Disagreeing with the Experts

Nothing gets the blood flowing like internecine warfare. It is very easy to lob bombs at the left and others who want to “socialize” medicine, but it is quite another thing — a much more difficult one — to disagree with a nationally-recognized advocate for free market health care.

John Goodman of the National Center for Policy Analysis, a health care expert with far more years in the field than I, recently blogged about some of the ideas put forth by Republicans in their health care meeting with President Obama. The idea that Goodman disagrees so vehemently with is to allow all out-of-pocket spending on health care to be deductible. This, proponents (like me) argue, would ultimately undermine the third-party-payer system of health care in this country because employees would no longer have the incentive to rely on their employers for health care and would instead take the additional pay and enter the individual market, more than likely adapting health savings accounts and other consumer-driven health care products in large numbers.

Goodman argues that eliminating taxes health care expenses would create a situation in which “government would be paying almost half the cost…” With this subsidy, health care spending would rise dramatically. He instead argues for equalizing the tax treatment of health care with other goods — an ideal solution that I agree with — but I doubt that Congress or the American people would go along with such a massive tax hike unless tax rates were lowered…and you get the picture. Very complex and not likely to happen.

So, I remain supportive of eliminating taxes on health care. Why? Well, first and foremost, even if you are being subsidized to the tune of 50% for health care, you still control the money and will work to keep costs down. Pricing will become a part of the health care industry in a way that it is not today because of the third-party system. Also, the individual market will grow, thus making that a more viable proposition and keeping costs down and giving millions of Americans greater control of their health care (no more remaining stuck in a job just because of health care). Lastly, consumer-driven health care like HSA’s will take off and flourish. These all seem like good things to me. Besides, do you really trust politicians to not cave into special interests by exempting health insurance from taxation as we did in New Mexico (NM’s gross receipts tax still hits certain health care costs like deductibles and co-pays).

Ending taxation of health care costs seems to have more benefits than drawbacks. Maybe I’m wrong. What do you think?

Obama and the Slacker Mandate

In his health care rally in the Philadelphia area earlier this week, President Obama touted a proposed regulation that insurance companies would have to allow children up to age 26 on their parents’ plans – i.e. a slacker mandate – designed to appeal to the college crowd.

I wonder however, if President Obama realized the Pennsylvania already has a slacker mandate (in fact, up to age 29); state lawmakers enacted it in 2008.

In testimony to both the state House and Senate Appropriations Committees in February, Pennsylvania Insurance Commissioner Joel Ario noted that very few young adults have been enrolled under the new mandate. Ario commented, as summarized by Pennsylvania Legislative Services (subscription), that:

• The cost to insure young adults on their parents’ plan was about the same as if they bought their own plan.
• “Low-risk” young adults would buy their own plan (or remain uninsured), leaving only high-risk cases looking to the slacker mandate–and insurers were naturally unwilling to give coverage to high-risk young adults as the same rates as children.
• The failure of the slacker mandate to reduce the number of uninsured is “generally symptomatic of the greater healthcare problem.”

That is pretty much what  in the Commonwealth Foundation predicted two years ago:

SB 1453 [the slacker mandate], however, ignores the primary reason why young adults often go without insurance—the high cost of coverage. This is especially true considering that most young adults use very little health care. …

Instead of more mandates, lawmakers should adopt reforms that allow individuals to purchase low-cost, mandate-lite insurance. Another alternative would be to allow individuals to opt out or waive certain coverage mandates to reduce the cost of their insurance. … The only way to substantially reduce the cost of health care is to put individuals in charge, not government bureaucrats. This means eliminating many of Pennsylvania’s costly health insurance mandates, not adding to them. Eliminating the burden of health care mandates will lower the cost of health care, provide more insurance to more individuals, and restore personal choice to citizens.

Faith-based Cash-only Payments for Health Care

Instead of trying to funnel all your health care purchases through insurance–making you hostage to the whims of the insurance company and whether or not your employer offers insurance–why not bypass insurers?

Samaritan’s Ministries is an organization that helps its members pay cash for services. National Public Radio recently published  a short story about the organization. It is a faith-based effort, not only in that participants are Christians. An insurance company has a legal obligation to pay for your services, in accordance with your contract. There is no similar obligation in a faith-based effort.

Birth Center Regulations

This article in the Post-Dispatch identifies a regulatory barrier to opening birth centers in Missouri:

Another challenge in Missouri is the state’s licensing requirements for birth centers, which Henman and others are trying to change[.] Birth centers are licensed as ambulatory surgical centers even though no surgeries take place. Many of the requirements are expensive and unnecessary, says nurse midwife Rachel Williston, 34, who wants to open a birth center in Independence, Mo.

Complying with all the regulations for ambulatory surgical centers is no simple task. The regulations can make the difference between a facility being profitable enough to operate and being forced to close. This was evident in 2007, when Missouri law was changed to impose the ambulatory surgical center regulations on abortion clinics, which challenged the law in court. They argued that imposing such onerous regulations was a ploy to shut them down.

It’s unfair to regulate birth centers the same way as surgery centers, when no one performs surgery in them. Women can legally give birth at home, and their houses need not meet all the code specifications of a surgery center. Births in birth centers should be regulated more like births in homes.

Malpractice Costly, but not a Silver Bullet in Health Care Reform

Dr. John Vigil was one of two doctors that appeared on a panel with me at Rep. Martin Heinrich’s town hall meeting last summer (video available here). (Remember the good old days when Obama and Congressional Democrats actually cared what form health care reform took rather than just attempting to pass any health care reform they could muster up the votes for?)

Anyway, I was pleasantly surprised when I sat on that panel to learn that Rep. Heinrich had not stacked the panel with pro-government reform proponents. Dr. Vigil in particular impressed me. Well, in today’s Albuquerque Journal, Dr. Vigil explains that medical malpractice, while not solving all of America’s health care problems, could have a significant, positive impact in terms of cost savings of $20-$30 billion annually or more.

Tort reform, as one component of other market-based reforms, could have a significant, positive impact on costs and quality, but as we have seen since Scott Brown’s election in Massachusetts, Obama is pushing harder than ever, regardless of what that “reform” ultimately looks like.

Taking It to the Street

I suppose it can’t hurt. Here’s a suggestion from Americans for Prosperity:

This week, the president actually said the nation is “waiting for [Washington] to act” on the health care issue. This is arrogance and political posturing at its worst. Like us, the president knows the truth. Every reputable public opinion poll for months has clear majorities of the American people saying “NO” to the health care “reform” coming out of Washington, D.C.

Now is the time to finish the job of protecting this most personal freedom by stopping the Democrats’ Washington takeover of our health care in the U.S. House of Representatives.

On March 16 at 12 noon your time, we’re asking you to drive to your nearest congressional district office and drive around honking your horn. Our goal is to have Americans across the nation telling the politicians to keep their hands off our health care through this “Honk Against the Health Care Takeover” effort.

To show people why you’re honking, when you register we’ll send you a “Honk Against the Health Care Takeover” bumper sticker. To receive the bumper sticker in time for the March 16th event, you need to register by 8am March 11th. Orders after will be mailed but might not get to you in time for the event.

Click here to register: http://honkno.com/2010/03/04/sign-up-for-a-honk-no-rally/

Nancy’s Nutty Rules

The next act in the drive to pass ObamaCare is the mother-of-all political maneuvers — in which Democrats will use an incredibly convoluted and possibly unconstitutional process.

Things were already arcane: President Obama, House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid have been threatening to enact “health-care reform” through the narrow path of budget reconciliation. It’s a ploy to allow the Senate to pass “reform” with just 51 votes — making the election of Scott Brown as the 41st senator against ObamaCare irrelevant.

To use reconciliation, Pelosi must first get House members to vote for the exact bill the Senate passed in December. That is, the House would “keep the process moving” so both the House and Senate could pass a second bill to fix things members don’t like in the Senate measure.

But the speaker is having trouble rounding up the 216 votes she needs to get the Senate bill through the House. Her members rightly fear that the Senate might prove unwilling or unable to pass the “fixed” bill — and, at the least, would have a huge advantage in negotiations over just what “fixes” to make.

The problem is straight out of a 7th-grade civics class: If both houses of Congress pass identical bills, the bill can go to the president to be signed into law.

House members are being told that they must vote for the Senate bill as a procedural step. But the bill would then be only a presidential signature away from becoming law. That is, House members might end up voting for the Senate’s Cornhusker Kickback, Louisiana Purchase, “Cadillac” tax, abortion coverage and other unpopular provisions — and then find it’s all become law.

The risks are plain enough that Pelosi doesn’t yet have the votes: Her members fear they’ll be left hanging to defend their votes for the hated Senate bill.

So now Democratic leaders say they’ll package a two-for-one vote: Moving the original Senate bill simultaneously with a “reconciliation” bill — thus, if the House votes for the bill of fixes, the main Senate bill will be deemed to also have passed. Then the reconciliation bill will go back to the Senate, where it only needs 50 votes (plus Vice President Joe Biden’s) to pass.

Hmm. Nowhere in the US Constitution does it say that Congress can deem a bill to have passed. Pelosi & Co. aren’t just making up policy as they go, but also procedure — possibly unconstitutional procedure, at that. All to enact a bill remaking a sixth of the US economy over the 3-1 opposition of the American people.

The Mystery of Health Care Policy

Who would you put in charge of the investigation? Hercule Poirot and Jane Marple? Or the person most likely to have committed the heinous crime? Believe it or not, in health care we are about to do the latter.

Writing in Health Affairs, Ken Thorpe and his colleagues offer a description of the current phase of the problem:

Medicare beneficiaries’ medical needs, and where beneficiaries undergo treatment, have changed dramatically over the past two decades. Twenty years ago, most spending growth was linked to intensive inpatient (hospital) services, chiefly for heart disease. Recently, much of the growth has been attributable to chronic conditions such as diabetes, arthritis, hypertension, and kidney disease. These conditions are chiefly treated not in hospitals but in outpatient settings and by patients at home with prescription drugs.

So how are we dealing with this challenge? Poorly.

More than half of beneficiaries are treated for five or more chronic conditions each year, and a typical Medicare beneficiary sees two primary care physicians and five specialists working in four different practices. System fragmentation means that chronically ill patients receive episodic care from multiple providers who rarely coordinate the care they deliver. Because of this structural deficiency, patients with chronic illnesses receive only 56 percent of clinically recommended medical care. That gap in care may explain a nontrivial portion of morbidity and excess mortality.

Now before moving on, let’s note that Prof. Thorpe is a long-time adviser to Democrats on health care issues. The reason that’s interesting is that the solution preferred by the entire left wing of the Democratic Party is to force everybody into Medicare (single-payer solution) and the only solution Democratic moderates have proposed is demonstration projects run by Medicare (ObamaCare)!

I hate to be the bearer of bad tidings, but isn’t this like putting Bernie Madoff in charge of the SEC? Although these reformers often call themselves “progressives,” they are really reactionaries. Their model for the future is the failed system of the past.
Continue Reading at the John Goodman blog.

The Pro-Life Fraud in the Nuclear Option

The Heritage Foundation says that there’s some mischief afoot regarding funding of abortion in health care reform:

A procedural fraud is being foisted on the American people. A wrinkle in the Obamacare Nuclear Option will allow pro-life Democrats to vote for taxpayer-funded abortion language, while being able to claim they never voted for it.

For more, see The Foundry blog, but I’d hope that pro-life members of Congress would have the loyalty to their position to not give in to such a gimmick.

Federal Rules Threaten Your Privacy

Upset that companies are buying and selling your personal information? Then consider the threat that the federal government poses to your medical privacy.

The Institute for Health Freedom explains the latest move, in a press release:

The proposed federal rule to create and exchange electronic health records without patients’ consent threatens Americans’ health privacy, warns the Institute for Health Freedom.

If adopted, the rule will provide higher federal payments to doctors and hospitals for creating and exchanging electronic health records (EHRs), and in a few years will actually penalize doctors and hospitals that do not do so.  It will affect all types of patients, not just those on Medicare and Medicaid.  Patients’ consent is not required before their personal health information is compiled and shared electronically for many purposes.

The Institute for Health Freedom encourages Americans to submit their comments about the proposed federal rule before the March 15 deadline. It’s important to note that:

More than 600,000 physicians, hospitals and other providers (chiropractors, dentists, optometrists, and podiatrists) — and their patients — will be affected.

Patients’ consent will not be required before personal health information is compiled in EHRs and exchanged electronically with many third parties including government agencies. The data will include weight, body mass index, race, ethnicity and other key pieces of highly personal information.

Doctors will have to spend about $54,000 each to purchase certified EHR technology and approximately $10,000 annually for maintenance.

Doctors will be financially rewarded for using electronic health records and could be paid up to $41,000 over five years for using such records. Then they would be penalized after 2015 if they don’t create electronic health records and exchange information as required by the Centers for Medicare and Medicaid Services.

The Congressional Budget Office estimates that adopting health-care IT will reduce costs in the health-care system by only 0.3 percent during the 2011-2019 period.

A summary of the EHR rule’s implications on privacy is posted here: http://www.forhealthfreedom.org/Newsletter/March2010.html

A copy of the proposed federal rule is posted here: http://www.forhealthfreedom.org/BackgroundResearchData/EHRs/EHR_IncentiveProgram_ProposedRule.pdf

Individuals and organizations should submit their comments online here by March 15 (by 5 PM ET): http://www.regulations.gov/search/Regs/home.html#submitComment?R=0900006480a7c4a8

For more information see the Institute for Health Freedom’s website: www.ForHealthFreedom.org