Health Care » Gress... Has Issues

ObamaCare Repeal Possibilities

Government, Health Care, Health Care Reform, History, Legislation, Taxation

Mar 312010

FDR,ObamaCare & States' Rights

The Judge (yes, he’s a real judge) gives us a heads-up, straight from the Constitution – a short video that’s a good start for a quick exploration of this ObamaCare repeal issue. FYI, the Interstate Commerce Clause and General Welfare provisions are not valid bases for imposing this legislation on the states and individuals. To find out why, we do some historical, political and legal analysis. So, either strap yourself in or risk emotional and intellectual whiplash.

First up is our link to a powerful look at how we’ve been here before, how it turned out, and the guidance offered for ourselves and the current administration. J.R. Dunn at The American Thinker had a well-commented-upon post up yesterday called The Supreme Court and FDR’s Power Grab. Now, I know a lot of you are going “Here we go again, the old Conservative animus against FDR.” Not so…at least not predominantly. This is thoughtful, relevant history that can be easily checked out. I urge you to take a look – it’s a fun and informative read.

Next, a short, healthy dose of Public Policy research by The Foundry, a policy blog from the conservative Heritage Foundation. They dig a little deeper than Judge Napolitano, especially regarding constitutional limitations on federal power.

None of these clauses—or any others found in the Constitution—gives Congress the power to create a government healthcare system.

The “General Welfare” clause gives Congress the power “To lay and collect taxes, duties, imposts, and excises, to pay the debts and provide for the common defense and general welfare of the United States.” This clause is not a grant of power to Congress (as constitutional law professor Gary Lawson has shown). It is a limit to a power given to Congress. It limits the purpose for which Congress can lay and collect taxes.

Finally, a contemporary take by political analyst Dick Morris on the steps necessary to repeal and how he weighs its chances of success. In a blog post for Andrew Breitbart’s Big Government, he has a post titled Take Back Congress to Stop ObamaCare. As you would expect, his is not the conventional, angry take on how to fight the constitutionality of this bill.

The Obama health care bill was an authorization measure which established a program and set down its parameters. But authorization bills are not appropriations. Each year the Congress must act on appropriations for each department and agency in the government. If no funds are appropriated, nothing can be spent.

Just in case you are out of time, patience or interest and decide to not go read this very short piece by Morris, I have to confess I really got a kick out of his Uncle Sam poster. So, through the magic of blog technology, here it is:

Morris is Serious About This

That’s pretty much of a wrap. We’ll be talking about this for the next four to six years, by which time the Democrats expect we will be totally (as in totalitarian) embracing ObamaCare in all its particulars, and the notion of repeal will be a small footnote in the history books. Or not

Health Mandates, or Incentives – Which is Smarter?

Government, Health Care Reform

Mar 242010

Government Ideologues Ignore Constitution, Avoid Real Problem-Solving

Think Harder

So it’s come to this – again. Mankind’s Overwhelming Question: Do we allow the government, or does the government – acting for our benefit, of course – allow us? If government has provided the physical infrastructure and the organizational enablers for our training and success, has it not earned the right to dictate our behavior on any matter that may have social consequence? If we are assured of being protected from enemies foreign and domestic, from extreme deprivation or disability, surely it would be selfish and ungrateful to not be obedient, when asked, to our benefactors.

And when it comes to setting our personal priorities, doesn’t service to the society that nurtures us and with whom we are totally interdependent have first call? Family and friends, neighbors and colleagues, after all, are also interconnected in the vast network we call society and upon which we all depend. And doesn’t it follow that the leaders we elect are merely acting out the mandate of history to make the best decisions possible on our behalf. Doesn’t the progress of civilization itself rely on their wisdom and valor?

And isn’t it essential to peace, harmony and cooperation that so-called individuals don’t arrogantly and selfishly assert themselves in a manner that is disruptive to the social milieu? What place is there in a truly harmonious society for narcissistic, competitive and combative egoists? And if that person cannot restrain himself from saying hurtful things and taking disruptive actions, shouldn’t a socially-just administration undertake his retraining into a more harmonious component of the whole?

NOT!!!

I was watching the early-morning Anchors on CNBC’s ”Squawkbox” (Carl Quintanilla, Joe Kernan and Becky Quick) discussing the aftermath of the Congressional passing of the two health care bills – and the discussion hit an odd cul-de-sac. They couldn’t determine the legitimate extent of government compulsion necessary when a common, necessarily shared, good was involved. This was probably touched off by the bills’ individual mandate, requiring citizens to buy insurance. Was it the same as states requiring auto insurance? Motorcycle helmets? Is it fair for someone to be allowed to abuse their own health if the rest of society is going to pay for the consequences? If not, where does government legislative remedy stop? Food? Tattoos? Smoking? Seat Belts?

And if the government recognizes that you are harming the planet with your careless use of energy (and exhaling CO2, and emitting methane), is it justified, for the good of all, to use various forms of coercion to control your social (and planetary) destructiveness?

And if the government can define what constitutes a threat to the society (and planet) it is charged with protecting, where will it end? Because in each of these scenarios, the threat is you! If you protest that a threat is not real and you, therefore, are doing no harm, to whom would you protest?

And that’s why we got rid of King George. Kings are able to make arbitrary rules about what constitutes a just society, and enforce it as they please. George Washington, it is said, was popular enough to become a King, or at least ruler for life. He didn’t want it. He recognized that, not only would the new US government need to continue the best aspects of the British system of the rule of law, but with a new twist: It was now the government’s job to protect the individual – from government! It’s the genius of the founders that has produced the “American Exception,” as well as the free market principles that have freed more people from poverty than any system ever devised.

That said, the first couple of paragraphs, above (just before “NOT!!!”) are nonsense. All of that infrastructure was bought and paid for, many times over, by the hard work and sacrifice of individuals in a society that works from the ground up. Some inventiveness may come from government labs and contractors, but we must remember who paid for the labs and contracts, and who selected the government representatives who made the decisions. Most businesses start very small, often with just one person with an idea. America’s job is to protect that person and to not hinder him in his (or her) individual efforts. The reward is a taxation bonanza and a prosperous, free country.

Health care is complicated and politically difficult. You can either tackle the difficult components of the problem or go for sweeping change. The lazy and unsatisfactory way is the latter. You don’t have to change 16% of the economy in order to mitigate a handful of problems that can be dealt with individually. You don’t have to mandate that every individual not getting employee health insurance buy insurance or be fined. Think a little harder, plan a bit, and you can come up with a plan that will incentivize each individual to want to buy insurance.

That’s the American way, Becky, Carl and Joe. The other is authoritarian and shouldn’t even be a consideration.

Medicare Docs Disappearing

Health Care, Health Care Reform

Mar 212010

RX Harold and Margret Thomas, with Dr. Steven Knope, a concierge doctor in Tucson who charges a yearly retainer

IF I were warning about something that might happen if we strip half a billion dollars out of Medicare and put it into a national health care experiment, some would be justified in labeling me an alarmist; If I were, on the other hand, to point out that doctors have been abandoning the failing Medicare system for years – but that nearly 30% of the remainder threaten to quit or retire if ObamaCare passes – I would be a very accurate alarmist! Alarmists sound alarms. Alarms are to let you know there is something terribly wrong, and you need to act to prevent bad things.

In an article written in April of last year by NYT’s Julie Connelly, it’s made pretty clear that we are way, way short of Primary Care docs willing to take Medicare patients, and bound to lose even more with any addition of 30 million (47 million, if you count our illegal immigrants) new patients to our already overstressed health care system.

Here’s what she says:

Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them - often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle.

When shopping for a doctor, ask if he or she is enrolled with Medicare. If the answer is no, that doctor has opted out of the system. Those who are enrolled fall into two categories, participating and nonparticipating. The latter receive a lower reimbursement from Medicare, and the patient has to pick up more of the bill.

Connelly (the ‘Alarmist’) not only warns about the missing Docs, but delves into some strategies that might be used to deal with the problem. Among these are a) A private contract with your doctor, b) Bargaining for continuing care from an “Urgent Care Center,” and c) Joining with a group that contracts with certain docs for “Concierge Care.”

Type “urgent care centers” into a search engine and thousands come up. In June, the Academy of Urgent Care Medicine plans to add a list of centers it has accredited to its Web site, www.aaucm.org.

Another, more expensive option is concierge or “boutique” care, which comes in two forms. In the most popular kind, doctors accept Medicare and other insurance, but charge patients an annual retainer of $1,600 to $1,800 to get in the door and receive services not covered by Medicare, like annual physicals. Before signing up and paying the retainer, patients should get a written agreement spelling out which services the doctor will bill Medicare for and which the retainer covers. And always check carefully for double-billing.

Since most of the cost of the health system we are so eager to fix globally is actually located in our elderly population, coupled with the expensive procedures that often occur in that age group, we need to consider what to do if Docs and hospitals are scarce, drugs hard to get, and waiting times intolerable. The younger folks not directly affected by those concerns (except to pay) can blithely vote for policies that will be disastrous for their elders – and with us for generations.

Photo by Chris Richards

Paul Ryan(R-Wis) Tells Obama True Health Care Costs

Government, Health Care Economics, Health Care Reform, Legislation, Taxation

Mar 212010

President Obama Sits Stunned

Is ObamaCare Worth This Much??

Long after the Great Health Care Reform Debate of 2009 & ’10 has become part of the history that goes untaught in our pathetic public school system, this six minutes of video will inform. Not only the ‘emperor’s clothes’ blast of reality concerning the health care numbers that had been fronted by the Democrats, but a priceless lack of reaction from a normally voluble and argumentative President. If you haven’t watched this on You Tube, already – and you really care about accuracy in this issue – spend a few minutes, and prepare to dazzle your friends!

If this clip is way too Republican and one-sided for you, take a look at our recent Post linking to a lecture by the President’s health care economist, titled “ObamaCare’s Planner Here,” starring MIT prof Jonathan Gruber. Enjoy!

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ObamaCare’s Planner Here

Government, Health Care Economics, Health Care Reform

Mar 202010

It Must be Popular!

Regardless of your political persuasion, here is a health care economist who claims to have been advising the Obama Administration on their HC Reform plans. Few of us have time for this stuff, but his presentation takes only the first half hour – the rest is actually pretty substantive Q & A from a Holy Cross audience sprinkled with physicians.

The plan may pass into law in the next few days and there will be a lot in it, so before it’s too late, get yourself the foundational viewpoint of the Progressive professional class.

Jonathan Gruber is an MIT health care economist. He claims to not know whether the proposed law will actually improve coverage or control costs, but asserts we must halt the trend toward health care as 40% of GDP. (It’s 17% now, but it seems odd to me that, as an economist, he acted like the journalists and politicians in treating the healthcare economy as if it were strictly cost/demand. He mentioned wealthy medical specialists, but skipped the tens of thousands who take home more modest paychecks and stimulate the economy with their spending.

Likewise, he explains that Pharma charges less abroad than here, so we rich American can subsidize TV commercial and (necessary) R & D. His solution is to get rid of the ads, but he doesn’t even consider having Pharma finally raise their drug prices abroad. Again, odd for an economist (but not for an ideologue).

He decries the emphasis over the last year on lowering cost, rather than emphasizing coverage; he then makes the argument that costs will be reduced dramatically over 20 years, primarily through waste & fraud elimination and tax hikes on companies and wealthy individuals. A cutback in hospital admissions and less testing should also help. He doesn’t say who will be available to actually provide the care mandated by his plan. (Something his audience was concerned about.)

Finally, regarding his uncertainty over future effectiveness, he leans heavily on the many “pilot projects” that are at the heart of ObamaCare, each one being an experiment in what might work to head off the destructive trend he claims we’re on. That being so, one has to wonder why the Administration – if it’s truly interested in discovering the most effective way forward – wouldn’t sponsor these experiments in the various states to demonstrate what might be practical to adopt nationally.

To view the interview, click here: Jonathan Gruber on Health Care @ Holy Cross 3/11/10 AP Photo/Susan Walsh

Is ObamaCare Really RomneyCare Writ Large?

Government, Health Care, Legislation

Mar 172010

Not Just Health Care

I highly commend to your attention this eye-popping article in today’s Wall Street Journal written by Grace-Marie Turner of the Galen Institute. Although Romney, who will probably once-again be running for President is obliged to deny it, RomneyCare in his home state of Massachusetts is experiencing all the cost and coverage problems the ObamaCare critics have been proclaiming for the last year.

There are only four major insurance companies in the state, according to the author, which bolsters my own conclusion in articles previously written on this blog, that companies restricted to a relatively small area cannot enjoy the benefits that competition in a much larger geographic area would produce: primarily, a larger risk pool that could keep cost low while providing comprehensive coverage with no exclusions. Of course, no one has experience with a large system of that type, but we can see in this article that it doesn’t work in a small one. Here’s a bit of what she says:

While Massachusetts’ uninsured rate has dropped to around 3%, 68% of the newly insured since 2006 receive coverage that is heavily or completely subsidized by taxpayers. While Mr. Romney insisted that everyone should pay something for coverage, that is not the way his plan has turned out. More than half of the 408,000 newly insured residents pay nothing, according to a February 2010 report by the Massachusetts Health Connector, the state’s insurance exchange.

Another 140,000 remained uninsured in 2008 and were either assessed a penalty or exempted from the individual mandate because the state deemed they couldn’t afford the premiums.

Mr. Romney’s promise that getting everyone covered would force costs down also is far from being realized. One third of state residents polled by Harvard researchers in a study published in “Health Affairs” in 2008 said that their health costs had gone up as a result of the 2006 reforms. A typical family of four today faces total annual health costs of nearly $13,788, the highest in the country. Per capita spending is 27% higher than the national average.

The state’s stubbornly high health costs are partly the result of intrusive government regulations that stifle competition in the insurance market and strict mandates on what services insurance must cover. A 2008 study by the Massachusetts Division of Health Care Finance and Policy found that the state’s most expensive insurance mandates cost patients more than $1 billion between July 2004 and July 2005. The Massachusetts health reform law left all of them in place.

Further, insurance companies are required to sell “just-in-time” policies even if people wait until they are sick to buy coverage. That’s just like the Obama plan. There is growing evidence that many people are gaming the system by purchasing health insurance when they need surgery or other expensive medical care, then dropping it a few months later.

The worst part is that the doctor and hospital shortages and extended wait times for care are exactly what our press generally refuses to describe in the foreign universal-care systems that the Obamanists seem to adore. I think we’re in for a very rough ride.

via Grace-Marie Turner: The Failure of RomneyCare – WSJ.com.

ADDENDUM A:

The Boston Herald just broke the news that Tim Cahill, the State Treasurer, says the state health system is being propped up with federal dollars in order to allow ObamaCare to use it as a model. The column, by journalist Jessica van Sack, is here.

The real problem is that this . . . sucking sound of money has been going into this health-care reform,” Cahill said. “And I would argue that it’s being propped up so that the federal government and the Obama administration can drive it through.”

Gov. Deval Patrick argues the state’s universal health care program has added 1 percent to the budget, but Cahill said the real impact is buffered by federal dollars.

Stay tuned for more skullduggery. There’s a lot of desperation in Foggy Bottom.

Prohibition Stupid & Immoral

Culture, Gangs, Government, Health Care, Legislation, Markets, Rule of Law

Mar 172010

Funding Enemies; Subverting Civilization; Incentivizing Crime

We Just Never Learn

An Investor’s Business Daily editorial on Monday, March 15th regarding the previous Saturday’s massacre of American citizens in Ciudad Juarez, Mexico, just across the border from El Paso, Texas:

President Obama expressed outrage Sunday over the broad-daylight massacre in Juarez of a pregnant American U.S. consular employee and her husband, which left their 1-year-old baby wailing in the back of their car. Within 10 minutes, a second attack by machine-gun-toting thugs killed the husband of another U.S. consular employee and injured his two children, ages 4 and 7, traveling in a separate car. All were returning from the same child’s birthday party.

Killings like this in the border city near El Paso are so numerous the State Department cautions against assuming it was a targeted hit — “although we are not discounting anything,” said spokesman Charles Luoma-Overstreet.

The death toll in the Mexican drug war has hit 19,000 now, with Juarez the worst-hit. Over the weekend, 50 people were killed elsewhere in Mexico.

The editorial goes on to rail against the violence directed at Americans, and calls for a tougher approach, on both sides of the border, to back up our inadequate $1.6 billion in equipment and training funds to fight the cartels.

While I am normally in agreement with the IBD editorial board, on this issue we part company. It is outrageous, immoral and delusional that, given the obvious carnage caused by prohibition – American prohibition – anyone can write with sincerity that the solution to the problem is stronger prohibition. It doesn’t work. It hasn’t worked. It will never work. Passing laws against human nature in order to enforce a social preference couched as a moral crusade against addiction is – in light of the observable global consequences – immoral. We have the addiction anyway, because the prospect of illicit earnings propagates armies of drug salesmen looking to create new addicts. That’s the incentive system and unintended consequence of law that we knew was bad when we were forced to repeal the 18th amendment to the Constitution.

Further consequences, without even trying to be comprehensive, are: 1) Funding our enemies in the War on Terror, 2) Exacerbating a sense of racial isolation among American minorities, esp. Blacks and Latinos, by stuffing our prisons with drug offenders, 3) Propagating criminal cartels and gangs all over the world, many of which are better armed than the police or army – and have no regard for the lives of other citizens, 4) Undermines the rule of law and the viability of our institutions by the use of bribery and intimidation – as well as huge shadow-economy profits that distort the economic life and incentives in any communities affected.

There comes a point in any large system where – regardless of its desirability or outcomes – so many people have a stake in its maintenance that it cannot be voluntarily changed. At that point, only catastrophic collapse is possible. We’re getting close to that conclusion, but I would like for our editorial writers to at least acknowledge that – so that we at least have the possibility of saving ourselves from this monstrosity in some more rational way.

Even just since the Nixon years, when the latest chapter of this ongoing debacle was written, shelves of largely ignored books have been printed, warning of the wrongheadedness of the scheme and its horrible consequences to individuals and whole societies. The bad consequences of addiction under legalization and regulation don’t even come close. And I assume that the journalist who wrote the article sincerely believes that the effort formerly called “the drug war” is correct policy, probably because, as William Bennett – one of our former Drug Czars believed – we simply cannot have a society that tolerates widespread drug use. Moral decay followed by chaos and economic collapse. And, of course, there’s really no such thing as ‘recreational drugs.’ Really?

That would be a fitting end to this rant, were it not for your all-time favorite feature:

FREQUENTLY UNASKED QUESTIONS

As drug cartels become more common – in your community and mine, with violent intimidation and bribery the norm (plata o plomo) – who will you be able to trust?

Do we tolerate the midnight raids on the wrong addresses and the resultant harassment – and occasional deaths – of our fellow citizens because it’s always happening to someone else; maybe someone you would never personally be associated with?

If millions of people routinely used marijuana in the 70′s and are currently productive members of society, how is it a “Gateway Drug?”

Did you know that most of our burglaries are caused by junkies trying to get money to support their habit, and that England briefly had a successful program that allowed heroin addicts to get their drug by prescription – not to get high, but to maintain themselves in order to function in normal jobs (a program, I hear, that was stopped by pressure from the US government)?

How are our unemployment statistics skewed by the existence of such a massive Black Market?

How profoundly does this affect the family and societal dynamics within Black and Latino communities?

Other than the cartels and minor drug pushers, who is profiting from the status quo, and why should we tolerate it?

Pelosi Tea Party Propaganda

Culture, Government, Health Care, Legislation

Mar 162010

Nancy

This via Steve Stevlic of Tea Party Patriots Chicago and Rich Johns of Chicago Townhall Meetup. Hope they don’t mind my pilfering, but it is clearly a good FYI for everyone who understands the essentiality of the Tea Party Movement and the consequent need to combat the lies used to thwart the will of the people.

It looks like Pelosi has had to rethink her original position of characterizing patriots as a bunch of kooks; probably a reflexive reaction based on her notion that the only people who legitimately conduct public demonstrations are Leftists, or those organized, bussed, duped by them. The list of supposed health care myths and recommended responses to them deserves a good Fisking, but this has already been done repeatedly on the floors of Congress.

Suffice it to say that her staff appears to be either too lazy or too intellectually bankrupt to come up with better lies than those that follow on this list. Might be interesting to note, though – since she’s still bothered by the idea of Death Panels – that it is not the explicit language of any bill that results in that conclusion, but the totality of the organization that makes it inevitable (not to mention the experience of the other countries currently practicing universal health care). Enjoy.

By Steve Stevlic, on Mar 15, 2010

Tuesday, March 16 will be a day of action both in Washington DC and here in the Chicago area.

Nancy Pelosi is resigned to the fact that on Tuesday DC will be overrun by people who actually want Congressmen to read the bill before they vote on it,want to know how healthcare will be paid for and want to know where in the constitution does the government have the power to control the healthcare industry and mandate American citizens to purchase health insurance.

Here is the memo her staff sent to their members on how to deal with Tea Partiers:

FROM SPEAKER PELOSI:

From: Thornell, Doug [mailto:Doug.Thornell@mail.house.gov]
Sent: Monday, March 15, 2010 5:25 PM
To: Thornell, Doug
Subject: Tea Party Etiquette

TO: Freshman and Sophomore House Democrats

FROM: Office of the Assistant to the Speaker

DATE: March 15, 2010

RE: Tea Party Etiquette

As many of you have read, tomorrow, Tuesday, March 16, 2010, tens of thousands of conservative and Tea Party activists will be on the Hill as part of what they are dubbing a “Surge Against Obamacare.” Rick Scott, a multimillionaire investor and former hospital executive, is helping to lead the grassroots effort along with a number of other groups on the right like Dick Armey’s FreedomWorks. While many of you have met with outspoken activists in your districts in the past, we wanted to remind you of some of the best practices to review with your DC staff:

1. Be prepared. Activists are expected to begin arriving around 9am and they have been given instructions to wait in your office until they can have a meeting. Please have an orderly process and enough staff and interns to welcome what could be a very large number of visitors throughout the day:

· Have staff and/or Member time set-aside to visit with attendees in small groups;

· Ask for extra chairs or seating to be brought to your office or the hall in case there are seniors or disabled visitors that need to be accommodated;

· Consider having some light snacks, H2O, and coffee available;

· Ask visitors to leave all signs and banners outside the office.

2. Prioritize listening to your constituents:

· Have multiple guest books/comment sheets available for all visitors to sign-in and leave comments – we recommend you have one for residents of your district, one for residents of your state (but not your district), and one for out-of-state visitors. Have a Capitol Directory and map available to direct visitors to their Member of Congress and written instructions on how to get over to the Senate side of the Hill.

· There is limited rationale for your Member to meet with out-of-district constituents, especially if you already had other business or meetings previously scheduled with constituents who had planned to visit with you tomorrow on other topics. It is up to individual offices to decide if staff would like to take these meetings.

3. Listen and communicate in small groups:

· As we learned in August, small groups are typically the best venue for exchanges on this complicated topic.

· Many of the conservative activists are not opposing the actual provisions in the bill, but are instead reacting to a caricature of the reform bill presented by right-wing media outlets. In fact, many conservative and GOP ideas and concerns are addressed in the legislation:

Reduces the deficit;

Cracks down on Medicare waste, fraud, and abuse;

Provides historic tax credit for small businesses and individuals to purchase health insurance;

Allows consumers to shop for health insurance across state lines via multi-state compacts;

Inaugurates medical malpractice reforms, (an area where the GOP failed to take any action when in charge of Congress for 12 years).

Also, don’t assume common myths about this bill have been debunked. Be prepared to explain that there are no death panels, that Medicare is in fact strengthened, and that reform is not a government take-over, but it is an attempt to crack down on the abusive practices of health insurance companies by providing oversight and increasing competition.

Finally, work to establish common-ground with visitors by ensuring they are aware and supportive of the important changes that will take place immediately:

Offer tax credits to small businesses to purchase coverage;

Prohibit pre-existing condition exclusions for children in all new plans;

Provide immediate access to insurance for uninsured Americans who are uninsured because of a pre-existing condition through a temporary high-risk pool;

Prohibit dropping people from coverage when they get sick in all individual plans;

Eliminate lifetime limits and restrictive annual limits on benefits in all plans;

Require premium rebates to enrollees from insurers with high administrative expenditures and require public disclosure of the percent of premiums applied to overhead costs;

Ensure consumers have access to an effective internal and external appeals process to appeal new insurance plan decisions;

Require plans to cover an enrollee’s dependent children until age 26;

Require new plans to cover preventive services and immunizations without cost-sharing;

Relief on the Donut Hole.

Race to the Top – Nationwide Insurance Competition

Government, Health Care

Mar 132010

INSURED YET?

Well, as we all know by now, Pelosi and the gang are straining at the halter to get the reform-less reform over the finish line. As a person of some years, I would dearly love to see a change in the current, absurdly manifested ‘situation.’ You can’t call something a system that was never designed or coordinated by anyone, so situation will just have to do. And God help us if it had been designed by anyone from the federal government.

I’ve already written on my conviction that a few, enormous, multi-state insurance pools would allow comprehensive coverage at a decent price, but it seems that the embedded state laws and agencies would be a formidable obstacle to that, i.e., each state would have to want to get on board a national plan for insurance consolidation; and radical changes would have to be made in state insurance bureaucracies. Not too promising.

2nd best might be pooling between or among consortia of states, again voluntarily, and hard to tell at what point, if ever, they reach the level of participation that would constitute a risk pool large enough. Currently, by federal or state fiat, minimum levels of coverage are required of all insureds, driving up the cost of premiums, as even those who would prefer to pay a lower premium for a lower level of everyday care are forced to buy the mandated packages.

The argument heard most frequently from proponents of the “Exchange” and its companion elements in the Senate health bill is that interstate insurance purchasing is a bad idea because it’s a “race to the bottom.” In order to understand this attitude, we have to assume a high level of mandated coverage and continuance of today’s state-by-state insurance oligopolies. Thus, if you shop all those other states for coverage at a decent rate, the tendency will be for the most attractive insurance company to be one (already) in a state that decides to lowball the rates and cleverly disguise the absence of real (expensive) benefits. In other words, a combination of what we have now with our trial lawyers well-known ‘venue shopping.’

This is silly. Painting the situation in known, static terms in order to make an argument for something else avoids making a tougher decision that might actually solve the problem you say you want solved. You say you want competition, but keeping all the insurance companies in place in their respective states doesn’t really help that. They get to compete on price across state lines, if they’re inclined to play, but maintain their monopoly positions at home.

Not what I had in mind.

Real competition means they are freed from the states and compete head to head across the nation. They would be freed from any obligations other than universal access. Each company that wanted to compete nationally in the health insurance market would then offer a range of coverages. Prior to that, they would be made to understand by their regional consortium of state Governors the territory and population they would be bidding on. Their actuaries would then determine the rates over the range of proposed coverages, based on the size of the risk pool.

Each company would arrive at different combinations of coverage options and premiums. Which consortium is best could only be sorted out over time, because there is no third party who could reasonably be expected to predict their actual performance in the market place in advance. On second thought, we haven’t decided what criteria determine the ultimate winners and who is to be the judge. Big problem, with lots of unintended consequences. A specialist in catastrophic care, for instance could do well in a national market that was not available before.

If you leave the selection to politicians, you have a large and irresolvable moral hazard. Leaving it all to the open market could be chaotic for quite a while, but none of the players at that time would be allowed to engage in the bad practices of the past. Universal access, or you’re not in the game. Few health insurance companies would wish to compete for such a long-haul, uncertain prize, so you’re going to lose a lot of insurance companies and their employees, a goal of the Obama administration, anyway. The administration, although preferring single-payer or public option, gets a few highly regulated giants who provide preventative care and psychiatric and dental – all the main Democrat health reform wishes.

The difference is it stays in the hands of people who can fire employees and administer efficiently in order to keep from going out of business. There needs to be an option for policy holders to rate their service periodically to their regulators, and for the regulators, once a threshold of complaints is reached, to restart the bidding process. Would the doctors and hospitals have an incentive to discard some current wasteful practices? Would those committing fraud be more likely to be caught, and thence eliminated? We’ll cover that in another Post; but by then, Obamacare may have rendered the whole exercise moot.

Single-Payer Proxy, or State Compacts?

Government, Health Care, Health Care Economics, Health Care Reform

Feb 272010

Aren't Larger Risk-Pools the Solution?

A Puzzlement for Us, Too

Well, As our old friend the King of Siam (aka Yul Brynner) was wont to say: ”It’s a puzzlement.” Our current President (peace be upon him) has often stated “there will be no government takeover of health care.” And, in his usual coded way, he’s right. Literally, that is. But both he and certain salient members of Congress have stated their strong preference for a single-payer system, government run, everyone covered. This has also been the oft-stated goal of various American Leftists and, in more recent years (post infiltration), of the Democrat(ic) Party. Nothing new there.

The puzzlement is, if they pass the sidecar bill and reconciliation and we wind up with “the National Exchange,” do the single-payer supporters get something they really want, i.e., low premiums and wholistic care? Near as I can tell, the exchange gets them a very good proxy for national health care. That is, instead of the public option that was intended to drive the insurance companies out of business – again, the President (pbuh) has stated he wants them gone – or the co-ops that would have done the same job a little more slowly, we offer for your delectation (Tah-dah!) – the Exchange.

This ‘corpus of deciders’ will approve which insurers can compete, decide which coverage is acceptable, and veto any premium level they find unacceptable. If you’re a single-payer person, this is way cool. OTOH, an insurance company that cannot determine what services it’s offering or what they charge for those services is effectively a government plan-administrator. Voila! Single-payer cleverly disguised as a bunch of lapdog insurance companies (Pay no attention to the person behind the curtain). Not as neat as direct government administration, but the good news (?) is that the feds get to pick the winners and losers.

Now, whether you’re a wise Progressive or a ‘Fascist Pig’ (you know who you are), you want to make sure that you’re not one of the losers. This requires some careful scrutiny, but not careful enough to make you roll your eyes back and think suicidal thoughts. I hope. Low premiums and wholistic care. Well, we all know that adding 30M people to the rolls and extending benefits represents a huge increase in costs.

The wholistic part means that more health care visits will be made, but presumably with less chronic complaints. That’s good… unless. Unless the crowded clinics operated by nurses or lesser-trained people proliferate, and you don’t get to see a real doc until things are very serious. And this transition may cause us to lose a lot of docs who don’t want to be told how to care for their patients under the guise of “best practice.” Just sayin.’ (And this combination could cause very long waits for either appointment).

But of course, none of that can happen at an affordable premium if the insurance companies’ risk pools aren’t large enough to accommodate the extra people and the extra care at a level that is an improvement over the present system. A common misconception about insurance companies and competition is that competition under any circumstance produces better service and lower prices as the companies vie for your business. An insurance company is a product that mitigates your risk by pooling your payments together with others who are at risk in order to have a large enough pool of money to handle the occasional loss experienced by only some of the people in the pool.

Our catch here is that we want to increase the number of insureds, and their level of care, without letting the insurers expand the risk pools enough to handle the increase. This is potentially bad news for anyone who will be buying coverage under the exchange.

There are two economic ways to lower these premiums: mandatory participation, and the reduction of the number of health insurers and expansion over state lines until a handful of very large insurance entities are created. Here it gets interesting (at last!). Insurance companies, as you probably know by now, are only licensed in states and the residents of those states are only permitted to buy insurance from them. These would be state monopolies subject to anti-trust prosecution, except for the federal exemption in place since the ’40′s. Congress just rescinded the exemption.

This seems to mean (I’d appreciate your comments on this – no registration necessary) that if the insurance companies tried to increase their client base by selling nationally, across state lines, as soon as they got large enough to have the size risk pool necessary to lower premiums and increase benefits, the federal government could target them for prosecution as monopolies (because this is not the federal government’s desired solution to health care). And, as an aside, they would also be approaching the realm of “too big to fail.” But if forced to remain small and not combine with one another in order to achieve the desired result (a Progressive plus), they simply could not break out of the current dilemma wherein competition in a small geographic area forces premiums high and care low.

There seem to be serious legal experts who think that federalizing any part of health care is an infringement on states’ rights and not justifiable using the usual interstate commerce clause of the constitution as an excuse. In other words, unconstitutional. Anything enacted without being initiated by the states could be subject to years of litigation and eventual overturning by the Supremes.

I’m clearly no expert, but, as I say – a puzzlement.

Which brings us to your favorite feature and mine:

FREQUENTLY UNASKED QUESTIONS

What legal obstacles need to be overcome in order to achieve an effective result?

Would it be better to leave reform to the states, passing federal legislation that allows them to form compacts that result in large insurance pools?

The insurance companies have offered to drop pre-existing exclusions if participation is mandatory. This increases the pool, but effects those who can’t afford the insurance. Is there a constitutional way for either the federal government or the states to require the purchase of insurance by every citizen?

Is there a way of incentivizing the voluntarily uninsured, especially the young, to insure without a mandate?

Perhaps low premiums that accumulate as refundable savings at specific intervals, if unused?

Healthcare Reform: Are Larger Insurance Pools the Answer?

Government, Health Care

Feb 132010

Less Providers Means Larger Pools With Lower Premiums

Bigger is Better - Pass it On!

When Congress has finally killed a bill and all opposed finally get to exhale, the jaded observer knows that, as in any other slasher film, the apparently deceased will soon rise from the floor, dagger in hand, and have to be killed at least once more. In DC, the conventional wisdom says it’s three deaths before you can relax and move on. And so it is with the health care reform bills. Looking dead, acting dead, fervently wished to be dead by their opponents – the bills’ benighted utopian sponsors hover – mumbling incantations, casting spells, drawing runes.

And that leaves the rest of us wearily, anxiously loading our arguments with silver bullets, praying that this time – at last – the thing will stay dead.

But enough with the metaphor. The best way to defeat these irrational measures that solve (almost) nothing while creating a financial black hole is to…replace them with something that actually accomplishes what the single-payer obsessives claim to really want: good care for everyone at a reasonable price.

Can this be done? (I think so) And, why should we still bother with this? (It’s just not going away; and the present situation sucks.)

Well, neither Congress nor the White House have given up. The President, in his desperation to have something passed that he can claim to be ‘health care reform’ before the fall elections, is going to stage a show of bipartisan effort, replete with recalcitrant Republicans – on C-Span. The problem is that he’s publicly stated that he has no intention of abandoning his current proposals. That reduces the Republican attendees to the role of supernumeraries in yet another Obama opera. (More ominously, they seem aware that they are meant to do another walk-on as the patsies in the Party-of-No, GOP obstructionists narrative that the Dems fabricated early on in this interminable process.)

So, before this fiasco occurs, let’s you and I take one last shot at figuring out what is essential, and what is politically possible in getting to cheap, universal insurance. You’ll have to bear with me here, because I have the beginnings of a theory, and I need for you to vet me on it. Continue reading »