You Scam, They Scam

I've been holding on to this link because a couple of questions continue to nag at me:

Authorities said busts carried out this week in Miami, New York City, Detroit, Houston and Baton Rouge, La., were the largest Medicare fraud takedown in history -- part of a massive overhaul in the way federal officials are preventing and prosecuting the crimes.

In all, 94 people -- including several doctors and nurses -- were charged Friday in scams totaling $251 million. Federal authorities, while touting the operation, cautioned the cases represent only a fraction of the estimated $60 billion to $90 billion in Medicare fraud absorbed by taxpayers each year.

First, did it really require "a massive overhaul" in order to define, discover, and prosecute outright fraud? And if new regulation of some sort was needed, couldn't that have been passed quickly and easily through Congress when the problem was first discovered? Which leads to:

Second, couldn't the savings and recovered money (if any) go toward making Medicare self-sustaining, rather than helping to balance out a costly new entitlement program?

The ObamaCare Scam

The healthcare legislation should never have become law, and as time goes on, we continue to discover what a shoddy bit of law-making it was:

Talk about a paperwork nightmare: Tucked into the massive new health care law is a demand that nearly 40 million U.S. businesses file tax forms for every vendor that sells them more than $600 in goods. ...

The goal of the provision was to prevent vendors from underreporting their income to the Internal Revenue Service. The government must think those vendors are omitting a lot because the filing requirement is estimated to bring in $19 billion over the next decade. ...

Republicans want to repeal the filing requirement and pay for it by changing other parts of the new health care law, a strategy that Democratic leaders won't support. Democrats want to repeal the filing requirement and pay for it by raising taxes on international corporations and limiting taxpayers' ability to use special trusts to avoid gifts taxes. Republicans won't support that.

Because of the method of the legislation's enactment, nobody caught this problem before it passed, and those who were aware of it were either too ignorant to foresee (or object to) the consequences or thought it would offer a nifty trick for repealing the problem and increasing taxes after the legislation had squeaked through to passage. Frankly, the whole bill is a scam and an atrocity and should be repealed in full.

Barring that, the Republicans are exactly right: repairs to the law should be made within the law.

Different Escalators to and from Sanity

Did you happen to catch this in the New York Times, last week?

Even as the new coalition government [of Great Britain] said it would make enormous cuts in the public sector, it initially promised to leave health care alone. But in one of its most surprising moves so far, it has done the opposite, proposing what would be the most radical reorganization of the National Health Service, as the system is called, since its inception in 1948.

Practical details of the plan are still sketchy. But its aim is clear: to shift control of England's $160 billion annual health budget from a centralized bureaucracy to doctors at the local level. Under the plan, $100 billion to $125 billion a year would be meted out to general practitioners, who would use the money to buy services from hospitals and other health care providers.

The plan would also shrink the bureaucratic apparatus, in keeping with the government’s goal to effect $30 billion in “efficiency savings” in the health budget by 2014 and to reduce administrative costs by 45 percent. Tens of thousands of jobs would be lost because layers of bureaucracy would be abolished.

Yes, the move is to doctors, but more importantly, it's toward patients. In other words, the much lauded National Health Service is decentralizing, even as the ruling class of the United States attempts to push our system in the other direction.

Note, also, the underlying justification for government bureaucracy: the employment of government bureaucrats! One wonders what is given up in the private sector in order for paper pushers to survive on plush government compensation.

Rationing Life

I'd forgotten it during the national debate about universal healthcare, but in processing old columns for my personal site, I came across this, from May 2005:

Intrinsic human worth may not dominate the scales during other lifecycle stages for long, either. One indication of the slide is the British judiciary's hearing arguments concerning a problem that arises from government-funded healthcare: deciding whether the patient or the doctor/public has the final say on when to cease care.

As the lawyer representing the General Medical Council stated, "a doctor should never be required to provide a particular form of treatment to a patient which he does not consider clinically appropriate." Instead, in a "joint decision-making" process, the doctor should provide a menu of "appropriate" courses of action from which the patient may choose. The lawyer for the National Health Service noted that the doctor should compile the list of options "having regard to the efficient allocation of resources." It may not be appropriate, in other words, for treatment to include a hospital bed and the expensive attention and technology associated with it.

When the government encourages expectations of "cradle to grave" care, the focus of major decisions shifts from humans' dealing with the contingencies of life to society's managing human beings. An ailing patient can weigh every consideration related to his or her own life and choose, or not, self-sacrifice for things that he or she values — whether personal dignity or the preservation of savings for a family's well-being. When the authority ultimately rests with the public, however, this opportunity translates into a judgment of comparative value between citizens. There is a bottom line to balance, and it helps to exclude patients who cannot move sustenance to their digestive systems, for example.

We're now on the path.

UPDATE: A Short-Lived Order Protecting Short-Lived Human Beings

Remember that executive order that supposedly gave pro-life Democrats cover to vote for Obamacare? Oh well:

[House Republican Leader John] Boehner [of Ohio] and other Republicans point to reports that the Health and Human Services Department is giving Pennsylvania $160 million to set up a new high-risk insurance pool that will cover any abortion that is legal in the state.

According to Boehner, the response of the Obama administration to inquiries has been not to respond. People may pretend otherwise, but I don't think anybody actually doubted this outcome. Hopefully, the current election cycle will prove that burying the truth in subtext will not avert consequences. Also hopefully, as I suggested this morning, a shift of power won't merely change the direction of the corruption.

On the matter of funding abortion, though, I remain concerned that recent jurisprudence out of Massachusetts, concerning same-sex marriages, there, may lead federal courts to invalidate the federal government's ability to place such strings and restrictions on the use of our money.

ADDENDUM:

After this matter began to draw attention, the Department of Health and Human Services released the following statement:

As is the case with FEHB plans currently, and with the Affordable Care Act and the President's related Executive Order more generally, in Pennsylvania and in all other states abortions will not be covered in the Pre-existing Condition Insurance Plan (PCIP) except in the cases of rape or incest, or where the life of the woman would be endangered.

Our policy is the same for both state and federally-run PCIP programs. We will reiterate this policy in guidance to those running the Pre-existing Condition Insurance Plan at both the state and federal levels. The contracts to operate the Pre-existing Condition Insurance Plan include a requirement to follow all federal laws and guidance.

Note, however, that this post had to do with a high risk insurance pool, not a PCIP. Perhaps it's an unnecessary distinction, but I'll believe it when I see the subsequent release. Note, also, that pro-abortion groups appear to believe that this statement changes things.

Healthcare's Unchanged Incentives

Offering some representative anecdotes from her experience as a doctor, Alieta Eck explains the problem with the Obamacare approach to healthcare reform:

Are these patients or their physicians committing fraud? No. They are simply acting legally to enhance their own well-being, following the incentives set up by the unwieldy system. People with "coverage" do not care what costs they incur, and those who provide services benefit by providing more. As with the oil rig in the Gulf, there is a lot of pressure behind the leak. Adding more pressure — as with the Democrats' idea of saving money by covering everybody — is not the answer. It can only make things worse.

Everybody assumes that bringing healthy people into the insurance fold will help to balance increased usage among the sick, but the incentive, for them, will be the same as for everybody: Use whatever services are conceivably needed. Even if "broadening the pool" does delay the inevitable, Eck sees this as our future...

Once the nation is bankrupt, hospitals have closed, and physicians have found alternate ways to earn a living, real medical needs will not be met. The best medical care in the world will simply cease to exist. Then all Americans, young and old, will feel the pain.

... and offers an alternative approach with which Anchor Rising readers will be readily familiar:

There is a better answer, pointed out by Rep. Ron Paul, M.D. (R-TX):

"We need a system in America where patients pay cash for basic services, and carry insurance only for serious illnesses and accidents. 'Health maintenance' is the responsibility of each of us individually. We cannot continue to collectivize the costs of healthcare and expect things to get better."

Insurance needs to be insurance, and consumers must be required to incorporate cost into their healthcare decisions.

Cures as the Positive Hook for Healthcare Policy

James Pinkerton offers a strategic angle for Republicans on healthcare:

Health-care spending is a problem, but it is important to remember that spending is a secondary issue. The primary issue is health itself — how to achieve it, how to maintain it, and how to regain it in the case of sickness or injury. Health-care finance is hotly contested political ground, yet Washington has had precious little to say on the subject of health in recent years.

That is perplexing — and a huge missed opportunity. After all, people don't go to the doctor because they have insurance plans or health-savings accounts. They go to the doctor to get well and to stay well. Americans' eyes may glaze over at the wonky debates that are catnip to Washingtonians, but, beyond the Beltway, they can't seem to get enough information about their bones, bladders, and blood pressure. ...

Those on the right who have been fighting Obamacare have been loud and articulate in their criticism of its bureaucratic aspects, but they have had precious little to say about curing and preventing diseases. The opportunity now exists for Republicans to reassociate themselves with the creation of health. Let the Democrats own the redistribution of health-care dollars and the management of scarcity; Republicans have a chance to own the much more powerful issue of solving health problems.

Extrapolating a little bit to derive policy from Pinkerton's suggestion, free-market based reforms — real choice when it comes to the context in which health insurance is purchased, a functional system that pushes high-deductible plans back toward being actual insurance rather than an unnecessary layer for routine care, and tort reform — would jump start the healthcare industry and probably free up money for public investment in research.

It's an approach worth candidates' consideration — not to be forgotten, of course, once they claim offices.

What Healthcare Is Like

R.R. Reno makes a fair point that our pre-Obamacare healthcare system ultimately created "an ad hoc mechanism for extracting payments from the insured to finance a haphazard effort to provide at least emergency and critical care for the uninsured as well as decent care for the underinsured."

Seeing this as socialization, Reno argues that something like the individual mandate is preferable, to explicitly provide general care (cheaper than emergency) to the uninsured and those with preexisting conditions. I'm not so sure, first of all, that forcing the involvement of young adults and others who opt not to insure themselves — effectively looking to one segment of the "uninsured" to pay for another — will make for an even swap.

More to the point, though, I don't think avoiding the excesses is possible when government gets involved. We're sure to find, for example, that those young adults will be permitted onto their parents' plans at ever older ages. We're also sure to see mandatory coverage expanding, redistributing wealth from the healthy to the ill (and those who treat and advocate for the ill). Given Reno's reliance on "political realities" for his argument, that he doesn't anticipate this response and address it in greater detail suggests that some of his premises require reconsideration, such as:

Think about getting hepatitis or breast cancer. The risk of suffering from these misfortunes is similar to the risk of being mugged or shot. It's a life-and-death matter, and if human government has any justification for its power over citizens, then surely it rests in its unique capacity to pool resources to protect life. As Albert Camus recognized, one moral source for solidarity can be found in our common struggle against the dehumanizing power of suffering and untimely death.

In circumstances of interpersonal violence, government is arbitrating between people. That's not the same as arbitrating between a person and a virus or cancer. That government can exert force to stop individuals from doing the same in an acute act of assault does not mean that it's appropriate for government to step in as a life manager.

A Leaked Document Followed by a Reluctant Confirmation: Under ObamaCare, 50% or More of Americans Will Not Be Able to Keep Their Health Care Plan

Friday's Investor's Business Daily.

Internal administration documents reveal that up to 51% of employers may have to relinquish their current health care coverage because of ObamaCare.

Small firms will be even likelier to lose existing plans.

The "midrange estimate is that 66% of small employer plans and 45% of large employer plans will relinquish their grandfathered status by the end of 2013," according to the document.

In the worst-case scenario, 69% of employers -- 80% of smaller firms -- would lose that status, exposing them to far more provisions under the new health law.

This contradicts the repeated reassurances made by President Obama as he was attempting to sell health care "reform":

If you like your health care plan, you can keep your health care plan.

There is one seemingly small characteristic of this document which is chilling in its long-term implication to American health care should ObamaCare remain unchanged before its implementation.

The 83-page document, a joint project of the departments of Health and Human Services, Labor and the IRS

Confirmation that the federal government is well on its way to edging market forces altogether out of the system and replacing them with the tax gun. Commenter David P correctly points to the next inevitable step, which is for government to dictate "the terms under which it provides service".

In Massachusetts, we are getting a preview of how this will unfold as government price controls combined with government mandates now begin to squeeze and then whittle down the number of health care providers willing to stay and dance to the tune of MassCare.

MassCare: Ominous Developments in the Precursor to ObamaCare

So in early April, Governor Deval Patrick's Division of Insurance rejected most of the rate increases for individual and small business plans which Mass insurers requested, marking the first time the state had flexed its authority in this way.

But, though most of us have a love/hate view of them, insurers are just the man in the middle. Note that Patrick's action in freezing premiums, which meets with the approval of the Obama admin, did nothing to address the underlying reason for cost increases. What it did do is pile ever more losses on the industry which, as it was, had entered 2010 in the red.

Sure enough, six weeks later, in mid May,

The four major Massachusetts health insurers yesterday posted first-quarter losses totaling more than $150 million, with three of them blaming the bulk of the losses on the Patrick administration’s decision to cap rate increases for individuals and small businesses.

The carriers attributed $116 million of their $152 million in losses to the April 1 ruling by the state Division of Insurance to deny most proposed premium increases for the so-called small-group market.

The next step for the carriers, naturally, is to attempt to pass the losses along to providers.

Massachusetts health insurers say they want to freeze or slash payments to some hospitals and large physician groups this year, setting up the toughest contract negotiations in memory and creating the potential for disruptions in where patients get their care. ...

Unlike in past years, insurers believe they have widespread backing from politicians, regulators, and employers to aggressively push back against large price increases, even if it means some unhappy providers drop out of insurers’ networks, forcing patients to find new doctors and hospitals.

Whoops. Sounds like Bay Staters may be on their way to losing their right to choose (... a doctor, anyway).

Now the latest development (h/t Michael Graham). The Patrick administration has moved to place three carriers into administrative oversight.

State officials said they sent letters to three health insurers earlier this year asking them to accept more intense oversight and supply additional data because of concerns about their financial health.

One of the insurance companies has agreed to administrative oversight, while regulators are negotiating details with the other two, the officials said. Administrative oversight is a first step regulators take when they determine there is a need to monitor the financial condition of insurance carriers more closely. It does not mean the companies are insolvent.

Officials said the heightened concern is related to the fragile economy, which caused several major insurers to lose money in 2009.

Really, a fragile economy? Or something else, like a government has taken a strangle-hold on your business? Michael Graham:

Was it really the "fragile economy" that's causing Massachusetts insurance companies to go broke, as the Patrick administration claims? Or is it the lousy Romney-Care plan they’re working under, and the fact that more and more people are getting services they're not paying for? Those costs are being shifted onto taxpayers and the insurance companies.

In Massachusetts, we are getting a real life preview of what will happen when, in four years, under Congress' orders, MassCare becomes a national pandemic. It's not pleasant. Can we please observe, learn and react accordingly, even if it means a "drastic" course change (back to the status quo)?

The Underlying Assumption of the Leftist Taxers

In a review of some of the tax consequences of Obamacare, Grafton Willey conveys this bit of policy that one suspects underlies many of the assumptions of those who advance policies in the mold of nationalized healthcare:

Imposing a 3.8 percent "unearned-income Medicare contributions" tax on higher-income taxpayers. The 3.8 percent unearned-income Medicare contributions tax is imposed on the lesser of net investment income or the excess of modified adjusted gross income (AGI) over the threshold amount ($200,000 for single individuals or heads of households; $250,000 for married couples filing a joint return and surviving spouses; and $125,000 for married couples filing separate returns).

Neither the $200,000 nor $250,000 amounts are indexed for inflation. Modified AGI is adjusted gross income increased by the amount excluded from income as foreign earned income less deductions attributable to such income.

Net investment income includes interest, dividends, royalties, rents, gain from disposing of property from a passive activity and income earned from a trade or business that is a passive activity. In determining net investment income, investment income is reduced by deductions properly allowed to that income.

Net investment income does not include distributions from qualified retirement plans, including pensions and certain retirement accounts. For example, income from individual retirement accounts (IRAs), 401(a) money purchase plans, 403(b) and 457(b) plans would be exempt.

Some of the hardest work that I've ever done was the back-room labor involved in selling fish from a truck, and there were times, while hauling crates in the snow or cleaning putrid wooden boxes in the beating sun, that I marveled that it should be so difficult to earn $7 per hour and wondered what one could possibly do to "earn" the salaries of the wealthy. (For clarity: I look back on those days very fondly and came around to appreciating them even while they were in process.)

I don't offer that anecdote as a means of transforming economic ignorance into a populist cry. To the contrary: the notion of "earned income" is hopelessly subjective and, therefore, merely a dash of political rhetoric to justify confiscatory taxation. Consider the amount of money that President Obama has earned as an author. Personally, I love writing and undertake it as a compulsion and balm. But in the course of lugging a table saw up the narrow steps to the third floor of a Newport mansion, I might be inclined to challenge the assertion that Mr. Obama "earned" that money in the sense implied by the Medicare tax.

A Direct Line from Health, Through Information, to Political Manipulation

The problem with giving government authority over everything is that, well, it gives government authority over everything. For a shocking example, consider Mark Steyn's description of a minor controversy in Great Britain.

It seems that, in the course of the recent election cycle, the then-ruling Labour party sent out postcards warning that, if victorious, the Conservatives would reduce access to breast cancer treatment. What's shocking is that Labour appears to have culled the list of all citizens to include only those who have" been either diagnosed with, treated for, survived or, in at least one case, died of breast cancer." Writes Steyn:

So a quantum leap in targeted marketing has just been made: The governing party of a free society was able to identify women with breast cancer in swing constituencies and send them a postcard warning that if you vote for the opposition they’ll cut off your chemo and kill you.

I suppose that's not much different than local school committees sending parents warnings that their children will have to return to paper-less one room school houses if they don't receive the budgets that they desire. The difference is that it's unavoidable for school departments to know which households have children in the school system, but at least in the United States, it isn't yet the case that political parties have ownership of everybody's personal health histories.

The easy availability of information has its pluses and minuses. The real danger lies in giving a centralized authority the power to use that information for its own purposes.

ObamaCare Less and Less Popular

Imagine how unpopular it will be when its costs really start to kick in:

Support for repeal of the new national health care plan has jumped to its highest level ever. A new Rasmussen Reports national telephone survey finds that 63% of U.S. voters now favor repeal of the plan passed by congressional Democrats and signed into law by President Obama in March.

Prior to today, weekly polling had shown support for repeal ranging from 54% to 58%.

And by "costs," I don't mean just the direct cost to the federal government, which (for those who've forgotten) is not the sum total of the United States. For one example, Americans are pretty good at intuiting this sort of outcome:

A study by the National Center for Policy Analysis shows that tax credits in the new healthcare law could negatively impact small-business hiring decisions.

The new law provides a 50 percent tax credit to companies offering health coverage that have fewer than 10 workers who, on average, earn $25,000 a year. The tax credit is reduced as more employees are added to the payroll.

The NCPA study finds the reduction in tax relief to be a cost concern for companies looking to hire additional workers, but operate on slim profit margin yet still provide employee health coverage.

Incumbents — making government less efficient and American life more difficult, year after year.

Complexity is Knowing that Government Control Must be Better, No Matter What that Pesky Constitution May Say

One of the more maundering sections in the Projo's recent Tea Party editorial began by looking at the view expressed at many Tea Party events that modern government needs to continue to be consistent with the principles of the founding of America...

They also make frequent reference to getting back to what the nation's Founders wanted, though it is not at all clear how the Founders would have governed a country that has grown from about 3 million people living in a mostly agrarian nation in 1790 to about 310 million in the highly urban/suburban, technological and multicultural one now. We do know that the Founders supported the right to amend the Constitution as things changed.

But complexity is anxiety-provoking, while simple slogans are comforting.

Indeed, much modern history has been shaped by human struggles with and against the consequences of contrasting formulations of government. The renowned philosopher and sociologist Raymond Aron described the key contrast in the past two-and-half-centuries as being defined by the difference in the ideas of...

...representative governments restrained by the balance of power, and so called democratic governments invoking the will of the people but rejecting all limits to their authority.

However, those who would feel comfortable with a system where the most important factor limiting a government's power is that government's ability to decide for itself when its actions serve true public interests really shouldn't be congratulating themselves on their ability to deal with complexity.

Why the Federal Health Insurance Mandate Cannot Be Made Constitutional By Calling it Tax

Article I, sections 8 and 9 of the United States Constitution originally defined the taxing authority of the Federal Government...

(s8) The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States...(s9) No Capitation, or other direct, Tax shall be laid, unless in Proportion to the Census or Enumeration herein before directed to be taken.

The Congress shall have power to lay and collect taxes on incomes, from whatever source derived, without apportionment among the several States, and without regard to any census or enumeration.

Not purchasing insurance is not income under the Court's definition of income because the non-purchase of insurance is not "an undeniable accession to wealth" and therefore cannot be taxed under the Sixteenth Amendment's grant of authority. Nor can the non-purchase of something meet the criteria of being subject to a directly apportioned or indirect tax, meaning that nothing in the Constitution allows the Federal government to tax an individual's non-purchase of health insurance.

But the dubious constitutionality of the Federal health insurance mandate doesn't end with this significant problem.

Congress and the President could have, in a clearly Constitutional manner, used its taxation power to influence the purchase of health insurance by creating a tax-deduction associated with the purchase of health insurance. This idea was, in fact, proposed by officials like President George W. Bush and United States Senator Ron Wyden. However, Congress chose not to go this route.

Given the current Federal tax code, such a deduction would extend an advantage already enjoyed by corporate purchasers of health insurance to individual purchasers of the same products. But in choosing not to create an individual deduction, and opting for a tax on non-behavior instead, Congress chose a mechanism of dubious Constitutionality specifically for the purpose of preserving an advantage that some purchasers of health insurance, i.e. the corporate ones, have over others.

One of the most fundamental purposes of a Constitution is to prevent a government from taking arbitrary actions that would favor some over others. When Congress stretches beyond its clearly enumerated powers, with the specific intent of preserving government created-advantages for some over others, it doubly violates the Constitution's reason for being.

Gov Calls on AG to Join Other States Challenging Healthcare Reform

I'd like to second this, along with Justin's reservations about "Obamacare". (The gov's office issued this press release a couple of hours ago.)

Governor Donald L. Carcieri today urged Attorney General Patrick Lynch to join 14 other states that have filed a complaint in the federal district court challenging the constitutionality of the federal healthcare legislation citing the new law as “a violation of the equal protection and commerce clauses and the 10th amendment, among other constitutional provisions.” In a letter to the Attorney General, Governor Carcieri writes, “Among the provisions of the recently enacted federal health care legislation is one which forces the citizens of Rhode Island to purchase health insurance and the state itself to form and participate in insurance exchanges; failure to comply can result in substantial fines.”

The Governor called upon the Attorney General to “exercise its discretion to protect our citizens from this unnecessary and probably unconstitutional intrusion of the federal government into the lives of Rhode Islanders whose freedoms to make their own choices about health care should be preserved and protected.”

Governor Carcieri cites the 10th amendment of the United States Constitution, which clearly defines that there are limits to federal powers and places where only the State and its citizens have authority to act.

A critic of the process by which the health care legislation was passed, Governor Carcieri reinforced his concerns that the law will “raise the costs of health care to Rhode Islanders, lower the quality of care, and shift another unfunded mandate on a state already overburdened with budget deficits.”

Insurance Doesn't Mean Health

Duncan Currie explains why it is speculation to assert that increasing health insurance coverage will mean improving health and decreasing avoidable deaths (subscription required). For the most part, it's a problem of separating data points. This part, however, moves beyond the immediate question and gives some reason to worry about the effects of ObamaCare, moving forward:

Here's another reason we should not expect the landmark bill to yield major health gains: A hefty chunk of the newly insured under Obamacare — anywhere from 15 million to 18 million people, according to projections — will rely primarily on Medicaid for their insurance. Unfortunately, the fact that Medicaid reimburses participating providers at low rates has made it increasingly difficult for recipients to find doctors. In a 2008 survey, only 40.2 percent of physicians told the Center for Studying Health System Change that they were accepting all new Medicaid patients, and more than a quarter (28.2 percent) said they weren't taking any. It can be even harder for Medicaid patients to locate dentists.

And yet this is the program that will soon be flooded with a massive wave of new enrollees. Dr. Edward Miller, dean and CEO of Johns Hopkins Medicine, has written that "without an understanding by policy makers of what a large Medicaid expansion actually means, and without delivery-system reform and adequate risk-adjusted reimbursement," Obamacare "will have catastrophic effects on those of us who provide society's health-care safety-net."

One foreseeable government "fix" will be a requirement that doctors not consider the type of coverage that potential patients have, forcing them to take all comers for whom they have room in their schedules (probably with regulations of how many patients doctors must accept). If that comes to pass, established doctors may just stop taking new patients at all, they might charge privately insured patients even more, or they might just quit the field.

The Healthcare Bill Due to Come Due

A recent essay in National Review by Avik Roy takes up the topic of healthcare inflation resulting from ObamaCare (emphasis in original):

Consider the numbers: Based on the gimmick-free assessment of former Congressional Budget Office director Douglas Holtz-Eakin, from 2010 to 2019 the act will increase the debt by $562 billion — almost $5,000 per household. Not great news, to be sure. But a PriceWaterhouseCoopers analysis projected that, over the same ten-year period, Obamacare will increase the cost of health insurance by approximately $20,000 per family.

This cost will be borne primarily by the young, who will be forced to subsidize the care of the middle-aged; by freelancers and small-business owners, who will not benefit from the exemptions afforded to large, self-insured employers; and by middle-class families, who will most feel the squeeze of higher insurance costs yet will also be expected to finance the health care of others.

The effects of this legislation on the debt are worrisome indeed. But, barring a Weimar-style collapse of the U.S. economy, they will be less visible to the typical family than health-care inflation will be. Rapidly rising insurance premiums will blow a hole directly in the monthly paychecks of tens of millions of middle-class households.

Mandates, consumer incentive to avoid "insurance" until it's actually needed, redistribution of costs from people in public programs to people with private insurance, and protection of monopolistic players are some of the ways in which the Democrats' big-government variation of "reform" will only exacerbate our healthcare system's current problems.

When polls ask about support for reform, respondents mean (or ought to mean) government action in pretty much the opposite direction from that which the Democrats have taken. That's why even in Rhode Island a majority supports repeal of ObamaCare.

Still Spinning Healthcare Down, Although Up

This won't be the first such report:

... the [Health and Human Services Department] analysis [of the healthcare legislation] also found that the law falls short of the president's twin goal of controlling runaway costs, raising projected spending by about 1 percent over 10 years. That increase could get bigger, since Medicare cuts in the law may be unrealistic and unsustainable, the report warned.

It's a worrisome assessment for Democrats.

In particular, concerns about Medicare could become a major political liability in the midterm elections. The report projected that Medicare cuts could drive about 15 percent of hospitals and other institutional providers into the red, "possibly jeopardizing access" to care for seniors.

Recall that what little actual support there was for this legislation, and what broad support there was for "need reform" questions, had to do with getting costs under control. Now the spin is that the legislation will only add 1% to costs. Of course, that's still taking into account cuts and changes that aren't politically plausible or financially workable.

Not for no reason does the legislation delay the bulk of its provisions until after a couple of election cycles. Life in the United States is about to become substantially worse, at least for those who have the misfortune of becoming sick or needing a job or not being rich or well connected.

Bishop Tobin Won't Let Catholicism Just Be a Brand

As much as it's disappointing to see division among Catholic organizations, unity can't be the core principle of any group that actually believes in anything. That is to say that I think Bishop Thomas Tobin got this one right:

Following a statement issued by the U.S. Conference of Catholic Bishops expressing regret that health care reform came with the possibility of expanded abortion funding, Bishop Thomas J. Tobin sent a letter March 29 to Sister Carol Keehan, the president and CEO of the Catholic Health Organization, requesting that St. Joseph Health Care of Rhode Island be dropped from the organization's membership and expressing his disappointment that the CHA, under her leadership, publicly endorsed the legislation that was signed into law.

Breaking with the position of the U.S. Bishops who support health care reform without federal funding for abortion, Sister Carol Keehan, a Daughter of Charity, said that "while not perfect, the reform law significantly expands coverage, especially to low-income and vulnerable populations, and is a tremendous step toward protecting human dignity and promoting the common good."

Just as Catholicism isn't only an ethnicity, it isn't only an organizational brand.

The Way to Government Ownership

Since I mentioned, earlier this morning, the government's "overtaking of healthcare," it's relevant to point out an explanation offered in a recent National Review, in the magazine's short-take "The Week" section (subscription required):

American college-loan policy offers an illustration of how the government can absorb an activity incrementally, claiming to cherish the benefits the private sector provides until the bait has worked and it's time for the switch. Government support for student loans began in the form of subsidies for private loans, much as the Democrats' health-care bill would succor the insurance industry by subsidizing its product while forcing people to buy it. In the 1990s, Democrats added a "public option" — making government the direct provider of some student loans — with the Clinton administration claiming that "students and schools are served by healthy competition" between the private sector and the government. This is the same rhetoric Obama used when he tried to sell us a public option for health care. And now we see how quickly Democrats dispense with the rhetoric of competition when a government takeover seems viable: The new student-loan bill would make the public option the only option, thus completing the absorption of the activity. In a similar way, the current health-care legislation isn’t the endgame.

Government ownership of student loans gives politicians strong influence over your career. Healthcare will do the same to your body.

The Nanny State Will Tax Your Skin

Fellow blogger and Providence Firefighter/EMT Michael Morse and his wife sent an op-ed to the Providence Journal objecting to an Obamacare tax on tanning salons:

A small group will be the first to pay for national health-care reform, the first to put their hard-earned dollars into the system. Starting July 1, they will pay 10 percent more for a service that helps them feel better and look better and promotes healthy living.

You can’t tax sunshine, right? Think again. The indoor-tanning industry, mostly small-business owners, the majority of them women, has been singled out to provide funds for a program that claims to be equitable for all.

As they note, other skin-related professions avoided proposed taxes because of the size of their lobbies and the urge to protect people from themselves that has begun to creep from smoking to tanning (let alone eating fast food). For their part, the Morses dispute the ill effects of artificial tanning on health.

Personally, I think that's besides the point. It isn't the role of government to impose a healthy lifestyle on individuals, especially with matters of such long-term repercussions as exposure to light. We'd best get used to it, though. With the government intimately involved in our healthcare system — even more than was already the case — your every behavior is now a matter of interstate commerce.

Can You Hear the Sly Taxation?

Here they go again:

Bills have been introduced by Sen. William A. Walaska (D-Dist. 30, Warwick) to increase medical insurance coverage for hearing aids and to require insurance coverage for surgery and services associated with hearing aid implants.

Without a doubt, hearing loss increases the difficulty of one's life. So does poor eye sight and any number of other ailments and disabilities. There are two problems with this continuing trend of legislating mandatory insurance coverage for related aids, medication, and surgeries:

1. It essentially turns insurance premiums into a tax to fund redistributed wealth, without allowing voters a direct influence on those increasing the cost/tax. In other words, the government is making the insurance companies levy a tax and block the political heat.
2. Determining how much addressing each health difficulty is worth works best on a case-by-case basis, and when somebody else is forced to pay for the remedy, nobody in the chain from provider to patient has significant incentive to make actual, often difficult decisions, thus driving up costs all around.

But, as I said, there's a firewall against political heat built into this practice, so the politicians will keep doing it until we all decide to reassert basic principles of good governance.

Perhaps Healthcare Will Be a Catalyst, at Least for a Permanent Alarm

Theodore Gatchel raises the operative question with regard to the reaction to the content and process of the new healthcare legislation:

On the positive side, the process the Democrats have used to pass this legislation appears to have caused more Americans than ever to read the Constitution.

The more they read it, the more they question not just the legitimacy of this particular process, but also how the immense power of today's federal government can be reconciled with any common-sense reading of the Constitution.

As Gatchel suggests, part of the answer will depend on the direction that the Democrats head from here. If they wipe the dirt off their hands and govern quietly from the center at least through the next election, public ire might subside. If they continue with their radical agenda, whether on immigration, energy, unions, or what have you, they'll reinforce public opposition.

On the other hand, even in our little blue, heavily propagandized state, we've seen people newly involved in a way that suggests a long-term commitment — and a long memory. Even if the politicians manage to lull a critical mass of Americans back into apathetic slumber, there is now a huge nationwide infrastructure for sounding alarms.

The Healthcare System Sinking In

It's probably not really worth mentioning, but Joe Baker's column in yesterday's Newport Daily News is an astonishing bit of cheer leading for the policies of the Obama administration. Most of it has to do with the economy and how wonderfully the stimulus program worked. Perhaps it's enough to note that he claims the recovery on which he's so bullish is "in the rebound a lot quicker than was being forecast when we were in the pits of despair last year."

My recollection is that, in the pits of despair, economists were predicting a clear recovery before 2010. If we find ourselves emerging from the darkness only a couple quarters later, that'll be wonderful, but I'd advise against managing your finances as if flush times are just around the corner.

What's really astonishing about Baker's essay comes when he decides that singing about rainbows in the economy isn't adequately partisan:

Republicans who went to the wall in an attempt to kill the health care reform measure were hoping for a rising backlash from its passage. But that hasn’t materialized, and as the reality of the program sinks in and nobody sees the dire consequences predicted by its opponents, methinks a lot of the remaining anger will float away.

Does this guy get his news purely from Obama press releases? Put aside the fact that he ignores the delay on most of the bill's provisions. One gathers that Baker missed the financial statements of major companies expecting billions of dollars lost to their bottom lines because of the legislation. Moreover, on the same day that Newport County's major daily paper handed its readers Baker's bubblegum, the state's major daily paper was informing its own of the following, on its front page:

While some experts are predicting better times for hospitals from the national health-care overhaul, an analysis conducted for the Hospital Association of Rhode Island predicts that the state's 11 acute-care hospitals stand to lose $465.7 million over the next 10 years.

The study found that any gains from more patients coming through the doors with insurance will be more than offset by cuts in payments the hospitals receive from the federal government, according to Edward J. Quinlan, the association’s president.

An accompanying article suggests that the government has a history, in this area:

Quinlan traces the hospitals' troubles back to the passage of the federal Balanced Budget Act of 1997, which led to steep cuts in Medicare payments. The association estimates that over 13 years, the cuts have resulted in a loss of $700 million. Medicare payments used to provide hospitals 14 percent more than the cost of care, providing a necessary buffer to help pay for general hospital expenses. Now the payments are about 89 percent of the cost of care.

Just wait until employers start dumping their workers into publicly subsidized programs. And just wait until this guy's ilk get the reins firmly in their hands:

Health-care reform may bring some relief. But Nick Tsongias, an executive board member of HealthRIght, which supports comprehensive health-care reform, says there's an even deeper problem to address.

"I think the business model that the hospitals are operating under is now obsolete," he says. ...

... increased competition isn't necessarily beneficial, says Tsongias. In fact, he says, it can be harmful. For example, Landmark Medical Center started a coronary-care unit, but had to close it down because it contributed to financial losses so severe the hospital had to seek protection from the courts, he says.

"It certainly poorly serves the public if the way we determine how many hospitals we have, and what the appropriate array of services are ... is through survival of the fittest," Tsongias says.

Competition leads to efficiency. Indeed, Tsiongas's complaint is that it drives down prices to the point that only the most effective providers can continue to profit from a particular good or service, and what ultimately makes them effective is that consumers wish to spend their money with them. I'm not an expert in hospital finance, but I'd wager that the reason hospitals have chased a narrow collection of identical services is that a mixture of government regulations and insurance company policies have created inadvisable incentives through mandates and the speed and percentage of payments.

The better approach to lowering costs and broadening care would be to allow consumers to pay more directly for the services that they want and need. Further embedding the "insurance" model — really a "healthcare services plan" model — and giving government regulators a more direct responsibility for and authority over the healthcare system will only yield additional strains on providers and higher costs. Which will only yield fewer providers and even higher costs.

I'd much rather live in Mr. Baker's world, in which one can trust that the cool smart guy running the show in Washington would manage of our every worry. We could all relax and be taken care of. Unfortunately, in the world that I've observed, that's just not realistic.

Media Message: Healthcare Simply Rosy

As Marc mentioned this morning, large companies have been assessing the direct cost of the Democrats' healthcare plan to them (i.e., their employees and customers) in the billions of dollars, and Congress has responded by "fuming." Those who read the from the mainstream media and left of there wouldn't have heard much about it, though.

I haven't combed the Providence Journal but about the closest thing to an admission that the healthcare plan might have such negative effects that I've noticed in the Providence Journal has been a column by John Kostrzewa saying that "nobody has a clear answer" the the question of whether small businesses will see their own costs rise. My general assessment, to which Kostrzewa alludes, is that the plan will wind up saving small businesses money inasmuch as they'll simply pay the government fee for unloading their employees into healthcare exchanges and any federal plans that pop up.

There could have been a healthcare reform in which that sort of switch would have been positive, but it would have been based on an increase of choices and decrease in mandates. Such an approach would lead employees to opt to fund their own healthcare and thereafter pressure their employers to give them some of the savings in increased pay. At the same time, consumer-controlled demand would have brought prices down.

As it is, healthcare costs will continue to rise, and small businesses will see canceling healthcare benefits as a necessary savings measure, so the push to split the savings with employees will not be as strong (at least for those employees who need the most help improving their hands in the power game)

Big Business v. Big Government on Healthcare

Big Business learns that Big Government giveth and taketh away:

On Capitol Hill and in the White House on Monday, Democrats were fuming over a series of announcements that started Friday from Fortune 500 firms saying their bottom lines will take huge negative hits because of changes in tax law mandated by Obamacare. That hit in turn means lower profit projections. Caterpillar estimates, for example, that Obamacare will cost it $100 million; John Deere faces expenses of $150 million; 3M, $90 million; AK Steel, $31 million; Valero, $20 million. And then there's AT&T, which is marking its balance sheet down by a whopping $1 billion. All in all, the Wall Street Journal estimated a $14 billion haircut for these corporations.

Under post-Enron accounting rules, the corporations were required to revise their projections to account for the effect of Obamacare on their bottom lines. The effect is negative because Democrats, in their zeal to raise revenues and improve Obamacare's claimed effect on the federal deficit outlook, took away a tax break these companies needed in order to supply prescription drugs to their retirees. The tax subsidy, itself a government accounting ruse crafted in 2003 by the Republican Bush administration to dissuade corporations from dumping their retiree drug benefit programs on the then-new Medicare Part D, becomes taxable under Obamacare. Corporations are now being reminded of the harsh truth: What Big Government giveth, Big Government taketh away, too.

The Constitutionality Proof Is Worse than the Pudding

Ed Fitzpatrick's column, yesterday, suggests that the healthcare law, including the individual mandate, is constitutional, but one needn't be as far right as Anchor Rising to be very concerned about the reason:

The Supreme Court has held that Congress "can tax for any legitimate reason, and certainly providing health care for all Americans is a legitimate reason," Goldstein said. "It was imposed based on Congress' reasonable conclusion that when some people don't have health insurance, it hurts them and shifts a lot of costs onto the rest of us. The tax is little different than taxes Congress imposes on companies that pollute, which are similarly based on the conclusion that pollution hurts everyone and could be deterred through a tax."

Also, the high court has upheld Congress' power to regulate "economic activity that substantially affects interstate commerce," Goldstein said. "And there is no question health care and health insurance affects interstate commerce."

So, not taking care of your own health is like large factories' polluting the air and your health-related habits also affect interstate commerce, making them a legitimate target for regulation and taxation. I took up this topic in a Rhode Island Catholic column a few months ago. The question arises: under such reasoning, what doesn't Congress have the authority to regulate?

Statists already would have answered "nothing," but shouldn't we find it frightening to stare down this dark slope? Now, not only is the authority asserted, but the federal government has a massive new entitlement to bolster and defend by making the American behave in particular ways.

After the Legislation, the Deluge

This might be the most frightening thing related to the healthcare legislation that I've read thus far:

Dr. Nick Tsiongas, who sounded jubilant when reached by phone Monday, actually agrees with Purcell that the bill is weak on cost control. But Tsiongas, who founded the local reform group HealthRIght, believes the federal legislation will allow Rhode Island to tackle that issue. The federal subsidies are necessary to cover the uninsured, he said. "It establishes a platform on which state reforms can now begin to take hold," he said.

Take hold like a hand around a throat. You may recall Dr. Tsiongas from one of my vlogs:

At Rep. Patrick Kennedy's townhall-esque AARP meeting, Tsiongas explained his desire to pool all of the money currently in the Rhode Island healthcare system — public and private — so that he and his fellow experts could allocate it in a way that they consider to be rational, determining such things as how much of each medical technology is available in the state. His jubilation at the "platform" that enables him to reach such goals is evidence enough that Congressional Democrats and President Obama have done a very bad thing, indeed.

Spotting the Spin in the Fact Check

Perhaps you've noticed the newspaper fad, in recent months, of printing "fact checks" that purport to offer readers a balanced and objective assessment of the spin surrounding various issues. I stopped bothering with them after the first couple, when it occurred to me that the articles are mainly useful for bloggers still interested in spotting media bias. In a recent example concerning the healthcare legislation, Ricardo Alonso-Zaldivar strives to explain how both sides are spinning the issue. The problem is that his fact checking of the opposition doesn't really present actual myths or the facts that debunk them.

The first "myth," for example is that "Obama has put the nation on a slippery slope toward socialism." The "fact" is that the nation has been on that slope for a while and still has farther to go until it reaches bottom. I don't know of anybody, on the right, who disagrees, so it appears that Alonso-Zaldivar has debunked a strawman.

When he gets to the question of abortion, it's not at all clear that the reporter has done any research about the actual arguments being made:

You will be forced to pay for other people's abortions.

Only if you join a health insurance plan that covers abortion. In that case, the costs of paying for abortions would be spread over all the enrollees in the plan—no differently from how other medical procedures are handled, except a policyholder would have to write a separate check for it.

Timothy Jost, a law professor at Washington and Lee University, said people who don't want to pay for abortion could simply pick a plan that doesn't offer it.

There would definitely be a demand for such plans, and not just from people with moral objections. Single men and older women would have no reason to pay an extra premium for abortion coverage.

The point isn't that the government will force us to join healthcare programs that offer abortion. The point is that the government will be subsidizing, with our money, the premiums of people who do.

However one feels about abortion or healthcare or socialism, it remains necessary to adjust for the medium through which one acquires news. Spin is chronic and addictive.

Except on Anchor Rising, of course, where all of our facts and conclusions are entirely objective.

Rhode Island's Lesson for America

It's been an education in the future of healthcare in the United States to watch Rhode Island's three insurers seek rate increases from the state as the Democrats have forced their legislation through Congress. On Thursday, the state health insurance commissioner, Christopher Koller "slashed" proposed premium increases and:

... that's not the only effect: Koller also reallocated how insurers should spend their premium dollars.

He ordered Blue Cross & Blue Shield of Rhode Island and UnitedHealthcare of New England to spend less than they had proposed on hospital care — a decision that could pressure insurers to negotiate lower payments to hospitals, at a time when hospitals are losing money.

The usual suspects are demagoguing about ruthless insurance companies and their endless rate increases, and Mr. Koller is bringing up "troubling trends," such as the unexplained fact that the average age of people receiving health coverage through work is going up, adding to premiums. Nobody is questioning the wisdom of allowing an unelected bureaucrat to manage every insurer in the state:

Koller does not merely rule on the total premium, but examines the factors that the insurers say underlie their need for more money — the costs of hospital care, medications, primary care, administration and profits. His only changes were: reducing inpatient and outpatient hospital costs at both Blue Cross and United, increasing United's primary-care costs, and slightly cutting the administration and profits at Blue Cross. ...

"We need to make the status quo as uncomfortable for insurers and providers as it is for employers, the people who are paying the bill," he said.

Is a healthcare system built upon mutual discomfort really the most effective approach? Artificially suppressing prices doesn't affect the factors driving those prices up, and however much provider and insurer greed may play a role, the limited number of choices, the disguising of costs within broad premiums and through government subsidies, and the requirements and restrictions that the state government places on the market are exponentially greater factors.

If we wish to bring down costs, we're going to have to increase the degree to which consumers must consider the price of each service. Unfortunately, our government — convinced of its own need for more power — is moving in the other direction. With the intention of taking decisions out of the hands of insurers, government operatives are pulling them into their own.

At least if consumers were unhappy with the deals offered by Blue Cross, they could switch to United (and now Tufts). What are our options supposed to be if we're not happy with the decisions of Mr. Koller? And why would additional companies choose to operate within a state (or nation) in which such a functionary ultimately runs their operations?

Patrick Lynch Not Interested in Challenging the Federal Government's Power to Impose a Purchase Mandate on Individuals

According to Steve Peoples of the Projo's 7-to-7 newsblog, Rhode Island Attorney General Patrick Lynch (to no one's surprise, really) is not interested in joining a potential lawsuit by the states challenging the Federal government's power to require that individuals purchase something...

"I don't like a lot of the decisions that the legislature makes every day. Do I go up and sue them? And do you have the basis to do so, more to the point?" Lynch said in a late-morning interview, characterizing the looming lawsuits in a dozen states as "political posturing....But at the outset, moments after the vote, when they're crying and putting up [lawsuit threats] on Facebook in Texas first, there's a procedure that we go through as attorneys general when something is more substantive, and this seems to be a partisan driven mechanism," said Lynch, a Democratic candidate for governor.

"To me it's a moment that should be celebrated," he said of Sunday's health-care vote.

At Some Point After Healthcare Reform Kicks In

Not understanding this. Long waits and worsening care. Costs increasing - strange, why didn't price controls take care of that? Looks like we're gonna need to do some more revenue enhancing.

Doctors dropping out. (Huh. Wonder if that's related to the price controls.)

Most doctors have stopped taking Medicare patients? Well, a "universal coverage" addendum ought to take care of that. If doctors don't accept Medicare patients, they won't get any reimbursements from us! That'll fix 'em.

Whoops, fraud and abuse up double digits. That's right, we never did get around to re-deploying those IRS agents.

Unemployment rate creeping up. That's got nothing to do with healthcare reform, though ...

Gee, looks like nobody has access to good healthcare now. ... Well, other than Congress and the very rich, of course. (Color me embarrassed on THAT point!)

Good thing Speaker Kucinich (and how funny is that! but it was the only way to keep his support) has convened a study commission. We'll get to the bottom of this, no matter how many junkets and how long it takes!

Okay, what's on the calendar? This afternoon - hearing to telescope med school and eliminate residency periods. Gotta get more docs pumped out. And tonight - oh, excellent, the trial lawyers' fundraiser. They've been a rock through all of this. Let's see. "Just keep saying no to tort reform!" H'mm ... "Together, we can hold off the scourge of tort reform!" Better! Must remember to hold up clenched fist ...

Your Democrat Congressman

We Awake in a Different Country

For almost a year, the people of the United States have taken every opportunity to tell their "representatives" not to absorb our healthcare system into the government. Tea Parties, town halls, elections (even unto taking a Massachusetts Senate seat out of Democrat hands), and poll after poll after poll. They didn't care. They've lied. They've gamed every internal analytical system, such that the Congressional Budget Office had to find falsely a deficit reduction. They've taken key votes on hidden days, even Christmas Eve. They've overtly bribed members. They've manipulated the legislative process. And now, like it or not, America, they've forced the costly, detrimental lemon down our throats:

A bloc of pro-life Democrats turned out to be the linchpin to passage of the Senate's massive health insurance overhaul Sunday night, as President Obama cemented a 219-212 victory with a pledge to issue an executive order "clarifying" abortion language in the Senate bill.

The House also voted 220-211 to support a "reconciliation" bill aimed to "fix" provisions in the Senate bill that many House Democrats opposed but viewed as better than nothing.

The one monomaniacal call that must now replace every objection that the American people have raised over the past year is: Repeal.

ADDENDUM:

Here's the vote list. Consult it before you ever vote for an incumbent of this Congress for so much as town garbage sorter.

Will Patrick Lynch be Getting a Phone Call Tonight...

...and do we have a new issue in both the Rhode Island Attorney General's and the Governor's races, based on this facebook post from the Attorney General of Texas (h/t NRO)...

Texas attorney general Greg Abbott Facebooks: "I am organizing a conference call tonight for AGs across the country. We will discuss our litigation strategy about the healthcare bill. I will update you on Facebook after the conference call."

Breaking: The Stupak Sell-Out

The Stupak pro-lifers have accepted an executive order for their votes:

Stupak announced support for the bill as the White House issued its statement about the executive order.

The president "will be issuing an executive order after the passage of the health insurance reform law that will reaffirm its consistency with longstanding restrictions on the use of federal funds for abortion," reads a statement from White House Communications Director Dan Pfeiffer.

As they're arguing in the Corner, an executive order simply doesn't do the trick. Kathryn Lopez: "I think we're witnessing Bart Stupak write the obit for the concept of the 'pro-life Democrat.'"

As a local matter, he may be writing the obituary for Jim Langevin's seat in Congress. If this is what pro-life Democrats get for their votes, they ought to throw the next primary to Betsy Dennigan and then vote Republican or independent as a lesson.

Re: Sunday Healthcare Whip Report

Stupak is now officially a "yes". National Review Online has identified 3 pro-life Congressmen that may not go along with the executive order solution. Two of them, Dan Lipinski and Jerry Costello both of Illinois, are on the Firedoglake Stupak-list. A third, Gene Taylor was already counted as a "no".

Earl Pomeroy has declared he is a "yes".

If we put the 7 remaining from the Stupak bloc as "yes" votes, plus Pomeroy, the Democrats now have 216, no matter how the remaining undecideds break (trusting the FDL information and the NRO report to be accurate).

UPDATE (5:08 PM)

...although the New York Times lists only 5 official "yes" votes, Stupak, Driehaus, Dahlkemper, Rahall and Mollohan.

Sunday Healthcare Whip Report

Firedoglake is reporting that Marcy Kaptur of Ohio, who had been in listed in their Stupak bloc (don't know that we can really call them pro-lifers as a group anymore) will vote "yes" regardless of any changes in abortion language. Bart Stupak's statement that he has 6 members in his bloc suggests least one or more of the others in the FDL "Stupak" category might go "yes", regardless of changes or non-changes that happen today. Reportedly, Stupak is negotiating with the White House on banning public funding for abortion via executive order, meaning the EO strategy could win his vote and the votes of his bloc.

FDL is also mentioning that Rick Boucher of Virginia, who they had as a "no" but other sources had as undecided, is a potential undecided. And no one is sure what Loretta Sanchez of California is going to do. All that taken into consideration, I'l interpret the FDL reports as saying 206 Yes, 207 No, 9 generic unknowns, 9 potential members of the Stupak bloc (but at least one who is probably already a "yes").

Fox News hasn't moved their tally from 216-215; I'm not sure where they had Kaptur before. The New York Times is enjoying Sunday Brunch.

UPDATE (12:32 PM)

Something is up with the Stupak discussions with the White House. A press conference that was supposed to have been held at noon has been cancelled. Nothing definitive has been reported yet.

Also, there appears to be one New England vote still undecided. Firedoglake has Michael Michaud of Maine as an undecided potential Yes-No flip, though the New York Times has him as a "yes". The Bangor Daily News reported yesterday...

With a historic vote on reforming the nation's health care system looming on the horizon, Rep. Michael Michaud isn't tipping his hand. In a prepared statement on Friday, Michaud said he is still reviewing the contents of the reconciliation package unveiled Thursday by fellow Democrats in the U.S. House...As of Friday afternoon, Michaud was the only member of Maine’s congressional delegation still on the fence about the legislation

UPDATE II (12:49 PM)

Firedoglake is reporting that MSNBC is reporting that the Stupak bloc has accepted the Executive Order, and will vote for the bill.

By FDL's count, one more commitment is still necessary to get the democrats to 216 (assuming they now will get all 9 of the Reps listed under the Stupak bloc). Could we see any confusion about Loretta Sanchez clear up very soon? I suspect she could weather the title of "the bringer of socialism to America" title better than Mike Michaud could.

UPDATE III (1:08 PM)

Here's the banner from MSNBC...

BREAKING NEWS: Sources tell NBC News that Rep. Stupak to vote yes on health care bill

UPDATE IV (1:17 PM)

Robert Costa of National Review Online is confirming Stupak as a "yes".

UPDATE V (1:30 PM)

Fox News is reporting that Brian Baird of Washington has announced he will vote for the bill, and they've moved their tally to 217-214.

Baird was on the Firedoglake list of unknowns, which means if all 9 of their Stupak bloc members come over, their tally is 216 votes in favor of passage. Baird, by the way is retiring from Congress.

UPDATE VI (1:42 PM)

Hold on a sec: a conservative group-blog (NRO) is linking to a twitter feed from a producer at an all-news network (CNN) which says...

Urgent -- Rep. Stupak to CNN producer Lesa Jansen: "I'm still a no...There is no deal yet. Its a work in progress."

UPDATE VI-B (1:54 PM)

Roll Call says...

Despite reports to the contrary, House Democratic leaders insisted Sunday that they do not yet have the support of anti-abortion-rights Rep. Bart Stupak (D-Mich.), who has been leading a bloc of key holdouts on the bill.

MSNBC reported earlier that Stupak — and others opposing the final health bill over the abortion language — would vote in favor. But according to Brendan Daly, spokesman for Speaker Nancy Pelosi (D-Calif.), “MSNBC is wrong.”

“We hope so, but it hasn’t happened yet,” he added.

UPDATE VII (2:01 PM)

The New York Times is reporting that John Tanner of Tennessee, who was undecided, will remain a "no". Firedoglake is reporting that Lincoln Davis of Tennessee will also vote "no", and that Bill Foster of Illinois will vote "yes".

That puts the total at 208-209, 5 generic undecideds (4 of whom voted yes on the previous bill), 9 members of the Stupak bloc possibly waiting on the outcome of the executive order deliberations.

A Little More Context for the Vote

As the national Democrat Party does back flips to pass its healthcare monstrosity, there's are important bits of context of which we shouldn't lose sight. The first is that: "Job loss has been a big factor in the loss of insurance coverage, but not the only one," and job loss has been the sickly child in the room that Congress has ignored in its fixation on further nationalizing healthcare. Here's the second:

"Nobody is saying that providing coverage for those Rhode Islanders who are fully or partially uninsured won't cost anything," [Owen] Heleen, of the Rhode Island Foundation, said. "We all know it's going to cost something. That's much of the fight going on in Washington."

Said Koller, the health insurance commissioner, "You need significant federal money if you want to reduce the number of uninsured — unless you want to reduce the benefits for everyone else, and that's a nonstarter."

"It's not something we can solve ourselves," [Deb Faulkner of the Rhode Island-based Faulkner Consulting Group] agreed. "We can do our own Rhode Island thing, but we need their money."

But somehow, coming up with that money at the federal level is going to reduce the national deficit. Got it?

Healthcare Whip Report

As of 8:15 pm, Fox News says there are 217 votes in the House of Representatives in favor of passage of the Democratic healthcare reform bill (216 are necessary for passage). National Review Online is reporting that a Maryland Congressman has said that he's "not sure" that the Democratic leadership needs the the Bart Stupak pro-life bloc in order to pass its bill.

On the other hand, the liberal website Firedoglake has posted its own tally of "unknowns". According to the numbers there, the Democrats have to pick up all 10 of the Congressmen listed as unknown (Rep. Jim Matheson has already gone "no") plus at least 2 of 10 from the Stupak bloc, in order for the healthcare bill to pass. A few hours ago, they had Zack Space of Ohio listed in their Potential Yes-No flips (he is now a "no"), so there seems to be something to their breakdown.

National Review Online, as of 8:15, says the current tally is 208-214 with 9 undecideds. That's close to the Firedoglake result, if you count the 10 Stupak bloc members as "no" votes.

If the Dems do have more than they need, Zack Space would be good choice to release, as Firedoglake notes that his district was +7 Republican in the Presidential election.

I have no idea what information is fully reliable, and what's being put out (by the politicos, not the news sources) for tactical purposes.

UPDATE I (8:33 PM):

Since I posted the original item, Fox news is now reporting 218 votes in favor of passage.

UPDATE I-B (10:07 PM):

Fox is back to 217-214 in favor. The New York Times also has a tracker up and is reporting the current state of affairs as 207-206 with 18 undecided.

UPDATE III (11:59 PM):

Glenn Nye of Virginia, a potential No-to-Yes Flip on the Firedoglake list has told his local paper he is a "no". If I'm counting this right, the Firedoglake tally is 204 Yes, 208 No, 9 generic unknowns, and 10 undecided members in the Stupak pro-life bloc. Passage now requires 3 members of the pro-life bloc to support the bill, if all 9 of the other unknowns decide "yes".

FDL is also indicating that a current "yes" has switched to "no", but the Congressperson hasn't said it herself yet.

UPDATE III-B (12:12 AM):

And Fox is now at 216-215. The New York Times has apparently gone to bed for the evening. Clearly, they've never heard Huey Lewis' The Heart of Rock and Roll.

UPDATE IV (1:15 AM):

Solomon Ortiz of Texas has issued a statement saying he will vote "yes", taking himself off of Firedoglake's potential Yes-To-No list. Let's call it 205 Yes, 208 No, 8 generic unknowns, 10 members of the pro-life group.

UPDATE V (1:32 AM):

One more, and I'm done for the evening. Bart Stupak in Roll Call says that he has six votes in his pro-life group...

Stupak, who once spoke for a dozen Democrats who were prepared to vote against the bill unless his strict abortion restrictions on insurance coverage were adopted, told reporters Saturday that his group was down to six, and he did not know if that would be enough to block the bill.

The Democratic Healthcare Penalty on Lower-Income Employees

Here at Anchor Rising, we slog through the dreck, so you don't have to! The paragraph below is some less-than-transparent text from the House reconciliation bill on healthcare "reform" (i.e. the dreck)…

[SEC. 1003(b)] APPLICABLE PAYMENT AMOUNT -- Section 4980H of such Code, as so added and amended, is amended-- (1) in the flush text following subsection (c)(1)(B), by striking ‘‘400 percent of the applicable payment amount’’ and inserting ‘‘an amount equal to 1⁄12 of $3,000’’;

(2) in subsection (d)(1), by striking ‘‘$750’and inserting ‘‘$2,000’’…

LARGE EMPLOYERS OFFERING COVERAGE WITH EMPLOYEES WHO QUALIFY FOR PREMIUM TAX CREDITS OR COST-SHARING REDUCTIONS.

Moving down to subsection (c)(1)(B), we find a set of circumstances that trigger a tax-penalty…

‘‘(B) [If] 1 or more full-time employees of the applicable large employer has been certified to the employer under section 1411 of the Patient Protection and Affordable Care Act as having enrolled for such month in a qualified health plan with respect to which an applicable premium tax credit or cost-sharing reduction is allowed or paid with respect to the employee, then there is hereby imposed on the employer an assessable payment equal to the product of the number of full-time employees of the applicable large employer described in subparagraph (B) for such month and an amount equal to 1⁄12 of $3,000.

In other words, it now costs a "large employer" $3,000 more a year in Federal taxes to hire someone who qualifies for a Federal subsidy than to hire someone who doesn't. This is, of course, what Democrats call rational economic policy.

If nothing else, this makes it understandable as to why House Democrats don't want to have their votes recorded on the substance of the Senate healthcare legislation. But as the fixes in the reconciliation legislation make clear, this is a provision House Democrats want to keep, not one they want to get rid of!

Despite Health Care Mess, There are Points of Agreement

Erstwhile Democratic presidential pollsters Pat Caddell (Carter) and Doug Schoen (Clinton) have penned a piece about the political prospects facing their party amidst the health-care drama. Yet, what caught my attention was their concise summary of the things upon which most everyone agrees:

There are enough Republican and Democratic proposals -- such as purchasing insurance across state lines, malpractice reform, incrementally increasing coverage, initiatives to hold down costs, covering preexisting conditions and ensuring portability -- that can win bipartisan support. It is not a question of starting over but of taking the best of both parties and presenting that as representative of what we need to do to achieve meaningful reform. Such a proposal could even become a template for the central agenda items for the American people: jobs and economic development.

Wanting (and Needing) a Different Kind of Reform

Perhaps it shouldn't be surprising, given the presumption of their label, but "progressives" have a tendency to assume that anybody who wants change wants their kind of change — as if there can only be one solution for reaching a given goal. Just about all conservatives, for example, really do desire world peace, but that doesn't mean they should be counted among those desiring unilateral retreat and disarmament. Most believe that regimes that initiate or foster violence and war must be removed in order for peace to be lasting.

Just so with healthcare. A conundrum that John Kostrzewa cites is not actually a conundrum:

...69 percent of the 200 members of the Greater Providence Chamber of Commerce who completed the survey in February said health insurance was their biggest concern. That's up from 63 percent in a similar survey a year ago. ...

But [these results] all run counter to national polls that show a clear majority of people is opposed to President Obama's proposal to overhaul the health-care system by covering more people and eventually cutting costs.

Kostrzewa never quite articulates the factor that resolves the question: It isn't just that individuals and businesses are generally suspicious of Washington and dislike political squabbling (Americans are more savvy than that); it's also that we don't believe that the approach to "reform" that defines Obamacare will improve costs or quality. And that's a problem on up the tiers of government. The state of Rhode Island could go a long way toward alleviating the healthcare concerns of its citizens were it to lighten regulations and let market forces work.

Healthcare as Inspiration for Fealty

Further to Monique's post about signs of the wisdom of the Democrats' desired healthcare regime, I thought I'd beat the drum again with Mark Steyn's Saturday column:

... Look at it from the Dems' point of view. You pass Obamacare. You lose the 2010 election, which gives the GOP co-ownership of an awkward couple of years. And you come back in 2012 to find your health-care apparatus is still in place, a fetid behemoth of toxic pustules oozing all over the basement, and, simply through the natural processes of government, already bigger and more expensive and more bureaucratic than it was when you passed it two years earlier. That's a huge prize, and well worth a mid-term timeout.

And well worth some golden-ticket promises to senators and congressmen who may lose their seats over their votes.

Red Flags that the Pending Healthcare Reform May not be a Good Idea

(... in addition to the Constitutional issue - i.e., the legality of compelling everyone to purchase health insurance.)

Much of the disagreement about whether the Democrats' health care reform should proceed centers around its long term consequences. Supporters of the pending reform don't see any problems long range if the bill passes. Opponents point to the inevitable consequences of compelling insurance companies to provide essentially open-ended coverage while demanding that they not raise premiums too high.

Okay, set that aside for a separate discussion. Here are some more immediate warning signs.

1. Congress has exempted itself from it. If better/more expensive health insurance policies are Cadillac plans, Congress has a Rolls Royce. And it stays right in their driveways even if they themselves pass health care reform "for" everyone else. If the proposed reform is such a good idea, why?

2. We start paying for it right away but the benefits don't begin for four years. (Side issue, which it clearly is for proponents: what happens to all of those sick, uninsured people in the meantime?) How viable is a proposed program if the required revenue needs a four year running start?

3. $500 billion cut from Medicare. Proponents have stopped even pretending that this will come from a crack down on waste, fraud and abuse. Setting aside the disgrace and misdirected priority of depriving seniors of this care, isn't a proposed program patently non-viable if another program has to be gutted to fund it?

4. Let's see if we understand the scenario. No insurance company can refuse anyone coverage. The penalty for an individual not obtaining coverage is $800. So wouldn't it be a lot cheaper for the healthy person (many millions of them) to not buy coverage, pay the penalty rather than the premiums year after year and then simply enroll as soon as a health issue crops up? Actually, we don't have to wonder. This is exactly the approach New York took.

New York's "reforms" meant that people could literally wait until they had an accident or illness before buying a policy -- changes that more than doubled insurance costs in the state, according to the Empire State Center for New York State Policy.

Premiums shot up so far and fast that healthy customers dropped insurance altogether -- with the number of people buying individual policies plummeting from 750,000 in 1994 to 36,000 now.

It's tough to come to grips with the longer term implications of the proposed reform to health care when we are asked to disregard such serious pitfalls up front.

Obama's Health Plan: Rhetoric vs. Reality

The Foundry helpfully breaks down President Obama's latest bid for health care reform:

President Barack Obama gave yet another speech this afternoon urging Congress to pass his health care reform plan.

The President again claimed his plan lowers health care costs. It doesn’t.

The President again claimed his plan would not give government bureaucrats or insurance company bureaucrats more control over health care. It does.

The President again claimed that “if you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor.” That simply is not true.

The President again said his plan gives the American people the same health care as Members of Congress. It doesn’t.

The President again claimed his plan is paid for. It is not.

Fundamental Differences Displayed

Heritage's Ed Haislmaier sums up the fundamental issue on display at yesterday's healthcare snoozefest:

The overriding reality behind this summit is that both the public and the politicians come to the table divided not over the details but rather over the basic approach to health reform. In his comments, Sen. Lamar Alexander (R-TN) highlighted three of those major divisions — comprehensive legislation versus incremental legislation, starting over versus pressing ahead with the bills passed in House and Senate in December, and a decentralized approach versus a centralized federal solution. Today’s debate showed few indications of a willingness by the President or the Congressional leadership to alter their basic approach. Though the summit served to highlight the fact that both parties are in favor of reform, differing only in their opinions on how to achieve it, the direction of the health care debate is unlikely to deviate from the course it has taken for the past year as a result of today’s discussion.

The pared-down bill would cost about a quarter of the 10-year, $950 billion plan Obama put on the table on Monday, sources told Fox News.

The Wall Street Journal first reported Thursday that Obama's staff had prepared the blueprint for a smaller-scale plan. Sources said the backup would extend coverage to about 15 million people, or half the number the larger plan would cover.

It would expand Medicaid and the Children's Health Insurance Program, while allowing people to stay on their parents' health plans until age 26.

But the idea of what one congressional Democrat called "skinny" health care reform may encounter stiff resistance in the House.

"Inaction and incrementalism are simply unacceptable," House Speaker Nancy Pelosi said in remarks released before Thursday's summit. House Democrats are almost sure to reject calls for a scaled-back bill.

"We are going forward with a big bill," a top Democrat told Fox News.

Doctors Point the Way to Reform

It should surprise nobody that I see this as evidence that healthcare reform must move in the free-market direction, not the government takeover and dictation direction:

"Something has been discouraging physicians from working the long hours they used to work," [Douglas Staiger, an economics professor at Dartmouth College] said.

The cause? Bureaucracy and limits to their pay.

Payment issues may have played more of a role. The overall decrease in hours coincided with a 25 percent decline in pay for doctors' services, adjusted for inflation. And when the researchers looked closely at U.S. cities with the lowest and highest doctor fees, they found doctors working shorter hours in the low-fee cities and longer hours in the high-fee cities. ...

"There's so much oversight for what we do, so many people we have to answer to and so little of it improves care, it's just driving us all crazy," [Dr. Robert Perlmuter, a Chicago internist,] said.

Officious government meddlers may not believe it, but the rest of us adults can conduct our lives just fine without their assistance. One is hearing murmurs here and there of local officials' wondering whether Rhode Island can move forward with some sort of healthcare reform regardless of what the federal government does. Somehow, though, they've seem disinclined to acknowledge that the General Assembly could eliminate the burdensome mandates right now and immediately improve healthcare quality and costs in the state of Rhode Island.

Government Can't Just Dictate Reality

I certainly don't want any of my family's regular expenses going up. Indeed, if I were able to dictate terms to companies who provide me services, I'd lower my rates. But that's not how the world works. Of course, one doesn't get the impression that government officials comprehend such mundane observations of reality.

Rhode Island's Health Insurance Advisory Council, for example, in considering insurers' requests to increase their rates, acknowledges that "most of the proposed increases result from growing hospital and pharmaceutical costs." But the body can only think to posture and demand more squeezing from the companies. Several candidates for public office who put in an appearance at the hearing had nothing additional to offer:

State General Treasurer Frank Caprio, a candidate for governor, offered the council "an update from kitchen tables across the state." He said bills are piling and people are forced to cut back. "I respectfully ask you to say, 'Enough is enough' to these insurers," Caprio said.

Lt. Gov. Elizabeth H. Roberts, a candidate for reelection, acknowledged that medical inflation was the underlying problem, but urged Koller to push insurers to develop proposals for dealing with it. "We need to put the challenge on the table," she said.

State Sen. Leonidas P. "Lou" Raptakis, D-Coventry, a candidate for secretary of state, suggested linking health-insurance premiums to the consumer price index.

Why is nobody proposing the clear solution to the problem of increasing in-state health insurance? Look, our mechanism for dictating terms to those who provide us services is to find another provider willing to agree to them. A market of just three insurers is clearly not enough, so we need to bring others in. To do that — and to enable them to keep down costs — we've got to lighten up our mandates and regulations.

Unfortunately, we're learning that the one thing that Rhode Island's ostensible leaders will not consider is decreases to their own authority. That's why we have to apply a political version of the Central Falls high school "turnaround model": Vote them all out of office and reelect no more than the one percent or so who might have something resembling a clue.

Hurry to Pass Big Stuff Now and We'll Fix it Later (Promise!)

As I've pointed out, one of the arguments made by the Healthcarism advocates was that we must pass something, anything and "the warts can be removed later." Apparently, that attitude exists amongst global climate changistas, too (h/t):

Some researchers have argued that it is unfair to attack the IPCC too strongly, pointing out that some errors are inevitable in a report as long and technical as the IPCC's round-up of climate science. "Part of the problem could simply be that expectations are too high," said one researcher. "We have been seen as a scientific gold standard and that's hard to live up to."

Professor Christopher Field,director of the Department of Global Ecology at the Carnegie Institution in California, who is the new co-chairman of the IPCC working group overseeing the climate impacts report, said the 2007 report had been broadly accurate at the time it was written.

He said: “The 2007 study should be seen as “a snapshot of what was known then. Science is progressive. If something turns out to be wrong we can fix it next time around.” However he confirmed he would be introducing rigorous new review procedures for future reports to ensure errors were kept to a minimum. {emphasis added}

How confident are you that a massive governmental program will be flexible enough to integrate such "change" on the fly? Or that the political will is there to do it. (Social Security, anyone)? No, every time I hear promises about fixing problems down the line, I recall that infamous line from Animal House about trust. My guess, in the wake of the Scott Brown win, is that most Americans are a little wary of Big Government for much the same reason.

Protestations to ProJo Pronouncements

1) The ProJo editors on global warming:

Still, that a few scientists are accused of manipulating a bit of data from some climate research does not do away with the preponderance of evidence. The latest controversy revolves around the validity of the collection and use of data behind a U.N. Intergovernmental Panel on Climate Change 2007 report that Himalayan glaciers will shrink dramatically, or even disappear, in a few decades. However, the scientific consensus that Himalayan glaciers will dramatically recede is unlikely to be overturned anytime soon.

The scientist behind the bogus claim in a Nobel Prize-winning UN report that Himalayan glaciers will have melted by 2035 last night admitted it was included purely to put political pressure on world leaders.

Dr Murari Lal also said he was well aware the statement, in the 2007 report by the Intergovernmental Panel on Climate Change (IPCC), did not rest on peer-reviewed scientific research.

2) Froma Harrop is ticked about Massachusetts electing a senator to stop national health care reform, especially since Masachusetts has already enacted state health care reform. (Echoes of the temper tantrum the ProJo editors published a few days ago--guess we know who penned that one!). Harrop thinks the national plan superior to the Mass. one, particularly in that it does a better job containing costs. But Massachusetts is going to fix it, which gets us to Harrop's favorite rejoinder to critics of national health care: "Politically, the Massachusetts program could serve as a national model. Pass universal coverage now, fix it later." Here's an idea: let's revert to the the "laboratory of the states" idea. The reason for the reputed success of national health care programs in other countries rests largely on their relatively smaller populations and cultural homogeneity. Neither of these are comparable in the U.S. So let states handle it, if they choose, like Massachusetts did.

3) Some minor quibbles with Ed Fitzpatrick's piece on what went wrong with Coakley, mostly with his parrotting of two memes that don't have much substance, but apparently make Democrats and liberals feel a little better. First:

Republicans might convince themselves that Brown’s victory heralds a new level of affection for the GOP. But voters aren’t expressing love. They’re expressing anger.

But after a year of economic turmoil and seemingly endless debate, many people remain unconvinced that a complex health-care overhaul should top government’s priority list. (If I had to guess, the top three priorities are simple: jobs, jobs, jobs). And now Brown, who as a Boston College law student posed nude for a Cosmopolitan magazine centerfold, has stripped Democrats of any easy way to move forward with the existing bill.

Move from Management to Insurance to End Payment Disparities

Rhode Island's health insurance commissioner, Christopher Koller, has released a report showing huge disparities in what health insurers pay local hospitals for the very same procedures. The reason is that members of the Care New England hospital group offer services not elsewhere available, so insurers have no choice but to include them, and the hospitals leverage those services for better payments throughout their organizations.

Note the way reporter Felice Freyer insinuates regulation as the strategy for resolution:

Koller’s report shines a flashlight beam into the murky world of hospital finance. Hospitals negotiate privately with insurers to establish how much they will be paid for each service. These talks are largely unregulated, and always private, so that no hospital knows exactly what its neighbor is being paid. All are forbidden by contract to reveal their rates.

Diving into the regulatory pool would only drive up rates. Whether government mandates forced insurers to pay above the rate that the market dictates, within its regulatory strictures, or one or more of the state's three insurers bow out, the cost will ultimately be borne by consumers.

The better approach would be to move away from a system that uses insurance as a healthcare management plan. If patients paid more directly for the services that they receive, the market would set prices based on those services, not on the leverage of hospital groups. That a hospital is the only one with a newborn intensive care unit matters less to an individual who needs heart surgery than it does to a large insurance company that must negotiate a full menu of services.

Carter: Kennedy "Killed the [Healthcare] Bill" in 1979

Thanks to a caller to the Matt Allen Show, I was tipped off to something I'd never heard before. In an event at his Presidential Library (broadcast by C-SPAN on September 15, 2009), former President Carter explained that, back in 1979, he had bi-partisan support for a health care reform package that was completely financed and approved by various committees. Well, except for one powerful committee chair who was opposed: Senator Ted Kennedy. That Carter's revelation came just a few weeks after Senator Kennedy's death may explain the dearth of media coverage.

Here is a link to the video (The question and answer begins at around 41:45 of the video and the explanation that Kennedy "killed the bill" is at around 43:30). Here is the relevant snippet as explained by President Carter:

[My health care proposal] would have passed except for---at that time we had the full approval of all of the committee chairman of the House and Senate; Republicans endorsed it with me in a press conference---except for the key Senator and that was Senator Kennedy, who at that moment had decided to run against me for President and didn't want to see us have success. So he killed the bill.

UPDATED: Here's a brief, contemporary story from the Harvard Crimson about the plan. CNN covered the speech last September, but reported the above as follows:

Carter blamed "political problems" for his inability to overhaul the nation's health care system in 1979 so that all 15 million Americans then without health insurance would have gotten coverage. That number has tripled in the intervening years.

ProJo's Last Shot at Brown - Scare Tactics

On election day in Massachusetts, the desperate ProJo editors have resorted to listing a bunch of "what ifs?" should Scott Brown be elected and Obamacare not pass. Notwithstanding that a counter-argument can be made that passing this particular monstrosity called health care "reform" would make all of the items they identify even worse, the panicked essay reveals that the fatal flaw in their reasoning still exists. They clung so stubbornly to a mythical, ideal single-payer system--like Medicare for all!--that they've been blind to other (yes, free market) reforms that would accomplish many of their desired goals, if differently. So they're left to exclaim that we need to pass something, anything ("the warts can be removed later") before it's too late.

The Haves and Don't Have Tos of Healthcare

Mark Patinkin begins a brief examination of "why there's all this fuss about revamping the [healthcare] system" with a faulty premise:

I'm guessing there have been two distinct audiences for the health-care debate.

Those who have an affordable plan and those who don't.

If you don't, you doubtless paid a lot more attention.

Patinkin's essay stands as evidence that there are at least three audiences, and since the third implies an antipode, there must be four:

1. Those who have an affordable plan and believe something like the Democrats' plan will not affect them.
2. Those who have an affordable plan and believe something like the Democrats' plan will threaten them.
3. Those who don't have an affordable plan and believe something like the Democrats' plan will ensure one.
4. Those who don't have an affordable plan and don't believe something like the Democrats' plan will ensure one.

So dramatically different is my understanding of the landscape than Patinkin's that he assumes the "don't haves" to be the most interested in the debate, while I've perceived the debate mainly to be between the factions of the "haves." Note that the Tea Party phenomenon was heavily populated by working and middle class folks, and that much of the advocacy for the Democrats' policies has come from Patinkin's peers in the media, academia, and government, all likely having excellent benefits.

A telling bit of the perspective difference between the "have" groups comes when Patinkin investigates the options that "have nots" can pursue. Just after explaining to his readers how a deductible and copay would work on a $2,000 MRI, he writes:

I was told you might be able to get that $660 monthly fee down to $487 if you proved you were very healthy. But you'd still have the deductible, leaving folks to debate every procedure.

Here's my question in response, as somebody who has decent (although too expensive) coverage and fears that the Democrats are on track to price me out of it: What is wrong with folks debating every $2,000+ procedure? Simply put, there will never, ever be an effective mechanism for controlling healthcare costs unless every potential patient weighs the value of every test, drug, and procedure. Pretending otherwise is going to cause a whole lot of suffering among a whole lot of people.

Labor Gets its Special Health Care Deal

At the end of this post I alluded to the special deal that unions--after much b***ing and moaning-- have extracted from Team Obama Health Care Force. In short, the tax on so-called "cadillac plans" won't be applied to collectively bargained health plans. Heritage's James Sherk observes:

What a deal. Unions want the health care spending, but they do not want to pay for it. Obama gave them just that. It also makes for a great recruiting pitch: join a union, get a tax cut.

That is just one of the many handouts unions get in the health care bill. It sets aside $5 billion to subsidize the costs of employer health benefits for early retirees. Few nonunion employers, of course, pay pension and health benefits for workers to retire at 55.

Or consider the small business exemption from the employer mandate for businesses with less than 50 employees. All businesses, that is, except construction companies. The costly employer mandate applies to any construction firm with more than four workers. Why would Congress kick small construction contractors when they are down? Because the construction unions asked Congress to. They did not want their small competitors to get out from under the bill’s costs and gain a competitive advantage. What if those costs put small contractors out of business? That is just too bad.

Look for Obama and Congressional Democrats to the expand the union carve-out to cover a swath of the "middle-class" (the universal solvent of American politics), so they can camouflage this massive giveaway to a pet constituency.

One House Democrat is already saying a "consensus" could be built around such a scheme by further increasing the Medicare payroll tax and applying it to capital gains to make up for lost revenue.

This would amount to nothing less than a bill of attainder against on all constituencies that are not especially useful to the president and his party.

ProJo Ideology Identified: Healthcarism

With the ProJo editorial board's endorsement of Martha Coakley for Senate, it's become more apparent than ever that the ProJo editorial board has become a single-issue shill for health care reform at all costs.

Most important to us is that she is the candidate most likely to carry on the work of the late Sen. Edward Kennedy in health-care reform.

Mr. Kirk’s immediate duty will be to ensure that the Democrats keep 60 votes in the Senate so they can push through major legislation, especially on health care. That is why Massachusetts’s Democratic leadership went through contortions to change the law to get their man in there. We’d be happy to see health reform pass with his help, of course.

Over the past few months, we've witnessed them twist and turn with every permutation of the various, nebulous health care reform bills that weaved through Congress. First, while they didn't necessarily like the Baucus bill (preferring a single-payer system), they urged Democrats to be ready to go it alone because "[t]he stakes are too high to let political wrangling stop Congress from addressing the many flaws of our chaotic health-care 'system.'” In October, they did accurately portray the opponents of this nebulous version of health care reform at one time:

One is the principled conservative, or at least libertarian, view that the less government role in health care the better. Another is just old-fashioned bribery, in which some legislators take care of health-insurance and pharmaceutical companies, which pay vast campaign contributions and thrive from the current arrangements. And another is the worry among Republicans that the Democrats might get long-term credit for health-care reform, as with Social Security and Medicare –– two other very popular “socialistic” plots opposed by much of the GOP when they were started....

Of course as often is the case in the sausage-making of legislation, the public’s memory of the hypocrisies involved is dim — for instance, that while many Republicans now in Congress voted for President Bush’s $1 trillion Medicare drug plan (which had no stated way of paying for itself and was a grandiose gift to the drug companies), they now oppose plans that would offer close to universal health coverage to non-elderly Americans –– including kids and poor working adults, of all people.

Now, even as their dreams have come true and a purely partisan bill has passed the Senate and moved into conference (or whatever the House and Senate Dems are doing behind closed doors), the ProJo editors are trying to have their cake and eat it too. They've argued for the passage of anything, explaining that "the warts can be removed later" and, as an example, recently urged the Democrats to remove the special deal cut by Nebraska Senator Bill Nelson that would exempt his state from any health reform related tax hikes. Fine and dandy. Now we await the editorials on the numerous other deals cut by Senators and other interest groups that enabled the passage of this health care "reform" that the ProJo editorial board has pushed at all costs. Right.

For now, they seem content to blame the majority of the public that opposes this mess for our "vast willful...ignorance of what’s actually in the House and Senate health-care bills." Silly us. And here we thought we were opposing a pastiche of bloated government power-grabbing and special deals masquerading as health care reform. I, for one, am all for reform. But this ain't it and calling it such doesn't make it so, no matter what the ProJo editors want us to believe.

ADDENDUM: It's being reported (h/t) that the leaders of organized labor have twisted enough arms to get an exemption for "collectively bargained health care plans" that would otherwise be considered "cadillac plans" and thus subject to taxation that would help pay for the current health care reform proposal. I wonder if the Providence Journal will draft an editorial against this "wart", too? It seems like creating a billion dollar program that everyone supposedly wants requires an awful lot of sausage making.

If You Don't See It, You Don't Feel It

For those who remember when health insurance used to be only "hospital insurance" or "catastrophic", this chart shouldn't be a surprise.

Veronique de Rugy puts it in context:

Much of the rationale behind the current reform of the healthcare system is about controlling inflation in healthcare costs. However, based on the trend presented above, a better alternative to the semi-nationalization that the president has in mind would be to increase individual responsibility for medical decisions and costs. When people aren’t exposed to the true cost of their care—even if they pay for it in foregone wages and higher taxes—they consume more.

It's Our Habits, Not Our Healthcare

Redington Jahncke explains why "skepticism turned out to be the correct impulse in the case of the WHO rankings" of nations' healthcare systems, as well as in the case of a Commonwealth Fund study of the "health of nations." It's his conclusion, though, that points toward a new question about Obamacare:

Indeed, lifestyle and behavioral factors, including unhealthy diet, lack of exercise, smoking, etc., are the prime causes of America's number one killer — heart disease. And the reversal of these factors is as important in preventing death from heart disease as any medical treatment. A doctor cannot "administer" lifestyle changes and behavior modification the way he can administer drugs.

Let's put aside, if we can, the probability that the Democrats' healthcare plan, whatever it ultimately turns out to be, will drive costs up even more while decreasing the effectiveness of the healthcare system overall. If we concede that lifestyle and behavior are critical contributors to health — and how can we not concede it? — then what sort of system would be more likely to encourage healthy behavior: A system that requires financially painful, but not physically fatal, treatments and procedures, or one that hides their costs in a combination of employer withholdings and welfare?

A more frightening question: How will the government seek to make you live more healthily when it turns its giant eye toward that problem?

Whitehouse Gets Things Backwards

Of all the letters that have appeared decrying or endorsing Senator Sheldon Whitehouse's recent screed against those who oppose Obamacare, one by Pamela Burdon, of Warwick, was especially poignant:

The Nazis took my parents from their families when they were teenagers. My parents miraculously survived under impossible conditions. They then fled communism, coming here to become American citizens and work their hardest to provide for their children.

They were so proud to be Americans that they would rarely speak the many European languages they knew. ...

As a way of honoring their memory, I feel it is my responsibility to preserve the freedoms that they valued so highly. Can I sit idly by and let their America be destroyed? Could I live with the knowledge that they sacrificed everything to come here, for a better life for their future generations, only to let hastily passed legislation eventually turn this country into a replica of the ones they fled?

Rights and Benefits

As Monique insisted, last night, healthcare is not an "inalienable right." Because it requires other people (doctors, et al.) to provide services, it is actually a consumer good. It's a vital one, to be sure, and one for which people will exchange significant percentages of their resources, but that doesn't make it a right.

It does, however, make it an attractive target for people who would like to control your life, such as the current collection of Democrats and their armies of government bureaucrats, who believe doing so to be their right. The ideological distortion of the nature of healthcare serves no purpose but to disguise the fact that government cannot provide this "right" at a lower cost than people can procure it for themselves. If the Democrats' motivation were otherwise, their solution would exclude all of the interference and fluff and provide for the government to grant healthcare to those who want it but can't afford it, and deliberations would consist of a debate about what aspects of "healthcare" are rights, and which are extra. Instead, the objective of legislation has clearly been to determine who controls the industry and how.

Recasting the structure of healthcare "reform" with the assumption that healthcare is a right shows the notion to be nonsense. What other "right" do we require citizens to purchase? What other right requires that people provide the services and that employers offer access to those services as a benefit? Again, rights aren't the sort of things subject to determination of cost effectiveness.

Ezra Klein makes a related point when he suggests that "health-care coverage is not a benefit. It's a wage deduction":

Cost control is not, in fact, all pain and no gain. It's some pain in return for a fat raise. A 2006 study, for instance, by Harvard's Katherine Baicker and Amitabh Chandra used malpractice payments to estimate the effect of premium increases on wages. They found that a 10 percent increase in health-care premiums "results in an offsetting decrease in wages of 2.3 percent" and an increase in unemployment of 1.2 percentage points. Compensation is basically a set sum for employers, and they don't seem to care much whether it goes into wages or into health-care costs.

Assessments of value exist all along the healthcare service chain. Doctors become doctors because the career presents an opportunity to earn the standard of living that they desire through an occupation in which they have an interest. Employers provide health insurance because it helps them to attract and retain employees more effectively than simple cash remuneration. Heretofore, as with all benefits, workers could presume the exchange to be worthwhile; they were giving up part of their natural pay in order to gain something that would cost them more were they to pay for it individually. If one spouse's employer provides better value, the couple switches. If the employee is healthy, he or she opts to take the money instead. The legislation on track to become law merely layers on disguises that enable citizens to ignore the fact that healthcare has a cost.

Back to Klein:

When Americans rejected managed care [such as HMOs], in other words, they didn't know they were ending wage increases, too. But since 1990, wages have tracked changes in premiums more closely than they've tracked the growth of GDP. Maybe if more workers knew that, they would be more interested in efforts to control health-care costs.

Anybody who has watched unions negotiate their contracts can appreciate the point. They'll give up wage increases if their negotiators believe that health insurance benefits will ultimately result in a greater transfer of wealth, and vice versa. What legislators who profess the healthcare-as-a-right doctrine are effectively doing is declaring that somebody must pick up the bill for extensive coverage without reference to the exchange in wages or economic activity or whatever else the burden will land on. And because those ultimately paying the cost won't know the dollar amount (indeed, they probably won't realize they are paying it at all), the bill can only increase.

Personally, I see it as more appropriate to insist that we have a right not to pay more for a service than we are willing to pay for it.

A Commission (a "Panel," if You Will)... That's the Ticket!

Thomas Sowell puts it pretty starkly:

The appointment of White House "czars" to make policy across a wide spectrum of issues — unknown people who get around the Constitution's requirement of Senate confirmation for cabinet members — is yet another sign of the mindset that sees the fundamental laws and values of this country as just something to get around, in order to impose the will of an arrogant elite.

The problem is that it isn't just the political elite who lack a sufficient understanding of the real value of democratic processes. Sowell blames "dumbed-down education in schools and colleges that have become indoctrination centers for the visions of the Left," although the reference to political direction might obscure the essence of the poorly formed vision — namely, that it is possible for people to figure out and design broad social programs that will improve life for all if they're only given the power to implement them. And so, we get this disappointing, but not surprising, editorial from the Providence Journal:

Neither Congress nor the Obama administration (nor that of George W. Bush) has shown the gumption to act honestly to confront these costs. Perhaps commissions will give them adequate cover to take on the "special-interest groups." (We're all de-facto members of several such groups; one man's pork is another man's national treasure.) ...

So a bipartisan congressional committee should pick the members of these commissions and give them as much power as possible. Such panels would probably feel compelled to recommend higher taxes and sharp cuts in some programs.

In the Projo's telling, such a plan is all up-side: giving an unelected panel as much power as possible (to break some eggs) with adequate immunity to push elected representatives to do that which the public does not want. That attitude is a recipe for totalitarianism and a collapsed nation, but it's frighteningly pervasive. Everybody, after all, has a vision that would clearly work... if only it could be forced on the nation.

As if to prove its own incoherence, the editorial shifts gears to complaints that people are heeding ideological sympathizers whom they trust to specialize in sensing political winds, rather than giving rein to Congressional "staffers specializing in the subject at hand" as they craft complex legislation. The essay ends thus:

Representative democracy is a terrible system, but, as Churchill noted, better than all the others.

One might get the erroneous impression that the editorial writers are supporters of representative democracy, even after they'd spent a few hundred words advocating for rule by unelected groups and behind the scenes staff experts.

A Refreshingly Different Projo Voice on Healthcare Reform

I'm going to go out on a limb and speculate that it's not Edward Achorn who's been the primary author of the Projo's recent series editorials on healthcare reform.

The position of the Projo editorial board has been pass anything, it doesn't matter if the legislation has been read or not, so long as it means that the government will be on the path to more control of the healthcare system.

Achorn's position is a bit more nuanced…

It is not an act of Aryan supremacy to wonder what part of the Constitution empowers Congress to compel people by threat of jail or fines to buy very expensive products — in this case, health insurance — produced by private companies with influential Washington lobbyists.

It does not make one a “birther” to question how the struggling middle class will afford all this — the vast new government entitlement in the teeth of massive deficits, the huge tax hikes to pay for some of it, and the mandates for expensive insurance.

One need not be a member of a right-wing militia to feel suspicious when a law that will affect every American is crafted behind closed doors, larded up with bribes to politicians, and rushed through the Senate in a series of votes in the dead of night, capped by one on Christmas Eve, when any reasonably sane citizen is distracted from guarding the national cookie jar.

The Members' Interests Are Not Primary

Mike, of Assigned Reading, noticed a strange omission of activism on the part of his and other teachers' unions:

Teachers enjoy some of the best benefits available. And as a result, we working class Americans will be subjected to a 40% premium tax, a punishment for having healthcare plans better than most Americans.

One would think the teachers’ unions in particular would be loud and vocal in their opposition. This would be true if the teachers’ unions were most interested in teachers. But when push comes to shove, the unions will put down their arms if it helps secure a victory for the Democrats.

I wonder if union organizers ever get heat from their members for activism that is either unrelated to or actually hostile toward their interests. The impression, from outside, is that there's a sort of compromise between teachers unions and teachers, such that the former pull all kinds of stunts and compromise the quality of education in order to provide ensure incessant growth for the remuneration of the latter, who pay dues more as a fee for service than as a cost of entry. In other words, the union gets to do whatever it wants, because it's really an independent organization from the workers whom it supports.

Somehow, I don't think it's supposed to work that way.

Roland Benjamin: Health Care Calculations

For those following the health care debate, this will come as little surprise. Linking the massive reform bill to practical, everyday application has largely been ignored by our lawmakers.

A recent non-partisan poll indicated that 91% of Americans with existing health coverage are at least somewhat satisfied with that coverage. The bill being debated in Washington does nothing to protect this.

Despite my business's currently competitive benefit package, the bill would penalize LFI, Inc., $750 per employee as the plan's design does not meet the new law's universal standard . The resulting choices would then be a) pay an approximately $53,000 fine/tax while paying $400,000 for the current plan structure, b) increase the current plan structure by $70,000 to $470,000 and avoid the fine, or c) discontinue offering health benefits and pay the $53,000 fine toward subsidies helping lower-income employees offset premiums they will be required by law to pay.

Thus, there is enormous pressure on employers to drop coverage. This is especially true when businesses pay into the subsidy pool regardless of whether they offer a health plan. These fines take effect in 2014, so preparations can be made. Some fines start sooner. The likelihood that LFI discontinues health benefits in 2014 is moderate, with hundreds of variables still unidentified.

Individuals will be required to buy a federal and state authorized plan. Consumer-directed plans enabling lower premiums will be dramatically restricted. By 2014, premiums for an authorized family plan will exceed $17,000 per year. Some will receive subsidies, but current language requires that individuals pay around 10% of household income toward their health plans (e.g., a two earner household with $70,000 in combined income will have to pay at least $7,000 in premiums before applying for federal subsidies). These subsidies phase out in households with combined earnings around $85,000. Anyone in that category will be required to pay the full premium. Additionally, because United Health and Tufts do not offer individual plans, most would have to buy a plan from Blue Cross Blue Shield under current regulations. This might change should a robust "exchange" emerge in the state. But it might not.

For employers, the reform offers an immediate and plausible exit option. Health care is one of the least controllable expenses we face and entails an immensely time-consuming process. I am forced to make decisions that must satisfy more than 50 families each year and explain to each why more dollars are diverted from their compensation toward unnaturally inflating health costs. This is not fun.

Once this law is enacted, annual renewals will see increasing pressure to drop coverage. Should reform perform some unintended miracle in trimming health care inflation, that pressure might ease. But the objective of the law is to expand coverage to the uninsured, not to tame the inflation in health care spending. Health care experts and economists around the country, including Rhode Island's own experts in a recent ProJo analysis, confirm that "Obamacare" does nothing to affect health care inflation. Within a few years, employer-provided coverage will erode until it is no longer a competitive advantage in the marketplace for new employees.

The decision to drop coverage would not be made lightly. But I would rather take the $400,000 now paid toward health premiums and divert some to employees while reinvesting the remainder in the business, knowing that those who need the most help will have a federal subsidy to buy coverage.

As an American, I am incensed by this, though. Today, the premium paid for by your employer is earned as part of your compensation. When forced to beg for a subsidy to offset health premiums, that sense of earning diminishes, and the independent spirit erodes with it. They are replaced with an unhealthy combination of entitlement and dependency that threatens the American experience.

Never in human history have the freedoms envisioned by our Founding Fathers been realized by so many. They recognized that liberty, having been endowed by our creator, could only be taken away by man and government, not enhanced. This unique American Experiment has enabled the broadest prosperity across an entire population ever known to mankind. And we have dragged the rest of the world forward with our innovations and generosities. Health care reform in its current state has the potential end this.

To prepare, pay close attention to your Health Savings Account. Should your employer discontinue health benefits after 2014, money in an HSA will be critical. Those dollars may be used to pay premiums and also may determine which plans you will be allowed to purchase by law. In other words, the greater the balance in your HSA, the more flexibility you will have.

There is still the possibility that this reform will be derailed. It faces several procedural hurdles. A Senate vote to advance the bill by Christmas was a political necessity for the Democrats, but the bill is extremely unpopular, with a significant majority of voters opposing it. Democrats want the bill out of the news as soon as possible. They hope the memories of the voting public are short. Republicans, with only 40 elected members in the Senate, do not have the numbers needed to continue the debate to make this reform right. Democrats, needing 60 Senators in lockstep, voted unanimously twice to cut off debate in order to meet the arbitrary Christmas deadline and then passed the bill with the same margin. Not a single Republican voted to end the debate or to pass the bill.

To get these 60 liberal Senators in line, the bill includes hundreds of millions of dollars to states like Louisiana, Connecticut, Vermont, Florida, Pennsylvania, and Nebraska. Because our Senators "drank the Kool-Aid" long ago, Rhode Island gets no "bacon" from Washington. Instead, we get Senator Whitehouse accusing concerned citizens of bigotry! The intellectual vacuum of his argument is an embarrassment to Rhode Islanders.

This health care bill is tyranny and is unconstitutional. Whitehouse showed quite clearly that liberals have lost the intellectual debate and resorted to slinging mud at the majority of Rhode Islanders uncomfortable with the bill. Pressure from everywhere can stop this reform. But it has the momentum to pass if nothing is done.

To Better Deceive the People: Hurry Up and Wait

All revved up for negotiations to reconcile the House and Senate versions of economically destructive health "reform"? Well, you're going to have to wait over a month, until after some soaring rhetoric from the Deceiver in Chief:

The White House privately anticipates health care talks to slip into February — past President Barack Obama's first State of the Union address — and then plans to make a "very hard pivot" to a new jobs bill, according to senior administration officials.

Obama has been told that disputes over abortion and the tight schedule are highly likely to delay a final deal, a blow to the president, who had hoped to trumpet a health care victory in his big speech to the nation. But he has also been told that House Democratic leaders seem inclined, at least for now, to largely accept the compromise worked out in the Senate, virtually ensuring he will eventually get a deal.

Internally, White House aides are plunging into a 2010 plan calling for an early focus on creating jobs, especially in the energy sector, along with starting a conversation about deficit reduction measures, the administration officials said.

In other words, the propagandists are going to give the United States a break from the masochistic legislative beating that the Democrats have been inflicting on voters, settle down for a few quiet winter weeks to see if Americans will (per habit) lull themselves back into apathetic slumber. Then, the president will play his preacher-like oratorical cards with a state of the union address once again promising the giveaways and fantasy improvements of healthcare and energy legislation that is, although he'll pretend otherwise, still pending and declaring it to be (guessing) "time to move past the divisiveness of the past and do the work that Americans so desperately need done."

Then, in his usual practice, Obama will make vague promises about jobs legislation... that he'll leave entirely up to legislators to define, so as to keep his hands abstractly clean... and try to paint Republicans as obstructionist when they point out that the Democrats are merely proposing to give more (unborn) taxpayer dollars to their political supporters. The only employment legislation that might have a chance of working would have to move in entirely the opposite direction from that in which the Democrats are marching on every single issue in their agenda.

Whether the political choreography will work is another matter. It would certainly be characteristic of Americans to long for some political hibernation, but media cheer leading notwithstanding, the economy is likely to remain stagnant, or worse, and people in pain are less able to drift into sleep. Moreover, a year's experience watching the centrist uniter and his party turn Washington, D.C., into an even more hyper-partisan, money-grubbing, backroom-dealing swamp of oligarchical vampirism should prove to have inoculated a sizable portion of those who've been fooled by the rhetoric before.

Mugged on Christmas Eve

Of all the aspects of the healthcare debate and legislation that are rightly making Americans shake their heads, I think the schedule is the most egregious and representative. Think about it: The major votes have all been held over the weekend, and the final vote came on the morning before Christmas.

The profundity of that struck me as I drove in to work this morning. No school buses. Light traffic. And massive legislation being voted on — and passed — in the Senate.

This is criminal "leadership," and I don't just mean the new taxes and other ways in which Congress is trying to rob the people whom it's meant to represent. This is a real taste of what citizenship is like in nations that have tipped toward one of those discomfiting descriptions, such as totalitarianism and oligarchy.

The Democrats think they've gotten over the threshold and now can enter a phase of recovery before the next election cycle rolls around. I think they're dramatically overestimating the chances that Americans will treat this matter with their habitual delayed apathy and forget about it. It's too much. Too dumb. Too sneaky. And if we let this go, we might as well get fitted for shackles.

What Obamacare Does to the Middle Class Budget

Terry Jeffrey helpfully boils down a key portion of the Congressional Budget Office's take on the Senate health care bill: how it would affect an average middle-class family's bottom line. How does another $15,000 in "fees" (or, taxes if you want to call 'em that!) sound? Here's a summary of his summary

Fact 1: You will be forced to buy health insurance...

Fact 2: You will be eligible for a federal subsidy to help you buy health insurance, but only if you earn less than 400 percent of the poverty level ($88,200 for a family of four), your employer does not offer you coverage and you purchase a government-approved plan in a government-regulated insurance exchange...

Fact 3: Your employer will not be required to offer you coverage, and will face a maximum fine of $750 per worker per year if it does not...

Fact 4: Your insurance provider will face new federal mandates that will increase its cost for any plan it offers you...

Fact 5: Your family insurance plan -- if your employer drops your coverage and you are forced to buy it on your own -- will cost about $15,000 per year when the legislation is in full force in 2016...

The Senate health care bill gives employers two powerful incentives to stop offering health insurance coverage to their workers. First, if an employer does offer coverage, its lower-wage workers will lose the federal insurance subsidy they would otherwise get. Secondly, if an employer does not offer coverage, the $750-per-worker fine it faces will be far less than the premiums it would pay if it did offer coverage.

Where does this leave a mom and dad with two children and an annual income greater than $88,200? It leaves them without employer-based health insurance and facing a federally mandated $15,000-per-year insurance bill.

Are key portions of Obamacare going to be unrepealable?

It is worthwhile to listen to Senator Jim DeMint discuss one critical aspect of the Senate Obamacare bill:

Sen. Jim DeMint (R., S.C.) has thumbed through Harry Reid's manager's amendment and discovered some "particularly troubling" rule-change provisions, especially with regards to the proposed Independent Medicare Advisory Board, which he finds could be unrepealable

John McCormack:

According to page 1001 of the Reid bill, the purpose of the Independent Medical Advisory Board is to "reduce the per capita rate of growth in Medicare spending." For any fearmongers out there tempted to call an unelected body that recommends Medicare cuts a "Death Panel," let me be clear. According to page 1004, IMAB proposals "shall not include any recommendation to ration health care"—you know, just like the bill says there's no funding for abortion.

William Kristol:

Why did the authors of the legislation want to specially protect the Independent Medicare Advisory Board by making it difficult for future Congresses to legislate in that area? Because the heart of the bill is the attempt to get control of our health care permanently in the hands of federal bureaucrats, who would allegedly know better than doctors and patients what’s good for them, and who would cut access to care and the quality of care...

A GOP Senate staffer writes:

The bill changes some Senate rules to say we can't vote in a future Congress to repeal the IMAB (death panels)....

It also shows that this provision in particular is very important to Dems. They chose this section out of all others to give the highest possible protection against change or repeal showing how insatiable their desire is to allow Washington bureaucrats to control our lives.

And for these sorts of issues, it is critically important to force a vote on Christmas Eve before the word can get out about the true nature of the bill.

Meanwhile, the Republicans are not articulating a compelling strategic alternative to draw American citizens into their realm.

It's too bad we can't send everyone home from Washington, D.C. until the 2010 elections.

Quinnipiac Poll on Healthcare

Quinnipiac University has released a poll today reporting a national level of opposition to Democratic healthcare reform consistent with the Rasmussen results released yesterday (h/t Instapundit)...

As the Senate prepares to vote on health care reform, American voters "mostly disapprove" of the plan 53 - 36 percent and disapprove 56 - 38 percent of President Barack Obama's handling of the health care issue, according to a Quinnipiac University poll released today.

Voters also oppose 72 - 23 percent using any public money in the health care overhaul to pay for abortions, the independent Quinnipiac (KWIN-uh-pe-ack) University poll finds.

Full Text of Senator Whitehouse's Healthcare Speech

Senator Sheldon Whitehouse’s floor speech on healthcare from Sunday has been receiving national blogospheric attention since the quote below, broadcast on C-SPAN, was picked up by the Washington Times...

Why all this discord and discourtesy, all this unprecedented, destructive action? All to break the momentum of our new, young President. They are desperate to break this President. They have ardent supporters who are nearly hysterical at the very election of President Barack Obama: the ``birthers,'' the fanatics, the people running around in rightwing militias and Aryan support groups. It is unbearable to them that President Barack Obama should exist. That is one powerful reason.

I believe that the “they” referred to by Senator Whitehouse are Senate Republicans, meaning that the Senator is not saying that all opponents of healthcare reform are birthers, fanatics, and/or rightwing militiamen (and militiawomen) -- only that support from birthers, fanatics, and rightwing militiamen (and militiawomen) is significant enough to merit mention in the assessment of Senate Republican motives.

Of course, opposition to the Democratic Party's plans for building healthcare reform around an employment-based system that's liked by no one -- except for, apparently, Congressional Democrats and insurance companies -- is very widespread...

The latest Rasmussen Reports weekly tracking update shows that 41% of voters nationwide favor the bill and 55% are opposed. Those figures are essentially unchanged from a week ago. This the fifth straight week with support for the legislation between 38% and 41%....Most voters (54%) believe they personally will be worse off if the legislation passes.

Or is expressing opposition to the Democratic party's belief that everything can be improved by higher taxes and more government control now enough, by itself, to make you a fanatic?

ADDENDUM:

The Washington Post's Dana Milbank picks up on a couple of historical references that I had passed over (full text of the speech below the fold, if you don't believe that they're all there)...

Sen. Sheldon Whitehouse (R.I.) had just delivered an overwrought jeremiad comparing the Republicans to Nazis on Kristallnacht, lynch mobs of the South, and bloodthirsty crowds of the French Revolution.

"Too many colleagues are embarked on a desperate, no-holds-barred mission of propaganda, obstruction and fear," he said. "History cautions us of the excesses to which these malignant, vindictive passions can ultimately lead. Tumbrils have rolled through taunting crowds. Broken glass has sparkled in darkened streets. Strange fruit has hung from southern trees." Assuming the role of Old Testament prophet, Whitehouse promised a "day of judgment" and a "day of reckoning" for Republicans.

What Government Healthcare Really Means

Well, this about sums it up:

Far from being a brilliant plan constructed by top doctors and financial experts in a government brain trust, this health-care bill is a twisted, deformed political document, seen in its entirety by only a few high-ranking politicians belonging to a single political party. Its components have not been precisely crafted as part of a fantastic system calibrated to ensure the maximum access to quality health care for all Americans.

The bill is not being examined with transparency and careful deliberation by representatives who behave as humble servants of the people and their Constitution. Instead, it's being hastily rammed through in the dead of night, over the objection of powerful majorities of the American people, with desperate last-minute deals cut to acquire the necessary votes, financed by vast sums of taxpayer money. The primary consideration is not crafting the most sophisticated and intelligent health care reform... it's getting a bill pushed through before angry voters have a chance to blast the Democrats out of Congress. Look at it this way: if the average middle-class American paid about $5000 in federal income tax last year, then you might be one of the 20,000 people who paid for Mary Landrieu's vote, in the hope of giving Barack Obama a bill to sign as a Christmas present.

Speaking of Healthcare...

Here's another result found in Rasmussen's polling:

Forty-nine percent (49%) of voters nationwide now rate the U.S. health care system as good or excellent. That marks a steady increase from 44% at the beginning of October, 35% in May and 29% a year-and-a-half ago.

The latest Rasmussen Reports national telephone survey finds that just 27% now say the U.S. health care system is poor.

I suppose as people go through the compare and contrast process, they become increasingly wary of results like this across the pond:

The key findings of the report were:

- appalling hygiene and cleanliness in A&E
- patients left in A&E for ten hours and treated in full view of others
- four deaths among patients with learning disabilties
- a lack of children's nurses and doctors in A&E
- blood splattered on curtains and mould in vital equipment
- lack of basic nursing skills with failure to feed patients or give medication correctly
- elderly patients frequently developing bed sores, prompting concerns from nearby care homes.

Maybe it's time for the newspapers to run some more of those nice letters from doctors in Canada who just happen to think it worth their while to let far away opinion page editors know how great their system is.

With Time, the Truth About Healthcare Is Coming Out

So, according to Rasmussen, public opinion on the Democrats' healthcare plan is currently at 38% for, 56% against. The specifics are even less positive:

Only 16% now believe passage of the plan will lead to lower health care costs. Nearly four times as many (60%) believe the plan will increase health care costs. Most (54%) also believe passage of the plan will hurt the quality of care.

One wonders how much of an effect it has had that, as the longevity of the debate carries it over Americans' great wall of apathy, people are catching on to the oft-repeated falsehoods such as Ramesh Ponnuru addressed in a recent National Review article:

Earlier this year, Ceci Connolly reported, in another front-page story for the Washington Post, that people who go without health insurance raise premiums for the rest of us by $1,000 a year. Supporters of universal coverage routinely invoke this factoid. It's not a fact. The source is a left-wing advocacy group, and nonpartisan observers, including the CBO, believe that the real premium increase is much smaller, perhaps $220 a year.

In the same piece, Connolly reported that the U.S. spends more money on health care than other countries while generating less impressive statistics. She specifically cited our high infant-mortality rate--without mentioning that we have, for example, a higher proportion of low-birthweight babies than other countries, which is hardly the fault of our system of health finance.

Maybe Connolly's worst blunder was to report that there is a "consensus" that the cost of health care undermines the competitiveness of American business. That consensus includes other news outlets, such as Reuters, and President Obama. There is a directly opposed consensus that includes most health-care economists, the CBO, and some members of Obama's economic team. It holds that health-care costs come out of wages, not profits, and thus generally do not affect firms' competitiveness.

The mainstream media, by the way, is in a tough spot. If they continue with their current practices, many of its practitioners will be entirely devoid of credibility by the end of the Obama administration, and the same will be the case if they turn around to the opposite tack. Of course, the opportunity always exists for a great self-reckoning and a deliberate, visible effort to recapture objectivity.

Guarding the State in the Church

The person who brought my attention to Senator Sheldon Whitehouse's scheduled appearance at Central Congregational Church, in Providence, this Sunday, suggested that the politician is likely to face a very friendly audience as he gives his national healthcare pitch. It's all too obvious to wonder what might be the reaction were a right-of-center politician giving a political presentation at a more conservative church, but it's curious the effect that the event's being held by a religious organization can have on political opponents.

My own religious observation would cause me to miss this particular gathering, anyway, but I have to admit a reluctance to crash an event on somebody else's holy ground, as it were. Even with explicit permission from the church's leaders, there would feel something surreptitious about attending as political opposition.

Others with challenging questions for the senator might not share my inhibitions.

SNL Parodies Obama's "Wimpy Economics"

Saturday Night Live's most recent parody of President Obama (he's finally fair-game, apparently) calls attention to his "Wimpy Economics"--pay now, and we promise you'll receive later. Right.

“I am noticing that each of your plans to save money involves spending even more money.”

Health care "reform" is but the latest example--cuts and taxes will kick in immediately while benefits will start in 2013, for instance. And the promised savings are dubious anyway. For instance, the plan actually shifts Medicare costs onto the states, forcing them to deal with finding additional revenue (tax increases?) to handle the additional burden mandated by the federal health care "reform" plan.

A Deadly Scheme

Henry Aaron and Isabel Sawhill, of the Brookings Institute, provide a wonderful example of the insanity of allowing individuals to plan large segments of the economy:

So here is what we propose: Congress should enact a value-added tax, the equivalent of a broad-based sales tax on all goods and services. It should take effect only after unemployment has fallen to a predetermined level or in, say, five years, whichever comes first. Congress should link revenue from the new tax and other sources directly to public healthcare spending through a newly created healthcare trust fund. The trust fund would pay for all federal healthcare spending. This framework would mean that Americans would get the healthcare they are willing to pay for. If spending outpaces projections, Congress will have to choose between raising taxes and finding ways to slow the growth of spending.

By balancing revenue and healthcare spending, such a reform would help solve America’s long-term fiscal problems. In the near term, it would also support and sustain the economic recovery. Consumers would be encouraged to buy now, before the tax takes effect. And by showing financial markets that Congress is determined to put our fiscal household in order, it would help keep interest rates low and encourage investment. The trust fund mechanism would strengthen incentives to institute reforms that will actually bend the healthcare cost curve, because measures to slow the growth of healthcare spending would avoid unpopular future tax increases that would otherwise be necessary.

How is it possible that people who are paid, essentially, to think can argue that a looming tax increase equivalent to one-sixth of the U.S. economy will encourage consumers to splurge while the splurging's good without making the parallel assessment that the huge taxes will suppress the economy once implemented? One of the reasons given in a previous paragraph for rejigging the healthcare system in a public direction is that, with ever-improving "medical interventions... [p]atients will insist on having them." Well, if the government must thus bend to supply what patients demand, why won't consumers learn the lesson and start demanding the things for which Aaron and Sawhill assume they'll splurge?

This program — which one may suspect will be the end result of the Democrats' healthcare path — would be a recipe for the hollowing and destruction of the United States of America, beginning with its entrepreneurial soul.

Incredulousness About Democratic Healthcare Promises is the Mainstream

If you didn't believe me last week when I posted…

We know that very few seriously believe that the Democratic reform proposals, in their current form, are going to truly reduce medical costs or control medical inflation.

Our health-care system suffers from problems of cost, access and quality, and needs major reform. Tax policy drives employment-based insurance; this begets overinsurance and drives costs upward while creating inequities for the unemployed and self-employed. A regulatory morass limits innovation. And deep flaws in Medicare and Medicaid drive spending without optimizing care.

Speeches and news reports can lead you to believe that proposed congressional legislation would tackle the problems of cost, access and quality. But that's not true....In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care's dysfunctional delivery system.

Progressive Warns: "If Conservatives Ran Healthcare"

Maggie Mahar of the Century Foundation warns:

If you’re a progressive like me, and you’re upset by the Stupak amendment, which bars federally subsidized insurance from covering abortions, consider this: What if we had a single-payer health-care system and someone like Jeb Bush or Sarah Palin were running the country?

Many liberals remain angry and disappointed that single-payer legislation never stood a chance in Washington. To them, a government-run health-care system seemed an obvious way to put patients ahead of profits.

But a single-payer system would have put us at the mercy of whomever happened to take control of Washington. I’m very happy to have a public plan as an option. But since I don’t know who will be in the White House in the years to come, I’m glad that government-run health care won’t be the only game in town.

Two Distinct Topics

Marc brought the topics of Vegas and boobies to last night's Matt Allen Show, and yes, they were two distinct topics. Stream by clicking here, or download it.

To Hell With "Government Experts", Keep Feeling Your Boobies

As an engineer, I'm quite familiar with the concept of the feedback loop, root cause analysis, etc. when it comes to preventive maintenance. For example, lets say you're supposed to change your oil every 3,000 miles. But over time, it's discovered that your car's engine runs just as well and doesn't wear any worse when the oil is changed every 5,000 miles. The obvious cost-savings is further bolstered by costs saved due to a reduction in the chances that the local lube shop will break something while performing this routine maintenance. (Generally, studies show that up to 20% of machine failures are introduced through scheduled maintenance).

It looks like the new recommendations that include pushing breast cancer screenings to 50 years old from 40 years old and advising against women performing self-breast examinations is based on a similar process.

The U.S. Preventive Services Task Force, a government panel of doctors and scientists, concluded that such early and frequent screenings often lead to false alarms and unneeded biopsies without substantially improving women's odds of survival.

"The benefits are less and the harms are greater when screening starts in the 40s," said Dr. Diana Petitti, vice chairwoman of the panel.

Dr. Eric Braverman, a clinical assistant professor of integrative medicine at Cornell Weill Medical College in New York, also backs the new guidelines, arguing that mammograms are not nearly as effective in detection as some other tests, like MRI's and ultrasounds.

"I'm not impressed by mammograms in general," said Braverman, who called manual examinations a "total failure."

"I support the new guidelines because I think it will lead to better testing. [The ultrasound] is a better screening procedure that's safer and easier and picks up things fast," he said, adding that he thinks women should receive ultrasounds as part of their routine medical exams, beginning at an early age.

Meanwhile Health and Human Services Secretary Kathleen Sebelius has said that "our policies remain unchanged" and that she "would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action." Wanna bet? Dr. Cynara Commer, a professor of surgery at Mt. Sinai's Surgical Oncology Department in New York...

...is very concerned that the new guidelines are the top of a slippery slope toward rationing, and questioned the timing as the Senate is about to vote on health care reforms that could end up containing a so-called public option.

"The government-run insurance companies are definitely going to be using these federal guidelines as opposed to using the American Cancer Society guidelines, and the American Cancer Society is not going along with these guidelines, and we can only hope that the private insurance companies don't follow suit," she said.

"I think it's coming down to saving costs. I don't think we should be doing that at the expense of women," she added.

A Fishy Kind of Reform

Andrew and Matt mulled evidence, on Wednesday night's Matt Allen Show, that there might be ulterior motives to current versions of healthcare reform. Stream by clicking here, or download it.

The Future of Healthcare Reform, If It's Built on Top of the Employer-Based System

An underreported aspect of the health reform proposals being advanced by Congressional Democrats (in both the House and Senate) is the conscious intent to maintain the current system of employment-based health insurance as the basis of the American healthcare system. Nobody implementing a healthcare system from the ground-up, from either the left or the right, would design a system that links health insurance eligibility to employment as American laws and regulations currently do, yet a majority of Congressional Democrats are firmly committed to extending into the immediate future, at least, the disproportionate role played by employers in access to health insurance.

Support for employer-based healthcare may make frighteningly raw political sense, if enough people have bought into the mistaken idea that employer-based healthcare is something that they receive for "free" (when in reality, it is no more free than any other part of employee compensation) and that tax-code and regulatory changes intended to remove the advantages that corporate health insurance purchasers have over individual insurance purchasers amount to corporate health plans being taken away by the government. Nobody likes to be told that something they already have is going to be taken away.

But I fear that an even more cynical calculation may underlie the Democratic commitment to employer-based health insurance.

We know that very few seriously believe that the Democratic reform proposals, in their current form, are going to truly reduce medical costs or control medical inflation. There just aren't that many convincing examples to point to where Federalizing regulation, providing subsidies and imposing mandates have historically reduced the cost of anything. Yet, Democrats are proceeding untroubled by this, mainly because of 1) a general detachment from fiscal reality that is the hallmark of the modern Democratic party and 2) a sincere faith that government can achieve any goal given enough power and treasure -- give government infinite resources and it will do infinite good!

Ultimately, the economics of the Democrats' plans depend upon cost-controls being imposed from the top-down, after the government has amassed enough power over healthcare to impose them. But Dems are not keen on explaining this aspect of their plan to the public -- they are quite fuzzy on what exactly the mechanism to control costs will be. So who will they blame, when it turns out that creating a government-run insurance company and new bureaucracies to oversee an employment-based healthcare system, in order to cover more people than are covered now without any reduction in quality of medicine, fails to reduce costs?

I suspect the blame will be directed towards the middlemen, to the employers placed by legislation and regulation between individuals and health insurers. Advocates for ever-increasing government power over healthcare will argue that their well-intentioned plans haven't worked because of choices made by greedy employers (who maintain disproportionate influence over healthcare choices under Democratic health reform plan) and that if more people can be moved into more directly government-controlled programs, then everything will improve as "planned".

In the end, the Democrats are setting up the American people for a choice between letting employers make their health insurance decisions for them and letting government make their health insurance decisions for them. If people are interested in a third option -- allowing individuals make their own health insurance decisions, without substantial interference from government or employers -- they need to let their representatives in Congress know that they want that choice, because the Democrats are in the process of creating a health care framework for the United States that could soon make this into an impossibility.

Medicare for None

Howard Walker, of Rockville, had a good letter in the Projo in response to the "Medicare for All" component of Froma Harrop's single-minded theme, of late. Unfortunately, the letter doesn't appear to be online, but here's it's key point:

Ms. Harrop never tells us how Medicare for All would contain health-care costs. In Rhode Island, Medicare "contains" costs by paying hospitals and doctors less than 90 percent of the actual cost of treating Medicare patients. Private insurers make up the difference: They pay more than the actual cost of treating patients and pass that expense on to their policy holders in higher premiums.

That is, Medicare doesn't "contain" costs at all: It just hides them by shifting them to private insurance, which subsidizes Medicare. ...

There is no way private insurers can compete in such a marketplace. They will go out of business, leaving the government as the "single payer" — exactly the result left-wingers want but know they cannot sell to the public honestly.

How are Medicare and Medicare for All going to contain health-care costs once there are no private insurers left to shift them to? ... Medicare is already $35 trillion in the hole.

As with much else, when it comes to government involvement in the economy and our lives, it sounds good at first blush — and one can even get multiple 700-word columns whacking the same topic — but it doesn't withstand scrutiny.

An Even Bigger Bomb

As much as it's more pleasant to spend Sunday morning talking about our near neighbors' building bombs, moral obligation requires us to note that, by a margin of five votes (out of 435), the House of Representatives passed an even larger bomb, in the night, one that is certain to destroy our nation:

In a victory for President Barack Obama, the Democratic-controlled House narrowly passed landmark health care legislation Saturday night to expand coverage to tens of millions who lack it and place tough new restrictions on the insurance industry. Republican opposition was nearly unanimous.

The 220-215 vote cleared the way for the Senate to begin debate on the issue that has come to overshadow all others in Congress.

A triumphant Speaker Nancy Pelosi likened the legislation to the passage of Social Security in 1935 and Medicare 30 years later. ...

The legislation would require most Americans to carry insurance and provide federal subsidies to those who otherwise could not afford it. Large companies would have to offer coverage to their employees. Both consumers and companies would be slapped with penalties if they defied the government's mandates.

There is no way that would-be nanny state totalitarians will be able to resist the temptation that this represents, or that our economy will survive it. It's times like this that I'm grateful that life forced me to learn a practical, hands-on trade.

We can only hope the behemoth collapses in the Senate.

No Coverage of Abortions Amendment to be Offered, in an Attmept to Get a Healthcare Bill Passed Today

Multiple sources are reporting that, in order to try to get the US House of Representatives to pass a Democratic version of healthcare reform today, House Speaker Nancy Pelosi has agreed to a floor vote on an amendment that would prohibit either a public-option insurance plan or any plan eligible for a government subsidy from covering abortions. Here's the New York Times' take…

[Congressman Bart Stupak’s] amendment would bar any insurance plan that is purchased with government subsidies and the new public plan from covering abortion. Other insurance plans, approved by the government for sale through new exchanges or marketplaces, would be allowed to cover abortion provided they did not accept federal money. Separately, people who purchase subsidized insurance, could buy separate coverage, with their own money, for abortions.

Absolutes Only Halt Debate When They Meet with Intransigence

I'm straining for a silver lining, to be sure, but Congressman Patrick Kennedy does offer the useful service, from time to time, of stating rhetoric that is sufficiently blunt to expose the error underneath. With reference to the fight he picked with the Catholic Church:

Kennedy also said that no group "is getting everything it wants" in the medical overhaul. The church "has every right to promote its position," he said, but if a group "seeks to impose absolutes on the debate, we are left standing idle instead of moving our nation forward."

That's only the case if those determining the course of the issue are intransigent in the face of the absolute. Every party to a negotiation has a bottom line that it will not cross; the process moves forward by determining the proximity to that line that other parties find tolerable.

This is even true of folks like me, whose bottom line is that the government should not be a significant force in the healthcare system. The way forward would be to figure out my determination of "significance" and explore alternate methods of achieving hoped-for ends. (That assumes, of course, that the hoped-for end isn't in actuality government ownership of the healthcare system, which is probably the case for more than a few healthcare "reform" advocates.)

Mark Zaccaria: Respite Care vs Political Posturing

As an avid follower of the activities of Representative James Langevin, I read with interest his recent release on the subject of Respite Care here in the Ocean State. I read it with interest, but also with a certain amount of approval.

The Congressman correctly highlights the aid rendered by the many uncompensated family caregivers here in Rhode Island, at least 114,000 by his count. All of us should celebrate the contributions made by these family members and friends of those in need of ‘round the clock care in an increasingly expensive world. Most of these important members of the health care chain became links in it due to circumstance rather than by choice. I know. For 28 years my wife, Ruth, and I were part of that team as we provided home care for our son Adam.

The eldest of our three children, Adam was diagnosed with autism as a toddler. It set our family on a path of gaining expertise about that syndrome which none of us ever planned on acquiring. Like the 114,000 Rhode Islanders the Congressman referenced in his release last week, though, Ruth and I did what we had to do. In fact, during the period of my business career when I was a corporate nomad we did it in several other states. None of them had programs or even formal support nearly equal to that we received when we got back here for good, ten years ago.

So I applaud my Representative in Congress for the focus on respite care he spotlighted in his recent release. It is a service to uncompensated caregivers that exists in this state but most certainly does not in many others. Respite care can also be a Godsend to parents, friends, or siblings who find themselves stretched to the breaking point. They can be recharged by a day-off from long term homecare duties. It frequently lets them return to the fray reinvigorated and better able to shoulder the load.

In reading my Rep’s account of his action in support of this cause, however, it was hard to miss a couple of glaring admissions. He wrote that he’d spent five years working to pass legislation to support respite care and he even referenced HR3248 of the 109th Congress, known as the Lifespan Respite Care Act of 2006. The bill was introduced in the House in September of 2005 by a New Jersey Rep. and it was passed in 2006 by both chambers and signed into law by President Bush on December 21st of that year. For the record, Congressman Langevin was one of this bill’s 84 co-sponsors in the House. Now, nearly 3 years after passage, he touts a grant of $200,000 for Rhode Island that has been secured under the legislation.

That amount, which averages out to just over $1.75 per Ocean State caregiver, will be split between three existing programs here. No doubt the money will be well spent to cover the on-going overhead expenses of keeping them running.

What I feel I do have to doubt is that this amount will be granted again at any predictable point in the future. It’s very nice that Mr. Langevin has brought home a couple slices of bacon, and chooses to trumpet that fact. It must mean that’s the best action on our behalf that he’s got to crow about right now. It also must mean that he has not set himself about assisting these important local programs with any kind of long term support that their managers could count on to help improve things for Rhode Islanders for years to come. Dare we ask why there was no talk in last week’s press release about expanding the availability of respite care as a direct result of the Congressman’s efforts?

They can’t all be home runs, of course, but it strikes me that our guy has tried to slip one past us with his recent puff piece on respite care. Right now the excess spending of past administrations has become the egregious and unsupportable spending of this one. It’s a time when I would have preferred to hear about how my Representative plans to assist in warding off the price inflation that looms on our horizon as a result. He seems to have voted in favor of every single one of the recent spending initiatives that have taken billion-dollar deficits and made them trillion-dollar deficits in less than a year. Can you help me understand how that’s a good thing for me, Congressman?

The saddest part of it all is that he must think we’re not watching. He must think he can get away with keeping his name in print with the legerdemain of an occasional misdirection press release while he attends to business as usual in Washington. As I said at the top, I’m watching. I bet you are, too.

Mark Zaccaria is a small businessman and former elected official who was Congressman Langevin’s GOP opponent in the 2008 election. Mr. Zaccaria plans to run again for the seat in 2010.

No Price Tag Doesn't Mean No Price

Professor Stephen Mathis has come across my post responding to his op-ed, and he comments, in part:

I think the ultimate problem with devaluing people or their organs is problematic precisely because it makes them vulnerable to more powerful folks. But I do disagree that disallowing a price tag on organs makes them worthless: I think it simply makes them incommensurable with money, which marks off their special status as things that are unlike everyday commodities. The same goes for laws outlawing the selling of sex. Making it impossible to buy or sell sex doesn't make it worthless, rather it delineates it as something so special it shouldn't be open to the pressures of the market (that usually come from the powerful/rich).

I don't know Mr. Mathis's background, but I'd suggest the possibility that he's just never encountered a situation in which he's needed a sufficient amount of money that would justify the sale of a body part. I'll tell you the honest truth: I'd part with certain bodily properties if I could thereby erase my debt.

The economics are unavoidable: Every body part has an abstract value; that we disallow their sale just removes the motivation to assign a dollar amount to it. The same is true of sex, although the value is so much lower, and unlike organs, its sale doesn't deprive the seller of its use, so some people will always make the transaction, whatever the law says.

Drawing the Wrong Conclusion from Statistics

Just a minor observation based on the story in ProJo about Tamiflu, which states:

A recent check of prescribing data from pharmacies around the state found that 15 percent of Tamiflu prescriptions were filled five days after they were written.

That means a lot of wasted Tamiflu, says Health Director David R. Gifford –– because the drug works only if you take it within a day or two after you start feeling ill.

Error and Redundancy

Congressional United Church Pastor Eugene Dyszlewski took to the Projo letters section, on Sunday, to attack Roman Catholic Bishop Thomas Tobin for his criticism of supposedly Roman Catholic Congressman Patrick Kennedy, who had attacked the Catholic Bishops for continuing to oppose abortion funding within healthcare legislation. Writes Dyszlewski:

The congressman poses a legitimate question about how the Catholic Church could be against the biggest social-justice issue of our time. It remains to be seen what specific language in what bill raises the abortion concern. Federal law already includes a ban on abortion financing; demanding redundant legislative language in the bill under the threat of opposition seems oddly unnecessary.

It would be preferable if religious leaders were less prone to logical error and the promotion of misinformation. For illustration of the first count, imagine a "comprehensive healthcare bill" that would cover all those millions of uninsured Americans (or non-Americans, as the case may be), but that had a provision for the execution of Protestant ministers. Would it be inexplicable opposition to "the biggest social-justice issue of our time" to require the removal of that provision as a prerequisite for supporting the bill? The reverend is merely trading in deceptive political rhetoric.

On the second count, Dyszlewski is astonishingly strident about the redundancy of the language for which pro-lifers are calling. At best, it appears that the only real question is the mechanism by which federal dollars would flow to abortion providers. If Dyszlewski is referring to the Hyde Amendment, he's simply wrong. That annual appropriations rider applies only to the Health and Human Services appropriation, from which healthcare legislation would have distinct revenue. The upshot is that unique legislation does, in fact, require a targeted ban.

If Rev. Dyslewski believes that financing the killing of unborn children is a small price to pay for a bill that will ensure the erosion of our healthcare system, then it would be more honest of him to come out and say as much. In the meantime, I'd caution him against making common cause with the likes of Stephan Brigidi, of Bristol, who used the same space a couple of days previous to express his zealotry for banning religious leaders and their beliefs from the public square. "For far too long," writes Brigidi, "this interference has gone unchallenged, such as the reciting of rosaries and prayers under the State House rotunda to oppose certain legislation."

There's a reason the "right" to abortion rises up in tandem with an urge to restrict rights of religion and free speech, and religious folk would do well to contemplate it.

In Favor of Options – Even Non-Government Ones!

Hurrah to the Projo editorial board, for recognizing that governmental regulations can artificially increase the price of health insurance in non-rational ways…

We noticed the other week, for instance, that an insurance policy in Maryland has a premium half the size, and with better coverage, than a similar policy sold by Blue Cross and Blue Shield of Rhode Island, but other than by moving to Maryland there is no way to buy it....

Getting rid of the antitrust exemption and letting people shop for insurance nationally would be good steps in controlling costs.

A Healthy Market

Wheaton College Philosophy Professor Stephen Mathis questions "how appropriate it is to address health concerns using a for-profit model":

Consider that we have numerous treatments for erectile dysfunction, while drug companies have resisted putting resources into finding a cure for malaria, a disease most prevalent in poorer countries.

Professor Mathis might profit from a viewing of my video blog describing the effects of attempts at manipulating economic behavior. We have treatments for erectile dysfunction because people want them. Reformulating the healthcare system in such a way as to deny that sort of research and to force investment in other areas of less market demand will not have the intended effect and will require escalating infringements on freedom.

For the individual, the choice isn't between cures for erectile dysfunction and malaria research, but between cures for erectile dysfunction and a new car (or whatever else the individual might spend his money on). Push hard enough, and the choice becomes one between funding malaria research and declining to work so hard or take financial risks with the hope of prospering.

Mathis has other misconceptions about medicine and the market:

First, we tend to think it inappropriate to profit from others' misfortunes, whether they are illnesses or accidents. This also helps explain why our police and fire departments are all either government-funded or volunteer. So when it comes to protecting lives or saving them, we disapprove of those who profit from others' misfortunes because they take advantage of others when they are vulnerable.

Second, we have laws against buying and selling human organs. We do not let individuals buy or sell organs because we think it is inappropriate to put a price tag on such things as bodily organs. This also explains why we do let individuals donate organs.

In the first case, I'd suggest that it isn't an abstract sense of appropriateness at play, but of danger. Nobody begrudges financial gain for those who save lives; rather, we're wary of circumstances in which lifesavers could leverage dire need at a crucial moment in order to extort greater payment. It's not that we have a moral problem with police and firefighters making a healthy living for their services and the risks that they take; it's that we fear a scenario in which they stand at the door with their hands out before collaring the murderer or dousing the flames. The former is a matter of compensation; the latter is a matter of complicity in crime and destruction.

Similarly, in the second case, we don't fear that devaluing organs through sale will devalue their owners. The devaluation of the person comes first. If you're a person with explicit dominion over your body, then others must approach you as a being capable of making decisions, a peer; if you're a shell for valuable organs, then others can focus on plying those organs from you. Consider:

... outlawing organ sales is a way of making clear that, as a society, we think individuals should never have to face certain decisions — say, between filing for bankruptcy or selling a kidney.

Wrong. Outlawing organ sales is a way of preventing immoral actors from targeting your finances as a means of acquiring your kidney. Indeed, it cannot be moral, and it devalues organs, to declare that a man must watch his family suffer because we've erased his kidney's market value. Not allowing individuals to "face certain decisions" doesn't relieve them of the horror of their circumstances. In that case, organs are literally worthless, except insofar as they keep individuals sufficiently healthy to make of themselves workhorses. But it devalues the entire person — and his family, too — if constructing an economy full of pitfalls can push him toward harvesting his body. In other words, it isn't the decisions of the individual against which we're guarding, but the decisions of the entire society.

The implications for our healthcare system are straightforward. My premise is that we restrict acute freedoms (such as selling one's organs) and circumscribe the profitability of safety in order to protect the vulnerable from the powerful. Consolidating healthcare decisions and handing the powerful a right to make them hardly alleviates that danger.

RE: Medicare Fraud

I referenced a 60 Minutes report on Medicare fraud earlier this week. Mark Hemingway adds some additional context:

Medicare fraud amounts to $60 billion dollars a year. That is one heck of a lot of money. In fact, Medicare loses seven times as much money in fraud every year than the combined profits of the 14 health insurance companies on the Fortune 500. Medicare currently covers 46 million people. How much more money will be lost to fraud when an additional 88 million people are dumped off of employer health insurance rolls in favor of a public option?

And remember, one of the primary reasons that the public option is supposedly better than private insurance is low administrative costs. Well, a major reason why private insurance has higher administrative costs is that, unlike the federal government, they make a genuine effort to combat fraud.

Medicare Fraud: "They would pay first and send an auditor later. "

Proponents of the "public option" like to point to MediCare. It ain't the panacea they say, as 60 Minutes reported:

President Obama says rising costs are driving huge federal budget deficits that imperil our future, and that there is enough waste and fraud in the system to pay for health care reform if it was eliminated.

At the center of both issues is Medicare, the government insurance program that provides health care to 46 million elderly and disabled Americans. But it also provides a rich and steady income stream for criminals who are constantly finding new ways to steal a sizable chunk of the half trillion dollars that are paid out each year in Medicare benefits.

In fact, Medicare fraud - estimated now to total about $60 billion a year - has become one of, if not the most profitable, crimes in America.

Once criminals like Tony get their hands on usable patient numbers, they try and charge Medicare for the most expensive equipment possible, which requires having access to a list of Medicare codes.

Asked what some of the best codes were, Tony told Kroft, "Artificial limbs, electric arms, electric wheelchairs. I mean, a regular patient, you can put them on two artificial legs and an artificial arm and they'll pay for it."

And that's what happened to former Federal Judge Ed Davis. He was one of those patients who started getting charges on his Medicare statement for artificial limbs.

"And I looked at it and it had charges for prosthesis. And I knew I had my arms," Judge Davis explained.

Though he has two healthy arms, his statement showed Medicare had been billed for a left and a right arm.

"Didn't anybody in Medicare check to see if any of these charges were valid?" Kroft asked Tony.

"Sometimes they'll do it. But by the time they did it, it was too late," Tony said. "We've already made $300,000, $400,000, $500,000 on it. And then we will never send 'em nothing back. And then at 30 days they'll send an inspector to your office. And by that time…it's all closed down."

They would pay first and send an auditor later.

Kim Brandt, Medicare's director of program integrity...[said] "Well, it really does come down to the size and scope of the Medicare program, and the resources that are dedicated to oversight and anti fraud work. One of our biggest challenges has been that we have a program that pays out over a billion claims a year, over $430 billion, and our oversight budget has been extremely limited," Brandt said.

About that there is little dispute: Medicare has just three field inspectors in all of South Florida to check up on thousands of questionable medical equipment companies.

"Clearly more auditing needs to be done and it needs to be done in real time," Attorney General Eric Holder said.

Asked why it has taken Medicare so long to figure out they were being scammed, Holder told Kroft, "I think lack of resources probably. And then I think people I don't think necessarily thought that something as well intentioned as Medicare and Medicaid would necessarily attract fraudsters. But I think we have to understand that it certainly has." {emphasis added}

Kennedy and Obama vs. Catholic Church and Fox

Something's been gnawing at me since Andrew posted video of Congressman Patrick Kennedy proving once again why we should all hope his handlers keep him well away from any real power, and it took a revistation of Ed Achorn's concern about the Obama administration's jihad against Fox News to jar the pest loose. Here's Achorn:

The White House's declaration of enemy status for Fox seems to reflect a growing disrespect throughout our society for free speech, the wellspring of America's greatness and generous spirit. A president of all Americans, even those who disagree with him, should have the grace and bigness to realize that.

Ominously, growing numbers of Americans seem to think that it is illegitimate for anyone to have an opinion at variance with their own. And that those who disagree — or would report facts that challenge their viewpoint — become a fit target for retaliation, punishment, abuse, even the coward's art of slander.

Kennedy's dismissing the Church's easily foreseeable objection to the probability that the Democrats' version of healthcare reform will fund abortions as a "red herring," and his declaration that the bishops are sowing "dissent and discord" is precisely in the line of Achorn's criticism.

When Reform Doesn't Fix What's Wrong

Firefighter and EMT Michael Morse, as he works to get his body back into occupational shape, reflects on the future of healthcare in a system that calls a city ambulance rather than permitting patients to take their cars to another building in the same medical campus:

... The medical community is as clueless as the rest of the population who abuse the 911 system on a daily basis. I can hardly wait for whatever healthcare reform comes out of Washington. Something tells me I'll be driving people to Physical Therapy appointments, at taxpayer expense.

And then what happens when the heathcare system planners work the cost of such transportation into the total cost of the therapy and begin denying treatment in some cases because the total expense is too high? I know, I know. It'll never happen. We can trust our government and its functionaries to be reasonable.

Killing in the Name of the Law

Put assisted suicide on the long list of issues that ought to be left to the states, but that I'd oppose in my own. In the name of civil liberties that conflict with the (until recently) long-standing moral consensus of our culture, we're building a giant trap that will at some point close on us all — probably too slowly to cause alarm — and leave us absolutely free to drug ourselves into a stupor for a neighborhood orgy as a sendoff to a middle-aged friend who'll be visiting the city death dispenser because public healthcare won't cover his methadone anymore. As for practicing religion, speaking our minds on politics during campaign season, and engaging in productive economic activity... well, a culture's got to draw the "unfree" line somewhere.

But back to states' rights and euthanasia — sorry, assisted suicide. The problem with the state-by-state experiment model is that those who advocate for the creation of innovative culturally discordant laws have incentive to make their ill effects difficult to trace, and so we get a scenario such as Wesley Smith describes here:

These advances would not have happened but for a powerful myth promoted by assisted-suicide advocates and helped along by a compliant media: the notion that Oregon's experiment with legalized assisted suicide has been a success, in which problems and abuses are rare or nonexistent. It is true that the annual statistical reports published by the Public Health Division (henceforth OPHD) of Oregon's Department of Human Services have revealed very few problems. But there's a reason for that: The reporting system was designed by the authors of the assisted-suicide legislation to be incapable of vigorous policing and in-depth data gathering.

As a result, nobody knows precisely what is going on in Oregon. The data in the state-published reports are based overwhelmingly on self-reporting by death-prescribing doctors — who are as likely to admit violating the law on this matter as they are to tell the IRS that they have cheated on their taxes. Indeed, as the bureaucrats charged with publishing the annual report admitted to an investigative committee from the British House of Lords, the OPHD engages in only very limited and random checking of the information it receives. Moreover, the department has no budget or authority to investigate apparent violations of the law, and all documentation relied upon in writing the annual report is destroyed once the report has been published. Dr. Kathleen Foley, perhaps the nation's premier palliative-care doctor, and suicide-prevention expert Dr. Herbert Hendin wrote in the Michigan Law Review last year that the OPHD "does not collect the information it would need to effectively monitor the law and in its actions and publications acts as the defender of the law rather than as the protector of the welfare of terminally ill patients."

The cliché of the distopia is a sepia-hued society in which everybody fears to act — fears to do anything but work and support the government. The reality, I prognosticate, will be much more a colorful pictures of people free to indulge their darkest notions but undermined wherever they seek to build something positive.

ProJo Editors Support Single-Payer and Higher Taxes

In his Wednesday column, "The trouble with health care is paying for it", Michael Barone wrote:

We know now that it costs a lot of money to pay for insurance policies with expanded coverage for an expanded number of people. And we know that no one wants to pay the price.

We may be in the process of learning something else. Which is that insurance coverage that further insulates patients from costs results in unanticipated increases in health care spending. Yes, it bends the cost curve, but in the wrong direction. That's what has happened with the much-praised Massachusetts system.

....how much more economical and efficient a single-payer plan would be than the mosaics being created in Congress to please the insurance companies spending so much money there. Health insurance works best for the public when the pool covers as wide a spectrum of the population as possible.

Such devices as taxes on fancy “Cadillac” insurance plans, meant to move people into less-expensive ones, and smaller federal subsidies for private Medicare plans, which have been wonderful cash cows for insurers though very expensive for the public and providing no real benefit to public health, would help a bit.

But broad-based taxes will have to be raised (or invented) to pay for universal coverage and for Medicare costs for the Baby Boomers as they slide into decrepitude.

That PwC Report on Healthcare Costs

The Providence Journal headline was "Insurance lobbyists take the gloves off," and the AP report above which it appeared cast the story in terms of the political battle, as if it is immaterial and unknowable whether a study issued by PricewaterhouseCoopers is accurate:

The firm's study projected that the legislation would add $1,700 a year to the cost of family coverage in 2013, when most of the major provisions of the Baucus bill would be in effect.

Premiums for a single person would go up by $600 more than would be the case without the legislation, it estimated.

In 10 years' time, premiums would be $4,000 higher for a family plan, and $1,500 more for individual coverage.

From the voter/consumer perspective, this is a bit like watching two giants wrestle over who gets to eat more of us. Neither of them is interested in measures that would actually set us free or in our desire to explore the marvelous facilities that they've promised will be found in their belies. So, put the article aside and refer back to it, in a decade, so we'll know whom it is we hear saying "I told you so" as we're digested.

Links to various articles

Power Line on Taking the National Debt Seriously

Stephen Spruiell on Obamacare Dissected: Ten things that probably will be in the health-care bill (but shouldn’t)

Kevin Williamson on Real Health-Care Reform: Ten things that ought to be in the health-care bill (but probably won’t)

Veronique de Rugy on Elinor Ostrom and the Essence of Economics

Matt Welch on The Unknown War: The defeat of communism 20 years ago was the most liberating moment in history. So why don't we talk about it more?

Jagdish Bhagwati on Feeble Critiques: Capitalism's Petty Detractors

Power Line on Democrats to Curtail Free Speech

Cato on What Does the State Department Not Want Us to Know about Honduras?

John Derbyshire on The Thatcher Giant

ADDENDUM #1:

Larry Kudlow on The Mundell-Laffer Solution: A stable King Dollar and lower tax rates could save the nation at this critical juncture

Harsanyi on The doers against the "thinkers"

Russ Roberts on Stimulus in the Real World

Victor Davis Hanson on The Power of Payback

Milton Friedman on 4 Ways to Spend Money

Milton Friedman on Libertarianism (Part 1 of 4)

Milton Friedman on Libertarianism (Part 2 of 4)

Milton Friedman on Libertarianism (Part 3 of 4)

Milton Friedman on Libertarianism (Part 4 of 4)

Friedman and Sowell on Equality

There Will Be Rationing

Further to this morning's vlog, John Goodman's got a good explanation of the reason that Sarah Palin's "death panel" comment was broadly accurate. He touches on the public sections of the healthcare industry, but then moves on:

As currently envisioned, private health plans and at least one public plan would compete. The plans would be free to set their own premiums but would have to charge all enrollees the same price, regardless of their health status. Because some plans will attract a greater percentage of sick enrollees than others, a government administrator will have the power to "tax" plans with healthier enrollees in order to subsidize plans with sicker enrollees, through a process called risk adjustment. And it is through this process that the government will have enormous power to control what is done for the sick.

Suppose a plan attracts an above-average number of people whose doctors say they need hip replacements. The company asks the government risk adjuster for a subsidy to cover the cost. The risk adjuster may decide these hip replacements constitute "unnecessary care" or "futile care" and deny the request. In this way, the risk adjuster will effectively force doctors to deny people care.

The risk adjuster will be aided by a national health board, which will do "comparative effectiveness" analyses. If the health board decides that a hip replacement is "unnecessary" or "futile," it will offer cover for the risk adjuster to deny payment and for insurers to deny care.

Vlog #9: Planning Against Human Nature

Herewith, further thoughts emerging from things said at healthcare town halls. The focus is, obviously, healthcare, but the argument is against socialism in general (ahem).

Swine Flu Disconnect

Is it just me, or is there an odd disconnect with this swine flue thing? The White House human services secretary has been giving the vaccine a round of marketing, and I know that schools in Tiverton, at least, are offering it to students on the premises. Yet, our pediatrician doesn't recommend it (which is not to say that she recommends against it).

It's a bad bug, as Mark Hemingway attests, but as Hemingway also attests, it's hardly a beast more fearsome than many of us who've made it into adulthood have already experienced several times. We face such illnesses down and survive, appreciating what it means to be healthy and sick.

Personally, I can't shake the feeling that there's something more to this hysteria. Some model to prove or cultural impulse to change, and being conservative, once suspicious, I'm resistant.

Congressional Candidate John Loughlin Healthcare Town Hall, 9/30/09

As I said, I was a little late to John Loughlin's healthcare town hall, a couple of weeks ago, but I did get most of it on video and capture a good number of interesting points from all involved.

More of the Same from Kennedy

Hiding behind his quaking fear of "violent rhetoric," Congressman Patrick Kennedy staged a comfy tele-town hall meeting:

Most of the participants — each of whom had their questions screened ahead of time by Kennedy staffers — appeared sympathetic toward changes to the nation's health-care system. ...

Tiverton resident Teresa Rudd said she remained on the line for much of the hour to ask Kennedy about how the proposals now in play treat the abortion issue. She didn't get the chance to ask.

"It didn't seem like there was any opposition," Rudd said afterward. "It seemed like one big commercial for health-care reform."

However much outrage Kennedy may express on behalf of the powerless rabble, it's clear by his actions that he doesn't hold his constituents in very high regard.

A Campaign Event Healthcare Town Hall

I'm about a half hour late, but I've made it all the way across town in Tiverton for John Loughlin's healthcare town hall event, as part of his campaign for Congressman Patrick Kennedy's seat. There are quite a few people here — somewhere around 130 or 140 — with a high local contingent. I can't be the only person who found the 5:30 start time a little early for a three hour event, but plenty of people turned out.

Steve Peoples and other Providence Journal folks are here. Local papers. And a couple small-camcorder folks.

As I set up, RIILE's Terry Gorman was talking about illegal immigration and healthcare. That issue has dominated the audience questions. It appears to be a very friendly crowd, by the way.

6:28 p.m.

Bill Felkner just quoted Obama's "if you like the healthcare that you have" line and the audience pretty broadly agreed: "he lies."

Loughlin: "Is Joe Wilson here?"

6:53 p.m.

One audience member noted that a family of five owes more as a function of national debt than the average mortgage payment in Rhode Island. "Are we nuts?"

7:01 p.m.

The tempo of the event seems to pick up when the topic pushes the boundaries of the healthcare issue. One audience member just asked Rep. Loughlin about his intentions with respect to the military and veterans. Loughlin was clearly more animated, and the audience began to get worked up.

Perhaps the lesson is that he should have issue-related events with targeted audience and relevant panelists (e.g., military folks speaking on military issues... Afghanistan would be good). Keep momentum rolling. Use the campaign almost as a political tool for raising current events, making the emphasis of his campaign the issues — and the voters' concerns — rather than himself.

7:07 p.m.

One of the panelists made the point that the American healthcare system is not the best healthcare system in the world. The audience was split on whether to shout objections or to shout objections to the objectors.

7:09 p.m.

Peter Asen (of Ocean State Action, I believe), who was also at the Kennedy event, just stated that, in Rhode Island, only Blue Cross offers individual plans because only Blue Cross is willing to play by the rules and abide by coverage mandates (such as preexisting conditions). His argument was that we can't allow healthcare buying across state lines because everybody will flock to the cheapest programs in states that let them get away with everything.

Well, that pretty much sums up the differences in philosophy. The left wants to institute "fixes" and then layer on controls when the outcomes don't match their desires. As they must, the controls will simply ratchet.

Every newspaper in the room sought comment from Mr. Asen.

7:20 p.m.

The audience isn't ready to move away from the question of whether the United States has a bad healthcare system.

Room thinning quickly.

Hints of Things to Come with Public Healthcare

An interesting find by Joseph Bottum. Belmont Abbey College, an institution sponsored by Catholic monks, opted to remove provisions for abortion, contraception, and sterilization from the healthcare plan that it offered employees, as it must do as an institution run by believing Catholics. The matter will end up in court, but the Equal Employment Opportunity Commission chimed in with this specious ruling:

Now, after a complaint was filed by eight faculty members, the U.S. Equal Employment Opportunity Commission has ruled that Belmont Abbey is discriminating against women: "By denying prescription contraception drugs, Respondent is discriminating based on gender because only females take oral prescription contraceptives. By denying coverage, men are not affected, only women." Should the college and the faculty members who filed the complaint not be able to reach an acceptable settlement, the EEOC can file a lawsuit against the college in federal court.

Apart from setting an apparent precedent that any medical procedure relevant to only one gender must be covered on the grounds that the other gender isn't affected by lack of coverage, the ruling contrasts explicitly with North Carolina law. An unelected federal board, in other words, is attempting to assert its authority above elected representatives at the state level.

This is one of those topics on which we must remind the ruling political faction that they will not always rule (no matter how confident "progressives" are that things will always move in their direction). Removed from all ideological specifics, the size and reach of the ever-growing federal bureaucracy cannot be otherwise than a suppressant of freedom.

Democrats Agree: Health Care Reform Should Cover Illegals

President Obama recently exhibited some clumsiness trying to play a shell game on illegal immigrants and health care reform:

Even though I do not believe we can extend coverage to those who are here illegally, I also don't simply believe we can simply ignore the fact that our immigration system is broken," Mr. Obama said Wednesday evening in a speech to the Congressional Hispanic Caucus Institute. "That's why I strongly support making sure folks who are here legally have access to affordable, quality health insurance under this plan, just like everybody else.

Mr. Obama added, "If anything, this debate underscores the necessity of passing comprehensive immigration reform and resolving the issue of 12 million undocumented people living and working in this country once and for all."

Fearful that they're losing ground on immigration and health care, a group of House Democrats is pushing back and arguing that any health care bill should extend to all legal immigrants and allow illegal immigrants some access.

The Democrats, trying to stiffen their party's spines on the contentious issue, say it's unfair to bar illegal immigrants from paying their own way in a government-sponsored exchange. Legal immigrants, they say, regardless of how long they've been in the United States, should be able to get government-subsidized health care if they meet the other eligibility requirements.

"Legal permanent residents should be able to purchase their plans, and they should also be eligible for subsidies if they need it. Undocumented, if they can afford it, should be able to buy their own private plans. It keeps them out of the emergency room," said Rep. Michael M. Honda, California Democrat and chairman of the Congressional Asian Pacific American Caucus....Mr. Honda and his allies, though, say illegal immigrants should be allowed to pay for insurance if they can afford it, even if it comes through a government-established exchange. As a generally young, healthy part of the population, illegal immigrants could help reduce overall costs for those who buy into health exchange plans, the lawmakers said.

Violence and Fear in Healthcare

Steve Peoples' article about this morning's event focuses on Kennedy's lamentation that heated protests may produce violence — of which (he stated) his family has seen too much. There's an interesting juxtaposition if we play Peoples backwards, as it were (emphasis added):

"Unfortunately, these town hall meetings have been hijacked by these Tea Party folks and extremists who really take away from the honest dialogue on the facts of the debate and end up seeing this issue devolve into fear mongering and the peddling of misconceptions," [Kennedy] said, referring again to the sign that referenced his father's death.

But earlier:

Tsiongas said that those who depend on the current health-care system are right to be afraid.

"What they should be afraid of is that we do nothing," he said, "because if we do nothing we can no longer be able to afford this health-care delivery system as it stands."

I guess fear mongering is only a bad thing when conservatives and Republicans do it.

Kennedy and Friends in Forum

Inasmuch as the first 10-minute video clip from this morning's forum on healthcare began attracting viewers almost as soon as I posted it, and the first has surpassed many clips from previous events that have been up for weeks, interest would seem to be high.

Therefore, I've put the videos that the various computers involved have finished processing in the extended entry and will add the rest as they're available. (There are twelve, in all.)

A Confusing Set of Intentions

The sales pitches for the Democrats' healthcare reform are flying so furiously that it's difficult to trace the intellectual threads that ought to be binding the various parts of the plan together. Consider:

President Barack Obama has endorsed the proponents of the insurance tax. This says it would help lower health care costs by encouraging people to become more cost-conscious health care customers.

Most high-cost health care plans cover co-payments and deductibles so there is no dollar spent for health care.

Unions argue that they are giving up higher pay to secure better health care benefits. It is likely that insurers will pass on the cost of the tax through higher premiums.

Even if we adjust for the journalist's poor writing skills, the rhetoric has a thrown-against-the-wall quality. Pull the sticking pieces apart, and this is about what you get:

• A tax on high-end health insurance plans will be levied to help with "covering the uninsured."
• The tax will be passed on to premiums, increasing the price to consumers.
• Consumers will move away from plans that hide copays, thus increasing their awareness of the costs of their healthcare and making them more likely to conserve.

What happens when people react to the incentives such that there are fewer high-end plans to tax, leaving insufficient money to cover the uninsured? One supposes that the answer would be some variation of, "It doesn't matter." It doesn't matter, because a coherent strategy is not the objective; either an emotional balm or a route to bigger government is.

Democrats and their supporters have spent far too much time rehearsing the Obama school of political salesmanship: promise to heal the wounds of the suffering, mix in some of the opposition's language so "moderates" can imagine that your policy is economically rational and objectively considered, and pretend the cost will be borne only by the ultra-rich minority.

If increasing "cost consciousness" among healthcare consumers were a goal, there would at least be lip service paid to health savings accounts. If the transfer of healthcare dollars from the rich to the poor were the goal, then there would be some plan to adjust to the predictable free-market shifts caused by government incentives.

Ultimately, the whole thing is either a scam or a failure of thought so thorough as to undermine the very premise that a government organization could operate a flashlight, let alone a healthcare system.

Healthcare Town Hall... Not So Much

Quite a different event, Congressman Patrick Kennedy's version of the healthcare forum. Whereas Congressman Langevin placed himself bare before a roiling theater setting and Senators Whitehouse and Reed rolled up their sleeves for a folksy round of after-dinner discussion (somewhat more controlled, but with agreement and disagreement), Kennedy is participating as a "special guest" in an AARP "health care reform forum." He's one of four panelists, the others being:

• RI State Nurses Association Executive Director Donna Policastro
• AARP-RI Executive Council Member Ann Gardella
• RI State Medical Society Former President Nick Tsiongas

Sadly, nobody is outside in the parking lot protesting either Kennedy's position on this issue or his version of "meeting with constituents."

9:07 a.m.

Lots of suspicious looks from the party folks and the other members of the media with whom I'm sharing the back of the room. I'm not the only small-camcorder tripod operator, either, although I take it that's not necessarily an indication of citizen journalism, any longer.

Kennedy's making the rounds. Were I a politician, apart from discomfort with the room-working, I have to say I'd be annoyed at the constant camera presence. Guess you learn to live with it.

9:21 a.m.

Well, the event is scheduled from 9:00 to 11:00, and the breakfasts were just served. So, we seem to be looking at an hour or so presentation shared by four panelists. Even if the congressman fights for equal time, that's a total of about 15 minutes in the hot seat. We probably shouldn't expect much depth.

9:36 a.m.

The event proper has begun, with the AARP moderator Kathleen S. Connell, Senior State Director, AARP-Rhode Island. Each speaker will make a presentation, and then questions will be accepted, at first in written form from the tables.

9:49 a.m.

Kennedy's staff should expend some effort to teaching him to adjust his speaking tone depending on setting. He's shouting at us like it's a potentially hostile audience, although I suppose it's fitting, inasmuch as he's throwing the world of politics at the issue: "This bill is not just about healthcare. It's about..." everything from peace of mind to homeland security.

"YOU'RE ALREADY PAYING FOR THE UNINSURED!"

The high price of healthcare is apparently the fault of uninsured asthmatics who use the emergency room for care.

9:53 a.m.

America needs the government to step in and get primary care doctors to coordinate all of the patient's care. See, without federal mandate, doctors just don't do that sort of thing.

"ONE-THIRD OF YOUR HEALTHCARE DOLLAR DOES NOT EVEN GO TO HEALTHCARE DELIVERY!" "That's a crime and we shouldn't allow it to continue."

Although, he just said that four-fifths of "your healthcare dollar" goes to 20% of healthcare consumers.

9:56 a.m.

And yet, doctors support the Democrats' reform 3 to 1 because... they're tired of paperwork.

10:00 a.m.

"Do you want the public, through the members of congress to be the ones who regulate healtcare, or do you trust the private insurance companies? They are accountable to stock holders and boards of directors. The public option is accountable to the public."

Hey, he's got a point. If the public is paying the bill, and the healthcare system is accountable to a representative democracy, the payer won't have to worry about customer backlash if it's got political cover for such things as, say, rationing.

10:01 a.m.

Kennedy: It's all paid for through efficiencies and other obvious savings. Defensive medicine, etc .

Why not save all that money first and then move to expand the government involvement?

10:04 a.m.

We need a public option because the current system doesn't treat people as anything other than a monetary unit, and the government would see them as people. (Or, you know, voting units and campaign donation units, but we'll put that aside.)

Kennedy just complained that his friends call him up from emergency rooms all the time so he'll come down and get them special handling. On the fact that powerful folks get special treatment: "That's morally outrageous, and that's the country we live in right now."

Bad, materialistic America.

10:09 a.m.

By the way, to put a face to the journalism, this is Steve Peoples:

10:13 a.m.

Kennedy's done. Ann Gardella is speaking. Congressman Langevin just arrived.

10:15 a.m.

Tivertonian Dr. Nick Tsiongas is up.

10:17 a.m.

Mr. Tsiongas related the story that his parents recently visited and suggested that he ought to take down the healthcare reform political sign he's put on his Main St. property. Everybody who receives healthcare should be "afraid" if this reform doesn't pass; reference to Churchill's line about Americans always doing the right thing... after they've tried everything else.

Bad, backward-looking America.

10:22 a.m.

Donna Policastro is up. She's pleased that this issue has brought the R.I. State Nurses Association together with the SEIU and Ocean State Action.

Nurses are tired of working so hard to make the healthcare system work for their patients. I wonder if Congressman Kennedy would position that in contrast to those primary care doctors who don't help their patients coordinate their various specialists.

10:29 a.m.

Langevin is wired with a mic, and he's going to get a turn to speak.

10:31 a.m.

10:34 a.m.

Q&A time (read off cards).

By the way, Langevin mentioned the unsustainable trends in premium costs. The argument brings to mind a graphic that reader Roland Benjamin emailed me the other day:

<

The big dip in 2003 follows the introduction of healthcare savings accounts.

10:47 a.m.

Interesting collision of issues: Ms. Policastro is talking about the coming shortage of nurses, and she cited the problem that many potential nurses get a year or two into their education and realize that there's more hard science than they'd expected, her conclusion being that high school and lower education has to improve.

Amen to that, for a multitude of reasons. Of course, the solution of the sorts of people populating this room is to flow more money to the problems, which happily benefits their friends in labor unions and other public-sector-related organizations. I suspect I'm not alone on the other side in believing that that solution is the problem.

10:53 a.m.

Kennedy's redirected to his push for more money and requirements for care, which will benefit those who provide care ("NO COPAY!" for screening procedures). Eventually, it comes down to taking money from some Americans to give it to others. Everything in between is quibbling about the "who" and in what form.

10:59 a.m.

Tsiongas just put the difference in practical philosophical approaches to the issue of healthcare: He wants to take "all of the money" currently constituting the healthcare system — consumers, unions, providers, insurers — and put it all together in one pile "so we can make better decisions."

How can such folks not see the clear consequence of that sort of consolidation? Defining the "we" who will make the decisions becomes a huge battlefield. Let's assume the pure motives of Mr. Tsiongas and everybody else who currently advocates his position. By what mechanism do the Tsiongasians intend to keep control of the decision making process? And to the extent that they create those mechanisms, why should we trust them to have that expanding power?

11:04 a.m.

Kennedy: "If the insurance companies and everybody is so good at lowering prices and finding efficiencies, why aren't they doing it?" Umm. Government mandates, requirements, and regulations.

11:11 a.m.

Moderator Kathleen Connell called for a round of applause for the press for coming out on a Saturday. Curious.

11:15 a.m.

Steve Peoples started to ask me my thoughts on the event but had to run after Kennedy for a comment. For the benefit of all media types who may want the right-wing opinion (as filtered through my potpourri of philosophical and personal inputs) should feel free to call or email or, you know, just read the above...

ADDENDUM:

I've posted the video from the event here.

Contrasting Healthcare Fora

I've just received word that I will be allowed to do my liveblogging, YouTubing thing at Congressman Patrick Kennedy's limited-attendance healthcare forum, on Saturday. We can then compare and contrast the candidate, audience, and message with State Representative John Loughlin's healthcare town hall meeting in Tiverton on Wednesday.

Roland Benjamin: A Response to RI Health Care Experts

The Providence Journal reported the responses of health care experts around the state to President Obama's speech on reform to Congress a few weeks ago:

Five Rhode Islanders with expertise in health care were among the many who watched President Obama's speech Wednesday night. A professor, a doctor, a hospital president, a businessman and a government official each offer a unique perspective…

Most of the responses in one way or another commended the President on his efforts to transform our health care system. With one exception, though, they seemed skeptical about the upside to the details.

For many individuals, inflation of care and plan costs is of paramount concern. The nonstandard inflation in health costs has eroded coverage as insurance prices push individuals out of the market. That said, two of the experts are not convinced that ideas will do anything in this regard.

Rhode Island Health Insurance Commissioner Chris Koller states:

Nothing in the president's proposal last night directly gets at changes in the way we use medical care services, which are what's driving our cost increases.

And Chairman of the Rhode Island chapter of the Smaller Business Association of New England Grafton Willey is concerned that businesses would pick up the price tag:

Mr. Obama said it would not be funded through tax hikes, but Willey worries that small businesses could end up paying.

If costs are to be contained, and there is only marginal indication that this is a goal of the reform, two other experts hint from where cuts will come.

The President of South County Hospital, Lou Giancola, expressed concerns that providers will bear this burden.

Giancola worries that cost control, as often happens, will come down to simply paying providers less. Reductions in Medicare reimbursements have already been proposed…

Professor James Munroe at Brown University, a political science expert and coauthor of a new health care reform book, offers little relief to the concerns of the provider community with a more pragmatic reality check on how cost containment might be achieved.

Once everyone is insured and the government is at risk for the costs, he said, the government will clamp down — by paying less to providers.

So the Rhode Island experts agree that either costs will continue to rise, requiring a necessary tax or premium increase, or providers will pay through diminishing reimbursements, ultimately affecting quality of care. But if the reforms are not designed to contain costs, where is the upside? Naturally, the ambiguous goal of insuring the uninsured might be coercively achieved, by requiring millions who do not see the value of insurance to buy it. But that is a revenue grab to force tens of millions of folks who already have access to insurance, but choose not to pay for it, to fork over their resources for the common good.

Beyond insuring the uninsured, the president promised to provide more consumer protections for those already covered. Commissioner Koller acknowledged that much of these reform elements already exist in the State:

Most of the insurance reforms that President Obama is proposing in his health-care plan, such as bans on preexisting-condition exclusion, are already part of Rhode Island law, Koller said. The state has a robust set of consumer protections passed by the legislature over the years.

This probably has little correlation to the fact that Rhode Island has higher family plan premiums than 42 other states and is only 3% less than the highest premiums in the country. Ask any employer whether these consumer protections have contained premium inflation rates.

The one Rhode Island expert that was completely supportive was Dr. Elizabeth Lange, President of the Rhode Island chapter of the American Academy of Pediatrics. She marginalized the opinions of those outside of the health field:

"I don't think nonmedical people understand what a crisis the system is in," Lange said. "What we're doing now is unsustainable. We have to make a change."

Of course, doctors, hospitals and pharmaceutical companies are on the receiving end of a vast majority of dollars pumped through the insurance process. The natural tendency of these groups is to protect what they have. Mr. Giancola is obviously cognizant of that and Dr. Lange seems more the purist in her beliefs that expanding primary care to everyone will make for a better society. In both instances, there is a bias towards increasing cost without any increase in overall quality care.

Once again, the true failure of the reform debate comes in the diagnosis of the problem. The patient is virtually completely insulated from the direct financing of health care purchases. This by itself has produced the unnatural inflation that has made much of health care, and now insurance premiums, unaffordable. Regardless of payer, reform that diminishes this insulation is the only path to cost containment that coincides with quality improvements.

Consumer Driven Health Plans do just that. A May compilation analysis from the American Academy of Actuaries found the following:

• First year savings of CDH implementation of 12% to 20% compared to traditional plan offerings.
• Inflation trends after the first year run 3% to 5% less than traditional plans. i.e. Normal inflation.
• All of the studies show increases in preventative services and most showed that participants were as or more likely to follow recommended care for chronic conditions while providers were more likely to follow evidence based protocols. i.e. Better quality of care.
• Premium cost shifting from employer to employee is not incurring. i.e. Employers are forwarding premium savings from higher deductible plans directly to the employees.

These real numbers are the exact results needed from reform, but the ideological left will not acknowledge these solutions. Our own Senator does not understand that premium savings fund health care spending. In Wednesday's speech, our President promised to "place a limit on how much you can be charged for out-of-pocket expenses". Both comments reveal fundamental misrepresentations of economics and health care. And in a study published in the American Journal of Managed Care last year, [emphasis mine]

…on a mail-in survey of 528 physicians… less than half (48 percent) said they felt ready to discuss medical budgets with patients, and 43 percent said they had little knowledge of how consumer-driven health plans work. About one-third said they had scant understanding of how health savings accounts function.

So it should be little surprise that Dr. Lange, Rhode Island's own primary care expert, does not see the value in consumers playing a role in their own health care financing:

If you have a plan with a $5,000 deductible, Lange said, "That makes you essentially uninsured as well. You're not going to be seeking medical care."

Of course, I know plenty of people with deductibles that high. This includes my family with a plan I chose deliberately. I had an appointment with my primary care physician last week. I have never had a better relationship with my children's pediatrician, nor have I spent as much with her. Anecdotally, I can give you dozens of examples that directly contradict what Dr. Lange believes. Empirically, the studies analyzed by the Academy of Actuaries contradict Dr. Lange's belief with significant data.

The real solution is to encourage a migration of health care financing to individuals. This is already being done and must be enhanced through tax policy. But when some of the stakeholders do not understand the basic economics of the solution, the ideas get pushed off the table. Couple this with the ideologically dominant progressive Democrats calling the shots, an idea that strays towards individual liberty is about as likely as the left extending the 2001 and 2003 tax cuts.

Taxing on Your Health

Periodically, I catch an episode of The Mentalist, in which a non-cop, always-right, psychiatrist-type character assists the police with their cases. One episode featured the actor who played Chip on Kate and Allie, who — if I may indulge in a spoiler — played a murderer who had spent years posing as a mentally handicapped fixture of the town.

The memorable moment came when the mentalist had figured the case out (based on the not-so-subtle clue that Chip had a well-worn copy of Moby Dick in his trailer) and was trying to draw him out of his facade in the interrogation room. "Come on. I see you," he said. That's how one begins to feel about long-running political debates.

Come on. We can be honest, now. Is there anybody who doesn't anticipate where this is going?

The tax [on "Cadillac" healthcare benefits] is meant to raise more than a quarter of the $774 billion needed to pay for the Baucus plan. But, just as much, the tax is intended to discourage the overly generous coverage that many experts say has helped fuel the country's reckless spending on medical care.

As it turns out, though, many smaller fish would get caught in Baucus' tax net. The supposedly Cadillac insurance policies include some that cover many of the nation's firefighters, coal miners and older employees at small businesses -- a whole gamut that runs from janitors to college professors, from union shops to Main Street entrepreneurs.

The net will catch more people than initially explained. Folks will begin taking their pay and benefits in a different form. Loopholes will emerge. And the government will have to find a way to come up with even more money to supplement the tax-the-rich shortfall. It's too obvious not to be incorporated into the Democrats' plan, even if only as a problem to address later, once the deal is sealed.

We need a national political mentalist to coax our leaders through the facade of their double-speak.

Union and Democrat Party, Speaking with One Voice

This past weekend's episode of Newsmakers, with AFL-CIO RI President George Nee, is worth a watch:

Nee is among the more reasonable-sounding of the labor representatives, but that presentation only emphasizes the absence of space between how he responds to questions and how any given Democrat partisan would answer them. Sure, he's the guy who said that the state needs more political competition between the parties, but some Democrats have said the same thing, and there's an underlying insinuation that the Republicans should become more like Democrats and, for one thing, court labor more enthusiastically.

His take on a "public option" in healthcare, for example, comes directly from a conversation with Senator Sheldon Whitehouse: He cites public universities as an example thereof. Perhaps to the extent that "public" means "union jobs," the comparison has some validity, but in practice the two structures are substantially different. Notably, public universities are state-level operations, not federal.

More importantly, though, universities hire professors and not only put course offerings together, but fulfill them, as well. Health insurance is almost purely a matter of paper processing and funding. "Public option" doctors would not be competing with private-sector doctors to offer a more attractive healthcare regimen. Moreover, given the location-specific nature of higher education, translating such a thing into healthcare would represent a dramatic restructuring — with clients having to travel to a central healthcare campus, or the government seeking to place its doctors in every community.

Federal and state governments also have not built a web of regulations and mandates for higher education. Apart from accreditation and general business laws, colleges and universities operate under their own directives, which allows actual competition. In healthcare, so many offerings are explicitly required, and the incentives guiding the means of payment are so heavily manipulated, that the entire system is effectively becoming a "public option."

Somehow, I suspect that Nee, like any partisan Democrat, would not extend the principle of competition — which the left is happy to extol under the currently restrictive circumstances — if it meant permitting citizens to purchase plans more freely and companies to offer a greater variety.

Medicaid as Boomer Inheritance Program?

Stephen Moses, Health Care Policy Fellow for the Ocean State Policy Research Institute, brings to light an easy to miss loss of state dollars:

In 1993, the federal government made it mandatory for state Medicaid programs to recover the cost of benefits paid to older people with exempt (sheltered) assets out of their estates. In research I conducted for the Health Care Financing Administration in 1988, we found that Oregon, for example, recovered 5.2 percent of its Medicaid nursing-home expenditures from the estates of deceased recipients.

The comparable number for Rhode Island is only .67 percent. In other words, Rhode Island, which recovered only $2 million last year from estates, is leaving over $13 million on the table by not pursuing this non-tax resource more vigilantly.

Whoa! Wait a minute. Isn’t estate recovery like "picking the bones of the elderly"?

Not at all. With very generous income- and asset-eligibility rules, easy ways to self-impoverish and little estate recovery, Rhode Island's Medicaid long-term care program has become, in effect, free inheritance insurance for Baby Boomer heirs. Is that really how Ocean Staters want to use their scarce public-welfare resources?

I remain in the starve-the-beast camp, but there are other sectors of the population that could make better use of this break.

The Distressing Versus the Frightening

The rapid transformation of this country into a European-style socialist democracy is certainly distressing. American life is on its way to becoming more difficult and less free, less innovative — in a word, less American. But it is the combination of that atrophy with the existence of nations seeking to duplicate the international accomplishment of the United States (a global sphere of influence, if you will) without adhering to its methods.

More specifically, it is the combination of a strong-handed government at home with a weak-kneed government on the international scene:

The U.S. Defense Secretary is already on record as opposing an Israeli strike. If it happens, every thug state around the globe will understand the subtext — that, aside from a tiny strip of land on the east bank of the Jordan, every other advanced society on earth is content to depend for its security on the kindness of strangers.

Some of them very strange. Kim Jong-Il wouldn't really let fly at South Korea or Japan, would he? Even if some quasi-Talibanny types wound up sitting on Pakistan's nuclear arsenal, they wouldn't really do anything with them, would they? Okay, Putin can be a bit heavy-handed when dealing with Eastern Europe, and his definition of "Eastern" seems to stretch ever farther west, but he's not going to be sending the tanks back into Prague and Budapest, is he? I mean, c'mon . . .

Ignorance, Arrogance, and Deceit

I suppose I lack the grounds to object to Robert Whitcomb's protestations in yesterday's Providence Journal (not online) that his experience living in France doesn't jibe with the warnings that he hears fellow Americans giving against socialized medicine:

The ignorance and dishonesty in the U.S. health-care debate are beyond belief. ...

Then there are the idiotic observations about other developed nations' health-care systems. ... In fact, there is far more red tape and bureaucracy in the American health-care "system" than in countries with universal coverage, as there is in our tax "code."

Inasmuch as Whitcomb doesn't cite any idiots in particular, one cannot address the relevance of his French experience or specific claims about red tape. (And I'll resist the temptation to make populist appeals to my fellow gauche Americans qui n'est pas comme il faut. But a logical fallacy has the same repercussions no matter the language or airplane hours logged:

Consider how some people loudly worry that their taxes will go up if the government covers more people, while never noting how much their premiums for for-profit insurance go up 7 to 10 percent a year. Would they rather pay 7 to 10 percent a year to, say, United Healthcare or 3 percent annual increases to pay for Medicare for all? Test scores often show how badly Americans do in math, b ut this innumeracy is amazing.

Whitcomb conveniently sidesteps the reality that the debate is over how to reform healthcare, not whether to do so. The dilemma is false. Obviously so. Amazingly so. And it raises questions about how much readers should consider Whitcomb's other points persuasive, lacking, as I've said, any particulars that one could address beyond Robert's own personal experiences at some unidentified time in the past with an unspecified segment of the French healthcare system.

Wyden Criticizes the Democratic Health Reform Product

Given his long record interest on the subject (which Anchor Rising was reporting on before reporting on the details of healthcare reform was a big thing in the blogosphere), Oregon Senator Ron Wyden's (D - Oregon) strong skepticism about Democratic healthcare reform plans is a potentially significant development.

From an article posted last night at the Oregonian newspaper's website…

The Senate's leading health care proposal is seriously flawed, Oregon Sen. Ron Wyden said Tuesday, declaring that it fails to fulfill President Barack Obama's primary reforms and could force millions of Americans to pay more for the medical care they receive.

"Under this bill as it is written now, more than 200 million Americans would not get choices like the president of the United States called for," Wyden said in an interview. "Middle-class people certainly will pay more, based on the draft we're seeing."

What Are They Investing In?

This graphic showing the stock gains made by six health insurance companies after President Obama's healthcare speech is interesting fuel for contemplation. What is it that has attracted investors' interest?

• The possibility that health insurers are moving toward becoming another category of government-backed business?
• The possibility that consumers will rush to acquire plans that will be grandfathered into the healthcare "reform" (if only for a few years)?
• The likelihood that the Democrats' plan will accomplish nothing so effectively as preserving the dominance of a handful of leading corporations

Now Democrats Want to Tax Artificial Hips to Pay for Healthcare

Blogger "Tigerhawk" is reporting on a proposal by Senate Democrats to raise taxes on medical devices to pay for their healthcare reform plans (h/t Instapundit)...

Senate Democrats are proposing [to levy] a "value added tax" on medical device companies according to their proportion of U.S. sales. This tax would be without regard to profitability, so it would amount to a capital tax on start-ups and a massive income tax surcharge on profitable companies, varying as net margins do.

The future of Senator Max Baucus’s compromise health care proposal is far from certain, but one industry group was quick to fire back on Tuesday. The protest came from makers of medical devices like heart pacemakers and artificialhips – companies that would have to pay hefty new fees under the Baucus plan.

In an interview, Stephen J. Ubl, the president and chief executive of the Advanced Medical Technology Association, a trade group, said the organization opposed the proposal’s call for annual givebacks from device makers. The fees, which the proposal says would be allocated on the basis of each company’s market share, would total $4 billion a year.

“We do strongly oppose the $4 billion tax, which we believe is a tax on medical progress,” Mr. Ubl said.

One question brought to mind by the Times' reporting is if this actually is a "giveback", then what have medical device makers been taking that they're being asked to give back? The answer, also from the Times article, doesn't seem to be anything more than payment for their products; the government wants the manufacturers to give some of that money back, because some of their customers are hospitals, and hospitals are reimbursed by Medicare...

For lawmakers, some form of tax-like fees might be the only way to extract givebacks from device makers because of the way such companies are reimbursed. Government-financed programs like Medicare do not pay directly for medical devices, but instead reimburse hospitals and other providers for the procedures in which they are used.

Based upon what the Times has presented (I leave it to the reader to determine the reliability of the source), the Democrats' reasoning is that because a big government program reimburses hospitals, taxes have to be raised on non-hospitals, so the government can take back part of what's been given to hospitals, so the government will be able via new subsidies to give more money to hospitals. But it is a bit difficult to see how raising taxes on medical devices, including things like pacemakers and artificial hips, will contribute to either lowering healthcare costs or raising the quality of medical care.

Call me a cynic, but I think that this scheme pretty well represents the quality of economic thought that's going into Democratic health reform plans.

A Quick Philosophical Point on Rights

Something resonated oddly for me, the other day, and it occurred to me that there's an important philosophical point to be made in response:

"What we can be proud of in Europe is the ground rules, that everyone has the right to health care," said Jose Martin-Moreno, a health expert at the University of Valencia in Spain. "But the implementation has been difficult and one size does not fit all."

We've gotten a bit too free, in the West, with the "rights" language over the past few decades, to the point that it's easy to slide within the same word choices from nice privileges that we'd like to provide in an ideal world to irreducible allowances that governments simply cannot take away. That's truly a detriment to language and a loss to social discourse.

So plainly put: Is there a right to healthcare? Well, compare it with other rights:

• With the right to free speech, we have a right to speak, but not to be heard.
• With the right to bear arms, we have a right to own and operate guns, but not to be given guns for free.

In these terms, we would have the right to procure healthcare, but not to have it provided to us, to an extent of our own or somebody else's determination.

Why Subsidize-And-Regulate Isn't Enough to Fix Healthcare

For another perspective on why plans that focus on Federalizing the regulation of and providing subsidies to the existing employer-based healthcare system aren't likely to be an effective pathway to reform, David Goldhill's article in September's Atlantic Monthly is worth reading. In the opening section of his article, Goldhill writes…

The persistence of bad industry practices—from long lines at the doctor’s office to ever-rising prices to astonishing numbers of preventable deaths—seems beyond all normal logic, and must have an underlying cause. There needs to be a business reason why an industry, year in and year out, would be able to get away with poor customer service, unaffordable prices, and uneven results—a reason my father and so many others are unnecessarily killed.

Like every grieving family member, I looked for someone to blame for my father’s death. But my dad’s doctors weren’t incompetent—on the contrary, his hospital physicians were smart, thoughtful, and hard-working. Nor is he dead because of indifferent nursing—without exception, his nurses were dedicated and compassionate. Nor from financial limitations—he was a Medicare patient, and the issue of expense was never once raised. There were no greedy pharmaceutical companies, evil health insurers, or other popular villains in his particular tragedy.

Indeed, I suspect that our collective search for villains—for someone to blame—has distracted us and our political leaders from addressing the fundamental causes of our nation’s health-care crisis. All of the actors in health care—from doctors to insurers to pharmaceutical companies—work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate ensurer of value.

Gotta Have Humor on Healthcare

Both of us being giddy with anticipation prior to the president speech last night, my conversation with the host of the Matt Allen Show was full of sarcasm and laughter, which strikes me as the only appropriate posture to the current situation. Stream by clicking here, or download it.

Oh, by the way, the person who called out "You lie!" — causing a very interesting moment in the speech #&151; when the president declared that no illegal immigrants would receive taxpayer-financed healthcare under his plan was Republican South Carolina Representative Joe Wilson. The Associated Press tsks at the "nastiness" of the moment, but if that's the gauge, there were plenty of moments of nastiness in the speech itself.

Health Care Reform - Onto a Tabula Not So Rasa

Under "Liveblogging the President's Healthcare Speech", Justin comments

It's almost nauseating to hear politicians argue for a "public option" on the basis that competition is so limited, when the reason is clearly government regulation and mandates.

This is an excellent point also raised recently by Andrew. Health care reform is being designed not upon the clean slate of a health care system operating under purely market conditions but upon layers of regulations built up over several decades - and not all were promulgated to advance the best interest of the consumer/patient.

Let me hasten to add here that I would be dubious at best of a health care system that operated under pure market conditions completely without regulation. But isn't it also possible to have too much of a good thing?

If, indeed, the goal is more competitive (stipulating for a moment that 1,200 insurance companies do not engender sufficient competition) and less expensive health care coverage, perhaps the best reform would be the modification or elimination of some existing regulations, not the addition of another layer.

Two items that come most readily to mind are tort reform and elimination of the barrier to buying health insurance across state lines, though the list certainly does not end there. This approach, happily, would also conform to President Obama's stated desire not to "accept the status quo as a solution". The change created by taking a red pen to certain sections of our health care law could be just as drastic as appending chapters to it.

Liveblogging the President's Healthcare Speech

We'll be using the comments section of this post to liveblog the president's speech to Congress on healthcare. Based on the information currently provided it looks like we're in for a guilt campaign that attempts to change the aesthetics of the debate without doing much to modify the substance. People are suffering. We must work together. The basic outline of the Democrats' plan is the only solution, and any attempt to suggest otherwise is merely divisive greed.

When I called in to his show, at the turn of the hour, Matt Allen quoted this excerpt from the speech:

Everyone in this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it most. And more will die as a result. We know these things to be true.

As I told Matt, this is merely another example of the President striving the conquer the Politics of Fear with the Politics of Hope.

One simple question and then some reflections

In advance of President Obama's speech tonight about healthcare, I have one simple question -

If a government-run option is such a good idea for all of the rest of us, why do Obama and the Congress refuse to sign up for it themselves?

On a related note, Ponnuru discusses the Left's disregard for truth.

Glenn Reynolds links to Martin Feldstein and adds his own comments:

"The higher taxes, debt payments and interest rates needed to pay for health reform mean lower living standards." But lower living standards for you are a small price to pay in exchange for more power for the political class — whose living standards won’t be going down at all...

All of which is what the American people have instinctively figured out. Just like we have throughout history.

Camille Paglia, an Obama supporter, writes about the divide:

...Why did it take so long for Democrats to realize that this year's tea party and town hall uprisings were a genuine barometer of widespread public discontent and not simply a staged scenario by kooks and conspirators? First of all, too many political analysts still think that network and cable TV chat shows are the central forums of national debate. But the truly transformative political energy is coming from talk radio and the Web — both of which Democrat-sponsored proposals have threatened to stifle, in defiance of freedom of speech guarantees in the Bill of Rights...

Why has the Democratic Party become so arrogantly detached from ordinary Americans? Though they claim to speak for the poor and dispossessed, Democrats have increasingly become the party of an upper-middle-class professional elite, top-heavy with journalists, academics and lawyers (one reason for the hypocritical absence of tort reform in the healthcare bills). Weirdly, given their worship of highly individualistic, secularized self-actualization, such professionals are as a whole amazingly credulous these days about big-government solutions to every social problem. The