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Use States as Health Reform Labs

Haven’t talked much health care around here recently. That’s in part because things in Washington have slowed down dramatically recently. It’s also because the debate has devolved from one based on ideas to being nothing more than a power struggle with Obama and the Democrats attempting to push something, anything through Congress — even if they have to resort to “Republican” ideas.

Unfortunately, as long as the Republicans and Democrats keep trying to “solve” health care in Washington, they’ll continue to fail. After all, the Republicans have not exactly achieved a stellar track record on health care reform in recent years. The focus, as this recent article from The Politico notes, needs to be on those laboratories of democracy, the states.

Certainly, there are federal issues like Medicare and Medicaid and the tax treatment of care that need to be addressed, but true solutions to our health care problems are not “one-size-fits-all” and they won’t come from Washington. This is one idea that could and should be bi-partisan and would actually improve American health care.

Words of Health Care Wisdom from WaPost’s Editorial Board

The editorial page of the Washington Post is not normally my preferred place to go for free market analysis of health care and other major issues of the day, but Charles Lane, a member of the editorial board, seems to have a reasonable grasp on the realities of health care reform. His recent article, which appeared in the Albuquerque Journal starts out with a discussion of the supposed problem of “diagnostic creep.” In the words of Lane, diagnostic creep happens when society medicalizes imperfections that formerly were either not defined as disease or thought to be too minor and/or too intractable for treatment.

Sometimes, this is a real problem and it unnecessarily drives up costs. But, as Lane points out “diagnostic creep sounds bad, but it obviously can be very good” because it has helped people with a whole host of real medical issues.

Ultimately, as Lane points out, government boards that might be set up to determine whether certain procedures are necessary will result in a political firestorm or, if they are too lax, will not result in savings. Unfortunately, Lane does not make the next step and call for an end to the whole charade of government-directed health care, but he is certainly on the right track.

Do We Need More Hospitals?

In a rational free market system, the need for hospitals in a particular area would be determined by a combination of market forces and the willingness of entrepreneurs to invest in that kind of business. But, as was discussed in a front page story on the cover of the Albuquerque Journal the influence of market forces in determining hospital need is somewhat minimal — and New Mexico is not (thankfully) — a certificate of need state (in other words, government permission is not necessary).

So, what determines where hospitals are located in New Mexico? According to the article:

The University of New Mexico (one of the 2 hospitals in question) is looking for financing from Housing and Urban Development;

Presbyterian (the other hospital, a non-profit) is asking its employees to help finance the project to the tune of $3 million;

Both hospitals are looking for property tax revenue from Sandoval County to finance operation costs.

So, how will the hospitals make money? Well, one of the most interesting quotes in the article is that “Hospitals often complain Medicare reimbursement aren’t high enough, but at least Medicare pays reliably, and Medicare patients utilize 2.5 times as many inpatient services than the average patient.” So, again, subsidies play a major role.

While Congress looks to rid the American health care system of the last vestiges of free market, the debate over two new New Mexico hospitals is yet another example of how non-market forces predominate.

Worst Case Scenario for Health Care Reform

As Obama and the Democrats bribe senators in their slow march to 60 votes in the Senate, more and more details continue to come out. The picture isn’t pretty. First, there are the bribes:

– Nebraska’s Ben Nelson, in exchange for a “yes” vote on the 10-year, $871 billion package — received permanent and full federal aid for his state’s expanded Medicaid population;

– Louisiana got up to $300 million in Medicaid benefits;

– Vermont and Massachusetts got $1.2 billion in Medicaid money — a change that was described as a correction to the current system which exempts those two states because they have robust health care systems. Vermont Sen. Bernie Sanders also boasted Saturday that he requested and won an investment worth between $10 and $14 billion for community health centers.

– Western states secured higher federal reimbursement rates for doctors and hospitals that serve Medicare patients. The provision covers the low-population “frontier” states and applies to Montana, North Dakota, South Dakota, Utah and Wyoming — the latter two states are both represented by two Republicans, but ended up as beneficiaries anyway since they qualify. The legislative language defines frontier states as states where at least 50 percent of the counties have fewer than six people per square mile.

– Florida, New York and Pennsylvania — where five of six senators are Democrats — will have their seniors’ Medicare Advantage benefits protected, even as the program sees massive cuts elsewhere.

– Sen. Max Baucus, D-Mont., reportedly secured expanded Medicare coverage for victims of asbestos exposure in a mine in Libby, Mont.

– Connecticut is receiving $100 million for a “health care facility” affiliated with an academic health center at a university that contains the state’s only “public academic medical and dental school.”

Then there are the actual policies. For starters, it now appears that the Medicare savings in the bill which most everyone believe will never come to pass, have been double-counted to make the “savings” contained in the bill look bigger.

All of this adds up to Robert Samuelson’s calling the Senate health care bill “a bad bargain because….health benefits are overstated, long-term economic costs understated. The country would be the worse for this legislation’s passage. What it’s become is an exercise in political symbolism: Obama’s self-indulgent crusade to seize the liberal holy grail of ‘universal coverage.’ What it’s not is leadership.”

Hopefully a left-right coalition of liberal Democrats and Republicans, spurred on by the American people who are repulsed by the process and its result, will convince the House to kill this incredibly bad legislation.

Taxing Soft Drinks Will Not Make People Healthier

A few years ago, New Mexico eliminated its tax on groceries. While this was not technically a tax cut because other taxes were increased, groceries are now a target for the tax-hikers in Santa Fe. Some, particularly self-appointed advocates for the poor, wish to only raise taxes on “bad” food items like soda pop. But, as this column rightly points out, taxing soda will not improve overall health measures.

For starters, “It’s pretty hard to single out soft drinks as a unique contributor to obesity when regular soft drink sales have declined 9.6 percent since 2000, but CDC data shows that adult and childhood obesity rates have risen during that period.” When lawmakers in Santa Fe are talking tax hikes (a misguided proposition), they need to be careful about taxing soda and cigarettes to name just a two because these items are disproportionately consumed by lower income workers. Ah, the dilemma of the do-gooders!

There’s no such thing as a free mammogram

While the idea of a government bureaucracy placing limits on when women can receive mammograms is a big potential problem of nationalized health care, as Sheldon Richman of the Future of Freedom Foundation points out, these mammograms are not free and (successful) Congressional efforts to: “guarantee women access to preventive health care screenings and care at no cost … [by requiring] all health plans to cover comprehensive women’s preventive care … with no copayments.” (Emphasis added)” are also a symbol of what is wrong with the health care legislation now in Congress.

After all, someone has to pay for the mammograms and Congress gets to grandstand and take credit, but ultimately the costs are borne by employers and others who will actually pay the bills. Under a rational system, women would have the “right” to have a mammogram as early as they like if they are willing and have the means to pay for it (or pay for an insurance policy that does), but Congress would not be in the business of micromanaging when this or any other medical procedure is provided.

Deficit Neutral Health Plan Impossible

While Democrats in Congress work overtime to make their health care reforms appear to be “deficit neutral,” University of New Mexico economist Micha Gisser cuts through the disinformation and explains exactly why the plans for a government takeover of America’s health care is simply not possible without dramatically increasing the deficit. Read the article here.

Can’t Manage Memorials; Can they Handle Health Care?

Irony can be fun. This article (actually a letter to the editor) from the Washington Post caught my eye. The reader discusses the sorry state of the memorial, which is located near the National Mall in Washington.

According to the letter-writer:

Many of the light fixtures that are crucial to enjoying, or even navigating, the memorial are burned out. Others have miscolored bulbs that distort. Many of the water cascades are now black pits, wet or even dry, instead of shimmering fountains.

Roosevelt’s great quotations — “I hate war” and “We have nothing to fear but fear itself” — are hidden in gloom.

This is not new; maintenance has been neglected for years and is getting worse.

First and foremost, I just love the fact that the memorial to one of the biggest proponents of government control of our daily lives is in disrepair. One would think that if anyone took extra special care of FDR’s memorial, it would be Obama. But the other thing about this that speaks to me is that this is a memorial that Obama can practically see from his front porch. Keeping a memorial in good working order is a simple, relatively inexpensive job for government bureaucrats to handle.

If they can’t handle the simple task of keeping a memorial in working order, should we really trust them to determine when women should get mammograms or when each of us should or should not receive surgery or other medical procedures?

Specific Market-based Medical Alternatives that Work

The debate in Congress has focused almost entirely on government solutions and while market advocates have brought ideas to bear, like purchasing health insurance across state lines, that have not really been applied at least in the medical sector in the United States.

This article from “The American” which is put out by the American Enterprise Institute discusses six market-based health care reforms that are working today in many states around the country. Rather than more government, these proven ideas should be the basis for health care reforms.

Ideas discussed and explained in the article include:

1. Retail clinics.
2. Retail clinic-hospital partnerships.
3. On-site workplace healthcare clinics.
4. Affordable $4 generic drugs.
5. Prepaid medical plans.
6. Concierge medicine.

Abortion and the Health Care Bill

As a state-level economic policy organization, the Rio Grande Foundation does not take a position on social issues like abortion. But With narrow passage of the House health care bill made possible by strict limits on taxpayer subsidies for abortion under the plan, the debate over abortion policy has moved front-and-center in the health care debate. Recently, in fact, a representative of a group calling itself “New Mexico Religious Coalition for Reproductive Choice” wrote on the pages of the Albuquerque Journal that abortion should not impact passage of the legislation one way or the other. President Obama echoed this sentiment saying “This is a health care bill, not an abortion bill.”

The problem, of course, is that when the federal government is paying for health care (including abortion), the legislation is inherently an abortion bill. It is, after all, one thing for an individual to not wish to pay for or subsidize abortions of others. This is largely the situation we have been living under to date. It is another thing for the government to force people who have serious moral concerns about abortion (or other medical procedures) to be forced to pay for that through their tax dollars. Their concerns are certainly justified and I can understand why abortion opponents demanded such an amendment before voting for the bill.

There may be a way to find a compromise here, but it is now the largest single stumbling block to health care reform and abortion opponents hold the cards.