest WHO report was just issued.
L.A. Times

Japan tops world life expectancies with 83 years

Girls born in Japan today are likely to live until 2095, some with a good chance of seeing the dawn of the next century thanks to having the world's longest life expectancy, the World Health Organization reported from Geneva on Thursday.

The tiny nation of San Marino boasts the longest average life span for men,

at 81 years. The United States lags behind the top nations, with an average life expectancy of 78 for the two sexes combined.

Men in Sierra Leone fare the worst worldwide, living on average just 39 years.

Here are the nations at the top of life expectancies for the two sexes combined as of 2007, according to WHO:

Longest life expectancies

Japan: 83

Australia: 82

Iceland: 82

Italy: 82

San Marino: 82

Switzerland: 82

Andorra: 81

Canada: 81

France: 81

Israel: 81

Monaco: 81

New Zealand: 81

Norway: 81

Singapore: 81

Spain: 81

Sweden: 81

Embarrassingly; the list is too long to show the order where America finally ranks.
Title: Re: The Politics of Health Care
Post by: Boyo on May 23, 2009, 08:09:13 AM
Hey to answer CCp's qustion from the other day
So who would one rather have limiting or controlling care?  Private insurance administrators or government bureaucrats?

I would rather have private insurance  . Do to the fact that a if a private provider is awful the  negative effects are limited and eventually the provider goes out of buisness.While in the govt version the negative effects are wide spread and never goes out of buisness or improves it just costs more.

Title: US Mortality Rates by Race
Post by: Body-by-Guinness on May 23, 2009, 10:03:01 AM
Not sure where the WHO data JDN cites came from as the CDC, that collects mortality data in the US, only had 2004-05 data available. As that may be, and as mentioned previously, there is a strong cultural component to these sorts of stats, a component that culturally homogenous countries with restrictive immigration policies (such as Japan) don't have to contend with.

Life Expectancy at Birth by Race and Sex, 1930–2005
Learn the life expectancy (measured at birth) of American men and women, differentiated by race. For the 2005, the latest data available, the life expectancy for men of all races is 75.2 years and 80.4 years for women.

     All races    White    Black
Year    Both sexes    Male    Female    Both sexes    Male    Female    Both sexes    Male    Female
2005    77.8    75.2    80.4    78.3    75.7    80.8    73.2    69.5    76.5
20041    77.8    75.2    80.4    78.3    75.7    80.8    73.1    69.8    76.3
2003    77.5    74.8    80.1    78.0    75.3    80.5    72.7    69.0    76.1
2002    77.3    74.5    79.9    77.7    75.1    80.3    72.3    68.8    75.6
2001    77.2    74.4    79.8    77.7    75.0    80.2    72.2    68.6    75.5
2000    77.0    74.3    79.7    77.6    74.9    80.1    71.9    68.3    75.2
1999    76.7    73.9    79.4    77.3    74.6    79.9    71.4    67.8    74.7
1998    76.7    73.8    79.5    77.3    74.5    80.0    71.3    67.6    74.8
1997    76.5    73.6    79.4    77.2    74.3    79.9    71.1    67.2    74.7
1996    76.1    73.1    79.1    76.8    73.9    79.7    70.2    66.1    74.2
1995    75.8    72.5    78.9    76.5    73.4    79.6    69.6    65.2    73.9
1994    75.7    72.4    79.0    76.5    73.3    79.6    69.5    64.9    73.9
1993    75.5    72.2    78.8    76.3    73.1    79.5    69.2    64.6    73.7
1992    75.8    72.3    79.1    76.5    73.2    79.8    69.6    65.0    73.9
1991    75.5    72.0    78.9    76.3    72.9    79.6    69.3    64.6    73.8
1990    75.4    71.8    78.8    76.1    72.7    79.4    69.1    64.5    73.6
1989    75.1    71.7    78.5    75.9    72.5    79.2    68.8    64.3    73.3
1988    74.9    71.4    78.3    75.6    72.2    78.9    68.9    64.4    73.2
1987    74.9    71.4    78.3    75.6    72.1    78.9    69.1    64.7    73.4
1986    74.7    71.2    78.2    75.4    71.9    78.8    69.1    64.8    73.4
1985    74.7    71.1    78.2    75.3    71.8    78.7    69.3    65.0    73.4
1984    74.7    71.1    78.2    75.3    71.8    78.7    69.5    65.3    73.6
1983    74.6    71.0    78.1    75.2    71.6    78.7    69.4    65.2    73.5
1982    74.5    70.8    78.1    75.1    71.5    78.7    69.4    65.1    73.6
1981    74.1    70.4    77.8    74.8    71.1    78.4    68.9    64.5    73.2
1980    73.7    70.0    77.4    74.4    70.7    78.1    68.1    63.8    72.5
1979    73.9    70.0    77.8    74.6    70.8    78.4    68.5    64.0    72.9
1978    73.5    69.6    77.3    74.1    70.4    78.0    68.1    63.7    72.4
1977    73.3    69.5    77.2    74.0    70.2    77.9    67.7    63.4    72.0
1976    72.9    69.1    76.8    73.6    69.9    77.5    67.2    62.9    71.6
1975    72.6    68.8    76.6    73.4    69.5    77.3    66.8    62.4    71.3
1974    72.0    68.2    75.9    72.8    69.0    76.7    66.0    61.7    70.3
1973    71.4    67.6    75.3    72.2    68.5    76.1    65.0    60.9    69.3
19722    71.2    67.4    75.1    72.0    68.3    75.9    64.7    60.4    69.1
1971    71.1    67.4    75.0    72.0    68.3    75.8    64.6    60.5    68.9
1970    70.8    67.1    74.7    71.7    68.0    75.6    64.1    60.0    68.3
1960    69.7    66.6    73.1    70.6    67.4    74.1    —    —    —
1950    68.2    65.6    71.1    69.1    66.5    72.2    —    —    —
1940    62.9    60.8    65.2    64.2    62.1    66.6    —    —    —
1935    61.7    59.9    63.9    62.9    61.0    65.0    53.1    51.1    55.2
1930    59.7    58.1    61.6    61.4    59.7    63.5    48.1    47.3    49.2
(—) Data not available.
1. Preliminary data.
2. Deaths based on a 50% sample.
Source: National Center for Health Statistics, National Vital Statistics Reports, vol. 54, no. 19, June 28, 2006.
Title: Re: The Politics of Health Care
Post by: JDN on May 23, 2009, 11:26:47 AM
Not surprising that blacks do not live as long as whites.  Being poor, uneducated, lack of adequate social welfare programs,
availability of top physicians and care, ability to pay, etc. all have a negative influence on longevity. 

Japan is homogenous.  Welfare systems are in place to protect the poor and in general Japan's National Health System seems
to offer good quality care from cradle to grave to all individuals. 
Social factors have bigger effect on longevity than genes
Posted in Longevity and Age Management, Demographics, Longevity on Tue September 02, 2008
A three-year-long analysis of the “social determinants” of health by the World Health Organization (WHO) has led them to the conclusion that social factors - not genetics - are to blame for the huge variations in ill health and life expectancy seen around the world, a report concludes.

The report, which was complied by a panel of experts forming the WHO’s Commission on the Social Determinants of Health, found that a girl born in Japan is, on average, likely to live for 42 years longer than a girl born in the African country of Lesotho. Inequities in life expectancy and morbidity between countries have been reported for many years, however this report is the first to highlight the large variations in life expectancy that also occur within different regions of countries and suburbs of cities throught the world. For example, a boy living in Calton, a deprived suburb of the Scottish city of Glasgow will, on average, live for 28 years less than a boy born in Lenzie, an affluent suburb a couple of miles away.
In short, the report showed that poor socioeconomic circumstances equated to poor health. Furthermore, the differences in morbidity and longevity were so significant that genetics were deemed insignificant in comparison. It also revealed that wealth alone does not determine the health of a nation. Several countries, including: Cuba, Costa Rica, China, and Sri Lanka, have managed to achieve good levels of health despite their relatively low national incomes. Â

The authors wrote: “[The] toxic combination of bad policies, economics, and politics is, in large measure responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible." To combat the problem of health inequity, they recommend that governments follow the shining example of Nordic countries that have introduced policies which encourage equality of benefits and service, full employment, gender equity, and low levels of social exclusion.

Closing the gap in a generation: Health equity through action on the social determinants of health. Commission on Social Determinants of Health. World Health Organization. Full report from WHO website.
Title: More of the Same?
Post by: Body-by-Guinness on May 23, 2009, 02:34:25 PM
Precisely, which is why single data point comparative studies are pretty useless when it comes time to address a nuanced issue. Presented as a single item the question appears to be "what do Americans need to do to live as long as the Japanese, et al?" The more nuanced data makes the question become: "how do we inspire cultural changes that will increase longevity in these national subset?" In view of the well documented failure of government to address these sorts of issues in these same subsets where, say, education, is concerned, one would hope suggestions are forwarded that don't rely on more of the same.
Title: Re: The Politics of Health Care
Post by: JDN on May 23, 2009, 03:56:17 PM
As the article pointed out and I am glad you agree;

"To combat the problem of health inequity, they recommend that governments follow the shining example of Nordic countries that have introduced policies which encourage equality of benefits and service, full employment, gender equity, and low levels of social exclusion.

As a method of encouraging equality of benefits, it should be noted that most the the industrialized highly rated countries have some form of a national health insurance plan.

Title: Re: The Politics of Health Care
Post by: Crafty_Dog on May 23, 2009, 04:05:47 PM
Well, didn't Sweden just let Saab go under? :lol: 

Also, see the Islam in Europe thread, it appears there is an argument to be made that Sweden, perhaps in part due to the burdens of its nanny state, seems to lack the will to defend itself from Lebanonization.
Title: Gullah-ble Notions
Post by: Body-by-Guinness on May 23, 2009, 04:27:10 PM
I actually do not agree with WHO's socialist agenda and think that so many other throw money at the problem solutions have failed so spectacularly that I'm baffled when recapitulation is suggested. I note further there are black American sub-cultures like the Gulla and the Geechee that embrace a different set of cultural ethics which appear to be related to a lower incidence of social pathologies found in other black populations. Alas, when members of those sub-cultures like Clarence Thomas ascend, one side of the aisle demonizes him and hangs "Uncle Tom" appellations while tapping their foot along to rap, hip hop, and gangster culture.

Egalitarian solutions failed in the Soviet Union, failed in Mao's China, fail in school districts throughout this nation, to name a few. How 'bout if before we start throwing money we don't have at solutions like the ones that haven't worked before we instead reward responsible behavior and chastise irresponsible? Or does that suggestion make me too culturally insensitive to be suffered further?
Title: Re: The Politics of Health Care
Post by: JDN on May 23, 2009, 06:54:53 PM
Well, didn't Sweden just let Saab go under? :lol: 

That is bad?
I wish we had let Chrysler and GM as well as a lot more banks go under. 
At least Sweden showed some common sense.

And... at least Sweden has a health system, a social support system, and test scores among high school students far superior to the US
that enables the workers to get back on their feet faster.

However, the subject at hand is mortality; they simply live longer...
Maybe (?) because they, like most of the countries high on the list have a national health care plan?

Title: Re: The Politics of Health Care
Post by: G M on May 23, 2009, 07:42:06 PM
Well, didn't Sweden just let Saab go under? :lol: 

However, the subject at hand is mortality; they simply live longer...
Maybe (?) because they, like most of the countries high on the list have a national health care plan?

**Yeah, generations of government healthcare has done wonders for American Indians. Let's give everyone this level of care!**


Members of 562 federally recognized American Indian and Alaska Native Tribes and their descendants are eligible for services provided by the Indian Health Service (IHS). The IHS is an agency within the Department of Health and Human Services that provides a comprehensive health service delivery system for approximately 1.9 million of the nation’s estimated 3.3 million American Indians and Alaska Natives (American Indian and Alaska Native alone; bridged 2000 census ) . Its annual appropriation is approximately $3.35 billion. The IHS strives for maximum Tribal involvement in meeting the health needs of its service population, who live mainly on or near reservations and in rural communities in 35 states, mostly in the western United States and Alaska.

Approximately 57% of American Indians and Alaska Natives living in the United States rely on the IHS to provide access to health care services in 46 hospitals and over 600 other facilities operated by the IHS, Tribes, and Alaska Native corporations, or purchased from private providers.
The American Indian and Alaska Native people have long experienced lower health status when compared with other Americans. Lower life expectancy and the disproportionate disease burden exist perhaps because of inadequate education, disproportionate poverty, discrimination in the delivery of health services, and cultural differences. These are broad quality of life issues rooted in economic adversity and poor social conditions.
American Indians and Alaska Natives born today have a life expectancy that is 4.6 years less than the U.S. all races population (72.3 years to 76.9 years, respectively; 1999-2001 rates), and American Indian and Alaska Native infants die at a rate of nearly 12 per every 1,000 live births, as compared to 7 per 1,000 for the U.S. all races population (2002-2004 rates).
American Indians and Alaska Natives die at higher rates than other Americans from tuberculosis (750% higher), alcoholism (550% higher), diabetes (190% higher), unintentional injuries (150% higher), homicide (100% higher) and suicide (70% higher). (Rates adjusted for misreporting of Indian race on state death certificates; 2002-2004 rates. )
Given the higher health status enjoyed by most Americans, the lingering health disparities of American Indians and Alaska Natives are troubling. In trying to account for the disparities, health care experts, policymakers, and Tribal Leaders are looking at many factors that impact upon the health of Indian people, including the adequacy of funding for the Indian health care delivery system.
The American Indian and Alaska Native population has several characteristics different from the U.S. all races population that would impact upon assessing the cost for providing similar health services enjoyed by most Americans. The Indian population is younger, because of higher mortality, than the U.S. all races. The IHS service population is predominately rural, which should suggest lower costs; however, the disproportionate incidence of disease and medical conditions experienced by the Indian population raises the costs, which almost obliterates the lower cost offsets.
Title: Re: The Politics of Health Care
Post by: JDN on May 23, 2009, 09:10:56 PM
Don't know about American Indians (no disrespect meant).  But ask BbyG; he seems to be the self appointed expert on statistical subsets and sub cultures.

Perhaps a better and much broader example of a government sponsored plan covering tens of millions of Americans is Medicare; most older people I know including my parents are quite happy with the
Title: Re: The Politics of Health Care
Post by: G M on May 23, 2009, 09:32:27 PM
**Yeah, we can't afford medicare now. This program is already a looming disaster. So let's spend more?**

Unsustainable Medicare
Fixes for the program's funding will be needed soon.
Saturday, May 5, 2007; Page A16

THE RELEASE last week of the annual report of the Medicare trustees underscores an unavoidable fact that too many politicians have nonetheless been avoiding for too long: Of all the entitlement programs, Medicare is on the most dangerously unsustainable financial course, squeezed simultaneously by rising health-care costs and an aging population.

When Congress passed the Medicare prescription drug bill four years ago, it included a mechanism designed to call attention to runaway spending in the health care program for seniors and the disabled. Medicare is funded by a combination of payroll taxes (hospital costs) and general revenue (doctor's visits and prescription drug costs). Bureaucratic alarms sound if the Medicare trustees project that the share of funds to be drawn from the general Treasury is set to exceed 45 percent in the near future. That alarm sounded for the first time last year and was repeated again last week. The second warning requires that the president -- in the budget he will submit early next year -- propose changes to reduce Medicare's drain on the Treasury. Under the law, Congress must quickly consider those remedies, though it doesn't have to act.

This is an especially blunt instrument to deal with an especially large problem, and the Bush administration's proposed solution, to require automatic cuts, is too crude. The challenge facing Medicare isn't how it's funded, it's how much it costs. Indeed, the program was designed to be financed in a hybrid fashion, and the very prescription drug bill that included the arbitrary 45 percent trigger tilted the mix more toward general revenue.

President Bush, to his credit, has proposed some ways of taming the Medicare monster. In this year's budget, he calls for $66 billion in Medicare cuts over the next five years. Of this, $10 billion would come from requiring higher-income beneficiaries -- $80,000 in annual income, $160,000 for a couple -- to pay higher premiums for prescription drug coverage, as they do now for their basic coverage, and by ending the indexing of this income test. The income ceiling may require adjustment, but for now this is a sensible proposal; in any event, higher premiums for the better-off should have been part of the plan from the start. Also worth discussing are the administration's proposals to cut payments to hospitals, nursing homes and other providers. But Democrats have greeted the proposals with more hostility than interest.

The administration can be faulted for insisting on retaining an expensive, lopsided payment scheme by which private insurance plans "competing" with traditional Medicare receive a government subsidy for doing so. These private plans have been growing rapidly, and they now cover one in five beneficiaries. That would be fine if such "Medicare Advantage" plans were competing on a level playing field, but they're not: The government is paying them on average 12 percent more than traditional fee-for-service providers. The Medicare policy board that advises Congress has endorsed leveling this playing field. The higher payments, according to the Congressional Budget Office, amount to $65 billion over five years, and $160 billion over 10. No wonder the companies that market these plans are lobbying so furiously to keep their undue Medicare advantage.
Title: Poor Health
Post by: Body-by-Guinness on May 24, 2009, 07:41:48 AM
But ask BbyG; he seems to be the self appointed expert on statistical subsets and sub cultures.

No just speaking to data sets already mentioned that you then ignore while petulantly positing another stupid argument. At what point do you note how poorly your technique works?

Hey, didn't see the UK on the single axis mortality stats you're attempting to weave an argument from. Seeing how they already have the health care system and other social programs you're pining for in the US, what does that say about the point you're already doing a poor job making?
Title: Re: The Politics of Health Care
Post by: JDN on May 24, 2009, 08:43:00 AM
Odd, most of the world's general public accepts the World Health Organization statistics except you BbyG.
And nearly every health organization in the world utilizes their statistics and findings.
But then I forgot you are an MD and a world famous Epidemiologist.    :roll:

You find some obscure Black American subcultures and therefore conclude the WHO statistics invalid...
Or you try to find an anomaly...

And that's your brilliant argument to disregard the entire WHO findings?

Do you ever read your own manure?  You should; it's good for a laugh.
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on May 24, 2009, 09:42:08 AM
Helluva afterdinner conversation here gentlemen , , ,  :x
Title: Re: The Politics of Health Care
Post by: G M on May 24, 2009, 02:59:23 PM
Odd, most of the world's general public accepts the World Health Organization statistics except you BbyG.
And nearly every health organization in the world utilizes their statistics and findings.
But then I forgot you are an MD and a world famous Epidemiologist.    :roll:

**I guess BBG should follow your example and only comment on things he has expertise in, right?**

Title: Re: The Politics of Health Care
Post by: Boyo on May 24, 2009, 04:18:59 PM
Here is something interesting from the WSJ .I wasn't sure where to post in the science thread or here but since it deals with the WHO and in a back door way healthcare here it is. :evil:

Malaria, Politics and DDT
The U.N. bows to the anti-insecticide lobby
In 2006, after 25 years and 50 million preventable deaths, the World Health Organization reversed course and endorsed widespread use of the insecticide DDT to combat malaria. So much for that. Earlier this month, the U.N. agency quietly reverted to promoting less effective methods for attacking the disease. The result is a victory for politics over public health, and millions of the world's poor will suffer as a result.

The U.N. now plans to advocate for drastic reductions in the use of DDT, which kills or repels the mosquitoes that spread malaria. The aim "is to achieve a 30% cut in the application of DDT worldwide by 2014 and its total phase-out by the early 2020s, if not sooner," said WHO and the U.N. Environment Program in a statement on May 6.

Citing a five-year pilot program that reduced malaria cases in Mexico and South America by distributing antimalaria chloroquine pills to uninfected people, U.N. officials are ready to push for a "zero DDT world." Sounds nice, except for the facts. It's true that chloroquine has proven effective when used therapeutically, as in Brazil. But it's also true that scientists have questioned the safety of the drug as an oral prophylactic because it is toxic and has been shown to cause heart problems.

Most malarial deaths occur in sub-Saharan Africa, where chloroquine once worked but started failing in the 1970s as the parasite developed resistance. Even if the drugs were still effective in Africa, they're expensive and thus impractical for one of the world's poorest regions. That's not an argument against chloroquine, bed nets or other interventions. But it is an argument for continuing to make DDT spraying a key part of any effort to eradicate malaria, which kills about a million people -- mainly children -- every year. Nearly all of this spraying is done indoors, by the way, to block mosquito nesting at night. It is not sprayed willy-nilly in jungle habitat.

WHO is not saying that DDT shouldn't be used. But by revoking its stamp of approval, it sends a clear message to donors and afflicted countries that it prefers more politically correct interventions, even if they don't work as well. In recent years, countries like Uganda, Tanzania and Zambia have started or expanded DDT spraying, often with the help of outside aid groups. But these governments are also eager to remain in the U.N.'s good graces, and donors typically are less interested in funding interventions that WHO discourages.

"Sadly, WHO's about-face has nothing to do with science or health and everything to do with bending to the will of well-placed environmentalists," says Roger Bate of Africa Fighting Malaria. "Bed net manufacturers and sellers of less-effective insecticides also don't benefit when DDT is employed and therefore oppose it, often behind the scenes."

It's no coincidence that WHO officials were joined by the head of the U.N. Environment Program to announce the new policy. There's no evidence that spraying DDT in the amounts necessary to kill dangerous mosquitoes imperils crops, animals or human health. But that didn't stop green groups like the Pesticide Action Network from urging the public to celebrate World Malaria Day last month by telling "the U.S. to protect children and families from malaria without spraying pesticides like DDT inside people's homes."

"We must take a position based on the science and the data," said WHO's malaria chief, Arata Kochi, in 2006. "One of the best tools we have against malaria is indoor residual spraying. Of the dozen or so insecticides WHO has approved as safe for house spraying, the most effective is DDT." Mr. Kochi was right then, even if other WHO officials are now bowing to pressure to pretend otherwise.



Title: Re: The Politics of Health Care
Post by: JDN on May 24, 2009, 05:11:53 PM
GM; the American Medical Association, et al seem to to accept and use WHO's findings.
Basically everyone does.....
Not perfect, but normal practice...

And oddly enough, since this particular forum is "The Politics of Health Care" except perhaps
for CCP's greater personal knowledge I am an "expert" using the term loosely having spend over ten years advising large (10,000+ employees) corporations
on their medical plans and having been married to a Board Certified Neurologist (I took care of the business aspects for her) for a number of years.

Title: Re: The Politics of Health Care
Post by: Body-by-Guinness on May 26, 2009, 08:06:05 AM
Do you ever read your own manure?  You should; it's good for a laugh.

I expect more hip waders are donned reading your inanities.

Again you dodge a larger point by thrumming your chest about a single data point and copping snotty attitudes about a UN agency cited as an authority. As the post about DDT should show, UN sponsored agencies are not paragons of scientific virtue so quoting their findings as the final word on the subject demonstrate your failings, not mine.

Time for another "nonny nonny boo boo," I suppose, as it appears to be your strongest argument.
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on May 26, 2009, 08:18:30 AM
Do you ever read your own manure?  You should; it's good for a laugh.

I expect more hip waders are donned reading your inanities.

OK folks, taking a poll here:  Any suggestions for the tone the conversation seems to be establishing?

a) Its the internet, what else do you expect
b) continue to call to their better nature
c) or?
Title: or
Post by: ccp on May 26, 2009, 10:05:14 AM
water boarding :-D
Title: Re: The Politics of Health Care
Post by: Body-by-Guinness on May 26, 2009, 11:33:25 AM
Suits me. Bet I'd hold out longer.
Title: Re: The Politics of Health Care
Post by: JDN on May 26, 2009, 12:13:24 PM
water boarding :-D

But please don't tell me CCP that you would be the attending physician? 
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on May 26, 2009, 08:37:57 PM
Humor is good.

Now take a dozen deep breaths and start FRESH with NO backward looking cracks please!!!
Title: Don't tax you, don't tax me, tax that fellow behind the tree
Post by: Crafty_Dog on May 29, 2009, 06:35:24 PM
Politicians wouldn't be politicians if they didn't trim their sails to the prevailing winds. Even so, the emerging 180-degree turn by Democrats on taxes and health insurance is one for the record books.

 Democrats have spent years arguing that proposals to equalize the tax treatment of health insurance are an outrage against the American people. Workers pay no income or payroll taxes on the value of job-based plans, but the same hand isn't extended to individuals who must buy coverage on their own. Last year liberals mauled John McCain for daring to touch the employer-based exclusion to finance more coverage for the individually uninsured. He was proposing "a multitrillion-dollar tax hike -- the largest middle-class tax hike in history," said Barack Obama, whose TV ads were brutal.

But now Democrats need the money to finance $1.2 trillion or more for their new health insurance entitlement. Last week Senate Finance Chairman Max Baucus released his revenue "policy options" and high on the list is . . . taxing health benefits. Or listen to White House budget director Peter Orszag, who recently told CNN's John King that the exclusion "was not in the President's campaign plan, it wasn't in our budget. Clearly, some Members of Congress are putting it on the table and we are going to have to let this play out."

Mr. King tried again. "Let this play out. But would the President sign a bill that includes a pretty significant tax increase? That would be a tax increase." Mr. Orszag: "We're not going to be -- I think it's premature to be commenting on individual items . . . There are lots of ideas that are being put on the table." Translation: You betcha he'd sign it.

The tax exclusion is such a big revenue prize because Mr. Baucus is scrubbing every other tax nook and cranny and only coming up with rounding errors. A sampler:

- Impose an excise tax on hard alcohol, beer and some kinds of wine. That would be in addition to a sin tax on beverages sweetened with sugar or high-fructose corn syrup, such as soda. Mr. Baucus doesn't offer revenue estimates, though the Congressional Budget Office says a $16 per proof gallon alcohol tax might raise $60 billion over 10 years, and another $50.4 billion at three cents per 12 ounces of sugary drink.

- End or limit the tax-exempt status of charitable hospitals, which only costs currently a mere $6 billion a year.

- Make college students in work-study programs subject to the payroll tax. Also targeted are medical residents, perhaps on the principle that they'll one day be "rich" doctors. CBO has no score on these.

- Reducing Medicare reimbursement rates for supposedly "over valued physician services," such as diagnostic imaging. CBO says that requiring doctors to get prior clearance could save $1 billion in 10 years.

- For individuals with high-deductible insurance plans, contributions to health savings accounts would no longer be tax deductible. That would penalize patients who choose plans that encourage them to be informed consumers. CBO says that banning HSA payments entirely would yield all of $10 billion.

By contrast, the employer-based exclusion offers a huge money pot -- an estimated $226 billion in 2008. Yet as liberal MIT economist Jonathan Gruber recently told Mr. Baucus's committee, "no health expert today would ever set up a health system with such an enormous tax subsidy to a particular form of insurance" (his emphasis). It creates a coverage gap between workers who receive it from their employers and those who pay -- or can't afford to pay -- with after-tax money.

The tax exclusion is also one reason health costs continue to rise. It encourages workers to take an extra dollar of compensation in fringe benefits instead of cash while also routing low-deductible health spending through third parties. Some 84 cents of every medical dollar is spent by someone other than the patient. The insured have no incentives to make cost-conscious decisions about care.

So reforming the exclusion would inject a dose of discipline into American medicine. But for most Democrats the goal isn't to create a more rational health-insurance market. They simply want the revenue for another government program. Mr. Baucus won't target gold-plated employer insurance plans in general, because union-negotiated benefits are usually gold-plated. Rather, he may cap or phase out the exclusion by income, starting with workers earning more than $200,000. Insurance options that don't conform to government diktats (health savings accounts) would also lose any tax advantage. This would do nothing for market efficiency, but it would be one more stealth tax increase.

Democrats owe an apology to Mr. McCain, and it'll be fascinating to see if they will now suffer a political backlash of their own making. Having told the country that this tax reform is really a tax increase, Democrats are opening themselves to the same attacks they leveled against Republicans.

They could avoid that fate if they used the tax exclusion money to finance, say, a tax credit for the uninsured. That would be a genuinely bipartisan reform. But liberals won't accept that because they want to take one giant step toward government-run health care. And the only way they can pay for it is by taxing everything in sight, including your current health insurance.

Title: Hospital Holding Pattern
Post by: Body-by-Guinness on May 31, 2009, 08:41:53 AM
Ah the joys of government run health care. Government mandates that patients be treated within four hours of admittance. Strapped for resources, hospitals don't have the beds to admit, so the meet the mandate by leaving patients languishing in ambulances etc:

Patients forced to wait hours in ambulances parked outside A&E departments
Ambulance chiefs have warned that lives are being put at risk "on a daily basis" by long delays allowing patients into Accident and Emergency units.
By Laura Donnelly, Health Correspondent
Last Updated: 10:04PM BST 30 May 2009

An investigation by The Sunday Telegraph has found that thousands of 999 patients are being left to wait in ambulances in car parks and holding bays, or in hospital corridors – in some cases for more than five hours – before they can even join the queue for urgent treatment.

Experts warn that hospitals are deliberately delaying when they accept patients – or are diverting them to different sites – in order to meet Government targets to treat people within fours hours of admitting them.
The extent of the problems have been revealed in correspondence between senior health officials, obtained under the Freedom of Information Act, which also show their serious concerns about the dangers the delays pose to patients.

A letter by Sir Graham Meldrum, chairman of West Midlands Ambulance Service, sent to hospital chief executives last November warns that patients are "being put at risk on a daily basis", with 7,600 patients a month facing delays of more than 30 minutes – a situation which has since deteriorated, with more than 8,000 such delays in March.

The documents also reveal an investigation into the death of a patient who waited three hours to be seen by A&E staff after being taken by ambulance to The Royal Wolverhampton Hospitals Trust.

On two occasions in January, ambulances took more than five hours to unload patients at Queen's Hospital in Romford, Essex.

In the same month, journeys to Weston-super-Mare hospital in Somerset were repeatedly held up, with more than a dozen waits of two hours, including delays of four and five hours.
Dozens of A&E units refused all 999 arrivals for periods of several hours, on hundreds of occasions, forcing crews to take desperately sick patients on lengthy journeys, and shifting pressures to other hospitals, the documents show.

In the course of six months, hospitals in the West Midlands ordered a "divert" on more than 450 occasions, closing A&E units to all 999 arrivals for hours at a time.

During a six-week period last autumn, hospital chiefs in the north east of England closed casualty units to 999 arrivals on 34 occasions, for up to 19 hours at a time.

Internal documents from the London Ambulance Service reports of extensive delays throughout December: "Ambulances have queued in large numbers for up to five hours to unload, and two hour delays were relatively common," it says.

The briefing note, written in January, says hospitals were so short-staffed that ambulance staff were regularly forced to look after multiple patients simultaneously, so that colleagues could respond to 999 calls.

Delays to patients arriving to A&E by ambulance are increasing in many parts of the country as hospitals struggle to cope with a massive increase in the number of emergency hospital admissions since family doctors stopped providing routine out-of-hours care.

Since the changes were made five years ago, the number of emergency hospital admissions has risen by 30 per cent, while the number of beds fell by more than 20,000.
More than 100,000 ambulance journeys were delayed at casualty units by more than 30 minutes in the month of March alone – an increase of 18 per cent in 12 months.
Mike Penning, the shadow health minister, said: "Labour's tick box culture is forcing staff to prioritise the four hour target ahead of ensuring patient get the treatment they need.
"It is madness that all of this has happened at a time when the number of people being admitted to A&E units is soaring."

Ambulance staff and patients groups said hospitals were routinely ignoring NHS guidance which says the "clock" for the A&E four hour wait should start 15 minutes after an ambulance arrives on site.

Katherine Murphy, from the Patients Association, said: "We are hearing increasing numbers of stories of seriously-ill patients lying in pain in ambulances, worried out of their mind, while others are taken on long journeys because casualty units have been closed.

"The guidance may say they should not be delayed, but the A&E target is the one that comes with financial penalties attached, and it is the one hospitals care about."
Most ambulance trusts measure delays by "turnaround time" – the time between the ambulance's arrival at A&E and its availability for the next call.
It includes any time cleaning or restocking the vehicle, which should take no more than a few minutes.

Research by one ambulance trust found three quarters of delays occurred before the patient was handed over to staff, and that 84 per cent of those cases were connected to bed shortages.

Sam Oestricher, ambulance representative for trade union Unison, said ambulances were being treated "as mobile waiting rooms".
He said: "Our members are spending hours effectively babysitting patients, who have been rushed to A&E departments because they need to be seen urgently.
"It leaves patients and crews in a terribly anxious, frustrating situation, and it greatly increases the risks."

Jim Wardrope, A&E consultant at Sheffield Northern Hospital and past president of the College of Emergency Medicine said: "The whole system is running hot, so that when the pressure comes, it backs up quickly and we end up desperately searching for trolleys."

Health Minister Ben Bradshaw said "severe action" would be taken against any hospitals found to be keeping patients in ambulances in an attempt to cheat on the A&E targets.
He added: "The vast majority of hospitals up and down the country are meeting the four hour target without keeping people waiting in ambulances."

More than 4,800 people have backed The Sunday Telegraph's Heal Our Hospitals campaign, which is calling for a review of hospital targets to make sure they work to improve quality of care.
Title: Re: The Politics of Health Care
Post by: ccp on May 31, 2009, 10:58:16 AM
Where I am patients are triaged.  Waits for the true emergencies are low but when the ED is busy some could wait for hours.
I don't see any other way.
All our lives are going to be nothing more than following mandates.
For doctors it already is that way, but it will get worse.

You should only use so much electricity, water, sugar, gas, oil, than the government hopes you do use more because then they can tax you/us.

Flush more than once per day per person per household then more can be confiscated.
Pelosi wants to inventory "everything".

I assume there will be a tax for too much TV, sitting, blogging, message boards.  Hey if your not walking your fat.  We tax for cigarettes alcohol why not for each pound you are over a certain BMI?

A National sales tax is coming. 

On and on.  Crafty you are so right.  We are totally screwed.
Title: Dissonance Accretes
Post by: Body-by-Guinness on June 02, 2009, 05:46:23 AM
There Is No Such Thing As a Free Health Care. But There Are Lots of Things Called Free-er Health Care That Get Really, Really Expensive In Ways That Range Far Beyond Dollars and Cents.

Nick Gillespie | June 2, 2009, 8:09am

Get ready for the Summer of Glove, as in rubber-examination gloves used for digital exams. This time the patient is the entire U.S. economy, which we're being told suffers from bloating and sluggishness due to way too much spending on health care.

Legislation to revamp the health-care system likely would cut the rate of annual growth in costs by 1.5 percentage points, increasing the gross domestic product by more than 2 percent in 2020 above what it would be if no changes were made, according to projections by President Barack Obama's Council of Economic Advisers.

"Health care reform is incredibly important not just for the American people but for the American economy," Christina Romer, who chairs the council, said in a briefing for reporters on the CEA report released this morning.

Those are the types of bold, long-term predictions that hold as much water as an 88-year-old man on a full-liquid diet. I mean, really, if you're going to make predictions that are completely pulled out of your ass, why not follow what Treasury did with the TARP bailout and just choose a "really big number" picked out of thin air?

More to the point, the Wile E. Coyote Super Geniuses in D.C. have been working overtime since their junior-high theses on proposals to finally fix health care (despite it not being totally clear what the term even means, or how it means very different things to very similar people).

They have seen the past and it didn't work. But that doesn't mean it can't not work this time:

Democrats, who control both the House and Senate, are considering proposals that would require employers to cover all full-time workers or pay a penalty to the government; create a "health exchange" to allow consumers to buy insurance at lower, group rates; set up a new government-run plan to cover some of the uninsured; and levy new taxes to pay for universal coverage.

Employer mandates. Insurance pools. Government programs. New taxes. Hope and change, and even without Tom Daschle in the cabinet! I don't know they do it, but goddamn, it's beautiful.

Exactly how any of the above differs from what we're already doing escapes me. Our health care system is the ugly accretion of decades of stupid government policies (starting with the decision not to tax employer-based health care costs as compensation, thus pushing the idea of tying coverage to the workplace) that have gotten gnarlier and more twisted with each additional, incremental add-on.

So, if you're actually legislatin' in the 21st century on the promise of hope and change, why not actually start thinking about doing some things that are genuinely different and have at least a snowball's chance in hell of working?

Start with injecting actual market forces into health care by disrupting professional cartels that raise the cost of buying any prescription drug by $100 or whatever you get charged for a perfunctory doctor's visit (and by the way, start questioning the prescription drug regime too)?

Inject some actual price signals into the system by getting rid of the tax-code hocus-pocus that creates third-party payer systems and gets employers, most of whom can't turn a goddamn dollar at their chosen field of expertise, into the business of providing health care?

Take an example from fields such as dentistry and eyecare, where fewer services are covered by insurance and hence more open to the sorts of competition and discovery process that routinely drives prices down and the level of services up in every area of exchange from airline tickets to hamburgers to high-tech computer gear. And recognize that health insurance is not the same as health; indeed, it's not quite clear just exactly how the two are linked.

And also take a deep breath and recognize that spending more money on health care is not necessarily a bad thing, if it's the free choice of people (which currently it isn't). Like eating more prepared meals, it can be a glorious sign of increasing wealth.

But most of all, stop acting like characters from Tennessee Williams or William Faulkner. Learn from the past already, don't just mindlessly repeat it.

Title: Re: The Politics of Health Care
Post by: HUSS on June 02, 2009, 07:57:27 PM
hahahahahahaha, i hope this hurts everyone who voted for him. I would love to witness the facial expressions of every single moron for voted for obama when they realize that not only did he lie to them but he is violating them 10X worse the then evil GWB did.

Obama said to be open to taxing health benefits

By ERICA WERNER, Associated Press Writer Erica Werner, Associated Press Writer – Tue Jun 2, 7:43 pm ET
WASHINGTON – President Barack Obama is leaving the door open to taxing health care benefits, something he campaigned hard against while running for president. Senate Finance Committee Chairman Max Baucus, D-Mont., raised the issue with Obama during a private meeting Tuesday with the president and other Democratic senators and later reported the president's response: "It's on the table. It's an option."

The federal government would reap about $250 billion a year if it treated health care benefits given to employees like wages and taxed them.

Baucus and others are eyeing that money as they search for ways to pay for a costly health care overhaul that would extend coverage to 50 million Americans who are now uninsured. That could cost some $1.5 trillion over 10 years.

The president adamantly opposed health benefit taxes during the campaign, arguing they would undermine job-based coverage. But he's now indicating openness to that suggestion from Congress, even if he criticized Republican presidential rival John McCain for proposing a sweeping version of the same basic idea.

Obama has made some suggestions of his own for paying for a health care overhaul, including cuts to Medicare and limiting tax deductions wealthy people can take, but they've run into opposition from Congress. And, they only add up to about $630 billion over 10 years.

"The president made it clear during the campaign that he has serious concerns about taxing health care benefits," White House spokesman Reid Cherlin said in a statement about Tuesday's meeting.

"He stated again his belief that health reform can't wait another year, and that while all options should be considered, those options should include the revenue proposals that he included in his budget," Cherlin said. "He made it very clear that he prefers the approach he has already outlined."

Some experts think limiting the tax exclusion for health benefits is the only way to get the necessary money to pay for a sweeping health care overhaul. But there's opposition from organized labor and from many Democrats, including House Ways and Means Chairman Charles Rangel, D-N.Y., who said recently there was "no way" he would support the approach.

Baucus wants to look at limiting — but not entirely eliminating — the tax-free status of employer-provided health benefits. Obama is leaving the details of crafting a health care bill to Congress and used Tuesday's meeting to urge senators to swift action.

"This window between now and the August recess I think is going to be the make-or-break period," Obama said before the meeting was closed to reporters. "This is the time where we've got to get this running."


Associated Press writers Philip Elliott and Ricardo Alonso-Zaldivar contributed to this report.

Title: Politics of Health Care - the meeting was closed to reporters
Post by: DougMacG on June 03, 2009, 07:37:47 AM
Huss notes the meaninglessness of Obama's positions in the campaign to his own positions now.  Unbelievable how many times on so many topics that has already happened, starting with when he joked (?) about things said in a campaign when he appointed Hillary to be Sec. of State.

I was most struck by a phrase tucked at the end of the AP story:

"... Obama said before the meeting was closed to reporters" !!!

When it was the old Hillary task force or when it is the new leftist machine, they do that to get things done for the American people.  When it was Cheney trying to develop a proposal for energy production so that the economy would not collapse in 8 years (whoops), it was black helicopters and evil conspiracies. 
Title: GOP plan
Post by: Crafty_Dog on June 06, 2009, 06:38:01 AM
GOP Health Plan Contrasts With Obamacare

While Democrats fret about how to find another $1.5 trillion to pay for their scheme to expand government health care to include all Americans, congressional Republicans have introduced their alternative Patients' Choice Act. The Act, which has no chance of passage by a Democrat-controlled Congress committed to expanding federal bureaucracy and power, is an attempt to redirect $300 billion in federal tax deductions from the employer-based health system that was created after World War II.

Under the proposal, families would qualify for tax credits of $5,700 a year and individuals $2,300 to buy insurance and invest in health savings accounts. Up to one-fourth of any unspent money in the accounts could be rolled over to the next year. The bill would allow lower-income Americans a way out of the Medicaid trap rapidly careening toward its inevitable bankruptcy less than eight years hence because it is $34 trillion in debt. In fact, Medicare is so deep in debt that devoting 100 percent of GDP to it still won't make this single government program solvent.

Despite admitting the insolvency of our national finances when he said last week, "[W]e are out of money," Barack Obama is trying to sell the notion that the proposed federal takeover of 18 percent of the nation's economy via his new health care plans somehow helps the nation economically. Obama also suggested myopically that $200 billion could be shaved from Medicare over the next 10 years (the program is bankrupt about three years earlier) even though a majority of physicians now refuse to see Medicare patients because of artificially low reimbursement rates. Instead of squandering the nation's future health care with legions of expensive bureaucrats, the GOP alternative deserves serious consideration because it doesn't cost the taxpayers anything and doesn't require the creation of a massive government bureaucracy to operate.
Title: Re: The Politics of Health Care
Post by: ccp on June 06, 2009, 09:02:21 AM
"Under the proposal, families would qualify for tax credits of $5,700 a year and individuals $2,300 to buy insurance and invest in health savings accounts. Up to one-fourth of any unspent money in the accounts could be rolled over to the next year. The bill would allow lower-income Americans a way out of the Medicaid trap"

How much do people on medicaid pay in taxes that this deduction is even going to apply to them?

Title: Re: The Politics of Health Care
Post by: Crafty_Dog on June 06, 2009, 10:11:31 AM
Dunno, but does not the term "tax credit" mean a one-to-one relationship with taxes paid?  In contrast, a deduction is worth only the % paid on the income/gain-- yes? 

Thus, if I am correct, most any taxes paid by these people (no doubt there will be some exceptions) will be applicable here.

Of course, the devil is in the details.
Title: Kennedy's First Draft
Post by: Body-by-Guinness on June 08, 2009, 01:04:41 PM
Kennedy’s Health Bill: A First Look

Posted by Michael D. Tanner

A draft of Sen. Ted Kennedy’s health care reform bill is finally available, and it is difficult to overstate how far he would move us to a government-run health care system. An initial read-through reveals among the key provisions:

An individual mandate, requiring that every American purchase a “qualified” insurance plan. (Sec. 161(a)) The mandate will be enforced through the tax code with Americans required to pay a penalty if they fail to comply.  In an extraordinary delegation of congressional authority, the Kennedy bill would give the Secretaries of Treasury and Health and Human Services the power to determine what this penalty should be. Individuals would be required to submit information on their insurance status over the previous year to the Secretary of HHS, along with “any such other information as the Secretary may require.” (Sec. 6055(b)(2) and (3)). Individuals who already have insurance could keep it. However, if they changed plans (or presumably changed jobs), their new insurance would have to meet the definition of “qualified.”

A “pay or play” employer mandate requiring employers to provide all workers with health insurance and pay a minimum amount of the premium, or pay a tax (Sec 162). Again, the amount of the new tax is left to the discretion of the Secretaries of HHS and Treasury. Some small employers would be exempt from the mandate, but the size of those firms remains TBA. (Sec. 3113(g)) Companies with fewer than 250 workers would be forbidden to self-ensure. (Sec. 2720)

A new federal bureaucracy, the Medical Advisory Council, which would determine what benefits will be required to be part of your “qualified” insurance plan. (Sec. 3103(h) and (i)). Lest anyone think Congress won’t get involved. The Council’s decisions can be disapproved by Congress if, say, they don’t mandate inclusion by a favored provider group or disease constituency. (Sec 3103(g)).

Massive new federal subsidies. Medicaid would be expanded to individuals earning 150 percent of the poverty level, and the federal government would pay all incremental costs of the increased enrollment. (Sec 152.) Single, childless adults would become eligible for Medicaid. Even more egregious, individuals and families with incomes between 150-500 percent of the poverty level ($110,250 for a family of four) would be eligible for subsidies on a sliding scale-basis.(Sec. 3111(b)(1)(A-G)).

Insurers would be required to accept all applicants regardless of their health (guaranteed issue) and forbid insurers from basing insurance premiums on risk factors (Community rating). There does not appear to be any exception for lifestyle factors, such as smoking, alcohol or drug use, diet, exercise, etc. Thus, not only will the young and healthy be forced to pay higher premiums to subsidize the old and unhealthy, but the responsible will be forced to pay more to subsidize the irresponsible.
A “public option” operating in competition with private insurance (Section 31__). How this plan would be funded, the level of premiums, etc. is left mostly TBA. In response to criticism, the Kennedy bill does require that the public plan pay providers 10 percent above Medicare reimbursement rates. (Sec 31__(B)). That would still allow for a considerable degree of cost-shifting to private insurance. And, we should recall that such promises are ephemeral. When Medicare began, proponents promised it would reimburse at the same rate as insurance. That promise didn’t last long.

States would be prodded to set up “gateways,” similar to Massachusetts’ “connector.” (Sec 3104(a)) If a state fails to do so, the federal government will set one up for them. (Sec. 3104(d)) The federal government would provide grants to states to help them set up these gateways. The amount of the grants is, you guessed it, left to the discretion of the Secretary of HHS. Gateways may also fund their operations by assessing a surcharge on insurers. Sec. 3101(b)(5)(A)/

A new federal long-term care program (Sec 171).

Kennedy does not include any estimate of how much his plan would cost, nor any proposal for how to pay for it.

More details will undoubtedly emerge, but it is very clear that the Kennedy plan would put one-sixth of the US economy and some of our most important, personal, and private decisions firmly under the thumb of the federal government.

Michael D. Tanner • June 8, 2009 @ 2:40 pm

Primary source:
Title: Model Behavior
Post by: Body-by-Guinness on June 09, 2009, 09:47:01 AM
June 09, 2009, 4:00 a.m.

How Not to Reform Health Care
Massachusetts is widely touted as a model for health-care reform. It isn’t.

By Michael Tanner

As the national debate over health-care reform begins, many in Congress are looking to Massachusetts as a model for what that reform might look like. Indeed, from mandates and subsidies to some form of exchange or “connector,” many of the key components of the Massachusetts reforms are likely to end up in the bill to be voted on this year.

But three years after it was voted in, experience suggests the “Massachusetts model” actually provides an object lesson in how not to reform health care. The program has failed in its main goal of achieving universal coverage. It has failed to restrain the growth in health-care costs. And it has greatly exceeded its initial budget, placing new burdens on the state’s taxpayers.

There is no doubt that the Massachusetts program has reduced the number of people without health insurance in the state — but by how much is a matter of considerable dispute. According to official statistics, the state’s uninsured rate has declined from 10.4 percent in 2006 to just 2.6 percent today. However, there are several reasons for doubting the accuracy of this number. For example, a door-to-door survey by the Census Bureau in March 2008 estimated that 5.4 percent of state residents were uninsured. And an examination of state income-tax returns indicates that roughly 5 percent of residents were uninsured as of Jan. 1, 2008. The best estimates suggest that more than 200,000 Massachusetts residents remain uninsured, out of the 670,000 uninsured in 2006. That’s a far cry from the “universal coverage” that was promised when the bill was passed.

Health-care costs continue to rise much faster in Massachusetts than in the nation as a whole. Proponents of the reform promised that it would reduce costs. Gov. Mitt Romney said “the cost of health care would be reduced” and the plan would make health insurance “affordable” for every Massachusetts citizen. Supporters went so far as to suggest that the reforms would reduce the price of individual insurance policies by 25 to 40 percent. In reality, since the program became law, insurance premiums have been increasing by 10 to 12 percent per year, nearly double the national average. On average, health insurance costs $16,897 a year for a family of four in Massachusetts, compared to $12,700 nationally. Meanwhile, total health-care spending in the state has increased by 28 percent.

New regulation and bureaucracy are limiting consumer choice and adding to costs. A new mandate for prescription-drug coverage was added, and high-deductible policies were restricted. Some Massachusetts residents who were happy with their old insurance policies have had to change their coverage in order to comply with the mandates.

Although much of the burden falls on individual policy-holders, the costs to the taxpayers have also skyrocketed. Despite one tax increase already, the program faces huge deficits in the future. As a result, the state is considering caps on insurance premiums, cuts in reimbursements to providers, and even the possibility of a “global budget” on health-care spending — with its attendant rationing.

The reforms have added a new burden on companies, especially smaller ones, wanting to do business in the state. The Small Business and Entrepreneurship Council cites the Massachusetts health-care regulations and the mandate on companies as its reasons for ranking Massachusetts dead last among the 50 states for business-friendly health-care policies.

A shortage of providers, combined with higher demand, is increasing waiting times to see a physician, especially primary-care providers. The wait for seeing an internist, for example, has nearly doubled since the reforms were implemented.

Supreme Court Justice Louis Brandeis rightly called America’s state governments “the laboratories of democracy.” States are able to experiment with policies on a small scale before these policies are adopted by the whole nation.

Let us hope that Congress learns from the failure of the Massachusetts experiment.

— Michael Tanner is a senior fellow at the Cato Institute and the co-author of Healthy Competition: What’s Holding Back Health Care and How to Free It.

National Review Online -
Title: Rove
Post by: Crafty_Dog on June 11, 2009, 01:36:53 PM

It was a sobering breakfast with one of the smartest Republicans on Capitol Hill. We can fix a lot of bad stuff President Barack Obama might do, he told me. But if Mr. Obama signs into law a "public option," government-run insurance program as part of health-care reform we won't be able to undo the damage.

I'd go the Republican member of Congress one further: If Democrats enact a public-option health-insurance program, America is on the way to becoming a European-style welfare state. To prevent this from happening, there are five arguments Republicans must make.

The first is it's unnecessary. Advocates say a government-run insurance program is needed to provide competition for private health insurance. But 1,300 companies sell health insurance plans. That's competition enough. The results of robust private competition to provide the Medicare drug benefit underscore this. When it was approved, the Congressional Budget Office estimated it would cost $74 billion a year by 2008. Nearly 100 providers deliver the drug benefit, competing on better benefits, more choices, and lower prices. So the actual cost was $44 billion in 2008 -- nearly 41% less than predicted. No government plan was needed to guarantee competition's benefits.

Second, a public option will undercut private insurers and pass the tab to taxpayers and health providers just as it does in existing government-run programs. For example, Medicare pays hospitals 71% and doctors 81% of what private insurers pay.

Who covers the rest? Government passes the bill for the outstanding balance to providers and families not covered by government programs. This cost-shifting amounts to a forced subsidy. Families pay about $1,800 more a year for someone else's health care as a result, according to a recent study by Milliman Inc. It's also why many doctors limit how many Medicare patients they take: They can afford only so much charity care.

Fixing prices at less than market rates will continue under any public option. Sen. Edward Kennedy's proposal, for example, has Washington paying providers what Medicare does plus 10%. That will lead to health providers offering less care.

Third, government-run health insurance would crater the private insurance market, forcing most Americans onto the government plan. The Lewin Group estimates 70% of people with private insurance -- 120 million Americans -- will quickly lose what they now get from private companies and be forced onto the government-run rolls as businesses decide it is more cost-effective for them to drop coverage. They'd be happy to shift some of the expense -- and all of the administration headaches -- to Washington. And once the private insurance market has been dismantled it will be gone.

Fourth, the public option is far too expensive. The cost of Medicare -- the purest form of a government-run "public choice" for seniors -- will start exceeding its payroll-tax "trust fund" in 2017. The Obama administration estimates its health reforms will cost as much as $1.5 trillion over the next 10 years. It is no coincidence the Obama budget nearly triples the national debt over that same period.

Medicare and Medicaid cost much more than estimated when they were adopted. One reason is there's no competition for these government-run insurance programs. In the same way, Americans can expect a public option to cost far more than the Obama administration's rosy estimates.

Fifth, the public option puts government firmly in the middle of the relationship between patients and their doctors. If you think insurance companies are bad, imagine what happens when government is the insurance carrier, with little or no competition and no concern you'll change to another company.

In other words, the public option is just phony. It's a bait-and-switch tactic meant to reassure people that the president's goals are less radical than they are. Mr. Obama's real aim, as some candid Democrats admit, is a single-payer, government-run health-care system.

Health care desperately needs far-reaching reforms that put patients and their doctors in charge, bring the benefits of competition and market forces to bear, and ensure access to affordable and portable health care for every American. Republicans have plans to achieve this, and they must make their case for reform in every available forum.

Defeating the public option should be a top priority for the GOP this year. Otherwise, our nation will be changed in damaging ways almost impossible to reverse.

Mr. Rove is the former senior adviser and deputy chief of staff to President George W. Bush.
Title: Savings in health plan from BO equals HMO medicine for all.
Post by: ccp on June 13, 2009, 09:20:03 AM
Notice that other than prescription savings he doesn't tell us the truth about where the savings are coming from.
It is going to come from limiting access to specialists, tests, and other services the "experts" will deem are "inappropriate".  It will be based on population based studies and essentially be like HMO medicine.  Care will be monitored (medicare already is anyway), and restricted in ways akin to Millman and Robinson flow charts that private risk managers use to determine what they will and what they won't pay for.

My understanding of this (though I am by no means an expert)  is that outcomes data is used to determine if doing things more cheaply or restricting care increases hospitalization, rehospitalization, death or morbidity rates.  I am not clear that the data is proof the care is as safe or as good.  It depends what one is measuring when determining the "outcomes".  On the other hand I am not clear there is any data that suggests health care is worse though it is certainly less convenient. For harder to measure outcomes itmay be worse.

As for the prescription savings I do agree that many patients are on more expensive non generic drugs that are no better of more effective than cheaper generic older drugs.

This is what the EMR is for.  To collect all the data and then come out with dictates that will instruct providers on how we must deliver care.  It will be mandated.  Whether private insurers can survive I am not sure.  I don't necessarily jump to the conclusion that some from the right are trying to scare us all into believing that "there is absolutely no way private health insurance will be doomed but that could very well be the case.  Certainly BO despite whatever he says he is certainly working with the goal in mind of a national health care system.  There is really no other rational conclusion.   BO's people have been looking at these things for years.  It ain't new.  It ain't BOs ideas though he obviously embraces them wholeheartedly.

In any case, there is no question BO isn't leveling with us about his real intentions:

Obama calls for new health care spending cuts AP  Reuters – President Barack Obama speaks about reforming America's health care system at a Wisconsin Town Hall … Josh Gerstein Josh Gerstein – Sat Jun 13, 7:06 am ET
President Barack Obama says he's now found savings that will pay almost all the costs of a massive overhaul of America's health care system.

Obama on Saturday is announcing an additional $313 billion in new proposed savings that he says would bring the total funding available for his top-priority health insurance reform to nearly $950 billion over 10 years.

White House officials insisted the new savings were rock-solid, but also acknowledged they had yet to settle on a specific mechanism to achieve lower prescription drug costs that make up nearly one-quarter of the new savings.

“Any honest accounting must prepare for the fact that health care reform will require additional costs in the short term in order to reduce spending in the long term,” Obama says in his weekly radio and Internet address. “Today, I am announcing an additional $313 billion in savings that will rein in unnecessary spending, and increase efficiency and the quality of care.”

The new proposals from Obama came as the drive for health care reform reaches a pivotal juncture in Congress. On Monday, the Senate Finance Committee is scheduled to receive Congressional Budget Office estimates on a slew of health-care options. On Wednesday, the committee is expected to unveil proposed legislation.

In advance of those milestones, the White House was moving aggressively to counter public criticism that funding plans for the health reform effort are unrealistic, particularly in the face of an expected 10-year pricetag of $1 trillion or more. Some analysts have faulted the White House for being overly optimistic about savings and tone-deaf to which tax-raising proposals are likely to fly in Congress.

In his address Saturday, Obama refers to a 10-year total of more than $600 billion in “savings” for health care. However, he does not explain in his latest comments that, under his revised budget released last month, $326 billion of that amount would come from tax hikes on Americans making over $250,000 a year, “loophole closers,” and higher fees for some government services.

In a conference call with reporters Friday, Office of Management and Budget Director Peter Orszag said the latest announcement signaled that the White House had met its obligation to identify funding sources for a broad-based effort to make health insurance more affordable and more widely available.

“We are making good on this promise to fully finance health care reform over the next decade,” Orszag declared.

The bulk of the new $313 billion in savings would come from cutting or reducing the growth of payments to hospitals, medical equipment manufacturers and laboratories — though the major cuts don't target doctors, Orszag said.

Over the next decade, $110 billion is slated to come from reducing reimbursements to take account of what Orszag described as the ability of providers to improve their efficiency. “Health care services should be able to achieve and do achieve productivity improvements over time,” he said. According to a fact sheet released by the White House, future increases in such Medicare payments would be reduced based on an assumption that health care providers achieve half the productivity increases seen elsewhere in the economy. The budget official said the reductions would take place even if providers failed to garner the projected efficiencies.

Another $106 billion would come from cuts in so-called disproportionate share payments the federal government makes to hospitals with large numbers of uninsured patients. “As the ranks of uninsured decline under health reform, those payments become less necessary,” Orszag said.


About $75 billion is slated to come from lower payments for prescription drugs. However, Orszag said the White House was “in discussions with stakeholders over the best way of achieving that $75 billion.”

Notwithstanding that ambiguity, Orszag asserted that the White House had put forward $950 billion in budgetary offsets that could be use to fund health reform. He called the proposals "hard" and "scoreable," meaning that they were sufficiently certain and specific to pass muster with CBO officials who formally tally the cost of budget items.

Asked about the discrepancy, Orszag said, “There’s been continuous skepticism that we will come forward with detail….The detail on the $75 billion for prescription drugs will be forthcoming in the very near future and I will rest my reputation as a former CBO director on the fact that there are multiple ways in which those savings can be achieved and we are committed to achieving that level of savings in this package.”

There were signs that the announcement of the additional $313 billion of savings may have been rushed. In addition to the vagueness about the $75 billion in lower drug costs, the White House’s health care reform coordinator, Nancy-Ann DeParle, did not join a conference call with reporters to announce the new proposals. Her presence had been advertised in advance, but a spokesman said she was in another meeting and could not participate.

The cuts and savings are likely to engender warnings from providers that de-facto rationing will occur as patients in some areas find themselves unable to find providers willing to perform lab tests, X-rays and the like, due to the lower reimbursement rates.

Hospitals are also likely to protest that the disproportionate share payments, which are targeted for cuts of 75 percent, are vital to maintaining hospitals in costly urban centers, and to keeping teaching hospitals viable.

“It is unlikely to be an exact match on a hospital-by-hospital basis but what we believe will occur is that the remaining DSH payments that will still exist can be better targeted to the hospitals most in need,” Orszag said.


Title: Cost Shifting Shell Game
Post by: Body-by-Guinness on June 13, 2009, 09:44:21 AM
June 12, 2009
A New Public Health Plan: How Congressional Details Will Impact Doctors and Patients
by Greg D’Angelo
WebMemo #2482
President Obama and congressional leaders are proposing the creation of a new public health insurance plan to compete with private insurance plans. The President first proposed a public insurance option during the 2008 presidential campaign, but now the details and design of this new option--like most other aspects of the health reform legislation currently under development--have been left almost entirely to Congress.

Many in Congress are looking to Medicare as a model for a new public health plan, yet they fail to realize the consequences for patients and providers alike, as millions of Americans would lose the private coverage that they have today.

Crucial Details

According to the Lewin Group, a nationally prominent econometrics firm, the two most crucial design details of this new option are the size of employers eligible to buy into the new plan and the provider payment levels used for reimbursement under the plan.[1]

These key issues are bound to be contentious in the upcoming debate over health care reform.[2] The Obama campaign proposal would have made individuals without employer coverage, the self-employed, and small employers (defined as fewer than 25 employees) eligible for the public plan. But the President never specified provider payment levels or the method for determining reimbursement rates for doctors, hospitals, and other medical professionals for the thousands of medical services that would be delivered.[3]

Members of Congress and their staffs will thus have to hammer out these crucial details in legislation if a public plan is to be introduced.

Unlevel Playing Field

If Congress creates a public plan modeled on Medicare--as some have previously proposed--the result, of course, would be to undercut any pretense of a promised "level playing field" for competition with private health insurance.[4] Public plan premiums would be 25-40 percent lower than private insurance premiums as the public plan would reimburse providers less than private payers would--and often less than the cost of care delivered.

Payment rates for doctors and hospitals under public programs are set administratively, not by the market. They are, on average, lower than private payment rates for similar care.[5] Medicare provider payments for hospital care are only 71 percent of private rates, while Medicare provider payments for physician care are only 81 percent of private rates.[6] In other words, Medicare payment levels are roughly 19-29 percent lower than private levels.

Congress's ability to impose low provider payments and artificially reduce the cost of the public option compared to private insurance will increase enrollment in the public plan while crowding out, or displacing, existing private coverage.

Loss of Private Coverage

When considering a public plan modeled after Medicare, Lewin finds that the estimated reduction in the number of uninsured does not vary greatly (observing a change of only 800,000 individuals) as eligibility for the plan is extended beyond small employers to employers of all sizes.[7] Instead, there is a substantial increase in enrollment in the public plan and in the loss of private coverage.

If the public plan were opened to only small employers, enrollment in the public plan would reach 42.9 million, and 32 million Americans would lose their private coverage.[8] However, if the public plan is opened to all employers, enrollment in the public plan increases dramatically to 131.2 million, and 119.1 million Americans would lose their private coverage.[9] In this particular case, of the 171.6 million people who currently have private coverage, about 70 percent of them would lose the coverage that they have today.[10]

More specifically, of the estimated 157.4 million Americans who have private employer coverage, up to 107.6 million people could lose their private employer coverage, even if they like it and would prefer to keep it.[11]

Imposing Higher Costs on Individuals and Families

Increased enrollment in a new public plan would likely result in higher premiums for those with private insurance.

Historically, public programs--specifically Medicare and Medicaid--have reimbursed providers at levels below the costs of their services. For example, in 2003, on average, Medicare paid hospitals only 95 percent of the cost of providing services, while Medicaid paid hospitals only 89 percent of the cost of providing services.[12] These below-cost payments in public programs are at least in part offset by above-cost reimbursements to providers by private payers--as evidenced by hospital reimbursements to the tune of 122 percent of costs in 2003.[13] This cost-shift, in turn, inflates private health insurance premiums for individuals and families.[14]

The cost-shift dynamic plays a prominent role in the health care sector. A study by the actuarial firm Milliman calculated that public programs currently shift $88.8 billion in costs onto private payers per year, increasing the typical American family's annual private health insurance premium by $1,512, or 10.6 percent.[15] Moreover, Lewin speculates that a new public plan could increase the annual cost-shift per privately insured by as much as $526, which will only serve to further perpetuate the crowd-out of private insurance.[16]

Lower Incomes for Physician and Hospitals

A new public plan could also significantly reduce provider incomes. As more people gain insurance, physicians and hospitals would benefit from decreased levels of uncompensated care. However, the increase in public coverage along with new demands to provide services to the newly insured could outweigh any increased revenues from reductions in uncompensated care.

If all employers become eligible for the public plan, the annual net income of hospitals could fall by $36 billion while the annual net income of physicians could drop by $33.1 billion. Increasing demands on health care providers coupled with decreasing provider incomes could compromise patients' access to high-quality care. Faced with low reimbursement, doctors are already reportedly opting out of Medicare--a problem that is likely to be exacerbated with the creation of a new public plan.[17]

Consider the Consequences

Discussions surrounding the creation of a new public plan, based on Medicare and intended to compete with private health plans, have not adequately considered the potential consequences for patients and providers.

Creating a new public health plan option is likely in direct conflict with the many promises Congress and the Obama Administration have made regarding health reform.

While many claim that a public plan would merely represent an alternative choice to private health plans operating on "a level playing field," the reality is that Congress will use the government's power to artificially deflate the cost of the public plan by lowering provider reimbursement rates.

It has been suggested repeatedly that if Americans like their health plan they can keep it and that nothing would change except that they would pay less. But the creation of a new public plan modeled on Medicare could result in the loss of the private coverage that millions have today by undermining the current system of employer-sponsored insurance. Those who are actually able to keeping their private insurance will likely be forced to pay more--not less--to cross-subsidize the public plan.

While patients have been ensured their choice of doctor and care without government interference, great uncertainties remain regarding what the future holds for the doctor-patient relationship as millions of Americans are pushed into a new public plan.

The Devil Is in the Details

It is unlikely that Congress and the President will be able enact a major overhaul of the health care system that both includes a new public health insurance option and meets their many oft-stated promises.

When it comes to health care policy, what politicians promise is less important than the details of their policy prescriptions. Watch carefully.

Greg D'Angelo is Policy Analyst in the Center for Health Policy Studies at The Heritage Foundation.

[1]The Lewin Group, "Opening a Buy-In to a Public Plan: Implications for Premiums, Coverage and Provider Reimbursement," February 11, 2009, at (June 11, 2009); see alsothe Lewin Group, "The Cost and Coverage Impacts of a Public Plan: Alternative Design Options," April 6, 2009, at
20DesignOptions.pdf (June 11, 2009).

[2]President Barack Obama, letter to Senators Edward M. Kennedy and Max Baucus, June 3, 2009, at
rom-President-Obama-to-Chairmen-Edward-M-Kennedy-and-Max-Baucus/ (June 11, 2009). See also Robert Pear, "2 Democrats Spearheading Health Bill Are Split,"The New York Times, May 30, 2009, at
05/30/health/policy/30health.html (June 11, 2009); Robert Pear, "Kennedy and Baucus ‘Seek Common Ground' on Health Care Legislation," The Caucus, May 30, 2009, at
legislation/?hp (June 11, 2009); "Text of a letter from Republicans on the Senate Finance Committee to the President," U.S. Senate, June 5, 2009, at
6509No_Public_Plan_SFCLetter.pdf (June 11, 2009).
[3]See Obama for America, "Barack Obama and Joe Biden's Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage for All," at careFullPlan.pdf (June 11, 2009); The Lewin Group, "McCain and Obama Health Care Policies: Cost and Coverage Compared," October 15, 2008, pp. ES1-ES4, 5, 21, and Appendix B (B20-B27), at
ObamaHealthReformAnalysisRev10-15-08.pdf (June 11, 2009).

[4]Cathy Schoen, Karen Davis, and Sara R. Collins, "Building Blocks for Reform: Achieving Universal Coverage with Private and Public Group Health Insurance," Health Affairs, Vol. 27, No. 3 (May 2008), at http://content.healthaffai (June 11, 2009); Cathy Schoen, Karen Davis, and Sara R. Collins, "The Building Blocks of Health Reform: Achieving Universal Coverage and Health System Savings," Commonwealth Fund, May 2008, at
20Savings/Davis_buildingblocks_1135_ib%20pdf.pdf (June 11, 2009); Commonwealth Commission on a High Performance Health System, "The Path to a High Performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way," February 2009, at
S-Health-System.aspx (June 11, 2009); "A Path to a High Performance U.S. Health System: Technical Documentation," prepared by The Lewin Group for the Commonwealth Fund, February 19, 2009, at
Documentation.pdf (June 11, 2009).

[5]Congressional Budget Office, "Key Issues in Analyzing Major Health Insurance Proposals," December 2008, pp. XIX, 91-97, at http://www.cbo.
gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf(June 11, 2009).

[6]Ingenix Consulting in partnership with the Lewin Group, "The Obama Health Reform Proposal: Impact on Payers," December 8, 2008, p. 7. See also two other studies by the same authors: "The Obama Health Reform Proposal: Impact on Providers," December 9, 2008, p. 4;"The Obama Health Reform Proposal: Impact on Employers," December 16, 2008, p. 3, 5-6.
[7]John Sheils, the Lewin Group, "The Cost and Coverage Impacts of a Public Plan," testimony before the Committee on Ways and Means, U.S. House of Representatives, April 29, 2009, at
Testimony_April_29,_2009.pdf (June 11, 2009).
[12]The Lewin Group, "Opening a Buy-In to a Public Plan"; see also Allen Dobson, Joan DaVanzo, and Namrata Sen, "The Foundation, History and Implications of the Cost-Shift Hydraulic," the Lewin Group, July 15, 2005, at
20slides%207.7.05%20History%20and%20Foundation%20of%20the%20Cost-Shift.pdf (June 11, 2009); Allen Dobson, Joan DaVanzo, and Namrata Sen, "The Cost-Shift Payment ‘Hydraulic': Foundation, History, and Implications," Health Affairs, Vol. 25, No. 1 (January 2006), at
t/abstract/25/1/22 (June 11, 2009).

[13]Ibid. Lewin suggests MedPAC data indicate that this cost-shifting hydraulic may have accelerated in recent years. As hospital payments declined to 91 percent of costs by 2007, over the same time private payer rates increased to 132 percent of costs.
[14]The Lewin Group, based on its analysis of the available cost-shift literature, concludes that about 40 percent of the costs of low public payments and uncompensated care are passed on to the privately insured in the form of higher prices.
[15]Will Fox and John Pickering, "Hospital and Physician Cost Shift: Payment Level Comparison of Medicare, Medicaid, and Commercial Payers," Milliman, December 2008, pp. 2-4, at
ublications/rr/pdfs/hospital-physician-cost-shift-RR12-01-08.pdf (June 11, 2009).
[16]Figure assumes Medicare payment rates and all employers eligible for the public plan. See Sheils, "The Cost and Coverage Impacts of a Public Plan."
[17]Julie Connelly, "Doctors Are Opting out of Medicare," The New York Times, April 1, 2009, at
retirementspecial/02health.html?_r=1 (June 11, 2009).
Title: Re: The Politics of Health Care
Post by: ccp on June 13, 2009, 10:06:53 AM
*The cost-shift dynamic plays a prominent role in the health care sector. A study by the actuarial firm Milliman calculated that public programs currently shift $88.8 billion in costs onto private payers per year, increasing the typical American family's annual private health insurance premium by $1,512, or 10.6 percent.[15] Moreover, Lewin speculates that a new public plan could increase the annual cost-shift per privately insured by as much as $526, which will only serve to further perpetuate the crowd-out of private insurance.[16]*

Milliman again (see my previous post).

This makes sense.  Someone has to pay for all the medicaid that doesn't cover a providers costs.  I doubt doctors lose money on medicare.  I am not sure about whether or not hospitals do.

One can only imagine the cost shifts to the rest of the country when we start subsidizing another 40 million.

How many of those are illegals I wonder?
I wonder how many of these are people with pre existing conditions who want insurance but cannot get?
I assume the rest simply can't afford it.

Title: Safeway Embraces Market Based Savings
Post by: Body-by-Guinness on June 13, 2009, 10:15:27 AM
This piece makes me nervous in that it intimates a behavior modification heavy hand is in order, but it's nice to see this debate framed in empiric rather than idealistic terms.

How Safeway Is Cutting Health-Care Costs
Market-based solutions can reduce the national health-care bill by 40%.


Effective health-care reform must meet two objectives: 1) It must secure coverage for all Americans, and 2) it must dramatically lower the cost of health care. Health-care spending has outpaced the rise in all other consumer spending by nearly a factor of three since 1980, increasing to 18% of GDP in 2009 from 9% of GDP. This disturbing trend will not change regardless of who pays these costs -- government or the private sector -- unless we can find a way to improve the health of our citizens. Failure to do so will make American companies less competitive in the global marketplace, increase taxes, and undermine our economy.

At Safeway we believe that well-designed health-care reform, utilizing market-based solutions, can ultimately reduce our nation's health-care bill by 40%. The key to achieving these savings is health-care plans that reward healthy behavior. As a self-insured employer, Safeway designed just such a plan in 2005 and has made continuous improvements each year. The results have been remarkable. During this four-year period, we have kept our per capita health-care costs flat (that includes both the employee and the employer portion), while most American companies' costs have increased 38% over the same four years.

Martin Kozlowski
Safeway's plan capitalizes on two key insights gained in 2005. The first is that 70% of all health-care costs are the direct result of behavior. The second insight, which is well understood by the providers of health care, is that 74% of all costs are confined to four chronic conditions (cardiovascular disease, cancer, diabetes and obesity). Furthermore, 80% of cardiovascular disease and diabetes is preventable, 60% of cancers are preventable, and more than 90% of obesity is preventable.

As much as we would like to take credit for being a health-care innovator, Safeway has done nothing more than borrow from the well-tested automobile insurance model. For decades, driving behavior has been correlated with accident risk and has therefore translated into premium differences among drivers. Stated somewhat differently, the auto-insurance industry has long recognized the role of personal responsibility. As a result, bad behaviors (like speeding, tickets for failure to follow the rules of the road, and frequency of accidents) are considered when establishing insurance premiums. Bad driver premiums are not subsidized by the good driver premiums.

As with most employers, Safeway's employees pay a portion of their own health care through premiums, co-pays and deductibles. The big difference between Safeway and most employers is that we have pronounced differences in premiums that reflect each covered member's behaviors. Our plan utilizes a provision in the 1996 Health Insurance Portability and Accountability Act that permits employers to differentiate premiums based on behaviors. Currently we are focused on tobacco usage, healthy weight, blood pressure and cholesterol levels.

Safeway's Healthy Measures program is completely voluntary and currently covers 74% of the insured nonunion work force. Employees are tested for the four measures cited above and receive premium discounts off a "base level" premium for each test they pass. Data is collected by outside parties and not shared with company management. If they pass all four tests, annual premiums are reduced $780 for individuals and $1,560 for families. Should they fail any or all tests, they can be tested again in 12 months. If they pass or have made appropriate progress on something like obesity, the company provides a refund equal to the premium differences established at the beginning of the plan year.

At Safeway, we are building a culture of health and fitness. The numbers speak for themselves. Our obesity and smoking rates are roughly 70% of the national average and our health-care costs for four years have been held constant. When surveyed, 78% of our employees rated our plan good, very good or excellent. In addition, 76% asked for more financial incentives to reward healthy behaviors. We have heard from dozens of employees who lost weight, lowered their blood-pressure and cholesterol levels, and are enjoying better health because of this program. Many discovered for the first time that they have high blood pressure, and others have been told by their doctor that they have added years to their life.

Today, we are constrained by current laws from increasing these incentives. We reward plan members $312 per year for not using tobacco, yet the annual cost of insuring a tobacco user is $1,400. Reform legislation needs to raise the federal legal limits so that incentives can better match the true incremental benefit of not engaging in these unhealthy behaviors. If these limits are appropriately increased, I am confident Safeway's per capita health-care costs will decline for at least another five years as our work force becomes healthier.

The Healthy Measures program currently applies only to our nonunion work force. While we have numerous health and wellness provisions in our union contracts, we are working with union leaders like Joe Hansen of the United Food and Commercial Workers to incorporate healthy measures provisions in our union work force as well.

While comprehensive health-care reform needs to address a number of other key issues, we believe that personal responsibility and financial incentives are the path to a healthier America. By our calculation, if the nation had adopted our approach in 2005, the nation's direct health-care bill would be $550 billion less than it is today. This is almost four times the $150 billion that most experts estimate to be the cost of covering today's 47 million uninsured. The implication is that we can achieve health-care reform with universal coverage and declining per capita health-care costs.

There is a very real possibility that we will see positive transformational health-care reform in the near future. I am encouraged by the effort I see on Capitol Hill, particularly the bipartisan effort in the Senate. While some tough issues remain, if we continue to work in a bipartisan manner I believe we will resolve these issues successfully and find agreement on meaningful reform.

Mr. Burd is CEO of Safeway Inc., and the founder of the Coalition to Advance Healthcare Reform.
Title: Re: The Politics of Health Care
Post by: ccp on June 15, 2009, 10:49:41 AM
June 15, 2009
Naive, Hypocritical and Dishonest
By Robert Samuelson

WASHINGTON -- It's hard to know whether President Obama's health care "reform" is naive, hypocritical or simply dishonest. Probably all three. The president keeps saying it's imperative to control runaway health spending. He's right. The trouble is that what's being promoted as health care "reform" almost certainly won't suppress spending and, quite probably, will do the opposite.

A new report from Obama's own Council of Economic Advisers shows why controlling health costs is so important. Since 1975, annual health spending per person, adjusted for inflation, has grown 2.1 percentage points faster than overall economic growth per person. Should this trend continue, the CEA projects that:

-- Health spending, which was 5 percent of the economy (gross domestic product, GDP) in 1960 and is reckoned at almost 18 percent today, would grow to 34 percent of GDP by 2040 -- a third of the economy.

-- Medicare and Medicaid, the government insurance programs for the elderly and poor, would increase from 6 percent of GDP now to 15 percent in 2040 -- roughly equal to three-quarters of present federal spending.

-- Employer-paid insurance premiums for family coverage, which grew 85 percent in inflation-adjusted terms from 1996 to $11,941 in 2006, would increase to $25,200 by 2025 and $45,000 in 2040 (all figures in "constant 2008 dollars"). The huge costs would force employers to reduce take-home pay.

The message in these dismal figures is that uncontrolled health spending is almost single-handedly determining national priorities. It's reducing discretionary income, raising taxes, widening budget deficits and squeezing other government programs. Worse, much medical spending is wasted, the CEA report says. It doesn't improve Americans' health; some care is unneeded or ineffective.

The Obama administration's response is to talk endlessly about restraining health spending -- "bending the curve'' is the buzz -- as if talk would suffice. The president summoned the heads of major health care trade groups representing doctors, hospitals, drug companies and medical device firms to the White House. All pledged to bend the curve. This is mostly public relations. Does anyone believe that the American Medical Association can control the nation's 800,000 doctors or that the American Hospital Association can command the 5,700 hospitals?

The central cause of runaway health spending is clear. Hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, either private or governmental. The open-ended payment system encourages doctors and hospitals to provide more services -- and patients to expect them. It also favors new medical technologies, which are made profitable by heavy use. Unfortunately, what pleases providers and patients individually hurts the nation as a whole.

That's the crux of the health care dilemma, and Obama hasn't confronted it. His emphasis on controlling costs is cosmetic. The main aim of health care "reform" now being fashioned in Congress is to provide insurance to most of the 46 million uncovered Americans. This is popular and seems the moral thing to do. After all, hardly anyone wants to be without insurance. But the extra coverage might actually worsen the spending problem.

How much healthier today's uninsured would be with that coverage is unclear. They already receive health care -- $116 billion worth in 2008, estimates Families USA, an advocacy group. Some is paid by the uninsured themselves (37 percent), some by government and charities (26 percent). The remaining "uncompensated care" is either absorbed by doctors and hospitals or shifted to higher private insurance premiums. Some uninsured would benefit from coverage, but others wouldn't. Either they're healthy (40 percent are between ages 18 and 34) or would receive ineffective care.

The one certain consequence of expanding insurance coverage is that it would raise spending. When people have insurance, they use more health services. That's one reason why Obama's campaign proposal was estimated to cost $1.2 trillion over a decade (the other reason is that the federal government would pick up some costs now paid by others). Indeed, the higher demand for health care might raise costs across the board, increasing both government spending and private premiums.

No doubt the health program that Congress fashions will counter this reality by including some provisions intended to cut costs ("bundled payments" to hospitals, "evidence-based guidelines," electronic record keeping). In the past, scattershot measures have barely affected health spending. What's needed is a fundamental remaking of the health care sector -- a sweeping "restructuring"-- that would overhaul fee-for-service payment and reduce the fragmentation of care.

The place to start would be costly Medicare, the nation's largest insurance program serving 45 million elderly and disabled. Of course, this would be unpopular, because it would disrupt delivery patterns and reimbursement practices. It's easier to pretend to be curbing health spending while expanding coverage and spending. Presidents have done that for decades, and it's why most health industries see "reform" as a good deal.

Copyright 2009, Washington Post Writers Group
Title: Imaginary Money Pays for Dubious Reforms
Post by: Body-by-Guinness on June 15, 2009, 01:16:14 PM
Price controls worked so well for Nixon, Ford, Carter, and the Soviet Union for that matter that it appears its time has come once again.

Price Controls "Pay" for President Obama's Health Care Reforms

Ronald Bailey | June 15, 2009, 3:12pm

Today in a speech before the American Medical Association, President Barack Obama outlined how he plans to raise the $1 trillion necessary to pay for his proposed health care reform agenda over the next decade. First, the president cited his $635 billion health reserve fund as the famous "down payment" for his reform agenda. About half - $300 billion - of this aspirational reserve fund is "paid for" by capping the tax breaks on charitable deductions of rich Americans to 28 percent. Never mind that this proposed tax hike has yet to pass Congress and that many key Democratic leaders on Capitol Hill oppose it.

Another chunk of the notional Health Reserve Fund will come from reducing payments - $177 billion - to private Medicare Advantage companies that provide insurance coverage for about 10 million Medicare beneficiaries. The president also plans to reduce hospital Medicare reimbursements by $25 billion over the next ten years. Another $30 billion is accounted for by charging wealthier Medicare beneficiaries more for their drugs. 

In his weekly radio address and his speech today, President Obama claimed to have found an additional $313 billion in Medicare and Medicaid savings over the next ten years which will help pay for his $1 trillion health care reform agenda. These savings include a cut of $109 billion in payments to physicians based on recalculating the federal government's productivity payment formula.

Another $106 billion will come from cuts in payments to hospitals for treating uninsured people. The argument here is that once the reforms are enacted there won't be many uninsured people seeking uncompensated services at hospitals. This gambit may "save" money for Medicare and Medicaid, but some other agency or enterprise will be paying for the hospital services that the newly insured receive. Isn't this shifting the pots from which $106 billion will come rather than reducing overall spending on hospital care? Isn't it likely that a good part of the $106 billion will have to come from the president's proposed government insurance scheme?

More "savings" of $75 billion that could used to "pay for" President Obama's health care reforms would come from "more efficient purchasing" of prescription drugs. The Medicare Part D prescription drug plan was adopted in 2003 with a non-interference clause that promised that the federal government would not impose price controls on pharmaceuticals. Of course, when Medicare was established in 1965, the government made the same promise to physicians and hospital then. I suspect that "more efficient purchasing" is just a nicer way of saying "price controls." And it should be noted that according to the president, "we can save about one billion more by rooting out waste, abuse, and fraud throughout our health care system." Just a billion?

After parsing the numbers, it looks as though most the "savings" that President Obama wants to use to finance his health care reforms are achieved by imposing price controls.

It must be asked: can federal government "savings" projected over a decade really be credible in any case? Recall that in December 2000, the Clinton administration declared that "the United States can be debt-free this decade. By dedicating the entire budget surplus to debt reduction, the United States can eliminate its publicly held debt by FY 2009."

It is undeniable that health care in America needs massive reform. But the best step toward health care reform would be to begin unwinding our dysfunctional system of third party insurance payments and shifting toward consumer driven health care. But President Obama has made it clear that it not the direction he intends to go.
Title: Universal, Except for 36 Million
Post by: Body-by-Guinness on June 16, 2009, 01:47:53 PM
June 16, 2009, 3:38 PM
Democrats Defend Health Care Plans, Despite Cost Estimate
Senate Democrats and the White House struggled on Tuesday to respond to an initial financial analysis by the Congressional Budget Office showing that a main proposal for overhauling health care would cost $1 trillion over 10 years but would leave 36 million Americans uninsured.

The preliminary analysis by the budget office, a nonpartisan number-crunching agency, showed Democrats falling far short of their goal, which is to provide insurance to all Americans and offset the expense of doing so with new taxes or cost savings. And Republicans quickly seized on the figures to charge that the Democrats’ efforts would fail.

In trying to answer both the Republican criticism and basic questions about the cost analysis, the Democrats exposed deep internal disagreements over how to pay for revamping the health care system, with some pushing to tax employer-provided health benefits above a pre-set limit, and others preferring tax increases outside the health arena.

Despite the challenges presented by the cost estimates for its sweeping bill, the Senate health committee said it would proceed on Wednesday with its first public work on the legislation.

“Obviously, we thought we’d get better numbers based on earlier work that was done, but this can’t stop you,” said Senator Christopher J. Dodd, Democrat of Connecticut, who is leading the efforts on the committee. “You have to move ahead and dealing with it accordingly and getting additional numbers where you can.”

The Senate Finance Committee, which is developing its own bill, said it would delay releasing a detailed description of its proposal for several days, partly out of concern over cost estimates from the budget office.

The cost study provided ready ammunition to critics, including the Republican Senate leader, Mitch McConnell of Kentucky.

“Preliminary estimates for this flawed legislative proposal are staggering,” Mr. McConnell said in a speech on the Senate floor. “The health care proposal being put together is not only extremely defective, it will cost a fortune. And that cost will come straight out of the taxpayer’s pocketbook.”

Mr. Dodd and other leaders of the Senate health committee argued at a news conference that the spending analysis did not factor in major components of the legislation that have yet to be made public, including a proposal for a new government-run insurance program that they said would save billions of dollars.

The Democrats, however, had no answers for several other concerns raised by the analysis, including the projection that the plan would leave 36 million people uninsured. The analysis also cast doubt on the Democrats’ claim that no one will lose coverage they now enjoy, concluding that 11 million people would change plans, for better or worse.

The cost-analysis also revealed some other potential consequences of the Health committee bill, including the possibility that some children could end up shifted off of Medicaid and the Children’s Health Insurance Program, which provide comprehensive health coverage, and instead be required to obtain new insurance with less extensive benefits. Advocates for children were already gearing up to fight that change.

The White House press secretary, Robert Gibbs, said on Tuesday afternoon: “One incomplete older proposal I don’t think is indicative of where we are now.”

But expanding coverage without adding to the deficit is looking like a steeper challenge than even many of the leading proponents of a health care overhaul had imagined.

Mr. Dodd and other Democrats complained that the budget office analysis did not reflect hundreds of billions of dollars in anticipated savings as broad structural changes in the system yield more efficient and cost-effective services. As a practical matter, however, Congress must abide by the budget office figures.

But Democrats are deeply divided over how to pay for their plan.

Mr. Dodd said he was opposed to taxing employer-provided benefits and would prefer other proposals, including limits on tax deductions for the highest wage-earners proposed by President Obama earlier this year, including some limits on the deduction of charitable donations.

Members of the Senate Finance Committee, including its chairman, Senator Max Baucus, Democrat of Montana, are developing a proposal that would tax employer-provided benefits. And Mr. Baucus said he believes that Mr. Obama would be open to the proposal, even though the president opposed the idea while campaigning for office.

Senator Tom Harkin, Democrat of Iowa, and a member of the health committee, said he was not necessarily opposed to taxing health benefits but that new taxes on unhealthy foods, including perhaps sodas and other high-sugar foods, might be appropriate.
Title: WSJ: The death and life of HC reform
Post by: Crafty_Dog on June 17, 2009, 05:15:11 AM
The following is a draft of a speech titled "The Obama Years: A Reappraisal" that mysteriously was never delivered at the 2070 national meeting of the Institute of Advanced Obamalogy:

So it came to pass in the waning days of the health-care wars that Democrats learned the American people really didn't want a nationalized health-care industry.

The Obama administration's "public option," which all knew to be a vote for a government takeover, proved a drink too stiff for four or five Democratic senators whose re-election was not in the bag.

President Obama applauded himself for achieving "85% of what we set out to accomplish." But pundits and wonks were in despair. They retreated to their watering holes and cried into their Stoli martinis. The cause of their lives was over. A once-in-a-generation opportunity had been muffed. Without a massive bill in Congress, with many titles and subtitles and subchapters, they moaned, there was no hope for fixing all that ailed the American health-care system.

But politics went on, and while the armies of wonkdom mourned, three little-known congressmen (Eric Paul, Ryan Cantor and Kemp Newtley) discovered an unexpected public enthusiasm for a flat tax.

Through incessant Twittering over the heads of the media, they persuaded millions of voters they'd be better off with lower rates even if it meant giving up tax-free employer provided health insurance. It didn't hurt, either, that the wailing of insurance and medical lobbyists was over-the-top -- convincing voters that the tax benefit really was just a form of corporate welfare disguised as a mostly illusory benefit for individuals.

Though the realization was slow in dawning, policy experts would eventually rediscover what they had known all along (but had conveniently forgotten in order to lend their voices to "solutions" that required ever more government spending) -- that tax reform, in the American context, is health-care reform.

And, lo, it proved true, as 100 million intelligent, well-educated employees of Corporate America were allowed to see for the first time what "tax free" health insurance was really costing them. They saw how it distorted their behavior and caused them to allocate far more of their incomes to the medical-industrial complex than they would have chosen for themselves.

Eyes newly opened, they demanded cheaper insurance options, covering fewer services (cancer wigs, family counseling, in-vitro fertilization), and opted for plans with higher deductibles and co-pays in return for much lower monthly rates.

Because consumers were now spending their "own" money on health care, doctors and hospitals found it necessary to publish and even advertise their prices. A hospital that specialized in heart surgery, performing thousands of procedures a year, found it had both the highest quality and lowest cost -- and now marketed itself as such. Ditto specialists in cancer, diabetes and other conditions.

For the first time, Americans spent less and got more. Spending fell overnight by 13%, which happened to be exactly what economists had predicted if the price tags were restored to health care and consumers were allowed to see clearly what they were getting (or not getting) for their money. As predicted, too, spending thereafter rose only in line with incomes.

What's more, many fewer people remained voluntarily uninsured now that health insurance was no longer a gold-plated extravagance affordable only by those in the top brackets who could slough off 40% of the cost on other taxpayers. Existing programs for the needy, in turn, could be downsized and revamped into voucher programs. The federal budget benefited twice over -- from fewer claimants and from medical care that was less costly. Fiscal wreck was avoided.

In truth, President Obama had been little involved to this point. Following his early domestic "successes," he was spending more and more time abroad sharing his matchless eloquence with previously unblessed audiences from Ulan Bator to Ouagadougou.

A highly symbolic moment, however, came when Mr. Obama, who had put on weight in office and now tipped the scales at nearly 300 pounds, returned from a speaking tour on the virtues of nonproliferation to audiences in the Islamic Republic of Palau. Having overindulged in local delicacies, he was surprised when the White House medical office handed him a Wal-Mart debit card and sent him to a nearby Wal-Mart supercenter boasting "Everyday Low Prices on Gastric Bypass Surgery."

Emerging afterward to the usual crowd of ululating network reporters and bloggers, Mr. Obama pronounced himself entirely pleased and satisfied with the "success of my health-care reforms."

And so it came to pass that historians and Obamalogists would count health-care reform among the incomparable triumphs of the Obama administration, and lost to history would be the names of Eric Paul, Ryan Cantor and Kemp Newtley.
Title: Teddy's Plan Under the Bus?
Post by: Body-by-Guinness on June 18, 2009, 06:17:30 AM
Sen. Kennedy’s Budget-Breaking “Reform” Bill

Posted by Doug Bandow

It appears that the Obama administration has decided to disown the venerable Senator.  No wonder.  The Congressional Budget Office estimated the ten-year cost of Sen. Kennedy’s bill at $1 trillion, but admitted that its analysis was incomplete.

Now the consulting group HSI Network, LLC comes foward with an estimate of $4 trillion:

The Senate Committee on Health, Education, Labor and Pensions (HELP) have proposed a health reform bill called the Affordable Health Choice Act (AHC) that seeks to reduce the number of uninsured and increase health system efficiency and quality. The draft legislation was introduced on June 9th, 2009. The proposal provided adequate information to suggest what the impact would be of AHC using the ARCOLA™ simulation model. AHC would include an individual mandate as well as a pay or plan provision. In addition, it would include a means-tested subsidy with premium supports available for those up to 500% of the federal poverty level. Public plan options in three tiers: Gold, Silver and Bronze are proposed in a structure similar to that of the Massachusetts Connector, except that it is called The Gateway. These public plan options would contain costs by reimbursing providers up to 10% above current reimbursement rates. There is no mention of removing the tax exclusion associated with employer sponsored health insurance. There is also no mention of changes to Medicare and Medicaid, other than fraud prevention, that could provide cost-savings for the coverage expansion proposed. Below, we summarize the impact of the proposed plan in terms of the reduction on uninsured, the 2010 cost, as well as the ten year cost of the plan in 2010 dollars.

HELP Affordable Health Choices Act

Uninsurance is reduced by 99% to cover approximately 47,700,000 people
Subsidy - Tax Recovery = Net cost:
$279,000,000,000 subsidy to the individual market
$180,000,000,000 subsidy to the ESI market with
Net cost: $460,500,000,000 (annual)
Net cost: $4,098,000,000,000 (10 year)
Private sector crowd out: ~79,300,000 lives

HSI figures that a lot more people will take advantage of federal health insurance subsidies, driving costs up far more than indicated by the CBO figure.  (H/t to Phil Klein at the American Spectator online.)

Of course, no one knows what the bill would really cost in operation.  But the history of social insurance and welfare programs is sky-rocketing expense well beyond original projections.  Go back and look at the initial cost estimates for Medicare and Social Security, and you will run from the room simultaneously laughing and crying.

Health care reform would be serious business at any moment of time, but especially when the country faces $10 trillion in new debt over the next decade on top of the existing $11 trillion national debt.  And with the $100 trillion Medicare/Social Security financial bomb lurking in the background, rushing to leap off the financial cliff with this sort of health care legislation would be utterly irresponsible.
Title: Wrong Numbers
Post by: Body-by-Guinness on June 19, 2009, 02:41:24 PM
Wow, when CNBC starts questioning the numbers being bandied by those foisting Obamacare the terms of the debate are surely changing.
Title: "Nobody Spends Somebody Else's Money as Wisely as he Spends his Own,"
Post by: Body-by-Guinness on June 19, 2009, 05:03:23 PM
Second post:

Medical Analysis By Milton Friedman
Peter Robinson, 06.19.09, 12:01 AM ET

President Obama, the press, all the Democrats and a fair number of the Republicans in Congress share the same assumption about health care. Whatever you believe should be done about the problem, it sure is complicated.

Yet one man figured it out.

In 2001 the economist Milton Friedman read up on health care, discovered that the inefficiencies in our system trace back to a single policy mistake, worked out a policy test that would help us correct it and then described his findings in a few thousand words of plain English.

Since the end of the Second World War, Friedman explained, medical care in the U.S. has displayed three features: technological advances, increases in spending and rising dissatisfaction.

The first of the three was common to one sector of the economy after another. Agriculture, manufacturing, electronics, communications--all had experienced technological progress. Yet the two final features proved unique to health care. While we were paying less and getting more when buying food or computers, in health care the opposite was happening.


Because, Friedman saw, most payments for medical care are made not by the patients who receive the care but by third parties, typically employers. Since, in Friedman's phrase, "nobody spends somebody else's money as wisely as he spends his own," this third-payer system by its very nature introduces inefficiencies throughout the health care system.

The reason for this wasteful third-party system? The tax code. Money spent on health care is exempt from the income tax only if the health care is provided through an employer. "We have become so accustomed to employer-provided medical care," Friedman wrote, "that we regard it as part of the natural order. Yet it is thoroughly illogical."

The policy mistake that produced this illogical mess took place during World War II, when the government imposed wage controls. Unable to compete for workers by paying them more, employers began providing medical care, and the new benefit spread rapidly.

When the Internal Revenue Service caught on, requiring employers to include the value of medical benefits as part of the wages they reported, workers, who had grown accustomed to the benefits, protested. Congress responded with legislation that made employer-provided medical benefits tax-exempt.

By the time the 1960s arrived, Americans were used to having third parties pay their medical bills. Thus the enactment of Medicare and Medicaid--under which the government, rather than employers, acted as the third party--seemed perfectly reasonable.

Friedman wrote: "Third-party payment has required the bureaucratization of medical care. ... A medical transaction is not simply between a caregiver and a patient; it has to be approved as 'covered' by a bureaucrat. ... The patient has little ... incentive to be concerned about the cost since it's somebody else's money. The caregiver has become, in effect, an employee of the insurance company or, in the case of Medicare and Medicaid, of the government. ... An inescapable result is that the interest of the patient is often in direct conflict with the interest of the caregiver's ultimate employer."

In that one paragraph of under 100 words, a diagnosis of our ailment.

What should we do about it? Ideally, Friedman argued, we should reverse the mistake that started all the trouble, repealing the tax exemption of employer-provided medical care. Yet Friedman was a realist. Vested interests, he recognized, would make such a radical reform impossible. Instead he believed we should seek incremental changes, asking of each proposal simply whether it would move health care "in the right direction."

Expanding savings accounts that allow individuals control over relevant spending, Friedman argued, would move health care in the right direction. So would extending the tax exemption to all medical expenses, whether they are paid by employers or individuals. A "sweeping socialization of medicine [such as that] proposed by Hilary Clinton"--and, now, by Barack Obama--would not.

Wherever possible, reduce the role of third parties. Increase the autonomy of individuals. Get the government and vast, bureaucratic insurance companies out of the way, permitting the free market to work its effects in health care, just as it does in virtually every other sector of the economy.

That's not too complicated, now, is it?

Peter Robinson, a research fellow at the Hoover Institution at Stanford University and contributor to, writes a weekly column for Forbes.
Title: Is it Constitutional?
Post by: Crafty_Dog on June 22, 2009, 06:09:57 AM
Is a government-dominated health-care system unconstitutional? A strong case can be made for that proposition, based on the same "right to privacy" that underlies such landmark Supreme Court decisions as Roe v. Wade.

The details of this year's health-care reform bill are still being hammered out. But the end result is sure to be byzantine in complexity. Washington will have immense say over how, when and through whom Americans are treated. Moreover, despite the administration's public pronouncements about painless cuts in wasteful spending, only the most credulous believe that some form of government-directed health-care rationing can be avoided as a means of controlling costs.

The Supreme Court created the right to privacy in the 1960s and used it to strike down a series of state and federal regulations of personal (mostly sexual) conduct. This line of cases began with Griswold v. Connecticut in 1965 (involving marital birth control), and includes the 1973 Roe v. Wade decision legalizing abortion.

The court's underlying rationale was not abortion-specific. Rather, the justices posited a constitutionally mandated zone of personal privacy that must remain free of government regulation, except in the most exceptional circumstances. As the court explained in Planned Parenthood v. Casey (1992), "these matters, involving the most intimate and personal choices a person may make in a lifetime, choices central to personal dignity and autonomy, are central to the liberty protected by the Fourteenth Amendment. At the heart of liberty is the right to define one's own concept of existence, of meaning, of the universe, and the mystery of human life."

It is, of course, difficult to imagine choices more "central to personal dignity and autonomy" than measures to be taken for the prevention and treatment of disease -- measures that may be essential to preserve or extend life itself. Indeed, when the overwhelming moral issues that surround the abortion question are stripped away, what is left is a medical procedure determined to be "necessary" by an expectant mother and her physician.

If the government cannot proscribe -- or even "unduly burden," to use another of the Supreme Court's analytical frameworks -- access to abortion, how can it proscribe access to other medical procedures, including transplants, corrective or restorative surgeries, chemotherapy treatments, or a myriad of other health services that individuals may need or desire?

This type of "burden" analysis will be especially problematic for a national health system because, in the health area, proper care often depends upon an individual's unique physical and even genetic history and characteristics. One size clearly does not fit all, but that is the very essence of governmental regulation -- to impose a regularity (if not uniformity) in the application of governmental power and the dispersal of its largess. Taking key decisions away from patient and physician, or otherwise limiting their available choices, will render any new system constitutionally vulnerable.

It is true, of course, that forms of rationing already exist in our current system. No one who has experienced the marked reluctance to treat aggressively lethal illnesses in the elderly can doubt that. However, what may be permissible for private actors -- including doctors and insurance companies -- is not necessarily lawful when done by the government.

Obviously, the government does not have to pay for any and all services individual citizens may desire. And simply refusing to approve a procedure or treatment under applicable reimbursement rules, as under the government-run Medicare and Medicaid, does not make the system unconstitutional. But if over time, as many critics fear, a "public option" health insurance plan turns into what amounts to a single-payer system, the constitutional issues regarding treatment and reimbursement decisions will be manifold.

The same will be true of a quasi-private system where the government claims a large role in defining acceptable health-insurance coverage and treatments. There will be all sorts of "undue burdens" on the rights of patients to receive the care they may want. Then the litigation will begin.

Anyone who imagines that Congress can simply avoid the constitutional issues -- and lawsuits -- by withdrawing federal court jurisdiction over the new health system must think again. A brief review of the Supreme Court's recent war-on-terror decisions, brought by or on behalf of detained enemy combatants, will disabuse that notion. This area of governmental authority was once nearly immune from judicial intervention. Over the past five years, however, the Supreme Court (supposedly the nonpolitical branch) has unapologetically transformed itself into a full-fledged, policy-making partner with the president and Congress.

In the process, the justices blew past specific congressional efforts to limit their jurisdiction and involvement like a hot rod in the desert. Questions of basic constitutionality (however the court may define them) cannot now be shielded from judicial review.

It is, of course, impossible to predict how and when the courts will ultimately rule on the new health system. Much depends on the details and the extent to which reasonable and practical private alternatives to the national plan remain. In crafting the law, however, its White House and congressional sponsors must keep privacy -- that near absolute right to personal autonomy they have so often praised and promoted -- squarely before them. The only thing that is certain today is that the courts, and not Congress, will have the last word.

Messrs. Rivkin and Casey worked in the Justice Department under Presidents Reagan and George H.W. Bush.
Title: Demand Side Rationing
Post by: Body-by-Guinness on June 23, 2009, 10:29:02 PM
Bringing Down the House
The sobering lessons of health reform in Massachusetts.
By Darshak Sanghavi
Posted Tuesday, June 23, 2009, at 6:45 AM ET
The debate over achieving universal health care can seem hopelessly confusing. But the issues are actually pretty simple when you consider the lessons of Massachusetts.

In 2006, state lawmakers seeking to broaden health coverage made it illegal to be uninsured. It works like this: Employers have to offer you a health plan. If you are jobless or don't like your employer's plan, you must buy your own. If you don't get one, you pay a stiff fine. This strategy—known as an employer and individual "mandate"—forms the backbone of the national health reform bills now making their way through Congress.

On paper, the experiment was a resounding success. According to an Urban Institute estimate, the number of uninsured residents quickly fell from 13 percent to 7 percent following the law's passage.

And yet, something strange happened. Despite having health insurance, roughly one in 10 state residents still failed to fill prescriptions, ended up with unpaid medical bills, or skipped needed medical care for financial reasons. Hundreds of millions of dollars were spent to insure more Massachusetts citizens, but many people still weren't getting necessary care. What happened?

Assume you're looking to buy insurance. The state has a handy Web site where you can find the cheapest plan. For a young family of four, that plan costs roughly $9,500 per year, which doesn't include a minimum annual deductible of $3,500 before many benefits kick in. (The state helps cover some of the premiums for those who make very little money, but many still have to pay the other fees.) And if anyone is hospitalized or needs a lot of specialized care, you also pay 20 percent of that bill. In this relatively cheap plan, the family can be liable for an extra $10,000 per year of medical costs. This sort of "high deductible" health plan is clearly structured to discourage medical care.

Imagine, for example, that your homeowner's insurance had a $1,000 deductible. If the faucet leaks, you'll try to fix it yourself instead of calling the plumber. The same thing applies to health care. If your newborn has a fever, you might give her Tylenol and just hope there's no serious infection rather than head to the emergency room and face a hefty co-pay.

Why does a progressive state like Massachusetts strong-arm many individuals and businesses into buying expensive insurance plans that don't encourage actual visits to the doctor and hospital? According to the Kaiser Family Foundation, the average person consumes more than $5,000 per year in health care resources. No matter how you slice it, some entity—government, business, or the individual—owes a boatload of cash for medical expenses. The annual costs for the 500,000 or so uninsured Massachusetts residents would run more than $2.5 billion, far in excess of the original state subsidy of $559 million.

That left billions to be paid by businesses and individuals. So for them, a high-deductible plan was a rational gamble. You (or your employer) front just enough money to get some coverage in case of catastrophe and then hope no one actually gets sick. But someone invariably does. As a result, out-of-pocket medical bills are the leading cause of bankruptcies—even though of most affected families actually have health insurance.

The expensive Massachusetts plan is not well-designed to systematically improve anyone's health. Instead, it's a superficial effort to clear the uninsured from the books and then clumsily limit further costs by discouraging care.

This brings us to the real task facing health reformers in our nation. Atul Gawande recently observed that for too long we've been "arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks." What's more important are the doctors who write the bills. The more procedures they do, the more money they make. To fix medicine, he argues, we have to create better incentives for doctors to do right by patients instead of their own bank accounts.

But that's not the whole story. Health care costs are rising everywhere, even in places like Minnesota, which Gawande cites as a prime example of low-cost, high-quality care that should be replicated nationwide. (Per capita health spending is actually 25 percent higher in Minnesota than in Texas, which has a hospital system that Gawande criticizes for profiteering.) In Massachusetts, some employers offering high-quality plans have annual rate increases of 10 percent to 15 percent. These jumps are certainly due to some overuse of services but also indicate increasingly high-technology care.

The lesson of Massachusetts is that really good health care is also really expensive. The concern isn't who writes the checks or who writes the bills. The real question is who makes the tough decisions about the limits of the checks and bills—in other words, who ultimately rations the money. Not everybody can have everything, and the sooner we admit that, the sooner our health care debate will get realistic.

In the haphazard Massachusetts plan, rationing fell to individuals, who then skimped on important prescriptions and routine visits. Gawande would leave rationing to properly incentivized doctors, but we have no data about whether this can be done widely. Others advocate for bodies like the Medicare Payment Advisory Commission (an impartial medical Federal Reserve Board), which can make the hard calls to promote and limit certain kinds of medical care. Britain, for example, has a national institute that makes precisely these decisions, like limiting drug-eluting stents for coronary artery disease and certain pricey drugs for kidney cancer. And health insurance executives here are again talking about "capitation," or fixed global budgets in which a group of health providers gets fixed monthly fees to handle all of a person's health needs.

In the meantime, one thing is sure: Without a smart plan to ration our resources well—that is, stick to a budget—and improve health, simply mandating that employers and individuals buy health insurance will only worsen the mess.

Darshak Sanghavi is a pediatric cardiologist and assistant professor of pediatrics at the University of Massachusetts Medical School. He is the author of A Map of the Child: A Pediatrician's Tour of the Body.
Article URL:
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on June 24, 2009, 05:33:11 AM
I'm not sure I agree with all of that.

As a general economic principle it seems sound to me to have the person consuming a service be the person paying for the service.  Indeed, IMHO a rather large percentage of our problems with this issue come from having someone other than the consumer pay.

It may well be that simply having a small or even no deductible combined with a higher percentage of patient participation in the bill is the way to go-- here I have no opinion.
Title: Re: The Politics of Health Care
Post by: Body-by-Guinness on June 24, 2009, 08:59:39 AM
I've some qualms to, though my purpose in posting the piece was to demonstrate that the MA solution many are touting has serious problems with it. The whole mandating privately purchased insurance at $9,600 that has so high a deductible that users self-impose rationing seems a far cry from the idyllics being touted to sell a government mandated program. Bottom line, each place I look where government is the prime move in health care has some pretty scary elements to it.
Title: Re: The Politics of Health Care
Post by: Boyo on June 25, 2009, 06:33:22 AM
Wow watched the annointed one last night talk about healthcare and I threw up in my mouth. :-DDid he really say that instead of an operation that a person should take pain killers.(paraphrase).

This is the real obama plan:[youtube][/youtube]

Boyo :lol:
Title: WSJ: Fannie Mae health care
Post by: Crafty_Dog on June 26, 2009, 06:06:50 AM
President Obama and most congressional Democrats say they want to preserve private health insurance. They also want to add a "public plan" to compete with private insurance plans. Their basic argument is that a public plan would offer needed competition, save money through low administrative costs and zero profits, realize greater economies of scale, and be a superior negotiator of the prices of medical services and technology.

 The first three arguments are bogus. The fourth argument is only half-bogus -- but the half that isn't reveals a great danger: If a public plan is inserted into private insurance markets, the American health-care system could rapidly evolve into a single-payer system, which would have devastating effects on R&D for new medical technology.

The first argument, that we need a public plan to spur competition, just isn't plausible. Hundreds of health insurance plans already exist, and employer benefit managers can choose among numerous alternatives. There is no lack of firms willing to compete to provide health insurance.

As to the second argument, what is to be saved by avoiding profits? Nonprofit health insurance firms are common, including many of the Blue Cross-Blue Shield plans. Nonprofit status has not proved to be a reliable source of efficiency and cost-saving. The addition of new nonprofit cooperatives and the like -- as a bipartisan group of senators has proposed -- would make little difference, unless the new plans are given the power to set prices and take on extra risk supported by government subsidies.

Would a public plan have lower administrative costs? Well, how often are public enterprises run more efficiently than private ones? Why did practically all economically advanced nations dismantle their public airlines, phone companies, and so on, invariably obtaining lower administrative costs and consumer prices?

As Stanford University health economist Victor Fuchs has pointed out, what "insurance" firms actually sell to large employers -- which account for the single largest segment of the entire health-care market -- is usually administrative services, not actual insurance. (Large companies are not insured; they pay benefits directly.) There is no reason to expect a Medicare-like public plan to match the administrative efficiency of Aetna, Blue Cross-Blue Shield, Cigna, UnitedHealth Group, and WellPoint. Medicare doesn't even try. It outsources most administrative services to the private sector.

Turning to public plans like Medicare and Medicaid for more efficient administration is a fool's errand.

What about economies of scale? Aetna currently serves about 18 million subscribers, UnitedHealth Care serves between 25 million and 30 million, and WellPoint more than 35 million. That is more than is served by the health-care monopoly of Canada (population 33.6 million), and more than the entire health-care systems of most European nations. Once a plan reaches a few million subscribers, there may not be a lot of economies of scale left that can enable public plans to provide lower prices.

Finally, there is the crucial task of negotiating prices for doctors, hospitals, clinics, drugs, devices and thousands of other items essential to modern health care. Here, there are really two arguments for a public plan. The first is about bargaining skill and the firm size, basic ingredients in any negotiating environment.

There is no reason to think the administrators of a public plan will possess skills superior to those honed by private plan personnel during years of negotiations under the pressure of competition. Nor is there any reason to think that mere size would help.

True enough, relatively small European nations routinely obtain better drug prices than are achieved by mammoth American pharmacy benefit managers such as Express Scripts (50 million patients) and Medco (60 million patients), each of whose numbers exceed the entire citizenry of all but the largest European nations. Even sparsely populated New Zealand (population four million) gets better prices than the giant drug-price negotiators in the American private market.

Their success is due to what economists call "monopsony power." Monopsony occurs when a single buyer negotiates prices with several competing sellers (as opposed to monopoly, where there are many buyers but one seller).

Thus, if you want to sell your branded drug in New Zealand, your prices are negotiated with PharMac, a branch of the government. Much the same is true when selling to Canada, Germany, the Netherlands, and essentially the entire developed world save the United States. The negotiating power of these government entities results from monopsony, not superior skill.

For example, the various sellers of cholesterol drugs (Lipitor, Crestor, and so on) have to compete with one another while they all face a single government negotiator. If one seller balks at government prices, it leaves competitors to pick up more sales. The same is true for most other drug classes and most medical devices. This uneven battle ensures that negotiated prices will be well below those in a competitive market.

But here is where the huge risks of creating a "public plan" to compete with private insurance firms come into focus. Foremost among these risks are the effects of monopsony power in the purchase of medical technology.

The U.S. is unique because it alone is the source of half of world-wide profits that provide the payoff for the complex, lengthy, and expensive process of developing new treatments. When other nations construct their health-care systems, they ignore the impact of their pricing policies on R&D incentives. As the dominant R&D funding wellhead, we do not have that option.

Competitive markets have generated the prices and the profits necessary to induce a steady flow of medical innovation in this country. A public plan option would tend to dismantle that system. The people in charge will not know how to set reimbursement levels to motivate reasonable R&D efforts, and there is no reason to expect them to try. In public plans, the tried-and-true method is to push the prices of suppliers down until something gives -- too few doctors willing to take on Medicare patients, for example -- and then to ease up. That is a destructive approach to medical technology R&D.

Who knows what drugs will not be developed if reimbursement levels for a new multiple-sclerosis treatment are too measly? In virtually every advanced economy but our own, pricing authorities simply make sure prices are high enough so that existing drugs continue to be made available. We can expect a public plan here to do the same. The inevitable result is to drastically under-incentivize R&D.

This problem would not matter if a public plan remained small -- but it would likely grow into a monster. Monopsony negotiating power will generate lower prices, so many consumers will switch to a public plan. Employers eager to offload health-care costs will also dump unwilling employees into the public plan. That is the basis for the Lewin Group's much-cited prediction that a public plan would come to dominate any market in which it is allowed to compete.

Bargaining power, however, is far from the only potential source of below-market prices for public plans. In the home mortgage market, the public plans -- known as Fannie Mae and Freddie Mac -- were for years viewed by investors as less risky because they would be bailed out by the federal government if they took on too much risk. That translated into lower prices (the interest rates paid by borrowers), which eventually translated into extraordinary and unseemly growth, culminating in bankruptcy and a federal bailout.

The lesson for health insurance is clear. All insurance plans -- especially in health-care markets -- have to take on risk. Prudent planning, including the maintenance of reasonable financial reserves, is necessary. That increases costs. It would be all too easy for a public plan to gain a competitive advantage by taking on extra risk while keeping prices low because everyone would expect the federal government to take care of financial surprises down the road.

In sum, a public plan would possess formidable and perhaps overwhelming competitive advantages -- generated not by efficiency but by the artificial advantages of "public" status. This would have two disastrous consequences. The first will be to cause most Americans now covered by private insurance to move to public insurance -- one step away from single-payer health care. The second will be to undermine incentives to develop more of the immensely valuable medical technology that is central to all of health care.

Mr. Calfee is a resident scholar at the American Enterprise Institute.
Title: Re: The Politics of Health Care
Post by: DougMacG on June 26, 2009, 11:57:53 AM
Followup to CCP's point that the number one contributor to the Democratic party is the taxpayer: Before we turn all healthcare workers in America into public workers could we please disband all public employee unions.  In the case of public employment,  there is no evil capitalist, only the will of the people, and therefore there is no underlying justification for employees to organize.

Look at the proportion of teachers union money given to Democrats and imagine the new public unions of doctors, nurses, physicians assistants, radiology technicians, etc. etc. and their demands for more and more money, shorter hours, cushier benefits combined with their political contribution clout.  Reagan won't be there to fire them when they go on strike.

Brit/former Brit? Mark Stein said last week that after national health care starts, all elections are about waiting times for service.  In other words further diluting and obscuring your ability to reward or punish them for their votes on other issues such as war, foreign policy, taxes, spending, judicial confirmations, gun control, abortion, you name it.  It all becomes about health service.

Is that what YOU want?  Not me.
Title: Re: The Politics of Health Care
Post by: ccp on June 26, 2009, 03:19:56 PM
Well the idea of doctors being able to go on strike is always a topic that brings out screams and hollers.
The idea of public employees being able to unionize though for some reason does not seem to bother anyone except me and you.
I have questioned this before in my posts.  There is some irony in the goernment hiring people, taxing all of us to pay for it, then allowing them to unionize to hit the taxpayers for more.
It appears it is from my googling that it is a state and local issue for most.

This is a bit out dated but I assume it applies to today:

Who Gets To Unionize?
Matt Alsdorf
Posted Tuesday, Dec. 7, 1999, at 7:14 PM ET
Last week, the National Labor Relations Board ruled that medical interns and residents at private hospitals were employees--not students--and could therefore form unions. What other types of employees can unionize?

The large majority of them. In 1935, Congress passed the National Labor Relations Act, which gives virtually every private sector employee the right to unionize and bargain collectively. (This is why last week's decision of the NLRB, which administers the act, affects only private hospitals.) Since 1935, most government employees--whether federal, state, or local--have gained the same rights through other national or state laws. So, only those workers specifically exempted from the NLRA are not guaranteed the ability to unionize. (However, this does not mean that they are prohibited from unionizing--rather, that they cannot seek federal protection if their employer refuses to recognize a union.) They include:

Small business employees: The definition of "small business" has not changed since the 1950s. As a result, there are very few companies that still qualify. (For example, a wholesale store would have to have annual sales below $50,000; a retail store, below $500,000; and a law firm, below $200,000.)
Managers and supervisors: This group includes anyone with hiring, firing, disciplinary, or compensatory authority over other workers. They are viewed as employers, not employees.
Independent contractors: These are people who are hired on an individual, project-by-project basis. They are a growing segment of the workforce, particularly in computer-related fields.
Agricultural workers: Because they are seasonal laborers and have a high turnover rate, they were excluded from the law. Only California has granted them unionization privileges.
Domestic employees: This group includes maids, butlers, and other live-in household help.
Although most American workers can join unions, a decreasing percentage are doing so. In 1998, only 13.9 percent of the workforce was unionized--down from 20.1 percent in 1983 (the first year comparable statistics were collected). And when government employees are excluded, the percentages are even lower: While 37.5 percent of public workers are unionized, only 9.5 percent of the private sector is.

Title: Re: The Politics of Health Care
Post by: Boyo on June 26, 2009, 03:51:07 PM
Public employees unoinizing is actually sort of silly.In Michigan it is illegal for public employees to strike, a good example are teachers or the national guard .Both have unions but they are forbidden from striking.So why bother.Oh, I know as payback to the unions. :roll:

Title: Re: The Politics of Health Care
Post by: Crafty_Dog on June 26, 2009, 06:14:20 PM
Indulge this old gray beard in reminding you that the Air Traffic Controllers Union, a public union, went on strike when President Reagan first took office.  He shocked the excrement out of them and the Dems when he fired them.  OTOH, NYC has a long and extremely expensive history of negotiating with striking public transit and sanitation unions.
Title: Monopsony Money & The Public Option
Post by: Body-by-Guinness on June 29, 2009, 03:54:07 PM
The Pitfalls of the Public Option
Published: June 27, 2009
IN the debate over health care reform, one issue looms large: whether to have a public option. Should all Americans have the opportunity to sign up for government-run health insurance?

Enlarge This Image
David G. Klein
President Obama has made his own preferences clear. In a letter to Senators Edward M. Kennedy of Massachusetts and Max Baucus of Montana, the chairmen of two key Senate committees, he wrote: “I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest.”

Even if one accepts the president’s broader goals of wider access to health care and cost containment, his economic logic regarding the public option is hard to follow. Consumer choice and honest competition are indeed the foundation of a successful market system, but they are usually achieved without a public provider. We don’t need government-run grocery stores or government-run gas stations to ensure that Americans can buy food and fuel at reasonable prices.

An important question about any public provider of health insurance is whether it would have access to taxpayer funds. If not, the public plan would have to stand on its own financially, as private plans do, covering all expenses with premiums from those who signed up for it.

But if such a plan were desirable and feasible, nothing would stop someone from setting it up right now. In essence, a public plan without taxpayer support would be yet another nonprofit company offering health insurance. The fundamental viability of the enterprise does not depend on whether the employees are called “nonprofit administrators” or “civil servants.”

In practice, however, if a public option is available, it will probably enjoy taxpayer subsidies. Indeed, even if the initial legislation rejected them, such subsidies would be hard to avoid in the long run. Fannie Mae and Freddie Mac, the mortgage giants created by federal law, were once private companies. Yet many investors believed — correctly, as it turned out — that the federal government would stand behind Fannie’s and Freddie’s debts, and this perception gave these companies access to cheap credit. Similarly, a public health insurance plan would enjoy the presumption of a government backstop.

Such explicit or implicit subsidies would prevent a public plan from providing honest competition for private suppliers of health insurance. Instead, the public plan would likely undercut private firms and get an undue share of the market.

President Obama might not be disappointed if that turned out to be the case. During the presidential campaign, he said, “If I were designing a system from scratch, I would probably go ahead with a single-payer system.”

Of course, we are not starting from scratch. Because many Americans are happy with their current health care, moving immediately to a single-payer system is too radical a change to be politically tenable. But for those who see single-payer as the ideal, a public option that uses taxpayer funds to tilt the playing field may be an attractive second best. If the subsidies are big enough, over time more and more consumers will be induced to switch.

Which raises the question: Would the existence of a dominant government provider of health insurance be good or bad?

It is natural to be skeptical. The largest existing public health programs — Medicare and Medicaid — are the main reason that the government’s long-term finances are in shambles. True, Medicare’s administrative costs are low, but it is easy to keep those costs contained when a system merely writes checks without expending the resources to control wasteful medical spending.

A dominant government insurer, however, could potentially keep costs down by squeezing the suppliers of health care. This cost control works not by fostering honest competition but by thwarting it.

Recall a basic lesson of economics: A market participant with a dominant position can influence prices in a way that a small, competitive player cannot. A monopoly — a seller without competitors — can profitably raise the price of its product above the competitive level by reducing the quantity it supplies to the market. Similarly, a monopsony — a buyer without competitors — can reduce the price it pays below the competitive level by reducing the quantity it demands.

This lesson applies directly to the market for health care. If the government has a dominant role in buying the services of doctors and other health care providers, it can force prices down. Once the government is virtually the only game in town, health care providers will have little choice but to take whatever they can get. It is no wonder that the American Medical Association opposes the public option.

To be sure, squeezing suppliers would have unpleasant side effects. Over time, society would end up with fewer doctors and other health care workers. The reduced quantity of services would somehow need to be rationed among competing demands. Such rationing is unlikely to work well.

FAIRNESS is in the eye of the beholder, but nothing about a government-run health care system strikes me as fair. Squeezing providers would save the rest of us money, but so would a special tax levied only on health care workers, and that is manifestly inequitable.

In the end, it would be a mistake to expect too much from health insurance reform. A competitive system of private insurers, lightly regulated to ensure that the market works well, would offer Americans the best health care at the best prices.

The health care of the future won’t come cheap, but a public option won’t make it better.

N. Gregory Mankiw is a professor of economics at Harvard. He was an adviser to President George W. Bush.
Title: Re: The Politics of Health Care
Post by: ccp on June 30, 2009, 06:40:53 AM
One question.
We keep hearing from the talking heads that we all agree that *everyone* should have health care.
To do so means rationing from the 90% that do.

Arguments from the Bama would state that the 10% can be covered with cost savings and more efficient care.
Electronic records, more preventative care, "keeping people well", paying providers for keeping people well not for each service provided.

There is one truth.  That of all these so called fixes -
No one knows if they would work.
Odds are very good they would reduce escalation of costs for a short period of time before the costs than star to go back up.
Just like the managed care of the 1990's.  It only works so much before people start yelping that they are not getting what they want.  Remember the Jack Nicholson movie with the criticism of HMOs?
HMO's did keep costs down, but only for a couple of years.
And their reputations plummeted.  There was this constant battle between patients wanting more tests, coverage and the insurers denying them.
The insurers even put doctors in the middle by giving them bonuses to limit and deny care.  Thus they were always off the hook blaming the docotr if something would go wrong.

Yet HMOs continued because they were the most affordable.  Especially with extra coverage for Medicare patients.

In any case we are looking at rationed care from 90% to pay for the 10%, apparantly a quarter of whom don't even belong in the US.

Title: Southbound Single Payers
Post by: Body-by-Guinness on June 30, 2009, 05:56:54 PM
Hadn't heard about the preemie statistics keeping standards mentioned below.

Canada's Single-Prayer Health Care
By INVESTOR'S BUSINESS DAILY | Posted Tuesday, June 30, 2009 4:20 PM PT

Health Reform: A critically ill premature baby is moved to a U.S hospital to get the treatment she couldn't get in the system we're told we should emulate. Cost-effective care? In Canada, as elsewhere, you get what you pay for.

Ava Isabella Stinson was born last Thursday at St. Joseph's hospital in Hamilton, Ontario. Weighing only two pounds, she was born 13 weeks premature and needed some very special care. Unfortunately, there were no open neonatal intensive care beds for her at St. Joseph's — or anywhere else in the entire province of Ontario, it seems.

Canada's perfectly planned and cost-effective system had no room at the inn for Ava, who of necessity had to be sent across the border to a Buffalo, N.Y., hospital to suffer under our chaotic and costly system. She had no time to be put on a Canadian waiting list. She got the care she needed at an American hospital under a system President Obama has labeled "unsustainable."
Jim Hoft over at Gateway Pundit reports Ava's case is not unusual. He reports that Hamilton's neonatal intensive care unit is closed to new admissions half the time. Special-needs infants are sent elsewhere and usually to the U.S.

In 2007, a Canadian woman gave birth to extremely rare identical quadruplets — Autumn, Brooke, Calissa and Dahlia Jepps. They were born in the United States to Canadian parents because there was again no space available at any Canadian neonatal care unit. All they had was a wing and a prayer.

The Jepps, a nurse and a respiratory technician flew from Calgary, a city of a million people, 325 miles to Benefit Hospital in Great Falls, Mont., a city of 56,000. The girls are doing fine, thanks to our system where care still trumps cost and where being without insurance does not mean being without care.

Infant mortality rates are often cited as a reason socialized medicine and a single-payer system is supposed to be better than what we have here. But according to Dr. Linda Halderman, a policy adviser in the California State Senate, these comparisons are bogus.

As she points out, in the U.S., low birth-weight babies are still babies. In Canada, Germany and Austria, a premature baby weighing less than 500 grams is not considered a living child and is not counted in such statistics. They're considered "unsalvageable" and therefore never alive.

Norway boasts one of the lowest infant mortality rates in the world — until you factor in weight at birth, and then its rate is no better than in the U.S.

In other countries babies that survive less than 24 hours are also excluded and are classified as "stillborn." In the U.S. any infant that shows any sign of life for any length of time is considered a live birth.

A child born in Hong Kong or Japan that lives less than a day is reported as a "miscarriage" and not counted. In Switzerland and other parts of Europe, a baby is not counted as a baby if it is less than 30 centimeters in length.

In 2007, there were at least 40 mothers and their babies who were airlifted from British Columbia alone to the U.S. because Canadian hospitals didn't have room. It's worth noting that since 2000, 42 of the world's 52 surviving babies weighing less than 400g (0.9 pounds) were born in the U.S.

It must be embarrassing to Canada that a G-7 economy and a country of 30 million people can't offer the same level of health care as a town of just over 50,000 in rural Montana. Where will Canada send its preemies and other critical patients when we adopt their health care system?

As we have noted, in Canada roughly 900,000 patients of all ages are waiting for beds, according to the Fraser Institute. There are more than four times as many magnetic resonance imaging (MRI) units per capita in the U.S. as in Canada. We have twice as many CT scanners per capita.

Expensive? Wasteful. Just ask the Jepps or the parents of Ava Isabella Stinson.
Title: WSJ: Parsing the arguments
Post by: Crafty_Dog on July 01, 2009, 07:26:01 AM
The health-care debate continues. We have now heard from nearly all the politicians, experts and interested parties: doctors, drug makers, hospitals, insurance companies, even constitutional lawyers (though not, significantly, from trial lawyers, who know full well "change" is not coming to their practices). Here is how one humble economist sees some of the main arguments, which I have paraphrased below:

- "The American people overwhelmingly favor reform."

If you ask whether people would be happier if somebody else paid their medical bills, they generally say yes. But surveys on consumers' satisfaction with their quality of care show overwhelming support for the continuation of the present arrangement. The best proof of this is the belated recognition by the proponents of health-care reform that they need to promise people that they can keep what they have now.

- "The cost of health care rises two to three times as fast as inflation."

That's like comparing the price of hamburger 30 years ago with the price of filet mignon today and calling the difference inflation. Or the price of a 19-inch, black-and-white TV 30 years ago with the price of a 50-inch HDTV today. The improvements in medical care are even more dramatic, leading to longer life, less pain, fewer exploratory surgeries and miracle drugs. Of course the research, the equipment and the training that produce these improvements don't come cheap.

 - "Health care represents a rising proportion of our income."

That's not only true but perfectly natural. Quality health care is a discretionary, income-elastic expense -- i.e. the richer a society, the larger the proportion of income that is spent on it. (Poor societies have to spend income gains on food and other necessities.) Consider the alternatives. Would we feel better about ourselves if we skimped on our family's health care and spent the money on liquor, gambling, night clubs or a third television set?

- "Shifting funds from health care to education would make for a better society."

These two services have a lot in common, including steadily rising cost. What is curious is that this rise in education costs is deemed by the liberal establishment smart and farsighted while the rise in health-care costs is a curse to be stopped at any cost. What is curiouser still is that in education, where they always advocate more "investment," past increases have gone hand-in-hand with demonstrably deteriorating outcomes. The rising cost in health care has been accompanied by clearly superior results. Thus we would shift dollars from where they do a lot of good to an area where they don't.

- "Forty-five million people in the U.S. are uninsured."

Even if this were true (many dispute it) should we risk destroying a system that works for the vast majority to help 15% of our population?

- "The cost of treating the 45 million uninsured is shifted to the rest of us."

So on Monday, Wednesday and Friday we are harangued about the 45 million people lacking medical care, and on Tuesday and Thursday we are told we already pay for that care. Left-wing reformers think that if they split the two arguments we are too stupid to notice the contradiction. Furthermore, if cost shifting is bad, wait for the Mother of all Cost Shifting when suppliers have to overcharge the private plans to compensate for the depressed prices forced on them by the public plan.

- "A universal plan will reduce the cost of health care."

Think a moment. Suppose you are in an apple market with 100 buyers and 100 sellers every day and apples sell for $1 a pound. Suddenly one day 120 buyers show up. Will the price of the apples go up or down?

- "U.S. companies are at a disadvantage against foreign competitors who don't have to pay their employees' health insurance."

This would be true if the funds for health care in those countries fell from the sky. As it is, employees in those countries pay for their health care in much higher income taxes, sales or value-added taxes, gasoline taxes (think $8 a gallon at the pump) and in many other ways, effectively reducing their take-home pay and living standards. And isn't it odd that the same people who want to lift this burden from businesses that provide health benefits also (again, on alternate days) want to impose this burden on the other firms that do not offer this benefit. What about the international competitiveness of these companies?

- "If you like your current plan you can keep it."

In other words, you can keep your current plan if it (and the company offering it) is still around. This is not a trivial qualification. Proponents have clearly learned from the HillaryCare debacle in the 1990s that radical transformation does not sell. What we have instead is what came to be dubbed "salami tactics" in postwar Eastern Europe where Communist leaders took away freedoms one at a time to minimize resistance and obscure the ultimate goal. If nothing else, a century of vain attempts to break the Post Office monopoly should teach us how welcoming Congress is to competition to one of its high-cost, inefficient wards.

- "Congress will be strictly neutral between the public and private plans."

Nonsense. Congress has a hundred ways to help its creation hide costs, from squeezing suppliers to hidden subsidies (think Amtrak). And it has even more ways to bankrupt private plans. One way is to mandate ever more exotic and expensive coverage (think hair transplants or sex-change operations). Another is by limiting and averaging premiums and outlawing advertising. And if all else fails Congress can always resort to tax audits and public harassment of executives -- all in the name of "leveling the playing field." Then, in the end, the triumphal announcement: "The private system has failed."

- "Decisions will still be made by doctors and patients and the system won't be politicized."

Fat chance. Funding conflicts between mental health and gynecology will be based on which pressure group offers the richer bribe or appears more politically correct. The closing (or opening) of a hospital will be based not on need but which subcommittee chairman's district the hospital is in. Imagine the centralization of all medical research in the country in the brand new Robert Byrd Medical Center in Morgantown, W.Va. You get the idea.

- "We need a public plan to keep the private plans honest."

The 1,500 or so private plans don't produce enough competition? Making it 1,501 will do the trick? But then why stop there? Eating is even more important than health care, so shouldn't we have government-run supermarkets "to keep the private ones honest"? After all, supermarkets clearly put profits ahead of feeding people. And we can't run around naked, so we should have government-run clothing stores to keep the private ones honest. And shelter is just as important, so we should start public housing to keep private builders honest. Oops, we already have that. And that is exactly the point. Think of everything you know about public housing, the image the term conjures up in your mind. If you like public housing you will love public health care.

Mr. Newman is an economist and retired business executive.
Title: Take a Number, Please
Post by: Body-by-Guinness on July 01, 2009, 07:54:17 AM
July 1, 2009
"Better" Health Care?

By John Stossel
President Obama says government will make health care cheaper and better. But there's no free lunch.

In England, health care is "free" -- as long as you don't mind waiting. People wait so long for dentist appointments that some pull their own teeth. At any one time, half a million people are waiting to get into a British hospital. A British paper reports that one hospital tried to save money by not changing bedsheets. Instead of washing sheets, the staff was encouraged to just turn them over.

Obama insists he is not "trying to bring about government-run healthcare".

"But government management does the same thing," says Sally Pipes of the Pacific Research Institute. "To reduce costs they'll have to ration -- deny -- care."

"People line up for care, some of them die. That's what happens," says Canadian doctor David Gratzer, author of "The Cure". He liked Canada's government health care until he started treating patients.

"The more time I spent in the Canadian system, the more I came across people waiting for radiation therapy, waiting for the knee replacement so they could finally walk up to the second floor of their house." "You want to see your neurologist because of your stress headache? No problem! Just wait six months. You want an MRI? No problem! Free as the air! Just wait six months."

Polls show most Canadians like their free health care, but most people aren't sick when the poll-taker calls. Canadian doctors told us the system is cracking. One complained that he can't get heart-attack victims into the ICU.

In America, people wait in emergency rooms, too, but it's much worse in Canada. If you're sick enough to be admitted, the average wait is 23 hours.

"We can't send these patients to other hospitals. Dr. Eric Letovsky told us. "Every other emergency department in the country is just as packed as we are."

More than a million and a half Canadians say they can't find a family doctor. Some towns hold lotteries to determine who gets a doctor. In Norwood, Ontario, "20/20" videotaped a town clerk pulling the names of the lucky winners out of a lottery box. The losers must wait to see a doctor.

Shirley Healy, like many sick Canadians, came to America for surgery. Her doctor in British Columbia told her she had only a few weeks to live because a blocked artery kept her from digesting food. Yet Canadian officials called her surgery "elective."

"The only thing elective about this surgery was I elected to live," she said.

It's true that America's partly profit-driven, partly bureaucratic system is expensive, and sometimes wasteful, but the pursuit of profit reduces waste and costs and gives the world the improvements in medicine that ease pain and save lives.

"[America] is the country of medical innovation. This is where people come when they need treatment," Dr. Gratzer says.

"Literally we're surrounded by medical miracles. Death by cardiovascular disease has dropped by two-thirds in the last 50 years. You've got to pay a price for that type of advancement."

Canada and England don't pay the price because they freeload off American innovation. If America adopted their systems, we could worry less about paying for health care, but we'd get 2009-level care -- forever.
Government monopolies don't innovate. Profit seekers do.

We saw this in Canada, where we did find one area of medicine that offers easy access to cutting-edge technology -- CT scan, endoscopy, thoracoscopy, laparoscopy, etc. It was open 24/7. Patients didn't have to wait.

But you have to bark or meow to get that kind of treatment. Animal care is the one area of medicine that hasn't been taken over by the government. Dogs can get a CT scan in one day. For people, the waiting list is a month.

Page Printed from: at July 01, 2009 - 08:17:48 AM PDT
Title: Contradicting Convention
Post by: Body-by-Guinness on July 01, 2009, 11:09:22 AM
2nd post.

Parsing the Health Reform Arguments
Some of the shibboleths we've heard in recent weeks don't make much sense.

The health-care debate continues. We have now heard from nearly all the politicians, experts and interested parties: doctors, drug makers, hospitals, insurance companies, even constitutional lawyers (though not, significantly, from trial lawyers, who know full well "change" is not coming to their practices). Here is how one humble economist sees some of the main arguments, which I have paraphrased below:

- "The American people overwhelmingly favor reform."

If you ask whether people would be happier if somebody else paid their medical bills, they generally say yes. But surveys on consumers' satisfaction with their quality of care show overwhelming support for the continuation of the present arrangement. The best proof of this is the belated recognition by the proponents of health-care reform that they need to promise people that they can keep what they have now.

- "The cost of health care rises two to three times as fast as inflation."

That's like comparing the price of hamburger 30 years ago with the price of filet mignon today and calling the difference inflation. Or the price of a 19-inch, black-and-white TV 30 years ago with the price of a 50-inch HDTV today. The improvements in medical care are even more dramatic, leading to longer life, less pain, fewer exploratory surgeries and miracle drugs. Of course the research, the equipment and the training that produce these improvements don't come cheap.

- "Health care represents a rising proportion of our income."

That's not only true but perfectly natural. Quality health care is a discretionary, income-elastic expense -- i.e. the richer a society, the larger the proportion of income that is spent on it. (Poor societies have to spend income gains on food and other necessities.) Consider the alternatives. Would we feel better about ourselves if we skimped on our family's health care and spent the money on liquor, gambling, night clubs or a third television set?

- "Shifting funds from health care to education would make for a better society."

These two services have a lot in common, including steadily rising cost. What is curious is that this rise in education costs is deemed by the liberal establishment smart and farsighted while the rise in health-care costs is a curse to be stopped at any cost. What is curiouser still is that in education, where they always advocate more "investment," past increases have gone hand-in-hand with demonstrably deteriorating outcomes. The rising cost in health care has been accompanied by clearly superior results. Thus we would shift dollars from where they do a lot of good to an area where they don't.

- "Forty-five million people in the U.S. are uninsured."

Even if this were true (many dispute it) should we risk destroying a system that works for the vast majority to help 15% of our population?

- "The cost of treating the 45 million uninsured is shifted to the rest of us."

So on Monday, Wednesday and Friday we are harangued about the 45 million people lacking medical care, and on Tuesday and Thursday we are told we already pay for that care. Left-wing reformers think that if they split the two arguments we are too stupid to notice the contradiction. Furthermore, if cost shifting is bad, wait for the Mother of all Cost Shifting when suppliers have to overcharge the private plans to compensate for the depressed prices forced on them by the public plan.

- "A universal plan will reduce the cost of health care."

Think a moment. Suppose you are in an apple market with 100 buyers and 100 sellers every day and apples sell for $1 a pound. Suddenly one day 120 buyers show up. Will the price of the apples go up or down?

- "U.S. companies are at a disadvantage against foreign competitors who don't have to pay their employees' health insurance."

This would be true if the funds for health care in those countries fell from the sky. As it is, employees in those countries pay for their health care in much higher income taxes, sales or value-added taxes, gasoline taxes (think $8 a gallon at the pump) and in many other ways, effectively reducing their take-home pay and living standards. And isn't it odd that the same people who want to lift this burden from businesses that provide health benefits also (again, on alternate days) want to impose this burden on the other firms that do not offer this benefit. What about the international competitiveness of these companies?

- "If you like your current plan you can keep it."

In other words, you can keep your current plan if it (and the company offering it) is still around. This is not a trivial qualification. Proponents have clearly learned from the HillaryCare debacle in the 1990s that radical transformation does not sell. What we have instead is what came to be dubbed "salami tactics" in postwar Eastern Europe where Communist leaders took away freedoms one at a time to minimize resistance and obscure the ultimate goal. If nothing else, a century of vain attempts to break the Post Office monopoly should teach us how welcoming Congress is to competition to one of its high-cost, inefficient wards.

- "Congress will be strictly neutral between the public and private plans."

Nonsense. Congress has a hundred ways to help its creation hide costs, from squeezing suppliers to hidden subsidies (think Amtrak). And it has even more ways to bankrupt private plans. One way is to mandate ever more exotic and expensive coverage (think hair transplants or sex-change operations). Another is by limiting and averaging premiums and outlawing advertising. And if all else fails Congress can always resort to tax audits and public harassment of executives -- all in the name of "leveling the playing field." Then, in the end, the triumphal announcement: "The private system has failed."

- "Decisions will still be made by doctors and patients and the system won't be politicized."

Fat chance. Funding conflicts between mental health and gynecology will be based on which pressure group offers the richer bribe or appears more politically correct. The closing (or opening) of a hospital will be based not on need but which subcommittee chairman's district the hospital is in. Imagine the centralization of all medical research in the country in the brand new Robert Byrd Medical Center in Morgantown, W.Va. You get the idea.

- "We need a public plan to keep the private plans honest."

The 1,500 or so private plans don't produce enough competition? Making it 1,501 will do the trick? But then why stop there? Eating is even more important than health care, so shouldn't we have government-run supermarkets "to keep the private ones honest"? After all, supermarkets clearly put profits ahead of feeding people. And we can't run around naked, so we should have government-run clothing stores to keep the private ones honest. And shelter is just as important, so we should start public housing to keep private builders honest. Oops, we already have that. And that is exactly the point. Think of everything you know about public housing, the image the term conjures up in your mind. If you like public housing you will love public health care.

Mr. Newman is an economist and retired business executive.

Printed in The Wall Street Journal, page A13
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on July 01, 2009, 11:47:43 AM
See entry #256 :lol:
Title: Re: The Politics of Health Care
Post by: Body-by-Guinness on July 01, 2009, 11:54:04 AM
Title: Making Sausage Ain't Pretty
Post by: Body-by-Guinness on July 01, 2009, 12:43:47 PM
Senate "Free Rider" Penalties: Taxing the Poor to Pay for Health Care
by Robert A. Book, Ph.D. and Edmund F. Haislmaier
WebMemo #2516
Congress's mad scramble to turn health care buzzwords and bumper stickers into legislation last week careened off in yet another direction.

Senators on the Finance Committee revealed that they are now considering a variant of the "play or pay" employer mandate idea--imposing so-called "free rider" penalties on businesses whose workers receive coverage through Medicaid or take advantage of new subsidies to buy health insurance elsewhere.

It is unclear whether the "free rider" penalties would to be in addition to, or a substitute for, the payroll tax "pay" part of a play-or-pay employer mandate. Either way, such penalties would in practice act as an extremely regressive tax on the working poor, reducing their cash wages and in some cases eliminating their jobs altogether.

Displacing Private Coverage

The Finance Committee seems to be engaged in the classic exercise of making new errors that compound previous ones. They are trying to solve a problem made by their proposal to create new subsidies for the currently uninsured that are larger than the existing subsides for those already insured.

Workers with employer-sponsored health insurance already get a substantial implicit subsidy because their coverage is treated as tax-free income. If Congress offers even bigger subsidies to the uninsured, many in the eligible income range who currently have coverage will try to switch to the new, more heavily subsidized coverage, meaning that new, more-subsidized coverage would "crowd-out" existing, less-subsidized coverage.

It seems that when presented by the Congressional Budget Office with enormous and unfunded cost estimates for their subsidy design--partially attributable to its significant crowd-out effects--committee members opted for a second mistake.

Unequal Treatment

Rather than equalizing the new subsidies to eliminate potential crowd-out, the committee apparently decided to enact a generous subsidy design while adding a so-called "free rider" penalty, imposed on businesses whose workers take advantage of the new subsidies or sign up for Medicaid. Presumably, the idea is to discourage employers from dropping their current health plans if enough of their employees become eligible for expanded government benefits--or at least to defray the cost to the government if they do so.

It is unclear whether the committee envisions these penalties to apply only to employers who currently offer coverage but later drop it, or to all employers who do not offer coverage after the law is enacted.

Furthermore, it is also unclear if these penalties would apply in cases where an employer offered coverage, but some employees decline it and enroll in Medicaid or other government-subsidized coverage options instead. For example, if an employee qualifies for Medicaid and signs up, would the employer be assessed a penalty? Taking that approach would effectively punish employers for decisions taken by Congress (to expand Medicaid eligibility) and workers (to sign up for coverage for which they become newly eligible) over which the employers have no control.

Taxing Workers

Of course, the biggest fallacy in all of this is the belief that somehow it will be employers, rather than workers, that bear the cost of any "play or pay" mandate or "free rider" penalty.

The reality is that either or both of these provisions will act as an extremely regressive tax on the working poor, substantially reducing their take-home pay and in some cases eliminating their jobs altogether.

When an employer decides whether to hire an employee and how much to pay, the employer has to consider the full cost of employing that person. That full cost includes not only cash wages and the employer's cost of providing benefits but also the employer's share of any employment-related taxes, such as the Social Security and Medicare taxes. When the costs of benefits or payroll taxes increase, their slices of the total compensation pie expand--forcing the cash wage slice to shrink.

Thus, if an employer is required to pay a "penalty" or "tax" for not providing health insurance, that too will reduce the amount available to pay the employee as cash wages. If the employer instead satisfies the mandate by spending more on health insurance, the effect is the same. Either way, the employee's take-home pay has to be cut.

If reports about some of the ideas being considered by the Finance Committee are correct, the actual effects could be dramatic and disastrous for low-income workers. In particular, the committee is reported to be considering "free rider" penalties that are equal to half of the national average cost of Medicaid or to the full cost of the federal subsidies for individuals with incomes above the (new, higher) Medicaid eligibility threshold.

That would, in effect, be a massively regressive tax--and one that applied only to people on the lower end of the income distribution scale. Furthermore, it would be regressive even within that subgroup. For employees eligible for Medicaid, the tax would be a fixed amount per employee (and therefore a larger percentage of income for lower-income employees). For those with incomes too high for Medicaid but low enough to quality for a health insurance subsidy, the subsidy will likely be reduced as the employee's income rises, with the "free rider" penalty being equal to the amount of the subsidy.

Consequently, the "free rider" tax will take more money--not just a higher percentage, but more actual dollars--from workers with lower incomes than from those with higher incomes. And for workers whose incomes are high enough, the tax would disappear entirely.

In essence, the Senators would be telling the poor: "If you now have to choose between food and health insurance, from now on you no longer have that choice--you have to buy the health insurance."

For some employees, the situation would be even worse. After all, what if the employee is earning only minimum wage? Or close enough to it that cutting cash wages by the amount of the tax would put the employee's pay below the minimum wage? In that case, there would be only one way for the employer to comply with the law: lay off all employees whose wages are too low.

Back to the Drawing Board

Businesses do not meet their payrolls out of magic pots of unlimited money that they dole out based on their own level of beneficence. They have to pay employees out of money they get from customers based on their employees' work. If that work does not generate enough revenue to pay at least the minimum wage plus the cost of benefits plus the taxes, then the business loses money and the employees have to be laid off. Like gravity, it is just that simple and that unalterable.

A large and regressive tax increase on low-income workers is not the solution to America's health care problems. Some people might gain coverage, but all will lose take-home pay, and many will lose their jobs entirely.

Robert A. Book, Ph.D., is Senior Research Fellow in Health Economics in the Center for Data Analysis and Edmund F. Haislmaier is Senior Research Fellow in the Center for Health Policy Studies at The Heritage Foundation.
Title: If you think health care
Post by: Crafty_Dog on July 01, 2009, 04:19:11 PM
is expensive now, just wait until the govt makes it free.
Title: Another Socialize Medicine Success Story
Post by: Body-by-Guinness on July 02, 2009, 02:07:21 PM
Disabled children wait up to two years for wheelchairs
NHS accused of relying on charities to plug funding gap, leaving patients facing postcode lottery
Press Association,    Wednesday 4 March 2009 13.34 GMT
 larger | smaller
The NHS was told today to stop relying on charities to fill funding gaps after figures revealed many trusts would not pay the full cost of electric wheelchairs for disabled children.

Freedom of information figures obtained by the Muscular Dystrophy Campaign found children were subject to a postcode lottery in terms of equipment.

Statistics from 54% of NHS trusts in England and Scotland revealed that disabled children in England are forced to wait five months on average for a wheelchair.

The worst performing primary care trust (PCT), East Lancashire, in the north-west of England, had an average wait of two years for an electric wheelchair.

The survey showed 58% of children in England had to wait at least three months for an electric wheelchair and 14% waited more than six months.

In the case of Westminster and Islington PCTs in London, children living just four miles apart could have a difference of 11 months in waiting time.

Overall, 50% of the PCTs that responded said they did not fund the full cost of a powered wheelchair for a disabled child.

Westminster PCT made an average contribution of only £700 towards the cost of a child's powered wheelchair, it said.

Almost all PCTs contacted by the charity said the cost of a wheelchair was around £2,000 but in fact the true cost of a basic electric wheelchair would be around £3,000.

A separate patient survey of 237 children found one in three did not receive any funding at all for their wheelchair.

Philip Butcher, chief executive of the Muscular Dystrophy Campaign, said: "Today's figures are nothing short of a national scandal.

"It is a damning indictment of the NHS that so many families across the UK are forced to rely on charities or be driven into financial hardship just to receive vital, life-improving equipment for their disabled children.

"It's time the NHS stopped relying on charities to fill the gaps left by its inadequate funding."

Two PCTs in the West Midlands – Birmingham East and North, and South Birmingham – have waiting times for a powered wheelchair of 18 months compared to a national average of just under five months, the report said.
Title: Re: The Politics of Health Care
Post by: DougMacG on July 05, 2009, 11:30:17 AM
A competing Democrat operative once said of the Clintons that they lie with such ease.  Now it is the Obamas.  We are told that there is no harm to let a "public option" compete with "private" options.  "No one is going to lose their current health plan if they choose to keep it."  Of course the elephant in the room is that the public option is subsidized by the taxpayer to the tune of trillions.  That's why private options won't be able to compete.

Here is David Axelrod on Meet the Press last week saying there will be no subsidy:
"Look, we believe strongly in, in a public choice; not one that's subsidized by the government, but one that will embrace the best practices, that will reduce healthcare costs and give people the best quality care."

Someone help me out here.  If there is no subsidy and no unfair advantage, what the hell do we need the government for to create it?  It will cost the taxpayer nothing(?), it has to paid for, no taxes are going up (except on the wealthiest among us) and it won't have any unfair advantage over private choices.  (Please weigh in here if you believe them.)

Of course they are lying.  All of the above are true.  It will be subsidized.  All government programs are.  Taxes will be raised even on the brokest among us.  Private choices will be squeezed out.  Costs will go up, not down.  Quality will suffer. Waiting will be the norm.  And turning back will be next to impossible.
Title: Re: The Politics of Health Care
Post by: ccp on July 06, 2009, 07:41:29 AM
"A competing Democrat operative once said of the Clintons that they lie with such ease.  Now it is the Obamas"

Clinton proved that the truth doesn't matter when one is pushing agendas that are popular in the polls.
BO is just taking the ball and running with it.

It is really frustrating that he is so personally popular in the polls.

I just don't get it that lying/honesty is not important with most people.

Especially with our leaders who seem more like scam artists.  When BO was *reading* his scripted 4th of July speech I really felt he was just reading lines he doesn't believe and certainly has no heart in.
He doesn't believe all those good things he says about America.  He is just reading it because as Alinsky wrote, "pretend you are one of them and then you can change them".

Honesty meant something in my family when I was growing up. 
At least to strive to be honest/straight and fair.
Now it is mocked for all to see.

And the Dems don't even pretend the facade of honesty.
The repubs perhaps are not much better and put on the facade.

Title: Re: The Politics of Health Care
Post by: Crafty_Dog on July 07, 2009, 06:53:06 AM
Speaking to the American Medical Association last month, President Obama waxed enthusiastic about countries that "spend less" than the U.S. on health care. He's right that many countries do, but what he doesn't want to explain is how they ration care to do it.

Take the United Kingdom, which is often praised for spending as little as half as much per capita on health care as the U.S. Credit for this cost containment goes in large part to the National Institute for Health and Clinical Excellence, or NICE. Americans should understand how NICE works because under ObamaCare it will eventually be coming to a hospital near you.

* * *
Associated Press
President Barack Obama speaks about health care during a town hall meeting at Northern Virginia Community College last Wednesday.
The British officials who established NICE in the late 1990s pitched it as a body that would ensure that the government-run National Health System used "best practices" in medicine. As the Guardian reported in 1998: "Health ministers are setting up [NICE], designed to ensure that every treatment, operation, or medicine used is the proven best. It will root out under-performing doctors and useless treatments, spreading best practices everywhere."

What NICE has become in practice is a rationing board. As health costs have exploded in Britain as in most developed countries, NICE has become the heavy that reduces spending by limiting the treatments that 61 million citizens are allowed to receive through the NHS. For example:

In March, NICE ruled against the use of two drugs, Lapatinib and Sutent, that prolong the life of those with certain forms of breast and stomach cancer. This followed on a 2008 ruling against drugs -- including Sutent, which costs about $50,000 -- that would help terminally ill kidney-cancer patients. After last year's ruling, Peter Littlejohns, NICE's clinical and public health director, noted that "there is a limited pot of money," that the drugs were of "marginal benefit at quite often an extreme cost," and the money might be better spent elsewhere.

In 2007, the board restricted access to two drugs for macular degeneration, a cause of blindness. The drug Macugen was blocked outright. The other, Lucentis, was limited to a particular category of individuals with the disease, restricting it to about one in five sufferers. Even then, the drug was only approved for use in one eye, meaning those lucky enough to get it would still go blind in the other. As Andrew Dillon, the chief executive of NICE, explained at the time: "When treatments are very expensive, we have to use them where they give the most benefit to patients."

NICE has limited the use of Alzheimer's drugs, including Aricept, for patients in the early stages of the disease. Doctors in the U.K. argued vociferously that the most effective way to slow the progress of the disease is to give drugs at the first sign of dementia. NICE ruled the drugs were not "cost effective" in early stages.

Other NICE rulings include the rejection of Kineret, a drug for rheumatoid arthritis; Avonex, which reduces the relapse rate in patients with multiple sclerosis; and lenalidomide, which fights multiple myeloma. Private U.S. insurers often cover all, or at least portions, of the cost of many of these NICE-denied drugs.

NICE has also produced guidance that restrains certain surgical operations and treatments. NICE has restrictions on fertility treatments, as well as on procedures for back pain, including surgeries and steroid injections. The U.K. has recently been absorbed by the cases of several young women who developed cervical cancer after being denied pap smears by a related health authority, the Cervical Screening Programme, which in order to reduce government health-care spending has refused the screens to women under age 25.

We could go on. NICE is the target of frequent protests and lawsuits, and at times under political pressure has reversed or watered-down its rulings. But it has by now established the principle that the only way to control health-care costs is for this panel of medical high priests to dictate limits on certain kinds of care to certain classes of patients.

The NICE board even has a mathematical formula for doing so, based on a "quality adjusted life year." While the guidelines are complex, NICE currently holds that, except in unusual cases, Britain cannot afford to spend more than about $22,000 to extend a life by six months. Why $22,000? It seems to be arbitrary, calculated mainly based on how much the government wants to spend on health care. That figure has remained fairly constant since NICE was established and doesn't adjust for either overall or medical inflation.

Proponents argue that such cost-benefit analysis has to figure into health-care decisions, and that any medical system rations care in some way. And it is true that U.S. private insurers also deny reimbursement for some kinds of care. The core issue is whether those decisions are going to be dictated by the brute force of politics (NICE) or by prices (a private insurance system).

The last six months of life are a particularly difficult moral issue because that is when most health-care spending occurs. But who would you rather have making decisions about whether a treatment is worth the price -- the combination of you, your doctor and a private insurer, or a government board that cuts everyone off at $22,000?

One virtue of a private system is that competition allows choice and experimentation. To take an example from one of our recent editorials, Medicare today refuses to reimburse for the new, less invasive preventive treatment known as a virtual colonoscopy, but such private insurers as Cigna and United Healthcare do. As clinical evidence accumulates on the virtual colonoscopy, doctors and insurers will be able to adjust their practices accordingly. NICE merely issues orders, and patients have little recourse.

This has medical consequences. The Concord study published in 2008 showed that cancer survival rates in Britain are among the worst in Europe. Five-year survival rates among U.S. cancer patients are also significantly higher than in Europe: 84% vs. 73% for breast cancer, 92% vs. 57% for prostate cancer. While there is more than one reason for this difference, surely one is medical innovation and the greater U.S. willingness to reimburse for it.

* * *
The NICE precedent also undercuts the Obama Administration's argument that vast health savings can be gleaned simply by automating health records or squeezing out "waste." Britain has tried all of that but ultimately has concluded that it can only rein in costs by limiting care. The logic of a health-care system dominated by government is that it always ends up with some version of a NICE board that makes these life-or-death treatment decisions. The Administration's new Council for Comparative Effectiveness Research currently lacks the authority of NICE. But over time, if the Obama plan passes and taxpayer costs inevitably soar, it could quickly gain it.

Mr. Obama and Democrats claim they can expand subsidies for tens of millions of Americans, while saving money and improving the quality of care. It can't possibly be done. The inevitable result of their plan will be some version of a NICE board that will tell millions of Americans that they are too young, or too old, or too sick to be worth paying to care for.
Title: Plain and simple though not politically correct.
Post by: ccp on July 07, 2009, 07:33:31 AM
I really don't want to pay for medical care for 40 million.
Frankly my dear, I don't care.
Why others can't or just won't say this I dont' know.  Lets stop beating about the Bush.  Anyone think the people who are going to get covered are going to be grateful to those of us who pay for it?
Not a chance.

I have enough trouble paying for my own.
I already work 5 months a year for money that is confiscated.
I said enough.
Title: WSJ: White House open to deal on public option?
Post by: Crafty_Dog on July 08, 2009, 08:10:51 AM
WASHINGTON -- It is more important that health-care legislation inject stiff competition among insurance plans than it is for Congress to create a pure government-run option, White House Chief of Staff Rahm Emanuel said.

"The goal is to have a means and a mechanism to keep the private insurers honest," he said in an interview. "The goal is non-negotiable; the path is" negotiable.

President Barack Obama has campaigned vigorously for a full public option. But he's also said that he won't draw a "line in the sand" over this point. On Tuesday, the White House issued a statement reiterating his support for a public plan.

"I am pleased by the progress we're making on health care reform and still believe, as I've said before, that one of the best ways to bring down costs, provide more choices, and assure quality is a public option that will force the insurance companies to compete and keep them honest," the president said in the statement. "I look forward to a final product that achieves these very important goals."

The jockeying over the public plan came as the Senate Finance Committee pushed for a bipartisan deal. To help pay for the package, the committee planned to announce an agreement Wednesday with hospitals and the White House for $155 billion over a decade in reductions to Medicare and charity-care payments for hospitals, according to a person familiar with the agreement. That will help pay for the legislation, expected to cost at least $1 trillion over 10 years.

One of the most contentious issues is whether to create a public health-insurance plan to compete with private companies.

Mr. Emanuel said one of several ways to meet Mr. Obama's goals is a mechanism under which a public plan is introduced only if the marketplace fails to provide sufficient competition on its own. He noted that congressional Republicans crafted a similar trigger mechanism when they created a prescription-drug benefit for Medicare in 2003. In that case, private competition has been judged sufficient and the public option has never gone into effect.

The deal with the hospitals follows a similar agreement with brand-name drug companies. And insurance companies were talking to Senate negotiators about cuts worth at least $100 billion over 10 years, according to two officials with knowledge of the negotiations.

Congressional negotiators and the White House hope to lock in support from the industry groups, which are backing a health bill in general terms but have opposed past efforts.

Hospitals and insurers hope to gain some degree of control over cuts to their federal payments. In principle, a health-care overhaul could benefit both groups by raising the number of Americans who buy and have health insurance.

"They've made an assessment reform is going to happen, so it's better to be part of that than not," Mr. Emanuel said.

However, insurers, and most Republicans, strongly oppose creation of a government-run insurance option, saying it would ultimately drive them out of business. Most Democrats support a public option.

The president and his aides already have signaled a willingness to consider an alternative to a public plan under which a network of nonprofit cooperatives would compete with for-profit insurance companies. That is the leading idea in the Senate Finance Committee.

The Senate Health, Education, Labor and Pensions Committee, meanwhile, has put forward its own version of a government-run plan, closer to what most liberals and the White House favor.

On Monday, Mr. Emanuel said the trigger mechanism would also accomplish the White House's goals. Under this scenario, a public plan would kick in under certain circumstances when competition was judged to be lacking. Exactly what circumstances would trigger the option would have to be worked out.

Some Democrats pushing for a vigorous public plan say the trigger idea isn't good enough. Sen. Charles Schumer (D., N.Y.) said in an interview, "If it's not there on day one, those of us who support a public option have a real problem with it."
Title: WSJ: Public Option Two-step
Post by: Crafty_Dog on July 09, 2009, 07:10:09 AM

Americans unschooled in liberal health-care politics may have trouble deciphering the White House's conflicting proclamations this week about a new government insurance program for the middle class. Allow us to translate: President Obama loves this so-called public option, but he needs to sell it in a shroud of euphemism and the appearance of "compromise."

On Monday, chief of staff Rahm Emanuel told the Journal's Laura Meckler that the Administration would accept a health bill without a public option, as long as there is "a mechanism to keep the private insurers honest . . . The goal is non-negotiable; the path is." Progressives went bonkers, so on Tuesday Mr. Obama took a break from his Moscow trip to come out strongly in favor (again) of the new trillion-dollar entitlement. Meanwhile, New York's Chuck Schumer has been loudly suggesting that compromise is unnecessary given 60 Senate Democrats -- even as the likes of Ben Nelson, Evan Bayh, Joe Lieberman and Mary Landrieu back away.

The reason left-flank Democrats are so adamant about a public option is because they know it is an opening wedge for the government to dominate U.S. health care. That's also why the health-care industry, business groups, some moderates and most Republicans are opposed. Team Obama likes the policies of the first group but wants the political support of the second. And they're trying to solve this Newtonian problem -- irresistible forces, immovable objects -- by becoming less and less candid about the changes they really favor.

Mr. Emanuel echoes his boss and says a government health plan is needed to keep the private sector "honest," but then why don't we also need a state-run oil company, or nationalized grocery store chain? (Or auto maker? Never mind.) The real goal is to create a program backstopped by taxpayers that can exert political leverage over the market.

In its strongest version, the federal plan would receive direct cash subsidies, allowing it to undercut private insurers on consumer prices. This would quickly lead to "crowd out," the tendency of supposedly "free" public programs to displace private insurance. As a general rule, Congress has to spend $2 of taxpayer money to provide $1 in new benefits. More precise academic studies of expansions in Medicaid and the children's insurance program put the crowd-out effect somewhere between 25% and 60%.

Because this is so expensive, the public version Mr. Schumer favors would supposedly receive no special advantages. But this is meaningless when Democrats are planning to mandate the benefits that private insurers must provide, the patients they must accept, and how much they can charge. Oh, and a government plan would still have an implicit taxpayer guarantee a la Fannie Mae, giving it an inherent cost-of-capital advantage.

A few swing votes such as Maine's Olympia Snowe might accept a "trigger," in which a government-run plan would only come on line if certain targets aren't met, such as reducing costs. But that only delays the day of reckoning. Another pseudocompromise is North Dakota Democrat Kent Conrad's idea to give the states seed money to set up health insurance co-ops. These plans would still be run under a federal charter and managed by a federal board, so they merely split the public option into 50 pieces.

The other goal of a new public plan is to force doctors and hospitals to accept below-cost fees. This is how Medicare tries to control costs today, but it's like squeezing a balloon: Lower reimbursements mean that providers -- especially hospitals -- must recoup their costs elsewhere, either by shifting costs onto private payers or with more billable tests and procedures. The only way costs can conceivably be managed via price controls is if government is running the whole show, which naturally leads to severe restrictions on care while medical innovation withers.

A rhetorical gong Mr. Obama has been banging a lot lately is the idea that the people pointing all this out are liars. "When you hear the naysayers claim that I'm trying to bring about government-run health care," he said in one speech, "know this: They're not telling the truth." He adds that opposition to a public option isn't "based on any evidence" and that it is "illegitimate" to argue that his program is "is somehow a Trojan horse for a single-payer system."

So much for changing the political tone. Perhaps the President should check in with his more honest liberal allies. Jacob Hacker, now a professor of political science at Berkeley, came up with the intellectual architecture for the public option when he was a graduate student in the 1990s. "Someone once said to me, 'This is a Trojan horse for single payer,' and I said, 'Well, it's not a Trojan horse, right? It's just right there,'" Mr. Hacker explained in a speech last year. "I'm telling you, we're going to get there, over time, slowly."

The real question the political class is debating now is how slowly, or quickly, it takes to get there. And how they're best able to disguise this goal -- ideally as a "compromise."
Title: Re: The Politics of Health Care
Post by: ccp on July 10, 2009, 08:38:26 AM
Interesting take.  I don't know if he is correct or not but I haven't thought of it from this angle.
As for the AARP, now I am over 50 I get solicitations from them every two days.
I joined for one year but I don't see any great benefits from it.
I wonder how much the people who run it get.

Anyway Dick Morris article:

By Dick Morris And Eileen McGann 07.9.2009 Obama’s health care proposal is, in effect, the repeal of the Medicare program as we know it. The elderly will go from being the group with the most access to free medical care to the one with the least access. Indeed, the principal impact of the Obama health care program will be to reduce sharply the medical services the elderly can use. No longer will their every medical need be met, their every medication prescribed, their every need to improve their quality of life answered.

It is so ironic that the elderly - who were so vigilant when Bush proposed to change Social Security - are so relaxed about the Obama health care proposals. Bush’s Social Security plan, which did not cut their benefits at all, aroused the strongest opposition among the elderly. But Obama’s plan, which will totally gut Medicare and replace it with government-managed care and rationing, has elicited little more than a yawn from most senior citizens.

It’s time for the elderly to wake up before it is too late!

In our new book, Catastrophe, we explain - in detail and in depth - the consequences the elderly of Canada are feeling from just this kind of program. Limited colonoscopies have led to a 25% higher rate of colon cancer and a ban on the use of the two best chemotherapies are part of the reason why 42% of Canadians with colon cancer die while 31% of Americans, who have access to these two medications, survive the disease.

Overall, the death rate from cancer in Canada is 16% higher than in the United States and the heart disease mortality rate is 6% above ours’.

Under Obama’s program, there will be a government health insurance company that gets huge subsidies of tax money. It will compete with private insurance plans. But the subsidies will let it undercut the private plans and drive them out of business, leaving only the government plan - a single payer - in effect.

Today, 800,000 doctors struggle to treat adequately the 250 million Americans who have insurance. Obama will add 50 million more to their caseload with no expansion in the number of doctors or nurses. Indeed, his plan will likely reduce their number by lowering reimbursement rates and imposing bureaucrats above them who will force medical decisions down their throats. Fewer doctors will have to treat more patients. The inevitable result will be rationing.

And it is the elderly who rationing will most effect. Who should get a knee replacement a 40 year old or a 70 year old? Who should get a new hip, a young person or an old person? Who should have priority in the operating room a seventy year old diabetic who needs bypass surgery or a younger person? Obviously, it is the elderly who will get short shrift under his proposal.

But the interest groups that usually speak up for the elderly, particularly AARP, are in Obama’s pocket, hoping to profit from his program by becoming one of its vendors. Just as they backed Bush’s prescription drug plan because they anticipating profiting from it, so they are now helping Obama gut the medical care of their constituents.

It is high time that the elderly of America realized what the stakes are in this vital fight to preserve Medicare as we know it and keep medical care open, accessible, and free to those over 65. It is truly a battle for their very lives.

Title: Re: The Politics of Health Care
Post by: G M on July 14, 2009, 09:31:23 AM

An American government health-care system you should know

Over the last few months, as Barack Obama’s plans to transform the health-care industry in America have proceeded, I have written extensively on the two existing government-run health-care systems and their myriad problems: Medicare/Medicaid and the VA.  It seems I missed a third that may be worse than either or perhaps both combined.  Mary Clare Jalonick of the Associated Press provides an eye-opening report on Indian Health Service, a single-payer system that rations care to Native Americans on reservations across the country — and kills them through neglect and a severe lack of resources:

On some reservations, the oft-quoted refrain is “don’t get sick after June,” when the federal dollars run out. It’s a sick joke, and a sad one, because it’s sometimes true, especially on the poorest reservations where residents cannot afford health insurance. Officials say they have about half of what they need to operate, and patients know they must be dying or about to lose a limb to get serious care.

Wealthier tribes can supplement the federal health service budget with their own money. But poorer tribes, often those on the most remote reservations, far away from city hospitals, are stuck with grossly substandard care. The agency itself describes a “rationed health care system.”

The sad fact is an old fact, too.

The U.S. has an obligation, based on a 1787 agreement between tribes and the government, to provide American Indians with free health care on reservations. But that promise has not been kept. About one-third more is spent per capita on health care for felons in federal prison, according to 2005 data from the health service.

Without a doubt, the people on the reservations represent some of the poorest of the poor in America.  Yet we already have a single-payer system in place to provide health care to Native Americans on these reservations.  Do we properly fund it?  Do we make sure that enough resources are applied to ensure good health care?  Not at all.  It is, as the agency itself describes, a system of rationing medical resources, and the end result is a poor population unable to seek out its own care locked into a system that only works when someone is on death’s door.

In fact, as Jalonick reports, it often doesn’t recognize when a patient faces death.  Jalonick profiles the heartrending case of Ta’Shon Rain Little Light, who began complaining of stomach pains at the age of 5, and stopped eating and playing.  The overwhelmed clinic diagnosed her as depressed, and ten subsequent visits to the clinic over the next several months while Ta’Shon’s symptoms worsened didn’t change the diagnosis.  Only when she suffered a collapsed lung did IHS airlift her to Denver, where Ta’Shon was diagnosed with terminal cancer.  Could it have been treated?  We’ll never know, thanks to a diagnostic service that appears to be just above the wild-guess level on the reservation.

When government owns the nation’s health-care system, we can all look forward to the same level of care.  After all, as Obama himself insists, a government-run system will “save costs,” but he never explains how those costs get saved.  We will all go into the rationing-system grinder, just as veterans do with the VA, seniors and disabled do with Medicare, and Native Americans do with IHS.
Title: Re: The Politics of Health Care
Post by: G M on July 14, 2009, 09:34:14 AM

Read this and tell me how great gov't health care is.
Title: Re: The Politics of Health Care
Post by: ccp on July 14, 2009, 09:47:49 AM
Don't think for a second that because it is in the New england Journal of Massechussetts liberal propaganda that it is not politically biased.
Folks Health care policy self proclaimed experts like this are at the forefront of the liberal think tanks that advise Democrats.
Notice the guy is a phD who has never taken care of a patient in his life.  I don't get how taxing employer provision of health care is a good idea.  I just don't see it.   I agree with Milton Friedman who thinks the whole concept of empolyer buying health care IS the problem.  But then, what do I know compared to another self proclaimed great one from the halls of IVy league gospel.
His written piece is written like OBama speaks.  Because he says it, it must be so:

*****HEALTH CARE 2009

Previous Volume 361:4-5  July 2, 2009  Number 1
A Win–Win Approach to Financing Health Care Reform

Jonathan Gruber, Ph.D.

No hurdle facing health care reform in the United States today is more daunting than the problem of financing universal coverage. There is an inescapable logic of reform that lies behind the search for financing sources. First, moving to universal coverage is now widely acknowledged to require a mandate that individuals carry insurance coverage. Second, such a requirement is unacceptable without subsidies to make health insurance affordable for lower-income people. Third, these subsidies will require new financing on the order of $1 trillion or more over the next decade. How can the government finance such a sizeable new expenditure?

There are a number of possible sources. One is reductions in existing government spending on health care through cost controls. President Barack Obama proposed more than $300 billion of such cost controls in his budget, but it is not clear that either politicians or providers have the appetite to go further. Another is increased taxation of "sin goods" — cigarettes, alcohol, and high-sugar or high-fat foods that cause obesity — whose use raises the cost of health care for all Americans. These taxes make sense, yet it is difficult to raise sufficient revenues from them. The government can also look outside the health care system to increased revenues from taxes on carbon emissions or on other goods and services. But this approach would involve expanding the fight over health care into other realms, compounding the difficulty of passing any legislation.

There is one final potential source: the elimination or limiting of the income-tax exclusion for expenditures on employer-sponsored insurance. Ending the massive tax subsidy for such insurance would result in both the most natural source of financing for health care reform and one of the few that is clearly large enough to finance the necessary subsidies.

The $250 billion per year in foregone revenues attributable to the tax exclusion of employers' health insurance expenditures represents the federal government's second-largest health insurance expenditure (after Medicare). When my employer pays me in cash wages, I am taxed on those wages. But the roughly $10,000 per year that my employer spends on my health insurance is not taxed, and it translates into a tax break for me of about $4,000. To be clear, this exclusion represents a tax break for individuals, not for firms; firms are largely indifferent about whether they pay employees in wages or in health insurance. But employees are not indifferent: they pay taxes on the former but not on the latter.

This tax exclusion has three flaws. First, the forgone tax revenue is an enormous sum of money that could be more effectively deployed elsewhere, especially through new approaches to increasing insurance coverage. Just taxing health benefits through the income tax as we do wages would raise $2.3 trillion in federal revenues over the next decade. Second, the exclusion is a regressive entitlement, since higher-income families with higher tax rates get a bigger tax break; about three quarters of these dollars go to Americans in the top half of the income distribution. Third, this tax subsidy makes health insurance, which is bought with tax-sheltered dollars, artificially cheap relative to goods bought with taxed dollars — a phenomenon that leads to overinsurance for most Americans and overspending on medical care.

Given these limitations, no health care expert today would ever set up a health care system with such an enormous tax subsidy for a particular form of insurance coverage. So why don't we just remove it? There are four counterarguments to using limits on the exclusion to create a financing source, but each can be effectively addressed.

First, some argue that it would be administratively infeasible to reduce this tax subsidy. But the process of including spending on employer-sponsored insurance in individual income taxation is actually quite straightforward. Employers would simply report the amount they paid for each employee's insurance coverage on the employee's W-2 form. If the employer is self-insured, it would simply use the premium amount it is already required to calculate in providing continuation coverage (or Consolidated Omnibus Budget Reconciliation Act [COBRA] coverage) to displaced workers.

The second argument is that since the current predominance of employer-sponsored insurance is predicated on this tax exclusion, policymakers must be wary about removing it: many employers offer health insurance only because of this "tax bribe," and sicker and older persons are treated much more fairly in employer groups than they will be in today's nongroup insurance market. As the provision of employer-sponsored insurance declines, we could end up with a large new uninsured population that either cannot afford nongroup insurance or cannot obtain it at any price. This possibility would certainly be cause for concern if we were reducing the tax exclusion in a vacuum — but not when the policy would be financing a universal coverage plan in which all individuals would get group rates and would be subsidized as necessary. Thus, any displacement from employer-sponsored insurance will lead not to uninsurance but merely to a shift to a new insurance exchange.

The third concern is that removing the exclusion would mean an across-the-board tax increase. I prefer to view this as a progressive tax increase, with 62% of the revenues raised from families with annual incomes of more than $100,000. Yet there would still be a sizeable increase in taxation for middle-income families, with 10% of revenues coming from families with annual incomes below $50,000 and 28% from those with annual incomes of $50,000 to $100,000. For this reason, and because not all the revenues to be gained by removing the exclusion would be needed to finance reform, we should reduce, rather than remove, the exclusion.

The exclusion can be reduced, for example, by capping the amount of employer-sponsored premiums that is excluded from taxation, so that individuals are not taxed on premiums below some level (say, the average value of premiums for employer-sponsored insurance) and pay tax only on premiums in excess of that level. This approach has the advantage of addressing the bias toward excessively generous insurance without raising the taxes of people who have basic insurance. Moreover, it would be more progressive than an across-the-board removal of the exclusion, since higher-income people tend to have more expensive insurance than lower-income people. Alternatively, we could scale back the exclusion only for those in higher income groups; such a strategy could be designed to protect middle-income taxpayers from any tax increase.

Either way, the dollars involved are substantial. For example, suppose the government capped the exclusion at the level of the typical employer-sponsored–insurance premium (currently $4,700 for an individual and $12,800 for a family), starting in 2012, and indexed that cap at the rate of growth of the consumer price index (so that the cap rose, but more slowly than the premiums). Such a policy would raise $500 billion by 2019. Considerable revenues would be raised even with a higher cap. A cap set at the 75th percentile of the premium distribution, so that only insurance plans in the top quarter of the price range were subject to taxation, would raise $330 billion between 2012 and 2019. Or, more progressively, capping the tax exclusion at the level of the typical premium but only for families with annual incomes above $125,000 would raise $340 billion between 2012 and 2019.

A final criticism of reducing the tax exclusion is that it would be unfair to high-cost groups — for example, people living in states where insurance is particularly expensive or those working for employers with an older workforce. But this problem can be readily addressed by adjusting the cap to account for differences among firms in underlying cost factors. Employers, for example, could easily compute an adjustment factor, based on their firm's location or their workers' ages, that could be used to set the cap.

Despite the resistance to changing the status quo, I believe that the most sensible source of financing for universal coverage would come from reducing the expensive, regressive, and inefficient subsidization of employer-sponsored insurance. Scaling back the exclusion would be highly progressive and would have the added benefit of reducing the incentives for overinsurance and excessive health care spending. This win–win solution would ameliorate a fundamental flaw in our current system while raising the revenues required to cover the uninsured.

No potential conflict of interest relevant to this article was reported.

Source Information

From the Massachusetts Institute of Technology, Cambridge. *****
Title: How 'Bout that Current Single Payer Plan
Post by: Body-by-Guinness on July 15, 2009, 08:18:28 AM
Surprise, surprise, we already have a single payer, government administered health care plan in the US. I wonder how what it's like:

PROMISES, PROMISES: Indian health care's victims

BY MARY CLARE JALONICK, Associated Press Writer
Mon Jun 15, 8:56 am ET

CROW AGENCY, Mont. – Ta'Shon Rain Little Light, a happy little girl who loved to dance and dress up in traditional American Indian clothes, had stopped eating and walking. She complained constantly to her mother that her stomach hurt.
When Stephanie Little Light took her daughter to the Indian Health Service clinic in this wind-swept and remote corner of Montana, they told her the 5-year-old was depressed.
Ta'Shon's pain rapidly worsened and she visited the clinic about 10 more times over several months before her lung collapsed and she was airlifted to a children's hospital in Denver. There she was diagnosed with terminal cancer, confirming the suspicions of family members.
A few weeks later, a charity sent the whole family to Disney World so Ta'Shon could see Cinderella's Castle, her biggest dream. She never got to see the castle, though. She died in her hotel bed soon after the family arrived in Florida.
"Maybe it would have been treatable," says her great-aunt, Ada White, as she stoically recounts the last few months of Ta'Shon's short life. Stephanie Little Light cries as she recalls how she once forced her daughter to walk when she was in pain because the doctors told her it was all in the little girl's head.
Ta'Shon's story is not unique in the Indian Health Service system, which serves almost 2 million American Indians in 35 states.
On some reservations, the oft-quoted refrain is "don't get sick after June," when the federal dollars run out. It's a sick joke, and a sad one, because it's sometimes true, especially on the poorest reservations where residents cannot afford health insurance. Officials say they have about half of what they need to operate, and patients know they must be dying or about to lose a limb to get serious care.
Wealthier tribes can supplement the federal health service budget with their own money. But poorer tribes, often those on the most remote reservations, far away from city hospitals, are stuck with grossly substandard care. The agency itself describes a "rationed health care system."
The sad fact is an old fact, too.
The U.S. has an obligation, based on a 1787 agreement between tribes and the government, to provide American Indians with free health care on reservations. But that promise has not been kept. About one-third more is spent per capita on health care for felons in federal prison, according to 2005 data from the health service.
In Washington, a few lawmakers have tried to bring attention to the broken system as Congress attempts to improve health care for millions of other Americans. But tightening budgets and the relatively small size of the American Indian population have worked against them.
"It is heartbreaking to imagine that our leaders in Washington do not care, so I must believe that they do not know," Joe Garcia, president of the National Congress of American Indians, said in his annual state of Indian nations' address in February.
When it comes to health and disease in Indian country, the statistics are staggering.
American Indians have an infant death rate that is 40 percent higher than the rate for whites. They are twice as likely to die from diabetes, 60 percent more likely to have a stroke, 30 percent more likely to have high blood pressure and 20 percent more likely to have heart disease.
American Indians have disproportionately high death rates from unintentional injuries and suicide, and a high prevalence of risk factors for obesity, substance abuse, sudden infant death syndrome, teenage pregnancy, liver disease and hepatitis.
While campaigning on Indian reservations, presidential candidate Barack Obama cited this statistic: After Haiti, men on the impoverished Pine Ridge and Rosebud Reservations in South Dakota have the lowest life expectancy in the Western Hemisphere.
Those on reservations qualify for Medicare and Medicaid coverage. But a report by the Government Accountability Office last year found that many American Indians have not applied for those programs because of lack of access to the sign-up process; they often live far away or lack computers. The report said that some do not sign up because they believe the government already has a duty to provide them with health care.
The office of minority health at the U.S. Department of Health and Human Services, which oversees the Indian Health Service, notes on its Web site that American Indians "frequently contend with issues that prevent them from receiving quality medical care. These issues include cultural barriers, geographic isolation, inadequate sewage disposal and low income."
Indeed, Indian health clinics often are ill-equipped to deal with such high rates of disease, and poor clinics do not have enough money to focus on preventive care. The main problem is a lack of federal money. American Indian programs are not a priority for Congress, which provided the health service with $3.6 billion this budget year.
Officials at the health service say they can't legally comment on specific cases such as Ta'Shon's. But they say they are doing the best they can with the money they have — about 54 cents on the dollar they need.
One of the main problems is that many clinics must "buy" health care from larger medical facilities outside the health service because the clinics are not equipped to handle more serious medical conditions. The money that Congress provides for those contract health care services is rarely sufficient, forcing many clinics to make "life or limb" decisions that leave lower-priority patients out in the cold.
"The picture is much bigger than what the Indian Health Service can do," says Doni Wilder, an official at the agency's headquarters in Rockville, Md., and the former director of the agency's Northwestern region. "Doctors every day in our organization are making decisions about people not getting cataracts removed, gall bladders fixed."
On the Standing Rock Reservation in North Dakota, Indian Health Service staff say they are trying to improve conditions. They point out recent improvements to their clinic, including a new ambulance bay. But in interviews on the reservation, residents were eager to share stories about substandard care.
Rhonda Sandland says she couldn't get help for her advanced frostbite until she threatened to kill herself because of the pain — several months after her first appointment. She says she was exposed to temperatures at more than 50 below, and her hands turned purple. She eventually couldn't dress herself, she says, and she visited the clinic over and over again, sometimes in tears.
"They still wouldn't help with the pain so I just told them that I had a plan," she said. "I was going to sleep in my car in the garage."
She says the clinic then decided to remove five of her fingers, but a visiting doctor from Bismarck, N.D., intervened, giving her drugs instead. She says she eventually lost the tops of her fingers and the top layer of skin.
The same clinic failed to diagnose Victor Brave Thunder with congestive heart failure, giving him Tylenol and cough syrup when he told a doctor he was uncomfortable and had not slept for several days. He eventually went to a hospital in Bismarck, which immediately admitted him. But he had permanent damage to his heart, which he attributed to delays in treatment. Brave Thunder, 54, died in April while waiting for a heart transplant.
"You can talk to anyone on the reservation and they all have a story," says Tracey Castaway, whose sister, Marcella Buckley, said she was in $40,000 of debt because of treatment for stomach cancer.
Buckley says she visited the clinic for four years with stomach pains and was given a variety of diagnoses, including the possibility of a tapeworm and stress-related stomachaches. She was eventually told she had Stage 4 cancer that had spread throughout her body.
Ron His Horse is Thunder, chairman of the Standing Rock tribe, says his remote reservation on the border between North Dakota and South Dakota can't attract or maintain doctors who know what they are doing. Instead, he says, "We get old doctors that no one else wants or new doctors who need to be trained."
His Horse is Thunder often travels to Washington to lobby for more money and attention, but he acknowledges that improvements are tough to come by.
"We are not one congruent voting bloc in any one state or area," he said. "So we don't have the political clout."
On another reservation 200 miles north of Standing Rock, Ardel Baker, a member of North Dakota's Three Affiliated Tribes, knows all too well the truth behind the joke about money running out.
Baker went to her local clinic with severe chest pains and was sent by ambulance to a hospital more than an hour away. It wasn't until she got there that she noticed she had a note attached to her, written on U.S. Department of Health and Human Services letterhead.
"Understand that Priority 1 care cannot be paid for at this time due to funding issues," the letter read. "A formal denial letter has been issued."
She lived, but she says she later received a bill for more than $5,000.
"That really epitomizes the conflict that we have," says Robert McSwain, deputy director of the Indian Health Service. "We have to move the patient out, it's an emergency. We need to get them care."
It was too late for Harriet Archambault, according to the chairman of the Senate Indian Affairs Committee, Democratic Sen. Byron Dorgan of North Dakota, who has told her story more than once in the Senate.
Dorgan says Archambault died in 2007 after her medicine for hypertension ran out and she couldn't get an appointment to refill it at the nearest clinic, 18 miles away. She drove to the clinic five times and failed to get an appointment before she died.
Dorgan's swath of the country is the hardest hit in terms of Indian health care. Many reservations there are poor, isolated, devoid of economic development opportunities and subject to long, harsh winters — making it harder for the health service to recruit doctors to practice there.
While the agency overall has an 18 percent vacancy rate for doctors, that rate jumps to 38 percent for the region that includes the Dakotas. That region also has a 29 percent vacancy rate for dentists, and officials and patients report there is almost no preventive dental care. Routine procedures such as root canals are rarely seen here. If there's a problem with a tooth, it is simply pulled.
Dorgan has led efforts in Congress to bring attention to the issue. After many years of talking to frustrated patients at home in North Dakota, he says he believes the problems are systemic within the embattled agency: incompetent staffers are transferred instead of fired; there are few staff to handle complaints; and, in some cases, he says, there is a culture of intimidation within field offices charged with overseeing individual clinics.
The senator has also probed waste at the agency.
A 2008 GAO report, along with a follow-up report this year, accused the Indian Health Service of losing almost $20 million in equipment, including vehicles, X-ray and ultrasound equipment and numerous laptops. The agency says some of the items were later found.
Dorgan persuaded Senate Majority Leader Harry Reid, D-Nev., to consider an American Indian health improvement bill last year, and the bill passed in the Senate. It would have directed Congress to provide about $35 billion for health programs over the next 10 years, including better access to health care services, screening and mental health programs. A similar bill died in the House, though, after it became entangled in an abortion dispute.
The growing political clout of some remote reservations may bring some attention to health care woes. Last year's Democratic presidential primary played out in part in the Dakotas and Montana, where both Obama and Democrat Hillary Rodham Clinton became the first presidential candidates to aggressively campaign on American Indian reservations there. Both politicians promised better health care.
Obama's budget for 2010 includes an increase of $454 million, or about 13 percent, over this year. Also, the stimulus bill he signed this year provided for construction and improvements to clinics.
Back in Montana, Ta'Shon's parents are doing what they can to bring awareness to the issue. They have prepared a slideshow with pictures of her brief life; she is seen dressed up in traditional regalia she wore for dance competitions with a bright smile on her face. Family members approached Dorgan at a Senate field hearing on American Indian health care after her death in 2006, hoping to get the little girl's story out.
"She was a gift, so bright and comforting," says Ada White of her niece, whom she calls her granddaughter according to Crow tradition. "I figure she was brought here for a reason."
Nearby, the clinic on the Crow reservation seems mostly empty, aside from the crowded waiting room. The hospital is down several doctors, a shortage that management attributes recruitment difficulties and the remote location.
Diane Wetsit, a clinical coordinator, said she finds it difficult to think about the congressional bailout for Wall Street.
"I have a hard time with that when I walk down the hallway and see what happens here," she says.;_ylt=AsAiGQwA3K1f_6nUFlb3ewN2wPIE;_ylu=X3oDMTB1MjgxN2UzBHBvcwMxNARzZWMDdG9vbHMtdG9wBHNsawNwcmludA--
Title: Slavery exists
Post by: ccp on July 15, 2009, 09:11:53 AM
Here is another one from the NEJM.  This one makes more sense and I agree with it in part that the answer is very complicated.
I agree we need to do something as costs will continue escalate.  Adding "47" million (if that is the number or all BS, I don't know) new people to the rolls (including nearly 10 million illegals - if the number is accurate - I suspect it may be even more) will only intensify costs, drive the economy into the gutter, result in rationed care, and make the rest of us pay for it all.
I am not sure by any means if a "value based system" is the answer but I do agree that many of the supposed answers being thrown around like electronic medical records, single payer system, government run health care, more preventative care, following guidelines (rationing) often sold as better value care, and all the other buzz phrases are just that.

I think this guy is right that it would take revolutionary new steps toward different delivery systems to even begin to control costs.

In the meantime, guaranteeing care as a right to everyone in the US, citizen or not, is also guaranteeing a collapse in quality care for the rest of us.  Specialists will be forced to accept even less payments, hospitals will be rationing services, and primary doctors will be replaced by nurses.  I don't see it any other way.

Somehow I feel like the majority are being made to be the slave labor for the minority who get entitlements.  The concept of a "safety net" has morphed into permanent slave-entitlement classes.  Bama is accelerating this and making it permanent.

****A Strategy for Health Care Reform — Toward a Value-Based System

Michael E. Porter, Ph.D.

Despite many waves of debate and piecemeal reforms, the U.S. health care system remains largely the same as it was decades ago. We have seen no convincing approach to changing the unsustainable trajectory of the system, much less to offsetting the rising costs of an aging population and new medical advances.

Today there is a new openness to changing a system that all agree is broken. What we need now is a clear national strategy that sets forth a comprehensive vision for the kind of health care system we want to achieve and a path for getting there. The central focus must be on increasing value for patients — the health outcomes achieved per dollar spent.1 Good outcomes that are achieved efficiently are the goal, not the false "savings" from cost shifting and restricted services. Indeed, the only way to truly contain costs in health care is to improve outcomes: in a value-based system, achieving and maintaining good health is inherently less costly than dealing with poor health.

True reform will require both moving toward universal insurance coverage and restructuring the care delivery system. These two components are profoundly interrelated, and both are essential. Achieving universal coverage is crucial not only for fairness but also to enable a high-value delivery system. When many people lack access to primary and preventive care and cross-subsidies among patients create major inefficiencies, high-value care is difficult to achieve. This is a principal reason why countries with universal insurance have lower health care spending than the United States. However, expanded access without improved value is unsustainable and sure to fail. Even countries with universal coverage are facing rapidly rising costs and serious quality problems; they, too, have a pressing need to restructure delivery.2,3,4

How can we achieve universal coverage in a way that will support, rather than impede, a fundamental reorientation of the delivery system around value for patients? There are several critical steps.

First, we must change the nature of health insurance competition. Insurers, whether private or public, should prosper only if they improve their subscribers' health. Today, health plans compete by selecting healthier subscribers, denying services, negotiating deeper discounts, and shifting more costs to subscribers. This zero-sum approach has given competition — and health insurers — a bad name. Instead, health plans must compete on value. We must introduce regulations to end coverage and price discrimination based on health risks or existing health problems. In addition, health plans should be required to measure and report their subscribers' health outcomes, starting with a group of important medical conditions. Such reporting will help consumers choose health plans on the basis of value and discourage insurers from skimping on high-value services, such as preventive care. Health insurers that compete this way will drive value in the system far more effectively than government monopolies can.

Second, we must keep employers in the insurance system. Employers have a vested interest in their employees' health. Daily interactions with their workforce enable employers to create value by developing a culture of wellness, enabling effective prevention and screening, and directing employees to high-value providers. Employers can also foster competition and drive broader system improvement in ways that are difficult for government entities to replicate. To motivate employers to stay in the system, we must reduce the extra amount they now pay through higher insurance costs to cover the uninsured and subsidize government programs. We must also create a level playing field for employers that offer coverage by penalizing employers that are free riders.

Third, we need to address the unfair burden on people who have no access to employer-based coverage, who therefore face higher premiums and greater difficulty securing coverage. This means first equalizing the tax deductibility of insurance purchased by individuals and through employers.

Fourth, to make individual insurance affordable, we need large statewide or multistate insurance pools, like the Massachusetts Health Insurance Connector, to spread risk and enable contracting for coverage and premiums equivalent to or better than those of the largest employer-based plans. Regional pools, instead of a national pool, will result in greater accountability to subscribers and closer interaction with regional provider networks, fostering value-based competition. We also need a reinsurance system that equitably spreads the cost of insuring Americans with very expensive health problems across both regional pools and employers.

Fifth, income-based subsidies will be needed to help lower-income people buy insurance. These subsidies can be partially offset through payments from employers that do not provide coverage but whose employees require public assistance.

Finally, once a value-based insurance market has been established, everyone must be required to purchase health insurance so that younger and healthier people cannot opt out. This will bring substantial new revenues into the system, lowering premiums for everyone and reducing the need for subsidies.

Although most U.S. health care reform efforts have focused on coverage, the far bigger long-term driver of success will come from restructuring the delivery system. That is where most of the value is created and most of the costs are incurred.

The current delivery system is not organized around value for patients, which is why incremental reforms have not lived up to expectations. Our system rewards those who shift costs, bargain away or capture someone else's revenues, and bill for more services, not those who deliver the most value. The focus is on minimizing the cost of each intervention and limiting services rather than on maximizing value over the entire care cycle. Moreover, without comprehensive outcome measurement, it is hard to know what improves value and what does not.

To achieve a value-based delivery system, we need to follow a series of mutually reinforcing steps. First, measurement and dissemination of health outcomes should become mandatory for every provider and every medical condition. Results data not only will drive providers and health plans to improve outcomes and efficiency but also will help patients and health plans choose the best provider teams for their medical circumstances.

Outcomes must be measured over the full cycle of care for a medical condition, not separately for each intervention. Outcomes of care are inherently multidimensional, including not only survival but also the degree of health or recovery achieved, the time needed for recovery, the discomfort of care, and the sustainability of recovery.5 Outcomes must be adjusted for patients' initial conditions to eliminate bias against patients with complex cases.

We need to measure true health outcomes rather than relying solely on process measures, such as compliance with practice guidelines, which are incomplete and slow to change. We must also stop using one or a few measures as a proxy for a provider's overall quality of care. Performance on a measure such as mortality within 30 days after acute myocardial infarction, for example, says little about a provider's care for patients with cancer. Active involvement of the federal government will be needed to ensure universal, consistent, and fair measurement throughout the country, like that already achieved in areas such as organ transplantation.

Since implementing outcome measurement will take time, an interim step should be to require every provider team to report its experience or the volume of patients treated for each medical condition, along with the procedure or treatment approach used. Experience reporting by providers will help patients and their doctors find the providers with the expertise that meets their needs.

Second, we need to radically reexamine how to organize the delivery of prevention, wellness, screening, and routine health maintenance services. The problem is not only that the system underinvests in these services relative to the value they can create but also that primary care providers are asked to deliver disparate services with limited staff to excessively broad patient populations. As a result, delivery of such care is fragmented and often ineffective and inefficient. We need structures for the delivery of specified prevention and wellness service bundles to defined patient populations with unified reimbursement. Employers with on-site health clinics are achieving extraordinary success in providing such services, highlighting the need for new delivery channels beyond conventional settings.

Third, we need to reorganize care delivery around medical conditions. Our system of uncoordinated, sequential visits to multiple providers, physicians, departments, and specialties works against value. Instead, we need to move to integrated practice units that encompass all the skills and services required over the full cycle of care for each medical condition, including common coexisting conditions and complications. Such units should include outpatient and inpatient care, testing, education and coaching, and rehabilitation within the same actual or virtual organization. This structure, organized around the patient's needs, will result in care with much higher value and a far better experience for patients. Government policies creating artificial obstacles to integrated, multidisciplinary care (e.g., the Stark laws) should be modified or eliminated. In a value-based system, the abuses that gave rise to such legislation will decline substantially.

Fourth, we need a reimbursement system that aligns everyone's interests around improving value for patients. Reimbursement must move to single bundled payments covering the entire cycle of care for a medical condition, including all providers and services. Bundled payments will shift the focus to restoring and maintaining health, providing a mix of services that optimizes outcomes, and reorganizing care into integrated practice structures. For chronic conditions, bundled payments should cover extended periods of care and include responsibility for evaluating and addressing complications.

Fifth, we must expect and require providers to compete for patients, based on value at the medical-condition level, both within and across state borders. This will allow excellent providers to grow and serve more patients while reducing hyperfragmentation and duplication of services. In order to achieve high value, providers need a sufficient volume of cases of a given medical condition to allow for the development of deep expertise, integrated teams, and tailored facilities. We may need to institute minimum-volume thresholds for complex medical conditions in order to jump-start consolidation and spur geographic expansion of qualified providers. At the same time, strict antitrust scrutiny must be applied to avoid excessive concentration among a small number of providers or health plans in a region.

Sixth, electronic medical records will enable value improvement, but only if they support integrated care and outcome measurement. Simply automating current delivery practices will be a hugely expensive exercise in futility. Among our highest near-term priorities is to finalize and then continuously update health information technology (HIT) standards that include precise data definitions (for diagnoses and treatments, for example), an architecture for aggregating data for each patient over time and across providers, and protocols for seamless communication among systems.

Finally, consumers must become much more involved in their health and health care. Unless patients comply with care and take responsibility for their health, even the best doctor or team will fail. Simply forcing consumers to pay more for their care is not the answer. New integrated care delivery structures, together with bundled reimbursement for full care cycles, will enable vast improvements in patient engagement, as will the availability of good outcome data.

Comprehensive reform will require simultaneous progress in all these areas because they are mutually reinforcing. For example, outcome measurement not only will improve insurance-market competition but also will drive the restructuring of care delivery. Delivery restructuring will be accelerated by bundled reimbursement. Electronic medical records will facilitate both delivery restructuring and outcome measurement.

Moving ahead now on all these fronts is also important in order to align every stakeholder's interest with value, or reform will once again fail. However, a health care strategy, like any good strategy, involves a sequence of steps over time rather than an attempt to change everything at once. Road maps will be needed for rolling out changes in each area while giving the actors time to adjust.

Some new organizations (or combinations of existing ones) will be needed: a new independent body to oversee outcome measurement and reporting, a single entity to review and set HIT standards, and possibly a third body to establish rules for bundled reimbursement. Medicare may be able to take the lead in some areas; for example, Medicare could require experience reporting by providers or combine Parts A and B into one payment.

The big question is whether we can move beyond a reactive and piecemeal approach to a true national health care strategy centered on value. This undertaking is complex, but the only real solution is to align everyone in the system around a common goal: doing what's right for patients.

Dr. Porter reports receiving lecture fees from the American Surgical Association, the American Medical Group Association, the World Health Care Congress, Hoag Hospital, and the Children's Hospital of Philadelphia, receiving director's fees from Thermo Fisher Scientific, and having an equity interest in Thermo Fisher Scientific, Genzyme, Zoll Medical, Merck, and Pfizer. No other potential conflict of interest relevant to this article was reported.****

Title: Re: The Politics of Health Care
Post by: DougMacG on July 15, 2009, 09:50:39 AM
Here is a flow chart of the new, simplified 1000+ page Democrat Health Plan:
It's just as simple as that. (sarc.)
Sorry I'm not able to post the image from the pdf. I hope someone else can.
Title: Re: The Politics of Health Care
Post by: Body-by-Guinness on July 15, 2009, 03:37:53 PM
Doug's chart:

Title: Medical Metaphor
Post by: Body-by-Guinness on July 15, 2009, 03:40:41 PM
Universal Health Care Isn't Worth Our Freedom
What would Thoreau have made of the current debate?

People who seek the services of auto mechanics want car repair, not "auto care." Similarly, most people who seek the services of medical doctors want body repair, not "health care."

We own our cars, are responsible for the cost of maintaining them, and decide what needs fixing based partly on balancing the seriousness of the problem against the expense of repairing it. Our health-care system rests on the principle that, although we own our bodies, the community or state ought to be responsible for paying the cost of repairing them. This is for the ostensibly noble purpose of redistributing the potentially ruinous expense of the medical care of unfortunate individuals.

But what is health care? The concept of reimbursable health-care service rests on the premise that the medical problem in need of servicing is the result of involuntary, unwanted happenings, not the result of voluntary, goal-directed behavior. Leukemia, lupus, prostate cancer, and many infectious diseases are unwanted happenings. Are we going to count obesity, smoking, depression and schizophrenia as the same kinds of diseases?

Many Americans would willingly pay for insurance to protect them against the exorbitant cost of treating their own leukemia. But how many Americans would willingly pay for insurance to protect them from the expenses of treating their own depression?

Everyone recognizes that the more fully we wish insurance companies to defray our out of pocket expenses for our car repairs, the higher the premium they will charge for the policy. Yet foregoing reimbursement for trivial or unnecessary health-care costs in return for a more suitable health-care policy is an option unavailable under the present system. Everyone with health insurance is compelled to protect himself from risks, such as alcoholism and erectile dysfunction, that he would willingly shoulder in exchange for a lower premium.

The idea that every life is infinitely precious and therefore everyone deserves the same kind of optimal medical care is a fine religious sentiment and moral ideal. As political and economic policy, it is vainglorious delusion. Rich and educated people not only receive better goods and services in all areas of life than do poor and uneducated people, they also tend to take better care of themselves and their possessions, which in turn leads to better health. The first requirement for better health care for all is not equal health care for everyone but educational and economic advancement for everyone.

Our national conversation about curbing the cost of health care is crippled by the vocabulary in which we conduct it. We must stop talking about "health care" as if it were some kind of collective public service, like fire protection, provided equally to everyone who needs it. No government can provide the same high quality body repair services to everyone. Not all doctors are equally good physicians, and not all sick persons are equally good patients.

If we persevere in our quixotic quest for a fetishized medical equality we will sacrifice personal freedom as its price. We will become the voluntary slaves of a "compassionate" government that will provide the same low quality health care to everyone.

Henry David Thoreau famously remarked, "If I knew for a certainty that a man was coming to my house with the conscious design of doing me good, I should run for my life." Thoreau feared a single, unarmed man approaching him with such a passion in his heart. Too many people now embrace the coercive apparatus of the modern state professing the same design.

Dr. Szasz is emeritus professor of psychiatry at Upstate Medical University in Syracuse, New York. He is author of "The Myth of Mental Illness," among other books (HarperCollins, 1961).
Title: "Optional"?!? Those lying SOBs
Post by: Crafty_Dog on July 16, 2009, 08:01:23 AM
A friend writes:

Here it is, Page 16 of the Health Care bill
"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law."
You leave a company with health care and go to a different company with a different carrier,  you are screwed.  You must go into the government plan. 
Start up your own company, you are forced into the government plan.
Obamism is alive and well

Here it is, Page 16 of the Health Care bill
"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law."
You leave a company with health care and go to a different company with a different carrier,  you are screwed.  You must go into the government plan. 
Start up your own company, you are forced into the government plan.
Obamism is alive and well


(a) Grandfathered Health Insurance Coverage Defined- Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term `grandfathered health insurance coverage' means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met:


(A) IN GENERAL- Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.

(B) DEPENDENT COVERAGE PERMITTED- Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day.

(2) LIMITATION ON CHANGES IN TERMS OR CONDITIONS- Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.

(3) RESTRICTIONS ON PREMIUM INCREASES- The issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner.

(b) Grace Period for Current Employment-based Health Plans-


(A) IN GENERAL- The Commissioner shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 101, including the essential benefit package requirement under section 121.

(B) EXCEPTION FOR LIMITED BENEFITS PLANS- Subparagraph (A) shall not apply to an employment-based health plan in which the coverage consists only of one or more of the following:

(i) Any coverage described in section 3001(a)(1)(B)(ii)(IV) of division B of the American Recovery and Reinvestment Act of 2009 (Public Law 111-5).

(ii) Excepted benefits (as defined in section 733(c) of the Employee Retirement Income Security Act of 1974), including coverage under a specified disease or illness policy described in paragraph (3)(A) of such section.

(iii) Such other limited benefits as the Commissioner may specify.

In no case shall an employment-based health plan in which the coverage consists only of one or more of the coverage or benefits described in clauses (i) through (iii) be treated as acceptable coverage under this division

(2) TRANSITIONAL TREATMENT AS ACCEPTABLE COVERAGE- During the grace period specified in paragraph (1)(A), an employment-based health plan that is described in such paragraph shall be treated as acceptable coverage under this division.

(c) Limitation on Individual Health Insurance Coverage-

(1) IN GENERAL- Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of Y1 as an Exchange-participating health benefits plan.

(2) SEPARATE, EXCEPTED COVERAGE PERMITTED- Excepted benefits (as defined in section 2791(c) of the Public Health Service Act ) are not included within the definition of health insurance coverage. Nothing in paragraph (1) shall prevent the offering, other than through the Health Insurance Exchange, of excepted benefits so long as it is offered and priced separately from health insurance coverage.
Title: Clearing it Right Up
Post by: Body-by-Guinness on July 16, 2009, 09:05:18 AM
Doug's chart explained:

Title: Re: The Politics of Health Care
Post by: Crafty_Dog on July 16, 2009, 10:41:41 AM
Title: Adding it Up
Post by: Body-by-Guinness on July 16, 2009, 11:33:57 AM
CBO Chief Criticizes Democrats' Health Reform Measures
Director Says Proposed Changes Would Weaken Economy
By Lori Montgomery
Washington Post Staff Writer
Thursday, July 16, 2009 1:51 PM

Instead of saving the federal government from fiscal catastrophe, the health reform measures being drafted by congressional Democrats would worsen an already bleak budget outlook, increasing deficit projections and driving the nation more deeply into debt, the director of the nonpartisan Congressional Budget Office said this morning.

Under questioning by members of the Senate Budget Committee, CBO director Douglas Elmendorf said bills crafted by House leaders and the Senate health committee do not propose "the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount."

"On the contrary," Elmendorf said, "the legislation significantly expands the federal responsibility for health-care costs."

Though President Obama and Democratic leaders have said repeatedly that reining in the skyrocketing growth in spending on government health programs such as Medicaid and Medicare is their top priority, the reform measures put forth so far would not fulfill their pledge to "bend the cost curve" downward, Elmendorf said. Instead, he said, "The curve is being raised."

The CBO is the official arbiter of the costs of legislation, and Elmendorf's stark testimony is certain to undermine support for the measures even as three House panels begin debate and aim to put a bill on the House floor before the August recess. Fiscal conservatives in the House, known as the Blue Dogs, were already threatening to block passage of legislation in the Energy and Commerce Committee, primarily due to concerns about the long-term costs of the House bill.

Cost is also a major issue in the Senate, where some moderate Democrats have joined Republicans in calling on Obama to drop his demand that both chambers approve a bill before the August recess. While the Senate health committee approved its bill on Wednesday with no Republican votes, members of the Senate Finance Committee were still struggling to craft a bipartisan measure that does more to restrain costs.

The chairman of the Senate Budget Committee, Kent Conrad (D-N.D.), has taken a leading role in that effort. This morning, after receiving Elmendorf's testimony on the nation's long-term budget outlook, Conrad turned immediately to questions about the emerging health care measures.

"I'm going to really put you on the spot," Conrad told Elmendorf. "From what you have seen from the products of the committees that have reported, do you see a successful effort being mounted to bend the long-term cost curve?"

Elmendorf responded: "No, Mr. Chairman."

Asked what provisions would be needed to slow the growth in federal health spending, Elmendorf urged lawmakers to end or limit the tax-free treatment of employer-provided health benefits, calling it a federal "subsidy" that encourages spending on ever more expensive health packages. Key senators, including Conrad, have been pressing to tax employer-provided benefits, but Senate leaders last week objected, saying the idea does not have enough support among Senate Democrats to win passage.

Elmendorf also suggested changing the way Medicare reimburses providers to create incentives for reducing costs.

"Certain reforms of that sort are included in some of the packages," Elmendorf said. "But the changes that we have looked at so far do not represent the sort of fundamental change, the order of magnitude that would be necessary to offset the direct increase in federal health costs that would result from the insurance coverage proposals."

Senate Majority Leader Harry M. Reid (Nev.) dismissed Elmendorf's push for the benefits tax. "What he should do is maybe run for Congress," Reid said.

But Senate Finance Chairman Max Baucus (D-Mont.) expressed frustration that the tax on employer-funded benefits had fallen out of favor, in part because the White House opposes the idea. Critics of the proposal say it would target police and firefighters who receive generous benefits packages. And if the tax is trimmed to apply only to upper income beneficiaries, it would lose its effectiveness as a cost-containment measure.

"Basically the president is not helping," Baucus said. "He does not want the exclusion, and that's making it difficult."

But he added, "We are clearly going to find ways to bend the cost curve in the right direction, including provisions that will actually lower the rate of increase in health care costs."

Ideas under consideration include health-care delivery system reform; health insurance market reform; and empowering an independent agency to set Medicare reimbursement rates, an idea the White House is shopping aggressively on Capitol Hill.

But Baucus is not giving up on the benefits tax. "It is not off the table, there's still a lot of interest in it," Baucus said.
Title: Penn & Stossel on Health Care
Post by: Body-by-Guinness on July 17, 2009, 10:17:48 AM
Some amusing takes on health care:

Title: Public Option Costs More
Post by: Body-by-Guinness on July 18, 2009, 10:01:37 AM

July 18, 2009 --
THE testimony by Congres sional Budget Office chief Douglas Elmendorf that the health-care legislation in Congress "significantly expands" costs shocked Capitol Hill. Yet the evidence shows that government-run care has always been more costly than private-sector care.

In claiming that the solution to skyrocketing health costs is more government-run care, President Obama has relied on a myth -- the belief that Medicare and Medicaid have restrained the growth in health expenses, relative to private care.

My new study, published by the Pacific Research Institute, shows that -- across four decades -- the costs of government-run health care have risen far more than the costs of private care.

My study compares the cost increases of Medicare and Medicaid with those of all other health care in the United States. The key finding: Since 1970, Medicare and Medicaid's costs have risen one-third more, per patient, than the combined costs of all other health care in America -- the vast majority of which is purchased privately.

Since 1970, Medicare and Medicaid's combined per-patient costs have risen from $344 to $8,955, while the combined per-patient costs of all other US health care have risen from $364 to $7,119.

Medicare and Medicaid used to cost $20 less per patient than other care. Now they cost $1,836 more. (And that's even without the Medicare prescription-drug benefit.)

In fact, if the costs of Medicare and Medicaid had risen only as much as the costs of all other health care in America, then, instead of costing a combined $807 billion last year, they would've cost a combined $606 billion. That savings of $201 billion would have amounted to more than $1,750 per American household last year alone.

These conclusions are true despite very generous treatment of Medicare and Medicaid. My analysis counts all Medicare prescription-drug expenditures as part of privately purchased care, rather than as part of Medicare. It doesn't adjust for billions of dollars in cost-shifting from Medicaid to the SCHIP program. And it counts health care purchased privately by Medicaid and Medicare patients (including Medicare co-payments and Medigap insurance) among the costs of private care, without counting those patients among the recipients of private care -- thereby magnifying private care's per-patient costs.

Despite such generous treatment, since 1970, Medicaid's per-patient costs have risen 35 percent more, and Medicare's 34 percent more, than all other health care in America.

President Obama says we must expand government-run health care to contain costs and that we don't have a minute to lose. But nearly 40 years of evidence shows that government-run care has succeeded only in raising costs.

During an economic downturn in which we are already running higher budget deficits than at the height of the Great Depression (even as a percentage of our gross domestic product), wishful thinking and empty rhetoric shouldn't be allowed to trump empirical evidence.

In truth, there's only one reliable pursuer of value in American health care: the American consumer. If Congress and the president are serious about improving our nation's health care, they should end the tax discrimination against the uninsured -- that is, allow others to purchase care with pre-tax dollars in the way that we now permit only for those with employer-provided insurance. They should promote a more vibrant private market with greater competition across state lines, greater consumer freedom and greater incentives for consumers to pursue value. These are the changes we need.

The empirical evidence is in, and the verdict could hardly be plainer: Government-run health care limits choice and is more expensive. Privately purchased care offers choice and is more affordable.

Only the federal government could struggle to choose between these two alternatives.

Jeffrey H. Anderson is a senior fellow in health-care studies at the Pacific Research Institute.
Title: Re: The Politics of Health Care
Post by: Crafty_Dog on July 18, 2009, 05:39:22 PM
Abridged version: (for full version see: )

What We Know That Ain't So

Will Rogers famously said, "It isn't what we don't know that gives us trouble, it's what we know that ain't so." So it is with the health care debate in this country. Quite a few "facts" offered to the public as truth are simply wrong and often intentionally misleading.

There are large groups of people in this country who want socialized medicine and they sense that the stars are aligning, and now is their time to succeed. They rarely call it socialized medicine, but instead "single payer health care" or "universal coverage" or something that their public relations people have told them sounds better. Whatever they call it, they believe (or pretend to believe) a lot of wrong-headed things, and they must be stopped. Step one is understanding how and why they are wrong. Step two is kicking their asses back to Cuba where they can get in line with Michael Moore and Al Gore for their free gastric bypasses.

Myth #1 Health Care Costs are Soaring

No, they are not. The amount we spend on health care has indeed risen, in absolute terms, after inflation, and as a percentage of our incomes and GDP. That does not mean costs are soaring.

You cannot judge the "cost" of something by simply what you spend. You must also judge what you get. I'm reasonably certain the cost of 1950's level health care has dropped in real terms over the last 60 years (and you can probably have a barber from the year 1500 bleed you for almost nothing nowadays). Of course, with 1950's health care, lots of things will kill you that 2009 health care could prevent.

In the case of health care, the fact that we spend so much more on it now is largely a positive. We spend so much more on health care, even relative to other advances, mostly because it is worth so much more to us.

In summary, if one more person cites soaring health care costs as an indictment of the free market, when it is in fact a staggering achievement of the free market, I'm going to rupture their appendix and send them to a queue in the UK to get it fixed.

Myth #2 The Canadian Drug Story

The general story is how you can buy many drugs in Canada cheaper than you can buy them in the US. This story is often, without specifically tying the logic together, taken as an obvious indictment of the US's (relatively) free market system. This is grossly misguided.

Here's what happens. We have a (relatively) free market in the US where drug companies spend a ton to develop new wonder drugs, a non-trivial amount of which is spent to satisfy regulatory requirements. The cost of this development is called a "fixed cost." Once it's developed it does not cost that much to make each pill. That's called a "variable cost." If people only paid the variable cost (or a bit more) for each pill the whole thing would not work. You see, the company would never get back the massive fixed cost of creating the drug in the first place, and so no company would try to develop one.

Drug companies that spent the enormous fixed costs to create new miracles are charging a relatively high cost in the free and still largely competitive world (the US) to recoup their fixed cost and to make a profit. But socialist societies like Canada limit the price they are allowed to charge. The US-based company is then faced with a dilemma. What Canada will pay is not enough to ever have justified creating the miracle pill. But, once created, perhaps Canada is paying more than the variable cost of each pill. Thus, the company can make some money by also selling to Canada at a lower price as it's still more than it costs them to make that last pill.

If we all tried to be Canada it's a non-working perpetual motion machine and no miracle pills ever get made because there will be nobody to pay the fixed costs.

Myth #3 Socialized Medicine Works In Some Places

This is a corollary to the "Canada as parasite" parable above. The funny part is socialized medicine has never been truly tested. Those touting socialism's success have never seen a world without a relatively (for now) free US to make their new drugs, surgical techniques, and other medical advancements for them.

To put it simply, right now the US's free system massively intellectually subsidizes the world's unfree (socialized) ones. That sucks. The only thing that would suck worse is joining them without anyone to subsidize us all.

Myth #4 A Public Option Can Co-Exist with a Private Option

Part of the current junta's plan is to add a "public option" for health insurance. That is health insurance provided by the government (actually provided by you and your neighbors). They claim this "public option" can co-exist fairly alongside private health insurance, increasing competition and keeping the private system "honest," and not deteriorate to a single payer (socialized medicine) system. They are wrong, or very dishonest, as in unguarded moments they admit that the single payer socialized system is what they really want.

By their logic the government must be a major player in every industry. Ah, just when you think you have them, you remember, they are socialists … dismantling liberty piece by piece.

The government does not co-exist or compete fairly with private enterprise. It does not play well with others. The regulator cannot be a competitor at the same time. Finally, it cannot be a fair competitor if when the "public option" screws up (can't pay its bills), the government implicitly or explicitly guarantees its debts.

Perhaps the best example of the destructive "public option" is our nation's schools. Here we clearly have a government provided "public option" competing with (and in fact dominating in size) private schooling. But, is it fair? Does it work well? Not by a long-shot.

With a "public option" things inevitably would go the horrific way of our public schools. It will be like looking in a funhouse mirror and seeing a doctor where you used to see a teacher.

Finally, let's worry a bit about the end game. We are not here yet, but in a world where the "public option" replaced all private options, would we still be allowed, if we had the resources, to pursue private medical alternatives? Some socialized countries say yes, some say no. Imagine the answer is no in this country, where freedom is valued more than anywhere else in the world. Imagine a person is to be prevented from spending their hard earned money on their or their children's health care, or a doctor was prevented from earning what he could in a parallel free system after all his training and work.

It takes literally seconds to realize that this "public option" cannot co-exist with liberty and thus will indeed lead to full-on socialization. Since the simplest answer is usually best, and the President has already declared his preference for a "single-payer" system, and since this "public option" leads there with near certainty, might I be forgiven for assuming he knows this and is lying, and has a socialized medicine end-game in mind?

Myth #5 We Can Have Health Care Without Rationing

Rationing has to occur. This sounds cold and cruel, but it is reality. If you have a material good or service, like health care, that is ever increasing in quality, and therefore cost, there is no way everyone on Earth can have the best at all times (actually the quality increases are not necessary for rationing to be needed, it just makes the example clearer). It's going to be rationed by some means. The alternatives come down to the marketplace or the government. To choose between those alternatives you judge on morality and efficacy.

It is an uncomfortable truth that tough choices will have to be made. There is no system that provides for unlimited wants with limited resources. Our choice is whether it should be rationed by free people making their own economic calculations or by a bureaucracy run by Congressional committee (whose members, like the Russian commissars, will, I guarantee you, still get the best health care the gulag hospitaligo can provide). Free people making their own choices only consume what they value above price, using funds they have earned or been given voluntarily. With socialized medicine health care is rationed by committees of politicians trying to get re-elected and increase their own power, and people consume as much of it as the commissars deem permissible. I do not find these tough alternatives to choose between.

Myth #6 Health Care is A Right

Nope, it's not.

This is more philosophy than economics, and I'm not a philosopher. But, luckily it doesn't take a superb philosopher to understand that health care simply is not a "right" in the sense we normally use that word. Listing rights generally involves enumerating things you may do without interference (the right to free speech) or may not be done to you without your permission (illegal search and seizure, loud boy-band music in public spaces). They are protections, not gifts of material goods. Material goods and services must be taken from others, or provided by their labor, so if you believe you have an absolute right to them, and others don't choose to provide it to you, you then have a "right" to steal from them. But what about their far more fundamental right not to be robbed?
So why do people scream health care is a "right" if it so obviously is not? If not a right it can still be willingly provided as charity by society.

So, Why Are These Crazy Things Believed (Or, Pretended to Be Believed)?

Lots of politicians understand that the simple free system leaves them out in the cold. No power for them. No committees to sit on to decide people's lives. No lies to tell their constituents how they (the government) brought them the health care they so desperately need. No fat checks from lobbyists as the crony capitalists pay dearly to make the only profits possible under this system, those bestowed by the government.

Finally, if the above is not enough, the rush to pass a huge expansion of government now, and limit debate and discussion, is indicative of a group that knows it is wrong, and if people have time to think they will refuse to go along, but is attempting an exercise of naked power, to impose dictatorship before the people wake up. Paraphrasing Mark Twain, a lie can travel halfway around the world while the truth puts on its shoes. They are counting on this, and they don't want to give the truth time to be shod.

And In Conclusion

We do not need a single payer (socialized medicine) system to cut confusion and inefficiency. On the contrary we need unfettered competition and clear legal standards. Another major concern is provision of basic healthcare to the needy. This is an important issue, but not an expensive one in the scheme of things, and not one that should drive the trillion-dollar healthcare debate. You do not reorganize the entire housing industry and tax policy around the need for homeless shelters, you just build enough shelters and let the market take care of, and discipline, the people who can pay for their own housing.
Finally there is the concern that healthcare costs make US workers too expensive to compete in global markets. As long as workers get full value for their healthcare dollars, it shouldn't matter whether companies pay in cash or in health benefits.
Title: Re: The Politics of Health Care
Post by: Body-by-Guinness on July 19, 2009, 09:46:00 AM
Reformers' Claims Just Don't Add Up
By INVESTOR'S BUSINESS DAILY | Posted Friday, July 17, 2009 4:20 PM PT

Health Reform: Many extravagant claims have been made on behalf of the various health care "reforms" now emerging from Congress and the White House. But on closer inspection, virtually all prove to be false.

Yet even as many Americans start to have second thoughts about our government's possible takeover of the health care system, Congress is rushing to make it happen.

On Friday, the House Ways and Means Committee approved a bill that would radically change our current system and expand coverage for the uninsured. The action came a day after the head of the Congressional Budget Office said none of the plans under review would slow health care spending. None of them.

Still, lawmakers and the White House press on, relying on GOP weakness in the House and a new veto-proof majority in the Senate. They're also relying on a lack of awareness that claims made on behalf of national health care may be mostly false. Among them:

• America has a health care crisis.

No, we don't. Forty-seven million people lack insurance. Of the remaining 85% of the population, or 258 million people, polls show high satisfaction with the current coverage. Indeed, a 2006 poll by ABC News, the Kaiser Family Foundation and USA Today found 89% of Americans were happy with their own health care.

As for the estimated 47 million not covered by health insurance, 20 million can afford to buy it, according to a study by former CBO Director June O'Neill. Most of the other 27 million are single and under 35, with as many as a third illegal aliens.

When it's all whittled down, as few as 12 million are unable to buy insurance — less than 4% of a population of 305 million. For this we need to nationalize 17% of our nation's $14 trillion economy and change the current care that 89% like?

• Health care reform will save money.

Few of the plans now coming out of Congress will save anything, says the CBO's current chief, Douglas Elmendorf. In fact, he says, they'll lead to substantially higher costs in the future — costs that will be "unsustainable."

As it is, estimates for reforming health care range from $1 trillion to $3.6 trillion. Much will be spent on subsidies to make a so-called public option more attractive to consumers than private plans.

To pay for it, the president has suggested about $600 billion in new taxes, meaning that $500 billion to $2.1 trillion in new health care spending over the next decade will be unfunded. This could push up the nation's already soaring deficit, expected to reach $10 trillion through 2019 without health care reform. Massive new tax hikes will probably be needed to close the gap.

• Only the rich will pay for reform.

The 5.4% surtax on millionaires the president is pushing gets all the attention, but everyone down to $280,000 in income will pay more. Doesn't that still leave out the middle class and poor? Sorry. Workers who decline to take part will pay a tax of up to 2% of earnings. And small-businesses must pony up 8% of their payrolls.

The poor and middle class must pay in other ways, without knowing it. The biggest hit will be on small businesses, which, due to new payroll taxes, will be less likely to hire workers. Today's 9.5% jobless rate may become a permanent feature of our economy — just as it is in Europe, where nationalized health care is common.

• Government-run health care produces better results.

The biggest potential lie of all. America has the best health care in the world, and most Americans know it. Yet we hear that many "go without care" while in nationalized systems it is "guaranteed."

U.S. life expectancy in 2006 was 78.1 years, ranking behind 30 other countries. So if our health care is so good, why don't we live as long as everyone else?

Three reasons. One, our homicide rate is two to three times higher than other countries. Two, because we drive so much, we have a higher fatality rate on our roads — 14.24 fatalities per 100,000 people vs. 6.19 in Germany, 7.4 in France and 9.25 in Canada. Three, Americans eat far more than those in other nations, contributing to higher levels of heart disease, diabetes and some cancers.

These are diseases of wealth, not the fault of the health care system. A study by Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa found that if you subtract our higher death rates from accidents and homicide, Americans actually live longer than people in other countries.

In countries with nationalized care, medical outcomes are often catastrophically worse. Take breast cancer. According to the Heritage Foundation, breast cancer mortality in Germany is 52% higher than in the U.S.; the U.K.'s rate is 88% higher. For prostate cancer, mortality is 604% higher in the U.K. and 457% higher in Norway. Colorectal cancer? Forty percent higher in the U.K.
But what about the health care paradise to our north? Americans have almost uniformly better outcomes and lower mortality rates than Canada, where breast cancer mortality is 9% higher, prostate cancer 184% higher and colon cancer 10% higher.

Then there are the waiting lists. With a population just under that of California, 830,000 Canadians are waiting to be admitted to a hospital or to get treatment. In England, the list is 1.8 million deep.

Universal health care, wrote Sally Pipes, president of the Pacific Research Institute in her excellent book, "Top Ten Myths Of American Health Care," will inevitably result in "higher taxes, forced premium payments, one-size-fits-all policies, long waiting lists, rationed care and limited access to cutting-edge medicine."

Before you sign up, you might want to check with people in countries that have the kind of system the White House and Congress have in mind. Recent polls show that more than 70% of Germans, Australians, Britons, Canadians and New Zealanders think their systems need "complete rebuilding" or "fundamental change."

• The poor lack care.

Many may lack insurance, but that doesn't mean they lack care. The law says anyone who walks into a hospital emergency room must be treated. America has 37 million people in poverty, but Medicaid covers 55 million — at a cost of $350 billion a year.

Moreover, as many as 11 million of the uninsured qualify for programs for the indigent, including Medicaid and SCHIP. But for some reason, they don't sign up. Are they likely to sign up for the "public option" when it's made available?
Title: Medical Travel Looms?
Post by: Body-by-Guinness on July 20, 2009, 11:02:38 AM
July 20, 2009
Welcome to Mexico, Gringos!

By James Lewis
I once had a minor medical procedure done in Mexico. The doc wanted to be paid in cash, and I obliged. Then I asked for a receipt. What followed was Keystone Cops. It took a while for me to realize I was being stupid. By asking for a receipt in the double economy of Mexico I was asking the doc to sign a confession to the tax police. He was right, I was wrong, and I learned something about the underground economy in socialized medicine.

Welcome to Mexico, friends, where the people are warm and wonderful, the drug gangs ruthless (but mostly gun for each other), and the medical profession is a sign of things to come in the US of A. Rich people get pretty good medical care in Mexico. Poor people? So-so to dreadful. Same thing in Italy, and most of the Left-dominated world. Want to get pretty good medical care in Russia? How many dollars you got?

The trouble with socialized medicine is that it corrupts the doctors. They start living a double life. So do the patients. And irony of ironies, it doesn't hurt the rich one little bit.

If ObamaCare is given the bum's rush through Congress in the next couple of weeks, first thing I'm going to do is check out medical travel.  Hong Kong has first-rate hospitals, inspected and rated by the British Health Authority. Israel has more qualified doctors per square inch than New York City. Taiwan, Singapore, the big cities in India, Thailand, the Philippines. Eastern Europe is heading that way. If they provide excellent care at lower cost than the US, it can only grow. Nobody in Congress has repealed the laws of supply and demand.

Want to build a great new business? Go into the medical travel game. Guarantee your clients only the best and most highly accredited doctors and hospitals in the world. Sell them medical and travel insurance. And tie it in with sunny retirement communities for Boomers. It will be a Gold Rush. 

Insurance companies can undersell any US government monopoly, just by sending their patients to high-quality hospitals abroad. The United States may lose General Motors, but we'll get International Blue Cross instead. And do you have any idea how much you can do diagnostically these days over the web? Your highly qualified offshore doc can just send you the testing kit, you send it back, and have long, cozy conversations over the free VoIP service. In five years we'll have EKGs plugged into your home computer to be read by Indian doctors in Hyderabad. Virtual microsurgery is in the cards. Computing is going to keep getting cheaper, the web will get faster and more interactive, and you'll be able to do some virtual medical travel without moving from home. Indian psychiatrists are so comforting, and they will talk with you for hours for $9.95, special rate just for you.

Obama and the Democrats will try to stop you -- but they will take advantage of medical travel themselves, of course.  The Left will raise your US taxes whether you use ObamaCare or not -- and no, the tax increases won't be limited to the upper five percent. Everybody will pay more, either in money or rationing of health care.

It will be a huge incentive for older Americans to retire abroad, and that could be a gigantic favor for developing countries. You can love this country from afar, and hope that when things get bad enough, some of the voters will wake up.  It could take a while if LeftiMed gets passed next week at some midnight session between Nancy and Harry Reid.

So when every American doctor's income is capped by price controls, when the paperwork is coming out of their ears, when their workload is up and their income is down --- just let them know you'll pay cash.

And don't ask for a receipt.

Hasta la vista, baby.

I'm off to Costa Rica!

Page Printed from: at July 20, 2009 - 01:53:49 PM EDT
Title: Re: The Politics of Health Care
Post by: ccp on July 21, 2009, 02:15:51 PM
The implication is that this is some sort of scandal.
600 million doses at a cost of 2.6 billion.  Isn't that cheap - ~$4 a dose.
What does it cost to drive the tunnel from NJ to NYC - 10 dollars for the port authority tax?  Ten dollars to drive into NYC???!!!
What is the tax on a single pack of cigarettes?
So why are the pharmaceutical companies not entitled to ~4 bucks for a squirt of influenza vaccine?

****Drug groups to reap swine-flu billions
By Andrew Jack in London

Published: July 20 2009 19:40 | Last updated: July 20 2009 23:43

Some of the world’s leading pharmaceutical companies are reaping billions of dollars in extra revenue amid global concern about the spread of swine flu.

Analysts expect to see a boost in sales from GlaxoSmithKline, Roche and Sanofi-Aventis when the companies report first-half earnings lifted by government contracts for flu vaccines and antiviral medicines.

In depth: Swine flu - Apr-28Health Blog: The advice about swine flu - Jul-21Date put on school swine flu decision - Jul-20WHO backlog hampers swine flu battle - Jul-21Swine flu warning to pregnant women - Jul-19UK braces for 100,000 swine flu cases a day - Jul-03The fresh sales – on top of strong results from Novartis of Switzerland and Baxter of the US, which both also produce vaccines – come as the latest tallies show that more than 740 people have died from the H1N1 virus, and millions have been affected around the world.

GlaxoSmithKline of the UK confirmed it had sold 150m doses of a pandemic flu vaccine – equivalent to its normal sales of seasonal flu vaccine – to countries including the UK, the US, France and Belgium, and was gearing up to boost production.

GSK also produces Relenza, an antiviral medicine that reduces the length and severity of the infection, and is preparing to increase manufacturing towards 60m annual doses. The UK placed an order for 10m treatments this year.

One beneficiary of the fears about the pandemic has been Roche of Switzerland, which sells Tamiflu, the leading antiviral drug, and has seen a sharp rise in orders from private companies as well as governments.

A report last week from JPMorgan, the investment bank, estimated that governments had ordered nearly 600m doses of pandemic vaccine and adjuvant – a chemical that boosts its efficacy – worth $4.3bn (€3bn, £2.6bn) in sales, and there was potential for 342m more doses worth $2.6bn.

It forecast that fresh antiviral sales could boost sales for GSK and Roche by another $1.8bn in the developed world, and potentially up to $1.2bn from the developing world.

But there were also uncertainties for the pharmaceutical manufacturers. With demand likely to outstrip supply, and initial production suggesting that the yield for the pandemic vaccine is relatively low, they may face difficult choices in determining how much to supply to the countries seeking orders.

They are also under pressure to provide more drugs and vaccines for free, or extremely cheaply, to the developing world.
Copyright The Financial Times Limited 2009

Title: Folly, Presumption, and Fancy
Post by: Body-by-Guinness on July 22, 2009, 06:11:41 AM
Arrogance. Its crazy for a group of mere mortals to try to design 15% of US economy [John Stossel]
Townhall | July 22, 2009 | John Stossel

It's crazy for a group of mere mortals to try to design 15 percent of the U.S. economy. It's even crazier to do it by August.

Yet that is what some members of Congress presume to do. They intend, as the New York Times puts it, "to reinvent the nation's health care system".

Let that sink