Sunday, July 01, 2007

Socialized Medicine Showdown

It's time for some GOP spine on health care

While most of Congress scrapped over immigration this week, a small band of Republicans doggedly toiled behind the scenes on quite a different subject. National Economic Council Director Al Hubbard and health secretary Mike Leavitt shuttled to and from the Hill; Senators hashed out the topic at a steering committee lunch; congressmen canvassed members, wrote and wrote legislation. Even President Bush gave a speech on the subject, exhorting his party to get it together.

The result--if Republicans know what's good for them--may be a broad new GOP health-care vision, a free-market reform to replace today's faltering employer-based system. The party has circled this for years, throwing out free-market ideas here and there, yet never proved unified (or brave) enough to get behind one bold, top-to-bottom reform. Democrats are now forcing their hand.

The setting is the upcoming debate over the State Children's Health Insurance Program, or Schip, a brawl that could well determine the future direction of U.S. health care. Democrats see expanding Schip as the first step toward socialized medicine. If Republicans fail to meet that challenge with their own more compelling plan for market-based, consumer-driven reform, it may prove the beginning of the end of today's private model.

If that sounds dramatic, consider the Democrats' strategy. The left still bears the wounds of HillaryCare, and knows that even with spiraling health-care costs, the nation still has little appetite for an abrupt shift to all-government care. So they've developed a craftier approach, one that takes longer but gets them to the same end. The new plot is to enact national health care one citizen at a time, slowly expanding the reach of existing government programs until they encompass the population.

Schip is the first step. The program, with its $25 billion budget, was originally designed to provide insurance to only the poorest children. Democrats want to throw an additional $60 billion at it, expanding Schip's rolls by three million. They would expand eligibility so much that as many as half joining would drop private insurance to do so. Even adults could sign up.

Next: Even as Democrats work to expand Schip to cover older Americans, they'd expand Medicare to cover younger Americans. House Energy and Commerce Committee Chairman John Dingell is said to have recently floated the idea of allowing the struggling Big Three auto makers to enroll workers in Medicare at the age of 55, or 10 years early. Consider this a pilot program for dropping Medicare's age limit overall and instantly subjecting tens of millions more Baby Boomers to the government's tender care.

Democrats will meanwhile argue the only way to pay for Schip and other expanded programs is to gut Medicare Advantage and similar free-market reforms. See how clever? Swallow up ever more Americans into federal programs, banish any last vestiges of popular market plans, and voilĂ ! It is Hillarycare! Only nobody ever had to use the dreaded word!

Republicans beat back the original HillaryCare by warning about Canadian waiting lines, but a negative message alone won't do this time. Our third-party-payer system, while still stacks better than France, is nonetheless collapsing--and Americans know it. Republicans can't simply be against socialized care, while not being for anything else. The left also chose its first battle wisely, with a program for "the children." The GOP's only Schip response so far has been to grouse about cost. And it's realizing a message of "We're for the children, just not as much as them," isn't a political winner.

This week's backroom talks--led by health-care innovators Tom Coburn and Jim DeMint in the Senate, and Paul Ryan and Jim McCrery in the House--were therefore about getting beyond Schip. The goal: a system that eliminates today's corporate subsidy and gives the money to individuals, cutting costs and reducing the number of uninsured. The political message: Dems want to put a few million more under government control for $60 billion, Republicans want to put 300 million in charge of their own care at zero extra cost.

The good news is that after 10 years of tinkering, Republicans have laid the foundation for bigger reform, from Health Savings Accounts to tort liability reform. The more intense policy debate this week instead focused on the biggie: how to revamp the tax code to get that money to individuals. On one side are tax wonks, among them Sen. Jon Kyl, who prefer giving every American a tax deduction--as President Bush has advocated. They argue it does the least damage to the tax code, and is less of a handout. On the other side are health-care wonks, among them Sen. Coburn, who prefer a refundable tax credit. They argue it does more to help with the uninsured, and is coincidentally a better political sell.

By the end of this week, the architects were coalescing around a tax-credit approach, on the belief it will attract the most GOP support. In a signal of White House approval, President Bush deliberately noted in his speech Wednesday that a tax credit would have a "similar outcome" to his deduction plan, and that he was "open to further discussion." Word was that Republican leaders were also climbing on board, with all concerned hoping to debut something big in coming weeks.

The challenge then will be to get the rest of the party to overcome its nervelessness on health care. The ringleaders of today's effort admit they may have to do a Sen. Phil Gramm, who in 1993 led by example, singlehandedly tearing into HillaryCare, proving his position a winner with voters, and pulling his colleagues in line. They'll need to roll up their sleeves. Most Republicans don't understand health care, so don't want to talk about it; many grimace at voting down money for "kids"; quite a few face tough elections and would rather not jump into an unknown debate. Reformers also aren't getting cover from should-be allies. Insurers and lobby groups like PHRMA--who ought to understand that a bigger Schip is a threat to their long-term business--are instead focused on short-term profits and PR images. Republican governors--who'd be huge beneficiaries of an individualized market--seem to only care about keeping federal dollars flowing into state coffers.

Democrats will hail a Schip victory as an example of how they can help Americans on their top concern of health care. They want to ride it to the White House and to bigger congressional majorities, making it that much easier to institute incremental national health care. If Republicans don't unify now, they might not get a better chance.


Australia: Public dentistry meltdown

THE true extent of the state's dental crisis can be revealed for the first time today, with figures showing a backlog of almost 200,000 people awaiting treatment. Of those, more than 45,000 are children living with tooth decay and oral disease so severe it could turn life-threatening. Exclusive waiting figures obtained by The Daily Telegraph show for the first time our decaying dental health industry. This is the first time in three years the data has been revealed and it shows on May 31 there were 178,876 waiting in NSW for dentistry, including 45,339 children. At one Sydney hospital, almost 60 patients were treated for dental infections so severe their airways were closed off.

The growing list reveals a country in crisis, with new Medicare data showing the federal dental scheme for people with chronic diseases has had poor uptake. Despite 650,000 Australians awaiting dental treatment, only 4027 in NSW have accessed the scheme in three years.

Federal Opposition health spokeswoman Nicola Roxon said: "This is more evidence that the Government is investing in the wrong area with dental health." A spokeswoman for federal Health Minister Tony Abbott said the project would pick up later in the year when new money from a Budget announcement of $378 million takes effect.

But Association for the Promotion of Oral Health chairman Hans Zoellner said the scheme was "a waste of money" and was flawed because it relied on a complicated referral system. "Government has increased funding but we think the medical barriers to getting to the funding are too high and that is a big mistake." Dr Zoellner said the high number in NSW awaiting treatment is creating a generation whose preventable dental decay is turning into chronic, life-threatening illness.

The Daily Telegraph understands up to 60 patients have been treated at Westmead Hospital this year with dental infections so severe their airways became closed. New research from The Australian Consumers Association released yesterday revealed 30 per cent of adults avoided dental care because of the cost, one quarter had untreated tooth decay and more than 20 per cent had moderate to severe gum disease.

And with recent medical studies showing poor oral health is a contributor to conditions like cardiovascular disease and diabetes, families across the country are now turning to charities for help. Armidale toddler Mark Schumacher was unable to eat and was living in pain and discomfort because the three-year-old's tooth enamel had worn away. Faced with a wait of up to 15 months for surgery, his mother Tracy pleaded for help and a local dentist did the procedure for free. "His four top teeth had no enamel and he wasn't eating - now we can't stop him eating," his relieved father told The Daily Telegraph. "He's eating fruit and everything now -- he was barely eating at all before."



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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when is playing up, there are mirrors of this site here and here.


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