Friday, October 30, 2009

House Dems reach deal on key health care elements

House Democrats reached agreement Wednesday on key elements of a health care bill that would vastly alter America's medical landscape, requiring virtually universal sign-ups and establishing a new government-run insurance option for millions. House Speaker Nancy Pelosi planned a formal announcement Thursday morning in front of the Capitol. Lawmakers said the legislation could be up for a vote on the House floor next week.

The rollout will cap months of arduous negotiations to bridge differences between liberal and moderate Democrats and blend health care overhaul bills passed by three separate committees over the summer. The developments in the House came as Senate Majority Leader Harry Reid, D-Nev., tried to round up support among moderate Democrats for his bill, which includes a modified government insurance option that states could opt out of. Reid met Wednesday with Arkansas Sen. Blanche Lincoln, who faces a potentially tough re-election next year.

The final product in the House, reflecting many of President Barack Obama's priorities, includes new requirements for employers to offer insurance to their workers or face penalties, fines on Americans who don't purchase coverage and subsidies to help lower-income people do so. Insurance companies would face new prohibitions against charging much more to older people or denying coverage to people with health conditions.

Pelosi has also said the bill would strip the health insurance industry of a long-standing exemption from antitrust laws covering market allocation, price fixing and bid rigging.

The price tag, topping $1 trillion over 10 years, would be paid for by taxing high-income people and cutting some $500 billion in payments to Medicare providers. The legislation would extend health coverage to around 95 percent of Americans.

Republicans criticized the bill even before it was unveiled. "Americans' health care is too important to risk on one gigantic bill that was negotiated behind closed doors," said Rep. Dave Camp, R-Mich. "The Medicare cuts will hurt seniors, the tax increases will kill jobs and the government takeover of health care will increase premium costs."

One change expected to be revealed Thursday is that some of the provisions of the bill, which were set to take effect mostly in 2013, have been moved up so Americans would see the benefits of the legislation more quickly, according to Pelosi spokesman Nadeam Elshami.

"I'm pretty confident that we've got the right pieces in place," said Rep. George Miller, D-Calif., chairman of the Education and Labor Committee, one of the three panels involved in writing the bill. "We can quibble over parts of it, but the fact is when you're taking a 60-year-old system that grew up in a rather haphazard fashion and you're trying to bring some coherence to it, these are sort of the things you have to do at the beginning of that process."

Plenty of work remains to be done before a bill could land on Obama's desk - and there's still no guarantee that Congress can complete the legislation before year's end, as the president wants. If Obama does sign a health overhaul bill, he will have bucked decades of failed attempts by past administrations, most recently by former President Bill Clinton in the 1990s. House leaders hope to finish the bill before Veteran's Day, Nov. 11. The Senate is aiming to start debate sometime in the next several weeks.

Bills passed by the House and Senate would have to be merged before a final product could be sent to Obama, and there are a number of differences between the two chambers that would have to be reconciled. Among them are the different approaches to the public plan. The House does not include the opt-out provision for states, and it has more stringent requirements for employers. The Senate would use a tax on high-value insurance plans to pay for the bill, an approach that the House version doesn't have.

In the end, Pelosi, D-Calif., and other House leaders were unable to round up the necessary votes for their preferred version of the government insurance plan - one that would base payment rates to providers on rates paid by Medicare. Instead, the Health and Human Services secretary would negotiate rates with providers, the approach preferred by moderates and the one that will be featured in the Senate's version. That marked a defeat for liberal lawmakers, who argued for months that a public insurance plan tied to Medicare would save more money for the government, and offer cheaper rates to consumers. Moderates feared that doctors, hospitals and other providers, particularly those in rural states, would be hurt, and in the end they looked poised to prevail, despite constituting a distinct minority in the 256-member House Democratic caucus.

Some liberals were prepared to accept the negotiated rate structure. Others were still withholding support, even while pointing to Reid's inclusion of a government insurance plan in the Senate bill as a victory in itself. "We were laughed at in August. Who would have thought that the Senate bill would have a public option?" said Rep. Lynn Woolsey, D-Calif., a co-chair of the Congressional Progressive Caucus. Woolsey was noncommittal about whether progressives would accept the negotiated rates. "This is not walkaway time and it is not acceptance time," Woolsey said.

Members of the progressive caucus, along with lawmakers from the black, Hispanic and Asian-Pacific American caucuses, were scheduled to meet with Obama at the White House on Thursday, she said.

The legislation would set up a new purchasing exchange where small businesses and individuals without affordable health care options could shop for and compare insurance plans. The new public plan would be one offered in the exchange, and it would be optional; an analysis by the Congressional Budget Office of early versions of the bill said that the public plan would be expected to cover 9 million to 10 million people by 2019. The House plan also envisions a significant expansion of Medicaid, the federal-state health care program for low income people.

Democratic leaders still faced disputes over prohibiting taxpayer money for abortions and health care for illegal immigrants, issues they hoped to resolve after the bill's unveiling.


The real costs and benefits of Obamacare

As individual citizens and taxpayers read the various healthcare bills that their legislators have not read, it becomes very clear that there are many losers in the Administration's healthcare reform plan. And it is experience with previous government healthcare programs shows that proponents of new government programs will misrepresent the cost to the public to get programs approved.

For example, when Medicare was proposed in 1965, the projected cost in 1990 was determined by the Johnson Administration to be 12 billion dollars. The real cost in 1990 was 107 billion dollars. The cost was underestimated by a factor of 9 to obtain passage of the legislation. Imagine what the real cost of healthcare reform would be in 10 years if the CBO estimate of 1.2 trillion dollars is equally under estimated. Clearly the American taxpayers are losers in this legislation.

The Medicare experience shows that when inexpensive medical coverage is offered, utilization increases. The only way to prevent greater utilization is to impose rationing. If Obamacare is to have any hope of containing costs it will have to limit care to those that use healthcare most extensively. Since more is spent on healthcare in the first and last years of one’s life than all the years in between, seniors will have rationed care.

To help pay for inclusion of the uninsured into healthcare, taxes will be levied on businesses that provide healthcare coverage to their employees and responsible individuals that purchase their own coverage. So clearly, small businesses and responsible individuals do not benefit from this reform.

However, there are groups that do benefit from this legislation. Those groups have “contributed” significantly to the Obama administration and the legislators drafting Obamacare.

In some ways, hospitals will benefit from not absorbing the cost of providing medical services to the uninsured. And this can be a significant cost especially if there is a large illegal alien population. But at the same time, Obama has promised to reduce Medicare/Medicaid spending on hospitals.

Pharmaceutical companies will have a new taxpayer-funded market for their products. In early March they met with the Obama team to negotiate support for the bill in exchange for more generous prescription drug reimbursement, which will undoubtedly cause costs to rise even faster.

Not to mention, insurance companies support this legislation because it will force 30 million young and healthy people to by insurance. This is almost half of the current uninsured and represents a profitable untapped market for insurers, making a massive government-granted cartel.

However, perhaps the largest beneficiary of this legislation is not quite so obvious. The Service Employees Union International (SEUI) contributed 60 million dollars and thousand of hours to the Obama campaign. Their purple shirted members have attended August town hall meetings to support Obamacare through intimidation and violence.

The real prize in this legislation is the ability to organize 7.5 million new government employees that Obamacare will create. The National Health Service (NHS) in England employs approximately 1.4 million workers in a country with a population of 60 million. The voting power of those workers effectively thwarts any NHS reform efforts in that country.

The SEUI has used threats and intimidation to pirate nurses and other service workers from other unions in California. It has used taxpayer funds fraudulently provided by ACORN programs to enrich its bosses and diverted member dues to subsidize ACORN’s supposedly non-partisan voter registration programs. In testimony before the Pennsylvania Legislature it recently admitted to knowingly organizing and collecting dues from illegal aliens. It has also been one of the most vocal advocates of Card Check legislation that would replace secret voting on union representation with public intimidation.

In the healthcare debate, if those wearing purple win, the American taxpayer, small business owners and senior citizens will lose.


“Public option” is a gimmick that won’t improve healthcare

In the Washington Post, Robert J. Samuelson explains in the “Public Plan Mirage” how the so-called “public option” contained in congressional health-care reform bills is just a gimmick: “It pretends to control costs and improve access to quality care when it doesn’t.” Steve Chapman wrote earlier about the “‘Public Option’ Health Care Scam.”

In other news, a study by PriceWaterhouseCoopers found that the provisions in the Senate health care “reform” bill sponsored by Sen. Max Baucus (D-Mont.) would add $1,700 a year to the cost of family coverage in 2013 and $600 for a single person. By 2019, family premiums could be $4,000 higher and individual premiums could be $1,500 higher.

CEI’s Greg Conko calls the Baucus bill “worse than the disease.” In a recently-released paper, “A Cure Worse than the Disease: Obama Care Won’t Cut Costs, But May Cut Quality,” Conko notes that most of the alleged cost-cutting measures in the Baucus bill merely shift costs from the federal government onto the states or private payers, without reducing long-term health care inflation. The only measures that could conceivably reduce the annual rate of growth in health care costs would erect government barriers between patients and their doctors, while jeopardizing long-term medical innovation.

A new study by the Oliver Wyman consultancy found that provisions contained in the health-care reform bills, like guaranteed issue and community rating mandates, would drive up premiums by 50 percent for individual policies and 19 percent for small group plans.

A study from the Independence Institute says that ObamaCare would drive up inflation and medical-care costs, while shrinking the economy.

As CEI’s Conko notes, many states have highly concentrated markets. In Hawaii, Rhode Island, and Alaska, for example, 95 percent or more of the health insurance market is served by just two insurers. But Obama and congressional Democrats oppose letting insurers compete across state lines, blocking competition that could make health insurance cheaper. Other countries with cheaper health insurance permit insurers to compete nationally.

ObamaCare would raise taxes. It would also explode state and federal budget deficits, and would actually cost $2 trillion — far more than its promised $800 billion price tag. It also ignores needed reforms that would actually reduce the costs of health care, like steps to reduce the cost of defensive medicine, which wastes $200 billion annually. And it contains special-interest pork, like racial preferences.


The malpractice problem

We can't have health care reform without tort reform

The extra imaging study, the extra day in hospital at the end of an admission, the repetitive laboratory testing, the admission to the hospital to be "sure" about the diagnosis are all inherent in the culture of American medical care. The avoidance of litigation has become ingrained into all aspects of medical care. Since physicians are not liable for the increased costs of care but are liable for any error or missed diagnosis, it would be foolish for them to act in any other fashion. The costs of this mindset cannot be easily assessed by surveys.

No one can identify how the current health care bills being debated and apparently continuously modified in Congress will reduce the cost of health care. They may produce a reduction in insurance premiums for some, but just paying less for health care does not magically produce a diminution in the actual cost of health care. The latter would only occur if there were large profits in the overall health care enterprise that could be trimmed without changing the basic character of the system. But no one has identified such profits. The president points to for-profit insurance companies, but for-profit insurance companies only make up 25 percent of the system and they are not that profitable, ranking 85th among all U.S. industries. "Reform" will redistribute the money, not reduce the overall cost. This is pretty much what the American Health Insurance Plans study, so denigrated by the president, concluded. Unless the costs of health care fall, lowering insurance payments in one segment of the populace will inevitably cause an increase for some other group.

There is much that can be done to make our system more efficient. Tort reform is a great place to start. Medical errors are common and fairness demands that compensation be paid when someone is injured. However, the price for the current system is enormous. The view from the left is that the direct costs of the current malpractice system -- the actual payout of dollars in lawsuits -- are pretty minimal compared to overall health care spending. The indirect costs, the use of tests and procedures to avoid lawsuits, are also said to be overstated in studies, as those who answer surveys about this issue are assumed to be biased. The view from the right is precisely the opposite and ascribes an important component of health care spending to malpractice costs. This view also blames the lawyers.

The experience in Texas, where there is a law capping payments for pain and suffering to $250,000, suggests some benefit. For example, as reported in the Wall Street Journal, malpractice suits have been dramatically reduced. The year before the caps on pain and suffering payments took effect, there were over 1,100 medical liability suits filed in Dallas. Only 142 cases were filed in 2004. In addition, there was a surge of physicians entering Texas to set up practice as malpractice premiums fell by about 50 percent. Texas also is actually a state with low health care spending. According to the National Center for Policy Analysis, although Texas is fifth highest in Medicare spending per capita, it is 43rd in per capita spending for the state's entire population. Whether the malpractice caps in Texas account in any way for these data is uncertain but the pattern is encouraging.

More here

The big “single-payer” lie

Scan the history of government programs. The scope and costs usually grow much larger than originally projected. Moreover, ham-fisted government intervention distorts markets, causing shortages or excesses of supply, leading to high prices for goods that should be cheap, and so on.

When the problems pile up one can either repeal the controls or heap on more controls. Guess which “solution” politicians tend to prefer.

Regarding medical care, the politicians’ answer to decades of government bungling is more bungling: regulation, subsidies, rationing, mandates and a new “public option” in health insurance to squeeze out private plans.

President Obama and other public option advocates promise, on stacks of Bibles, that this is not “somehow a Trojan horse for a single-payer system.” But they’re lying. Go to YouTube. Watch the videos of Obama and congressmen explicitly admitting their goal of a single-payer system. Just two years ago, Obama was saying, “But I don’t think we’re gonna be able to eliminate employer coverage immediately. There’s gonna be potentially some transition process. . . .”

That’s how we lose our freedoms. Not all at once, but a slice at a time.

Oh, and about employer-provided medical insurance. That’s a clumsy institution that exists because of World War II wage controls. We do have to transition out of that system. But we should “transition” towards more freedom, not less.


Why government health care keeps falling in the polls

The health-care debate is part of a larger moral struggle over the free-enterprise system

Regardless of how President Barack Obama's health-care agenda plays out in Congress, it has not been a success in public opinion. Opposition to ObamaCare has risen all year. According to the Gallup polling organization, the percentage of Americans who believe the cost of health care for their families will "get worse" under the proposed reforms rose to 49% from 42% in just the past month. The percentage saying it would "get better" stayed at 22%.

Many are searching for explanations. One popular notion is that demagogues in the media are stirring up falsehoods against what they say is a long-overdue solution to the country's health-care crisis. Americans deserve more credit. They haven't been brainwashed, and they aren't upset merely over the budget-busting details. Rather, public resistance stems from the sense that the proposed reforms do violence to three core values of America's free enterprise culture: individual choice, personal accountability, and rewards for ambition.

First, Americans recoil at policies that strip choices from citizens and pass them to bureaucrats. ObamaCare systematically does so. The current proposals in Congress would effectively limit choice across the entire spectrum of health care: What kind of health insurance citizens can buy, what kind of doctors they can see, what kind of procedures their doctors will perform, what kind of drugs they can take, and what treatment options they may have. Meanwhile, ObamaCare would limit the ability of people to choose affordable insurance coverage through less-comprehensive, consumer-driven insurance plans. And it wouldn't allow Americans to shop for better health-care plans from out-of-state carriers.

Second, Americans believe we should be responsible for the consequences of our actions. Many citizens bitterly view the auto and Wall Street bailouts as gifts to people who took imprudent risks, imperiled the entire economic system, and now appear to be walking away from the mess.

Similarly, Americans are cold to a health-care system that effectively rewards individuals for waiting to get insurance until they get sick—subsidizing their coverage by taxing those who responsibly carry insurance in good times and bad.

On its face, the reformers' promise to provide health insurance to nearly all, regardless of pre-existing conditions, is appealing. But as most instinctively realize, if people don't have to worry about carrying insurance until they need it, many won't buy it. Already, the Census Bureau tells us that 21% of the uninsured are in households earning at least $75,000. Although there are certainly plausible reasons for this in some cases, this phenomenon will worsen under ObamaCare.

Third, ObamaCare discourages personal ambition. The proposed reforms will institute a set of government mandates, price controls and other strictures that will make highly trained specialists, drug researchers and medical device makers less valued now and in the future. Americans understand that when you take away the incentive to make money while saving lots of lives, the cures, therapies and medical innovations of tomorrow may never be discovered.

Yet we are told this is all for the best. In his commencement speech at Arizona State University earlier this year, Mr. Obama told the graduates not to "fall back on the formulas of success that have been peddled so frequently in recent years": "You're taught to chase after all the usual brass rings . . . let me suggest that such an approach won't get you where you want to go."

Crass materialism is indeed a tyranny that can lead to personal misery. But most Americans believe it's up to individuals, not a nannying government, to decide what constitutes too much income and too much ambition.

An April 2009 survey conducted by the polling firm Ayers, McHenry & Associates for the conservative nonprofit group Resurgent Republic asked respondents which of the following statements about the role of government came closer to their view: (a) "Government policies should promote fairness by narrowing the gap between rich and poor, spreading the wealth, and making sure that economic outcomes are more equal"; or (b) "Government policies should promote opportunity by fostering job growth, encouraging entrepreneurs, and allowing people to keep more of what they earn." Sixty-three percent chose the second option; just 31% chose the first. This is consistent with nonpartisan surveys showing that most Americans think our increasingly redistributionist government is overstepping its bounds. For example, a September 2009 Gallup Poll found that 57% believe the government is "doing too much"—the highest percentage in more than a decade. Just 38% said it "should do more."

We will continue to hear both sides of the health-care debate argue about particulars of insurance markets, the deficit impacts of reform, and the minutiae of budgetary assumptions. These arguments, while important, do not address the deeper issues involved.

The health-care debate is part of a moral struggle currently being played out over the free enterprise system. It will be replayed in every major policy debate in the coming months, from financial regulatory reform to a cap-and-trade system for limiting carbon emissions. The choices will ultimately always come down to competing visions of America's future. Will we strengthen freedom, individual opportunity and enterprise? Or will we expand the role of the state and its power?


No comments: