•
Hey, here’s a novel idea—I’ll get my own health insurance!
A new Gallup poll indicates that the majority of Americans might go for that idea:
In a recent Gallup survey, 89% of Republicans, 64% of independents, and 61% of Americans overall say Americans themselves — rather than the government — have the primary responsibility for ensuring that they have health insurance. Six in 10 Democrats say the government should be primarily responsible.
The real meaning of this poll? That the current debate over health care is an attempt to foist upon us something we don’t want. Who does want it? Six in 10 Democrats. That’s what this is all about, folks.
•
“Someday this country will have a health-care debate that’s not abject in its idiocy.” That is the prediction today in a Wall Street Journal piece by Holman W. Jenkins. Mr. Jenkins does not view our current debate as being of this order. He characterizes it this way:
President Barack Obama made a “public option” his centerpiece not because it’s the answer to what’s broken in the U.S. system, but because it’s a halfway house to a single-payer setup that liberal Democrats have always wanted. Team Obama also knew the public is concerned about rising costs, so they jammed together a hooey-filled argument that the public option was somehow the solution to rising costs.
The public is not as dumb as it’s made out to be, and Mr. Obama’s public option died a bipartisan death yesterday in the Senate Finance Committee. What’s left is a package of “reforms” that are mere trite extensions of what we’ve been doing for decades. That is, piling up mandates on private insurers and then lying that this somehow isn’t driving up the cost of health insurance; piling up subsidies for health consumption and then lying that this somehow isn’t responsible for runaway health-care spending.
Some of us fear that we won’t get to have the debate Mr. Jenkins heralds because the current plan will be rammed through Congress through a legislative process called reconciliation.
But what if we do have the real debate? What should we talk about in that debate? Holman says we should focus on “incentives” and “price-tags.” Jenkins notes:
Yes, the politics are difficult when it comes to restoring price tags. Voters would have to understand how a tax code that allowed them to choose for themselves how much of their incomes to devote to health care would serve their interests.
They would have to be persuaded of the benefits of a marketplace where insurers are free to design policies to appeal to different budgets and needs.
They might have to decide for themselves whether they have better uses for their income and savings than extending life at all cost.
In that sense, the jabbering on Capitol Hill is irrelevant to the central problem, wherein consumers see larger and larger chunks of their income mysteriously and involuntarily sucked into health care for questionable benefit.
A few brave legislators, including Democrat Ron Wyden, are willing to say as much. But as Max Baucus put it in an unguarded comment to the Washington Post: “Basically the president is not helping.”
Mr. Obama may be “not helping” because he doesn’t understand or believe in the role of absent price tags in creating our current woes. He may genuinely favor a system in which government decides who will receive what care.
•
President Barack Obama has made some attractive claims about what his health care reform would bring. But Sally Pipes, president & CEO of the Pacific Research Institute and author of The Top 10 Myths of American Health Care argues that the president’s reforms would cause just the opposite of his claims. “[Obama’s] marketing just doesn’t describe the product,” Pipes writes. Pipes debunks the all the major claims made by the president in his congressional speech.
For example:
Stability and security: Every Democratic plan would break this promise — and in multiple ways.
For starters, every bill would make everyone buy a plan that offers a government-designed benefits package. So, while they wouldn’t directly force people to shift plans, they’d force most employers to change what they offer their workers — and employer-provided coverage is the top way Americans get insurance.
Worse, the mandates would price many employers out of the insurance market — dumping their employees onto the government-provided backup, whether that’s the “public option” that liberals prefer or the “co-ops” being offered as a compromise. The Lewin Group has estimated that “reform” will push 119 million people out of their current coverage.
Pipes notes that the Democratic plans would raise money largely through looting GOP programs, including Medicare Advantage, which is popular with many older citizens. Medical Health Savings Accounts, which now meet the needs of a large segment of the population, would be severely curtailed.
And the biggest—er—misleader concerns insuring the uninsured:
[T]he bills don’t so much “cover” the rest of today’s uninsured as simply force them to buy a policy: Middle-class Americans would have to spend up to 12 percent of their income on insurance alone or face fines — that is, taxes — on penalty of jail.
If Pipes is right, the public is being treated to Orwellian debate of an issue that will affect each and every one of us. Her analysis is well worth reading. The conclusion:
“Everyone in this room knows what will happen if we do nothing,” [Obama] said in the speech before. “Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it most. And more will die as a result. We know these things to be true.”
In fact, this list of horrors is exactly what will happen if America is saddled with the plan Obama is pushing Congress to pass.
We’re talking big government shop of horrors.
•
We love you, Michael Moore! We especially love you because right after the Senate Finance Committee twice voted down the public option (government-run health plan) that is the lynchpin of Obamacare, you had this to say:
To the Democrats in Congress…find your spine. Read the polls. And see us coming.
Yes! Listen to the socialist film mogul! Ram through some socialized medicine, Dems!
As Hot Air’s Allahpundit writes:
Never mind the polls showing that the public’s already gagging on a watered-down bill; never mind the warnings from analysts across the spectrum that the GOP’s set for major gains in Congress next year thanks to the backlash over government expansion; never mind the fact that, against that backdrop, Blue Dogs aren’t about to fall on a grenade for Obama by agreeing to a public option, let alone single-payer, no matter how much of his own political capital the president might be willing to invest. In fact, at this point, it might be more than just the Blue Dogs who are ready to bail.
Needless to say, I encourage Obama to take his advice, thereby dooming the bill in Congress, confirming the worst fears of grassroots conservatives that the president’s a none-too-secret socialist, and making a Republican tidal wave next year pretty much a fait accompli….
Nonetheless, Sen. Tom Harkin, chairman of the Health, Education, Labor and Pensions Committee, is still insisting that the public option can garner 51 votes on the Senate floor–even though centrist Democrats and all Republicans (except maybe Olympia Snowe) have said they won’t support a bill containing that provision. Harkin is also counting on the presumably filibuster-proof 60-Democrat Senate majority that would allow the public option to slip into the bill by amendment on the Senate floor.
I don’t think the Blue Dogs are dumb enough to fall for the Harkin strategy myself–because it’s always a good idea to take off in the opposite direction from anything pushed by Michael Moore.
•
From the Dow Jones wire service today:
By a 15-8 vote, the [Senate] Finance panel rejected an amendment sponsored by Sen. Jay Rockefeller, D-W.Va., that would create a public health insurance option. Under Rockefeller’s amendment, a government-run plan would inherit Medicare’s network of doctors and hospitals and pay them based on Medicare payment rates for its first two years.
All Republicans on the panel voted against Rockefeller’s amendment, in addition to Senate Finance Chairman Max Baucus, D-Mont., and Sens. Bill Nelson, D-Fla., Kent Conrad, D-N.D., Blanche Lincoln, D-Ark., and Thomas Carper, D-Del.
***
Republicans lambasted the amendment as an attempt to expand the federal government’s reach and eliminate private insurers. A public plan would “crowd out” private insurers with artificially low prices, eventually forcing private insurers to absorb unpaid costs within the U.S. health system and charge their policyholders higher premiums.
“I think it is a slow-walk toward government-controlled, single-payer health care,” said Sen. Charles Grassley, R-Iowa.
***
Sen. Charles Schumer, D-N.Y., will offer another amendment Tuesday that would create a public health insurance option, but which would pay doctors and hospitals at negotiated rates, rather than Medicare rates. Many health-care providers complain that Medicare pays too little for procedures, physician and hospital visits, and equipment.
Schumer’s amendment is also expected to fail, but in prepared remarks, he indicated that he would offer it as an amendment when the full Senate considers health-care legislation.
Now let the fun begin. House Speaker Nancy Pelosi has said over and over that a healthcare bill without a public option won’t pass the House. That’s the ticket, Nancy!
•
First, Granny had to worry about having the plug pulled. But now her grandkids have to worry about a less lethal but nevertheless decidedly unpleasant intermediate fate: jail time.
Yes, meet another unfortunate aspect of Obamacare: a regulation that would send citizens who refuse, for whatever reasons, to buy health insurance to jail. Investors Business Daily has a word for this: tyranny.
Tyranny: What kind of country would imprison citizens who felt it was in their best interest not to purchase health care insurance? We may soon find out.
This is not an exaggeration. In response to a question about what would happen to citizens who don’t buy government-mandated health insurance, Republican Senator John Ensign received a handwritten note from the chief of staff of Congress’ Joint Committee on Taxation that set forth a scary policy: “Violators [of the mandatory buy or tax provision] could be charged with a misdemeanor and could face up to a year in jail or a $25,000 penalty, Barthold wrote on JCT letterhead,” Politico has reported.
There are so many parts of the Democratic proposals that go against the democratic grain, and this is one of them. And are the Democrats listening to our concerns? IBD sums it up:
The more the public knows about the proposed plans, the less it likes what Washington is offering. Yet the Democrats have become even more determined to get their legislation through.
In fact, it’s starting to appear as if the stronger the opposition becomes, the harder the Democrats work on their plans. It’s as if they are legislating out of spite against citizens who must be governed by a heavy hand because they don’t know what’s good for them.
But we’ve heard that before. Just last week, Energy Secretary Steven Chu likened Americans to “teenage kids” who “aren’t acting in a way that they should act” in regard to carbon emissions.
One has to wonder whom he wants to throw in prison.
•
Haste has always been the essence of the Democratic plans for health care “reform.” It’s almost as…they’re hiding something. Mark Hemingway notes today (as the public option is taken up on the Hill) that “it’s become obvious that Senate Democrats want to pass this bill in a hurry, and that hiding the contents from the American people is an instrumental part of their attempt to do so.”
Hemingway says that the Democrats have—er—mislead about the costs of the bill, your ability to keep your own health insurance, and promises better health care with fewer doctors (an inevitable result of Obamacare). These are a few of the reasons for the rush.
•
The Senate Finance Committee resumes work today on markups for its $900 million healthcare bill. Here’s one way the committee won’t be cutting health costs: medical malpractice reform. Reining in the tort industry, which makes thousands of lawyers and a few patients rich, could save $200 billion annually. But that’s not gonna happen, thanks to trial lawyers, who are major bankrollers of the Democratic Party.
Lawyer and Common Good chairman Philip K. Howard, writing in today’s Wall Street Journal, lists the rebuffs to tort reform that the President Obama and congressional Democrats have accumululated over the past two months:
• On July 31, Rep. Bart Gordon (D., Tenn.), a Blue Dog Democrat, introduced an amendment to the House health-care reform bill (H.R. 3200) to fund pilot projects for liability reform, including pilots for “voluntary alternative dispute resolution.”
What happened? According to the online newsletter Inside Health Policy, “While Gordon’s amendment originally had seven policies that states could implement in order to receive federal funding, the other five suggestions were crossed out . . . due to the agreement with the trial lawyers.”
• On Aug. 25, at a town-hall meeting in Reston, Va., Howard Dean, former chair of the Democratic National Committee, was asked why there is nothing in the health-care proposals about liability reform. Mr. Dean replied: “The reason that tort reform is not in the bill is because the people who wrote it did not want to take on the trial lawyers. . . . And that is the plain and simple truth.”
• On Sept. 9, President Obama made a commitment in a speech before Congress to fix the problem of defensive medicine. On Sept. 17, his secretary of Health and Human Services, Kathleen Sebelius, announced an initiative that will allow states to test a variety of programs to “put patient safety first and let doctors focus on practicing medicine.” But in the initiative’s statement of goals made no mention of defensive medicine, or of pilot projects such as special health courts. The funding for the initiative is a tiny $25 million. According to Katharine Seelye on the New York Times’s Prescriptions blog, “the comparatively small budget seems commensurate with the administration’s level of interest in the subject.”
Obama is on record as opposing limits to malpractice liability and its giant jury verdicts–even though 54 percent of all malpractice expenditures go to lawyers and administrators, not patients, according to a 2006 article in the New England Journal of Medicine. As John Edwards’s famous victories in cases involving babies born with cerebral palsy (about which prenatal and delivery care can’t do much about) indicate, medical malpractice is essentially a courtroom lottery in which most patients recover little or nothing but those who do win win big.
The effects on the practice of medicine are poisonous, however, as Howard writes:
One in 10 obstetricians have stopped delivering babies, unable to pay malpractice premiums on the order of $1,000 per baby, according to the American College of Obstetricians and Gynecologists (ACOG). Some hospitals, including Methodist Hospital and Chestnut Hill Hospital in Philadelphia, have stopped delivering babies altogether; and the number of unnecessary caesarian sections have increased to the detriment of the health of mothers, according to the ACOG.
But don’t look for reform from Democrats, who need those trial-lawyer dollars.
•
That’s the title of a must-read article in this month’s Atlantic by David Goldhill, CEO of the Game Show network. Goldhill’s father was an otherwise hale and still-working 83-year-old who walked into a hospital two years ago with pneumonia. He contracted a series of hospital-acquired infections and died five weeks later. The villains weren’t the competent, dedicated doctors and nurses who cared for Goldhill’s father. The villain was the healthcare system itself, in which most patients don’t pay for their care directly and thus cede control to bureaucrats when they get sick.
Goldhill is a self-described Democrat who supports healthcare reform, but after studying America’s healthcare sector for two years after his father’s death, he came to realize that the usual Democratic solutions (exemplified in the pending bloated congressional bills), involving massive expansion of a more heavily regulated insurance system with its high costs and enormous inefficiencies are all wrong. Goldhill believes that if patients paid most of their own bills, with insurance reserved for catastrophic medical events, the resulting market competition would encourage cheaper and higher-quality care. He writes:
Indeed, I suspect that our collective search for villains—for someone to blame—has distracted us and our political leaders from addressing the fundamental causes of our nation’s health-care crisis. All of the actors in health care—from doctors to insurers to pharmaceutical companies—work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate ensurer of value.
Medical blogger Ultrabrown calls Goldhill’s article a “fascinating read”:
The nut of the article is that we think insurance is free only because it’s pre-deducted from our paychecks and depresses our wages. We’re actually paying for a massive insurance bureaucracy, and removing our names from the checks hospitals see distorts the price and quality signals in a free market. Variable pricing is rampant; bills are inflated up to ten times what insurance companies actually pay. Many hospitals will refuse to even quote a price for a procedure because they want to avoid price comparisons and their real customers are insurers rathe than individuals.
Goldhill argues that insurance ought to handle catastrophic events only, the same way we buy auto or house insurance. Ongoing medical costs should be paid out-of-pocket in a transparent fashion. Laser eye surgery, an elective procedure usually paid out-of-pocket, has fallen in price by 80% over the last few years; the same would happen if you were paying directly rather than through a middleman and could transparently compare cost and quality.
Economist David Henderson calls Goldhill’s piece a “stemwinder” and offers these excerpts:
To achieve maximum coverage at acceptable cost with acceptable quality, health care will need to become subject to the same forces that have boosted efficiency and value throughout the economy. We will need to reduce, rather than expand, the role of insurance;
For fun, let’s imagine confiscating all the profits of all the famously greedy health-insurance companies. That would pay for four days of health care for all Americans. Let’s add in the profits of the 10 biggest rapacious U.S. drug companies. Another 7 days.
If seniors were the true customers, they would likely flock to geriatricians, bidding up their rates–and sending a useful signal to medical-school students. But Medicare is the real customer, and it pays more to specialists in established fields.
Health care is an exceptionally heavily regulated industry. Health-insurance companies are regulated by states, which limits interstate competition. And many of the materials, machines, and even software programs used by health-care facilities must be licensed by state or federal authorities, or approved for use by Medicare; these requirements form large barriers to entry for both new facilities and new vendors that could equip and supply them.
Better information technology would have improved my father’s experience in the ICU–and possibly his chances of survival. But my father was not the customer; Medicare was.
The finder’s fee here goes to Michael F. Cannon, health policy analyst for the Cato Institute. If you’re in Washington on Thursday, Cato will be hosting a discussion with Goldhill in room B-340 of the Rayburn House Office Building at noon. Here’s where to register.
•
If you have a son or daughter ready to graduate from college and enter the workforce, you might see them facing a heavy financial burden that previous generations haven’t faced. This obligation, not incurred by them, will limit their professional choices and take money from them that they might prefer to allocate in other ways (savings accounts, for example, if they are thrifty).
Healthy young people could be forced by law to buy health insurance. But they might need health care, you say. Unfortunately, this legally enforceable requirement would not be to benefit them.
The premiums they will be required to pay will go to support an onerous, heavily government-regulated (if not actually run) system that is not designed to help those who will be required to assume the cost. It will be the only way to pay for the government’s mandate that pre-existing conditions can’t be a factor in the insurance market.
What this really amounts to, as explained in the Wall Street Journal today, is a gigantic wealth transference:
But the combination of a guaranteed issue, community rating and an individual mandate means that younger, healthier, lower-income earners would be forced to subsidize older, sicker, higher-income earners. And because these subsidies are buried within health-insurance premiums, the massive income redistribution is hidden from public view and not debated.
If Congress goes down this road, health insurance premiums will increase dramatically for the overwhelming majority of people. Even if Congress mandates that everyone have health insurance, many will choose to go without and pay the tax penalty. If you think people are dissatisfied with health care now, wait until they understand that Congress voted to mandate hidden premium increases and lower wages.
There are wiser and more equitable ways to ensure that every American has access to affordable health insurance. Policy experts and state policy makers have experimented with different solutions, including high risk pools and taxpayer-funded vouchers subsidized for those who are both poor and sick. Medicaid, charity care, and uncompensated care provided by hospitals cover some of these costs today.
I must say, if I were a parent—or more to the point, a young person just entering the post-graduate world of work and family—I would not be pleased.
