Health Care: March 2010 Archives

Reading and watching the reactions to the passage of ObamaCare has been educational if for no other reason that it illustrates the differences between those supporting the poorly thought out piece of legislation and those opposing it. Probably the biggest difference has got to be an understanding of economics in regards to the Law of Unintended Consequences. Those supporting ObamaCare (primarily the Left) apparently have a poor or non-existent understanding of economics or the effects of laws, taxes, spending, and mandates. Those opposing it (primarily the Right and the Center) understand economics all too well and particularly in relation to ObamaCare. They also understand the aforementioned Law of Unintended Consequences and how it is already coming into play.

The first and most profound effects will have far-reaching consequences, with large companies like Caterpillar, Verizon, and AT&T having to pay hundreds of millions, if not billions of dollars they might have used for other expanding their businesses and hiring more people. Of course I expect the Left to say it's all smoke and mirrors and that heartless businesses are just using this as an excuse to hurt their employees. (Yeah, like successful businesses will purposefully hurt the very people they need to remain successful.) They don't understand that when you take that kind of money away from businesses they'll have no choice but to react in ways that will allow them to survive.

Another unanticipated effect of ObamaCare: Retirees presently receiving prescription drug benefits from their former employers may lose that coverage and be forced to convert to Medicare Part D. Why? Because ObamaCare just made it far more expensive for the former employers to keep providing the benefits by adding billions in new taxes on those benefits, which is one heck of a disincentive to keep doing so. By not providing this benefit they won't have to pay the taxes. It also means the government won't collect the billions in new taxes they expected and they'll have to spend billions more to cover the now benefitless retirees. Between the lost revenues and the new expenditures the government will come out the loser on this, meaning the rest of us will have to make up the difference. We just don't know exactly how it is we'll be paying for it but it won't be cheap.

Another not so unexpected unintended consequence: Some of the very people we'll depend on to provide all this health care will bail out of the medical profession because they'll be heavily taxed on their income, won't be the ones deciding what care their patients require, and won't be reimbursed enough by Medicare to cover their costs under the 21% cut in Medicare payments that are part of ObamaCare, just to name a few. This is the same thing that happened in the UK and Canada when their governments took over control of health care - doctors and nurses left the profession or left the country and practiced the United States.

Will ObamaCare initiate a rebellion among health care professionals as has happened in Canada, where some doctors have refused to take 'national insurance' and opened private cash-only clinics? Some practitioners here in the US have already shed themselves of the headache of health insurance, taking cash-only patients and/or offering concierge medical services (patients pay an annual retainer in return for a certain number of visits and services, which in the long run can be cheaper and easier than insurance).

In light of this I have a question for the ObamaCare proponents - Just because an additional 30 million people lacking health insurance will get it in the not so near future, what makes you think there will be any doctors willing or able to take them on as new patients?

Some may claim the only reason doctors will do something like that is because they're greedy bastards who really don't give a damn about patients, only about money.

A lot of the times, they offer treatments and surgeries for cancer or whatever that might cost $200,000 and they KNOW that they will only help the patient live MAYBE 4 months longer. The doctors have seen it happen over and over. It sure does make you wonder if the doctors are offering these treatments more for THEMSELVES financially or for the good of the patient.

A response to this piece of ignorant crap came from Dr. Ann Contrucci, MD, a pediatrician in Atlanta, Georgia:

Mr. Foster, I don't believe I saw M.D. behind your name? For those of us real doctors who assess real patients and make decisions regarding their treatments, your comments are nothing short of arrogant and insulting. Did you look this stuff up on, I'm sure, a reputable medical website so now you "get" what a doctor does and understand how he or she makes decisions? Do you actually have ANY idea how we make medical decisions? Do you have any idea what kind of education, training, and experience makes up what we do? We are given one of the biggest, if not the biggest, responsibilities of any job known and that is to heal. Unfortunately, despite even our best treatments sometimes, that is not the case. That is because medicine is still an art and not 100% exact science...therefore, bad outcomes still result. What used to be accepted as part of the circle of life is no longer so. Now it is patients coming in demanding this or that test, this or that medication because they "saw it on TV" or read it on the internet. If something bad occurs, well it must be the doctor's fault. There is no trust in physicians and with the bottom dwelling plaintiffs' attorneys lurking, frankly there isn't much trust in the patients. If I had a dollar for the number of times I've heard, "if you don't do the CT scan, I'm going to sue you," I'd be one of those "rich doctors" I always hear about. Funny, none of the docs I know are those "rich doctors."

I canNOT believe you would actually think that "doctors are offering these treatments more for themselves financially..." If you actually think that most physicians are of this mindset, you are a sick, sick man and there is no hope for you. Thank God you didn't go into medicine!

Here's the "DIRTY LITTLE SECRET" - physicians want to do the right thing for our patients, we do our best every day under, oftentimes, extreme circumstances and in stressful, chaotic environments with a risk to benefit ratio that is nearly always not in our favor. We do all of this while being held to an impossible standard of accountability while the politicians who are making all the decisions have none whatsoever. Perhaps your time would be better spent looking into those dirty little secrets... By the way, I truly hope that you or no one in your family every needs a physician's services for anything - you really wouldn't want to have to trust one of us to help you, would you? If, God forbid, you or someone you love has to be rushed to the ER for, say, a heart attack, what dirty little secret do you think your ER doctor will be harboring? Hmmm, I would bet that you will be given any and every treatment there is to SAVE YOUR LIFE! But that's just a guess...

Unfortunately the attitude of the first commenter, Dan Foster, is all too common, particularly among supporters of ObamaCare. As Dr. Contrucci says, too many people like Foster have no idea what is involved in becoming a physician and the pressure they're under every single day they're treating patients. The problem is there are far too many others out there with the same attitude as Mr. Foster, which might be why they support ObamaCare - pure ignorance. It would also explain why they have overlooked the unintended economic consequences of ObamaCare.
Resistance to ObamaCare at the state level is growing. AG's of a dozen states have already said they'll bring suit to the Supreme Court, challenging the constitutionality of ObamaCare, in particular the part making to mandatory for American citizens to purchase a service or be fined (or imprisoned). Some states are working on or have passed legislation negating that requirement, seeing it as a violation of the Commerce Clause and the Tenth Amendment.

New Hampshire State Senator Jeb Bradley has filed such legislation here in the Granite State, making mandatory health insurance illegal without due process, meaning a court could order someone to obtain it as part of divorce/custody/child support agreement, but only then.

I wonder if the Democrats, and specifically Obama, will get the message that this piece of legislation is hated by a majority of the American people. No need to answer that as we already know they know, but don't care.
Now that I've had a chance to cool down a bit and think more upon the effects of ObamaCare, I can see my initial thoughts about it were, if anything, far too optimistic.

While masquerading as a health care reform bill, ObamaCare is nothing more than yet another means to slowly achieve the socialist revolution rather than having to fight a bloody insurgent campaign. It's kind of like the old saw about boiling a frog - Don't drop the frog into the boiling water because he'll hop out. Instead, put him in a pot of cold water and slowly raise the heat. By the time he realizes the water is boiling he's already been cooked. And that's what ObamaCare is really all about, boiling the frog (or in this case the American people, our freedoms, and the Constitution).

Am I being paranoid? Could be. But the question I pose to myself is, am I being paranoid enough? Because when a bunch of progressive jerk with little true understanding of the American people, the American economy, or of the Constitution of the United States start dictating to us what is good and bad for us, it's time to take up arms, figuratively speaking, and disabuse them of the notion that they are somehow our betters. And if they still don't get it, then it may time to take up arms, literally.

The Democrats in Congress ignored the wishes of a majority of Americans. They only paid lip service to bipartisanship. (Their definition of bipartisanship is to tell the Republicans to sit down, shut up, and vote the way the Democrats tell them to vote.) While many on the Left will cite Social Security and Medicare as social programs people said wouldn't work and would severely damage the economy (which they both will unless both programs are revamped top to bottom), both of those programs had true bipartisan support. ObamaCare had absolutely none.

Well, maybe I should clarify something about that last statement. In actuality there was bipartisanship in regards to ObamaCare. Unfortunately for Obama it was bipartisan opposition to the bill.

Across America the response to the passage of ObamaCare was one of dismay, shock, and anger. Some few applauded its passage, loving the idea of a massively dysfunctional budget-busting government-run health care system. One commenter to this WSJ piece is not one of them:

I'm sure most Americans, or at least thinking Americans, those that considered their heritage one of freedom and liberty, had already condemned Obamacare on a gut level from the start, as they should, but probably few know the exact details of this gross unconstitutional intrusion into their lives and what it will mean to them. Here are the highlights divided into three lamentable categories: increased taxes and fees, spiraling costs, and reduced services.

Marc's comment, which is excerpted above, is rather extensive and covers the salient points of ObamaCare and its major downsides. As the saying goes, Read The Whole Thing.
It seems Nicholas Kristof is confused about health care reform, thinking it's all about making sure everyone has access to health care. Obviously he has not been paying attention to the debate or the proposed legislation.

Poor Nicholas. Apparently he can't tell the difference between access to health care and health insurance.

Everyone in America has had access to health care by law since the the 1980's. No one needing care can be turned away, even if they can't pay for it. ObamaCare has nothing to do with access, at least not directly.

According to the Democrats ObamaCare is all about is health insurance, something entirely different. Of course once everyone has insurance there will be an effect on health care access, just not the one they expected - there will be less of it. Doctors will be unwilling or unable to take on new patients, just like in Massachusetts under RomneyCare. So even if you have insurance there's absolutely no guarantee you'll be able to find a doctor to take you as a patient.

See the difference now, Nicholas?
In light of the increasing pressure from the President and the Congressional Democrat leadership to pass the overreaching and economy-busting health care destruction bill, a number of states have been proactive, working to short-circuit the Left's attempt to grab even more power over the lives of their citizens.

Idaho took the lead in a growing, nationwide fight against health care overhaul Wednesday when its governor became the first to sign a measure requiring the state attorney general to sue the federal government if residents are forced to buy health insurance.

Similar legislation is pending in 37 other states.

Constitutional law experts say the movement is mostly symbolic because federal laws supersede those of the states.

With Washington closing in on a deal in the months-long battle over health care overhaul, Republican state lawmakers opposed to the measure are stepping up opposition.

[Idaho Governor] Otter, a Republican, said he believes any future lawsuit from Idaho has a legitimate shot of winning, despite what the naysayers say.

"The ivory tower folks will tell you, 'No, they're not going anywhere,' " he told reporters. "But I'll tell you what, you get 36 states, that's a critical mass. That's a constitutional mass."

Considering Congressional Democrats and the President have been ignoring the will of a large majority of the American people, is it any wonder state legislators are taking measures to send a message to them, telling them we won't stand for having this version of health care reform shoved down our throats? The states are rebelling against the Left's arrogant belief that they know better than we what it is we need.

Throughout history such belief by the self-proclaimed elite has always led to grief, misery, and tyranny. They can justify any action as being for "the good of the people" even when it was only good for the elite. And so it is with Obama, Pelosi, Reid, and the other members of the Leftist cabal. They do not believe we are capable of running our own lives, that we aren't smart enough to make our own decisions, that if we don't follow their leadership that we must be deranged and need to forced to surrender our will to the State.

That's what this whole ObamaCare kerfuffle is all about - Power.

Procedural Differences?

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While browsing the news today, I came across an interesting story on Fox. Evidently, I must be old-fashioned. I always thought debate and free thought were integral parts of the American way, and all aspects were to be considered before a decision is made. Evidently, the President disagrees.

President Obama is not worried about the "procedural" debate over whether House Democratic leaders should go ahead with a plan to approve health care reform without a traditional vote, he told Fox News on Wednesday. 

Now this is interesting. Rather than just note that there are others (a majority, in fact) that happen to disagree with the President's ideas on socializing improving healthcare, he simply writes off this disapproval as a "procedural" event, almost as if those who oppose don't really oppose - they're just playing the part. This, in my opinion, just shows the true arrogance of a man who clearly does not see reality. I'm sure in his world this is a cut and dried deal, just waiting to be sealed with a tally. Unfortunately, for the millions of us who can't escape reality on Capitol Hill, things may be a bit different (like, really different... Really, really different).

President Obama is not worried -- and doesn't think Americans should worry -- about the "procedural" debate over whether House Democratic leaders should go ahead with a plan to approve health care reform without a traditional vote, he told Fox News on Wednesday. 

So, let's get this straight. The debate against your plans is just a "procedural" event; yet, your primary plan for passing this measure is bypassing the traditional voting method? Logic seems to be telling me that if there are only routine "devils-advocate" debates against you, why not put it up for a real vote, and enjoy near-unanimity? Oh, wait. They can't do that, because the debate is real. I'm sorry, but when your voting tactics are raising legal questions, one of your own floors' whip is in disagreement with your methods, a 12-point margin is calling your plan an outright "Bad Idea", and you have to come eerily close to buying votes, it may just be time to give it up.



A Bad Model

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Following up on this post, particularly the additional information about ObamaCare Lite (also called MassHealth and RomneyCare), it this op-ed piece from the Wall Street Journal, covering the abject failure of 'mandatory' and subsidized health insurance in the Commonwealth of Massachusetts. ObamaCare used this as a model. Unfortunately it's a bad one.

As one commenter put it:

That RomneyCare is no better than ObamaCare should be undeniable. The chief problem with health care is COST. The second and third most significant problem with health care is COST and COST. Litigation drives cost, defensive medicine drives cost, bureaucracy drives costs, a price regulated public marker drives up costs in the private market, shortages of primary care physicians and nurses drives up costs, complex regulations which prevent an emergency room from sending a non-emergency patient to urgent care or a retail clinic drives up costs, mandates drive up costs...

The other problem with ObamaCare is that no one knows what the real goal is. At first it was the uninsured, then it was health care itself, then it was insurance reform. Not once has one elected member of government said in once concise statement what the goal is. Not once, and I think this is totally doable, has congress or the white house gone to the private market and said, price out the rates and benefits for the policies you intend to sell.

If the goal was reasonable access to quality health care at an affordable price that limited government and insurance company bureaucracy and maximized choice of plans and providers...then we could have a discussion...for example, what is reasonable access? What determines this? Most certainly it is not 44 days to get an appt with a primary care doctor!

'Nuff said.
Though he won the argument, he realizes it may not matter. He will not comply, however, if it's passed.

John Hood has been a policy wonk superstar for over twenty years now. He was a household name to me when I interned at the Cato Institute in 1990.
The machinations of the Democratic leadership has made me realize (yet again) that they truly have contempt for the people they profess they represent.

Rather than submit the Senate version of ObamaCare to a vote in the House, where every vote aye or nay will be recorded and become part of the public record, they want to use the so-called Slaughter Rule to avoid actually having to show their constituents whether or not they voted in favor of the Obama Health Care Destruction bill.

They must believe we won't figure out this bit of legislative legerdemain and know who really supported this piece of legislative manure. It's not like it will save them from the rage of those of us who voted them into office. We're already pissed off enough at them that we'd like to fire them now. (This means you, Carol Shea-Porter.)

Nancy Pelosi is crowing as if she's already won, claiming ObamaCare will cure the lame, allow the blind to see, all while costing us less money, and raise Obama to the level of deity and shepherding the Democrats to permanent power. (Well, three of the five are hyperbole...maybe, but I know she believes the last two.)

But there are far too many examples to illustrate that government control of anything is fraught with corruption, fraud, and endemic institutional inefficiencies. Health care will be no different, claims by the Wicked Witch of the West notwithstanding.

Before casting "yea" votes in favor of a government health care grab later this week, wavering House Democrats may want to struggle out of the left's ideological fog for a moment and consider the sad, but instructive, tales of the U.S. Postal Service and the city of Detroit. Both are poster boys (excuse me, poster persons) for how government can get almost anything gloriously wrong.

That the U.S. Postal Service is swimming in red ink isn't news. The important news to Americans as they follow Washington's three-ring health care circus is that U.S. Postmaster General Joe E. Potter wants to drop Saturday mail delivery as a cost-cutting measure.

Imagine a hamburger joint announcing to its customers that it plans to stop selling hamburgers a day or two a week to cut costs. Of course, a hamburger joint wouldn't limit the sale of hamburgers to keep its costs down. The guy who owns the hamburger joint would get creative in his marketing and pricing to sell more hamburgers. He might trim costs operationally but not at the expense of selling as many hamburgers as he and his help could flip. Why the difference? The hamburger joint can go out of business. The U.S. Postal Service, being immune to risk, cannot.

Just like the nation's postal service, if enacted, government-run health care will eventually have to limit access to services in an attempt -- however vain -- to contain costs.

There are plenty of other examples showing why government shouldn't be running anything as important as health care. Two quick examples: Medicaid and Medicare.

If we need another example, all we need to do is look at Detroit, a shining example of decades of liberal Democrat policies.

It's an economic basket case, much like Michigan, only more so. It's population is half what it was at its peak. Entire neighborhoods are abandoned, like modern day ghost towns. While some might blame the downturn in the economy, and particularly the auto industry, for its decline, plenty of other American cities have seen their primary industry or industries disappear, but they have thrived in spite of it. But Detroit's government has made sure that wouldn't happen, killing off any chance for economic revival.

Detroit is a sump of corruption, high taxes, and tangles of red tape. Public schools are mostly warehouses for poor minority kids (provided those kids even show up for school). Crime, principally drug-fueled, is endemic. The middle classes -- mostly white, but not all -- have long voted with their feet, seeking safety and stability in Detroit's suburbs or by scooting off to Sun Belt locations.

Consider the universals in government failure. The order will vary from failure to failure, but here goes: 1) corruption; 2) waste and fraud; 3) ballooning costs, higher taxes, and mountains of red tape; 4) sorry management with little or no attention to the bottom line; 5) few (if any) penalties for failure; and 6) big time union involvement, which factors adversely into any of the first five elements.

With all the manifest failure, what's Detroit's liberal establishment's response? Does the establishment make a mea culpa, renouncing the policies and programs that have laid low Detroit? Is pro-growth/pro-family reform -- not the cockeyed liberal variety -- on the lips of Detroit leaders? Where are the big brooms to sweep corruption out from every nook and cranny of government? Why aren't Detroit's leaders standing up to the unions and telling them in no uncertain terms that their days of privilege are over?

And just like Detroit, when government-run health care begins to fail, how will Democrats respond? Will Democrats own up to their failure or will they concoct a bunch of government-centered fixes? When those fixes don't work, as liberal fixes haven't worked in Detroit, then what will remain for Democrats to do? Smartly manage government-run health care's decline and failure?

Despite this and plenty of other examples, the Democrats insist only their way - the Big Government way - can possibly 'save' health care in the US. Never mind that a large majority of the American people don't want this monstrosity, though they do want some kind of health care reform. Never mind that government has a very poor track record managing anything. And the bigger the thing it manages, to poorer the job it does. Since health care is one-sixth of our economy, I expect it to do an exceptionally poor job of it. All we'll get out of this deal is poorer quality health care at many times the existing cost.

How is it again the Democrats expect us to be happy about this? Actually, they don't. They want us to stay home, shut up, and do what they tell us to do because they're the only ones qualified to make our decisions for us.

Yeah. Right.

UPDATE: Massachusetts State Treasurer Timothy Cahill is slamming ObamaCare, saying "If President Obama and the Democrats repeat the mistake of the health insurance reform here in Massachusetts on a national level, they will threaten to wipe out the American economy within four years."

He should know, seeing as ObamaCare Lite is crushing the Bay State, costing far more than projected and still not covering everyone as it was designed to do.
about this.

I was given some garbage political talking points by the nice young liberal male on the other end about her efforts to relieve doctors of their onerous school loan debt and to create more doctors in rural areas.

Count me as unimpressed.

HT: Hugh Hewitt
I've seen Reich taken to task before by real economists. Robert Barro of Harvard just embarrassed him on the PBS NewsHour way back on September 14, 2004. Reich has a Harvard Law degree, that's it.

But this is something to remember for a long time. Ah, those moments of clarity.
This is gross.

One in six Americans between the ages of 14 and 49 have genital herpes and close to one in two black women are infected, new figures from the CDC reveal.

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