The Coming Referenda on Obamacare

The contests for statehouses in New Jersey and Virginia are the best referenda the country could ask for on Obamacare, and Congress would be wise to wait to see how these two states vote in November before it takes any final vote on the president's plans to radically rewrite the rules of American medicine. Recent polls show that Republican Bob McDonnell in Virginia leads his opponent Creigh Deeds by double digits. An anti-Democrat trend is also shaping up in New Jersey where GOP nominee Chris Christie is also far ahead of incumbent Jon Corzine.

Both New Jersey and Virginia went for President Obama ten months ago and thus should be providing their liberal nominees with a cushion, not a collapse. What has happened? The answer is obvious: the president's policies are deeply unpopular outside of the Beltway and the hard left precincts of the Democratic Party, and the idea of giving even more power to the party that controls all the levers in D.C. is out of the question. The stimulus is understood not to have worked. The cap-and-tax-and-tax-and-tax House bill threatens every business in the land. The vast deficits dwarf those that triggered anger against Republicans. And now Obamacare looms over every American with health insurance they like, including seniors who understand that the president's program targets Medicare and thus their access to doctors and treatments.

Polling on the health care scheme being pushed on the country show its support plummeting and opposition soaring. Even a huge infusion of cash from Big Pharma on behalf of the "government option/public plan" will not decisively impact the debate. The ice has hardened, in fact, and the doctors America depends upon are overwhelmingly against the scheme which means that most patients who talk to their physicians will hear the same negative message. All of AARP's spin can't change this, and the doctors won't sit quietly by as their profession is nationalized no matter what the AMA advises. A San Diego neurologist e-mailed me yesterday saying that he was refusing to meet with any pharmaceutical rep until Big Pharma withdrew from the field. I expect that sort of hostility will deepen, and those sorts of actions will spread. Unlike most debates inside the Beltway, this one has immediate and huge real-world implications for tens of thousands of professionals and millions of seniors, not to mention everyone with health insurance through their employer. Spin doesn't work when people are paying close attention. The president's "guarantees" aren't believed.

Pursuing such a deeply unpopular and obviously ideologically-driven extremist solution like a "government option/public plan" is a recipe for electoral disaster for Congressional Democrats and even races far emoved from the federal level. Allowing Nancy Pelosi to slander the huge majorities against Obamacare is not good politics, but telling people to sit down and shut up as the president did in Virginia last week --"Get out of the way!"-- is even worse. Arrogance never works in politics.

The president is still well-liked, even by many conservatives, but his agenda has disquieted the center and everyone on the right. Even many Democrats and not just the Blue Dogs are worried that the huge lurch to the left if the fist six months of the new administration has sowed the seeds of a counter-reaction next November.

Whether that counter-reaction is building into a huge political shift back to the right will be clearly visible after November's votes, and if Democrats see two statehouses swept away, they will know that the center of American politics has rejected the grab-bag of initiatives and massive deficits as well as the president's excuse that he inherited all the problems besieging the country. The Bush-bashing is already a tired tune, and even those who have talked themselves into believing the housing bubble was W's fault know that the public doesn't much care for excuses.

Self-preservation is telling the Blue Dogs that the president's insistence on the radical parts of his program is a legislative suicide note, and they are reluctant to sign. Even some Senate Democrats must sense a huge and unnecessary risk in the president's plan. If Corzine and Deeds can rally and win against the backdrop of the debate in D.C., these fears will be allayed and a vote taken on health care with much less risk a year out. A president concerned with his party would wait to see how the agenda is affecting his colleagues.

But because the president's pollsters must be seeing the same thing as everyone else, don't expect him to accept a delay until the referenda are in. The hard sell is all he has left, and if the Congressional Democrats lack the spines to resist it for two months, they will have no one but themselves to blame a year hence.

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Why Americans fear the accountant’s knife

Protesters against Obama’s reforms are defending their excellent medical service. It’s all about cost-cutting, not liberty

A pregnant American arrives at her doctor’s office. It’s time for her ultrasound check. The doctor wheels over the machine from the corner of the room: of course he has his own.

A child has a fall from a slide. There’s blood in his urine. The parents race him to the emergency room. Two hours later, the boy’s having a CAT scan. (An American is twice as likely to use a CT machine in any given year as a Canadian, four times as likely as a Briton, and seven times as likely as a Dane.) A car driven by an illegal immigrant smashes into a tree. The driver and his family are horribly injured. They are raced to the nearest emergency room and treated, no questions asked, no bill presented.

That’s American healthcare at its best. America at its worst, of course, you know. Or do you? Europeans see the American health system as a brutal Darwinian struggle. The poor are abandoned, the sick must produce credit cards at hospital emergency rooms and government disavows responsibility for the health of the population.

But those are largely imaginary or exaggerated ailments. The hardest problems for Americans are not so much medical as financial. Insurance premiums have doubled in the past decade and Medicare and Medicaid, the government health programmes, are growing at a rate that cannot possibly continue. Tens of millions of people lack insurance. Yet they do not go uncared for. Rather they use the most expensive care, emergency care, and hospitals add the cost on to the bills of paying patients.

Almost all the problems of the US health system trace back to a pair of unexpected ironies: profit-driven private insurance corporations find it much harder to say “no” than governments do, and American governments are more unsustainably generous than their European and Canadian counterparts.

That sounds incredible, I know. But consider: government looms huge in the US health system. An absolute majority of all health dollars spent in America are spent by one form of government or another. Everybody knows that the US has a private health system while neighbouring Canada’s is public. Yet US federal and state governments spend as much public money on healthcare per American as Canadian federal and provincial governments spend per Canadian.

For all practical purposes, healthcare is just as much a right in the US as it is in Europe. Since 1986, federal law has required all hospitals that receive federal money (ie, just about all of them) to provide emergency care to any patient who presents himself or herself. Many states back this federal law with even stronger laws of their own.

Government generosity drives private health costs higher and higher. Health insurance is regulated by state governments. Each government decides what local insurers must cover and how they may cover it. Fifteen of the 50 states require insurers to cover fertility treatments. Twenty-four states require coverage of eating disorders. Thirty-five states require coverage of reconstructive surgery after a mastectomy. New York state requires insurers to charge the same rate for all customers, regardless of health conditions, while 11 other states tightly restrict the ability to charge more for more sick patients.

Despite the rhetoric, Republican administrations expand government coverage just as much as their Democratic counterparts do. George W. Bush’s Administration, for example, created one huge new healthcare programme (prescription drug coverage for the elderly) and greatly expanded another (the State Children’s Health Insurance Programme, which now covers under-18s whose parents earn up to 250 per cent of the poverty level).

Again despite the rhetoric, Democratic administrations fret as much about healthcare costs, perhaps even more, than Republicans. Because of the Clinton Administration’s fierce promotion of health maintenance organisations — the much-hated but super- economical insurance plans — healthcare costs grew more slowly in the 1990s than in the decades before and after. Barack Obama has publicly mused about the need to spend less on the elderly in their final years. Here he is speaking to The New York Times in April, a comment that puts some credibility in those fears of “death panels”:

The President: “The chronically ill and those toward the end of their lives are accounting for potentially 80 per cent of the total healthcare bill out here.”

Interviewer: “So how do you — how do we — deal with it?”

The President: “Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance.”

The raucous protesters at the town hall are not defending the liberty of the individual; they are defending the status quo, a status quo that for many means lavish government healthcare for the elderly. They (rightly) fear that government is much more concerned to hold costs down than to improve care.

Objective studies find little difference in outcomes between America’s costly care and the much cheaper care in more statist systems. Canadians live longer, the Dutch have better infant mortality statistics, etc. Healthcare systems do not make much difference to health outcomes. Americans are more likely to be obese than Europeans. (One health dollar in ten is attributable to the obesity-caused type 2 diabetes.) Americans shoot each other, and give birth prematurely, more often. Healthcare can do only so much to compensate for these choices (and a severely underweight baby is more likely to survive in the US than just about anywhere on Earth).

What the US system offers to those who enjoy good coverage is much harder to measure: convenience, security, responsiveness to patients and personal attention from doctors who compete to attract customers. Fear of the loss of American medicine at its best is what is riling the town halls. Americans like what they have. They worry that it cannot continue. And they correctly surmise that a President with other spending priorities seeks to take it away.

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British women say that they were "tricked" into telling the truth

Two British women who have become the unwitting stars of a campaign to derail Barack Obama’s healthcare reforms yesterday said that their views on the NHS had been misrepresented. Katie Brickell and Kate Spall said that they strongly supported state-funded healthcare, but their descriptions of poor treatment at the hands of the NHS form the centrepiece of an advertising campaign against the proposed reforms in America. Both appear in adverts for Conservatives for Patients’ Rights (CPR), a lobby group that opposes Mr Obama’s plans for universal medical insurance, which have caused a transatlantic rift over the merits of the NHS.

Government ministers and the Prime Minister have weighed in to the row to defend the healthcare service as Republicans claimed that adopting an NHS-style system would lead to “death panels” that would preside over who received lifesaving treatment.

Ms Spall, whose mother died of kidney cancer while waiting for treatment, and Ms Brickell, who had cervical cancer diagnosed after being refused a smear test because she was too young, appear in the adverts telling how they were failed by the NHS.

But they informed The Times that they were told they were being interviewed for a documentary examining healthcare reform. Neither was aware that the footage was to be used for right-wing advertisements. Ms Spall said: “It has been a bit of a nightmare. It was a real test of my naivety. I am a very trusting person and for me it has been a big lesson. I feel I was duped.”

CPR was set up by Richard Scott, a multimillionaire who founded the Columbia Hospital Corporation. Ms Spall was approached by a woman, who identified herself as Betsy Kulman, who said that she was making a documentary for the company. In an e-mail Ms Kulman wrote: “Columbia Healthcare in the US is underwriting a web documentary spanning the US, the UK, and Canada on the debate on healthcare reform. This segment will explore the difficult issues around the intersection between private and nationalised medicine. “Who has been failed by socialised medicine and why? What can be done to change things for the better?”

Ms Spall, who runs the Pamela Northcott Fund, to fight for patients denied treatment, said that she stood by what she said but was horrified by how her words had been used. “What I said is what I believe, and I stand by it, but the context it has been used in is something I was not aware would happen,” she said. “The irony is that I campaign for exactly the people that socialised healthcare supports. I would not align myself with this group at all.”

Ms Brickell, whose cancer is in remission, said that she had had a similar experience. “I was told that they were a company in the United States who were doing a documentary on whether healthcare in the US should be nationalised,” she said. “The NHS let me down and I just wanted to make the point that people should not rely solely on it. But what I said has been skewed out of proportion. I am slightly worried that people might think I am taking a negative position on the NHS.

“My point was not that the NHS shouldn’t exist or that it was a bad thing. I think that our health service is not perfect but to get better it needs more public money, not less. I didn’t realise it was having such a political impact. I did sign a piece of paper saying they could do what they wanted, so it’s my own fault.”

Karol Sikora, a British cancer specialist who also appears in the adverts, has said that he fell victim to the same technique. Dr Sikora, an outspoken critic of the NHS, told The Guardian: “They came and saw me in my office about a month ago and I gather I am appearing in some advert. They didn’t tell me that would happen.”

Stephen Hawking, the Cambridge scientist, has also been drawn into the row after the American newspaper Investor’s Business Daily used an editorial to claim that he “wouldn’t have a chance in the UK” because the NHS would have deemed him “worthless”, given his physical disabilities. Mr Hawking, who has motor neuron disease, rejected criticism of the NHS yesterday as he collected America’s highest civilian honour, the Presidential Medal of Freedom. “I would not be here today if not for the NHS,” he said.

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Health Care Compromise A Poison Pill For Small Business

Much ado has been made of the tenuous “compromise” between President Barack Obama and “Blue Dog” Democrats in Washington on the issue of government-run health care. Sadly, the reality is that the latest version of “Obamacare” is still a poison pill for America’s small businesses and the millions of workers they employ.

Most small businesses spend between 60 and 80 cents of every dollar they earn on payroll, which is precisely where Obama’s plan would hit them. Not content with simply bleeding “the rich” to pay for the massive up-front costs of his $1.5 trillion socialized medicine proposal, Obama also wants to impose a massive new tax increase on American small businesses – one that will directly impede their ability to create jobs and stimulate economic activity.

In other words, Obama wants to choke off America’s number one job-creating engine in the depths of a recession that has already cost millions of jobs – all so he can create a government health care monopoly that will not only increase costs but also reduce the quality of care. That’s a recipe for disaster, not real reform, and yet Obama continues to use rhetoric to mask his true intent. For example, in proclaiming a “National Small Business Week” three months ago, Obama touted small businesses as “the lifeblood of cities and towns across the country.” “(Small businesses) help enhance the lives of our citizens by improving our quality of life and creating personal wealth,” Obama said. “Small businesses will lead the way to prosperity, particularly in today’s challenging economic environment.”

Obama further claimed that he supported “economic policies that encourage enterprise” and “tax policies that promote investment in small businesses.”

Unfortunately, Obama’s rhetoric of support for small businesses has been accompanied by policies that threaten to put them “out” of business. For example, while state and local government bureaucracies have been bailed out to the tune of hundreds of billions of dollars, small businesses remain overtaxed and frozen out of credit markets. So much for “stimulating Main Street.”

With his socialized medicine proposal, however, Obama is attempting to erect the most sizable roadblock yet in the path to small business prosperity in America. In addition to imposing a new surtax on the “wealthiest Americans” – including the sixty percent who report income from small businesses or partnerships – Obama’s plan would also force a new tax hike directly on the backs of small businesses with annual payrolls of $500,000 or more.

According to data released by the U.S. Small Business Administration, the small businesses that would be affected by the latest “Obamacare compromise” employ 70% of all small business employees in America – or 42.3 million workers.

Even worse, the new small business tax rises dramatically – and quickly – the more a company expands its payroll. In fact, small businesses with payrolls of $750,000 or higher would have to pay 8% of that total cost to the government. This would create a direct disincentive to economic growth and job creation. After all, why would a small business add employees (i.e. additional payroll expenses) if it meant incurring a higher tax rate?

At the same time small businesses are absorbing this new tax, they would be sending a steady stream of new “customers” to the government-run plan, which would force nearly 84 million Americans out of their current health coverage, according to a new study by the Lewin Group.

Simply put, Obama’s plan would force small businesses to pay for in a way that would directly impede their ability to create jobs and stimulate economic activity. In addition to going against everything this nation was founded on, that’s something America’s small businesses simply cannot afford.

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The Health Care Chaos

by Emmett Tyrrell

Allow me a word of encouragement to our president. Mr. Obama, you are doing just fine. You wanted to set a new tone in Washington, and you have. You wanted an open debate on health care, and you have it. Admittedly, the tone is astoundingly rancorous, and not incidentally, your approval ratings continue to decline. Then, too, support for your health care reform is dropping, especially among independents. Yet I believe you can take heart. You have roused the interest of the American people in you, the Democratic Party, the Congress and health care. That is good news, at least for us conservatives. Again, you are doing fine. Ever-larger numbers of Americans are alarmed by you, your party, the Congress and your health care monstrosity. Mr. President, you are doing fine. Keep it up. Let me know if there is anything I can do to help.

Truth be known, what else were we to expect from the new administration? In the Senate, our president was the most left-wing member by a lot. That is a fact, clearly visible to those who followed his voting record. He was also the least experienced major-party presidential candidate in more than a century. As for his experience before he entered upon his brief political career, he never was in the private sector, where he might have gained knowledge about profit margins, the difficulty of maintaining a work force, or the burden of even a slight tax increase. His sole experience has been a fleeting period teaching law and the anomalous experience of being a community organizer, that is to say, a rabble-rouser who organizes needy people to pester governments and corporations for cash or services.

This campaign for health care reform has been an ongoing chaos. From all I have been able to tell, the Obama White House is a chaos, too. The other day, I heard of a highly placed White House staffer, with glittering credentials, who sits in a cubicle answering 300-400 urgent e-mails a day. That only reinforces the reports that this White House is nearing a state of "burnout." The word circulating about the Democrats is that they are "desperate" over the state of the Obama health care plan. They have reason to be, and my guess is that things will get much worse. Democrats, what were you thinking of when you nominated the most left-wing and inexperienced candidate in the 2008 Democratic field?

Out on the campaign trail, where the Prophet Obama is thumping for health care reform, he should be very much at ease. Campaigning is the one aspect of politics he does well. But here, too, we see desperation. The other day, he accused his critics of engaging in "scare tactics." He objects to their claim that the bill is exorbitant, though that claim is reinforced by the nonpartisan Congressional Budget Office, which puts the price tag at more than $1 trillion. He says he will shave off $500 billion from that sum by cutting waste, fraud and abuse, though the CBO estimates the savings at only 1 percent of the trillion-dollar cost increase. He says his reforms will not fall heavily on the elderly or the disabled, though his own health care advisers have written that reforms (SET ITAL) should (END ITAL) fall heavily on these groups. We can quote them. Call it scare tactics if you will.

Dr. Ezekiel Emanuel -- who is the health-policy adviser at the White House Office of Management and Budget and a member of the Federal Coordinating Council for Comparative Effectiveness Research, as well as White House chief of staff Rahm Emanuel's brother -- propounds discrimination against the elderly and other less-than-robust patients. In the medical journal The Lancet, he wrote in January: "Unlike allocation by sex or race, allocation by age is not invidious (an irrelevancy) discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years." As for the less-than-robust, in The Hastings Center Report, he has written that medical care should be withheld from those "who are irreversibly prevented from being or becoming participating citizens. ... An obvious example is not guaranteeing health services to patients with dementia." Thus, the state should decide when and whether you get treatment. Does that not have a grisly ring to it?

Dr. Emanuel veers from the grisly to the delightfully frivolous in his pontifications on cost cuts. Savor this one, from the Journal of the American Medical Association in May 2007: "Too much money spent on health care reduced the ability to obtain other essentials of human life as well as some goods and services not essential to life but still of great value, such as education, vacations, and the arts." Yes, he said "vacations and the arts." So once we have Obamacare and you are sitting around waiting for a hip replacement or a CT scan, remember that tax revenues are being better spent on vacations or perhaps the performance art of that lady who smothers chocolate on her naked body. On second thought, she may be sitting nearby also awaiting a hip replacement. Remember, chocolate stains.

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Some other recent articles:

Senate committee eliminates “end of life” provision in Obamacare: "A plan to provide hospice counseling and other end-of-life advice to patients and their families is being dropped by US Senate health care negotiators after critics charged that it would lead to the formation of federal ‘death panels,’ a key GOP senator said yesterday. … The original sponsor of the provision and a variety of specialists all debunked the allegation and said end-of-life counseling can help families deal with difficult choices. Nonetheless, Senator Chuck Grassley, the Senate Finance Committee’s top Republican and one of six committee members trying to hash out a bipartisan bill, said yesterday that the provision could be misinterpreted and that it will not be contained in the committee’s proposed legislation.”

Ringo’s law and the healthcare system of doom: “Some years ago, noted philosopher Ringo Starr described an important and now-famous discovery: “By now it should be clear to anyone: This government ‘help’ has made things dramatically worse in healthcare, just as government reliably makes things worse in all spheres of life that government involves itself in. For many reasons, coercive government is the worst way to do anything. Like gravity, Ringo’s Law is a built-in rule of the universe, omnipresent and unavoidable. There is no country on Earth where the Law is not conspicuously on display: ‘Everything government touches turns to crap.’”

Medical mosh pits : "Clashes keep breaking out at the ‘town hall’ meetings devoted to discussing health care reform. Usually the excitement amounts to some angry questions and heckling, but sometimes there’s more. Six people were arrested at a demonstration outside a meeting in St. Louis. Violence erupted at a town hall in Tampa after opponents of ObamaCare were locked out of the building. A North Carolina congressman cancelled a meeting after receiving a death threat; the pro-market group FreedomWorks, which was involved in some of the protests, fielded a death threat of its own. Supporters of the president’s health care reforms, who used to tout the support he’d received from the pharmaceutical and insurance industries, are now accusing the very same companies of riling up ‘mob violence’ to stop the plan.”

Eyes on the real prize: “If you asked House Democrats what they most wanted to leave as their legacy in public office, it’s a good bet that a healthy number would offer a variation of ‘a government-managed health-care plan that is available to every American citizen.’ Some would classify it as ’single payer,’ others would want the ‘public option,’ but they all add up to a massive new entitlement, in which Americans depend upon the federal government for their health care. Conservatives have dreaded it; looking around the globe, they know that once created, these programs are just about politically impossible to repeal. Many congressional Democrats, told that passage of the sweeping health-care legislation will cost them their seats, may find the choice a harder decision than many observers think. Yes, no one should doubt a politician’s instinct for self-preservation. But it’s quite possible that long-serving Democrats might want to enact a sweeping social change instead of taking the safe route.”

Trust the government : “How much is one additional year of your life worth? Or one more year of life for your father or your wife? For your child? In Great Britain, the government has settled on a number: $45,000. That’s how much a government commission with the Orwellian acronym NICE has decided British government-run health care will pay for one additional year of life for a British subject. Think it could never happen here? Then you need to pay closer attention to what Washington is planning for your health care.”

If Uncle Sam becomes your doctor: “Americans are doing their homework on healthcare reform. And, unlike some members of Congress, they’re reading the legislation, even though it’s more than 1,000 pages long. They see that the numbers don’t add up. They note the contradictory claims by the Obama administration and Democrat-controlled Congress. And they recognize the unintended consequences of the government controlling one-sixth of the US economy. According to several recent polls, on key issues of access, quality of care, and cost, Americans don’t support this government power grab.”

Health care protests on target: “Now we know the enemy in the health-care debate, the really, truly despicable people, the worms who ought to be stuffed back in the dirt they crawled out of. It’s ordinary citizens who have had the temerity to show up at meetings of their representatives in Congress, asking in so many words — ‘What in the name of heaven are you planning to do with our lives?’ Happy enough to be cheerleaders when Cindy Sheehan and her ragtag followers were out and about calling George W. Bush a mass murderer, Democrats, the left generally, some pretend journalists and a number of big-name commentators are aghast at a lack of respect for the Washington malefactors, fearful that someone will think everyday Americans actually know what they’re talking about and worried about how hard it will be to set the record straight if their critiques are widely circulated.”

Busting the Bay State: “Health care’s silly season is upon us. If we can be sure of anything, it is that President Barack Obama and his congressional allies will do whatever they can to hide the cost of their health plan. Lucky for them, former Massachusetts Gov. Mitt Romney, a Republican, has shown the way.”

Obamacare meltdown: “The revelation last week that a majority of Americans may actually disagree with the President was something for which his team was clearly not prepared. Their attempt to marginalize citizens across the country who dared to speak out against a government-takeover of health care is shameful, arrogant, and desperately sad. With the American people growing increasingly unhappy with the President’s health care plan, Democrats in Congress are working feverishly to cast those who are concerned as radical props to the special interests. … The notion that Americans may not want the federal government making health care decisions on their behalf appears to be truly beyond the comprehension of Democrats in Congress and the White House. So they have responded by slandering honest folks looking to have their voices heard.”

Yes, they really are mad as hell: “Who, exactly, were these people who had converged in the middle of Lebanon to protest ObamaCare? Walking through the crowd, finding them waving signs as they chatted with each other, they were happy to talk. These were in fact the flesh-and-blood of John O’Hara’s Pennsylvania world. There was the registered nurse who was so incensed about the President’s plans she went on the Internet to find Senator Specter’s list of town meetings — and drove two hours from her home in Chambersburg only to find the meeting already filled. She chose to stay, her own sign held high with a scrawled message on free speech, her feet firmly planted on the street corner. There was the local small businessman, the woman who had lost a beloved sister to cancer — teary but deeply gratified that her sister had health care choices every step along the way. Her friend, a child of immigrants who arrived in 1924 — ‘legally’ she added with a smile — shyly gave a name but preferred to think of herself as just ‘an American patriot.’”

This Libertarian and health care: “In this I differ from a lot of other Libertarians. I am a Braudelian: super-concentrations of capital beyond a certain point become anti-free-market and threaten human freedom in almost as many ways as the State can. But that does not exonerate the State here either: there are literally thousands of Physicians’ Assistants, Nurse Practitioners, and even LPNs or midwives who would be more than willing to make careers in the small towns across America providing low-cost basic care to good people. Yet the licensing laws that the health professionals’ lobby have so carefully cultivated over the years prevent that.”

Health reform must endure for the long term: “Health reform has dominated the news lately, but many Americans are wondering what reform will actually entail for them. According to a recent survey conducted by my firm, most believe that healthcare reform will provide coverage for long-term services and supports. These are medical services for people who can’t care for themselves for extended periods of time due to illness or disability. And they’re of critical importance, as 60 percent of Americans over the age of 65 will require long-term care during their lives. But it’s hardly a foregone conclusion that the final health reform package will ensure that Americans have access to affordable long-term services.”