Wrong RX: Dr. Obama doesn't know what he's talking about

Another Obama policy that reveals him as an empty vessel without a single orginal idea in his head

Barack Obama's presidential campaign is supposed to represent a new politics that transcends traditional partisanship, open to new ideas from all sides, and leavened with optimism. But if Obama's new health-care plan is an example of this new politics, give me old fashioned partisan bickering and gridlock anytime.

That plan, unveiled Monday in Des Moines, is a dog's breakfast of bad ideas from Left, Right, and center, topped with an unhealthy amount of wishful thinking. If enacted it would cost Americans dearly - in higher taxes, lost jobs, reduced freedom of choice, and lower quality health care.

From the Left, along with the usual mishmash of increased subsidies, Obama, has taken the idea of an employer mandate. Obama would establish a "play or pay" system under which employers would be required to provide their workers with health insurance or pay a payroll tax to fund government-provided insurance. There are two big problems with this approach. First, it flies in the face of basic economics. The amount of compensation a worker receives is a function of his productivity, and an employer is indifferent as to whether that compensation is in the form of wages, taxes, health insurance, or other benefits. Such a mandate simply increases the cost of hiring workers without increasing their productivity. Employers will therefore have to find ways to offset the added costs. This they can do by raising prices, lowering wages or reducing future wage increases, reducing other benefits such as pensions, or hiring fewer workers. Almost certainly, employees will be the net losers under such a mandate, with the low-skilled suffering most.

Second, an employer mandate locks us further into an employment-based health insurance system at a time when there is a growing bipartisan consensus that we should be moving in the opposite direction. There is no logical reason for tying health insurance to employment. There are many good reasons for not doing so.

At the same time, he looks right to call for a Massachusetts-style insurance "connector," an idea being promoted by the Heritage Foundation among others. (Obama calls it "an exchange.") The exchange would allow workers to purchase individual health insurance with pre-tax dollars, leveling the playing field for individual insurance and giving workers the chance to buy personal and portable insurance - a good idea. The problem is that "exchanges" are also regulatory bodies. Indeed, Obama wants the "exchange" to regulate all sorts of things, including minimum benefit packages, premium caps, limits on copayments and deductibles, and "standards of quality and efficiency."

Like Hillary Clinton, who announced part of her health-care plan last week, Obama would require insurers to cover everyone regardless of their health status and charge community-rated premiums. One goal of health-care reform should be to encourage people to enter the insurance pool while they are young and healthy. We can do this by making insurance inexpensive for them, and penalizing them if they wait to buy insurance when they are old and sick. Community rating and guaranteed issue does precisely the opposite, raising the cost of insurance for the young and healthy and removing any penalty for waiting. Inevitably, this means more young healthy people will make the rational choice to go without insurance. Hillary Clinton (and former Massachusetts Governor Mitt Romney, for that matter) dealt with this by mandating that everyone buy insurance. Obama seems unaware of the problem he is creating.

Finally, there is the question of how to pay for all this. Obama does not put a price tag on his plan, but there is no doubt it will be expensive. Indeed, it will almost certainly be far more expensive than he assumes, since his ideas for cost savings are mostly figments of his imagination. For example, Obama assumes that allowing the federal government to directly negotiate Medicare drug prices will yield substantial savings. But the Congressional Budget Office has said that private insurance plans have already reduced drug prices about as far as they can go, and unless the government is prepared to severely restrict drug formularies, denying seniors access to some drugs, further savings are unlikely.

And Obama, like everyone else from Newt Gingrich to Hillary Clinton, assumes that there will be enormous savings from having the government design a system for electronic medical records. Electronic medical records would undoubtedly be a good thing and would reduce both costs and medical errors. The private sector is already moving rapidly in that direction. But the federal government has not yet figured out how to get the FBI's computers to talk to each other. What makes anyone think that a single federally-imposed medical IT system will be more efficient? [And Britain has already spent 12 billion pounds on attempting to implement such a system -- and seems unlikely ever to get it to work. See here]

So far three Democrats (Obama, Hillary Clinton, and John Edwards) and one Republican, (Mitt Romney) have put forward plans for health-care reform. For supporters of free market health care, it is looking like a very long and disappointing campaign.

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Another gross bungle in a Melbourne public hospital



In the photo above the former patient is holding the plum stone the careless public hospital doctors could not see -- plus the X-rays they could not see either

A PROFESSIONAL opera singer performed eight shows with a plum stone stuck in her throat after doctors failed to see it in an X-ray, even though it was "clearly visible". Soprano Tania de Jong could not eat solid food for six days after the emergency department bungle. The Alfred hospital later admitted it had misread the X-ray and vowed to review its procedures.

"I underwent the most excruciating pain," Ms de Jong said. "It felt like I was being strangled. "The stone was sitting between my mouth and vocal cords, and it really hurt to do anything - eat, drink, sing."

After the April 2005 debacle, Ms de Jong was forced on to a diet of baby food, painkillers and anaesthetic sprays for a week until she sought advice from a different hospital. X-rays revealed the object in her badly swollen oesophagus, and the stone was removed in an urgent operation.

The Herald Sun has seen letters in which the Alfred admitted its mistake and agreed to reimburse Ms de Jong's medical expenses on condition the law graduate did not sue. The hospital's emergency department head, Prof Mark Fitzgerald, wrote in an email sent in May 2005 that the stone was "clearly visible" and "should not have been missed". On July 7, the hospital apologised to her in writing, saying it would introduce a system of "double checking" X-rays.

Ms de Jong is satisfied the hospital has reviewed its systems. The accomplished performer founded singing group Pot-Pourri and runs entertainment consultancy Music Theatre Australia. "It could have been life-threatening, and with me being an opera singer it could have affected my whole livelihood," she said. "I was told I may never sing again because they'd have to stretch my vocal cords so much to get it out. "It was very, very frightening."

Her story follows the Herald Sun's report this week about nurse Bernadette Ireland, who says the Alfred sent her packing after she swallowed part of a mussel shell. Prof Fitzgerald last night said such cases were common. "Often the symptoms resolve and then people aren't sure whether they still have something in their throat or whether it's a scratch on the surface of the oesophagus that's caused in the passage of the object," he said. Some objects did not show up clearly on X-rays and it was easy to overlook them because of "variation in light and shade". He said he was still investigating the case of Ms Ireland, who had not lodged a formal complaint with the hospital.

Health Minister Bronwyn Pike said yesterday an Australian Institute of Health and Welfare report showed Victoria's emergency departments were the nation's best. Half of all patients were seen by a doctor five minutes faster than the national average. [So the other half weren't! Meaning no overall difference!]

But Opposition health spokeswoman Helen Shardey said the same report revealed median elective surgery waiting times had increased by four days - more than for any other state.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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