Voice For Liberty

Tag: Government health care

  • Health care reform threatens anesthesiology, patients

    While doctors aren’t the only source of information we should use when considering health care reform, they are on the front lines of providing care, and so their insights are valuable.

    Recently, Ronald Dworkin contributed An Anesthesiologist’s Take on Health-Care Reform to the Wall Street Journal. He makes some good observations on doctors in general, and on the special nature of anesthesiology.

    Dr. Dworkin warns of a mistake liberals always make: that they can raise tax rates, and people will still earn as much as they did. With the higher tax rates, it’s hoped that revenue to the government soars.

    Dworkin explains that “today’s upper-middle class professionals are very sensitive to marginal tax rates. To preserve ‘lifestyle’ and ‘quality time,’ they will work less.” So the higher tax revenues may not materialize. They’ll be working less, it should be noted, at the same time that demand for medical care may soar.

    A problem with Medicare is its low reimbursement rate to doctors, often less than the cost of providing services. Dworkin also explains, referring to anesthesiology: “In no medical specialty is the spread between the Medicare rates and private insurance rates greater. … According to one of the health-care bills in Congress, H.R. 3200, the public option would reduce reimbursement for anesthesia by over 50%.”

    Dworkin warns that these low reimbursement rates will cause anesthesiologists to leave the field, leading to reduced care and more deaths. Obstetrics, he says, will be impacted first: “At the very least, pregnant women will be waiting a lot longer for epidurals. But more pain on the labor floor is only the beginning. If hospitals delay the administration of anesthesia because Congress skimped, needless deaths will certainly result.”

    Some of the comments left to this article are informative. One: “Just another greedy doctor trying to scare people like some kind of clumsy Glenn Beck. The doc is afraid that the gilded age of over-sized paychecks is coming to an end. The truth is, you really do not need a new Mercedes Benz every year.” One person replied “I’ll take a smart, greedy doctor over a dumb, altruistic one any day.”

    Another person reminded us that “Mr. Obama’s wife earned more than many doctors working as vp of community relations for a Chicago hospital.”

    Mrs. Obama’s job, which paid over $300,000, may be one reason why health care costs are so high. Evidently it wasn’t all that important of a job, as in January the Chicago Daily Observer reported a story with the headline Michelle Obama’s job eliminated.

  • Health Czar, interrupted

    The Sam Adams Alliance presents another humorous look at health care reform in America. The first, Health rations and you, was very popular on YouTube. Now: “After months of Americans happily sacrificing for the Health Administration Bureau, Health Czar O’Brien holds his first press conference, ready to answer the tough questions.”

  • Death goes to Washington

    Wendy Aylworth in DC 01Wichita’s Wendy Aylworth, dressed as the grim reaper, appears in Washington, D.C. (For a larger version, click on the photo, then click on “All sizes.”)

    Wichita activist Wendy Aylworth has taken her cause, Morticians for National Health Care, to Washington. This group, a tongue-in-cheek preview of the future Wendy believes we face under ObamaCare, seeks to inject a little humor and satire into the debate over health care reform.

    (I know, there aren’t death panels mentioned in the current health care bills working their way through Congress. The President also says that care isn’t going to be rationed. But there’s simply no way the cuts in Medicare spending can be accomplished without restricting care to seniors, and that means some will die sooner than they would have otherwise. The Obama administration is proposing big cuts in reimbursement rates to specialists, which will have the effect of making less care available to seniors. The proposed increase in reimbursement rates for primary care physicians may make up some of the difference.)

    Wendy Aylworth in DC 03

    Wendy — as the grim reaper — delivered a talk at a recent tea party event in Wichita. You can view the video of that event by clicking on Morticians for National Health Care.

  • President Obama’s health care speech

    Speaking to a joint session of Congress and the American people, President Barack Obama laid out his latest vision for health care reform.

    The President said that he doesn’t want a radical shift. Instead, he wants to build on what works, and fix what doesn’t. He criticized those who use scare tactics that split people into unyielding idealogical camps.

    The time for bickering is over, he said. Now is the season for action.

    President Obama outlined three goals. The first is security and stability for those who have insurance, the second is to provide insurance for those who don’t have it, and the third is to slow the growth of costs.

    First, for those with insurance, including Medicare, Medicaid, and VA, nothing in this plan will require a change of coverage or doctors. Nothing, he repeated, requires you to change what you have.

    Also, insurance companies can’t deny coverage for pre-existing conditions, or drop coverage when people get sick. There will be no caps on coverage for a year or lifetime. There will be a limit on out-of-pocket expenses. At no extra charge, companies must cover exams like mammograms and colonoscopies.

    Second, for those without health insurance, he proposes to offer quality, affordable, choices. “You’ll be able to get coverage.” An insurance exchange, established and run by government, will let consumers shop for insurance at competitive rates. Insurance companies get to compete for millions of customers, which will cut prices.

    Tax credits will provide subsidy for those who still can’t afford insurance premiums. This will take effect in four years. Meantime, the government will immediately offer low-cost coverage.

    What about those who still don’t want coverage? Some companies may refuse to give coverage to their workers. This costs the rest of us money. So, individuals will be required to carry basic coverage. Also, businesses will be required to provide health care coverage, or to help their employees pay for it. Most small companies will be exempt, but large companies that can afford this will have to pay.

    The President said that misinformation has been spread, and this has made Americans nervous. He debunked the bogus claims spread by those want to kill reform, such as panels with power to kill off senior citizens. This charge is a lie, plain and simple, he said, to a standing ovation from Democrats.

    He said this plan will not insure illegal immigrants. No federal dollars will be used to fund abortions, and federal conscience laws will remain in place.

    What about those who criticize what they term a government takeover of health care? The President said his guiding principle is that consumers do better when there is choice and competition. He doesn’t want to put insurance companies out of business, he just wants to hold them accountable. A not-for-profit public option in the insurance exchange would provide this accountability. No one would be forced to choose it, as it would be available only for those who don’t have insurance.

    This public insurance option would have to be self-sufficient, but by avoiding costs, it could provide a good deal for consumers.

    The President insisted that this won’t result in a government takeover of health care, and that he won’t back down from providing a choice to those who can’t find insurance.

    He added that no bureaucrat, government or otherwise, will get between you and the care you need.

    Finally, he asked how to pay for this plan. He said that he will not sign a plan that adds to the deficit, now or in the future. To show he is serious, he said that spending cuts will be forced if savings don’t materialize.

    The source of payment for this plan is savings.

    The President gave a slight nod to tort reform, and directed Secretary of Health and Human Services Kathleen Sebelius to look into demonstration projects on this matter.

    Analysis

    The biggest criticism of the President’s plan is that coverage can be increased — in terms of the number of insured, the generosity of benefits, and ability to get insurance — without increasing costs. This goal of rooting out waste and inefficiency is elusive. Politicians at all levels claim to want to get rid of it, but little progress is ever made.

    The President refuses to recognize that employer-provided health insurance is a problem. He wants to create a co-op so that there will be a vigorous market for insurance. This market could be created very quickly, without government oversight, by simply ending the present system of employer-provided insurance.

    The President’s claim that illegal immigrants will not be covered can’t be believed. Illegals are not supposed to be able to work in America, and we don’t have the national will to vigorously enforce that law.

    His claim that he doesn’t want a government takeover of health care isn’t believable, either. Aspects of the plan such as the public option are the first step to the end of a private market in health insurance.

    The idea that there will be a mandate for everyone to be insured is a characteristic of the Swiss system, and it seems to work for them.

    I believe the President is mistaken in his belief that tort reform would provide only modest savings, saying that “defensive medicine may be contributing to unnecessary costs.” Directing Secretary of Health and Human Services Kathleen Sebelius to look into seeing if malpractice reform could help is not likely to produce results. She is, after all, the former lobbyist for the Kansas Trial Lawyers Association.

    Related on this site: Fact-checking the president on health insurance and In health care debate, can we trust the president?

    The complete text of the President’s speech is at Obama’s Health Care Speech to Congress.

  • Government institutions not role model for health care

    One of the arguments used to promote more government involvement in the provision of health care is this: government already provides so many services, and government provides these so well, that we ought to turn over medicine to it too.

    The New York Times’ Nicholas D. Kristof made such an argument in a recent column, citing, specifically, “fire protection, police work, education, postal service, libraries, health care” as examples of where “governments fill needs better than free markets.”

    This might possibly make sense if the premise of the argument — that government does all this stuff well — wasn’t false. Kristof himself has written several columns in the past year that are critical of public (government) education in America.

    Something that almost everyone assumes that only government can provide — libraries — illustrates how we end up with sub-standard institutions and service. My post Consider the alternative to a public library in Wichita provides additional detail.

    For deconstruction of the myth that there are things — like police protection and the streets and highways — that government provides best, or government can be the only provider of, see For A New Liberty: The Libertarian Manifesto by economist Murray N. Rothbard. In his introduction to this work, Lew Rockwell wrote: “Murray Rothbard was the creator of modern libertarianism, a political-ideological system that proposes a once-and-for-all escape from the trappings of left and right and their central plans for how state power should be used. Libertarianism is the radical alternative that says state power is unworkable and immoral.” For streets and highways, see the introduction to Walter Block’s new book A Future of Private Roads and Highways.

    Yet, many people love these public institutions because they’re free, or at least they seem to be. It doesn’t cost anything to call the police or to check out a book from the library, and enrolling a child in a public school costs only a modest fee.

    But these institutions not free. They cost a great deal. But they seem to be free, and that’s a dangerous illusion.

    Already much of the trouble attributed to our health care system stems from its appearance of being free of cost, or at least having very low cost compared to its actual cost. This is the case for Medicare and Medicaid recipients, and for most people who have employer-provided health insurance.

    When more people begin considering health care to be free, that will truly be a dangerous time. Our government-run schools, post office, and libraries are not institutions that provide good role models.

  • Some without health insurance are eligible

    Last week we looked at U.S. Census data regarding the number of people in America without health insurance, and we saw that a large number of people are eligible for various free insurance programs, but haven’t applied. The number may be as high as 14 million.

    Today’s Wichita Eagle has a story that may illustrate such a case. A family of four — two adults, two children — earns $2,000 per month, but has no insurance.

    Given these facts, it appears that at least the two children in this family are eligible for insurance coverage under HealthWave, which is the implementation of SCHIP in Kansas. This family’s income is roughly 133% of the poverty level for a family of four in Kansas, and according to a page at the HealthWave site, “Children in households with income up to 200% of the Federal Poverty Level may qualify for HealthWave.”

    I’ve identified one reason why maybe some in Kansas who are eligible for HealthWave haven’t applied: A web page meant to direct people to HealthWave contains at least two clickable links that look like they’d take you to page you need to visit, but they mistakenly refer to the page you’re already viewing. A little bit of proofreading of these web pages would make things a lot easier for applicants.

  • Articles of Interest

    Kansas budget, expensive college, Kansas education funding, alternatives to ObamaCare.

    Budgeting outside the box

    Reporting by the Flint Hills Center for Public Policy covers last week’s meeting of the Kansas House Appropriations Committee. (Although the Kansas Legislature is in session from January to May, there are many “interim” committee meetings during the summer and fall.)

    School funding is always a topic, and as usual, spending advocates focus on the small portion of spending that makes their case: “Committee members challenged school districts on focusing only on reductions in state base aid per pupil and ignoring all other funding sources which, taken collectively, have schools budgeted to receive just 0.2% less this school year.”

    There was also discussion of the Flint Hill Center’s work in exposing huge balances in funds.

    Maybe this is why college is expensive

    The University Daily Kansan reports on the generous deals given to three former Kansas public university chancellors in the news story Hemenway stays with University.

    ‘Montoy’ threat again hangs over education-funding discussions

    Kansas Liberty reports on the hammer used whenever Kansas K-12 school funding is the topic of discussion. At the same time Kansas school districts complain of lack of funds, they resist accounting system reforms that would increase transparency and provide better information about how efficiently districts use funds:

    A 2007 audit conducted by the Kansas Legislative Division of Post Audit determined that out of the 20 states sampled, Kansas was one of six states that did not have requirements for how accounting transactions are recorded. The audit concluded that “Kansas’s reporting requirements are at a very summary level of detail.”

    An audit released in July determined that some Kansas districts appeared to be using state dollars inefficiently for non-instructional purposes. The investigation was supposed to include fieldwork so auditors could actually see how funds were spent; however, the scope of the audit was limited after superintendents complained to the 2010 Commission.

    The commission then stopped the audit, saying it would be too stressful for schools to accommodate auditors at a time when budgets were being cut.

    The Whole Foods Alternative to ObamaCare

    John Mackey of Whole Foods Market Inc. reports on ways to reform health care without bigger government. Some of these would be very easy to accomplish, such as “Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits.” That law might take, maybe, one page of legislation to implement.

    Mackey’s reform proposals, because they are market-based rather than government-based (his article starts with Margaret Thatcher’s quote “The problem with socialism is that eventually you run out
    of other people’s money.”), has earned him much hatred from liberals. Currently the “Boycott Whole Foods” Facebook group has 31,000 members. Too bad we don’t have Whole Foods Market in Wichita. (The locally-owned Whole Foods in Wichita is not the same company.)

  • Uninsured count needs explanation

    One of the problems in the health care debate today is lack of facts — at least facts that all sides of the debate can agree on. Without such agreement, without a basic set of facts and data to reason from, we’re not likely to make any progress.

    One example of a fact often used as evidence is the high number of uninsured in America. Often the number cited is 45.7 million, which is a substantial fraction of our population. The source of this number is the United States Census Bureau report Income, Poverty, and Health Insurance Coverage in the United States: 2007. Specifically, the table “People Without Health Insurance Coverage by Selected Characteristics: 2006 and 2007” (page 22) gives this number, along with some detail and breakdown by various characteristics.

    When we look at these breakdowns, we can start to see that while 45.7 million is a big number, it is not indicative of the large and pressing problem the raw number suggests.

    The table starts by giving the number of uninsured people as 45,657,000 (in 2007).

    Below this number, one breakdown tells us that non-citizens number 9,737,000 (21%) of these uninsured. Many people feel that non-citizens, especially undocumented aliens , should not be entitled to government benefits such a health insurance. (Not all non-citizens are undocumented.) The Obama administration claims that the plans under consideration will not cover undocumented aliens. But it includes them in the number of uninsured people.

    Other lines in the table tell us that 8,488,000 (19%) live in households where the household income is from $50,000 to $74,999. Another 9,115,000 (20%) live in households with incomes over $75,000. These people, especially the over-$75,000 households, may not like spending money on health insurance premiums, but they could, in most cases, afford their own health insurance, even if premiums are over $1,000 per month.

    There’s also the issue that many people are eligible for some sort of government assistance with health insurance, but they don’t take advantage of it. Yet, these people are counted as uninsured. As explained in The Top Ten Myths of American Health Care: A Citizen’s Guide by Sally Pipes of the Pacific Research Institute: “As many as 14 million of the 45.7 million uninsured—poor and low-income Americans—are fully eligible for generous government assistance programs like Medicare, Medicaid, and SCHIP. The problem is, they’re just not enrolling in these programs.”

    We can see that substantial portions of the uninsured are not really problems that require huge government intervention to fix. It’s not possible to tell exactly how many, as the categories listed above are overlapping.

  • Swiss system could be best of the big-government reform alternatives

    At a recent forum on health care in Wichita, the system of health care in Switzerland was mentioned as a system that we could learn from.

    Dr. Brian Michael, a physician at the Wichita Clinic, specializing in endocrinology, diabetes, metabolism and thyroid disease, outlined the basic characteristics of the Swiss system. Switzerland has no government health care and no employer-funded health care. Each person must purchase commercial insurance, and each person owns their own policies.

    (Michael also said that policies must be in effect for five years before changing carriers, but I have not been able to verify this feature.)

    A more detailed list of the features of the Swiss system can be found at Healthcare Economist.

    An article in the Wall Street Journal by Regina E. Herzlinger provides more detail about the Swiss health care system:

    • In 2003, health care costs were 12% of GDP for Switzerland; 15% for the U.S.
    • “[Switzerland has] far better health outcomes than the U.S., even when Switzerland is compared to socio-demographically similar U.S. states such as Connecticut and Massachusetts.”
    • “The sick … can afford to buy health insurance, and also pay the same price. Yet private insurers compete in the market because they are paid more for sick enrollees through various risk-adjustment systems.”
    • “The Swiss government accounts for only a quarter of the health-care spending versus nearly 50% for the U.S.”
    • “The Swiss system is consumer-driven because consumers themselves pay for their purchases.”

    Not all is perfect with the Swiss system, however:

    • “… the government limits insurance competition with requirements for extensive minimum benefit packages and considerable micromanagement of prices.”
    • “Even worse is the Swiss government’s micromanagement of medical care suppliers. Unwisely adopting the U.S. government’s Medicare payment system, it not only dictates medical care prices but also specifies the bundles of care for which it will pay.”

    In a policy paper The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World, the Cato Institute’s Michael D. Tanner wrote this about the Swiss system: “… it is notable that Swiss health care spending remains below that of the United States for nearly comparable care. Strong evidence suggests that the exposure of Swiss consumers to the cost consequences of their health care decisions has made them more conscious consumers and helped limit overall health care costs.” We should note that the public option plan favored by many in the U.S. would shield us from these costs, just as many employer-provided plans do now.

    The purchase mandate and a government-defined benefits package is a problem, too: “Public choice dynamics are such that providers (who would make money from the increased demand for their services) and disease constituencies (whose members naturally have an urgent desire for coverage of their illness or condition) will always have a strong incentive to lobby legislators for inclusion under any minimum benefits package. The public at large will likely be unaware of the debate or see resisting the small premium increase caused by any particular additional benefit as unworthy of a similar effort — a simple case of concentrated benefits and diffused costs. … That is exactly what has happened in Switzerland, leading to a growing expansion of the basic benefits package.”

    Will the Obama administration and Congress consider adopting Swiss-style health care, where at least some market forces are at work? In a recent Roll Call column that reports on Herzlinger’s research and recommendations, by Morton M. Kondracke writes: “But even more compelling than her acid evaluation of what’s wrong is Herzlinger’s recommendation of the right alternative. ‘Consumer-driven health care,’ she insists, can be universal, efficient and end up costing less money than the current system — or any system being considered this year by Congress.”

    Kondracke concludes: “Right now, most health care reform plans being considered in Congress don’t even give consumers a role in controlling costs. Letting them run the system is hardly on anyone’s radar screen.”

    It doesn’t seem that we’ll learn from the Swiss.