Commentary:

For up the minute reports on the Senate Healthcare Bill:  this WSJ article is a great one.  In broadcasting support, Obama said that this Bill will reduce costs:  "Anyone who says otherwise simply hasn't read the bills," as Obama said over the weekend.

This is so utterly disingenuous that we doubt the President really believes it.  Anyone who has read the Bills will attest that this is not a cost reduction, but a huge entitlement program.   Are you aware that the Medicare Bill was 256 pages long, and this Senate Bill is nearly 2100 pages long.  This is a huge increase in bureaucracy, cost, disincentive for cost reduction, etc.  

We started the reform process with a need for covering the uninsured and reducing costs.   We now have a Bill that expands entitlement, makes insurance a public utility, takes more decisions out of the hands of the doctors and patients, and reduces competition.  The talk of death panels seems so long ago, but what is real about this Bill is that it will cost many lives.  

It will curtail or at least damage the medical innovation effort, and for example will "destroy over 200 of America's best and safest hospitals, says Physician Hospitals of America says about ObamaCare."  Eugene Steuerle of the left-leaning Urban Institute points out, Obamacare is "a new welfare and tax system".   The 60th vote, Sen Nelson of Nebraska, was bought by exempting his State from future Medicaid increases. 

So the legislative process is corrupt, the Bill is flawed in most ways, and the liberals praise it as a historic moment.  This is historic as Strassel in WSJ, not a favorite of liberals, looks at what this Bill means in the longer term case for liberalism and bigger government:   

So why the stubborn insistence on passing health reform? Think big. The liberal wing of the party—the Barney Franks, the David Obeys—are focused beyond November 2010, to the long-term political prize. They want a health-care program that inevitably leads to a value-added tax and a permanent welfare state. Big government then becomes fact, and another Ronald Reagan becomes impossible. See Continental Europe.   The entitlement crazes of the 1930s and 1960s also caused a backlash, but liberal Democrats know the programs of those periods survived. They are more than happy to sacrifice a few Blue Dogs, a Blanche Lincoln, a Michael Bennet, if they can expand government so that in the long run it benefits the party of government.

Henninger puts it further in historical perspective as to how many times liberals have tried to nationalize healthcare.   Reagan warned that socialism will attack healthcare first.  

It is a sobering moment in our history, and one we will not look back up with pride or hope.

Shikha writes in Forbes:  "What the Medicare buy-in idea reveals is that the left cares little about who it tramples in its health care battle so long as it can keep marching toward socialized medicine. Americans can sense this triumph of ideology over humanity, which is why they are abandoning Democratic reform efforts in droves. If Democrats want to win them back, instead of ramming something through the Senate as they are hoping to do, they ought to pause till they recover their moral compass. Otherwise, they will have a hard time finding their way back to Capitol Hill next November."

The Reid or Senate Bill however remains quite scary even without the Public Option and the mandates and panels established. See NCPA's analysis for details. The strategy, as was suggested, might have been all along to have easily removable parts, so as to forestall debate on the core provisions of mandatory coverage and subsidies.   This Bill remains a huge entitlement program that will be very costly.

One is left with the inevitable conclusion that the agenda is about government price fixing of prices in healthcare, and ultimately a single payer system, like Canada's.  There is no cost reduction incentives, but rather more bad incentives in any of these Bills.   This is the largest entitlement program in modern times.  Henninger writes in WSJ:  "ObamaCare and the Liberal Obsession - Every Democratic president since FDR has failed to pass national health insurance. The current legislation in Congress is likely the last chance to enact it."  Detailed in the video at right, is a sobering statement about liberal values and intent.

Jonathan Bush, chairman and CEO of Athenahealth, a major player in information technology services for physicians writes in WSJ: "And these princes, they mean well and they're lovely," he says, "but they're living in this alternate universe where there's no such thing as a market in health care and they don't understand why one might be remotely useful."  He pauses. "That's weird to me."

Nice to see an industry figure actually comment on the lack of a market in healthcare.

This is a historic moment, for we are at the precipice of becoming France in so many ways, all negative.  We are seeing a borage of tax increases being proposed, from taxes on medical devices, to taxes on VC income, to a repeal of the death tax.   Henninger writes in WSJ this past week, that this time is more than historic.  It is transformative in a bad way:

"Set aside income taxes as the unransomed hostages of progressive dogma. Justify this: The Senate health-reform bill imposes a $4 billion annual excise tax on medical devices and diagnostic equipment. In a slow-innovation economy, which is what we have now, medical and diagnostic miracles sit at the intersection of American science, technology, education and IQ. That stuff defines American entrepreneurship and ingenuity. If the Obama Democrats will tax these people, they'll tax anything that produces income, no matter how innovative or job-creating.

The Obama bet is that the U.S. can be a Franco-German welfare state, with a mammoth public sector, and still compete with China, India, Brazil, Korea and the rest. This is a pipedream. We are going to spend four years treading water. If we tread quickly enough, we may get enough growth to save the Democrats, but not the nation."

News Bytes:

The so-called Reid Bill is well along in the negotiations process, in the attempt to find 60 Senators to approve and avoid the Bill-killing filibuster. In an attempt to garner support and keep some semblance of the Public Option alive, there have been various compromises and modifications.  No details yet on the specifics or the CBO cost estimates.

CEO's are beginning to see how negative these ideas are for their business, as evidenced in this WSJ article.

Great video from Reason, a summary of what is being proposed and what should really happen.

Reid Bill:   Budget gimmicks in the Reid Bill are reaching new highs of deception.   What if one accounted for the cost of these gimmicks and computed the real cost of this Bill.  Cato has done this and $6.25T is the estimate.    Someone thought they were buying a Ferrari, and they ended up with the used Yugo.

Further dissection of the deception was detailed by WSJ:  it is not about cost savings, it is about putting Washington in charge of health insurance, at any cost.

Well the 11th hour for putting Obamacare into effect is upon us.   The Reid Bill will now be debated on the Senate floor.   There are a number of issues ahead, but it appears that the payoffs have been made and the ducks lined up, for the most part.   We will see.   Shikha reports.

What is in this Reid Bill is more of the same old things that have been discussed in the House Bill and other Bills.   It has a mandate for all to buy insurance, plenty of subsidies, a increase in Medicaid, reduction in Medicare, and a lot of other egregious things like the public option and loss of privacy.  Have a look at these two articles on the invasive aspects of this and the other Bills.

The head of Harvard Medical School gives Obamacare a failing grade for all of the right reasons.

Senator Dodd pronounced that "this is America, we should have rights, not all of them, but certainly healthcare for everyone."  Many things could be said about this statement including the essential factor that he and others will decide what are our rights.  The essential rights by now should be clear, in this country's history and development. Certainly the lack of ethics is apparent in implying that anyone has the right to someone's else's wallet.  I thought we had rights to basic freedoms.  Apparently I am mistaken, for increased entitlements is the goal here. 

From WSJ:  Another Tax idea in the Reid Bill:   "Another day, another tax increase to finance the trillion-dollar health-care overhaul.

Just what an economy with 10.2% unemployment rate needs: Another tax on hiring.

The versions leaked so far would add as much as 0.5% on workers who earn more than $200,000. If assessed on both the worker and employer, this would increase the Medicare tax rate to 3.9% from 2.9% today. It would also create the first progressive payroll tax in American history, with wealthier workers paying a higher Medicare payroll tax rate than lower income workers.

Until 1993 the Medicare tax was capped— the Social Security tax still is capped at $106,800 this year—because Medicare was supposed to function like an insurance program. For example, the rich don't pay more for auto insurance than the poor do. But Democrats lifted the cap with their 1993 tax increase, so the Medicare levy now amounts to a marginal rate tax on every new dollar of wage income. Mr. Reid's payroll surtax would sever the link between the tax paid over a lifetime and the medical benefits received, officially making Medicare an income redistribution program."

Polls: Most recent survey results show a sharp decline in support for Obamacare.  Rasmussen reports:   "Just 38% of voters now favor the health care plan proposed by President Obama and congressional Democrats.  That’s the lowest level of support measured for the plan in nearly two dozen tracking polls conducted since June.

The latest Rasmussen Reports national telephone survey finds that 56% now oppose the plan."

Polls continue to show degrading support of Obama:  "The Rasmussen Reports daily Presidential Tracking Poll for Tuesday shows that 27% of the nation's voters Strongly Approve of the way that Barack Obama is performing his role as President. Forty-two percent (42%) Strongly Disapprove giving Obama a Presidential Approval Index rating of -15. This is the lowest Approval Index rating yet measured for President Obama (see trends)."

Panels, Business models:  Mammograms being discouraged by a Fed panel caused some deserved controversy.  It shows how a bureaucracy is the wrong way to handle a personal decision.   The Mayo Clinic and the Previous head of the NIH are against these findings from the panel.  This panel will be used as the source of rationing in the near future with Obamacare, and that is what makes this issue of breast exams so interesting.

Do remember that in both of these Bills the benefits are delayed for 4-5 years while the cost is incurred immediately.   These are massive tax programs, government control takeovers, and do not solve the questions regarding bending the cost curve down or covering the uninsured.  And just when some were hoping that the CBO cost estimates are factual, we are reminded that the history of Gov predictions is often off by not just a few %, but sometimes by 5 to 10x. 

Don't you love these politicians who say "but this Bill is paid for", in referring to the idea that the CBO analysis determined with great caution that the Bill would not increase the deficits, wink, wink.   Paid for the people who now have to foot the bill, when they should be foot kicking the Bill.  

A factory model for hospitals in India is cutting costs.  Next stop medical tourism in the Cayman Islands.   Good investment:  condos in the Caymans.

From a WSJ article:  "A 2006 survey of CEOs by the Conference Board, an organization that collects and analyzes business information, reported that wellness programs yield up to $5 of health-care savings per dollar invested. CEOs noted that awarding employees who drop weight with cash, extra vacation days, and insurance rebates has helped them reduce their health-care costs. And no doubt such incentives could work on a national scale with insurers offering reduced premiums or rebates to individuals who maintain a healthy weight. But the House health-care legislation prohibits such incentives because it is "discriminatory." "

Overview on Healthcare Reform:

Politics:  Her vote bought, the Louisiana Democrat Senator Mary Landrieu proclaimed:  "I will correct something. It's not $100 million, it's $300 million, and I'm proud of it and will keep fighting for it," she told reporters.   Corruption is a tag that applies only to those not in power.

You know it is just one in so many that would benefit from that treatment, so why not just increase the age for mammograms?  This question was answered by a Fed Advisory Panel, writes the New York Times.  Seems innocent enough, right?  I have a friend who would have likely died if this was a requirement.  It points clearly to the need for individuals to be in charge of their own health, with their doctor's assistance.  To turn this over to a central panel as with the Bills passed in the House and the one in the Senate, is simply unacceptable.

Will fear work to stave off this nationalization of healthcare?    Seems as though the Republicans want to focus on this mechanism.   Shikha comments on seizing the moral high ground instead.

Incentives:   Again the incentives are being further unbalanced and that can only move us further away from having the best incentives for cost reduction and quality enhancement, while also insuring that we can take care of those who really need healthcare assistance.   The skew in incentives is the real problem in healthcare today, and these Bills make it much worse.

Comments:  Let everyone know what you think!

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