Defend It, Don't Mend It

You can do a lot with 59 Senate votes, and that was certainly clear this week as Majority Leader Harry Reid and his fellow Democrats slammed the door on a bipartisan attempt to repeal ObamaCare's new 1099 reporting requirement on small business. 

The Democrats, unable to sell ObamaCare to their consituents, have resorted to saying:  "it's not perfect, but it's a start, and we will fix the problems with it over time."  Well, the issue of the 1099 reporting requirements shows how empty that promise is.  Virtually everyone, including the IRS' own Taxpayer Advocate,  agrees that the new 1099 reporting requirements are an abomination:

The office of the National Taxpayer Advocate within the IRS estimates that this provision will affect 40 million businesses. In July, they issued a harsh report on the consequences of the 1099 provision. They noted that small businesses in particular will be harmed by the new reporting requirements.

They state that the new burden on businesses would be disproportionate compared the actual revenue gained. For a relatively small increase in revenue, small businesses across the country would need to purchase new software and accounting services to handle the new paperwork.

Well, the opportunity to fix this clearly flawed provision of ObamaCare came up this week, with a bipartisan majority of senators supporting it.  But Harry Reid made sure it didn't pass.  If the Democrats can't mend this provision, they can't mend any provision of ObamaCare.   They intend to defend it, not mend it.

The Inescapable Allure of the Public Option

As we near the finish line on health care "reform" legislation, the Dems are converging on various flavors of "public option." The pundits are all weighing in on the political considerations driving this move (mollify the MoveOn wing of the party), and no doubt that has its role. But the real reason it has come down to the public option is that the public option is the only type of plan that Congress can rig to appear as if it is saving the taxpayer money. Only in a public option can Congress get the CBO to score fictitious savings that are written into law by fiat. For example, legislating a schedule of reimbursement decreases to health providers year after and then counting those "savings" as offsetting the massive costs of their plans.

I think almost all Americans know that such savings will never materialize. And in case anyone had any doubts just look at the "Doc Fix" bill that went down to defeat last week. The Doc Fix bill was a brazen attempt by the Dems to buy off doctors by cancelling out years of legislated reductions (aka "savings" of $250B) in payments to health providers. Year after year, Congress backs out the phony savings promised when they passed the bill, under pressure from reality as well as from special interests:

"Since its enactment in 1997 the so-called 'sustainable growth rate' mechanism [aka "savings'], which uses a complex formula to establishes annual target costs for physicians' services under Medicare, has not kept up with actual costs.

That's required Congress to step in almost annually with one-year fixes to prevent doctors from facing ever-bigger potential cuts in payment rates. The cut that loomed for doctors in 2010 was 21 percent. Without a permanent redo of the payment formula, Congress would presumably have had to continue to do one-year fixes, something that would also have cost money and that doctors hated because of the uncertainty involved."

Rural legislators hated these legislated "savings" because it had the effect of greatly diminishing the supply of and access to quality health care in their rural districts.

For the "savings" to ever become real would require Congress and the President, year after year, to have the discipline and the integrity to follow through with the painful choices that need to be made, and resist the temptation to cave to special interests or to buy votes by reneging on their responsibilities. The sad history of our Congress clearly argues against our ever seeing any savings.

The Congress is not serious about fiscal responsibilities. It is telling you so by cancelling out Medicare "savings" at the same time it is telling you its new health care plan will be paid for through "savings" in Medicare. And the President is going along with this charade, all the while accusing his opponents of intellectual dishonesty. How stupid do they think we are?

Powerful Parable

PatriotPost.US: "Many years ago, as a small child, I was told one of those old-fashioned fables for children. It was about a dog with a bone in his mouth, who was walking on a log across a stream.

The dog looked down into the water and saw his reflection. He thought it was another dog with a bone in his mouth-- and it seemed to him that the other dog's bone was bigger than his. He decided that he was going to take the other dog's bone away and opened his mouth to attack. The result was that his own bone fell into the water and was lost...

..the passing years and decades have made me ralize how important that story was, because it was not really about dogs but about people.

Today we are living in a time when the President of the United States is telling us that he is going to help us take that other dog's bone away-- and the end result is likely to be very much like what it was in that children's fable.

Whether we are supposed to take that bone away from the doctors, the hospitals, the pharmaceutical companies or the insurance companies, the net result is likely to be the same-- most of us will end up with worse medical care than we have available today. We will have opened our mouth and dropped a very big bone into the water."

Thomas Sowell is a great thinker and renowned economist. He could throw around the economic and health care jargon with the best of them. But with this simple fable, he has made one of the most compelling arguments I have read for opposing ObamaCare. I recommend reading the whole column.

Hat tip to Horendo for bringing this one to my attention.

The Joe Wilson Affair - A "Teachable Moment" Squandered

The mainstream media coverage of Congressman Joe Wilson's audacious "speak truth to power" moment in the joint session of Congress on Wednesday predictable avoids the real issues at hand:

1) Mr. Wilson is right - the President's speech was a litany of falsehoods and half-truths.
2) Mr. Wilson was only screaming from the frustration of being subjected to yet another high profile speech that served up all the same, discredited Democrat talking points, instead of the President answering the concerns of tens of millions of Americans about this plan - which was how the speech was billed by administration
3) How else are Republicans to be given a chance to debate this plan - they have been virtually shut out from any meaningful debate in Congress over where we should take our health care system in the future. Would you have ever heard about Joe Wilson's point of view if he hadn't shouted out of turn in the House chamber the other night?

Mr. Wilson should have offered a conditional apology: "I will apologize for my outburst when the President offers some concrete evidence in any of the pending legislation for his claim that these health care benefits will not be extended to illegal aliens." If you don't know the background, Mr. Wilson was a supporter of two amendments offered up in the House that would have required the Democrats to do just that, and both were soundly defeated. For some reason, the Democrats, who have generated thousands of pages of law on this topic, are unwilling to commit to paper the rules and procedures designed to ensure illegal aliens do not abuse our health care system.

Tell Your Government Health Care Buddies To Watch This Video

John Stossel does a terrific job of exposing the failings of government-run health care. Click the link above and enjoy...

They Don't Have DEATH PANELS in Britain Either...

Sentenced to death on the NHS - Telegraph: "In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.

Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.

But this approach can also mask the signs that their condition is improving, the experts warn.

As a result the scheme is causing a “national crisis” in patient care, the letter states."

The fact that the words "death panels" don't appear in the legislation doesn't mean that's not where we are heading.

A Great Solution To Health Coverage for Indivuals That Won't Bankrupt Uncle Sam!

Insurance Companies Should Be Allowed to Sell Policies Across State Lines - WSJ.com: "A 2008 publication 'Consumer Response to a National Marketplace in Individual Insurance,' (Parente et al., University of Minnesota) estimated that if individuals in New Jersey could buy health insurance in a national market, 49% more New Jerseyans in the individual and small-group market would have coverage. Competition among states would produce a more rational regulatory environment in all states."

Oh, but wait, it won't concentrate power in Washington and necessitate a huge expansion of the federal bureaucracy. This idea stinks. Never mind.

Grasping for Straws, Obama Touts Savings From Preventitive Medicine

Charles Krauthammer - Preventive Care Isn't the Magic Bullet for Health Care Costs - washingtonpost.com: "Obama followed suit in his Tuesday New Hampshire town hall, touting prevention as amazingly dual-purpose: 'It saves lives. It also saves money.'

Reform proponents repeat this like a mantra. Because it seems so intuitive, it has become conventional wisdom. But like most conventional wisdom, it is wrong. Overall, preventive care increases medical costs.

This inconvenient truth comes, once again, from the CBO. In an Aug. 7 letter to Rep. Nathan Deal, CBO Director Doug Elmendorf writes: '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.'"

The President just keeps on trotting out rationalizations for ObamaCare, and they continue to be refuted by the facts. Savings from electronic medical records were going to pay for the whole thing. Nobody bought that. The Example of Britain's out of control NHS EMR program was brought to the fore. Then, his unaccountable national health board was going to drive savings that paid for the program. The CBO shot that down.

Now he claims prevention will pay for it, and he give wildly inaccurate anecdotal examples like his $30,000 diabetic foot amputation example. The CBO has already shot this one down, too. The President is not a dumb fellow. He could be educated on health care economics if he wanted to be. But of course, this whole program has nothing to do with health care economics, it has to do with wresting away control for 17% of our economy.

Petulant Child

Transcript: President Obama's Montana Health Care Town Hall Meeting - Kaiser Health News: "When the previous administration passed the prescription drug bill, that was something that a lot of seniors needed, right? They needed prescription drug help. The price tag on that was hundreds of billions of dollars. You know how we paid for it? We didn't. It just got added on to the deficit and the debt."

This response blew me away. It ranks right up there with the comment about how we shouldn't be afraid of a public option since we all know how inefficient the Postal Service is. In this one, the President is bringing up a fact that certainly argues against his health care expansion plans - we have yet to pay to pay for the last big government expansion in health care - yet he brought it up any way. WHY? He's like a petulant child who's being prohibited from doing something his older sibling got away with - "Georgie got to expand health care without paying for it, so I should be able to also, IT'S NOT FAIR!!!"

Axelrod better get the President back on teleprompter.

The Gipper Warned Us 48 Years Ago! The audio will give you chills.

Eject Eject Eject » A VOICE FROM THE PAST: "Now back in 1927 an American socialist, Norman Thomas, six times candidate for president on the Socialist Party ticket, said the American people would never vote for socialism. But he said under the name of liberalism the American people will adopt every fragment of the socialist program.

One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It’s very easy to disguise a medical program as a humanitarian project. Most people are a little reluctant to oppose anything that suggests medical care for people who possibly can’t afford it.

Now, the American people, if you put it to them about socialized medicine and gave them a chance to choose, would unhesitatingly vote against it. We had an example of this. Under the Truman administration it was proposed that we have a compulsory health insurance program for all people in the United States, and, of course, the American people unhesitatingly rejected this."

-- Ronald Reagan, 1961

Uncannily prescient. What a joy to hear some much-needed common sense from this great man, plucked from 48 years ago. He goes on to talk about how supporters tried to ram the proposal through under the guise of crisis, and their unwarranted insistence that the probem be handled through a universal, mandatory, government program. Listen to Ronald Reagan himself delivering this message: Reagan audio

No Facts Please, We're Leftists!

John H. Cochrane: What to Do About Pre-existing Conditions - WSJ.com: "Health care and insurance are service-oriented, retail businesses. There is only one way to reduce costs in such a business: intense competition for every customer. The idea that the federal government can reduce costs by negotiating harder or telling businesses what to do is a triumph of hope over centuries of experience."

Private, competitive insurance markets are a superior way to solve the pre-existing-conditions problem, and the only hope to lower costs.

In this column the author, a University of Chicago professor (not a mere lecturer) explains how the means to handle the difficult problem of "pre-existing conditions" is already available in the private health insurance marketplace.

Obama's End Game

SteynOnline - UNTANGLING THE SPAGHETTI: "The end-game is very obvious. If you expand the bureaucratic class and you expand the dependent class, you can put together a permanent electoral majority. By “dependent”, I don’t mean merely welfare, although that’s a good illustration of the general principle. In political terms, a welfare check is a twofer: you’re assuring the votes both of the welfare recipient and of the vast bureaucracy required to process his welfare. But extend that principle further, to the point where government intrudes into everything: a vast population is receiving more from government (in the form of health care or education subventions) than it thinks it contributes, while another vast population is managing the ever expanding regulatory regime (a federal energy-efficiency code, a government health bureaucracy) and another vast population remains, nominally, in the private sector but, de facto, dependent on government patronage of one form or another – say, the privately owned franchisee of a government automobile company, or the designated “community assistance” organization for helping poor families understand what programs they’re eligible for. Either way, what you get from government – whether in the form of a government paycheck, a government benefit or a government contract – is a central fact of your life."

None of the Obama agenda makes sense except in this context. It's not about health care, global warming, the auto industry, financial regulation, etc. - it is about control and the concentration of power in Washington. If we allow this power to be wrested from our states, our corporations, our civil institutions, our churches, and our individual citizens, we will never wrest it back. That's what's at stake in America right now.

Highlights of Coming Attractions In Canadian Health Care

Thousands of surgeries may be cut in Metro Vancouver, leaked paper reveals:
"# Health authority to cut funds for mental health and addiction service providers to save $400,000
# Core patient services face deep cuts in Metro Vancouver, NDP says
# Massive cuts planned for Fraser Health region: NDP
# 2,500 elective surgeries delayed for 2010 Games
# Health jobs cut, your fees and wait times will increase
# Elective surgeries to be cut by 35 per cent during Olympics"

I'll say it again. Despite all of President Obama's protestations, no nationalized health care system has demonstrated any propensity to slow or control the growth of health care spending, except thru draconian service rationing. Hat tip to Pragertopia.

Leftist M.O. - Screw Up A Market and When It Fails Propose To Fix It With More Government

The Truth About Health Insurance - WSJ.com: "If you develop an expensive condition such as cancer or heart disease, and then get fired or divorced or your employer goes out of business—then individual insurance is going to be very expensive if it's available. But what the President and Democrats won't tell you is that these problems are the result mainly of government intervention.

Because the tax code subsidizes private insurance only when it is sponsored by an employer, the individual market is relatively small and its turnover rate is very high. Most policyholders are enrolled for fewer than 24 months as they move between jobs, making it difficult for insurers to maintain large risk pools to spread costs."

When Leftists tell me the free market has failed in health care, I respond, "How do you know, we haven't tried it!"

I Didn't Know That!

Charles Krauthammer - Obama Will Settle for Less on Health Care - washingtonpost.com: "The CBO put in writing the obvious: In its second decade, Obamacare significantly bends the curve upward -- increasing deficits even more than in the first decade.

This is obvious because Obama's own first-decade numbers were built on arithmetic trickery. New taxes to support the health-care plan begin in 2011, but the benefits part of the program doesn't fully kick in until 2015. That excess revenue is, of course, one time only. It makes the first decade numbers look artificially low, but once you pass 2015, the yearly deficits become larger and eternal."

Doesn't it make you nostalgic for a straight-talking President like Bill Clinton?

Real Health Care Reform

Charles Krauthammer - A Better Plan for Health-Care Reform - washingtonpost.com: "Defensive medicine, estimates the libertarian/conservative Pacific Research Institute, wastes more than $200 billion a year. Just half that sum could provide a $5,000 health insurance grant -- $20,000 for a family of four -- to the uninsured poor (U.S. citizens ineligible for other government health assistance)."

Krauthammer has a simple, two-point plan to reform health care:

1) Tort Reform
2) Real insurance reform, including ending the subsidization of employer-provided health care and giving the tax deduction/credit to the individual

I've advocated the same policies in prvious posts on this blog. Until such reforms are tried, the Left can't truly claim that the free market has been tried and found wanting.

France Fights Universal Care's High Cost - WSJ.com

France Fights Universal Care's High Cost - WSJ.com: "France claims it long ago achieved much of what today's U.S. health-care overhaul is seeking: It covers everyone, and provides what supporters say is high-quality care. But soaring costs are pushing the system into crisis. The result: As Congress fights over whether America should be more like France, the French government is trying to borrow U.S. tactics.

In recent months, France imposed American-style 'co-pays' on patients to try to throttle back prescription-drug costs and forced state hospitals to crack down on expenses... And service cuts...are prompting complaints from patients, doctors and nurses that care is being rationed."

The French system's fragile solvency shows how tough it is to provide universal coverage while controlling costs, the professed twin goals of President Barack Obama's proposed overhaul.

Click the link above and read this article. One of the most persistent arguments I get from people defending the ObamaCare agenda is, "it works well in Europe, Europeans love their health care." Well, after I point out the Americans overwhelmingly love their health care too, I point out that the Europeans are living on borrowed time. As the article points out, the French system is running persistent deficits and health care costs are climbing steeply. Unfortunately, after decades of French citizens considering health care a God-given right, it has become politically impossible to implement reforms to bring costs back in line.

France has a nice system - lot's of choice - limited central planning. But, it does not have any free market mechanisms to help reduce costs at the margin. There are only two choices for the French going forward: 1) accept free-market reforms like co-pays, health savings accounts, etc, or 2) create an ObamaCare central authority to ration care. The health care free lunch is over.

When a Lib Asks Why You Oppose Government Run Health Care, Respond "Tennessee, Hawaii, and Massachusetts

Tried and Found Wanting: "'There is not a credible example of having brought about a cost savings and insured everyone. We have seen that in TennCare,' Blackburn told me. 'I just find it unconscionable that they are not talking about the lessons that they learned from the TennCare experience, the lessons that are still being learned every day from the TennCare experience.'

Blackburn, a member of the House Energy and Commerce Committee, one of the committees that have reviewed health care legislation, had a simple enough question for Health and Human Services secretary Kathleen Sebelius. 'I would like to know what lessons the administration has taken from Tennessee's experiment with 'public option' health care; a program known as TennCare,' Blackburn wrote."

You don't need to point to foreign countries like Canada and Great Britain. Tennessee, Hawaii, and Massachusetts have already demonstrated the myriad flaws in the Dems health care proposals. And none of these systems is remotely the size of what Pelosi, Reid, and Obama are trying to ram down our throats.

Is This the Best the Nobel Prize Winner Can Do?

Why markets can’t cure healthcare - Paul Krugman Blog - NYTimes.com: "Why markets can’t cure healthcare

Judging both from comments on this blog and from some of my mail, a significant number of Americans believe that the answer to our health care problems — indeed, the only answer — is to rely on the free market. Quite a few seem to believe that this view reflects the lessons of economic theory.

Not so."

Krugman so vastly oversimplifies things as to render this whole column meaningless. I don't think anyone is arguing for laissez faire health care. But showing that a laissez faire free market approach cannot totally solve all health care economics problems is a far cry showing that free market principles have no place in health care. Read the column. Krugman claims:

1) that the free market is not relevant to health care because the expenditures are large and unpredictable. Sounds to me like he's focusing only on the catastrophic side of health care. But today's bloated "insurance" plans, distorted by more than a half century of government meddling are about a lot more than catastrophic care. They cover virtually all doctor visits, drugs, therapies, etc. In each of these myriad smaller transactions, market forces would be vastly more effective at optimizing the use of health care resources than the arbitrary guidlines and mandates coming down from government. A quick recent example: I was at the dermatologist and he said he needed to remove a large mole from my back. He could either cut out all the skin in the affected area (as a previous dermatologist had done elsewhere on my back a year earlier), or he could shave off only the affected layers of the skin, eliminating the need for stitches. At this point, we should have had a conversation about the cost of the two procedures, but since it was irrelevant to me, we didn't. I'd pay the same either way. But the skin removal procedure was in fact significantly more expensive. I chose the less expensive procedure in this case, but not because of cost, but because the more involved procedure would have required two extra visits to the doctor's office. Think how many millions of times a day such small decisions are made, and think how hard it is for government to oversee them all vs. just giving the patient appropriate information and incentives.

2) You can't trust insurance companies.
Well, sorry, but I trust an insurance company competing for my business FAR more than I trust a monopoly board of faceless government bureaucrats. I have been on private insurance for nearly thirty years, and no member of my family has been denied needed care, even through some pretty serious and expensive medical issues.

3) Private insurers waste money in their efforts to resist paying out on claims.
I am sure that there is truth to this, but it is certainly not as significant as another fact. It is estimated that waste, fraud and abuse in Medicare and Medicaid are in the 15-18% range, whereas in private plans it is about 2%.

4) You can't rely on experience or comparison shopping.
You can't now, because there is no market for such information. Consumers of health care currently don't give a darn about cost. When consumers do pay out of their pocket, for example with Lasik eye surgery, or cosmetic procedures, there is a lot more information available about costs and outcomes. And by the way, competition has continuously driven lower costs and better procedures in these areas.

Krugman's column is sloppy, lazy, and wrong. There is certainly a legitimate government role in health care, to address the ways in which health care does not behave economically like other goods and services. But as much as possible, we must deliver health care in a way that leverages free market principles, not central government control, to optimally utilize scarce resources.

Reality Deals Obama Health Care Savings Claims Another Punch in the Gut

Obama Defends Proposed Health Office - NYTimes.com: "WASHINGTON — The Congressional Budget Office said Saturday that a new agency proposed by President Obama as a way to cut health costs might save only $2 billion in its first four years, and that there was a high probability that “no savings would be realized.”"

I say it again, thank God for Mr Elmendorf and the CBO.