ObamaCare Updates

A disaster in the making ....

'If You Think Health Care is Expensive Now — Just Wait Until it’s Free.' [Veronique de Rugy]

Cato Institute's Chris Edwards has a new Tax and Budget Bulletin about how to pay for President Obama's $1.5 trillion health-care plan. As it turns out, in spite of many promises not to increase taxes on the lower and middle classes, the administration won't have a choice. However, there are many ways to skin a cat, as Edwards demonstrates. The president could tax employer-provided health insurance, eliminating HSAs and FSAs, limit the deductibility of medical expenses, increase taxes on alcohol and beverages, or hike the already too high corporate taxes. Either way, the cat won't like it.
Keep reading this post . .


It’s Getting Less Inevitable by the Day [James C. Capretta]

The administration and Democrats in Congress have been trying to cultivate the impression in the media that passage of an Obama-style, sweeping health-care reform bill is all but inevitable — the only questions are about details and when.

But Obamacare was never inevitable (see my post from April), and it is getting less so by the day.

The reason is simple: There is no coherent and credible plan to pay for it. Most observers expect the legislation will cost somewhere between $1.0 trillion and $1.5 trillion over ten years.

Keep reading this post . .


Obama Packs Green Bay with Health-Care Delusions [John R. Graham]

Speaking at a rally of the faithful in Green Bay, Wisc., President Obama proclaimed that his health reforms would bring the whole country up to the health-care standard of this high-quality, low-spending community. If it were 1959, instead of 2009, he’d have said his football policy would bring every NFL team up to the standard of the Packers under their flawless new coach, Vince Lombardi.

The Obama White House has succumbed to the fundamental fallacy of socialism: believing that the government can collect information, analyze it, and then command its citizens to act in accordance with the government’s conclusions. In this case, the information is the Dartmouth Atlas, a well-known body of research that documents variance in Medicare spending and outcomes across the country. While places like Green Bay demonstrate low spending and high quality, places like Miami or Los Angeles demonstrate the opposite.

Advocates of the practice of medicine by government dramatically oversimplify the implications of the Dartmouth research, claiming that the variance is caused by too much medical care delivered to patients who actually suffer from it. If the government just commanded all medical providers to deliver the same volume of care nationwide, we’d cut health spending by 30 percent.

Well, okay: If President Obama believes that he’s got enough charm to convince Miami’s seniors that Medicare is going to cut back their access to care by 30 percent (sorry, we’ve already done all the coronary artery bypass grafts allocated to this ZIP code for this year), then he’s got political guts — that’s for sure.

But the truth is more complex. In the journal Health Affairs, Dr. Richard Cooper analyzed data which included private health spending, as well as Medicare spending, and concluded that more spending did result in better outcomes.

Dr. Cooper’s findings indicate that it is the centrally controlled Medicare program that has trouble paying for quality, not the 1,800 private insurers that compete against it.
— John R. Graham is director of Health Care Studies at the Pacific Research Institute.


Go with the Flow [Mark Steyn]

This story from Le Journal de Montréal is en français, but you don't have to know the lingo of the Continent to figure out the meaning of le mot "incontinent":

Des patients souffrant d'un problème d'incontinence grave doivent attendre jusqu'à trois ans pour une opération qui dure à peine 30 minutes.

Which means: In the Province of Quebec, patients suffering from serious incontinence — ie, they have to aller aux toilettes jusqu'à 12 fois par nuit (that's 12 times a night) — have to wait three years for a half-hour operation. That's 3 years times 365 nights times 12 trips to the bathroom.
There are only two urologists in the province who perform the operation, in part because hospital budgets are so tight they decline to buy the necessary "neurostimulator."

The central point about socialized medicine is that restricting access is the only means of controlling costs. And, when comparisons of health "costs" between nations are made, the time you spend in the bathroom each night and the subsequent impact on your work performance the following day are not factored in.

Of course, if you get sick of the three-year wait, you can always drive a couple of hours south, with frequent rest stops, to Fletcher Allen Hospital in Vermont or Dartmouth-Hitchcock in New Hampshire, and write a check. For the moment. Once the U.S. system has been "reformed" so that its wait lists are up to Euro-Canadian standards, poor incontinent Quebeckers will have to drive to Costa Rica. And that's a lot more rest stops.


Have Americans Accepted the Idea of Big-Government Health Care? [Michael G. Franc]

Today’s Washington Post contains a story that assesses the political prospects for the most brazen attempt ever to insert the government into the day-to-day micro-management of our $2 trillion health care system.

"The great unknown of the health-care debate," Post reporter Shailagh Murray writes, "is whether the current political landscape will prove more hospitable to mandates, cost controls and tax increases — all measures now on the table that helped doom the Clinton plan."As part of her assessment, Murray dismissed Senate Republican opposition to the "big government" elements of the recently released Democratric proposal as nothing more than a throwback to a bygone era, a veritable "Back to the Future" political moment. She writes:

But Republicans are betting that the specter of "big government" can still unsettle voters. When Senate Minority Leader Mitch McConnell (Ky.) spoke on the chamber floor Thursday morning, his remarks sounded as if they had been pulled from an early-1990s focus group.

Advocates of the big government approach, she reports, believe things have changed enough since 1994 to allow the reform effort to succeed. Senate Finance Committee Chairman Max Baucus (Mont.) insists that a successful health-reform effort this time is "a given" and, indeed, "inevitable." Democratic pollster Geoff Garin believes the odds of a reform measure passing are greater because we’re in a moment of "greater realism."

Are Senate Republicans and their colleagues in the House stuck in some sort of time warp? Are Americans more open to a government takeover of our health system today than 16 years ago?
Well, let’s go to the videotape.
Keep reading this post . . .


Trouble in Paradise [Yuval Levin]

The Obama administration and congressional Democrats have been doing all they can to keep the medical provider groups on board with their health-care reform plans, and as long as those plans remained just vague promises they seemed to have some success. But now that they’re getting to particulars — like a huge new government role in health insurance aimed at driving private insurers out of the game — the coalition is beginning to fray. Yesterday the American Medical Association, the most significant of the groups the Democrats seek to keep on board, announced it would oppose any plan with a public insurance “option” component. “The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans,” the AMA said.

The idea of compelling doctors who take Medicare funds to participate in the new public plan is especially onerous, the organization argued, and it even took it upon itself to remind Congress of its fiscal responsibilities (someone has to), writing in a letter to the Senate Finance Committee that driving private insurers out of business would create a flood of refugees into the public plan, and “the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers.” Quite right.

The doctors are surely also worried about the broader effects of a greater government role in their profession, worries well described by Scott Gottlieb last month.

It is no coincidence that the AMA’s announcement came just a few days before President Obama addresses a large AMA gathering, on Monday. We’ll see how he handles their challenge, but it’s increasingly apparent that the path to Obamacare is not as clear as it looked earlier this spring. Other major players in this debate, and especially employer groups (concerned about the employer mandate in the drafts now beginning to leak out) and the health insurers (concerned about being strangled to death), are gearing up for a fight. All that combined with the facts that this plan would cost at least $1.5 trillion, create a huge and growing new entitlement that isn’t paid for in any evident way, lead more or less inescapably to serious health-care rationing in the future, and do very little else to control health-care costs should give Republicans something to talk about, shouldn’t it?


How Not to Stop Socialized Health Care [Ramesh Ponnuru]

Karl Rove's WSJ op-ed on health care reflects the thinking of a lot of Republicans. He concludes, "Defeating the public option should be a top priority for the GOP this year. Otherwise, our nation will be changed in damaging ways almost impossible to reverse." In my view, Rove is defining Republican goals too narrowly.

Congress and the president can expand federal control of the health-care system a great deal without a "public option" (that is, a new government program to provide health insurance to people who choose it). They could set mandatory minimum standards for health insurance, impose price controls, mandate that individuals or employers buy insurance, and so forth. If Republicans say that the public option is the chief defect of liberals' approach to health care, they may be leaving themselves with no rationale for opposing these steps if the Democrats drop it—which they might just do. (Or they might cosmetically weaken the public option in various ways. They could, for example, set up a "trigger" that brings the option into being only if certain conditions in the health market are met, and then design those conditions so that they will be met.)

The public option appears to be one of the biggest political vulnerabilities of the Democrats' emerging health-care plan, but it isn't the only one, and it shouldn't be targeted to the exclusion of the plan's other features—or of its general government-first orientation. Republicans ought to be making the case against individual mandates and employer mandates as well, both of which are disguised tax increases.

It isn't incumbent on Republicans to see that a health-care bill passes Congress. To warrant conservative support, a bill should have no public option—but also no mandates and no price controls. Which is to say: No government-directed health-care system.