health care

With a reported bump in public support for some variation on Obamacare after the President’s speech last week, there is no time to rest. Rather, it’s time to drive stakes into the heart of the “public option” vampire. And stakes we shall provide. The following are solid reasons why no version of the public option must be resurrected:

1. A government “competitor” can’t go out of business when it fails. Failing government entities only drains resources from more productive places—not to mention from taxpayers. (Witness the Postal Service.) The left has been particularly disingenuous with this constant doublespeak about the public options offering “competition and choice.” This is another example of the left trying cleverly to co-opt the language of the right. Call the b.s.  
2. Sooner or later any public option will be subsidized by the government. This will put private companies at a competitive disadvantage, which is not only unfair, but threatens the private market so many Americans currently enjoy (despite all the cost-drivers created by government).
3. A public option will create a new set of special interests and dependents. These supplicants will be beholden to the Democrats and Barack Obama. This is why government programs never go away. People who don’t think this is really about buying their power with our tax dollars are kidding themselves.
4. Co-ops are a ruse. We already have non-profit health insurance companies with their own special place in the tax code. They’re called Blue Cross Blue Shield. Talk of co-ops is but a ruse to reawaken the vampire. Co-ops too must be killed.
5. A public option will have different rules to play by.That’s not fair.  Believe it or not, the regulations and mandates that make premiums unaffordable in places like MA, NJ and NY are not as bad at the federal level. So the regulatory framework for the public option would be more favorable than for insurance companies in most states. Another reason private insurers would die off—preparing the way for a complete government takeover of healthcare.

There are fundamental asymmetries between government and private companies. Those asymmetries make government provision of most goods and services unfair and illiberal. Let’s take these stakes and kill the public option. (Lest cries of “you have no proposal” go up from the Left, this should keep you busy. And this.)

(Note: Baucuscare – i.e. Obamacare Plan B – has most of the elements of the failed Massachusetts plan. The MA plan jockeys for most expensive in the country with NJ and NY. All are more expensive due to regs Baucus is proposing for the whole country.) 

President Obama gave a speech tonight extolling the virtues of getting his way on health care reform, and paying for it by finally tracking down the Bigfoot of federal spending: Medicare Waste.  Politicians have stalked it for decades on campaign trails, yet this elusive savings has never been captured by actual politicians. (Note: Perhaps "the Flying Dutchman of federal spending" would be a better metaphor; table it for now)  Cato @ Liberty has a good live-blog.

But let's skip a discussion of Democratic health care proposas for the moment.  And let's skip the standard Republican proposals - inter-state health insurance markets, tort reform, ending the employer-based health insurance problem, etc.

What health care reform proposals should Republicans consider? I'll start with a couple:

• Safety Net: Eliminate Medicare/Medicaid and replace it with Megan McArdle's suggestion: "catastrophic federal insurance for those whose medical bills exceed 15-20% of gross income".  The safety net would still be in place for everybody - stronger, even - but it would be more targeted on actual need and unpredictable, catastrophic health care bills.  Plus, since insurance companies wouldn't have to worry about unpredictably escalating costs, health insurance should cost dramatically less.

• Break up the Medical Cartels: Absurdly restrictive licensing barriers to providing even rudimentary care make health care very, very expensive.  Any parent can tell you children's ear infections are about as common as weekends.  And they're about as hard to diagnose, too.  Yet, instead of just picking up the amoxicillin over the counter and giving it to the crying child (20 minutes, tops), parents have to spend a very substantial portion of a day trying to see the doctor (and kids never have ear infections during regular doctor's hours) and getting a prescription filled.  That's insane.  It doesn't take a decade's worth of medical training to diagnose an ear infection.  So let's have a more graduated licensing system, with vocational schools teaching the lower-level diagnostics and treatments.  Let's expand the Physician's Assistant and Nurse Practitioner classifications (a good start), so that more people can provide more health care options (supply) at lower prices. 

Your turn. 

Ever heard the term useful idiots? Thousands of them gathered in the streets of D.C. at the height of the Iraq War. Pink-bedizened. Face paint. Bush/Hitler signs… strutting and fretting their 15 minutes on the stage. They were incapable of engaging in rational discussion. Arguments began with an effigy and ended with a ‘No Blood for Oil’ sign. America eventually turned against the War. Perhaps the idiots were useful. But when it came to “rational discourse,” there was no outcry from the establishment left.

These days, useful idiots comprise a small percentage of the town hall meetings and tea-parties of the center-right. This subset is loud, angry and not particularly conversant on the subject of health care. But they may be useful. Early on, the MSM tried to magnify this minority as a means of discrediting all opposition to healthcare nationalization. Turns out, they were more useful to the right for whipping up the base and expanding opposition to healthcare nationalization despite the MSM. For better or worse, people did a double-take.

Now that these idiots are being somewhat effective, the left (and even some libertarians) are whining about “rational discourse.” Part of me longs for an intelligent conversation. But as one who has witnessed way too much useful idiocy on the left – from Code Pink to the Hope and Change sheeple – I am no longer terribly eager to explain the nuances of end-of-life consultation now that the tables have turned. Democracy is warty. And tit was made for tat.

When it comes down to it, the right has been offering good ideas for healthcare reform for years—one of which was completely sandbagged in 2006. Saner rightwing voices are being marginalized by the MSM. The MSM's favorite narrative is that the right is being “obstructionist,” offering no reform ideas of their own. Nothing could be further from the truth. Now that a merry band of useful idiots is helping shut down the left’s aspirations for a “public option,” I’m okay with some of these folks being right for the wrong reasons. Until the left and the MSM are willing to a) acknowledge our reform ideas exist, b) discuss them intelligently before the public, and c) stop framing genuine opposition as nothing but a bunch of birthers, racists and troglodytes, I for one will sit back and smile whenever I hear a useful idiot say something like “death panel.” 

(Note: none of this is meant as my weighing on on the World Net Daily controversy. Some forms of idiocy are not useful.)

Here is a letter that I wrote to my Congressman and Senator.  Please feel free to use it as a template to send to your representatives:

Dear Congressman/Senator/Mr. President,

I am writing to express my opposition to all health care/insurance reform bills currently in Congress, and my overall opposition to a public option.  Not one of the bills currently crafted by the Congress in their respective chambers and committees meet the President's goals and assurances.

First, I'd like to say that I agree with the President that we need health care/insurance reform to bend the cost curve downward.  I agree with him that any bill that comes out of Congress must be deficit-neutral.  I applaud him when he assures us that if our existing coverage works and we are satisfied with it, then great, we can keep it.  I applaud him when he says that Americans do not want a government bureaurcrat involved in our health care choices, but at the same time do not hold favorable views of insurance companies.  However, the goals that the President has outlined and the assurances he has made do not match the reality of the bills currently in Congress.

With respect to costs, the President rightly argues that reform must alter the trajectory of federal health spending.  However, Congressional Budget Office (CBO) director Douglas Elmendorf testified before lawmakers that the main proposals under consideration would fail to contain costs and would actually exacerbate the problem.  He stated, "We do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount.  On the contrary, the legislation significantly expands the federal responsibility for health-care costs" (1).  Elmendorf went on to say that the cost curve is actually being raised (2).  As for the savings that the President argues would be generated through preventive care, Elmendorf reported in early August that "[a]lthough different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall" (3).  He then proceeded to expand, saying, "For example, many observers point to cases in which a simple medical test, if given early enough, can reveal a condition that is treatable at a fraction of the cost of treating that same illness after it has progressed. In such cases, an ounce of prevention improves health and reduces spending — for that individual.  But when analyzing the effects of preventive care on total spending for health care, it is important to recognize that doctors do not know beforehand which patients are going to develop costly illnesses. To avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway. ... Researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness" (3).  The only conclusion that has been consistently drawn on these bills in Congress is that costs will only increase.

These costly bills will surely add to the deficit.  In fact, Elmendorf reported back on July 17 that HR 3200 would add nearly $240 billion to the deficit (4).  He also reported that the Senate bill coming out of the Committee on Health, Education, Labor, and Pensions would add a whopping $1 trillion to the deficit (5).  In either case, this is unsustainable and unacceptable.  We are already staring at a $1.5 to $2 trillion deficit and national debt as far as the eye can see.  Adding to this would be reckless and irresponsible.  At a time when Americans are tightening their belts, we expect the Congress and the President to tighten their belts as well.  Senator Mark Warner (D-Va) said it best in an article titled Deficit Plays Into Health Reform in the Washington Post on August 14: "It's not good enough that it's just paid for; it actually has to start driving long-term costs down" (6).  According to the CBO, none of the bills currently under consideration will accomplish that.

The President also assures us that those with existing health care coverage should have no fear of losing their coverage.  However, a Washington Post analysis reported on August 17 shows that none of the bills in Congress will succeed in keeping that promise.  According to the report, "Legislation written by three House committees and the Senate Committee on Health, Education, Labor, and Pensions would allow eligible employers to move workers into a new marketplace for insurance, where they could choose from various coverage options" (7).  The analysis goes on to explain that the legislation could prompt "employers to drop coverage" (7).  With respect to the House bill, the CBO estimated that millions of Americans would lose their employment-based coverage (7).  The CBO and JCT estimate that by 2016, 3 million Americans covered by an employment-based plan would not be offered coverage under the proposal in the House (7).  The CBO also left open the possibility that a larger number of Americans would lose their employment-based coverage (7).  Further, an analysis of the Senate Health, Education, Labor and Pensions Committee bill estimated that 10 million workers could lose their employer-provided health benefits and would have to find insurance elsewhere (8).  This is very concerning.  There seems to be a disconnect between what the President is assuring us and what the bills in Congress will actually do.

The evidence suggests that the root cause of these failures to meet the President's goals and assurances is the public option.  So my question to you is this: Why would you even consider voting for a bill that does not meet any of the most important goals and assurances in this health care debate?  This makes no sense.  The only conclusion that I can draw from this is that the real goal in pursuing the public option is, as Barney Frank himself stated, to lead us to a nationalized single payer health care system.  Therefore, I am asking you, for the sake of your constituency and the sake of our health care system, please vote against any bill that includes a public option.  It is fiscally irresponsible and it fails to meet the most fundamental goals necessary for real health care reform.

Further, I do not think any reasonable person would believe that the government would allow the public option to compete fairly in the free market.  This is the very same government that refused to allow banks and financial institutions to compete fairly, and it was less than two years ago that Freddie Mac and Fannie Mae were quasi-government institutions.  Today they are full on government entities.  There is no evidence to suggest that the government would take a hands off approach.  In addition, the litany of regulations that would be in place in the public option would give us government health care by proxy.  I do not want to see us move towards a nationalized single payer health care system.  We have seen from our Canadian and British friends that these health care systems are dysfunctional.  They cannot contain costs and the shortage of resources cause waiting lists and force them to ration care.  I am asking you to instead support reform as outlined by John Mackey, CEO of Whole Foods, in the Wall Street Journal on August 11:

http://online.wsj.com/article/SB1000142405297020425140457434217007286507...

This is the type of reform that we need to see.  We do not need the government, nor does it have the Constitutional authority, to involve itself in the free market.  The free market is by definition a market free from government intrusion.  This is also the one component of the President's proposals that is causing the most division.  For the President to be pushing something this divisive is a violation of his campaign promise to bring Democrats, Republicans and Independents together.

Again, please vote against any health care/insurance reform bill that includes a public option.

Thank you for your time.

References:

1. http://online.wsj.com/article/SB124775966602252285.html

2. http://www.washingtonpost.com/wp-dyn/content/article/2009/07/16/AR200907...

3. http://blogs.abcnews.com/politicalpunch/2009/08/congressional-budget-exp...

4. http://www.cbo.gov/ftpdocs/104xx/doc10464/hr3200.pdf

5. http://www.cbo.gov/ftpdocs/103xx/doc10310/06-15-HealthChoicesAct.pdf

6. http://www.washingtonpost.com/wp-dyn/content/article/2009/08/13/AR200908...

7. http://www.washingtonpost.com/wp-dyn/content/article/2009/08/16/AR200908...

8. http://www.usatoday.com/news/washington/2009-08-11-healthcare_N.htm

Organizing citizen involvement in campaigns is a lot easier than mobilizing Americans in the legislative process.  It's a hard lesson President Obama and his team are learning this summer.

The White House says it's going to pull out all the stops to show a groundswell of support between now and when lawmakers return to Washington after Labor Day.

I'm skeptical it will work.  Some of the reasons are outlined here.

Part of it has to with asymetrical energy.  My friend Jon Henke has it right when he says the Democrats enjoyed the power of a "storming the fortress" mentality while Bush was president. No more.   Now  the enthusiasm is with conservatives and Republicans.

Then there's the issue of lawmaking vs. campaigns.  Elections involve a binary choice: vote for candidate A or B; give money or not; make telephone calls for a candidate or do something else, etc.

The legislative process is more nuanced and often requires compromise.  It's hard to get people energized about supporting a middle ground position.

For all the talk about conservative "astro-turf" grassroots, it seems the White House and DNC are more guilty of trying to prime their allies.  My guess is the genuine energy and enthusiasm we see developing this summer around a "counter moblization" to the President's health care approach will only grow int he weeks ahead, no matter what the White House tries to orchestrate.

Whatever the outcome of the health care saga, it seems safe to conclude that the public option is dead. It is worth analyzing its impending demise for what it teaches us about American attitudes towards government, and how political battles are won.

The key fact here is that the public option is not some long-standing, highly pedigreed idea engrained in the liberal psyche, in the way that school choice or private Social Security accounts have been for the intellectual right. In fact, the idea of a public option is very new. It was first raised in 2007 by Berkeley economist Jacob Hacker, and popularized as a device that would "someday magically turn into single payer."

Continues Mark Schmitt at TAPPED:

Following Edwards' lead, Barack Obama and Hillary Clinton picked up on the public option compromise. So what we have is Jacob Hacker's policy idea, but largely Hickey and Health Care for America Now's political strategy. It was a real high-wire act -- to convince the single-payer advocates, who were the only engaged health care constituency on the left, that they could live with the public option as a kind of stealth single-payer, thus transferring their energy and enthusiasm to this alternative. It had a very positive political effect: It got all the candidates except Kucinich onto basically the same health reform structure, unlike in 1992, when every Democrat had his or her own gimmick. And the public option/insurance exchange structure was ambitious.

The public option is an idea that was born, literally, in the last Presidential campaign. Even so, it was little discussed in 2008, when the main bone of contention was Hillary's individual mandate to purchase health insurance. A Google News search from the height of the Hillary-Obama primary battle shows two health care-related mentions of the "public option" in January 2008, zero in February, and two in March, one in April, and two in May and June.

That the public option was new and unfamiliar made it easily characterized as a ploy to introduce single-payer in miniature, which it was self-transparently was in the eyes of its originators.

Indeed, reading through the founding documents of the public option is about as damning as if one got ahold of a secret dossier of Milton Friedman's proclaiming school vouchers a necessary "compromise" that would eventually usher in the death of public education in America.

So, the public option was not serioiusly discussed in 2008. It was never seen as central to Democratic demands for health care until mid-2009. Since the failure of Hillarycare, Democrats have continually stressed that they would get to universal coverage by regulating and by building on the existing system. Indeed, for all that Hillarycare was being pilloried as socialized medicine, not even it contained as overt a nod to single-payer as a government-run health care "option."

Exactly like the Social Security fight in 2005, liberals hoped that by injecting more government into the health care system they could change the political culture, just as conservatives hoped private accounts would awaken more of us to the rich abundance of the free market.

However, as the economic crisis showed, the political system is only designed to tolerate sudden changes to America's economic model in a crisis atmosphere. We've seen more than a good bit of economic nationalization in recent years/months, but only as a response to a perceived crisis. Could health care in America be nationalized? Sure -- if the pandemic flu struck the United States and was well on its way to killing millions of Americans and private institutions were judged inadequate -- and even then, political leaders would caution that it was a temporary measure. Welcome to the "bailout" school of health care reform.

The problem for Obama is that after months of "crisis" after "crisis", the welcome mat has worn thin. Not unexpectedly, "emergency" moves toward socialism in the auto and financial sectors have sidelined elective moves towards the same in health care.

This GOP Senior Health Care Bill of Rights is a depressing example of the kind of Keynesian Political Strategy of that now defines the Republican Party.

• Protect medicare and not cut it in the name of health care reform
• Prohibit government from getting between seniors and their doctors
• Prohibit efforts to ration health care based on age
• Prevent government from interfering with end-of-life care discussions
• Ensure seniors can keep their current coverage
• Protect veterans by preserving tricare and other benefit programs for military families

What exactly is the message here? That Republicans think Medicare is peachy? Republicans are now the Party of the Entitlement Status Quo?

The Democrats tried to address Iraq like this in 2004.  Their proposals amounted to "The same, but....better! And less expensive! No hard choices for America! Please like us."

The GOP is doing the same thing on health care.  This is not a policy vision; it is a campaign vision.  The message is: We want to pick off some senior citizen votes in 2010.

On the off chance that the Republican leadership is listening to anybody but their campaign operatives these days: The horse is supposed to go in front of the cart.  Policy should not be made by polling.  Campaign committees and operatives should be selling policy, not making it.

Democrats say they'll "go it alone on a health bill", which sounds all mavericky and bold and makes progressives quiver with excitement.

Given hardening Republican opposition to Congressional health care proposals, Democrats now say they see little chance of the minority’s cooperation in approving any overhaul, and are increasingly focused on drawing support for a final plan from within their own ranks.

But let me translate that into practical, electoral terms:

Given hardening [voter] opposition to Congressional health care proposals, Democrats now say they see little chance of [winning many seats in 2010 if they pass a controversial bill], and are increasingly focused on drawing support for a final plan from within their own ranks [that allows Democrats to vote whichever way is most likely to get them reelected].

"Go it alone" = optimizing their chances for re-election.  Remember, you don't win elections by winning a legislative fight.  Winners don't need to turn out again; they already won.  You win elections by convincing your base that you are in a fight and victory is just around the corner...if we win this election.

This is how it will likely shake out:

• YES: Blue District Democrats will vote for the Exciting Progressive Health Care Plan, and then go home and tell everybody how principled they were.
• POLLING: Swing District Democrats will take a principled stand one way or the other just as soon as their internal polling is finished.
• NO: Red District Democrats will vote against the unfortunate bill that just isn't right for America but if you reelect me I'll vote for Free Health Care and Unicorns For Everybody.
• ATTACK: Democratic challengers, unencumbered by actual votes or responsibility, will be free to attack their opponents on whichever grounds seems most useful, and (like Red District Democrats) will promise lower costs, more coverage and a pony.

You’ve heard some chatter about scrapping the “public option” in favor of a co-op model. Remember: government healthcare by any other name smells just as bad. We can’t let them sneak in any variant on the original evil using doublespeak and legerdemain. As Harry Reid said: “We’re going to have some type of public option, call it ‘co-op’, call it what you want.”

Congress is also considering a federal mandate that would force insurers to cover people after they get sick or injured, called “guaranteed issue”. In states like New York and Massachusetts where this mandate is already the law, premiums are about four times the national average. This is simply unacceptable if Congress wants to make insurance affordable for people. (It’s not insurance if you can call and buy a policy after your house burns down. Likewise, it’s not insurance if you can call and buy a policy after you break your leg.) But they’re not interested in making insurance affordable. That’s never been the goal.

It’s always been about getting us to a socialized system. If you can drive up costs with government mandates, then turn around and blame insurance companies—that’s the quickest way to get what you want: single payer.

With this bill, Congressional Democrats are going to do anything they can to create dependant constituents and special interests. In other words, people, companies and providers will depend on them for resources. Creating dependents helps keep them in power, so they're happy to hop into bed with the very companies they publicly malign. This reform bill is, and has always been, a resources for votes-n-contributions deal. So they’re going to pull out all of the tricks. But it’s now clear: we won’t be duped. Let us go forward with Zen-like patience and continue to oppose anything these shifty politicians propose.

Today, the Social Security Institute (SSI) joined with Patients First to carry an urgent message to three critical states: ObamaCare as originally conceived is dead, and the real danger now is RINOcare or ObamaCare Lite, which the Administration is trying to smuggle into law disguised as a "bipartisan compromise." The purpose of the tour is to convince critical Republican Senators in these states that the time has come to abandon unrealistic and potentially dangerous efforts to negotiate a bipartisan compromise. Instead, the Congress should put consideration of major healthcare reform on hold for at least a year until the economy improves and the supercharged political environment settles down. The only bipartisan agreement Senators should be seeking at this time is to abide by the 60-Vote rule for health reform the Senate TWICE voted (by unanimous consent and 79 yeas respectively) earlier this year to apply to the healthcare debate.

In a statement released yesterday, Hunter said:

"The American people have rejected ObamaCare. The President knows it, which is why he changed the definition of ObamaCare from 'healthcare reform' to 'health insurance reform' and why he pivoted from promoting a mandate that requires employers to provide health insurance to their employees to a direct federal mandate that individuals purchase insurance or pay a fine. The president also is repositioning himself to accept health-insurance co ops, the medical version of Fannie Mae and Freddie Mac--call them Frannie Med--as a means of smuggling in a public option and eventually a single-payer system.

"The Hands-Off-My-Health Care Express is touring Wyoming and Iowa because Senators Mike Enzi (R-WY) and Chuck Grassley (R-IA) are two of the three most important United States Senators in the land right now. Senator Olympia Snowe (R-ME) is the third, and SSI is in the process of putting together a Maine tour before the Senate returns to session in September. These are the three Republican Finance Committee members trying to negotiate a so-called 'bipartisan compromise' on healthcare.

"We are concerned that the three Senate Republicans locked inside the hothouse of Washington, DC negotiations do not become so obsessed with the quixotic quest of forging a grand "bipartisan compromise" that they lose sight of the economic, political and fiscal realities of the situation and lose touch with the views and opinions of their constituents. The simple fact is, there is no way the Obama framework for reform within which Senate Republicans are being forced to negotiate can produce a solution that comports with the values and principles that most Americans hold dear; nor can that framework for reform produce a solution that will actually improve the healthcare system and be fiscally responsible. ObamaCare violates the fundamental laws of economic, and therefore it is time to go back to square one.

"Instead of trying to rush to enact a plan the American public is severely split over, Senators should come to a bipartisan consensus to abide by the 60-Vote rule for health reform the Senate TWICE voted to apply to the healthcare debate earlier this year. In Senate parliamentary terms, this means agreeing on a bipartisan basis NOT to ram health reform through the Senate by a simple majority vote under the special budget procedure known as Reconciliation.

"Reconciliation was devised as a special BUDGET PROCEDURE exclusively to facilitate annual budget legislation NOT for major reform of almost one fifth of the U.S. economy, which is at stake in healthcare reform. The Senate already has voted twice to maintain the REGULAR ORDER on health reform, i.e., NOT ram health reform legislation through under Reconciliation. These two overwhelming votes were ignored when the Senate Budget Committee Chairman (Senator Conrad-ND) took it upon himself to allow the 60-vote provision to be removed in the dead of night from the Conference Committee Report on the Budget Resolution despite a bipartisan vote of 79 Senators instructing the conferees to insist on the Senate's 60-Vote provision.

"The integrity and tradition of the Senate require that Senators of both parties abide by the Senate's cherished rules of unlimited debate unless 60 Senators agree to cut off debate and bring a matter to a vote. Senators who refuse to abide by the REGULAR ORDER in the Senate are resorting to legislative trickery and back room maneuvering to cram government healthcare down America's throat."

For more information on the Social Security Institute please visit our websites below:http://socialsecurityinstitute.comhttp://patientoptout.com