Memo to Bishops: Don't Fall For It

The Washington Post has collected a spectrum of religious reactions to the Obama administration's "compromise" — apparently announced as such without first consulting with the parties implicitly involved in the negotiations (a sure sign that Obama is more concerned about appearing to compromise than actually doing so). Religious leaders and others concerned about religious liberty — in particular those concerned about our ability to work through cultural avenues distinct from government to help shape society — should pause in their deliberations about the specifics of this overture.

Note what position the President's games put us in: We're not arguing about the morality of contraception (including abortifacients). We're not even arguing about the legitimacy of the government's declaration that everybody should have access to them free of cost (at least free of immediate cost to them). We're merely arguing about who else must pay — who has to chip in for the pills that address pregnancy as an illness to be treated and against which to be inoculated.

One hopes that the administration's initial overreach was enough to awaken the bishops and others to the reality that a deal with the Devil is always, always conditional on his ability to force you to the next-least-moral space on the playing field.

Government Sets a Thief to Catch... a Business

Yes, the story isn't as simple as a gut reaction allows, but broken down into a summary, this story feels like a cautionary tale of the leviathan state:

David Whitaker's cooperation with the Google investigation was called extraordinary several times during his sentencing [for Internet fraud crimes] in U.S. District Court in Providence. Assistant U.S. Attorney Andrew Reich said that because of the probe, millions of Americans have been protected from rogue online Canadian pharmacies advertising prescription drugs through Google's AdWords program. ...

After his arrest, Whitaker disclosed to investigators that he had been selling prescription drugs online in Mexico with the help of Google's AdWords program, Reich said. Whitaker described how he developed relationships with Google employees who allowed him to place ads for drugs obtained from overseas without a prescription, Reich said.

Whitaker helped investigators construct phony websites that purported to sell the drugs, officials said. Then, an undercover investigator would tell Google employees who were creating the advertising for the products that they were manufactured overseas and did not require customers to have a valid prescription, officials said.

Ailing people seek legal drugs sold in Canada because U.S. government regulations (among other things) drive up the cost in their own country. Canadian pharmacies advertise on the World Wide Web, and American customers follow those links and purchase their products. So, the U.S. government enlists a criminal to help set up essentially a scam designed to relieve Google of $500 million. (Funny how, in the context of government spending, that hardly seems like a significant amount of money.)

Somehow, I can't help but think of some of our government's other activities that have been in the news lately, such as this one (although, at least in this case, the targets are criminal organizations selling drugs that are illegal with or without prescription):

Fast and Furious was a Bureau of Alcohol, Tobacco, Firearms and Explosives program, overseen by the Justice Department, which facilitated the sale of thousands of weapons, via straw purchasers, to Mexican drug cartels. Straw purchasers are people who can legally purchase guns in the United States but do so with the intention of illegally trafficking them into Mexico.

At least 300 Mexicans were killed with Fast and Furious weapons, as was U.S. Border Patrol agent Brian Terry. Gosar said Holder bears responsibility for the operation. Holder is expected to face another round of questions about the scandal on Thursday when he appears before the full House oversight committee.

And that stops short of consideration of state involvement with the gambling industry...

The Hidden Power Grab

So, the Obama administration has given Rhode Island another $58 million to work on its government-run healthcare exchange, along with compliments for being so resourceful as to skip the legislative process in its implementation. At this point, the federal government shuffling around money that it doesn't have is hardly news, nor is the Obama administration's affection for imposing policies on the electorate. The real news, in my view, comes in the third-to-last paragraph of the Providence Journal story:

Additionally, it [the exchange] will decide how many plans will be included, and how they will be designed

Presumably, reporter Felice Freyer doesn't mean that the exchange will be an entity with artificial intelligence, so the decisions will actually be made by the really smart people (like Lincoln Chafee and Elizabeth Roberts) whom we elect to office, and their appointees. As I've noted before, the exchanges are just a sly way to impose government-run healthcare without elected officials' ever having to tell the American people explicitly that they're doing so. Create an exchange that enables regulation to the point of minute control, and then draw people toward its offerings.

One can hope that the world of the future will be such that the history books make note of the shadowy organization that used foreign money borrowed on future generations' backs to build a trap designed to give it minute control over the life decisions of a supposedly free people.

To Hell With "Government Experts" 2: Keep Covering Your Ass

Almost exactly two years ago, I wrote a post titled "To Hell With 'Government Experts', Keep Feeling Your Boobies" in which I explained my disagreement--admittedly in a gut-level sense--with new guidelines pushing breast cancer screenings for women out a decade further (from 40 years old to 50). I ended by warning, "And men, don't take this sitting down. Your ass (colonoscopy guidelines) could be next."

I was right: now the same agency, the U.S. Preventive Services Task Force, has issued guidelines stating we may be over-doing the PSA screening test.

The truth is, after reading the reasoning behind the decision, I can see the cost/benefit analysis that has gone into the decision (here is a decent point/counterpoint on it). Basically, many of those who have screened positive are either "false" positives or their cancer was so slow growing it wouldn't be (to put it bluntly) their ultimate cause of death. So many men go through the treatment to "cure" them of something that just may not actually kill them. Similar arguments were made regarding the breast cancer screenings. Of course, this is all based on averages, not actual lives. Sucks to be an outlier!

Guidelines serve a purpose, but it still boils down to a personal decision. However, as Glenn Reynolds noted, "when [you] politicize health care, the suspicion is that all health care decisions are political." Especially when it seems decisions are being made based on a cost/benefit analysis model that defines cost in dollars, not lives.

An Inapplicable Model

Honestly, something about Governor Chafee's fact-finding missions makes me very nervous. Consider this, from his latest trip, to Pittsburgh. It focuses on the University of Pittsburgh Medical Center (UPMC), which is attracting all sorts of federal money and expanding the prominence of the University's medical program:

Dr. Edward Wing, now dean of medicine and biological sciences at Brown's Alpert Medical School, worked 23 years at the University of Pittsburgh. He notes that the western Pennsylvania medical school — with massive collaboration, clinical-research dollars and consolidation — has since catapulted from the middle of the pack to among the nation's top-tier medical schools.

UPMC is now a $9-billion global health enterprise that operates more than 20 hospitals and 400 outpatient sites; employs more than 2,800 physicians and 54,000 employees; ranks as western Pennsylvania’s largest employer and the state’s second-largest. ...

In the midst of the tour, Wing noted, "It's very hierarchical, so they can make decisions easy. It's much harder in Providence." ...

At UPMC, it's clear that money drives activity.

So, you've got a massive, hierarchical structure fueled with giant infusions of public money and absolutely central to the local economy. That sounds extremely risky, and while I don't know enough about Pennsylvania politics to know how they're handling it, out there, I simply wouldn't trust the power brokers of Rhode Island with such an entity.

And that's if the feat would be possible to reproduce. One need only look at a map to see one way in which Pittsburgh differs tremendously from Providence: There's no urban competition in proximity. We've got Boston and New York City within easy striking distance.

The governor should turn his sights away from top-down behemoths and look toward making Rhode Island notable, in the crowded Northeast, for being an easy and inexpensive place to start and grow business. Our economic development people look to UPMC and see the flow of money that they could use to get entrepreneurs and innovators over the hump of high expenses and difficulty, in RI, when they should be looking to flatten it, instead.

"Exchange" as in Bait and Switch

When I initially heard of the concept of state-government healthcare exchanges, my first thought was that only three insurers are willing to do business in Rhode Island — how extensive could such an exchange be? The hook by which Governor Chafee is presuming to step in and legislate via executive order to create Rhode Island's exchange raises more questions about what, exactly, they're planning to develop:

The state faces a Sept. 30 deadline to apply for tens of millions in federal money to develop the exchange, but needed to first establish the authority to create, govern and finance the exchange.

The model cited for the exchange is Travelocity and other comparison-shopping sites, but with three insurers to review, how could it possibly take "tens of millions" in (borrowed) federal dollars to put such a thing together? The state ought to be able to get somebody to pull together the necessary documents and deploy a slightly tweaked out-of-the-box search engine for under $100,000.

Apart from finding ways to spend taxpayer money that the state and federal governments do not have, Lt. Gov. Elizabeth Roberts gives some indication of what the expanded scope of the exchange might be:

... Roberts said the exchange will provide more active assistance to people choosing health insurance. It may also set standards for the types of health insurance products offered.

Indeed, the executive order also explicitly calls for "payment reforms and innovative benefit designs" that promote quality and efficiency.

"One of the goals of this executive order is to create the infrastructure with some early goals," Roberts said. "A lot of those bigger issues are very appropriately going to be discussed by the board going forward."

As I've speculated before, the "exchange" is more of a bait-and-switch. As Roberts describes it, the site will either be a welfare-style means of drawing people toward taxpayer-subsidized programs, or it will grant a small range of technocrats the ability to shape everybody's healthcare programs in very detailed ways, or both. And a look at the board already in place to guide the thing is not encouraging:

In addition to [former U.S. Attorney Margaret] Curran, the chairwoman, the board's public members will include Vice Chairman Donald Nokes, president and co-founder of the small business NetCenergy; Michael C. Gerhardt, a former health insurance executive; James Grace, president and CEO, InsureMyTrip.com; Linda Katz, policy director and co-founder, The Poverty Institute; Peter Lee, president and CEO, John Hope Settlement House; Dr. Pamela McKnight (not currently practicing); Tim Melia, UFCW New England Council; and Minerva Quiroz, case manager, AIDS Project RI.

The government members are: Steven M. Costantino, secretary of Health and Human services; Christopher F. Koller, health insurance commissioner; Richard A Licht, director of administration; and Dr. Michael D. Fine, director of health.

In addition to the government bureaucrats, we've got a former lawyer, a former health insurance executive, a former doctor, two executives from businesses that offer related technology services, three paid activists, and the obligatory union representative. Not present is a single person who looks apt to approach this sly government power-grab from the perspective of Rhode Islanders' civil rights (in the government-limiting sense) or of protecting the free market or taxpayers' wallets. There isn't even anybody whose background suggests an especial concern with the ethical questions that inevitably arise in matters of medicine.

A further frightening thing is that the only organized voice that the reporter finds in opposition is Barth Bracy, of the Rhode Island Right to Life Committee. About the only other opposition that I've seen has come from Mike Stenhouse, CEO of the newly formed Rhode Island Center for Freedom and Prosperity, in an op-ed arguing that the state should be wary of jumping into ObamaCare because many questions remain — not the least being whether the law will even remain in effect. For the most part, that's a statement of process, not of principle, although he does step beyond the practical argument a bit:

Government does poorly vs. the free market. The very idea of a government-controlled exchange is antithetical to our nation's historical free-market principles, which is the only proven way to consistently deliver a good service at the lowest possible rate. A true free-market is an exchange in itself!

Unfortunately, politicians (especially in Rhode Island) have long thought the handling of healthcare to be too important to leave to people who actually know what they're doing. Their exchanges will not be tools to guide consumers to the products that most closely align with their needs and resources, but to tell taxpayers how much they have to spend on healthcare, for what, and for whom.

Healthcare Exchange More than Commonly Thought

As I explained in a video blog a couple of years ago, Tiverton resident, one-payer healthcare advocate, and just-about-overt socialist Nick Tsiongas is an instructive figure to watch in Rhode Island politics, and the op-ed that ran in yesterday's Providence Journal is a fine example.

I'm thinking that many of us have underestimated the intended reach of the state-level healthcare exchanges that will be implemented as part of ObamaCare:

Any reform with a chance of success would require that we move as much of the money as possible into one place and coordinate its use with a state health plan. The power of the plan and the purse would let us use carrots and effective sticks to change this crazy system.

Such an opportunity exists: It’s the exchange, a marketplace set up by the state under the Affordable Care Act where people and businesses could buy health insurance. We have the chance to build an exchange where all Rhode Islanders can buy public or private insurance.

If your view of the healthcare exchange has been as a sort of benign, non-binding Web site on which to compare possible plans in a straightforward manner, you (like me) forgot that everything that government does is not about serving the public, but about government power. In Tsiongas's telling, the exchange is an opportunity to filter all of our healthcare dollars through a single point, at which the government can impose requirements that force users of health services to conform with best practices as defined by Nick Tsiongas and friends.

By opening the exchange to all our residents and linking it to an explicit state health plan, we can finally empower ourselves to get off the cost treadmill, maintain quality and start treating this ailing system.

He doesn't go into how, exactly, the exchange will be "linked" to "an explicit state health plan." On one end (no doubt his ideal), all companies allowed to sell healthcare plans would have to do so through the exchange, and the exchange would require them all to conform with government-defined benefits, creating a de facto single plan over which bureaucrats, ideologues, and special interests have government access.

On the mild end, a state plan would compete with other plans which may or may not have to be on the exchange or meet additional requirements than they currently face. If that's the case, then it's hard to see how a state plan could be so attractive as to draw people away from other options unless it exacerbates cost problems by subsidizing member benefits through additional revenue confiscated from taxpayers.

Either way, the exchanges cannot be written off as a mild distraction for unnecessary government functionaries if the likes of Tsiongas have such strong intentions for them.

Not Getting to Keep the Coverage That You Like

It's too bad nobody was able to see this as a probably consequence of ObamaCare:

Nearly one of every 10 midsized or big employers expects to stop offering health coverage to workers after insurance exchanges begin operating in 2014 as part of President Barack Obama's health care overhaul, according to a survey by a major benefits consultant.

Towers Watson also found in its July survey that another one in five companies are unsure about what they will do after 2014. Another big benefits consultant, Mercer, found in a June survey of large and smaller employers that 8 percent are either "likely" or "very likely" to end health benefits after the exchanges start.

If this outcome weren't so unexpected, one might be tempted to wonder whether President Obama's assurances that anybody who likes his or her health coverage could keep it was deliberately deceptive.

Seems to me that I haven't been hearing near enough from elected officials about repealing the healthcare legislation, lately.

Moving the Goal Posts on Healthcare

See, I don't recall this being the sales point with which President Obama and his allies pushed ObamaCare:

New projections show that health care spending will grow faster than the nation's GDP over the next decade. But the increase will be only slightly more than would be the case without the new national health law.

At least that's what the White House and other health law supporters drew from a new analysis of actuarial data released by the U.S. Centers for Medicare and Medicaid Services. The analysis, published in Health Affairs last week, reported that health spending through 2020 would rise only one-tenth of one percent more under the health law than it would have otherwise — despite some 30 million more people getting health coverage.

Sure, a bunch of young, healthy people will now have insurance that they wouldn't otherwise have purchased without incurring Earth-shaking costs, but ObamaCare wasn't sold on the great deal that it would provide in covering additional recipients. It was going to slow the inflation of health care costs. Indeed, it was going to be a sort of deficit reduction program for the government. That's clearly not expected, now, and wasn't expected by many of us who opposed the legislation in the first place:

Over the next 10 years, federal actuaries expect the pace to pick up. By 2020, the national bill will be $4.6 trillion — one in every five dollars spent in the U.S. economy. The government's share also will rise. Washington will pay 30 percent of the tab, and state and local governments will pay almost 20 percent. Average annual spending growth over the decade will be 5.8 percent, according to the analysis.

Our broke and flailing government is currently covering about 27% of $2.7 trillion in healthcare spending, or $729 billion. In 2020, that federal expenditure will be $1.38 trillion, with state and local governments paying another $92 billion. (The article doesn't say what the lower-tier governments currently pay.)

Repeal this monstrosity.

Massachusetts and Connecticut More Generous with Medicaid than RI

Apparently RI legislators haven't gotten updated or correct numbers when it comes to the income limits for offering RIte Care (Medicaid* in RI).

The information, presented at a public hearing on Monday, portrayed Rhode Island as more generous in its RIte Care benefits than either of its neighboring states, Connecticut and Massachusetts, citing information from the Rhode Island Public Expenditure Council, “How Rhode Island Compares.” Rhode Island was said to allow parents to enroll at 175 percent of the poverty level, compared with 150 percent for Connecticut and 133 percent for Massachusetts.

The problem, according to Reynolds, is that the figures being used were not accurate. In Massachusetts, eligibility extends to 300 percent of the federal poverty level, and the 133 percent figure is when cost-sharing premiums kick in for the participants. In Connecticut, eligibility extends to 185 percent. (See chart.)

“From what we are hearing, there is a misperception by some in the Legislature that eligibility requirements for RIte Care are more generous than those of our bordering states,” said Reynolds. In fact, both Massachusetts and Connecticut cover parents at higher incomes than Rhode Island does today.”

*Thanks to brassband for the correction.

"If You Like Your Insurance, You Can Keep It."

Remember when the President of the United States repeated that promise over and over to the American people? Well quite a few of us less-lofty folks predicted this contrary outcome:

Once provisions of the Affordable Care Act start to kick in during 2014, at least three of every 10 employers will probably stop offering health coverage, a survey released Monday shows.

But that's not all:

The survey of 1,300 employers says those who are keenly aware of the health-reform measure probably are more likely to consider an alternative to employer-sponsored plans, with 50% to 60% in this group expected to make a change. It also found that for some, it makes more sense to switch.

In some cases, the lost benefit might transition to some other form of compensation (although many of us have also predicted that ObamaCare will not stop, and may accelerate, cost inflation and quality deflation in the medical industry). In the push for government control of healthcare, though, spanning its peculiar procedural maneuvers and bold flight in the face of taxpayer concerns, likely outcomes were downplayed, not thoroughly vetted.

Pension Pinch is Bad...so is Healthcare

WPRI's indefatigable investigative team has turned up the fact that RI cities and towns owe a combined $3.6 billion in healthcare benefits (Sen. Dennis Algiere wrote about this a few days ago). From the WPRI report:

The state's municipalities have promised to provide nearly $3.6 billion worth of medical coverage to their current and future retirees over the next three decades, but government financial reports show they've put aside almost nothing to pay the bill – just $27.5 million, or less than 1 percent of the future cost.

To put it in perspective, the $3.6 billion unfunded liability for city and town retiree health care is significantly larger than their pension plans' shortfall of roughly $2.2 billion.

As with pensions, communities do not need to come up with the money for these so-called "other post-employment benefits," or OPEB, all at once. But most have barely begun to grapple with the cost.

"You've heard the general treasurer recently say pension reform for state employees and municipal employees isn't a problem – it's the problem," said Dan Beardsley, executive director of the Rhode Island League of Cities and Towns. "Well, I would say OPEB obligations and dealing with those obligations is either equal to or just a notch down from the needed pension reform."

Waivering Health Care Reform

About his then residence that had undergone extensive renovations, Dave Barry once observed,

When prospective buyers ask: ''What kind of construction is this house?" I answer: "Spackle."

Similarly, health care reform now seems to be comprised largely of waivers. 204 more companies were granted waivers in the last ten days, 20% of them going to companies located in the district of former (ahh!) House Speaker Nancy Pelosi. The total number of purportedly temporary (but how easy will it be to grant one year extensions ... year after year after year) waivers issued now tops 1,700.

Just as notable as those issued to companies in CA-8 is the waiver that recently went to everyone's (???) favorite senior advocacy organization. Ed Morrissey at HotAir explains the significance, not to say irony.

No one seems to know what criteria HHS uses to grant or deny waivers to insurers from provisions in ObamaCare. The White House won’t release the names of those insurers and employers refused waivers or discuss denials at all. But maybe, just maybe, we could all agree that organizations that publicly pushed ObamaCare to approval should be ineligible to escape its consequences?

Indeed, why would the AARP be anxious to duck out of a law for which they themselves advocated?

ADDENDUM

Anthony correctly reminds us that entire STATES - Maine, New Hampshire and, most recently, Nevada - have obtained waivers from ObamaCare.

Forty seven more to go!

Coffee News to Wake Up To

Early morning seemed the appropriate time to mention this news report:

Drinking coffee, regular or decaffeinated, may reduce the risk of prostate cancer, according to a study by Harvard University researchers.

The study found that men who consumed six or more cups of coffee a day had a 60 percent lower risk of developing deadly metastatic prostate cancer and a 20 percent reduced risk of developing any form of the disease. One to three cups cut the risk of lethal prostate cancer by 30 percent. The findings, published today in the Journal of the National Cancer Institute, suggest non-caffeine elements in coffee may provide the benefit.

Yeah, the researchers stress that there are harmful effects to coffee, as well, and encourage readers not to conclude that they should increase their intake of the beverage. Still, I'll take it as reason to pep up a little before having my regular daily doses.

Democrats in Massachusetts Take Health Care Out of Collective Bargaining

Reality has hit Massachusetts' Democratic politicians, from the Governor on down: they realize the state can no longer afford to negotiate fixed medical co-pays in government employee contracts that span multiple years while the actual costs quickly increase well past the negotiated level.

House lawmakers voted overwhelmingly last night to strip police officers, teachers, and other municipal employees of most of their rights to bargain over health care, saying the change would save millions of dollars for financially strapped cities and towns.

The 111-to-42 vote followed tougher measures to broadly eliminate collective bargaining rights for public employees in Ohio, Wisconsin, and other states. But unlike those efforts, the push in Massachusetts was led by Democrats who have traditionally stood with labor to oppose any reduction in workers’ rights.

“What we've recognized is that unfortunately, because of the cost of health insurance, that a very large percentage of the monies we commit are unfortunately going to fund municipal health insurance,” said House Ways and Means Chair Brian Dempsey (D-Haverhill). “Now, that’s not anyone’s fault. We’re not blaming anyone for the rise in health insurance. But, it's a fact. It’s a fact. The cost of health insurance is going up, and the money we commit every year, it’s unfortunately not going to textbooks. It’s not going to classroom size. Unfortunately, it’s going to a large degree to fund municipal health insurance.”

“I applaud the members of the House for taking the vote that will save more than $100 million for cities and towns,” [Massachusetts House Speaker Robert] DeLeo said in a statement. “By spending less on the healthcare costs of municipal employees, our cities and towns will be able to retain jobs and allot [sic] more funding to necessary services like education and public safety.”

Health Care: Yes, we have no bananas

It's up to over 1,000 entities that have acquired a waiver from adhering to President Obama's national health care law. One is the entire State of Maine, whose motto, Dirigo or "I lead," could be prophetic as other states look to do the same.

Meanwhile, the unintended, but predicted, consequences (h/t) of this hurried health care reform are coming to fruition.

Patients are demanding doctors' orders for over-the-counter products because of a provision in the health-care overhaul that slipped past nearly everyone's radar. It says people who want a tax break to buy such items with what's known as flexible-spending accounts need to get a prescription first.

The result is that Americans are visiting their doctors before making a trip to the drugstore, hoping their physician will help them out by writing the prescription. The new requirements create not only an added burden for doctors, but also new complications for retailers and pharmacies.

"It drives up the cost of health care as opposed to reducing it," says Dr. Chung, who rejected much of a 10-item request from a mother of four that included pain relievers and children's cold medicine....Some doctors, irked by the paperwork and worried about lawsuits, are balking at writing the new prescriptions. Pharmacists and retailers say the changes mean they have to apply a personalized label on some 15,000 different everyday products for customers paying with certain debit cards.

Health-policy experts predicted that new insurance pools for high-risk patients would attract so many expensive enrollees that funding would be quickly exhausted. In fact, enrollment is running at just 6% of expectations, partly because of high premiums.

A provision preventing insurers from denying coverage to children with pre-existing health conditions prompted insurers in dozens of states to stop selling child-only policies altogether.

And a piece of the law designed to centralize patient care by encouraging health-care providers to collaborate is running into antitrust concerns from regulators.

Observed from Within the Complications

The complaints against high-deductible health insurance coupled with health savings accounts presented in Richard Salit's article, yesterday, seem more like groans against change than anything:

... some health experts say that you can't expect people who are ill to be cost-conscious consumers — even healthy people have difficulty price-shopping for medical services. That's why Christopher Koller, the state's health insurance commissioner, says the plans are no "silver bullet" for curbing the nation's health-care costs. ...

Higher-deductible plans can be challenging to understand. They include a new vocabulary of terms and quite a few acronyms to decipher. They also require people to get involved in managing their health-care expenses in a way they never have before.

The Coastal Medical group has witnessed first-hand how some patients get confused by the plans.

Sure, high-deductible plans are more confusing than top-of-the-line offerings that allow consumers to go anywhere at any time, but those are increasingly rare. In general, health insurance has hardly been a simple matter. Referrals, primary care, copays, coshares... most people, I'd hazard to suggest, already tend to go where they're advised to go and pay whatever bill is sent their way once the insurer has trimmed it down.

The only added complication, with high-deductible plans, is that the bills don't get trimmed until the plan member has paid a certain amount. When coupled with health savings accounts, that money just comes from them, first. Frankly, the notion that people are too ignorant to comprehend this added step is suspiciously patrician.

Koller does raise the reasonable concern that bills that patients find unpayable end up stuck on hospitals' and doctors' books. Similarly, employer Donald Nokes, who recently switched his company to a higher-deductible plan, observes that employees who had health issues during the year weren't as happy with the change as those who did not. Of course, they're likely happier than they would have been if the company had not been able to afford any benefit at all.

What unites Koller's and Nokes's points is that they are indications that the price-conscious reform of high-deductible plans and health savings accounts is still beginning. As such an approach becomes more common, more people will have years of healthy buildup in their savings accounts to absorb the pain of tougher years. When that's the case, fewer health care providers will find their invoices unpaid.

Above everything, though, what gets lost in the article is the comparison of doing nothing. Moreover, any reform that attempts to avoid the necessity of patients' involvement in their own care will fail to control costs, unless it puts decisions in the hands of supposed experts with the power to deny care.

We have no choice, that is, but to choose the path of education and individual investment.

Health Care "Reform" = IRS Expansion

U.S. News tells us that the IRS is ramping up because of the new health care reform plan (we're all so surprised!):

The Internal Revenue Service says it will need an battalion of 1,054 new auditors and staffers and new facilities at a cost to taxpayers of more than $359 million in fiscal 2012 just to watch over the initial implementation of President Obama's healthcare reforms.

Among the new corps will be 81 workers assigned to make sure tanning salons pay a new 10 percent excise tax. Their cost: $11.5 million....[They] will be tasked just to handle the tax reporting of 25,000 tanning salons. They face a new 10 percent excise tax on indoor tanning services. Another 76 will be assigned to make sure businesses engaged in making and import[ing] drugs pay their new fee which is expected to deliver $2.8 billion to the Treasury in 2012 and 2013. The new healthcare corps will also require new facilities and computers.

The Obamacare Waiver List Grows

Melissa Clouthier called attention to this from Ethel Fenig at the American Thinker:

In August, 2009, as he was extolling the virtues of his proposed Obamacare, President Barack Obama (D) famously promised "If you like your health care plan, you can keep your health care plan." And if you're a union member you certainly can; if you're not, well...

The Health and Human Services site Helping Americans Keep the Coverage They Have and Promoting Transparency (sic) conveniently lists the 773 waivers approved to date. Scroll through the list; notice that most of the waivers, more than 650 went to unions exempting well over 2 million employees.

This ever-expanding list of waivers is the direct result of ObamaCare raising the annual benefit caps on certain health plans. Obviously, a plan with higher annual limits is potentially more costly than one without them. The money to cover the difference in premiums has to come from somewhere. Without the waivers, it will come from the employer who are forced by law to upgrade to the more expensive plan. In other words, the...organizations who have received waivers are not seeking refuge from an unintended consequence, but from the costs associated with one of ObamaCare’s features.

Seems Folks Argued This All Along...

This point was made so early in debate over the federal healthcare overhaul — before the Democrats rammed it into law despite every negative signal from the American people — that it's difficult to believe that anybody still believes the opposite. Still, it's worth noting its restatement:

Two of the central promises of President Barack Obama's health care overhaul law are unlikely to be fulfilled, Medicare's independent economic expert told Congress on Wednesday.

The landmark legislation probably won't hold costs down, and it won't let everybody keep their current health insurance if they like it, Chief Actuary Richard Foster told the House Budget Committee. His office is responsible for independent long-range cost estimates.

Legislators cannot simply ignore the law of supply and demand, no matter how much the resulting policies may please the special interests to which they cater or how much more invasive authority over citizens the legislation grants them.

Marriage as Healthcare Policy

Pankaj Ahire, of Charlestown, uses extremely condemnatory language, laying the potential death of his same-sex partner at the foot of RI Roman Catholic Bishop Thomas Tobin:

The lack of marriage equality implies that my excellent health and dental insurance does not cover my partner. Unfortunately, my partner has had health issues, and could not go to a doctor. To see him suffer when I could have provided for him is agonizing to say the least.

But more importantly if tomorrow something happens to my partner, you can bet that I will take him straight to emergency room. Who foots the bill now? The State of Rhode Island. In this economic climate, shouldn't taxpayers try to get coverage for as many people as possible? Marriage equality is a way to do that.

Ahire provides an excellent example of the error in progressive thinking that has wrought so much damage throughout the United States and Western society at least since the mid-1800s. Radically altering cultural institutions in order to serve immediate economic and personal desires and needs — no matter how just and urgent they may be — ignores the pillars that have evolved over centuries and that such institutions developed to support.

Marriage is fundamentally about joining of the two halves of human biology, man and woman, most significantly in the bodies of the children that only a man and a woman can create. The ability to extend employment benefits to a loved one is not its key quality, neither is tax policy, neither is a government stamp of equality, and behaving as if any of these ancillary aspects should be focal points undermines an institution that is in dire need of fortification, in our time.

Mr. Ahire would be more rational to direct his ire at those who've held up healthcare reform. He'd be more intelligent to advocate for reforms that lower the cost thereof and increase freedom and choice when it comes to insurance plans and means of acquiring medical services.

Health Care Wrangling

The U.S. House of Representatives will most likely try to repeal the Obama Health care program this week, though that's where the effort will stop because of the political realities (Democrats control the Senate) while on another front, we are now up to 26 states that are suing the Federal Government over the imposition of the Obama program.

Advocates explained to the ProJo why repeal isn't a good idea, basing their argument on the benefits accrued by filtering your tax dollars up through the beltway bureaucracy and back down to the state level so that several programs can be implemented by local bureaucrats to help manage the plethora of benefits forthcoming from the aforementioned feds. Promise!

Meanwhile, the impact of the health care reform so far has resulted in a winnowing of "choice." Some examples, as explained by Sally Pipes: 1) the construction of at least 45 physician-owned hospitals has been halted because they didn't open in time to qualify for Medicare certification; 2) doctors are planning on dropping patient care or limiting the amount of patients they treat who are Medicare/Medicaid because they can't afford to treat them; 3) Rules requiring small plans to spend 80% of premiums on medical claims will push many out of existence (those efficiencies are tough to reach in smaller plans--economies of scale, etc.). So smaller plans that may be able to compete against the giants in certain sectors will be pushed out.

Then Pipes explains the impact of the new over-the-counter drug restrictions, which--I can tell you--has been much discussed at my workplace and home:

Other measures kicking in are petty -- but punitive. For example, people can no longer use tax-free Health Savings Accounts on basic over-the-counter drugs. Instead, they must pay for a doctor's appointment -- and then get a prescription for a pricier pharmacist-dispensed drug.

Consider the case of Claritin, an allergy medication that recently was approved for OTC use. A report from the National Center for Policy Analysis found that longtime users of the drug saw their daily costs fall 80 percent, from about $2.50 to just 50 cents. ObamaCare reverses this trend by encouraging people to opt for higher-priced prescription drugs when a cheaper OTC medication would work just as well.

The Predicament of Dementia

Father Tadeusz Pacholczyk notes an unfortunate, but natural, reaction to dementia. Relating the story of a woman who could only connect with her afflicted mother by singing hymns, with the lesson being that "there's always someone in there," Pacholczyk goes on to lament our tendency to behave as if that's not the case:

Sometimes we may view the situation more from our own vantage point, rather than the patient's. In a report on care for the elderly, physicians Bernard Lo and Laurie Dornbrand put it this way: "Family members and health professionals sometimes project their own feelings onto the patient. Life situations that would be intolerable to young healthy people may be [made] acceptable to older debilitated patients."

[Steven] Sabat notes how this raises the prospect of reducing the patient to a kind of object:

The dementia sufferer is not treated as a person; that is, as one who is an autonomous center of life. Instead, he or she is treated in some respects as a lump of dead matter, to be measured, pushed around, manipulated, drained, filled, dumped, etc.

Two thoughts: First, it's possible to see a debilitating mental illness of late-life as a means of easing the process of death's separation. To the loved one, the circumstances of the patient appear intolerable — perhaps more so than death itself — but if treated properly, the sufferer may not have to see the circumstance as one of suffering. In that way, the gradual loss of a connection to reality makes the final separation bearable.

Second, the particular affliction of dementia relates intriguingly to a metaphysical interpretation that I've come to see as broadly explanatory. Basically, we are all instantiations of the idea of us in every circumstance in which it would be logical for us to appear, given the constraints of physics and history; that is, if it were logically possible for you to be a millionaire movie star at this moment in time, an instance of you exists in that very role.

Our individual awareness of continuous time (another way of saying "our souls") moves from one instance to the next with each passing moment, but according to the rules of reality. Your soul can't, in other words, instantly leap into the version of you that's a movie star, but you could take the steps — educational, social, economic — that lead you closer. This isn't just a linear progression in a unique, circumscribed reality; it's a transition of the very state of your being.

The experience of mental disorders, therefore, would be movement from one step to another with no logical coherence. To those of us living in a more ordered sequence of reality, that incoherence seems unreal.

So, it would be more correct, by this model, to say that the demented person is "over there," rather than "in there" (lateral, rather than buried) although it remains no less possible to draw them back, perhaps so strongly and sustainedly as to effect what appears to be a miracle overcoming of biological logic.

Almost Like Another Ponzi Scheme

This doesn't appear to be a sustainable system:

Consider an average-wage, two-earner couple together earning $89,000 a year. Upon retiring in 2011, they would have paid $114,000 in Medicare payroll taxes during their careers.

But they can expect to receive medical services - from prescriptions to hospital care - worth $355,000, or about three times what they put in.

As each generation shrinks in size from the previous, the number of payers decreases, and as medical science and individual longevity advance, the pay outs increase. That's why folks my age don't really expect to see a penny of such "entitlements."

So Rep Lally Favors an Increase in Health Insurance Premiums for Rhode Island?

On Thursday, the Providence Journal printed an OpEd by Dr. Joseph Cambio of Urologic Specialists of New England and RI House Deputy Majority Whip Donald J. Lally (D, Narragansett & South Kingstown). We'll stipulate for a moment the problem that they name because it sounds all too plausible.

... Rhode Island health insurers reimburse the state’s physicians at a very low rate. This is a particular problem with such medical specialties as urology. Urology is only one of many medical fields, as well as dentistry, from which we are losing our best and brightest to other states. We also have aging field of doctors. As older physicians in our state retire there are fewer and fewer newer doctors to take their place. The reason is quite simple: Why would a new physician with over $150,000.00 in debt from medical school loans set up a practice in the state if he or she could make significantly more money by going to Massachusetts, Connecticut or somewhere else?

It is becoming increasingly difficult to recruit new physicians to Rhode Island. Urologic Specialists of New England had one promising young doctor recently turn down its offer when he saw that he would make significantly more for the same practice in Massachusetts.

So let's agree, in the absence of new and contradictory information, that pay for doctors practicing in Rhode Island needs to be increased. Now the question is, where does that additional money come from? Who pays for the increase?

Apologies for answering a question with a question. But maybe I'm missing something.

Within the insurance framework, is there any source for higher compensation - i.e., an increase in spending - other than rate payers?

Federal Judge: Obamacare "Individual Mandate" = Unconstitutional

A Federal Judge in Virginia has ruled that the individual mandate portion of President Obama's health care reform law is unconstitutional. From a note on page 36 of the decision:

If allowed to stand as a tax, the Minimum Essential Coverage Provision would be the only tax in U.S. history to be levied directly on individuals for their failure to affirmatively engage in activity mandated by the government not specifically delineated in the Constitution.

An Insidious Mindset

So, the Providence Journal editorial board likes ObamaCare. What are you gonna do? A recent unsigned editorial, though, points toward a disturbing underlying premise:

Let us start with one of the provisions most beefed about on the campaign trail but also most necessary — the requirement that everyone buy coverage. Forcing people to obtain insurance is essential for two reasons: One is that it ensures a larger insurance pool to cover the expenses of sick people. Does this mean that the healthy must subsidize the ill? Yes, but that’s how insurance works.

This, in a phrase, is socialized medicine, and there's no difference between this sort of involuntary insurance and compulsory redistribution of resources. Indeed, what redistributive scheme would not be possible to present in terms of "insurance"?

Relatedly, note this double misconception:

Perhaps the most important place to trim waste is in the unhealthy economic incentives that nudge doctors to prescribe more treatments and office visits than are necessary. This is also the hardest to fix, because it means narrowing or shutting down some income streams in a health-care industry that has virtually bought many members of Congress.

The Medicare program and private insurers are the ultimate payers and therefore perfectly placed to move health care away from the wasteful fee-for-service model and toward a results-oriented one.

First of all, Medicare bureaucrats and insurance providers are not the "ultimate payers." They are middle-men between the people you pay for healthcare and people who deliver it. The ultimate payers are policy holders and taxpayers. They are perfectly positioned to trim waste from the system by deciding whether they're willing to pay for it.

That suggestion leads to the second of all: It is hardly obvious that the players in the healthcare industry who neither receive the care nor deliver it have any incentive to lower costs in a way that maintains services. Their incentive is to extract more money from the payers and procure lower prices from the providers. Take more money from the payers, and they're going to seek more services to make the higher price worthwhile; give less money to the providers, and they're going to seek ways to tack more services on to their bills.

A Foreseeable Consequence for Health Insurance Consumers

Remember when those of us who opposed ObamaCare were insisting that the law would increase costs and result in fewer options and others, including members of the Service Employees International Union were getting downright violent in support of the law? We were right, and they were working to their own detriment:

Late last month, the Service Employees International Union informed dues-paying members of its behemoth 1199 affiliate in New York that it was dropping its health care coverage for children. That's right. A radical leftist union, not an evil Republican corporation, is abandoning the young ‘uns to cut costs.

More than 30,000 low-wage families will be affected, according to The Wall Street Journal. Who's to blame? SEIU 1199 benefits manager Mitra Behroozi singled out oppressive new state and federal regulations, including the much-ballyhooed Obamacare rule forcing insurers to cover dependents well into their 20s.

Megan McArdle layers on some context, but this response to a perfectly foreseeable consequence of legislation that the union itself was prominent in promoting does have relate interestingly to the exemptions and waivers that we keep hearing about.

What Healthcare Poll Results Really Show

The Providence Journal's headline: "Public split on health-care law." The source, McClatchy Newspapers, states the implication more boldly: "New poll undercuts GOP claims of a midterm mandate."

A majority of Americans want the Congress to keep the new health care law or actually expand it, despite Republican claims that they have a mandate from the people to kill it, according to a new McClatchy-Marist poll.

The post-election survey showed that 51 percent of registered voters want to keep the law or change it to do more, while 44 percent want to change it to do less or repeal it altogether. ...

On the side favoring it, 16 percent of registered voters want to let it stand as is.

Another 35 percent want to change it to do more.

On their face, though, the available answers to the question of "what Congress should do with the 2010 Health Care Law" are confusing. The first evidence that this is a factor comes later in the article:

Independents, who swung to the Republicans in the Nov. 2 elections, are evenly divided on how to handle the health care law, with 36 percent for repealing it and 12 percent for restraining it — a total of 48 percent negative — while 34 percent want to expand it and 14 percent want to leave it as is — also totaling 48 percent.

McClatchy's summary of these results isn't anywhere near plausible. According to the analysis, folks who responded to Obama and the Democrats by switching to Republicans are more likely than the average to "favor" the healthcare law, as defined as "wanting to change it to do more." Looking at the raw data (PDF), more Tea Party supporters want to "change it so it does more" than "change it so it does less." The question is clearly ambiguous. What if I want healthcare laws to allow more high-deductible plans with health savings accounts? Or to enable individual purchase of health insurance across state lines? Or to reform tort law? On the scoreboard, those policies are on the opposite end of the spectrum from ObamaCare, yet some poll respondents almost certainly were thinking of such things when they said they want the law to "do more."

To bolster its analysis, McClatchy considered responses to individual components of the law. Respondents liked the facts that it "stops insurance companies from denying coverage because of pre-existing conditions" (59% to 36%), "allows children up to age 26 to stay on their parents' health insurance policies" (68% to 29%), and "closes the so-called donut hole in Medicare prescription drug coverage by providing assistance to pay for costs" (57% to 32%). But respondents flip their opinions on the signature aspect of the law that defines ObamaCare. Only 29% think "Americans should be required to buy health insurance," while 65% believe "it is unconstitutional to require it." (Note that the poll is sloppy even at this level of detail: Why must the choices be support for the insurance mandate or unconstitutionality? Surely it's possible to think it's constitutional but still oppose it.)

Clearly a case can be made that:

1. A more choice-driven health insurance regime would enable Americans to choose policies that suit them (e.g., covering adult children).
2. Less-expensive high-deductible and catastrophic coverage plans with health savings accounts would be more broadly affordable and, therefore, translate into fewer Americans caught with "pre-existing" conditions, because they wouldn't be without insurance for periods of time or lose it when they switch employers.
3. All of the benefits that Americans wish to derive from healthcare law can (perhaps must) be sought only after all of the obscure and detrimental aspects of ObamaCare have been stricken wholesale from the legal code.

Intro: Federal Judge Rules that the Attorney Generals' Suit Against the Federal Healthcare Law can Continue. What Do the Candidates for RI AG Think About This?

Last Thursday, Judge Roger Vinson of the Federal District Court of Northern Florida ruled that the lawsuit challenging the new Federal healthcare law filed by 20 state Attorney Generals should be allowed to continue. His reasoning is very straightforward. The Federal Government’s power to act is limited by the Constitution...

My review of the statute is not to question or second guess the wisdom, motives, or methods of Congress. I am only charged with deciding if the Act is Constitutional. If it is, the legislation must be upheld --- even if it is a bad law...Conversely, if it is unconstitutional, the legislation must be struck down --- even if it is a good law.

At this stage in the litigation, this is not even a close call...The power that the individual mandate seeks to harness is simply without prior precedent.

Healthcare "Huh" for Today

The article's a couple of weeks old, but it's still worth noting a bit of writing that I don't think Projo journalist Felice Freyer or her editors would have allowed into print if they weren't fundamentally in favor of government healthcare:

The increases will pay for the coverage of dependents through age 26 and preventive services that now must be provided without any cost to the consumer.

Yup. The extra money you'll be paying for insurance is intended to make sure that you don't have to pay for certain services. Makes sense...

Of course, there may be a correlation-is-not-causation effect, here. Perhaps an habitual tendency to believe that something is free as long as its cost is filtered through a few steps of disguise results in a preference for government solutions.

Congressional Timidity on ObamaCare - Or - We Certainly Won't Remind You What We Did

Further to Justin's post, ABC's The Note is hard pressed to find any congressperson expending precious campaign dollars to broadcast their "Yea" vote for ObamaCare.

Six months after President Obama signed a sweeping health care measure into law, how many Democrats nation-wide are running TV ads touting their votes for the law?

Answer: Zero

Caveat: We have trolled through ads ourselves and checked with Republicans and Democrats who would know. So its possible there is some innocuous ad out there. But it would be the exception that proves the rule.

A survey two weeks ago by Jennifer Haberkorn at Politico came to the same conclusion.

Many congresspeople voted for Obamacare. They must have thought it was a good thing. So why the scarcity of tv ads bragging about that vote? Why the reluctance to run on their own voting record on this matter?

Reminders of What They Did

The Washington Examiner offers a useful reminder of some of the actions of ObamaCare:

Six months ago, President Obama, Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi rammed Obamacare down the throats of an unwilling American public. Half a year removed from the unprecedented legislative chicanery and backroom dealing that characterized the bill's passage, we know much more about the bill than we did then.

Costs will go up; abortions will be funded; consumers will lose the coverage that they like; doctors will be harmed, economically; jobs will be lost; the government will grow and become more invasive. The slight correction may be necessary that a lot of us "knew" these things about the bill inasmuch as we expected them to be included.

Government Drives Us Crazy

My first thought, upon reading about Butler Hospital's attempts to gain government approval for a 26-bed addition for psychiatric patients was, "Must everything be a controversy?" Unfortunately, the more government involves itself in every corner of American society, the more the answer becomes, "yes."

Psychiatric hospitals around the country have also been expanding, and about a dozen new psychiatric hospitals have been built in the past few years, said Mark Covall, president and CEO, of the National Association of Psychiatric Health Systems, in Washington, D.C.

This is in reaction to a decline in psychiatric beds during the previous decade, the closing of state mental hospitals, and today’s surging demand as insurance coverage improves and the stigma of mental illness eases, Covall said.

The improvement of insurance coverage can be substantially explained, one supposes, by the government parity mandates spearheaded by our own Rep. Patrick Kennedy. And when people feel like they are either getting something for free or paying for it regardless of usage, they'll tend to use it more, eliminating price mechanisms as a fulcrum for supply and demand. What people are willing to pay for becomes moot to the extent that government requires that they (or others) provide financing.

Naturally, it therefore falls to government to regulate usage — whether through quotas, rationing, or the allocation of funds for supply. Thus, when a provider, like Butler Hospital, perceives a shift in demand and seeks to adjust accordingly, competitors, like Rhode Island and Miriam hospitals, and organizations that handle the money, like Blue Cross & Blue Shield, have the opportunity to stop it from doing so through public hearings. The determination, ultimately, is made by unelected bureaucrats, in this case, in the state Health Department, tasked with oversight of the entire system.

Such judges will perforce be drawn from within the industry and, however much they proclaim a narrow focus on the public interest, will be most approached, wheedled, and manipulated by large, powerful entities. Which entity wins, ultimately, is only incidentally related to the well-being of one-voice-one-vote citizens who live and die by the ability to acquire that which they need.

Maybe I'm Too Cynical, But...

Did you happen to catch this article by Felice Freyer?

Do you want a governor who will embrace the law and make the most of it? Independent Lincoln D. Chafee, Democrat Frank T. Caprio and Moderate Party candidate Kenneth J. Block all accept the law — with varying degrees of enthusiasm — and all pledge to carry it out fully.

Do you want a governor who will resist the law, perhaps join other states in challenging it in court, and take a minimalist approach to its requirements? Either of the Republican candidates would probably satisfy you on that score. John F. Robitaille and Victor G. Moffitt both say they believe the law is unconstitutional.

Do you want a governor who will enter office with a deep understanding of the health-care system and the nuances of the federal overhaul? You're out of luck.

Two points follow from the above. First, developing a nuanced understanding of ObamaCare hasn't been necessary, because opinions are generally formed, and the issue has been defined by the side that believes the whole "reform" ought to be scrapped on both pragmatic and principled grounds.

Second, ObamaCare defined the current Congress and administration — and set the tone for this election season — in terms of the fact that voters who wanted elected officials who would develop an understanding of "the nuances of the federal overhaul" before making it the law of the land were out of luck.

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.