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Oct 2: Deal with Pharma sticks and avoids a vote to amend the deal but by Obama. These comments are by Kate Pickert: "Nelson's amendment would have gutted a deal struck earlier this year between the White House and pharmaceutical companies. Although the amendment failed to pas, Nelson got the support of nine other Democrats; all 10 Republicans, plus Baucus and Democratic senators Thomas Carper and Robert Menendez voted against the proposal, which in effect, leaves the White House deal in place - for now.
As I wrote in an earlier post when Nelson first offered the amendment on Tuesday, the White House deal with PhRMA essentially calls for drug companies to cut prices on name brand drugs by 50% for seniors stuck in what's known as the doughnut hole, a gap in prescription drug coverage. (The deal is written into the current Baucus bill.) PhRMA also agreed not to oppose health care reform and to, in fact, wholeheartedly support it with cold hard cash in the form of advertising and lobbying. In exchange, President Obama - who appeared at a press conference with AARP and Baucus to announce and endorse the deal - reportedly promised the industry would not have to weather any more cuts. The deal, struck in June, had one further purpose - to publicly show early in the health reform debate that special interests were "coming to the table." In essence, the White House was trying to send a signal to other special interests that if they wanted to escape the wrath of Democrats writing health reform legislation, they had to step up to the plate early.
Debate over Nelson's amendment today, however, did not get as heated as on Tuesday, when Grassley said Democrats should be "embarrassed" by Obama for cutting the deal with PhRMA. Today, as the senators calmly laid out their positions on prescription drug coverage, they even offered advice on their favorite methods for lowering cholesterol. Democrat Chuck Schumer said Lipitor works for him, while Grassley said he likes Omega-3 pills, to which Nelson quipped that grapefruit might work just as well."blog comments powered by Disqus
Sept 30: Much is being said about the public option, but COOPs are perhaps going to pass anyway, and this just a slower path to having the government control healthcare. What single payer is, the ultimate goal of a liberal, is simply wage and price controls for healthcare. I do not think that Americans would want the government in this position, and so the inevitable change-politics of Obama seems quite apparent. If healthcare is better off with government in control, what is to say that this could not also extend, for instance, to energy. Maxine Waters, a liberal from Calif (I am sorry to say), had few things to say about how she might advocate nationalizing the oil industry. The tactics of calling everything liberal socialism wears us all a bit thin, but when the shoe fits..well.
Sept 29: The Public Option came up for debate today again. Again it went done to defeat in two committees. Why is the notion of increasing competition between insurance companies by removing mandates, State and Federal, to restrict access by anyone to any policy sold in the country? This lack of logic is overwhelming.
Tort reform seems to just not be possible, despite the overwhelming support within the population. Howard Dean sometime ago said that this is due to the idea that Congress is not willing to go up against the trial lawyers. This further places the citizen and the needs of reform lower and lower on the list of groups to be considered. Clearly this issue, as with so many in healthcare, needs to be thought through carefully. There is however an opportunity to take small steps and do serious pilot programs to assess.
The myth of no tax with mandate should be clearly established now with the following article below from WSJ. Doesn't this point out the danger of bending the truth. Shouldn't Obama have said in the beginning that he was committed to solving the key issue, of truly bending the cost curve? Instead he tried to hit a home run and guarantee no tax increase. Now he looks foolish and not presidential.
"President Obama's effort to deny that his mandate to buy insurance is a tax has taken another thumping, this time from fellow Democrats in the Senate Finance Committee.
Chairman Max Baucus's bill includes the so-called individual mandate, along with what he calls a $1,900 "excise tax" if you don't buy health insurance. (It had been as much as $3,800 but Democrats reduced the amount last week to minimize the political sticker shock.) And, lo, it turns out that if you don't pay that tax, the IRS could punish you with a $25,000 fine or up to a year in jail, or both.
Under questioning last week, Tom Barthold, the chief of staff of the Joint Committee on Taxation, admitted that the individual mandate would become a part of the Internal Revenue Code and that failing to comply "could be criminal, yes, if it were considered an attempt to defraud." Mr. Barthold noted in a follow-up letter that the willful failure to file would be a simple misdemeanor, punishable by the $25,000 fine or jail time under Section 7203.
So failure to pay the mandate would be enforced like tax evasion, but Mr. Obama still claims it isn't a tax. "You can't just make up that language and decide that that's called a tax increase," Mr. Obama insisted last week to ABC interviewer George Stephanopoulos. Accusing critics of dishonesty is becoming this President's default argument, but is Mr. Barthold also part of the plot?
In the 1994 health-care debate, the Congressional Budget Office called the individual mandate "an unprecedented form of federal action." This is because "The government has never required people to buy any good or service as a condition of lawful residence in the United States."
This coercion will be even more onerous today because everyone will be forced to buy insurance that the new taxes and regulations of ObamaCare will make far more expensive. Too bad Mr. Obama's rhetorical tax evasion can't be punished by the IRS."
Sept 28: The poll numbers from Rasmussen show a further decline in support for Obamacare:
"Just 41% of voters nationwide now favor the health care reform proposed by President Obama and congressional Democrats. That’s down two points from a week ago and the lowest level of support yet measured.
The latest Rasmussen Reports national telephone survey finds that 56% are opposed to the plan."
The box of do ability and support within Congress and the Special Interests for the Baucus Bill seems also to be shrinking. It seems that the Insurance Industry wants higher penalities for not buying insurance, in order that folks do not just opt into insurance when they are sick. On the other hand, liberal organizations, like moveon.org, see this Bill as is as a large gift to the insurance industry. Is it just me or have we forgotten what problem we are trying to solve here.
Gen Powell commented at a recent meeting that "socialized healthcare systems cost half of ours." Seems simple enough, just socialize the healthcare system. Why stop there. Why not socialize manufacturing if it is more effective? Clearly the issue in healthcare in this country is quite constrained by the fact that the system is already socialized in the worst way.
Kim Strassel offers another very insightful analysis of the politics of healthcare reform. It is quite apparent that the next 6 weeks, leading up to the elections in Virginia, will be a key time. It could very well be that the Democrats will loose in a manner to slow the enthusiasm for Obama's statist agenda.
Sept 24: A head of a Foundation comments on the FDA and its refusal to approve a drug, Yondelis, that seemed to be on track and showed good promise in the fight against rare cancers for women: "Those of us in the rare-cancer community were sickened by the fate of Yondelis. Women's gynecological cancer has always been an afterthought to drug developers. The more drugs we have to fight these diseases the better.
This episode shows that a healthy dose of reform is needed in two areas at the FDA Office of Oncology Products. The first reform is that the FDA should tell the sponsor exactly what is needed for approval. A concrete measure of efficacy should be added if doubts exist about toxicity.
The other area is reform of the manner by which the cancer panel is chosen by the FDA cancer director in the first place. Given the life and death importance of the issues, there should be a more independent process to assure that the "jury" has been selected fairly, so that, when needed, truth can be spoken to power. A truly independent and impartial ODAC, critiquing both the regulated and the regulators, is the best way to show that the FDA is secure in its science. That will help restore public trust in this important institution."
It does seem that the political risk aversion strategy of the FDA is out of line when it comes to really maximizing lives saved, but also does this portend the condition of politics over care in a national healthcare program like Obamacare?
Henninger of WSJ again puts the political intent and struggle into perspective, in today's WSJ. He writes that not only does the context for Obamacare go way back, but that its underlying intentions should be in question: "... that the national health insurance movement rose alongside a larger transfer of responsibility from the family to the state: "Every time the state assumes an additional function such as health insurance, child care or benefits for the aged, the need for close family ties becomes weaker."
But even the state must bond: "It may be that one of the most effective ways of increasing allegiance to the state is through national health insurance." This would have been Bismarck's purpose. "We live at a time when many of the traditional symbols and institutions that held a nation together have been weakened and fallen into disrepute. A more sophisticated public requires more sophisticated symbols, and national health insurance may fit that role particularly well." Updating the public symbols, Mr. Obama says health care is one of the two "pillars" of U.S. prosperity in the 21st century.
Profs. Marmor and Fuchs support Mr. Obama's broad health-insurance goals. But their thoughts suggest why many Americans would resist the pull of what Congressman Pete Stark has called "Medicare for all."
For liberals, ObamaCare is the Gunfight at the OK Corral, the last battle for universal insurance. After 70 years and the Obama media blitz, the public once and for all either wants this, or doesn't. If it doesn't, the Baucus bill will be crammed down via reconciliation. If so, the post-partisan president may make worse, if that's imaginable, one of the most partisan periods in our history."
Sept 23: Intimidation and dishonesty - apparently those have become accepted tools in any political campaign. Baucus ratcheted up a notch on seeking censure of communication from an insurance company. WSJ reported that Humana Insurance in notifying its customers that the Medicare Advantage program was likely to be cut, prompted this response from him:
" "It is wholly inappropriate for insurance companies to mislead seniors regarding any subject—particularly on a subject as important to them, and to the nation, as health-care reform," Mr. Baucus said in a statement yesterday, playing the role of Congressional censor. "The health-care reform bill we released last week strengthens Medicare and does not cut benefits covered under the Medicare program—and seniors need to know that."
In fact, the Baucus draft legislation slashes $123 billion over the next decade from Medicare Advantage, which Democrats hate despite the fact that almost one-fourth of beneficiaries have chosen it over traditional fee-for-service Medicare. One reason seniors like it is because private insurers focus on quality and preventive care and try to manage benefits, as opposed to simply paying bills.
A new study from America's Health Insurance Plans, the industry trade group, finds that seniors on Advantage in California spent 30% fewer days in hospitals over fee-for-service patients, based on federal data. Democrats say that insurers are "overpaid," but the cuts—as Humana correctly noted—mean that seniors may lose this coverage.
Mr. Baucus doesn't want seniors to be educated about these facts, and obviously he's willing to use his enormous power to punish any private company that doesn't affirm his, well, creative version of reality. Nearly half of Humana's yearly revenue comes from Medicare Advantage, and the insurer says that it is complying in full with the CMS investigation. Yesterday, the agency also barred all Advantage insurers from providing similar information to their beneficiaries."
Sept 22: If you have not seen Kaiser's website on preventative medicine, check it out.
PBS ran a segment on the Newshour on the mandates. It is in part an answer to the WSJ Journal article on the "Obama Nontax Tax". Cannon from Cato was part of the interview and was paired off with a MIT Professor who had contributed to the healthcare mandates in Massachusetts. You can view the segment online at this link.
The upshot of the issue and discussion is that a mandate is required if you want to have all of the folks buy insurance. Obama makes the claim that we all pay more for insurance since some do not buy it. This makes no sense mathematically since uncompensated care only constitutes 2.2% of the total. However if one wants to insure all without concern for pre-existing conditions, then an insurance mandate is required otherwise folks would take out insurance just after becoming sick, which of course they may still do. So in reality it is a tax to fund the "no pre-existing conditions" requirement.
A better way to handle this would be to pool the ones with pre-exisitng conditions and process them with a larger cost to them and perhaps to the community, if that was necessary. There needs to be a added cost for not having insurance, which under any of the Bills from the Democrats, is not the case. Otherwise, once again the incentives are wrong, on top of all of the other bad incentives.
Sept 21: NY Times wrote: "No other president has been a guest on so many Sunday talk shows at once, which signaled how much Mr. Obama wanted to reclaim the health care debate and persuade skeptics that his plans would not increase taxes on the middle class. But for so well-spoken and confident a president, the lack of spontaneity on Sunday was striking. So was the homogeneity: Mr. Obama appeared on Univision, but he drew the line at Fox.
Viewers have grown accustomed to the drama of live politics. Sunday looked more like a string of TNT reruns, an Obama health care overhaul marathon."
One can wonder how much longer he will hammer on the same message: I know best for the American people despite what they think. Even the NY Times is beginning to pan the presentation.
NY Times came out in favor of a change in the fee for service model for healthcare, as if this was the silver bullet. An author writes in answer to this claim:" NY Times wrote: "The Obama administration ... needs to cut the cost dramatically. This can be done only by abandoning the fee-for-service payment model. The problem with fee-for-service is not merely that it pays providers to provide service; it pays them to create service as well. It is this almost limitless ability of doctors to create service that makes our per capita health care costs twice that of any other developed country."
This analysis is bad economics.
If the high and rising costs for medical care were caused by fee-for-service, then this method of provision should also cause high and rising costs for almost everything else in our economy. The reason is that the vast bulk of the private sector operates according to fee-for-service.
It's a mystery why medical care cannot be supplied in the same way that, say, accounting services and food are supplied. Like medical care, these things are valuable. (Indeed, food is even more essential to life than is medical care!) Also like medical care, some types of accounting and some types of food are more crucial than are other types -- and accounting services and food are supplied on a fee-for-service basis."
Why is economics so hard? It seems that data and logic are not useful tools when one already has an outcome in mind.
An interesting and insightful view of the healthcare legislation, whichever Bill he is referring to, in the following video:
Sept 18: The Gov of Massachusetts wrote an article on why their State healthcare system is a model for healthcare reform. The data suggests a quite different story. It always amazes when politicians turn away from data to take the political self-serving approach. This is why this website exists, to ask the citizens to not accept this kind of false arguments, and to become educated as to the alternative views.
Strassel writes that the just announced yesterday Baucus Healthcare Bill has diminishing support. It has lost any support from the Republicans and the left liberals find many things to object to. She writes:
"What has changed is Mr. Obama's determination to push a bill through, regardless of what his party, or the public, thinks. The White House will make the case to waverers that the political fallout of a health-care failure will be worse than backlash that comes with voting for a bill. Maybe. Behind that is the further threat that Dems will go this alone, via 50-vote reconciliation, if necessary.
They'd like to avoid it, as reconciliation will be messy, uncertain and carry political fallout. Yet if the Baucus bill has done anything, it has brought the White House further down this road. The president may yet regret he didn't hit the restart button."
It is looking more and more like Obama should have taken my proposal and done the right thing at a pace that would lead to cost reductions and reform on a number of levels, giving the free market a chance to change the system from the current lobbyist-government influenced system we have now.
Is the insurance mandate constitutional or not? WSJ weighs in on the topic, and this article says perhaps not, and yet it will be a good test to see if the Supreme Court will do the right thing, even when the Congress and the President are not.
Harvard study: 45,000 deaths linked to lack of insurance: The study was released by Physicians for a National Health Program, an organization that favors a single-payer system. This organization is quite a promoter of Obamacare. I would certainly want to see these numbers well vetted before adopting them as valid. These are quite different than other analyses published previously.
The study disputes a previous one conducted by The Institute of Medicine, which, in 2002, estimated that some 18,000 Americans between the ages of 25 and 64 died each year because of a lack of health insurance. Employ Institute writes:
"Finally, the authors show that while the uninsured use fewer health services, they still receive a large amount of care, and there is little discernable difference in mortality based on insurance status."
Sept 17: Perhaps the race card shows how desperate the supporters of Obamacare are becoming. Last evening the discussion on the Lehr Hour, lead by Gwen Ifel, was a poor display of argumentative journalism, trying to position the ideas as objective, while sending a message that the opposition to Obamacare was racist. Matt Welch from Reason acquitted himself quite well in the panel, attempting to bring the discussion back to the ideas that were really driving the March on DC, but to avail, Gwen was having none of this idea, and took the opportunity to blast Glenn Beck, as a racist. It is getting ugly and we are getting further away from the issue at hand, the reform of the healthcare system in the US.
WSJ reports: "Most Americans are unpersuaded by Carter's attacks anyway. According to a Rasmussen poll, only 12% of Americans "believe that most opponents of President Obama's health care reform plan are racist." That's 29% less than voted for Carter's re-election in 1980, a time when people were actually living through his disastrous presidency. The latter point leads us to think that Carter may have a conflict of interest in attacking Americans on Obama's behalf. Perhaps he secretly hopes Obama fails so miserably as to supplant Carter as the worst president of the past century."
Sept 16: Rasmussen reports that the bounce is now gone, the upward rise after Obama's speech. The disapproval rating is higher than even before the speech. The latest report: "One week after President Obama’s speech to Congress, opposition to his health care reform plan has reached a new high of 55%. The latest Rasmussen Reports daily tracking poll shows that just 42% now support the plan, matching the low first reached in August."
Goodman writes about a single payer system: "A single-payer (or a very, very large payer) could use its monopsony buying power to force providers to accept lower fees, in the same way a monopoly seller can extract higher prices from consumers than they would pay in a competitive market. This is the argument used by Paul Krugman and by the Physicians for Socialized Medicine (or whatever they call themselves these days).
The trouble is, this is not what Medicare does. Although, I suspect most people on the left are completely unaware of it, Medicare is actually operated by private contractors — more often than not by Blue Cross. Is there something Blue Cross does for its Medicare enrollees that is more efficient than what it does for its private sector enrollees? Not that I’m aware of. If anything, it’s the other way around. Moreover, when Medicare pays 25% to 30% lower fees to providers, that has nothing to do with Blue Cross or any other private contractor. Blue Cross does not negotiate Medicare fees with doctors. These fees are set by the federal government. Blue Cross just pays whatever fees the law requires. "
If it is not yet clear, the only manner in which all of these mandates being considered in Obamacare work is if the Federal government sets prices. The strategy is most clear in setting up this entitlement, that Obama and the Democrats have no interest in pursing market based cost reduction. The only logical alternative is forceful setting of prices. Of course this will lower care in quality and supply.
The Baucus Bill will be released for review today, having no public option and a lower mandate penalty charges for employers than the House Bill. The price tag is nearly $900B over the first ten years, although this analysis has not been done yet by the CBO, so if anything will be low.
WSJ reports another falsehood in Obama's speech: "Speaking of health-care distortions, as President Obama likes to do, consider his assertion to Congress that "buying insurance on your own costs you three times as much as the coverage you get from your employer." He liked that one so much that he repeated it over the weekend in Minneapolis, this time as a swipe at "the marketplace." The media's "fact-check" brigade hasn't noticed, but this is simply false.
The Congressional Budget Office expects premiums for employer-sponsored coverage to cost about $5,000 for singles and $13,000 for families this year on average. "Premiums for policies purchased in the individual market," adds CBO, "are much lower about one-third lower for single coverage and half that level for family policies." "
One can only be concerned about the motivations of not using the truth if the objective is to serve the people. The growth of policies and favoritism towards labor unions in this Administration is of concern. The appetite for serving special interests is quite high.
Sept 15: The attempt to spin the real underlying drivers of the tea party activities continues. The piece on the Jim Lehr hour was most partisan in its message: these are folks that are not representative of the center of American life. That oversight is quite consistent with the position of the Democrats over time. Seib in WSJ charges it up to a section of the populace that is most concerned about government spending and not about the control or how it is financed. I would take issue with this position, as I think it is about the threat of extension of control over our lives. Yes it might not be ideological, nor focused on supporting the free market, but it is about reducing government's role in so many aspects of the economy and how our freedoms are realized.
Napolitano makes a good case for the unconstitutionality of Obamacare, since healthcare is about receiving a service in-State. Interesting if this has any legs legally, given the long standing case of Medicare as an accepted policy. However requiring all citizens to have insurance will no doubt be tested in courts, if Obamacare is passed.
From Slate, Sept 15, 2009: "How Did the AMA Get Such a Sweet Deal in Health Reform? The American Medical Association has opposed health care reform many times in the past but has now emerged as one of the strongest proponents of President Obama's efforts.
Critics say this came at way too high of a price, considering that the group that represents America's doctors got the best deal out of any of the interest groups that have unleashed their lobbyists in Washington. The government has agreed to stop planned cuts in Medicare payments that are worth $228 billion over 10 years, plus the proposal that would require everyone to have health insurance would include premium subsidies to pay for doctor bills.
Unlike other industries, the AMA really didn't have to make any concessions to obtain the goodies from the government. "They were bought off," one health policy expert said. "And the price tag was $228 billion."
Meanwhile, in other health care reform news, the Washington Post wonders whether it would be possible for the government to force people to buy insurance without hurting millions of middle-class Americans. The chairman of the Senate finance committee vowed to write a health-reform bill that would address a number of GOP concerns, but affordability remains a contentious issue for members of both parties. Although Democrats have proposed helping less-well-off families pay for the insurance, offering more help means the cost of the bill would pass the $1 trillion mark. But some estimate that under the current plan, millions of American could end up paying as much as 13 percent of their income on insurance premiums.
"We're talking about the equivalent of a middle-class tax increase," a health care expert at the libertarian Cato Institute said. "Yes, they're paying it to an insurance company instead of to the government. But, suddenly, these people are paying more money to somebody.""
Sept 14: Obama was on 60 Minutes last evening, trying to stay in the public's view and sell his version of the truth. The fact checking article on the insurance abuse tells a story of his more than stretching the truth. We need him to be honest. Also the car insurance analogy Obama used, seems to be a real reach, and one that is working less for his argument.
There is a growing gap between what would work and the quality of his presidency and what he is doing. The only conclusion to draw is that his advisors and special interests are quite insistent on a government controlled system. He is not following the will of the American people for less government and true reform, but rather his ideology and policies. Change, hope - well where are we going here?
More on the tea party in Washington DC, this video from Reason TV:
The interviews do underscore the broad appeal to independents of resistance to Obamacare that was also seen at the Town Hall meetings. My favorite line: "drain the swamp."
Sept 13: 100's of thousands of folks turned out in DC to protest Obamacare. With this huge turnout, this will be noticed. A friend in DC at the time, said that this story was all that was on the news. Tea parties around the country were quite vocal as well.
New York Times article by a Berkeley Prof goes as far as to say that insurance companies would be better off if the insurance companies have to insure all at the same rate, despite that individual having made bad life style choices. His reasoning is that with this insurance for all at the same price will require insurance companies to take the issue of obesity seriously and apparently not avoid the issue. It is to say that it must be the insurance companies' fault that someone is obese. Why is it so hard for some to say that folks should be more accountable and should also be free to make choices on their healthcare?
This type of contradictory reasoning, or no reasoning at all, is quite prevalent in the healthcare debate. Obama tried using his own myths in his speech the other night. It is about setting the correct incentives, as incentives have been very distorted in the healthcare industry, and Obamacare is trying to further distort these incentives and choices.
Sept 12: If you think Medicare is a good model for healthcare, then read about why it is not. The numbers are so overwhelming that one can only wonder why is no Democrat in Congress really recognizing and using them? They seem so intent to construct entitlements and to socialize medicine, more than it is already, that numbers do not seem to matter in the discussion.
Sept 11: While most of the news has focused on Obama's speech from the other night, there are some good realizations of what the ramifications are from his statements. Clearly his focus was on solidifying the left and Democrats in general, and it was not to answer or even acknowledge the concerns of the American people. The comments and the summary of the speech, along with other links can be found on this page. The winners, if all goes according to his plan, are the special interests lined up behind Obama.
One such insight comes from Strassel at WSJ on tort reform: "It isn't clear if Republicans would or should take that deal, but we won't know since it won't be offered. The tort-reform issue has instead clarified this presidency. Namely, that the bipartisan president is in fact very partisan, that the new-politics president still takes orders from the old Democratic lobby." The lawyers clearly will never see reform of their own, but will continue to lobby in Washington with their fellow lawyers in Congress.
The latest Rasmussen poll: "The latest Rasmussen Reports national tracking survey shows that 46% favor the plan and 51% are opposed. The survey was conducted on Wednesday and Thursday nights. The previous two-day sample, conducted Tuesday and Wednesday nights, found that 44% favored the plan while 53% were opposed." So the bounce upward that the Democrats expected has not occured yet.
Sept 9: Well the Obama speech is today, that will provide details on what he advocates in Obamacare. It is already apparent that he wants the public option, having been pressured by the liberal left. He has not responded negatively yet to such pressure. Is he listening to America or to his special interests,? This we will find out tonight. All indications are that he will proceed full steam ahead on the government centered bill. It is also apparent that the Democrats are going to drive their tank over the Republicans as soon as they can confuse the American people.
I say "confuse" for the simple truth of the matter is that this effort began with the issue of a need for cost reduction and the need to cover the uninsured. So far there is no cost reduction program, just a series of tax and fee revenue options to enable the installation of government mandates on healthcare. See Goodman on rationing for great insight into how Obamacare really will work.
The chronically uninsured could be covered in a variety of ways, but those means are not being discussed. The legislation is lost in the complexity of the bureaucracy that it attempts to create. This is government at its worst, in terms of installing ineffective programs, and at its best in attempting to market confusion. The goal now is to build a huge bureaucracy.
Obama has not lead in setting direction, but has been a commentator, giving criticism but no real workable solutions. At the speech to Labor, he told a loudly supportive crowd "Every debate at some point comes to an end. At some point it's time to decide. At some point it's time to act. Ohio, it's time to act and get this thing done." He had to say the debate should come to a close, despite the fact that his plan has not been seen yet, and that there are still 5 versions in Congress. Debate needs to increase, not go away. Sounds like paternalism rather than constructive leadership.
An excerpt from a WSJ article on the Finance Committee Healthcare Bill in the Senate:
"Starting next year, the plan also calls for annual fees of $6 billion on health-insurance providers, $4 billion for medical-device makers, $2.3 billion on drug makers and $750 million on clinical laboratories. The fees would be levied on individual companies based on market share. Insurers also face an excise tax of 35% for any health plan worth more than $8,000 a year for individuals and $21,000 a year for families."
And then there is Pelosi, in her own world, sounding like she has a plan: "If you have a triggered public option, it's because the insurance industry has demonstrated that they're not cooperating, they're not doing the right thing, and I think they'll have a tougher public option to deal with." And of course the government will not make it impossible for the insurance companies to meet the requirement. The seemingly hatred of the insurance industry in DC is palpable and disturbing. So much of the difficulties that insurance companies have is because of government mandates on coverage causing a reduction of competition, something some insurance companies like.
Sarah Palin, with all of the criticism she has earned and enjoyed, wrote a very nice piece in WSJ, giving clarity to the various proposals from the Democrats. Like her or not, she is eloquent in her description of the proposals coming from the Democrats. An excerpt:
"Instead of poll-driven "solutions," let's talk about real health-care reform: market-oriented, patient-centered, and result-driven. As the Cato Institute's Michael Cannon and others have argued, such policies include giving all individuals the same tax benefits received by those who get coverage through their employers; providing Medicare recipients with vouchers that allow them to purchase their own coverage; reforming tort laws to potentially save billions each year in wasteful spending; and changing costly state regulations to allow people to buy insurance across state lines. Rather than another top-down government plan, let's give Americans control over their own health care.
Democrats have never seriously considered such ideas, instead rushing through their own controversial proposals. After all, they don't need Republicans to sign on: Democrats control the House, the Senate and the presidency. But if passed, the Democrats' proposals will significantly alter a large sector of our economy. They will not improve our health care. They will not save us money. And, despite what the president says, they will not "provide more stability and security to every American."
We often hear such overblown promises from Washington. With first principles in mind and with the facts in hand, tell them that this time we're not buying it."
Sept 8: The public option, still alive in the minds of the leftist Democrats, and disliked by the American people, will not go away. In this editorial piece, WSJ hits hard on the result of any attempt to have a public option, whether it is in the form of an exchange or other mandates. Excerpts from the article:
"The latest political gimmick is the notion of a "trigger" for the public option: A new government program for the middle class would only come on line if private insurance companies fail to meet certain benchmarks, such as lowering overall health spending or shrinking the number of the uninsured.
Keep in mind that every version of ObamaCare now under consideration essentially turns all private insurers into subsidiaries of Congress. All coverage will be strictly regulated down to the fine print, and politics will dictate the level of benefits as well as premiums, deductibles and copays. Under the House bill, a "health choices commissioner" will have the final say, no doubt with Democrats Henry Waxman and Pete Stark at his elbow, if not another part of his anatomy.
The larger reality is that private insurance won't be less expensive until overall health-care costs go down. Democrats may be confused on this point because government, which paid nearly 47 cents of every medical dollar in 2007, simply sets lower prices when Congress feels like it. On average, doctors and hospitals are forced to accept 20% to 30% less for their services in Medicare. That's another reason insurers wouldn't meet a trigger's thresholds, given that providers shift costs onto private under-65 patients to make up government shortfalls.
ObamaCare doesn't bother with incentives, instead merely increasing government command and control of private insurance while making it more expensive in the process. That's why a trigger will inevitably lead to the public option, and also why ObamaCare will make all of our current health problems worse."
Deficits still remain top on the concerns of the citizens, and Obama and Congress ignore these concerns in favor of more spending. Feldstein writes in WSJ today on how this might work:
"While the deficits caused by the fiscal stimulus package will end in 2011 and will help to sustain a fragile recovery in 2010, the deficits projected for the longer term are a threat to our economic future. The starting point for controlling those future deficits is for Congress to abandon the administration's health-care plan—a plan that will cost more than $1 trillion.
The deficits projected for the next decade and beyond are unprecedented. According to an assessment released in March by the Congressional Budget Office (CBO), the president's budget implies that deficits will average 5.2% of GDP over the next decade and will be 5.5% of GDP in 2019. Without the president's proposals, the budget office forecasts a 2019 deficit of only 2% of GDP.
The CBO's deficit projections are based on the optimistic assumptions that the economy will grow at a healthy 3% pace with no recessions during the next decade; that there will be no new spending programs after this year's budget; and that the rising national debt will increase the rate of interest on government bonds by less than 1%. More realistic assumptions would imply a 2019 deficit of more than 8% of GDP and a government debt of more than 100% of GDP.
Such enormous deficits would crowd out productivity-enhancing investments in new equipment and software as the government borrows funds otherwise available to private investors. The result would be slower economic growth and a lower standard of living."
It is also clear that Obama intends to come out in his speech to Congress tomorrow with the same message: we shall overcome the opposition. This will be one of the moments in a presidency that we will look back upon as an important milestones and lost opportunity. His commitment to the public option, driven mostly by the far left, is a testament to whom he is listening, and it is not the American public. In a speech to a group of labor leaders, he praised the work of unions, and gave them credit for raising America to where it is today. This sentiment might win applause in the moment, but it should also send a message to the hard workers and innovators around the country, who have actually had more responsibility for raising this country, that they are not represented at the moment in DC.
Sept 7: Peggy Noonan wrote a most thought provoking article in WSJ, asking serious questions about leadership and the centrist political population in America. An excerpt:
"The past 10 months, the president has lessened and not increased the trust of the big center. He did a number of things wrong, but one has not been noticed much, or noted. He moved too quickly, before he'd earned the right to change a big chunk of American life. You earn that right by establishing trust. Absent crisis, leaders have to show, over a certain amount of time and through a series of actions, that they're sober, sound, farsighted, looking out for the middle. In addition, of course, middle America is worried about two dramas, the economy and war, and he's showing he's worried about a third drama, health care, which they've put to the side. His concerns do not coincide with theirs. Which makes him, not them, look out of touch. "
Two Republican Congressman also wrote in WSJ, an article on how to insure all Americans.
"When was the last time you asked your doctor how much it would cost for a necessary test or procedure? In all likelihood, you can't remember. That's because your employer-provided health plan or the government "paid for it." In fact, you paid. We all pay for health care.
There's no denying that our health-care system is complex. However, we can trace most of the problems in the current system to the lack of control individuals and families have over their care. If there's one lesson we've taken away from the thousands of citizens at town-hall meetings, it's that one massive health-care bill isn't the solution. Americans nationwide have voiced their desire for greater control over their care and for reform in digestible pieces.
Roughly 60% of all health care in America is employer-provided. This third-party payment structure has divorced the consumer—the patient—from the real cost of services. It encourages excess spending, runaway lawsuits, defensive medicine (doctors ordering unnecessary tests and procedures out of fear of being sued), and huge malpractice premiums.
President Obama and Democrats in Congress say that a new federal health-care bureaucracy and a so-called public plan is the answer. They are wrong.
Government has caused the problems we face in health care. Our tax code incentivizes employer-provided health care, rewards health insurance companies by insulating them from accountability, and punishes those who lack employer-provided care.
The political disagreement is not whether to cover everyone, but how to do so. The president and congressional Democrats say we should create a new government-run plan, outlaw the health coverage Americans enjoy today, and let federal bureaucrats control the content and price of health plans. Their bill, H.R. 3200, is filled with more than a thousand pages of new mandates, penalties, regulations and taxes. It is nothing short of a complete takeover of the entire health-care system by Washington politicians. ...
We believe that all Americans deserve the ability to select health-care coverage that meets their needs—not the preferences of politicians. Republicans in Congress want to empower Americans to make their own choices by providing a dollar-for-dollar tax credit for you to purchase the plan of your choice. Those who cannot presently afford coverage would be able to select and purchase their own plan using a health-care voucher provided by the federal government.
If we give citizens the ability to control their own care, cover pre-existing conditions, and provide resources to the uninsured, we will have fixed health care in America. No bureaucrats. No new czars. No mandates. Just choice and coverage for every American."
There is a lot of wisdom in this statement, although there are ways to improve their proposal, such as adding tort reform, this is a good start. Watch the progress of HR3400, (not 3200 the Democratic Pelosi Bill) the Bill being proposed to do the above.
Sept 6: WSJ reports that Obama will try again to convince the public of the need for the public option. This becomes the week of truth, to see if Obama has been listening to the public or will follow his special interests. In today's article WSJ writes: "Republicans in Congress have said they will not support legislation that includes a public insurance plan, while House Speaker Nancy Pelosi has said Democrats would not support any bill without it.
Rep. Maxine Waters (D. Calif.) speaking on "This Week," urged Democrats to go it alone. "We're not going to get their support," she said of Republicans. "I appreciate the work that's been done by the president to try and get a bipartisan bill, but there will be no bipartisan bill."
Former House Speaker Newt Gingrich said the president is at "a strategic crossroads." If Mr. Obama comes in with primarily the same message he has delivered in recent months "I think that clearly the country will conclude that he is not listening." That will lead to the Democrats pushing for a partisan bill "that I think will frankly, be a tragedy for the administration and the country." "
Sept 4: the pleas for a more moderate and bipartisan healthcare reform are louder and louder. The idea that we do need another speech seems quite evident, but the upcoming speech by Obama is coming next week, and will give a good indication if he will stay inside the walls of his special interests, and proceed ahead with a bill that will not be bipartisan. The American people want a bill that solves some problems, but does not create a huge deficit and federal control of healthcare. We will see if Obama hears that message.
Tom Price speaks out in summary of what could and should happen, as well as Bill HR3400 which is a alternative to the HR3200 detailed elsewhere in this website.
Sept 3: How wonderful it is to have Daschle back again, this time being sure that the blame is on the republicans. Some things never change. He wrote in WSJ this morning:
"However, should Republican intransigence continue, Democrats cannot simply stop. They cannot ignore the human suffering as well as their fiscal responsibility to act. They must focus on the budgetary implications of health reform and use the Senate rules of budget reconciliation to allow a health-care bill move with majority support. The choice between complete legislative failure and majority rule should not pose a dilemma for any Democratic senator."
This shows how out of touch with Americans and the needs of America, that he and so many others in DC are. The anger seen at town meetings is more than a few folks wanting to express concern over the government taking on too much. It is much more than that, says Henninger of the WSJ. In today's article he continues in the stream of articles talking about the super state and the response from the people. In the latest segment, he looks at the rising debt around the world and see a revolt of the masses. See the video for the summary:
Sept 2: What forms does this debate take? See my response to an article in WSJ that needs to increase its acuity if the debate is to progress. Also the survey results show 68% of those polled believe that the reform Bills will increase the deficit, which they believe to the number one issue.
Senator Coburn writes in WSJ: "I spoke with thousands of voters at town-hall meetings this summer. What I gathered from them is that it's not just the proposed overhaul of health care that has them upset. Many also expressed a sense of betrayal. In spite of their hope for change, it still appears that the government in Washington is run for its own benefit and the benefit of special interests—not for the benefit of the American people. The folks I met with also don't trust politicians in Washington to address mounting long-term challenges to our economy.
It's not just the attendees of town-halls meetings in Oklahoma. Voters across the country are telling Washington what's on their mind, if only more people inside the Beltway would listen. A Rasmussen poll released last month showed that 40% of voters said that cutting the deficit in half by 2012 should be President Barack Obama's top priority. Only 21% said health-care reform should be his No. 1 priority."
George Leef advises to look also at the big picture, and not the just the details on page whatever, something that happens in each government run healthcare system, that it is highly politicized as to what care is approved:
"Here is the big picture: Do we want a health care system that’s overwhelmingly political in nature? President Obama believes we need a system mainly directed by federal mandates and prohibitions. If he has his way, our already somewhat politicized system would become heavily politicized. Supposedly that would be in the public interest.
There are many Americans, however, who think that a heavily politicized health care system would be much worse. I’m among them. We believe, fundamentally, that systems of any kind that are dominated by politics do not do a good job of satisfying human needs. Whether it’s health care, food, housing, or anything else, government intrusion leads to increasing costs, declining quality, and the loss of freedom.
We get far better results from systems based on freedom and voluntary exchange. When individuals make decisions, they know their own circumstances and will either benefit from good choices or suffer the consequences of bad ones. That creates a strong incentive to make good choices and quickly change when you realize you’ve made a mistake.
When government officials make decisions, things are different. That’s mainly because there is only a weak feedback loop. Politicians may say they “feel our pain,” but they really don’t. They know almost nothing about individuals they represent and when they make bad decisions, they aren’t the ones who are harmed."
Sept 1: Early indication is that the Obamacare advocates will pursue a divide-and-conquer approach, giving some Republicans something to accept in the form of reform, to capture their vote for the entitlement program otherwise known as Obamacare. This allows the Democrats to use their majority in Congress to push through a Bill.
The outrage however is still there at town hall meetings despite the attempts of the SEIU and the administration to head off dissonance. It also seems to be aimed not just at healthcare but also at other policies that the Congress has passed or is pursuing. The public has awoken to having the government in their living room, in their wallets and they are mad about it.
So the battle lines are drawn. Obama still has a great opportunity to jump over the barriers he has created and seek a more gradual, market driven approach (see my proposal), or dive into the partisan political arena and just drive the democratic tank over the Republicans. It seems that the latter is the choice, as far as some can determine.
Aug 29: Obama continues to deny that any of the criticism of his healthcare reform has any of the warts that are in the Bills in Congress. Of course this is true, because he has not detailed his reform, just left it up to the members of Congress to define. House Bill has all of the warts that most have detailed. See this link if you need any further justification. This campaigning approach is quite inappropriate for a President of the USA, I must say. Leadership is not about a shifting shell game. I have to say bluntly so, that his lack of experience is showing. He was quite good at campaigning, and now he has to learn how to be a good President. He is somewhere between Lyndon Johnson, Jimmy Carter and some better presidents. If he could grab the bull by the horns, and stop paying attention to his special interests, he could actually be a good President.
WSJ writes of yet another foible in Obama's delivery on a campaign promise. With the polls falling as favorable to his policies, he has be paying attention and wondering how he got himself into this dilemma and how he will get out of it.: "President Obama has promised a "new era of transparency" in Washington, so perhaps he should talk to the Senate about getting with his program. On July 15, six weeks ago, the Senate Health, Education, Labor and Pensions Committee passed an amended $1 trillion health-care bill, with acting Chairman Chris Dodd calling it a "historic achievement." Too bad the committee won't reveal this history even to other Senators, much less to the public.
Three weeks ago Republicans on the committee wrote Mr. Dodd "to reiterate our request for a full copy of the bill as amended, in the four-week mark-up." Mr. Dodd has refused to comply. The Senate bill that is available on the committee Web site is 790 pages long. While that is some 300 pages shorter than the House health bill, that's in part because it doesn't include nearly 200 amendments that passed when the committee redrafted the bill. Amended sections of the bill might as well be written in invisible ink.
The whole process was so haphazard that at one point during the committee mark-up Barbara Mikulski, the Democrat from Maryland, declared: "Giving me language on little pieces of paper on which I'm going to commit the sacred fortunes and honor of the United States for decades, this is not the way to go. We can't do this on the backs of envelopes."
We called Mr. Dodd's committee office last week to ask why the bill isn't posted, and a spokesman explained that it is still being "worked on." Will it be ready by October? "Don't count on it," the staffer said.
Meanwhile, President Obama has been saying that critics are "misrepresenting" his proposals. But who's to know what's reality and what's a myth when the public and Members of Congress aren't able to read a bill that would restructure one-seventh of our economy. We don't have any idea what the bill will cost or how many people it will provide insurance for, because the Congressional Budget Office can't score it. No wonder the public is increasingly skeptical of this entire exercise."
Aug 27: Having just watched the PBS Lehr Hour I have to comment. The news hour had a segment on healthcare myths, and did a marvelous job of representing the Obama side of the argument, in the guise of the full story and debunking myths and falsehoods. This style of partial reporting of the full picture serves no one. It was a good means to portray a position as very reasonable, while at the the same time forgetting to tell the whole story. The score of the general media continues to go down on serving the interests of the people of this country, and this PBS segment did nothing to shed the proper light on the issues. Obamacare is going to raise costs and reduce options. It is a necessity of any of the plans in Congress, save the one by Rep. Ryan. I sent a comment, and will publish here any response they give to my criticism.
Betsy McCaughey explores the intent of Obama's key adviser , Ezekiel Emanuel, in his views on rationing and the role of the doctor. He has been striving for a government take over of healthcare. It points to the inevitable question: do you want to make the decision on your healthcare or do you want the government to tell you? That simple statement sums up a lot about the healthcare reform we are seeing currently proposed. If you want to make the decision then you are lead logically to the conclusion that the patient must be in charge, and certainly in charge of the cost decision as well. That does not make sense to Emanuel or his advocates, nor to Obama.
The simple measure of putting the patient in charge would seem entirely American. As McCaughey writes, it does not make sense to this administration:
"Dr. Emanuel has fought for a government takeover of health care for over a decade. In 1993, he urged that President Bill Clinton impose a wage and price freeze on health care to force parties to the table. "The desire to be rid of the freeze will do much to concentrate the mind," he wrote with another author in a Feb. 8, 1993, Washington Post op-ed. Now he recommends arm-twisting Chicago style. "Every favor to a constituency should be linked to support for the health-care reform agenda," he wrote last Nov. 16 in the Health Care Watch Blog. "If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration's health-reform effort." Is this what Americans want?"
Shikha reminds us of the manner in which the sourcing of doctors has been manipulated for far too long, much to the detriment of the public. We also face a shortage of doctors in the near future. It also points once again to the notion of centrist controls gives tow options: shortages or run away budgets, and rarely anything in between. I do agree with Stossel when he wrote that there is a large arrogance in even suggesting control of healthcare centrally, in effect saying that the decisions of this centrist body has more wisdom and efficacy than 300 million people. The contradiction is most apparent if one rises to the right altitude on this issue.
Further in WSJ: "Adding to the Democrats' woes are polls that show weak support for ObamaCare among Independents and Democrats. In the new ABC/Washington Post poll, only 45% approved of Mr. Obama's plan and 50% opposed it—with 40% "strongly" opposed.
Despite Mr. Obama's barnstorming tour, last week's Fox/Opinion Dynamics poll said "the health care reform legislation being considered right now" is opposed by 21% of Democrats, 50% of Independents, and 81% of Republicans. Only 37% of Democrats and 15% of Independents think their families would be better off if it passed."
Aug 26: The news events have slowed, with Congress out on a recess and the President vacationing. The general public still appears to be quite excited about this large entitlement program. The CBO report today on the huge total Federal deficits will affect this healthcare legislation in a big way, and this analysis includes some quite optimistic assumptions, along with the cancelation of the Bush tax cuts.
Lieberman's request to go slow, a sentiment that is no doubt growing in the Congress and in the public, is going to be the inevitable direction that will be taken, as it will seem that anything that is passed soon using any form of policies that are in play now in Congress will suffer the criticism that it costs too much.
In a WSJ opinion piece: "The White House issued a statement yesterday that the President is "very concerned about these out-year deficits." But apparently not so concerned as to stop pushing for a new $1 trillion health-care entitlement that is conveniently not included in these latest budget forecasts.
The real fiscal crisis in Washington is that neither Congress nor the White House are offering any escape from these trillion-dollar deficits. Mr. Obama has not called for automatic and immediate spending cuts. He has not proposed eliminating hundreds of wasteful programs. To the contrary, the White House still hasn't ruled out another fiscal stimulus, as if a $1.6 trillion deficit isn't Keynesian stimulus enough. The Administration's celebrated scrub through the budget this summer identified $17 billion in agency savings. That's what Uncle Sam is borrowing every three days.
Obamanomics has turned into an unprecedented experiment in runaway government with no plan to pay for it, save, perhaps, for a big future toll on the middle class such as a value-added tax. White House budget director Peter Orszag promises that next year's budget will have a "plan to put the nation on a fiscally sustainable path." Hide the children."
As Ajami wrote in WSJ: "Obama's Summer of Discontent, The politics of charisma is so Third World. Americans were never going to buy into it for long." American democracy has never been democracy by plebiscite, a process by which a leader is anointed, then the populace steps out of the way, and the anointed one puts his political program in place. In the American tradition, the "mandate of heaven" is gained and lost every day and people talk back to their leaders. They are not held in thrall by them. The leaders are not infallible or a breed apart. That way is the Third World way, , the way it plays out in Arab and Latin American politics.
So perhaps Obama has reflected on this turning point in his presidency and made some wise decisions. We cannot depend on the Pelosi's of the political world to find their way. It will take Obama to take the "Yes we can" and turn it into "yes we will reason and do it right."
The democrats are hanging on to the image that they are "sticking up for the average guy on the street". What they will end up with the current strategy is that they have screwed the average guy on the street. It shows once again that government should not be in the business of transfer payments, service providing, beyond basic security and rule of law and defense. How many times are we going to learn that the people can do well and often much better than the government (see above), on their own.
The budget deficit will loom now as the number one issue, as detailed in this video:
Aug 22: /strong> As the weekend comes to a close, and the various sides rally their troops , we can ponder the basic question: is healthcare better off with a Post Office model. A recent article in WSJ gives us a good idea as to what would be in store for us. You can argue that it is a bad analogy, but one can also argue that it has great relevance.
The idea of government providing vast service in controlling cots and insurance and even what treatments can be done (see Bills for more details) is much more complex service than the Post Office does today. So the Post Office is a minimal comparison, meaning that it had better pass this test to qualify for the next round. The mere fact that the Post Office costs a net $20B a year is worth mentioning, and the inability to change it and make it more competitive should also give a strong clue as to the challenges that Obamacare would face and create.
Maine is another case study, for they have tried Obamacare and come up short. Along with Tennessee, Massachusetts, and Oregon having universal care is a fast track to insolvency and bad care for all. The data keeps coming in, and it becomes more and more obvious that seeking success is not he quest here. Data does not matter in this debate for so many interests have a form they want to see, and dam the cost or quality of care.
Obama's strategy shifts back again to aiming blame at the GOP for stalling his reform. It is a revolving door of political laser light shining on yet another group to attract the attention away from the issues at hand.
Aug 21: By MICHAEL O. LEAVITT Wrote in WSJ: "The Democrats are insisting that their version of a "co-op" wouldn't be government-run health care, but I ran Medicare and Medicaid as secretary of Health and Human Services, and I know this isn't true. When Washington provides the money, names the directors and ultimately pays the bills, government controls health care. Lobbyists will lobby, Congress will respond, and bureaucrats will decide who gets care, what drugs are prescribed, what procedures are covered, and how much money providers can charge. This is true for Medicare, it's true for Medicaid, and it would be true of Mr. Conrad's "co-ops." "
Aug 20: The powers-to-be in the Democratic Congress are considering splitting the final assault on healthcare reform into two Bills, one that would be expedited through the Senate using a legislative process called reconciliation. This would allow the Bill to be filibuster proof. The second Bill would be one that would be more bipartisan, and contain some elements that could not fall under the reconciliation process. So the Democrats are saying, if we cannot have it our way, we will just power our way through one way or the other. The combined total contents of both Bills will remain about the same as current proposals: mandates, must insure all folks regardless of conditions, at about the same price, etc. It is is wage and price controls for healthcare, slam dunk style.
Obama's town-hall tour left serious questions about his consistency and his intentions. He is seeking a change, in a simple form, saying there will be no changes to what you like, but at the same time creating a system that will make the problems of Medicare financing seem pale by comparison. It is looking more and more like a setup game, and the end game is single payer, rationed healthcare. He reiterated today that he will not sign a bill that is not budget neutral, meaning no increase in the deficit and that it also must include cost reduction. Neither condition is met by any Bill, so much work needs to be done, or perhaps we will continue to see the shell gamer we have seen thus far, and very fancy rhetoric.
Co-ops are but a setup as well, as detailed in this article by SCOTT HARRINGTON. He writes:
"While details are sketchy, the basic idea is to subsidize the creation of nonprofit health insurers on a state or regional basis. These supposedly would be run independent of the government and compete with traditional private health-insurance plans. These government-authorized co-ops would serve no useful purpose. And they would risk the same adverse consequences as a public plan.
Absent taxpayer subsidies or special rules, co-ops would not have any inherent advantage over private health insurers in establishing provider networks, negotiating with providers, and monitoring health-care utilization and fraud. Proposed co-ops instead would require billions of dollars of "start-up" subsidies.
More important, the creation of government-authorized co-ops would entail significant risk of ongoing subsidies by taxpayers (if not by private health-insurance buyers), of substantial private insurance crowd-out, and of eventual conversion to a government-run plan. Like a proposed public plan, government-authorized co-ops would be backed implicitly if not explicitly by taxpayers. They would not have to hold the amounts of capital that private health insurers hold to back their promises. Government-authorized co-ops would almost certainly not have to pay income or premium taxes that private for-profit and nonprofit insurers must pay.
Although co-ops might initially be required to negotiate their own reimbursement rates with hospitals and doctors, substantial pressure would arise over time for centralized negotiations, with eventual benchmarking off Medicare reimbursement rates. Compared with a public plan, government-authorized co-ops could simply be a slower road to government health care. The potential benefits are nil; the potential costs are large."
Aug 19: Obama Struggles to Strike a Health Care Deal Palatable to All Sides, an article from Fox News: President Obama finds himself stuck between a rock and a hard place, going round and round in a dizzying cycle of give and take that doesn't seem to be advancing his top domestic priority. The difficulty arises from the fact that he set such large expectations and has also shown that he is swayed easily by special interests. It has caused a frenzy of influence, a huge budget for advertising, and conflicting expectations that cannot be met.
Aug 18: Obama claims that the special interests will derail Obamacare if it fails. With a budget and expense of 5 to 1 in TV advertising, and 3 to 1 in print ads, the Obamacare special interests are way ahead of their opposition. Also the playing on the emotions of the citizens by using the tale of the grand-mother who was denied coverage is on que, with the emotion card being played at the right time. What is needed is a good argument in favor of constructive reform, which is being proposed repeatedly in the media.
Certainly the left did not care for Mackey's article on how to reform well and without huge deficits. They are mounting a boycott of Whole Foods to teach him a lesson. Sounds like good terrorist tactics used here in the US. Interesting that the intolerance is so apparent, and perhaps because they have not had a voice for so long. Our country has to decide how it wants to govern in the future, as this is not working. The political fringe is now controlling a large of the advertising and counter arguments: (7% of the total private sector labor force) labor unions are huge in the political power matrix, and the far-right wing is using tactics to counter.
Polly, an employee of Rocky Mountain Orthopedics in Grand Junction, asked Obama at a recent town hall meeting the following question: "Q: The original health care House bill included funding for federally qualified health centers whose future budget would be based on expenses plus inflation. If private physicians, hospitals, and other providers are going to be given incentives to reduce waste and cost, what will be done to ensure the government programs will do the same?"
Mr. Obama replied: "Well, it's an excellent question. Part of what's so important about reform is that right now the way Medicare and Medicaid operates, if it's starting to go over budget, we basically have two choices. Either we raise taxes and just keep on paying more and more, and health care inflation is going up at least twice as fast as inflation on everything else, or what we do is we just tell the providers, we're going to give you less money -- period. We'll reimburse you 80 cents or 90 cents for every dollar of services that you provide."
And then what happens is that the providers, they end up just charging people with private insurance to make up for the difference. So that drives everybody's costs up. As one can see Obama lacks a good understanding of the free enterprise or market system. In other words he will use price controls whenever it is needed to meet the budget goals. I believe that this is a strong indication of his lack of a sound understanding of economics.
Obama continues to use all of his immense campaigning skills and oratorical skills, to keep Obamacare inching towards something realized. His HHS Sec is now admitting that the public option might be dropped, appearing to change their position in listening to the people. However most of the control of healthcare in either bill is not through the public option, but rather in all of the boards and reviews, funding decisions that are embedded. Even the so-called exchanges are referred to as a poor man’s public option. There are multiple ways in which the final legislation can be onerous to freedom or even to the healthcare industry becoming competitive.
Aug 16: the campaigning continues, with large budgets now being reported for advertising. MoveOn.org is attacking the more conservative Democrats, and the Labor Unions are in with both feet and a hefty budget. So the political rhetoric continues in the same vane. All this while the Rasmussen report shows a decline in support for Obamacare. 54% are in favor of no reform if the options are what is in Congress now.
Barak Obama writes in the New York Times: "In the end, health care reform isn’t about politics and fear. It’s about changing a system that often works better for the health-insurance companies than it does for millions of Americans." He continues to try to change the parameters of debate and the issues or even solutions as limited. He has not wavered from his views on no-rationing, maintaining the choices you have, and about special interests will kill this reform.
Obama has tried to buy off all of the special interests with deals, has followed the will of the unions, and been steadfast in not listening to the American people or free market ideas. He is simply trying to campaign by amplifying the concerns that the public had, not what they have currently. Unfortunately the truth and the cause and effect are left by the roadside in the process. When will we actually have change? When the citizens demand it, and now is a god time.
Some of the politicians are continuing their dismissal of the energetic town hall meetings as hired thugs or worse. It is not a good moment in our democracy when anger cannot be honestly demonstrated. What would the media have said about Bush if he labeled the anti-Bush demonstrators as un-American? I think it is safe to say they would have roasted him. So the hypocrisy continues in politics, until which time the citizens say be just. It is all about what will get the citizens' attention and sway their opinion.
Aug 15: Interesting that the AARP, with its liberal leadership is backing away from a very open endorsement of Obamacare. Also a study was released by Congress showing that the fraud and waste in Medicare is endemic, and is likely to be replicated by Obamacare over a wide portion of the healthcare industry.
Noonan of WSJ writes: "The big, complicated, obscure, abstruse, unsettling and ultimately unhelpful health-care plans, proposals and ideas keep rolling out of Washington. Five bills, thousands of pages, "as it says on page 346, paragraph 3, subsection D." No one knows what will be passed, what will make its way through House-Senate "conference." They don't even know what the president wants, what his true agenda is. He never seems to be leveling, only talking. Everything's open to misdirection and exaggeration, and everything, people fear, will come down to some future bureaucrat's interpretation of paragraph 3, subsection D, part 22.
What a disaster this health-care debate is. It strains, stresses and pierces, it unnecessarily agitates and is doomed to be the cause of further agitation. Who doubts the final bill will be something between a pig in a poke and three-card Monte?"
Obama continues to want to pursue the same line of promotion for Obamacare. It is about attacking insurance companies as bad folks who limit or even cancel healthcare benefits for their customers. A lot can be said about Medicare doing that even more than private insurance, causing most Medicare beneficiaries to have supplemental insurance. Rationing of care is the direct result of having a service have much higher demand than can be afforded or needed. So why are we not putting the patient back in charge of this decision? Obamacare reduces the importance of the patient in this decision, not increasing it.
Aug 14th: Tanner of Cato details further to increase competition, it is imperative to have the insurance companies compete against each other. A public option could operate at a loss, and would be driven towards that condition by the political need to reduce pricing. The cost shift to the private sector that would result just increases demand for resources, without increasing competition.
The government in dictating prices of care, temporarily shows that it affected costs, but in fact all it did was increase demand and not change the basic costs. Shifting the cost to the private sector, which in turn raises the cost to the private insurance companies are arbitrarily made less competitive, since they also have to make a profit. If you think this is a good idea, then you should read the analysis of how Medicare works, for this is a repeat of that basic economic model.
Join The Mob & Flag Yourself! Stand Up to the White House Today! The White House doesn't like the fact that the majority of Americans are against the proposed Healthcare Bill. Maybe that's why the Obama Administration is calling for Americans to "flag" anyone spreading "fishy" information about the bill. So flag yourself if you so believe.
Why the elderly are right to worry when the government rations medical care, and for good reason. Having Medicare for All seems a much faster way to bankrupt the nation then a market based approach. There is also a plausible market approach to pre-existing conditions, detailed in this article.
In an interview published yesterday, Sen. Harry Reid (D-Nev.) added his name to the list of dismissive of opposition, calling those speaking out against the government takeover of health care at Congressional town hall meetings around the country “evil-mongers.”
Rep. Darrell Issa (R-Ca.), the ranking Republican on the House Committee on Oversight and Government Reform, yesterday released a Staff Report on the enormous fraud and waste in the Medicare system. The report points out that H.R. 3200, the Democrats’ government-run health care bill that has been reported out of three jurisdictional committees, does not address the systemic failures that facilitate the fraud but replicates these same faulty mechanisms for fraud and waste.
Aug 13: Big Pharma lobby is undaunted by the deal breaking that the Whitehouse has conducted. No matter, as one writer put it: "It's one thing to accept the Capitol Hill advice that if you're not at the table, you're on the menu." We see the continued acquiescence of the lobbying groups, something the Democratic political elite have hoodwinked. It is not like business is great for Pharma at this time. Also AARP has just recently backed away from openly endorsing Obamacare.
From WSJ, Aug 13: The drug maker CEOs seem to believe that ObamaCare will pad their profits, at least in the short run. According to a new analysis in the journal Nature, the internal rate of return on drug industry research and development is now about 7.5%—and has fallen below assumed rates of capitalization between 8.5% and 11%. In other words, the industry estimates that it costs more to develop a drug than the actual returns from bringing one to market.
If passed, the wheels of rising costs with Obamacare will grind away, and any political advantage that Pharma might have had will be at great risk, as is their business. Another excerpt from the WSJ article: Under more stringent price controls the pharmaceutical industry will come to resemble Europe's, where the companies that have not fled to the U.S. or merged have stagnated or collapsed. Which is another way of saying that these allegedly hard-headed businessmen also believe in magic beanstalks.
The political campaigning for Obamacare took the view that the special interests were behind the town hall outspoken few and the rumors as it put it. So I guess it could not be just angry Americans with valid concerns. This dismissal will not be forgotten by the concerned citizens. Mr. Obama said: "History is clear. Every time we come close to passing health-insurance reform, the special interests fight back with everything they've got. They use their influence. They use their political allies to scare and mislead the American people. They start running ads. This is what they always do. "We can't let them do it again. Not this time. Not now."
John Mackey's WSJ article on an alternative to Obamacare has collected quite a few comments on WSJ and elsewhere. It is a sound basis for a market approach to healthcare, similar to that proposed elsewhere in this website. The comments seem split along tribal lines. How to to manage care for the poor seems to dominate. Simple answer is that there is already a government program that tries to address this population, called Medicaid. It is not an effective means however, as more and more doctors refuse to take these patients, and to gain some measure as to why this is happening , read the letter from a doctor in Atlanta.
Aug 12: the town hall meeting that Obama conducted had a most agreeable crowd, raising concerns about being a stacked deck. The crowd outside was much more contentious. He continues to attack the insurance companies, so the new attack strategy of picking on the bad guy is being sustained. His focus, as has been with other Democratic leaders, is to shine the focus on the need for not having preexisting conditions disallow insurance.
WSJ writes how the disallowing of pre-existing conditions simply encourages citizens to take out insurance only when they are sick. This distorts the entire underpinnings of insurance as a means to manage risk as a group. The 5 States who already have this mandate have proven this mandate is unworkable, but the policy persists. One can conclude that it is more about enhancing entitlement than making good reform.
Obama continues to dismiss the the criticism of the public option, something he continues to support. He mentions the example of the Post Office in business along side FedEx and UPS, and that the Post Office is the one that is not competitive. This statement is supposed to prove that the public and private can co-exist in the same area. This is a curious statement in that it is a good argument for a totally private mail service. The Post Office has a Federal Mandate and costs the taxpayers billions every year, in one type of mail service, while FedEx and UPS have run circles around the PO in other areas of delivery service. The Post Office would cease to exist without this mandate. So it becomes a good argument for not having a Public Option.