health care

Chris Dodd's committee.: We "heart" rationing care.

No word on whether Senators will get "enchanced customer service" from the public insurance option.

Paul Krugman is not concerned about how much universal health care will cost taxpayers.

I’m not that worried about the issue of costs. Yes, the Congressional Budget Office’s preliminary cost estimates for Senate plans were higher than expected, and caused considerable consternation last week. But the fundamental fact is that we can afford universal health insurance — even those high estimates were less than the $1.8 trillion cost of the Bush tax cuts.

Krugman waves away the matter of cost with "One way or another, the numbers will be brought into line".  However, in a 2005 interview with the Asian Times, Paul Krugman explained what he thinks we need to do...

"We should be getting 28% of GDP [gross domestic product] in revenue. We are only collecting 17%."

2008 tax revenue was 17.7% of GDP.  So, in Paul Krugman's ideal world, we would see a 60%+ increase in taxes.  But Krugman is "not that worried about the issue of costs."

This is what happens under a monopoly.  Consumer concerns about cost and value are called irresponsible, and the only "responsible" option - ever - is to gouge consumers for even more money.

If Democrats want to pass the health care legislation, then let's pass the tax hike necessary to pay for it simultaneously.  Let's bring those numbers into line and see how Americans feel about universal health care then.

Obama’s internist from Chicago, David Scheiner, says that Obama is on a wrong track with regards to health care reform. No, he is not a doctor opposing health care reform but is recommending a single payer system. From Forbes:

Scheiner, 71, was Obama’s doctor from 1987 until he entered the White House; he vouched for the then-candidate’s “excellent health” in a letter last year. He’s still an enthusiastic Obama supporter, but he worries about whether the health care legislation currently making its way through Congress will actually do any good, particularly for doctors like himself who practice general medicine. “I’m not sure he really understands what we face in primary care,” Scheiner says.

Scheiner takes a few other shots too. Looking at Obama’s team of health advisors, Scheiner doesn’t see anyone who’s actually in the trenches. “I have a suspicion they pick people from the top echelon of medicine, people who write about it but haven’t been struggling in it,” he says.

Scheiner is critical of Obama’s pick for Health and Human Services secretary–Kansas Gov. Kathleen Sebelius, who used to work as the chief lobbyist for her state’s trial lawyers association.

“He doesn’t see all the pain, it’s so tragic out here,” he says. “Obama’s wonderful, but on this one I’m not sure if he’s getting the right input.”

What should the president be focused on? Scheiner thinks that a good health reform would be “Medicare for all,” a single-payer system where the government would cover everyone and pay for it by cutting out waste in the system. “A neurosurgeon gets paid $20,000 for cutting into the neck of my patient. Have him get paid $1 million a year instead of $2 million or $3 million. He won’t starve,” Scheiner says.

Conservatives apparently loved the title of the article (Obama’s Doctor Knocks ObamaCare) and the beginning, but then had to change the tone after reading Scheiner’s support for a single payer plan. Gawker noted:

After first quoting approvingly, the National Review’s Mark Hemingway actually updated his post on Schneier. He had initially quoted the first three paragraphs and concluded “Ouch.” But then he read all the way to the sixth paragraph and discovered Schneier spouting Maoist propaganda. Like we said, whatever. The headline’s out there. Take it away, Hannity.

Scheiner also said that the proposed public plan doesn’t go far enough, and that Obama isn’t doing enough on malpractice reform:

Scheiner, like most others in his profession, thinks that it should be harder to sue doctors and that awards should be capped. He says that he and other doctors must order too many tests and imaging studies just to avoid being sued.

While conservatives often exaggerate the significance of malpractice when they sometimes claim that solving this problem will end most of the cost problems, the fact remains that this is probably the largest area where health care expenses can be cut without lowering quality. It makes little sense to talk about saving small amounts of money in other areas, or to spend large amounts of money on computerization of medical records in the hopes of future savings, without doing anything about money wasted on defensive medicine.

Malpractice reform will provide a test of whether the Obama and the Congressional Democrats are more concerned about lowering health care costs or appeasing the trial lawyers who typically support them.

Ezra Klein says the health care public plan is very popular in polling, so Senate opposition to it means "the Senate hates democracy" and "is resolutely, aggressively, anti-democratic."

Paul Krugman says poll results show that a majority of Americans prefer deficit reduction to higher government spending, but Krugman says "most people don’t know much about macroeconomics" so "the moral for Obama is, of course, to ignore this poll".

Discuss.

NOTE: Aside from the fact that people tend to accept or dismiss polls results based almost entirely on what they already wanted, I think there are two problems with the idea that popular support equals legitimacy, propriety or even democracy.

1. Stated preference (poll) and revealed preference (how people actually behave when making a choice) differ widely.
2. With no real price mechanism through which people can evaluate the costs and benefits of policy, we end up with simultaneous public support for massive spending and minimal taxation.  Well, who doesn't want something for nothing?

#1 is a political problem that can't really be changed - thus, we have a representative democracy, rather than direct democracy.

#2 is a policy problem that both Republicans and Democrats should be doing more to fix - e.g., indexing tax rates to spending, pigovian taxes, federalism, etc.

The latest Congressional Budget Office (CBO) report recently reported their findings on the cost of the Senator Ted Kennedy’s health care bill that would cover 16 million of the 46-47 million uninsured.  Before going into the nitty-gritty of the report, the uninsured count includes illegal immigrants, those who are eligible for federal programs but have not signed up, and those who have the ability to pay for insurance but choose not to do so.

Back to the costs: The CBO has estimated that $1.3 trillion would be required over 10 years to cover just 16 million of the uninsured. This does not include the public option, the deal that President Barack Obama wants. The reality is that the public option would ultimately lead to a government-run, single-payer health care plan for America.

Based on these numbers, the cost to cover one of the uninsured is $8,125 per person per year. If the estimated population of the United States was put at 307 million, the end cost per year of ObamaCare would be just over $2.49 trillion per year.

Considering that there are over $77 trillion coming in liabilities in Medicare, Medicaid, Social Security, interest on the debt, and the debt itself, adding this will ultimately break the bank and kill any hope of economic freedom for Americans who will be enslaved by the government to cover the debt either by confiscation taxes on all Americans or by massive hyperinflation.

Congratulations, America. You’ve been had (for electing these weasels in Washington) and now you, your children, and your children's children are going to pay the consequences.

Here are some draft scripts for a two-part series advert I think would work.  We’re following our middle-tier cube dweller, Mike.  Mike and his team represent office-working middle America, who are being told by the Democrats that they’ll “be allowed to keep their private insurance”.

#1 - "The Meeting"

[Cube-farm setting] 

SECRETARY - [leans over Mike’s cubical] - They want you in Meeting Room B to discuss the Johnson account. 

[Mike nervously opens door on meeting in progress.  Executives line a conference table.  Big-shot executive with salt & pepper hair and power suit is giving a PowerPoint presentation.]

BIG-SHOT - Mike! Thanks for coming in.  Have a seat I’m just finishing up something. [Continues presenting] So to summarize, when the government health insurance plan goes through, we’ll be able to pawn off the lower level employees to the government plan and save big-time on the bottom line. 

MIKE - [Interrupting as executives nod gently and agree.] Excuse me, ... uh, my team will still be on the private plan, right? 

BIG-SHOT - [Brief pause] Yeah, sure, Mike!  You guys have nothing to worry about. 

[Executives glance at each other cautiously.] 

MIKE - [Forced smile] Great. [Look of concern] 

--[Cut to voice over]

#2 - "Break Room" 

[Mike walks into the break room, complete with table, water cooler, coffee maker, etc.  A woman is seated, reading a newspaper.  A man is eating a doughnut.  Another man is pouring himself a cup of coffee.] 

COFFEE GUY - Hey, Mike! How did the meeting with the big-shots go?  

MIKE - Uh, fine.  Hey - what do you guys think about the government health insurance plan they’re taking about ?  

DOUGHNUT GUY - Well, they say we’ll be able to keep our existing health insurance, so I guess I’m fine with it. 

MIKE - Yeah, but you don’t think the company would drop our coverage and make us go on the government plan, do you? 

WOMAN - [Looking over newspaper, sarcastically] To save a buck?  So they can take their executive retreat in Tahiti next year?  Nah.

--[Cut to voice over] 

On a blogger call today Senator Coburn and Representatives Nunes and Ryan discussed their alternative health care plan entitled 'Patients' Choice Act.' Representative Nunes noted that the Obama administration has yet to release any of the details of the plan that it is already starting to promote. Summaries of the Patients' Choice Act as well as additional information are given on Representative Ryan's website.

“The Patients’ Choice Act of 2009,” transforms health care in America by strengthening the relationship between the patient and the doctor; using choice and competition rather than rationing and restrictions to contain costs; and ensuring universal, affordable health care for all Americans. “The Patients’ Choice Act” promotes innovative, State-based solutions, along with fundamental reforms in the tax code, to give every American, regardless of employment status, age, or health condition, the ability and the resources to purchase health insurance. The comprehensive legislation includes concrete prevention and transparency initiatives, long overdue reforms to Medicare and Medicaid, investments in wellness programs and health IT, and more.

Republican Health Care Alternative, Patients' Choice Act

It will be a few weeks yet before we see the final details, but the broad outlines of the democratic proposals to take over the American health care system are becoming apparent. And from what we can see so far, it looks like bad news for American taxpayers, health-care providers, and, most important, patients. The plan would not initially create a government-run, single-payer system such as those in Canada and Britain. Private insurance would still exist, at least for a time. But it would be reduced to little more than a public utility, operating much like the electric company, with the government regulating every aspect of its operation.

• At a time of rising unemployment, the government would raise the cost of hiring workers by requiring employers to provide health insurance to their workers or pay a fee (tax) to subsidize government coverage.

• Every American would be required to buy an insurance policy that meets certain government requirements. Even individuals who are currently insured — and happy with their insurance — will have to switch to insurance that meets the government's definition of "acceptable insurance."

• A government-run plan similar to Medicare would be set up in competition with private insurance, with people able to choose either private insurance or the taxpayer-subsidized public plan. Subsidies and cost-shifting would encourage Americans to shift to the government plan.

• The government would undertake comparative-effectiveness research and cost-effectiveness research, and use the results of that research to impose practice guidelines on providers.

• Private insurance would face a host of new regulations, including a requirement to insure all applicants and a prohibition on pricing premiums on the basis of risk.

• Subsidies would be available to help middle-income people purchase insurance, while government programs such as Medicare and Medicaid would be expanded.

• Finally, the government would subsidize and manage the development of a national system of electronic medical records.

Taken individually, each of these proposals would be a bad idea. Taken collectively, they would dramatically transform the American health care system in a way that would harm taxpayers, health care providers, and — most importantly — the quality and range of care given to patients.

In the face of this assault on one sixth of the US economy and some of the most important, personal, and private areas of our lives, one would think that the Republican response would be a resounding “No!”  One would be wrong.

Instead, the Republican response has been a plan of their own to increase regulation, mandates, and government control over the health care system. 

Sens. Tom Coburn (R-OK) and Richard Burr (R-NC) and Reps. Paul Ryan (R-WI) and Devin Nunez (R-CA) have proposed a plan based on the failed Romneycare experiment in Massachusetts.  

It is not all bad. 

In fact, it contains some very good proposals, such as changing the tax treatment of health insurance and expanding HSAs. However, it would also preempt many state insurance regulations, establishing new federal insurance rules, including a requirement that insurers accept all applicants regardless of their health or age.   There would also be a federal “risk adjustment” board that would tax some insurers and subsidize others based on whether the people they insure are healthy or sick. These policies will mean higher insurance premiums for the young and healthy.

The plan falls just short of an individual mandate, setting up automatic enrollment in exchange plans at “places of employment, emergency rooms, the DMV, etc.” — essentially, trying to achieve universal coverage by nagging Americans to death.

Notably, Coburn-Burr-Ryan-Nunez abandons one of the best recent Republican ideas for health reform, Rep. John Shadegg’s proposal to allow Americans to buy insurance across state lines, in favor of a requirement that states establish Massachusetts-style connectors. But the Massachusetts Connector has been one of the worst aspects of that state’s reform, acting as a super-regulatory body, adding new mandated benefits, restricting consumer’s choice of plans, and adding both regulatory and administrative costs to insurance. (In fact, the Connector adds its own administrative costs, estimated at 4 percent of premium costs, for plans that are sold through it.) What the Connector has not done is live up to its promise of breaking the link between employment and insurance, giving workers personal, portable insurance that they could take with them from job to job, and which they would not lose when they lost their jobs. Unfortunately, the Connector has not lived up to its promise in the latter regard. In fact, as of May 2008, only 18,122 people had purchased insurance through the Connector. That’s very little gain for so much pain.

Since there is virtually no chance that the Coburn-Burr-Ryan-Nunez will actually be enacted, perhaps one shouldn’t get too excised about its failings. It is clearly far superior to Obamacare. But one can’t escape the feeling that the best way to show the American voters that Republicans have regained their commitment to limited government—and to defeat Obamacare—is not with Obamacare Lite.

Chris Dodd's effort to change the subject for the 2010 election to health care made a pit stop yesterday at Derby's Griffin Hospital.

Since the Senator got it from both sides, maybe he should have skipped the event and checked himself in.

Before he got there, he was greeted by a picket line of protesters from Dump Dodd. This is a sight he was unaccustomed to seeing in his travels around Connecticut.

Then it got worse, Dodd may have thought he was going to run a pep rally for Obama-style "health care reform", but was confronted with a cadre of militants demanding the immediate adoption of single payer health insurance.

Needless to say, it looks like it was ugly.

DERBY — A “town hall discussion” on health care reform held at Griffin Hospital Saturday became contentious when advocates of a single-payer health insurance system shouted at U.S. Sen. Christopher Dodd to put the plan back “on the table.”.......The two people evicted from the meeting in Derby Saturday were members of the group Single Payer Action. Russell Mokhiber of West Virginia, formerly of Simsbury, was the first to stand and shout at Dodd. He asked him several times, “Why did you take single pay off the table?” Then he added, “Tell us about your corporate connections.”Jerry Kann of New York was the second person to stand and ask Dodd why he had taken the single-payer proposal “off the table.” He, too, was escorted from the building. 

The Democrats in general have a rather large problem on their hands which us poor Republicans can;t solve.  There are millions of lefties out there who actually believed their party's diatribes and think the Democrats are going to hand the Gitmo detainees a plane ticket home and an ACLU lawyer; and implement every social policy pipe dream that got a favorable mention in Mother Jones or the Nation.  

The Obama  Adminstration and folks like Dodd now have to cater to Rachel Maddow's whims as well as trying to run a government. Reap what you sow, folks.

Chris Dodd is a lot of things, but if you think he's going to crush the private insurance industry in CT, which only accounts for 65,000 jobs and is the highest concentration of such jobs in the nation, might I suggest you move on to marijuana legalization.

The internal contradictions of "health care reform" are rather immense; it appears to be the theory that somehow better management will lower costs to consumers; lower costs to the government. cover everybody, and maintain the expected standard of care.  I'm not bright enough to figure out how this is going to work, but then again maybe Peter Orslag has invented a perpetual motion machine in his spare time.  It doesn't seem NY Governor Paterson has had much luck reducing the excess cost of his state's health care system  and closing hospitals and laying off insurance workers is not going to be an easy sell in what is likely to be a jobless economic recovery.

So, the Obama team has decided that rather than engage in the merits of the issue, it will merely accuse skeptics of "swiftboating". To wit.

We knew healthcare reform would face fierce opposition -- and it's begun. As we speak, the same people behind the notorious "swiftboat" ads of 2004 are already pumping millions of dollars into deceptive television ads. Their plan is simple: torpedo healthcare reform before it sees the light of day by scaring the public and distorting the President's approach

 Dunno guys, looks like the more dangerous squadron is coming at you from your exposed left flank, arguing you guys aren;t socialist enough.  Gonna explain why healthcare costs money to the likes of them?

Looks like this prescription isn't going to restore the ailing Dodd back to political health.  Then again, every day he spends on this is a day he isn't socializing the financial services industry.

* Full disclosure: My wife works in the CTICU at a local CT acute care hospital (Not Griffin).

In my last installment of “No Risk, No Reward,” I suggested 5 risky policy changes for the GOP. Remember, you’re not selling plausibility of passage in Congress. You’re selling bold ideas and, by contrast, setting up the party-in-power as sclerotic, bloated, elitist and bureaucratic (all of which is true). Perhaps one of these reforms, like entitlement reform in the 1990s, will even take. Here are 5 more, as promised.

6. Healthcare “1,2,3”

1-Medical savings accounts for every American –  Give every American the option to divert part or all of their Medicare portion of payroll taxes to a medical savings account (aka HSA). These interest-gaining accounts can be used for out-of-pocket medical care and high deductibles. Mitigates the expense account effect running up the costs of healthcare and pulls us back from the cliff (See Singapore).

2-Refundable Tax Credits for the poor (straight into your MSA). Perhaps we can “afford” to help the poor, but not the way we’re doing it. Means-test people and give poor folks refundable tax credits on a sliding scale. They put these resources into their HSAs and choose where their healthcare dollars go.

3-Kill State Monopolies - Let people buy less expensive insurance across state lines. If I can cut my insurance premium in half by buying in Idaho, I should be able to. The only thing that prevents me from doing so is government. Let’s end that bullshit.

7. Dollar-for-Dollar Schools – Create the conditions for the emergence of creative new private, non-profit schools by allowing people to deduct a portion of the tuition to place their kids in these innovative schools. (Then, perhaps this will happen.)  If you’re taking a full pupil out of the DMV-style school but leaving a large portion of the tax money for said pupil, no one can credibly argue that it “takes resources from the public schools.”  Add refundable tax credits for the very poor and you’ve got a viable alternative to the mediocre-at-best public schools system. Universal primary school is maintained. Competition and iterative innovation radically improves our kids’ education. Everybody’s happy (except the teachers’ cartel, uh, union).

8. Congressional Crowdsourcing - Public solutions for public problems means big-dollar contests and public suggestion-box-type efforts can get the best ideas out of the American people. Bureaucrats have terrible incentives. And seriously, there are no Steve Jobs(s) in Congress. Congresspeople and their staffers should find ways to let the "wisdom of crowds" – even ideas futures markets - solve genuine public problems. Who ever heard of an innovative populist meritocracy? Well, now you have.

9. 1% Rule – For every dollar a federal department saves taxpayers relative to a reasonable budget baseline, those employees get 1 percent of that savings directly in their paychecks (according to pay grade). This would encourage bottom-up departmental efforts to tighten up. To prevent artificially bloating budgets the following years in order falsely to reward these functionaries, you’d have to set up the baseline to avoid political gaming of the system. Such may only be possible with a TABOR-like provision. I agree that the devil would be in the details. Just tossin' it out there.

10. Toleration – I have written elsewhere that the GOP should replace the social conservative policy leg of their tripod with a leg of toleration. Toleration is the cultural institution that means conservatives have their own private social conservatism and let others have their own lifestyles, religious beliefs, or whatever as they see fit. The kids today are much more tolerant and you won’t get anywhere with them unless you let go of all the stuff that smacks of theocracy or social engineering a la Falwell. Persuasion and privacy on social issues is preferable to power.(Here are 1-5)

(Note re: this post by Yglesias. Technology contests for CO2 sequestration would cost Americans this much-$. Carbon taxes would cost this much--$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$. Yes, subsidizing carbon sequestration technologies requires tax money. But there are differences of degree and differences of kind. I’m afraid Yglesias's criticism conflates the two. Spending this much ($) versus orders of magnitude more means throwing alarmists a bone, while not continuing to bankrupt the country. Clearly, the case of anthropogenic climate change is losing ground rapidly. But even if it weren't, not one person yet has made the case that these taxes, subsidies and green boondoggles would have any appreciable effect on emissions (or mitigation). Though they are clearly corporate welfare opportunities, which the Obama Administration looooooves.)