Friday, July 31, 2009

ObamaCare Will Rid Us of Useless Eaters

Some old Nazi propaganda above. A quick translation: "60,000 Reichsmarks is what this born-disabled man costs the peoples' community during his lifetime. People's comrades, this is your money. Read "New People", the monthly magazine of the race-politics bureau of the National Socialist German Workers' Party"

The defeat of Nazi Germany was a big setback for the progressive cause, but under Chairman Zero, it's making up ground fast. A key player in his bid to seize control of the healthcare industry is Ezekiel Emanuel, brother of top teleprompter programmer Rahm "Dead Fish" Emanuel. Ezekiel
wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.

Many doctors are horrified by this notion; they'll tell you that a doctor's job is to achieve social justice one patient at a time.

Emanuel, however, believes that "communitarianism" should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those "who are irreversibly prevented from being or becoming participating citizens … An obvious example is not guaranteeing health services to patients with dementia" (Hastings Center Report, Nov.-Dec. '96).

Translation: Don't give much care to a grandmother with Parkinson's or a child with cerebral palsy.

Here's how Ezekiel defends denying healthcare to the elderly:
Unlike allocation by sex or race, allocation by age is not invidious 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 (Lancet, Jan. 31).
You had your chance to be young. Now you're done paying taxes so die already.

Welcome to Logan's Run.


What Obama Doesn't Know Can Hurt the Rest of Us

President Obama admits he doesn't know about major parts of the House health care bill, but he's promoting the measure anyway. He's violated a cardinal rule of salesmanship: Know your product. Nobody should buy from a salesman willing to make false claims.

When asked in his blogger phone conference about Section 102 and its destruction of private health coverage, Obama replied, "You know, I have to say that I am not familiar with the provision you're talking about." Anyone who even skims the 1,018-page bill finds this part immediately; it's right at the start, actually beginning with Section 101, and it would impose restrictions on private health insurance. (The entire bill is available online at

The ability of private carriers to make a profit is curtailed. One provision empowers a presidential appointee to dictate how much profit or administrative costs will be permitted.

Obama's approach is stealthier than President Clinton's 1993 proposal for a total health care makeover. Realizing that whoever controls the payment system can call the shots, Obama has chosen the takeover route. Supplant private insurance with a government-run program and government now has control. Takeovers are the vogue, in health care as in banking, mortgages and auto-making.

So let's look at the consequences, and then the details.

Polling shows 77 percent of Americans are satisfied with their existing coverage. Too bad for them: 88 million Americans would be forced out of their current private health plans, with 83-million of them pushed into a government-run plan. That means almost half of everyone with private coverage today would lose it very soon. (The numbers come from a Lewin Group report, commissioned by The Heritage Foundation.) Remaining private plans would then wither and be supplanted more gradually.

President Obama simply doesn't like private enterprise. He told NBC News' Nancy Snyderman last week, "A whole lot of people are having bad experiences because they know that recommendations are coming from people who have a profit motive."

So he's backing a bill that would drive private health plans into government-sponsored oblivion by destroying their ability to succeed.

How? By outlawing the methods used by private insurance to control costs and hold down the premiums you pay:

Section 101 outlaws new health benefits plans that don't meet the new federal requirements.

Section 102 requires existing employer group plans to meet the new requirements within five years.

Section 111 requires insurers to accept anyone regardless of previous health, without limits or conditions. Presumably, you could enroll after arriving at the hospital and still be covered for whatever problem sent you there.

Section 113 requires charging the same premium to everyone, varying only by age and geography. No discounts for non-smokers, non-drinkers, fitness buffs, healthy eaters or anything else. It also limits higher premiums based on age, thereby increasing the premiums charged to younger people.

Section 114 outlaws any limits on coverage of mental health and substance abuse.

Section 115 shifts authority over networks of health care providers, moving them from state regulation to federal control.

Section 116 is the real kicker. If insurers are able to turn a profit despite the federal restrictions and public plan competition, they must give back much of that profit to their customers, as dictated by a new federal bureaucrat. This so-called "medical loss ratio" gives power to a presidential appointee, the new Health Choices Commissioner, to dictate the permitted level of administrative costs and profits.

Even without these provisions, the bill gives an automatic advantage to the new public health plan. The public plan uses price controls, requiring doctors and hospitals to accept Medicare-designated payment amounts. Typically, these are significantly lower than private plan payments, often paying less than the cost of providing the care. (This is why so many doctors today refuse Medicare patients.)

Private plans lack this power, so doctors, hospitals and clinics will offset their public plan losses by shifting the costs onto the bills of their other patients -- making private plans even costlier. The Lewin study estimates this cost-shifting will add an extra $460 per person per year to the cost of private insurance. That worsens the automatic disadvantage they have of competing against a taxpayer-subsidized government plan.

Trying to rush this 1,018-page bill through Congress before the public disenchantment grows worse is like a midnight burglar trying to grab all the goods before the homeowners wake up. When the president doesn't know what's in a bill, that's a sign everybody else should start finding out. Ignorance may be bliss for some, but not for the rest of us.


Does Obama believe what Obama is saying?

Listening to President Obama explain "his" health care plan, I can't help but wonder if he actually believes his own words. Maybe it's been so long since the adoring press corps has held him accountable for his innumerable exaggerations, omissions and misstatements that he believes he can create a new reality simply by speaking it into existence. However, for anyone who's been paying attention, the President's recent health care pep rally disguised as a press conference was littered with statements that just don't square with reality:

- Obama: "So let me be clear: if we do not control these costs, we will not be able to control the deficit." Here, the President comes so close to the truth as to stare into its eyes before veering away like an over-correcting teenage driver on a country road. Medicare and Medicaid, the government's previous forays into health care, are devouring the budget and exploding deficits. Controlling the costs of those programs should be the target, but few in Congress have demonstrated the courage to do so. Instead, Obama's prescription is to fix these fiscal disasters by expanding government's authority over what's left of the voluntary private health care market. That's like your doctor wanting to break your right arm to be sure he sets your broken left arm correctly.

- Obama: "I have also pledged that health insurance reform will not add to our deficit over the next decade - and I mean it." Reminds me of the famous "read my lips" pledge by the first President Bush. We all know how well that worked out. Congress has consistently under-estimated the costs of government health care programs. Medicare cost $3 billion when first implemented in 1966. At that time, costs for 1990 were estimated at $12 billion (allowing for inflation), but actual costs in 1990 were $107 billion - or 791% greater. When the Congressional Budget Office pegs the cost of ObamaCare at an opening bid of $1 trillion (others estimate as much as $4 trillion), that should scare the pants off anybody who cares about how deeply in debt we bury our children and grandchildren.

- Obama: "In addition to making sure that this plan doesn't add to the deficit in the short-term, the bill I sign must also slow the growth of health care costs in the long run." CBO economists recently told a Senate committee that the current legislation, which the President admits he "isn't familiar with," would actually make matters worse by "significantly expand(ing) federal responsibility for health care costs." Over the long run federal spending would keep rising at an "unsustainable pace."

- Obama: "It will keep government out of health care decisions, giving you the option to keep your insurance if you're happy with it." What's the point of this huge expansion of the federal health care bureaucracy if not to put government - instead of silly, selfish citizens - in charge? If the President really believes what he says, then the prescription is simple: repeal federal laws governing private health care. That's the surest way to "keep government out of health care decisions." That, however, would undermine the nanny-statists inherent desire to regulate and tax everything that might adversely affect your health. And then why would you need government? Instead, Obama and the Democrats demand that you purchase insurance, micro-manage the coverage you must buy, empower the IRS to penalize you should you refuse, and establish a government commission to decide which treatments your doctor can provide for you.

All this from the President who says, "When you hear the naysayers claim that I'm trying to bring about government-run health care, know this: They're not telling the truth." Whatever you say, Pinnochio


Health care: We don't need the Lexus

by Jeff Jacoby

IMAGINE THE SORT OF CAR you'd drive if government regulations made it illegal to sell any automobile that didn't feature 380-horsepower direct-injection V6 engines, computer-controlled electric power steering, eight-speed automatic transmission, four-wheel-drive, automatic climate control (including humidity and smog sensors), "smart key" technology, touchscreen navigation, backup cameras, LED headlights, acoustic glass, surround-sound stereo, and leather seat stitching.

If those were the minimum requirements every car had to meet before it could be offered for sale, would you commute to and from work every day in a Lexus LS 460 or some other luxury vehicle? Well, you might, if the steep price wasn't an obstacle. But it's more likely you wouldn't be driving at all. If the government barred you from buying anything but a high-end car, you might have no choice but to rely on the bus or subway, or to find a job closer to home.

Make the Lexus mandatory, and fewer people would drive

Lawmakers can decree that every car on the road be a Lexus or its equivalent, but they can't make driving more luxurious for all. They can only make it more expensive -- and for many drivers, unaffordable. And what is true of transportation is true of everything else: Raise the number of amenities that a product or service must include, and more consumers will be unable to pay for that product or service.

That is why one of the simplest strategies for making health insurance more affordable is to reduce the minimum number of benefits that insurers are required to cover.

In every state in the union, legislators and regulators drive up the cost of health care by making insurance policies more comprehensive. Rather than allow the free market to determine which medical services health plans will cover, states force consumers to pay for an array of covered benefits they may not need nor want. For example, 45 states require insurance policies to include treatment for alcoholism and 34 mandate coverage of drug abuse treatment. By law, contraceptives are covered in 31 states, as are hairpieces in 10 states, and in vitro fertilization in 13 states. It is not unusual for consumers who want health insurance to be forced to buy coverage for services they may consider highly dubious, such as acupuncture (benefits are mandatory in 11 states), chiropractic (46 states), osteopathy (22 states), and naturopathy (4 states).

Forty years ago, there were only a handful of benefits that health policies were required by law to cover. Today, the Council for Affordable Health Insurance identifies an astonishing 1,961 mandated benefits and providers. While any one mandate may not add appreciably to the price of an insurance policy, in the aggregate their cost is huge. The Cato Institute, citing the Congressional Budget Office, estimates that state regulations increase the cost of health insurance by 15 percent. And since "each percentage-point rise in health insurance costs increases the number of uninsured by 300,000 people," as scholars John Cogan, Glenn Hubbard, and Daniel Kessler point out, it is clear that the proliferation of insurance mandates is one reason why millions of Americans are uninsured.

Yet instead of pruning back this thicket of compulsory benefits, lawmakers are busily planting even more of them.

As Kay Lazar reported in the Boston Globe on Monday, Massachusetts legislators have filed more than 70 bills this year to increase the array of services the state's health insurers are required to cover. Among the benefits the pending bills would mandate are hearing aids for children, cleft palate surgery, treatment of infantile cataracts, 48-hour hospital stays following a mastectomy, smoking cessation products, "asthma education," vitamin supplements for mitochondrial disease, post-partum depression screening -- and the list goes on and on.

As it is, health insurance in Massachusetts -- which already mandates coverage for more than 40 itemized benefits, providers, and patient populations -- is among the nation's most expensive. The last thing the Bay State (or any state) needs is for government to be driving the cost of medical coverage higher still. It should be left to the market, not to lawmakers and lobbyists, to decide which medical services should be included in a basic-vanilla insurance policy. When lawmakers yield to special-interest pleas that this or that benefit be made compulsory, the results are less choice, higher premiums, and more individuals priced out of the market.

The key to health care reform is lively competition, not the dead hand of government compulsion. Legislators, take note: Enacting new mandates won't make medical insurance more affordable. Repealing old ones just might.


ObamaCare: It’s not about money

People have always quarreled about money, and sometimes these conflicts conceal a deep animosity.

President Obama has made Health Care Reform a priority for his first year in office. His website promises that his program will "Reduce costs, guarantee choice, including a public option, and ensure quality care for all." The big claim is that the President's Health Care Reform will be a vast improvement compared to the present system.

Supporters of the President's initiative point out that health care spending is enormous, that the price of health insurance for businesses and individuals is increasing and becoming unaffordable, and that the consequences of failing to bring down costs is dire. They argue that only the government can make things right.

But critics of the President's plan are warning that it will bring about both lower quality health care and will have a more expensive price tag. Free market advocates point out that government health care programs - such as Medicare - not only do not save money but also have ballooning costs that exceed their original forecasts.

It does not help the case for the Obama plan that the Congressional Budget Office has estimated that the proposed program will increase health care spending in the United States - exactly the opposite of what its supporters claim it is intended to do.

Of course, ObamaCare enthusiasts say that the Congressional Budget Office is mistaken, and even if spending goes up for a few years, costs will be reduced in the long run under wise government guidance.

So we have two factions slugging it out. The Obama team, representing the statist approach, insists that its plan will economically make the nation healthier. Free market advocates, the principled opposition to increased government intrusion, are convinced that Obama's Health Care Reform will be extravagant and ineffective.

You might imagine that the way to resolve the conflict between the partisans is to find a fair way to forecast what health care spending would be with and without ObamaCare. But that would miss the point, because the dispute is not really about cost: it is about who will control health care. Statists yearn for a system where the government is in charge, while free marketers want individuals to make their own decisions. Both sides are focusing on health care spending because they know that cost is always important, and saying you are thrifty while your opponent is wasteful makes for a good talking point. But in their attempt to be persuasive the antagonists are deliberately sidestepping the core issue.

Consider the typical attitude of the ObamaCare advocate: he believes that people often make foolish choices and health care is an area where they need to be 'nudged' to make wise decisions. Of course, the assistance should come from experts who are empowered by the government to 'assure the right choice is made.' He understands that when the government becomes the major player in health care it has the power to control costs - by rationing services, if necessary. And rationing does not bother him because he feels that a lot of health care expenditures are currently wasted and there is a need for a more sensible way--other than the unbridled choices of individuals--to decide who gets treated and how.

If the ObamaCare enthusiast believed that total spending on health care would go down if the government refrained from fiddling he would not be impressed. A health care system that is allowed to go its own way, that relies on markets, that is not centrally planned is odious to him. It is worthwhile to spend more money on health care if the result is a system managed by progressives who are looking out for 'the interests of society as a whole.'

And what is in the mind of the free marketer? He knows that each person owns his life and has a natural right to manage it for himself. He understands that the proper role of government is to protect natural rights - not to direct the lives of individuals. He appreciates that people have the capacity to make intelligent choices, and that when some people act imprudently, it is not a justification for a government takeover. He knows that when government extricates itself from meddling in the health care system the result will be more innovation, better services, and less expensive costs. But it is the importance of freedom, not saving money, that is the essential reason to proscribe government interference.

If the free marketer believed that additional government intervention in health care would result in reduced spending he would not be impressed. A health care system---and a human life---that is managed by a central authority is unacceptable. It is worthwhile to spend more money on health care if the result is a citizenry that is self-reliant and not subjugated to the will of the government.

People have always quarreled about money, but the ObamaCare debate is about much more.


Thursday, July 30, 2009

Britain's Left-run NHS deliberately kills off older people

Do you really think Obamacare will be different?

Older women with breast cancer are less likely to receive “standard” treatments such as chemotherapy, radiotherapy or surgery than younger women, a report says today. Only 16 per cent of patients over 65 received chemotherapy compared with 77 per cent of patients under 50, according to an audit of British health services by the charity Breakthrough Breast Cancer. A total of 48 per cent of women aged 80 and over did not receive any type of surgery, compared with 3.5 per cent of women aged under 50. Only 42 per cent of women aged 65 and over received breast-conserving surgery, compared with 51 per cent of women under 65. Meanwhile, only 31 per cent of breast cancer patients over 80 received radiotherapy, compared with 78 per cent of patients under 50.

The audit, which was published in the British Journal of Cancer, analysed 48,983 cancer patients from 11 regional cancer networks. Breakthrough Breast Cancer said that although some of the findings could be accounted for by some women not wanting some of the treatments or surgery, the figures were too high to be explained through patient choice alone.

Maggie Alexander, the charity’s director of policy and campaigns, said: “Breakthrough is concerned that there appear to be significant differences in treatment given to patients depending on their age. “All women should be offered appropriate treatment options no matter what their age, and that’s why we are now investigating this issue to find out what lies behind these differences.”

Gill Lawrence, the director of the West Midlands Cancer Intelligence Unit, who led the project, added: “We encourage breast units to review their services and to identify ways in which they can be improved. “Although the data in this report are for breast cancers diagnosed in 2004, we are confident that the data highlight issues that still exist today.”


Is There a ‘Right’ to Health Care?

In Britain, its recognition has led to substandard care


If there is a right to health care, someone has the duty to provide it. Inevitably, that “someone” is the government. Concrete benefits in pursuance of abstract rights, however, can be provided by the government only by constant coercion.

People sometimes argue in favor of a universal human right to health care by saying that health care is different from all other human goods or products. It is supposedly an important precondition of life itself. This is wrong: There are several other, much more important preconditions of human existence, such as food, shelter and clothing. Everyone agrees that hunger is a bad thing (as is overeating), but few suppose there is a right to a healthy, balanced diet, or that if there was, the federal government would be the best at providing and distributing it to each and every American.

Where does the right to health care come from? Did it exist in, say, 250 B.C., or in A.D. 1750? If it did, how was it that our ancestors, who were no less intelligent than we, failed completely to notice it? If, on the other hand, the right to health care did not exist in those benighted days, how did it come into existence, and how did we come to recognize it once it did?

When the supposed right to health care is widely recognized, as in the United Kingdom, it tends to reduce moral imagination. Whenever I deny the existence of a right to health care to a Briton who asserts it, he replies, “So you think it is all right for people to be left to die in the street?” When I then ask my interlocutor whether he can think of any reason why people should not be left to die in the street, other than that they have a right to health care, he is generally reduced to silence. He cannot think of one.

Moreover, the right to grant is also the right to deny. And in times of economic stringency, when the first call on public expenditure is the payment of the salaries and pensions of health-care staff, we can rely with absolute confidence on the capacity of government sophists to find good reasons for doing bad things.

The question of health care is not one of rights but of how best in practice to organize it. America is certainly not a perfect model in this regard. But neither is Britain, where a universal right to health care has been recognized longest in the Western world. Not coincidentally, the U.K. is by far the most unpleasant country in which to be ill in the Western world. Even Greeks living in Britain return home for medical treatment if they are physically able to do so.

The government-run health-care system—which in the U.K. is believed to be the necessary institutional corollary to an inalienable right to health care—has pauperized the entire population. This is not to say that in every last case the treatment is bad: A pauper may be well or badly treated, according to the inclination, temperament and abilities of those providing the treatment. But a pauper must accept what he is given.

Universality is closely allied as an ideal, ideologically, to that of equality. But equality is not desirable in itself. To provide everyone with the same bad quality of care would satisfy the demand for equality. (Not coincidentally, British survival rates for cancer and heart disease are much below those of other European countries, where patients need to make at least some payment for their care.)

In any case, the universality of government health care in pursuance of the abstract right to it in Britain has not ensured equality. After 60 years of universal health care, free at the point of usage and funded by taxation, inequalities between the richest and poorest sections of the population have not been reduced. But Britain does have the dirtiest, most broken-down hospitals in Europe.

There is no right to health care—any more than there is a right to chicken Kiev every second Thursday of the month.


10 Questions for Supporters of 'ObamaCare'

1. President Barack Obama repeatedly tells us that one reason national health care is needed is that we can no longer afford to pay for Medicare and Medicaid. But if Medicare and Medicaid are fiscally insolvent and gradually bankrupting our society, why is a government takeover of medical care for the rest of society a good idea? What large-scale government program has not eventually spiraled out of control, let alone stayed within its projected budget? Why should anyone believe that nationalizing health care would create the first major government program to "pay for itself," let alone get smaller rather than larger over time? Why not simply see how the Democrats can reform Medicare and Medicaid before nationalizing much of the rest of health care?

2. President Obama reiterated this past week that "no insurance company will be allowed to deny you coverage because of a pre-existing medical condition." This is an oft-repeated goal of the president's and the Democrats' health care plan. But if any individual can buy health insurance at any time, why would anyone buy health insurance while healthy? Why would I not simply wait until I got sick or injured to buy the insurance? If auto insurance were purchasable once one got into an accident, why would anyone purchase auto insurance before an accident? Will the Democrats next demand that life insurance companies sell life insurance to the terminally ill? The whole point of insurance is that the healthy buy it and thereby provide the funds to pay for the sick. Demanding that insurance companies provide insurance to everyone at any time spells the end of the concept of insurance. And if the answer is that the government will now make it illegal not to buy insurance, how will that be enforced? How will the government check on 300 million people?

3. Why do supporters of nationalized medicine so often substitute the word "care" for the word "insurance?" it is patently untrue that millions of Americans do not receive health care. Millions of Americans do not have health insurance but virtually every American (and non-American on American soil) receives health care.

4. No one denies that in order to come close to staying within its budget health care will be rationed. But what is the moral justification of having the state decide what medical care to ration?

5. According to Dr. David Gratzer, health care specialist at the Manhattan Institute, "While 20 years ago pharmaceuticals were largely developed in Europe, European price controls made drug development an American enterprise. Fifteen of the 20 top-selling drugs worldwide this year were birthed in the United States." Given how many lives -- in America and throughout the world – American pharmaceutical companies save, and given how expensive it is to develop any new drug, will the price controls on drugs envisaged in the Democrats' bill improve or impair Americans' health?

6. Do you really believe that private insurance could survive a "public option"? Or is this really a cover for the ideal of single-payer medical care? How could a private insurance company survive a "public option" given that private companies have to show a profit and government agencies do not have to – and given that a private enterprise must raise its own money to be solvent and a government option has access to others' money -- i.e., taxes?

7. Why will hospitals, doctors, and pharmaceutical companies do nearly as superb a job as they now do if their reimbursement from the government will be severely cut? Haven't the laws of human behavior and common sense been repealed here in arguing that while doctors, hospitals and drug companies will make significantly less money they will continue to provide the same level of uniquely excellent care?

8. Given how many needless procedures are ordered to avoid medical lawsuits and how much money doctors spend on medical malpractice insurance, shouldn't any meaningful "reform" of health care provide some remedy for frivolous malpractice lawsuits?

9. Given how weak the U.S. economy is, given how weak the U.S. dollar is, and given how much in debt the U.S. is in, why would anyone seek to have the U.S. spend another trillion dollars? Even if all the other questions here had legitimate answers, wouldn't the state of the U.S. economy alone argue against national health care at this time?

10. Contrary to the assertion of President Obama -- "we spend much more on health care than any other nation but aren't any healthier for it" -- we are healthier. We wait far less time for procedures and surgeries. Our life expectancy with virtually any major disease is longer. And if you do not count deaths from violent crime and automobile accidents, we also have the longest life expectancy. Do you think a government takeover of American medicine will enable this medical excellence to continue?


The Perils of Socialized Medicine

by John Campbell

Regular readers know that I am a numbers, financial, and economic guy, as betrayed by my CPA certification. As important as these issues are, we are now presented with an issue even more vital. The socialized healthcare bill being considered by the House will likely result in tens of millions of Americans dying sooner than they otherwise would have to.

When the free-market, doctors, and patients are taken out of health care decisions, and the care is paid for by somebody else, the establishment of an organization to ration care is inevitable. In fact, the legislation creates the National Institute of Comparative Effectiveness. As benign as it may sound, this is the bureaucracy that will be used to ration care. A similar institution exists in Britain, and has the rather ominous acronym of NICE (National Institute for Health and Clinical Experience). Rulings on whether people live or die are made frequently in Britain and Canada, and if you have a pre-existing condition, are elderly, or for some reason deemed ‘unfit’ for a life saving procedure, then your chances of being granted that life saving procedure become even murkier. Your life will hang in the balance, subject to the whims of government and its bureaucrats. This is why the survival rates from cancer, heart disease, and many other life-threatening diseases are 30-50% lower in countries with socialized medicine than they are in countries with private medicine.

And why are we doing this? It is generally accepted that about 85% of Americans have some form of health insurance. But, 15% do not. Of the 15% that do not, about one third have plenty of income and wealth, but choose not to buy insurance because they think they are healthy and want to save the money, and if they have a problem they will just go to the emergency room. Another third are eligible for Medicaid or Medicare or other subsidized care, but have not signed up. Only that last third, or 5% of the population, are truly uninsured, want insurance, and have no realistic option to get it.

Without question, there is a problem with which we must deal. But we should not sacrifice the quality of care and the life expectancy of 95% of the population for 5% as the Obama/Pelosi plan does. Furthermore, their plan fails to cover that 5%.

The Democrats in the House are practically at war amongst themselves over this because their more moderate members see the folly in socialized medicine. As I left the Capitol earlier today, the final committee with jurisdiction on this bill, Energy and Commerce, still had not met to vote on the bill. Committee Chairman Henry Waxman (D-CA) suggested that maybe his committee should just be bypassed if the votes to pass the bill weren’t there. That, is truly desperation.

They know how powerful a message it is. Democrats, led by Nancy Pelosi are so nervous that the public might find out what is really in this health care proposal that they have taken the unprecedented step of trying to use the rules of the House to censor the minority, and restrict what we are allowed to say or send out to you. In other words, they want to limit the only real power the loyal minority has, which is the power to communicate criticisms of the majority's proposals and present alternatives. Among the items to which they have objected to is the chart shown below. They have not been able to say that this chart, which reflects the organization of the Obama/Pelosi Health Care bill, is inaccurate. They say that some of the descriptions of the agencies are "misleading." Right. If you want to see misleading, read my blog on the 10 "inaccuracies" in President Obama’s news conference last week.

The Greeneyeshade Blog - Obama Misleads us on Healthcare

Your government run health care system will look like this if this bill passes. The Speaker and her minions just don't want you to know it.

John Locke must be rolling in his grave. This socialized medicine package is a leap in a direction to which the government will now view its citizens as liabilities. This is in a republic that was founded on the premise that the government derives its power from the ‘consent of the governed.’ If this bill passes, perhaps we should change that to ‘consent of the governed, unless they represent too high of a liability.’

I admit, I am little worked up about this. But darn it, it's really important.

SOURCE (See the original for a larger chart)

The uninsured now secondary

That sudden jolt just felt by the 40 million uninsured Americans and their supporters was the presidential carpet being yanked out from under their feet, as President Barack Obama unexpectedly abandoned so-called “universal coverage” as the chief reason a health care overhaul bill was so urgent. He’s decided instead to focus on the cost of health care for all, insured or not.

Unfortunately, the plans he and the congressional Democrats are offering would be as ineffective at that as at covering the uninsured.

The president’s abrupt abandonment of the uninsured came after a series of polls showed his proposal has lost support now that the public has discovered how expensive and intrusive it would be.

A Rasmussen Reports poll released July 13 showed more Americans (49 percent) oppose Obama’s health care proposal than favor it (46 percent). Five days later, another Rasmussen poll showed 61 percent believe high costs are the biggest problem the nation’s health care system currently faces, with only 21 percent saying so-called “universal coverage” was their chief concern.

The loss of his initial casus belli didn’t lessen Obama’s eagerness for a government takeover. As concern about universal coverage dwindled, he simply abandoned the uninsured and changed his tune to a concern for cutting costs. In a speech on Monday (July 20) Obama placed the emphasis squarely on the latter. “I’ve said this before,” he said. “Let me repeat: The bill I sign must reflect my commitment and the commitment of Congress to slow the growth of health care costs over the long run.”

Unfortunately for the 62 percent of Americans who see high costs as the biggest problem, the bills proposed by the congressional Democrats and supported by Obama would increase taxes while doing nothing to lower costs. You don’t have to take my word for it. In his July 16 testimony before the Senate Budget Committee, Doug Elmendorf, director of the nonpartisan Congressional Budget Office, reported the proposed health care bills would add significantly to the federal budget deficit while doing nothing to “reduce the trajectory of federal health spending by a significant amount.”

The bills before Congress are designed to push millions of Americans into a government insurance plan—in evaluating it, just consider what a great deal you’re getting from Social Security—and somehow cut costs by taking advantage of government’s universally acknowledged brilliance at running lean and mean. What that all really means is forcing consumers into a government program that rations your care, as other countries’ nationalized systems do. Get ready for long waits for treatment, if you can get treatment at all.

The sensible alternative is to deal directly with the cost problem by enabling consumers to cut costs by giving them more choice, not less. The government could do that very easily by stripping out unnecessary mandates and regulations and standardizing the tax treatment of health insurance. The increased competition would reduce insurance premiums, thus allowing the uninsured to find affordable policies if they want them.

Unfortunately, Obama and Congress aren’t considering such liberating notions, preferring instead to increase government power and decrease consumer choice.

As for the uninsured, the CBO said the proposed overhauls would enable only about a third (16 million) of them to gain coverage. That probably made it even easier for Obama to drop them from his list of concerns. But instead of throwing the uninsured overboard, he and his fellow Democrats in Congress should consider liberalizing measures that would benefit everybody.


Wednesday, July 29, 2009

More beds, not more bureaucrats, are what Australia's hospitals need

Australia shows where socialized medicine leads

RUDD should invest in a voucher scheme instead of taking over hospitals. It's a quarter of a century since Medicare was established, but no one is celebrating. No wonder, considering the critical condition of the public hospital system throughout Australia. Instead we have a 300-page reform blueprint from the National Health and Hospital Reform Commission.

At least the report has identified the main problem. The reality is that Australia's dangerously overcrowded public hospitals don't have enough beds to provide a safe and timely standard of care even for emergency patients. Unfortunately, the commission has strongly supported a range of non-solutions. The primary care reforms it proposes will not help our dysfunctional state-run public hospitals cope with an inexorable rise in demand from an ageing population.

Since 1983 the state health bureaucracies that are responsible for allocating funding, planning services and rationing public hospital care have cut the number of public hospital beds by one-third: from 74,000 beds to just over 54,000. This is a 60 per cent cut, taking population growth into account, from 4.8 public acute beds for every 1000 Australians to 2.5 beds.

Overcrowding occurs when bed occupancy exceeds 85 per cent in hospitals, operating near or beyond full capacity. Average bed occupancy in most leading metropolitan public hospitals is above 90per cent and hospitals routinely operate above 100 per cent occupancy because of political pressure to reduce electorally sensitive waiting times for elective surgery.

The nationwide bed shortage means one-third of emergency patients wait longer than eight hours for a bed to become available. Emergency staff spend more than one-third of their time caring for these patients, which leads to more than 30 per cent of patients not being seen in emergency departments within the recommended time.

The queue for free public hospital care now starts in crowded hospital corridors lined with ailing, mostly frail, elderly patients who are parked on trolleys for hours and sometimes days.

The pressure on hospitals is intensifying because rising numbers of older patients with complex conditions are requiring unplanned admission for bed-based medical and nursing care. In the past five years, admissions by patients aged between 75 and 84, and 85 and older, increased by 25 per cent. A decade ago, the 85-plus demographic wasn't even distinguished in the statistics.

The problem is not that hospitals are underfunded. Over the past decade, real expenditure on public hospitals increased by 64 per cent to top $27 billion in 2006-07. The real problem is that not enough of the money gets through to the frontlines. Between 1996 and 2006 the number of acute public hospital beds fell by 18 per cent per 1000. But between 2001 and 2006, the number of administrators increased by 69 per cent.

The large and costly area health services that administer public hospitals in most states are better at paying for bureaucrats than for beds, and have a deservedly notorious reputation among overworked hands-on hospital staff for warehousing armies of clerks and managers who have no involvement in patient care.

As more and more people live to older ages, a tsunami of demand will break in public hospitals. Increasing numbers of very old patients will inevitably require emergency and bed-based hospital care due to the age-related onset of chronic conditions. Going by the state of the health reform debate, the hospital crisis will become a catastrophe. The wrong-headed premise of the Rudd government's reform agenda is that the commonwealth must spend billions on a national network of comprehensive general practice "super clinics" to take pressure off hospitals.

The NHHRC has fully endorsed this approach. It claims that 10 per cent of public hospital admissions can potentially be prevented by providing better co-ordinated primary and allied health care for chronically ill and elderly patients.

Yet even the discussion paper on the subject commissioned by the commission shows that trial co-ordinated care programs have failed to keep people out ofhospital.

The 15 per cent boost in bed numbers recommended by the commission is welcome. But even if the government accepts this, a one-off and costly boost in bed numbers is not a long-term solution.

Instead of wasting money building stand-alone elective hospitals and wasting political capital trying to take full responsibility for the primary care system, the Rudd government should focus on structural reform of the hospital system.

Flexible and responsive funding and administrative arrangement must be created to allow hospitals to increase the supply of beds and meet the demand that rising numbers of older and sicker patients will generate in coming decades.

The first step towards rebuilding the hospital system is for the commonwealth to take full control of public hospital funding and introduce Medicare-issued, case-mix-calculated hospital vouchers to pay for treatment in either public or private hospitals. The second step is for state governments to agree to re-introduce local public hospital boards with full financial and administrative responsibility for their facilities. The third step is to close down the area health services and use the money saved to fund vouchers and open and staff more hospital beds.

This isn't a plan for Canberra to take over and run hospitals. Funding will be centralised by converting the present federal grants and state hospital budgets into vouchers, while the management of hospitals will be decentralised to local boards. Nor is this a plan to privatise the health system. Tying taxpayer funding to the treatment of patients, increasing choice and competition, and freeing hospitals to respond appropriately to the health needs of the community is not that radical.

This parallels the voucher-based policies the Rudd government is considering implementing to increase efficiency and improve access to publicly funded education in schools, TAFE and universities.

A 50 per cent increase in patients presenting at emergency aged over 85 is predicted over the next five years alone. Bed numbers must increase significantly to equip the hospital system to cope with the unprecedented impact of demographic change. The challenge for policy-makers is to dispense with the failed methods of running public hospitals that have created a continuing crisis 25 years in the making.


Obamacare: It’s even worse than you think

President Obama's strategy to pass sweeping health care legislation rested on stealth and speed. The idea was to fill the conversation for months on end with vague talk about expanding coverage, "bending the cost-curve," improving quality, and rooting out waste, without showing the public how the plan would actually work or what it would cost. Legislation, meanwhile, would be composed behind closed doors, and the bills would be introduced as close as possible to when they might come up for a vote to minimize the time in which they could actually be read and thought about by those who would vote on them and those who would live under them. By the time the details emerged, maybe momentum and being "closer than ever before" would be enough to overcome the torrent of objections that were sure to be raised when people got a real look at the nuts and bolts.

That moment has now come. House Democrats finally unveiled their plan on July 14, with the aim of passing it by July 31, the last day before the August congressional recess. The Senate's Health, Education, Labor, and Pensions Committee has released its part of the plan, but the Finance Committee (which must figure out how to pay for it all) has yet to do so. There, too, the leadership hoped for a vote before the recess.

But things have not gone as the Democrats intended. As details have emerged, an extraordinary wave of public concern has washed over the debate and left the plan's champions reeling. It is all but certain that both the House and Senate will recess for August without voting on health care, despite the president's insistence on its urgency. And the emerging tone of the public debate casts serious doubt on the fate of Obamacare more broadly.

The reasons for the public revolt are easy to see. The Democrats want to spend $1.5 trillion over a decade, impose an $800 billion tax increase in the midst of the worst recession in a generation, increase federal borrowing by $239 billion (on top of the $11 trillion the Obama budget already requires us to borrow through 2019), impose costly mandates on employers that will discourage hiring as unemployment nears 10 percent, force individuals to buy one-size-fits-all government defined insurance, and insert the government in countless new ways between doctors and patients. All of that would occur whether or not the plan includes a "public option," which at this point it does include and which will exacerbate all of these problems.

As these facts have become clear, Obama's standing has fallen and public opinion has grown decidedly less enthusiastic for the administration's approach. The trend is likely to continue, because the details of the plan reveal that its two most serious drawbacks--its cost and the prospect of government rationing--are worse than even most of their critics have grasped.

First, there are massive hidden costs inherent in a little-understood provision of the plan. The centerpiece of Obamacare is a new premium subsidy program. In the House bill, families with incomes up to four times the poverty level would get a fixed cap on their insurance premiums, tied to their incomes. For instance, a family whose income is twice the poverty level would pay no more than 5 percent of its total income for insurance. But providing that guarantee to all such households in America would cost far more than even the Democrats are willing to propose. The plan therefore would make subsidies available only to households getting insurance through the new "exchanges," insurance pools set up in each state as a parallel system to job-based coverage. And full-time workers in all but the smallest firms would be barred from entering the exchanges, at least for a time, so they wouldn't have access to the new entitlement.

More here

Giving less care is the only way healthcare can be made cheaper

President Obama has made many promises about his health-reform agenda, but none looms larger than: "You will save money." Not only has the president promised to lower consumers' health-insurance bills; he says his plan will trim federal spending as well. Thus, when the head of the Congressional Budget Office (Congress's fiscal watchdog) testified last Friday that none of the bills under consideration in the House or Senate would rein in spending--and that all would likely increase it--the president's reform push took a heavy hit. The CBO's assessment underscored an important reality about health care. Lowering health-care costs (which have been rising faster than inflation for decades, except for a brief perio! d in the 1990s) while improving quality is possible, but it's awfully hard, for one simple reason: when it comes to health-care spending, death is the only really cheap option.

William Osler, a renowned nineteenth-century doctor and the first physician-in-chief at Johns Hopkins Hospital, once remarked, "Pneumonia may well be called the friend of the aged. Taken off by it in an acute, short, not often painful illness, the old man escapes the 'cold gradations of decay,' so distressing to himself and to his friends." If Osler were alive today, he might call pneumonia the friend of Medicare accountants, since it kills victims quickly, in contrast with the lingering and expensive chronic illnesses that account for about three-quarters of all Medicare spending.

Few policymakers working on health-care reform in Washington stop to consider the obvious corollary: dying early is cheap, and keeping people alive long enough to collect Medicare is expensive. Instead, experts talking about health spending promulgate what I call the Eat Your Vegetables Theory: we can save gobs of money by focusing on technological fixes (like electronic health records) and disease prevention, which will yield a healthier population that is cheaper to treat. The savings generated can then be used to subsidize coverage for millions of the uninsured. But this approach is unlikely to work as advertised: as Osler's dictum suggests, increasing prevention efforts may wind up costing more.

Take pneumonia. We have relatively cheap and effective treatments for it, especially vaccines and antibiotics. As a result, many older Americans who might have died from pneumonia in Osler's day now live years or decades longer--long enough to qualify for Medicare and then develop much more expensive ailments like diabetes, cancer, and Alzheimer's. Researchers at the RAND Corporation noted the conundrum across several studies and came to roughly the same conclusion: "Medical innovations will result in better health and longer life, but they will likely increase, not decrease, Medicare spending."

In one study, the researchers postulated three different scenarios for the health costs of seniors entering Medicare from 2002 to 2030. Scenario A took into account everything that we know today about the health of the current cohort of seniors entering Medicare and future enrollees, up to 2030. (This is a mixed bag. Seniors' health started improving in the 1980s, but rates of chronic diseases have been increasing rapidly in recent years, and newer enrollees are likely to be sicker and thus more expensive.) Scenario B assumed that future cohorts would be as healthy as those in the 1990s. And Scenario C (the most optimistic) assumed that seniors' health would continue to improve. Under rosy Scenario C, the researchers found, health spending would be $10,275 per Medicare enrollee in 2030--just 8 percent lower than under Scenario A. Why? Healthier seniors live longer and accumulate more costs; also, costs are rising faster among less disabled seniors, presumably because they! use more new drugs and devices that prevent them from becoming disabled (knee replacements, for example).

In another study, RAND researchers looked at how ten important medical innovations likely to emerge in the near future might affect Medicare spending in 2030. These included anti-aging compounds for healthy people, cancer vaccines, tiny defibrillators implanted near the heart, better treatments for stroke and cancer, and Alzheimer's prevention. Every hypothetical innovation, the researchers found, would increase Medicare spending. Even the cheapest, an anti-aging compound taken by healthy people that would cost just $11,245 per life-year saved, would increase health-care spending by 14 percent in 2030--because there would be 13 million more beneficiaries collecting benefits.

Finally, RAND examined the effects of fighting four risk factors for heart disease. If we could get all the elderly to stop smoking and control their diabetes, their health would improve, of course, but costs would rise, again because those ex-smokers and diabetics would eventually be vulnerable to other health problems. If we effectively treated hypertension and slashed obesity rates by 50 percent, however, health would improve and costs would fall. Reducing obesity produced the clearest gains because obesity, though it sharply increases costs, doesn't reduce longevity significantly.

What all three studies suggest, then, is technological innovations or disease prevention will likely result in slight savings or even increased costs (though obesity may be the exception to this trend). This doesn't mean, of course, that we shouldn't keep inventing drugs and devices to keep people alive longer, or that we shouldn't develop better prevention strategies. It just means that we should stop pretending that good health is always cheaper. Sometimes, you really do get what you pay for.


Ghoulish science + Obamacare = health hazard

by Michelle Malkin

Health and Human Services Secretary Kathleen Sebelius tried to reassure citizens in New Orleans this week that Obamacare bureaucrats will make sound medical decisions for all Americans. She failed. Under the government-run plan, she promised, a team of health care experts will recommend what should be covered: “I think it would be wise to let science guide what the best health care package is.”

Gulp. It’s precisely the Obama administration’s view of sound “science” that should send chills down patients’ spines. Case in point: The president’s prestigious science czar John Holdren refuses to answer questions about his radical, published work on population control over the last 30 years.

Last week, I called the White House Office of Science and Technology Policy (OSTP) to press Holdren on his views about forced abortions and mass sterilizations; his purported disavowal of Ecoscience, the 1977 book he co-authored with population control zealots Paul and Anne Ehrlich; and his continued embrace of forced-abortion advocate and eugenics guru Harrison Brown, whom he credits with inspiring him to become a scientist.

After investigative bloggers and this column reprinted extensive excerpts from Ecoscience, which mused openly about putting sterilants in the water supply to make women infertile and engineering society by taking away babies from undesirables and subjecting them to government-mandated abortions, the White House issued a statement from Holdren last week denying he embraced those proposals. The Ehrlichs challenged critics to read their and Holdren’s more recent research and works.

Well, I did indeed read one of Holdren’s recent works that reveals his clingy reverence for, and allegiance to, the gurus of population control authoritarianism. He’s just gotten smarter about cloaking it behind global warming hysteria. In 2007, he addressed the American Association for the Advancement of Science conference. Holdren served as AAAS president; the organization posted his full slide presentation on its website.

In the opening slide, Holdren admitted that his “preoccupation” with apocalyptic matters such as “the rates at which people breed” was a lifelong obsession spurred by scientist Harrison Brown’s work. Holdren heaped praise on Brown’s half-century-old book, “The Challenge to Man’s Future,” then proceeded to paint doom-and-gloom scenarios requiring drastic government interventions to control climate change.

Who is Holdren’s intellectual mentor, Harrison Brown? He was a “distinguished member” of the International Eugenics Society whom Holdren later worked with on a book about – you guessed it – world population and fertility. Brown advocated the same population control-freak measures Holdren put forth in Ecoscience. In “The Challenge to Man’s Future,” Brown envisioned a regime in which the “number of abortions and artificial inseminations permitted in a given year would be determined completely by the difference between the number of deaths and the number of births in the year previous.”

Brown exhorted readers to accept that “we must reconcile ourselves to the fact that artifical means must be applied to limit birth rates.” If we don’t, Brown warned, we faced a planet “with a writhing mass of human beings.” He likened the global population to a “pulsating mass of maggots.”

When I pressed Holdren’s office specifically about Holdren’s relationship with Harrison Brown, press spokesman Rick Weiss told me he didn’t know who Brown was and balked at drawing any conclusions about Holdren’s views based on his homage to lifelong intellectual mentor, colleague and continued inspiration Brown just two years ago.

Weiss lectured me rather snippily about the need for responsible journalism (he was a Washington Post reporter for 15 years). He then me not to expect any response from Holdren’s office to my question on whether Holdren disavows his relationship with a eugenics enthusiast who referred to the world population as a “pulsating mass of maggots” and championed a scheme of abortion and artificial insemination quotas. If this is the kind of ghoulish “science” that guides the White House, we can only hope that Obamacare is dead on arrival.


Tuesday, July 28, 2009

Australian mother sues public Hospital after nearly bleeding to death

A DIABETIC mother has begun legal action against Ipswich Hospital, alleging staff's negligence nearly caused her to bleed to death during childbirth. The 32-year-old has served Ipswich Hospital, west of Brisbane, with a notice of claim for negligence.

The Ipswich mother of four, who only wanted to be known by her first name Kylie, said she was traumatised after haemorrhaging 1.5 litres of blood two hours after giving birth in May. "Instead of sending me to the operating theatre, they were giving me morphine and trying to fix the clotting by reaching into my cervix not just once but four agonising times," she said. "I was screaming in agony and they had my legs pinned down telling me to be quiet.

"My daughter, who was there holding the newborn, was crying and my sister was crying because the midwives and the doctor wouldn't listen."

Her lawyer Olamide Kowalik said Kylie had begun action against the hospital over her treatment and also for the trauma her 12-year-old daughter suffered from witnessing her mother's ordeal.

Ipswich Hospital was served the notice of claim in early July and has 30 days to respond and supply medical records. The hospital's executive director, Dr Gerry Costello, declined to comment, saying it was inappropriate due to ongoing legal action.

Ms Kowalik said the hospital should have been aware there would be complications because medical records showed Kylie bled through her three previous pregnancies.


Another big government medical bungle in Australia

Something very similar happened in Britain a couple of years ago but do governments ever learn? Rhetorical question

HUNDREDS of international medical students were told this week they would not be guaranteed internships in NSW public hospitals because there are not enough staff to supervise them. The warning comes despite the Federal Government ramping up university places in the past three years to solve the state's crippling shortage of doctors.

The students, who each paid about $200,000 in course fees, are furious, saying it is now too late for them to get internships in their home countries and any forced break between the end of their studies this month and starting work in a hospital was "career suicide".

For the first time, the State Government invoked a priority system this year when 879 students applied for 670 positions, saying it did not have enough money to offer internships to all graduates wanting to work in NSW.

The Institute of Medical Education and Training, which allocates internships, has blamed a surge in the number of interstate students applying for jobs in NSW because they have been unable to find enough supervised roles in their home states. It said the problem was compounded by some students accepting multiple internships in several states, then not showing up for work when the rotations began in January.

Under the priority system, NSW students are offered places first, then Australian and New Zealand residents from interstate, then other international students studying in Sydney.

But overseas students have been told final offers will not be made until January, well after interns overseas have started their hospital rotations. "We're shell-shocked," one student said. "All along we've been assured we would get placements, then on Monday afternoon we got a two-line email rejecting us. "We wanted to live our lives in Australia and work in the NSW hospital system. Now we don't know what to do. You just can't take a break between university and vocational training. It is virtually impossible to get back in."

Medical student numbers in NSW soared from 493 in 2007 to 1104 last year, prompting universities to issue warnings the health system would not be able to support the rise. "These are people who want to work in the system," the president of the Australian Medical Association, Andrew Pesce, said yesterday. "They've paid for something and they have every right to be angry that they are not getting it. "What is the point in training yourself if you are not able to work as a doctor at the end? The Government needs to make a serious commitment to investing properly in training these people. It's an investment, not a cost."

The president of the Australian Medical Students Association, Tiffany Fulde, said hospitals were facing a "student tsunami" which would only worsen with three more medical schools turning out graduates in the next three years. "The system isn't coping now, so where will we be when we have double the number of students?" she said.

In April, the dean of medicine at the University of Sydney, Bruce Robinson, said the restrictions made NSW a "less attractive destination" for international medical students. "[It] places an extraordinary additional stress on them," he said. "International students in every year of their medical studies are rightly expressing deep concerns about their future prospects, and [this] is detracting from their experience of studying here," he said.

International students deserved a "fair go", he said. "We simply would like to be able to offer our international students the same education and training opportunities as we provide for our local students."


Obama has only himself to blame for his faltering healthcare measure

Here’s the dirty secret behind Washington’s health-care “fight”: Democrats won everything in last year’s election. You wouldn’t know it from the way President Barack Obama is blaming the GOP for his flagging health agenda. “There are those [read the GOP] who are advocating delay just as a desperation move to try to kill it,” complained White House budget director Peter Orszag. Republicans are working to “block health-care reform,” groused the president. “Republicans should immediately put an end to their political games,” demanded Democratic Rep. Chris van Hollen.

Indeed. The party of the left owns the White House, a filibuster-proof Senate, and a 70-seat House majority. As one House Republican aide quipped: “We could have every GOP congressman and their parents vote against a Democratic bill, and still not stop it.” All Democrats have to do is agree on something.

You can’t blame the GOP when you own every Washington institution. That they can’t is testimony to Team Obama’s mismanagement of its first big legislative project. The president is a skilled politician and orator, but the real test of a new administration is whether it can shepherd a high-stakes bill through Congress. In retrospect, the mistakes are growing clear.

• Living in the short term: The administration thought it was clever back in February, using its $787 billion “stimulus” as an excuse to pass all manner of non-stimulating spending. But the bill sent deficits soaring, forcing those numbers to the center of today’s health debate and unnerving Democratic deficit hawks. Mr. Obama’s demand that a bill be deficit-neutral enthused House liberals to propose crushing tax hikes that further alienated conservative Democrats.

Mr. Obama boxed himself in on taxes back in his campaign. Senate Finance Chairman Max Baucus and counterpart Chuck Grassley were merrily on their way to a bipartisan deal based on taxing existing health benefits. Yet having slammed John McCain for that idea, the White House vetoed the compromise, derailing an agreement. “The President is not helping us,” bluntly stated Mr. Baucus. “He does not want [that tax]. That’s making it difficult.”

• Unleashing Congress: Not wanting to repeat Hillary Clinton’s mistaken attempt to micromanage Congress, the administration took the equally dangerous path of no management at all. Left to wild impulses, Nancy Pelosi, Henry Waxman and Ted Kennedy took the most radical of Mr. Obama’s proposals (a public option entitlement) as a starting point, and ran left with new mandates, income tax surcharges, and business penalties. The House bill stirred a Blue Dog rebellion and mired the bill in committee. Mrs. Pelosi failed to include enticements for susceptible Republicans, leaving her hard-pressed to poach GOP votes.

The White House’s decision to let Mrs. Pelosi charge ahead with her climate bill has also been a disaster. To get that unpopular energy tax through, Mrs. Pelosi had to strip conservative Democrats of their committee rights and then arm-twist them into votes. Their egos and poll ratings bruised, this crew is balking at taking a second one for the team. “If you’re a member who voted for cap and trade and had a bad experience back home, you’re probably not looking forward to a bad vote on a health-care bill that’s not going to go anywhere in the Senate,” says Pennsylvania Blue Dog Jason Altmire.

• The perils of spin: Selling a huge expansion of government health care in the middle of a recession was never going to be easy. The Obama team hit on the argument that by adding to the government rolls, it would in fact save money and boost the economy.

Bizarre as this claim was, it became the administration’s prime rationale for “reform.” Until last week, when Congressional Budget Office director Douglas Elmendorf blew it up, noting that the existing House and Senate bills would “significantly expand” federal costs. This gave Democratic senators such as North Dakota’s Kent Conrad an excuse to back away from existing bills, and place new emphasis on a highly uncertain Baucus compromise.

• False deadlines: Mr. Obama is right to worry this project is a race against time and falling poll numbers. But the administration’s unwavering demand for bills before recess led to the gridlock it hoped to avoid. The deadline inspired the House leadership to rush out a bill without consensus, further antagonizing the Blue Dogs. In the Senate, the pressure on Mr. Baucus to produce has very nearly pushed away Mr. Grassley, who Democrats need for cover.

A unified Republican message helped raise public alarm. But if they were the problem, Mr. Obama’s campaign arm, Organizing for America, wouldn’t be running TV ads that target his own Democrats. This debate has a stretch to go, and we’re about to see if the administration is nimble enough to adapt its strategy. Some Democrats are even hinting the White House needs to start over. At this point, that might not be bad advice.



How many ways can the "reformers" be wrong?

The effort to reinvent medical care is so full of fallacies and bad logic that it would take volumes to properly expose them. Nevertheless, in this short space, let’s take a crack some of the problems.

To begin, the “reformers” want to compel insurers to cover people who are already sick for the same price charged healthy people pay. But if someone is already sick, no government plan to pay his medical bills can be accurately called “insurance.” Insurance is a voluntary way to spread risk. Risk comes from uncertainty. But someone already sick doesn’t face a risk that he might need medical attention for his ailment. He is certain to require the attention. There’s a reason you can’t buy homeowner’s insurance after your house has burned down or life insurance for a deceased person. Why should one expect to be able to buy insurance to cover medical treatment for a disease one already has contracted? When private donors voluntarily pay the bills, we call it charity or philanthropy or benevolence. When government pays them after extracting money by force from taxpayers or by requiring insurance companies to overcharge healthy people who are compelled to buy coverage, we should call it (at the very least) welfare.

If someone wants to defend medical welfare, let him do so. But don’t let him get away with calling it insurance. He not only does violence to the language; he also clouds the discussion. This is another application of the tacit premise that no one should have to pay for his own medical care. Bastiat’s line about the state being the means by which we all try to live at everyone else’s expense comes to mind.

President Obama says he will finance “reform” by shifting Medicare reimbursement decisions from Congress to an independent board of experts. Too bad he is unaware of the Austrian critique of central planning. Outside the marketplace, no one can know how much doctors and hospitals should be paid. Bureaucrats can’t tell what is too much or little compensation because they can’t have the relevant knowledge. Markets are good at setting prices because that knowledge is communicated through people’s buying and abstention from buying.

This is not just an academic discussion. Prices are information, and when they are “wrong” there are consequences. If the bureaucrats pay too little, costs will be shifted to others and providers will leave the market, creating shortages. If the bureaucrats pay too much, resources and labor will drawn away from other needed areas. With the collapse of the Soviet Union and the continuing examples of Cuba and North Korea, we should all know that government doesn’t know how to set prices.

Obama promises overall “cost containment.” But government has only two ways to accomplish this: rationing or price controls. The drawback to the first is obvious. People are forbidden to buy the services they want, even when they are willing to pay for them themselves. Bureaucrats — rather than individuals and their doctors — decide what tests and procedures are necessary. The drawback to the second is that services will disappear from the marketplace. Price ceilings create shortages.

On the other hand, the market has a method for containing costs. It’s called economizing, and people practice it naturally when they face the costs and consequences of their decisions. People are less likely to buy unnecessary services if they have to pay for them. And if they were buying their own insurance, they wouldn’t typically buy policies that covered smaller, routine expenses. The administrative overhead would make such policies a bad buy.

Conflicting Goals

The New York Times points out that the reformers have two conflicting ostensible goals: “to expand health coverage to nearly all Americans while reducing the growth of health spending.” How can they do both? Obama goes back and forth between stressing universal coverage and cost containment, but he doesn’t discuss one in relation to the other. Newly subsidized coverage will bring new demand for medical services and put more upward pressure on prices. As noted, higher prices can be counteracted only by denying service (say, hip replacements for octogenarians) or by imposing price controls, overtly or covertly.

What is it government’s business how much we spend on medical services? Government’s only concern should be to eliminate the ways it interferes with and influences our choices. The aggregate cost of our freely chosen actions is our concern alone, not the government’s.

But of course, government interferes with and influences our choices in many ways, and by doing so raises the costs. As Obama said the other night, “[T]he biggest driving force behind our federal deficit is the skyrocketing cost of Medicare and Medicaid.”

For once Obama was conceding that the government is at fault. Medicare and Medicaid are two ways the government forces the taxpayers to pay for medical care. Those who obtain their medical care through those programs have no incentive to economize because it’s free to them. That’s why the budgets are out of control — people act rationally according to the incentive system they are in — and why Obama is looking for ways to control costs. As long as those programs exist, he won’t be able control costs without bureaucratic rationing of services one way or another.

If the “reformers” get their way, something much like this failed system will be extended to the general public.

Ending Waste

Obama says two-thirds of the estimated cost of “reform” — at least $1.5 trillion over a decade — will be paid for “by reallocating money that is simply being wasted in federal health care programs.” I wouldn’t take seriously any of the reformers’ numbers. The safe bet is that cost of the program will far exceed what they project, and the most of the savings will never materialize. When Medicare was being put together, the pooh-bahs projected that by 1990, hospitalization coverage would cost only (!) $9 billion. when 1990 arrived, the price tag read $66 billion.

The final third of cost would likely come from surtaxes on upper-income earners. Are high earners likely stand still when targeted for new taxes? No. They will adjust their income-earning activities to minimize the tax take, and that will mean lower-than-projected revenues. Then what? Taxes on the middle class, perhaps. Or more debt and inflation.

Competition and Choice

Does anyone else laugh when politicians promise that government will bring competition, choice, and efficiency to the medical industry? Government routinely can’t account for millions, even billions, of dollars. And competition and choice? As a compulsory monopoly, government is the enemy of those things.

Competition and choice is what you get when the government backs off. You don’t get them by having government interject itself even further in an area of life.

Finally, the way to rig a debate over public policy is to never acknowledge the only genuine alternative your proposal. Obama says, “I’m confident that when people look at the costs of doing nothing they’re going to say, we can make this happen.” Why is “doing nothing” the alternative to a conscious attempt to reinvent the healthcare industry? While it is true that doing nothing would be preferable to what Obama and his congressional allies want to do, it is not the best alternative. The best alternative is the free market. But have you ever heard the advocates of government control offer an argument against the free market? The answer is no, and the reason is that to argue against it would be to acknowledge it as an alternative. And that they cannot afford to do. Better to have the people think we already have a free market in medicine and that it has failed. That way they will be more likely to win support for government control. The “reformers” task would be more difficult if people understood that what has created the problems is government, not the free market.

This effort ignore the market solution is abetted by an alleged limited-government party that is unwilling or unable to speak the truth. That help explains the predicament we are in.


Obama Health Care Bill Contains Race Preferences

Black Activist Speaks Out Against Proposed Unequal Allocation of Health Resources

An examination of the 1018-page "America's Affordable Health Choices Act of 2009" (H.R. 3200) - the official Obama health care bill - finds several cases in which grant money for medical training can be awarded solely on factors of race and class.

Project 21 member Bishop Council Nedd II, an Anglican bishop and director of the Ecumenical Institute for Health Policy Research based at Valley Forge Christian College, is condemning the addition of racial preferences to the President's legislation.

"The U.S. Supreme Court just struck down racial preferences. So why does a newly-introduced bill want to perpetuate something that has just been declared unconstitutional?" asked Project 21's Nedd. "Racial preferences will not improve health care. They will increase tensions when some people are being unfairly put at the front of the line."

Between pages 878 and 909 of H.R. 3200, in an area related to grants for medical training, the Secretary of Health and Human Services is empowered to grant preference in awarding training grants. For the specialties of "family medicine, general internal medicine, general pediatrics, geriatrics and physician assistantship" (pages 878-882); "medical residents on community-based settings" (pages 883-886) and "general, pediatric and public health dentists and dental hygienists" (pages 887-891), it is written that "the Secretary shall give preference to... entities that have a demonstrated record of... training individuals who are from underrepresented minority groups or disadvantaged backgrounds."

Further, the bill amends the Public Health Service Act to give preferences in "advanced education nursing grants" to programs that "increase diversity among advanced education nurses" (pages 892-895). Grants for "enhancing the public health workforce" similarly give preference to "entities that have a demonstrated record of... training individuals who are from underrepresented minority groups or disadvantaged backgrounds" (pages 907-909).

Nedd added: "By making racial preferences a shortcut to federal funding, schools will reduce their quest for the best and turn it into a hunt for the right racial numbers. This, in the long run, will hurt the quality of our nation's health care. We need to stop the social experimentation and focus on cost and performance."


Monday, July 27, 2009

Australia: More public hospital negligence

Would YOU like to be the one being operated on in such circumstances? Where warnings were ignored, equipment wasn't working and personnel had no previous experience in the procedure? That could be coming to you too under Obamacare

A DOCTOR whose patient died after a common throat operation says he "neglected to go through the paperwork" and failed to heed warnings from a nurse to delay the procedure. The comments came yesterday during an inquest into the 2007 death of popular Emerald grandmother Yvonne Davidson, who died at Rockhampton Base Hospital.

A critically ill Mrs Davidson died shortly after intensive care specialist Dr Robin Leigh Holland performed a percutaneous tracheostomy to help her breathe easier. Although her official cause of death was septicemia (blood poisoning) triggered by pneumonia, an examining pathologist said the operation hurried her death by two days to two months.

New hospital guidelines for the procedure stated two specialists had to perform the operation after the relevant equipment was checked. Registered nurse Lois Gillespie said she gave Dr Holland a printout of the guidelines and told him about the need for another specialist to be present, and that the monitor to be used was problematic.

Although Dr Holland denied the nurse told him the monitor was not working, he admitted appointing Dr David Guitierrez, who had never performed the procedure, to assist him. "Robin said David was as good as any consultant and (David) was his consultant," Ms Gillespie told the court. "Robin was saying that he would do it right and that he didn't need (the monitor)."

The nurse then said Dr Holland couldn't get the bronchoscope light to flash, but assured her "I'd be right. I'll go blind". She claimed she advised Dr Holland to delay the operation in light of equipment failures and a shortage of back-up staff.

Dr Holland said he did not recognise the hospital guidelines given to him because they looked like a list of medical equipment on a trolley. He said he had all confidence in the pair's ability to complete the operation, even when Dr Guitierrez's first attempt to insert a tube did not work.


Four years to ban a horror surgeon in an Australian public hospital

The usual level of protection that you can expect from Australia's medical "regulators". There has got to be some means of fast-tracking this sort of thing

A SURGEON being sued for allegedly performing botched gynaecological operations - some without consent - on women in WA public hospitals has been banned from practising medicine. The obstetrician and gynaecologist, who has now left the country, has been permanently stripped of his right ever to work as a doctor in WA.

The ban comes as the Medical Board of WA pursues further shocking allegations of misconduct by the surgeon involving more than 100 female patients. The Sunday Times can now reveal the first details of what is potentially the most serious medical scandal in the state's history after a blanket suppression order was partially lifted on Monday following legal action by this newspaper and the Medical Board.

It can now be reported: The doctor is facing civil court claims that could result in large compensation payouts for the State Government. One woman interviewed by The Sunday Times said she was ``angered and disgusted at the outcome'' and the doctor had left her ``feeling and thinking I'm not normal''.

While knowing of the investigation against him, the doctor attempted to cover up the allegations while trying to obtain work overseas. He lied in an interview and produced fake documents of his good standing in WA.

The judge who banned the doctor ruled his behaviour as ``disgraceful or dishonourable'' conduct for a member of the medical profession. The scandal was so serious former attorney-general and health minister Jim McGinty thought public exposure so important he personally intervened and challenged the suppression in late 2007. He lost the application.

The Medical Board lawyers have been fighting to suspend the doctor since November 2005 and have filed 14 complaints against him in the State Administrative Tribunal. The Sunday Times, which understands all potentially affected WA patients have been contacted by health officials, has been investigating the scandal for more than a year, fighting to bring the case to the public's attention.

The doctor is also being sued by five former patients in the District Court, seeking personal-injury damages for medical negligence. More civil actions will follow in coming months. One woman claims in a writ that surgery performed by the doctor ``constituted trespass as it was performed in the absence of the plaintiff's consent to do so''.

Another alleged victim and her husband filed a writ over a botched sterilisation in which the doctor failed to apply a fishie clip to her right fallopian tube and resulted in her becoming pregnant and having a child.

The doctor at the centre of the scandal is now believed to be in South Africa, having fled halfway through the tribunal and court proceedings. He hasn't worked in WA since June 2006.

Tribunal president John Chaney ordered the doctor's permanent work ban in March this year and in a judgment found he deceived South African health officials while trying to work at a hospital near Durban....

Judge Chaney allowed his judgment to be made public but he ordered the continued suppression of the doctor's identity and all details of the 13 unresolved tribunal cases, including patient names

Mediation is listed for later this year but one alleged victim said she was ``angered'' that she has been gagged from talking about her case and the length of time taken in hearing her complaints. Health Minister Kim Hames declined to comment. The Sunday Times has lodged an appeal in the WA Supreme Court seeking to overturn the remaining suppression orders and allow us to inform the WA public about what is going on.


Stupid British health bureaucracy overwhelms the ambulance service

Overstretched ambulance crews are needlessly attending emergency call-outs from people wrongly advised to dial 999 by the Government’s swine flu hotline

One paramedic said he had raced to four unnecessary calls in one 12-hour shift on Friday. None of those he attended needed emergency treatment but all had been told to dial 999 after ringing the flu hotline for an assessment. It is feared that a combination of unqualified staff and a series of vague questions at the start of the telephone assessment are to blame.

The situation was revealed after the paramedic, from East Midlands Ambulance Service, rang the flu line from the home of a 55-year-old woman in Nottingham whose daughter had been advised to ring the emergency services. By chance his call was answered by a Mail on Sunday reporter working at the Teleperformance call centre in Leicestershire. He told the reporter: ‘This lady doesn’t need an ambulance, she just needs the drugs.’ He added: ‘This is the fourth today. Four call-outs to people who think they have swine flu and have been told to ring an ambulance.’

The reporter explained what had happened to the team leader, Adam, who was clearly very busy. All the agents at the centre said they had referred callers to 999. There are fears seriously ill patients could be put at risk while ambulances are diverted needlessly. As our investigation found, one worker at the centre, Brian, admitted he had instructed all six of his callers to ring 999 ‘because that’s what the computer tells me to do’.

At the start of each call, the workers have to ask 11 vaguely worded questions to assess whether the suspected swine flu victim is in need of emergency treatment. An affirmative answer to any of these questions, which include ‘Are they breathing irregularly?’, immediately leads the staff to a screen that says: ‘Assessment Complete – Dial 999.’

An ambulance worker, who asked not to be identified, said: ‘If you ask someone if they have difficulty breathing, they might say yes, even if they just have a blocked-up nose. That makes it a high priority call. 'It would be better if they employed medically qualified people who were able to ask follow-up questions.’

A spokesman for the Department of Health said: ‘Staff in the call centres have to ask certain questions to make sure anyone who needs emergency treatment gets it. We are keeping an eye on this and how often it’s happening and are talking to the ambulance trusts.’ [Talk is all they are capable of]


Obama throws old people ‘under the bus’ with Obamacare

By Vincent Gioia

"Doctors take the Hippocratic Oath too seriously, as an imperative to do everything for the patient regardless of the cost or effects on others" (Journal of the American Medical Association, June 18, 2008).

Would you vote for a person to be president if you knew when elected he would appoint someone who thought and said this, Obama did? The President appointed Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel, to two key positions: health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research. Emanuel added to his comments that Doctors take their jobs too seriously and need to change to reduce costs – "Savings will require changing how doctors think about their patients," he wrote.

Emanuel knows that the cuts will not be pain-free. "Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely 'lipstick' cost control, more for show and public relations than for true change," he wrote last year (Health Affairs Feb. 27, 2008).

Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else. You know what this means; if you are old it’s not cost effective to keep you alive, the money is better spent on a younger person. In the world of Obamacare no longer will doctors try to keep patients alive, they will be told that a doctor's job is to achieve social justice one patient at a time.

Emanuel believes that "communitarianism" should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those "who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia" (Hastings Center Report, Nov.-Dec. '96).

To defend discrimination against older patients, Emanuel says: "Unlike allocation by sex or race, allocation by age is not invidious 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" (Lancet, Jan. 31).

Medicare was started in 1965 and since then seniors' lives have been extended by new medical treatments such as angioplasty, bypass surgery and hip and knee replacements. These procedures have allowed the elderly to lead active lives. But Emanuel criticizes Americans for being too "enamored with technology" and is determined to reduce access to it.

Dr. David Blumenthal is another key Obama adviser; he agrees with Emanuel and recommends slowing medical innovation to control health spending. Blumenthal has long advocated government health-spending controls, though he concedes they're "associated with longer waits" and "reduced availability of new and expensive treatments and devices" (New England Journal of Medicine, March 8, 2001). But he says whether the timely care Americans get is worth the cost is "debatable." (If you or a loved one has cancer, do you think it’s debatable - delay lowers your chances of survival?)

Obama appointed Blumenthal as national coordinator of health-information technology. This is a job that involves making sure doctors obey electronically delivered guidelines about what care the government deems appropriate and cost effective.

In the April 9 New England Journal of Medicine, Blumenthal predicted that many doctors would resist "embedded clinical decision support" -- a euphemism for computers telling doctors what to do.

Betsy McCaughey, founder of the Committee to Reduce Infection Deaths and a former New York lieutenant governor, thinks you need to know who will be involved in your healthcare decisions and provided the information about Drs. Emanuel and Blumenthal, two of the Obama appointees who will be carrying out Obama’s orders to control lives by controlling what medical care people (other than Obama, congress and government bureaucrats) receive.

"Americans need to know what the president's health advisers have in mind for them. Emanuel sees even basic amenities as luxuries and says Americans expect too much: "Hospital rooms in the United States offer more privacy . .. . physicians' offices are typically more conveniently located and have parking nearby and more attractive waiting rooms" (Betty McCaughey - JAMA, June 18, 2008).

The Democrat news media house organs will not tell Americans the thinking behind government health "reform" nor have most people heard about the arm-twisting, Chicago-style tactics being used to force support by Democrat opponents in the House and Senate. In a Nov. 16, 2008, Health Care Watch column, Emanuel explained how business should be done: "Every favor to a constituency should be linked to support for the health-care reform agenda. If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration's health-reform effort."

The health bills in the House and Senate will put decision-making about your care in the hands of presidential appointees with the beliefs of Emanuel and Blumenthal who likely reflect what Obama himself thinks. These people will decide what medical insurance plans cover, how much flexibility your doctor will have and what seniors get under Medicare.

This is what we got when voters responded to the clamor for "change" and elected Barack Obama – Obama has showed a willingness to throw folks "under the bus" when it suits him and old folks are no exception.


Health reformers' Claims Just Don't Add Up

Many extravagant claims have been made on behalf of the various health care "reforms" now emerging from Congress and the White House. But on closer inspection, virtually all prove to be false.

• America has a health care crisis.

No, we don't. Forty-seven million people lack insurance. Of the remaining 85% of the population, or 258 million people, polls show high satisfaction with the current coverage. Indeed, a 2006 poll by ABC News, the Kaiser Family Foundation and USA Today found 89% of Americans were happy with their own health care.

As for the estimated 47 million not covered by health insurance, 20 million can afford to buy it, according to a study by former CBO Director June O'Neill. Most of the other 27 million are single and under 35, with as many as a third illegal aliens. When it's all whittled down, as few as 12 million are unable to buy insurance — less than 4% of a population of 305 million. For this we need to nationalize 17% of our nation's $14 trillion economy and change the current care that 89% like?

• Health care reform will save money.

Few of the plans now coming out of Congress will save anything, says the CBO's current chief, Douglas Elmendorf. In fact, he says, they'll lead to substantially higher costs in the future — costs that will be "unsustainable." As it is, estimates for reforming health care range from $1 trillion to $3.6 trillion. Much will be spent on subsidies to make a so-called public option more attractive to consumers than private plans.

To pay for it, the president has suggested about $600 billion in new taxes, meaning that $500 billion to $2.1 trillion in new health care spending over the next decade will be unfunded. This could push up the nation's already soaring deficit, expected to reach $10 trillion through 2019 without health care reform. Massive new tax hikes will probably be needed to close the gap.

• Only the rich will pay for reform.

The 5.4% surtax on millionaires the president is pushing gets all the attention, but everyone down to $280,000 in income will pay more. Doesn't that still leave out the middle class and poor? Sorry. Workers who decline to take part will pay a tax of up to 2% of earnings. And small-businesses must pony up 8% of their payrolls.

The poor and middle class must pay in other ways, without knowing it. The biggest hit will be on small businesses, which, due to new payroll taxes, will be less likely to hire workers. Today's 9.5% jobless rate may become a permanent feature of our economy — just as it is in Europe, where nationalized health care is common.

• Government-run health care produces better results.

The biggest potential lie of all. America has the best health care in the world, and most Americans know it. Yet we hear that many "go without care" while in nationalized systems it is "guaranteed."

U.S. life expectancy in 2006 was 78.1 years, ranking behind 30 other countries. So if our health care is so good, why don't we live as long as everyone else?

Three reasons. One, our homicide rate is two to three times higher than other countries. Two, because we drive so much, we have a higher fatality rate on our roads — 14.24 fatalities per 100,000 people vs. 6.19 in Germany, 7.4 in France and 9.25 in Canada. Three, Americans eat far more than those in other nations, contributing to higher levels of heart disease, diabetes and some cancers.

These are diseases of wealth, not the fault of the health care system. A study by Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa found that if you subtract our higher death rates from accidents and homicide, Americans actually live longer than people in other countries.

In countries with nationalized care, medical outcomes are often catastrophically worse. Take breast cancer. According to the Heritage Foundation, breast cancer mortality in Germany is 52% higher than in the U.S.; the U.K.'s rate is 88% higher. For prostate cancer, mortality is 604% higher in the U.K. and 457% higher in Norway. Colorectal cancer? Forty percent higher in the U.K.

But what about the health care paradise to our north? Americans have almost uniformly better outcomes and lower mortality rates than Canada, where breast cancer mortality is 9% higher, prostate cancer 184% higher and colon cancer 10% higher.

Then there are the waiting lists. With a population just under that of California, 830,000 Canadians are waiting to be admitted to a hospital or to get treatment. In England, the list is 1.8 million deep.

Universal health care, wrote Sally Pipes, president of the Pacific Research Institute in her excellent book, "Top Ten Myths Of American Health Care," will inevitably result in "higher taxes, forced premium payments, one-size-fits-all policies, long waiting lists, rationed care and limited access to cutting-edge medicine."

Before you sign up, you might want to check with people in countries that have the kind of system the White House and Congress have in mind. Recent polls show that more than 70% of Germans, Australians, Britons, Canadians and New Zealanders think their systems need "complete rebuilding" or "fundamental change."

• The poor lack care.

Many may lack insurance, but that doesn't mean they lack care. The law says anyone who walks into a hospital emergency room must be treated. America has 37 million people in poverty, but Medicaid covers 55 million — at a cost of $350 billion a year.

Moreover, as many as 11 million of the uninsured qualify for programs for the indigent, including Medicaid and SCHIP. But for some reason, they don't sign up. Are they likely to sign up for the "public option" when it's made available?