Tag Archives: Health Care

Pelosicare Would Vastly Expand Government, Penalize Millions

Posted on by
Reply

housecoveragecms_thumb copyGWB advisor Keith Hennessey drills down into the report of the Chief Actuary of the federal Centers for Medicaid & Medicare Services (CMS) to describe the effects of the health care “reform” bill passed by the House.  In 2019:

  • The bill would mean almost 30 M new people in government-run insurance, more than four times as many as would be newly insured through private coverage.
  • By far the largest effect of the bill would be to enroll more than 23 M new people in two existing government programs, Medicaid and S-CHIP. Medicaid is today widely regarded as fiscally unsustainable before adding more people.
  • Foster estimates that 18 M people would remain uninsured and have to pay the penalty tax. These people are clearly worse off than they would be under current law.

Emphasis added.  Sounds like a pretty huge cost to pay while not achieving universal coverage.

Hat tip: Mankiw — yeah, like he needs traffic from me 🙂

“Every Republican in Congress Supports Reform” is a Stronger Message Than “No”

Posted on by
1

Mitch McConnellI usually have little patience for people on either the right or the left who claim that only the other side plays politics, or only the other side has this attribute or that one.  (Earth to fellow conservatives:  Ann Coulter is every bit as much of a self-caricature as Michael Moore or Senator Unfunny Franken.  Maybe more so.)

But sometimes it seems like only the Democrats know how to win an argument by framing the issue strategically.  For example, there is no controversy about the established historical fact that Saddam Hussein actually used weapons of mass destruction (chemical weapons) not just against the Iranians in the Iran-Iraq War, but also against his own Kurdish citizens in Halabja.  I can’t help thinking that the Bush Administration would have enjoyed more support for the Iraq War if Bush and every senior Republican had insisted, in every interview and public statement from 2003 through 2006, that the only proper way to frame the debate was to consider whether Saddam still had WMD.

But I digress.  (Even before I get started!)

Senate Minority Leader Mitch McConnell — who has always struck me as a fairly reasonable guy, at least by the standards of partisan Congressional leaders — today calls out the other side for dishonest framing of the healthcare debate, in a USA Today op-ed (emphasis added):

Listening to [Congressional Democratic leaders], you would think Republicans haven’t been part of the health care debate at all. I understand the tactic. It’s an old political trick to accuse one’s opponents of being against something very worthwhile when what they’re really against are the specifics that you’re proposing.

In this debate, though, proponents of the administration’s health care plan have turned this old strategy into something of an Olympic sport.

The simple fact is, every Republican in Congress supports reform.

Health care costs are too high, and too many Americans lack health insurance. I have said so in just about every one of those 50 speeches and in dozens of interviews. And every other Senate Republican is on record favoring common-sense reforms for a system that needs them — ideas such as medical liability reform and equalizing the tax treatment for businesses and individuals who buy insurance.

Republicans are also on record about what we don’t favor, and that’s a 1,500-page bill that includes a lot of things Americans didn’t ask for and very little of what they did.

An intellectual case can be made that conserve-atives should proudly embrace the Democrats’ derisive description of the GOP as “the party of no.”  (Bill Buckley standing athwart history yelling Stop, and all that.)  But “no” is intrinsically… well… negative.  I fear the Republicans may have lost the healthcare battle simply by letting the issue be framed, improperly, as healthcare “reform.”

Huck_Finn_Travelling_by_RailRather than let themselves be tarred as the enemies of reform, the Republicans should propose a different enemy, and McConnell hints at it above when he uses the term “medical liability reform.”  The more precise term is “tort reform,” and the “enemy” is John Edwards and every other legal charlatan who has ever struck it rich by repeatedly rolling the dice in hopes of getting a third of an unjust award from an inflamed jury.

Oh, and the reference above to “tarred”?  That comes from the Early American practice of tarring and feathering.  No, dammit, it’s not racial code — and opposing the President’s proposal is not racism just because the President is black.

Clintonite Matt Miller Makes the Case Against the Public Option

Posted on by
3

matt millerMatt Miller is the host of my favorite treadmill companion, KCRW’s weekly podcast “Left, Right and Center.”  The four (sic) participants might more accurately be described as “Left, Left, Left and Right,” since Miller, who represents the nominal Center, is a former Clinton White House aide — although I’ll concede he’s more of a centrist than Arianna Huffington and Bob Scheer.  But I digress.

Miller is out today with a sensible op-ed titled “Why Liberals Should Drop the Public Option” in the Washington Post.  He argues that universal coverage can best be achieved by market-based means — pointing to Switzerland and the Netherlands as models, rather than “fully socialized systems, such as those in Britain and Canada.”

I respect those in my party who seek the single-payer system into which the public option might eventually evolve. But I don’t agree that it’s the best answer for the United States. Though single payer has merits, especially in administrative efficiency, it is also likely to freeze in place our fragmented, uncoordinated system of fee-for-service care. It would encourage providers to goose volume (to boost their incomes) rather than improve quality and would offer greater rewards for providers of acute care when we need a fresh focus on chronic disease management. Single payer also asks government to do things I don’t think it is competent to do, such as setting prices across a large swath of the health sector in ways that seem certain to create damaging rigidities or resource misallocations (as happens in Medicare).

Finally, if government is the sole payer, provider payments will become even more politicized than they are today. On the eve of beneficial innovations in drug therapies, devices and cost-effective ways to deliver better care, it is ill-advised to make the government’s hand too rigid. Private health plans have many flaws, to be sure, but if sensibly regulated they’re likely to respond more nimbly to disperse medical innovations.

Liberals should make peace with the notion that a regulated market of competing private health plans can be the vehicle for getting everyone covered.

This argument resonates for me — even though in a single paragraph (see boldfacing), Miller opines that single-payer would be more efficient, then notes that Medicare (a limited single-payer system) causes resource misallocations.

No system will be perfect, but to me it’s axiomatic that competing, regulated insurers will be more responsive to change and innovation than a government bureaucracy.

BTW, I found Miller’s column via “The Slatest,” Slate‘s new thrice-daily compilation of the hottest stories in the current news cycle.  My politics have moved to the right since 1998, when I (and perhaps a few dozen other people) shelled out $19.95 for a year’s subscription to Slate, but I still give them props for online innovation.  I also like their weekly political podcast, “The Gabfest” — even though it could be described as Left, Left and Left.

http://www.kcrw.com/news/programs/lr

The Perverse Incentives of Our Health-Care System

Posted on by
6

healthcare costsAn article in the September Atlantic does the best job I have ever seen of describing why health care is so resistant to cost-control efforts.  At 11,000 words, “How American Health Care Killed My Father” is not a quick read, but it’s not a dry policy treatise by any means.  (Hat tip: TigerHawk.)

When David Goldhill’s father died from an infection he contracted in the hospital, Goldhill went looking for someone to blame.

But my dad’s doctors weren’t incompetent—on the contrary, his hospital physicians were smart, thoughtful, and hard-working. Nor is he dead because of indifferent nursing—without exception, his nurses were dedicated and compassionate. Nor from financial limitations—he was a Medicare patient, and the issue of expense was never once raised. There were no greedy pharmaceutical companies, evil health insurers, or other popular villains in his particular tragedy.

As a business executive, Goldhill is no enemy of capitalism or market-based systems.  As a self-identified Democrat, he is no enemy of government.  And while he may have started his year-long research effort in anger over his father’s premature death, he has produced an absorbing essay that is remarkably measured and clear-eyed. Anyone of any political stripe who cares about America’s health-care system would benefit from reading it.

Some excerpts, with emphasis added:

But health insurance is different from every other type of insurance. Health insurance is the primary payment mechanism not just for expenses that are unexpected and large, but for nearly all health-care expenses. We’ve become so used to health insurance that we don’t realize how absurd that is. We can’t imagine paying for gas with our auto-insurance policy, or for our electric bills with our homeowners insurance, but we all assume that our regular checkups and dental cleanings will be covered at least partially by insurance.

…

Insurance is probably the most complex, costly, and distortional method of financing any activity; that’s why it is otherwise used to fund only rare, unexpected, and large costs. Imagine sending your weekly grocery bill to an insurance clerk for review, and having the grocer reimbursed by the insurer to whom you’ve paid your share. An expensive and wasteful absurdity, no?

Is this really a big problem for our health-care system? Well, for every two doctors in the U.S., there is now one health-insurance employee—more than 470,000 in total. In 2006, it cost almost $500 per person just to administer health insurance. Much of this enormous cost would simply disappear if we paid routine and predictable health-care expenditures the way we pay for everything else—by ourselves.

…

The unfortunate fact is, health-care demand has no natural limit. Our society will always keep creating new treatments to cure previously incurable problems. Some of these will save lives or add productive years to them; many will simply make us more comfortable. That’s all to the good. But the cost of this comfort, and whether it’s really worthwhile, is never calculated—by anyone. For almost all our health-care needs, the current system allows us as consumers to ask providers, “What’s my share?” instead of “How much does this cost?”—a question we ask before buying any other good or service. And the subtle difference between those two questions is costing us all a fortune.

…

How would the health-care reform that’s now taking shape solve these core problems? The Obama administration and Congress are still working out the details, but it looks like this generation of “comprehensive” reform will not address the underlying issues, any more than previous efforts did. Instead it will put yet more patches on the walls of an edifice that is fundamentally unsound—and then build that edifice higher.

You get the idea.  Read the whole thing.

(Illustration from The Atlantic.)

Is Pro-Obama News Coverage Hurting ObamaCare?

Posted on by
3

At Commentary Magazine‘s Contentions blog, Jennifer Rubin argues that the news media has done Obama a disservice by not being more skeptical on health care:

140px-CaduceusMoreover, while the press often has acted as an early-warning sign for troubled presidential initiatives, the press corp did not perk up until the public was in open rebellion. Only the most tepid questions were raised, and few hard questions about rationing and costs were posed before August. As a result, the White House was largely caught unprepared for the storm of anger and protest that greeted congressional Democrats this month.

She then provides the most succinct explanation I’ve seen of the reasons why ObamaCare is foundering (although “threatening to consume the presidency” is a little over the top):

slow_d16None of this is to diminish the responsibility that the president and his advisers bear for the debacle now threatening to consume the presidency. They made the decision to delegate draftsmanship to Congress. They decided to reinvent a health-care system that serves a large majority of Americans very well. They chose to conceal the costs of their plan until the CBO blew the whistle. And Obama personally and repeatedly spun nonsense (e.g., red/blue pills, bending the cost curve by spending more money, a guarantee that Americans could keep their plan while pushing a government option that would chase private insurers from the market). So the fault is the president’s. But his devoted fans in the media certainly helped.

The thing I find most appalling is that the administration was intent on passing health care “reform” before the August Congressional recess… even while taking a hands-off attitude toward what should actually be in the legislation.  Watching Congress pass the porkulus bill without even reading it made people nervous, but hey, the whole idea was to throw money at the economy as quickly as possible.  (Ooops, they didn’t achieve even that.)  Now that the focus has moved on to health care — which people passionately care about — the public appetite for radical change at breakneck speed has evaporated.

Hitler Comparisons are Odious, Whether About Obama or Bush

Posted on by

bushitler2You may have seen and applauded the YouTube video of Barney Frank’s verbal smackdown of a twit who accused him at a town hall of backing Obama’s “Nazi” healthcare plan.  I agree that Frank’s righteous put-down was well-executed, but I have to protest the notion that anti-Obama rhetoric represents a recent coarsening of the public discourse.

Bush=Hitler comparisons were common throughout Bush’s tenure.  They got little exposure in the mainstream media — journalists recognized that the Bushitler loonies undermined more serious criticisms of Bush.  But Zombietime spent years collecting photos — the two here are chosen from hundreds on his site.

Interestingly, the young moron in Barney Frank’s audience turns out to be a member of the LaRouche cult.

bushitler4Lyndon LaRouche doesn’t operate on the same political spectrum as most Americans, but he is a seven-time candidate for the Democratic presidential nomination, and LaRouchians say ObamaCare is a “Nazi” policy because it does not include complete socialization of healthcare through a single-payer structure.

In other words, the video shows Barney Frank taking fire from his left.

My point here is not to say “the Left brought this on themselves” with eight years of Bush Derangement Syndrome.  My point is that the flamethrowers on both sides of the aisle do a disservice to their own cause by distracting from more worthy arguments. Also: comparisons with Hitler should be reserved for people with eight-figure death tolls.

At least when the extremist is a protester, it’s relatively easy to shrug it off.  It’s a little bit harder when the inflamed rhetoric comes from the Senate Majority Leader.

Update: GayPatriotWest, who is not a Barney Frank fan, has some parallel thoughts.

Senator Reid’s Odd Notion of Evil

Posted on by
1

harry-reid“Evil” is a central concept for me.  I named my blog about the need to fight evil.  Two presidents in my lifetime have issued clarion calls about evil, and I think history may well ratify Bush’s usage as it already has ratified Reagan’s.

If “evil” is to mean anything, it must be reserved for the worst of the worst.  So let’s take an inventory of evil:

  • Stalin and his legacy? Check.
  • Saddam Hussein? Check.
  • Iran and North Korea, the other members of the Axis of Evil? Check, check.
  • People with opposing viewpoints on health care policy? Umm….

In yesterday’s Wall Street Journal, William McGurn reviews the grief that Reagan and Bush both caught for calling evil by its name, then writes:

With all this history, you would think Harry Reid (D., Nev.) had ample warning. Nevertheless, the Senate majority leader invoked the e-word himself last week at an energy conference in Las Vegas, where he accused those protesting President Barack Obama’s health-care proposals of being “evil mongers.” So proud was he of this contribution to the American political lexicon that he repeated it to a reporter the next day and noted the phrase was “an original.”

This is the same Senator Reid who openly rooted against his own country in 2007 by declaring that “this war is lost, and the surge is not accomplishing anything.”  People in high leadership positions should not indulge in partisan flame-throwing about critical issues.  Reid’s rhetoric is disgraceful.

A Center-Right Nation Balks at Obamacare

Posted on by
Reply

Newsweek-ConservativeOn the eve of the election last fall, Editor Jon Meacham wrote a cover story for Newsweek titled “America the Conservative — How a President Obama Might Govern a Center-Right Nation.” Predictably, he caught a lot of partisan grief for it, with one commentator calling him “conservative dittohead Jon Meacham” — an odd comment about the editor of one of America’s most resolutely pro-Obama publications.

The center-right label seemed right to me at the time, even though it was clear that Obama was about to win the election.  Obama’s movement toward the right, both before and after the election, has been a recurring theme on this blog.

Now comes Gallup with a poll that seems to indicate that America is not just center-right as a whole, but pervasively throughout the country.

We all know that some states are more conservative than others, and the Gallup poll supports this.  But the poll also found that self-identified conservatives outnumbered self-identified liberals in every single state.  In three states (Hawaii, Vermont and Massachusetts), the conservative margin was small enough to be statistically insignificant — but only in the District of Columbia were liberals found to outnumber conservatives.  The map below shows the relative conservative strength in each state, and as you’d expect, the most conservative states are clustered in the South and the non-coastal West.

2009 -08-04-consumer-confidence-better

How then does it occur that Democrats control not just the White House and both houses of Congress, but also a majority of the governorships and state legislatures?

Partly it reflects the fact that Republican does not equal conservative, and Democrat does not equal liberal.  But I also think the poll results may be skewed because of a difference of acceptance level of the terms liberal and conservative.   I have no data to support this, but it seems like the word “liberal” has become tainted in the minds of many people in a way that “conservative” has not. Some liberals choose to call themselves “progressive” to avoid the taint, while there is no similarly popular synonym for conservative.  If I’m right about this, people who are somewhat left of center would be more likely to call themselves “moderate,” while people the same distance to the right of center would be more willing to cop to being conservative.

Reeling this all back into the policy realm, I think this center-right orientation explains why Obama and the Democrats are having trouble selling health care “reform” — which, as Melissa Clothier points out, would more accurately be described as health care “transformation.”

The Democrats managed to ram through a porkulus bill that included hundreds of billions dollars of non-stimulative long-term spending on Democratic priorities because the country was perceived to be in an economic crisis — something had to be done now now now now now.  Certainly some people across the spectrum were concerned about committing to so much spending, but hey, deficit spending is just politics as usual.

The proposed health care transformation is different.  Certainly our health care system is not perfect, but most Americans see that it functions pretty well in their personal experience, however much they may grumble about costs.  Despite Obama’s disingenuous talk about having the insurance companies “compete” with a “public option” backed by the vast resources and regulatory clout of the government, most people recognize that no such competition is sustainable.

With a public option, the corporations who currently fund health insurance for their employees will have two choices — they can continue to negotiate with insurance companies to try to get the best deal for themselves and their employees, or they can get out of the middle, stop bothering with insurance companies and just dump all their employees into the public “option.” Hmmm… decisions, decisions.

slow_d16People intuitively understand that the “public option” is a first step toward a single-payer world in which the government directly controls one-sixth of the economy, and has no competitive incentive to reduce costs and improve service. Some on the Right refer to this as “postalizing health care,”  although that’s not really fair.  Thanks to Fedex, UPS, email and the telephone, the post office has a lot more competition than a single-payer health care system would have.

Maybe single-payer is the way to go.  I don’t think so, but let’s have that debate.  But let’s stop pretending that it’s not the direction the Left intends to head.