Voice For Liberty

Tag: Health care

  • Fact-checking the president on health insurance

    Advocates for more government control over health care, including President Obama, cite cases where people have been abused by private health insurance companies. We ought to be sure that these cases are real, and we need to be aware of the scope of the problem, before we assign weight to these arguments.

    Wall Street Journal reporting (Fact-Checking the President on Health Insurance: His tales of abuse don’t stand scrutiny, September 14, 2009) provides some vitally important information in the health care debate.

    As it turns out, the facts underlying two cases that President Obama cited in his address to Congress last week are quite different from what the president wants us to believe.

    In one case, the president said this in his speech: “One man from Illinois lost his coverage in the middle of chemotherapy because his insurer found that he hadn’t reported gallstones that he didn’t even know about. They delayed his treatment, and he died because of it.”

    Here’s the Wall Street Journal reporting on this same case: “Although the president has used this example previously, his conclusion is contradicted by the transcript of a June 16 hearing on industry practices before the Subcommittee of Oversight and Investigation of the House Committee on Energy and Commerce. The deceased’s sister testified that the insurer reinstated her brother’s coverage following intervention by the Illinois Attorney General’s Office. She testified that her brother received a prescribed stem-cell transplant within the desired three- to four-week ‘window of opportunity’ from ‘one of the most renowned doctors in the whole world on the specific routine,’ that the procedure ‘was extremely successful,’ and that ‘it extended his life nearly three and a half years.’”

    In the second case, the president said this: “Another woman from Texas was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne.”

    The Journal reporting: “The woman’s testimony at the June 16 hearing confirms that her surgery was delayed several months. It also suggests that the dermatologist’s chart may have described her skin condition as precancerous, that the insurer also took issue with an apparent failure to disclose an earlier problem with an irregular heartbeat, and that she knowingly underreported her weight on the application.”

    Did President Obama lie about these cases? Or is he simply misinformed, and if so, who is feeding him misinformation?

    A second issue is the number of cases of rescission. That’s where an insurer cancels a policy, leading to stories like the two above. The number of cases identified by Congressional staff analysis is 20,000 over a five-year period. This may be evidence of a small problem that needs some gentle reform. A wholesale government intervention is not justified by these cases.

  • Articles of Interest

    Van Jones, Jay Leno, smoking in Kansas, Obama’s health care speech.

    Obama and the Left: The lesson of the rise and fall of Van Jones

    This Wall Street Journal commentary analyzes the resignation of “green jobs czar” Van Jones. “Our guess is that Mr. Jones landed in the White House precisely because his job didn’t require Senate confirmation, which would have subjected him to more scrutiny. This is also no doubt a reason that Mr. Obama has consolidated so much of his Administration’s governing authority inside the White House under various ‘czars.’ Mr. Jones was poised to play a prominent role in disbursing tens of billions of dollars of stimulus money. It was the ideal perch from which he could keep funding the left-wing networks from which he sprang, this time with taxpayer money. … [leftists who helped elect Barack Obama] are increasingly frustrated because they are discovering that Mr. Obama will happily employ ‘movement progressives,’ but only so long as their real views and motivations aren’t widely known or understood. How bitter it must be to discover that the Fox News Channel’s Glenn Beck, who drove the debate about Mr. Jones, counts for more at this White House than Mr. Sirota.” Ouch.

    Rooting against Jay Leno

    Tonight, Jay Leno’s new television show makes its debut. Not all are happy. As reported in the Los Angeles Times story Jay Leno’s new show is surrounded by drama: TV insiders hope NBC’s cut-rate alternative to scripted content fails: “… a fair number of industry insiders — and not just rival executives — will be rooting for it to flop. That’s mostly because, as part of NBC’s controversial experiment to overturn 60 years of prime-time TV traditions with relatively cheap programming, Leno’s new show is perceived as a potential job-wrecker.”

    Evidently the Leno show will cost only one-third of the cost of the scripted dramas that usually appear at the 9:00 pm (Central time) slot, and that means fewer jobs. But because of the show’s low production costs, it can be a business success even with low ratings compared to its competition.

    Kansas casino smoking ban

    The Wichita Eagle story Group claims smoking in Kansas casinos an ADA problem tells of an effort to force the state of Kansas to prohibit smoking in casinos.

    It should be noted that in Kansas, the casinos are owned by the state itself, and the state hopes to collect a lot of tax revenue from these operations. That may be why earlier this year when the Kansas senate passed a sweeping state-wide smoking ban, it proposed to allow smoking in state-owned casinos.

    Whether or not you believe in the merits of the smoking ban, the attitude of the state is clear: regulate everyone else, but not my myself.

    A Bipartisan Plan to Wreck the System

    In a funny — well, it would be funnier if it weren’t so sad because it’s so true — the Wall Street Journal’s Holman Jenkins writes the speech that President Obama should have given last Wednesday. Here’s an excerpt:

    Now, much has been said about our “public option” that’s been confusing and misinformed. It’s in that spirit that I speak to you tonight.

    Critics wonder: How can a new “public option” bring meaningful competition to the health-insurance marketplace and drive down costs?

    They miss the point. The great work done so far has tended to squash competition, and we would continue this work—by restricting the ability of insurance companies to design and market their policies; by regulating what coverage they can offer; by using tax distortions to keep consumers in the dark about what their health care really costs, so they will continue to treat it as a “free lunch” when it actually gobbles up more and more of their disposable incomes.

    People, this is why insurance rates keep going up and up, and why a competitive marketplace, in which consumers reward those who provide high-quality care at low cost, hardly exists. And I say again, with all humility, this is a great bipartisan achievement.

    I think he’s right: the present system is a product of both parties.

  • 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.

  • Health care video fails to make case for universal, “socialized” medicine

    A video that’s getting some viewers on Youtube (235,000 as of this moment) serves as an illustration of how wrong the left is in its diagnosis and prescription for health care reform.

    As a way to diffuse the actual implications of turning over control of medicine to government, the narrator uses the phrase “universal, socialized, whatever you want to call it.” This is repeated several times throughout the short video.

    This is a common technique used to divert attention away from a negative aspect of an argument or position. By using the “s” word — “socialized” — early on, and by using it several times in a dismissive fashion, the speaker hopes to take this issue off the table. It doesn’t work.

    The video makes the case that since many things are already provided by government, why shouldn’t health care also be the responsibility of government? The New York Times’ Nicholas D. Kristof made this same argument recently, and he didn’t do much better. The argument that because government currently provides a service, it means that government does it well, does it efficiently, and is the only institution capable of doing it is a fallacy.

    As to the high cost of being sick, the video states that “very, very, very few people” can afford health care when someone gets “really, really, really sick.”

    (I might have been persuaded if the narrator had used “really” just one more time. This condescending technique of repeating words several times — as if each time adds more truth to the speaker’s position — is another favorite tactic of the left. It doesn’t work.)

    This argument — that it’s expensive if you have a serious illness — is true. But most health insurance plans don’t address this need, which is to provide inexpensive coverage for the relatively rare cases when people need expensive care to get well. Instead, most health insurance plans are really pre-paid medical care plans, where the plan pays for routine, foreseeable events like an annual physical exam, flu shots, obstetrical care for women of child-bearing age, etc. Plans that pay for expensive disasters like a heart attack without paying for routine care are quite inexpensive. These are generally known as high-deductible plans.

    The video states that 10 to 20% of what we pay to health insurance companies goes to administrative costs, contrasting that to the 2% to 3% commonly given for Medicare. The video doesn’t state that Medicare is overrun with fraud because of these low administrative costs. As Malcolm K. Sparrow, an expert on fraud in health care said: “The rule for criminals is simple: if you want to steal from Medicare, or Medicaid, or any other health care insurance program, learn to bill your lies correctly. Then, for the most part, your claims will be paid in full and on time, without a hiccup, by a computer, and with no human involvement at all.”

    The video also condemns “pure profit,” stating that one of the best ways to increase profits is to deny paying claims. Stories of health insurance companies refusing to pay for treatment are common. We need to ask a few questions, however. First, are all these stories true? But more importantly, we need to recognize that most people have little choice in who handles their health insurance, because they receive it from their employer. They can’t shop for health insurance in the way they can shop for auto or homeowners insurance.

    If it became known that an auto insurance company failed to pay the claims it promised to pay in its policy, what do you think would happen? Would customers continue to patronize that company, no matter how clever their advertisements?

    The difference is that since people have to purchase their own auto insurance, companies compete for business on a variety of factors, including price and claims service. That’s not the case with health insurance. The lack of a robust market for personal health insurance leads to this situation. It leads to another problem, too, where the video complains about lengthy, complicated insurance contracts.

    Topping off the video is a ridiculous comparison of health insurance to fire-fighting insurance. The two markets are not comparable at all, especially in the dishonest and disingenuous way this video strikes a comparison. For one, few people set fire to their own house. Yet many people do just that to their health by failing to follow simple health guidelines. Second, fire fighting services are something used only in an emergency, and most people take great care not to need this service. Health care services are used for a variety of reasons, such as annual physical exams, that are not emergencies.

    These are the major problems with the arguments used in this video. It’s simply not credible.

  • 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.