Reason Foundation

Reason-Rupe Poll: Americans Don't Think Health Care or Broccoli Mandates Are Constitutional

Posted on March 26, 2012, 9:01am

As the Supreme Court hears challenges to the Patient Protection and Affordable Care Act this week, a new Reason-Rupe poll of 1,200 adults finds 62 percent of Americans believe it is unconstitutional for Congress to mandate the purchase of health insurance, while 30 percent think requiring health insurance is constitutional.

Legal experts have suggested that if Congress has the power to require individuals to buy health care insurance, it may also mandate that Americans buy broccoli. The Reason-Rupe poll finds 87 percent of Americans believe Congress does not have the power to require the purchase of broccoli, while 8 percent say Congress can force you to buy vegetables.

Reason-Rupe finds 54 percent of Americans think the health care law will result in the rationing of health care services. Half of Americans have an unfavorable view of the health care law, while 32 percent have a favorable view of it. Similarly, 49 percent say the law should be repealed and 36 percent would let it stand.

When it comes to addressing their health care needs, just 23 percent of Americans trust the government. That’s less than half of the 50 percent who say they trust health insurance companies and considerably lower than the 84 percent who trust their doctors.

The Reason-Rupe poll results reveal some health care reforms that the American public would support. Over two-thirds, 69 percent, of Americans would like to be able to shop for health insurance in the same way they shop for auto insurance. And many are willing to move away from our existing system to do so: 48 percent of Americans would prefer to receive the money their employers spend on health care as part of their paycheck and then shop for their own health care plans. Forty-one percent would like to continue to get insurance through their employer.

If they were allowed to shop for health care plans across state lines, 43 percent of Americans say insurance premiums would go down and 23 percent believe they’d go up.

In thinking about the quality and cost of their own health care, 67 percent of Americans tell Reason-Rupe that public sector workers have better health care benefits than private sector workers. Twenty-two percent say the benefits are about the same, and 4 percent say private sector workers get better benefits than government workers.

With Rep. Paul Ryan’s budget plans back in the news, the Reason-Rupe poll also finds voters are open to changing the future of Medicare. For people not yet in the program and under the age of 55 right now, 65 percent of Americans favor changing Medicare into a program that would give recipients a credit that could be used to purchase private health insurance. Just 24 percent would oppose the change. If those modifications were made to Medicare, 34 percent of Americans think the quality of care would improve, 33 percent believe it would stay the same and 24 percent say it would worsen.

A majority of Americans, 52 percent, support the health care law’s provision that prevents insurance companies from denying coverage to those with pre-existing conditions. However that support collapses when trade-offs are presented. Only 37 percent would support the pre-existing conditions law if tax increases were needed to pay for it; just 38 percent would support it if it caused higher premiums; and 41 percent would support it if it caused longer wait times to see a doctor.

The Reason-Rupe poll also asked about organ donation. Most Americans, 55 percent, believe healthy adults under medical supervision should be allowed to sell their own organs. Thirty-four percent oppose the sale of organs.

Full Poll Online

The complete Reason-Rupe survey is online at http://reason.com/poll and here (.pdf).

This Reason-Rupe poll, conducted March 10-20, 2012, surveyed a random, national sample of 1,200 adults by telephone (704 on landlines, 496 on cell phones). The results have a margin of error of plus or minus 3 percentage points. The poll was conducted for Reason Foundation by NSON Opinion Strategy.

This is the latest in a series of Reason-Rupe public opinion surveys dedicated to exploring what Americans really think about government and major issues. This Reason Foundation project is made possible thanks to the generous support of the Arthur N. Rupe Foundation.

Non-Violent Resistance to ObamaCare

Posted on March 26, 2010, 11:36am | Shikha Dalmia

ObamaCare this week was signed, sealed and delivered to the American people. The question is what now? Should Americans simply sit back and accept its panoply of Big Government provisions like the individual and employer mandates, taxes, regulations, what have you? In my latest Forbes column, I say: No. Americans should take inspiration from Gandhi to bring down the coercive state apparatus that ObamaCare is erecting. I note:

By some estimates, Uncle Sam will need to hire an additional 17,000 IRS agents or so just to enforce the coverage mandate. But even if a few million Americans simultaneously refuse to abide by it, they could easily overwhelm the system. Self-rule or swaraj, Gandhi said, requires a collective understanding of the immense capacity of citizens to "regulate and control" the coercive apparatus of the state through mass nonviolent resistance.

President Obama and his fellow Democrats are counting on this resistance petering out. That could happen. But it will be a lot easier for opponents to maintain this zeal in the age of social networking. Facebook already has numerous groups with millions of members demanding the repeal of ObamaCare. It won't be impossible to mobilize enough of them when the denouement arrives.

After all, this issue is not just about the fate of an industry. It is about maintaining control over basic decisions about one's own life and health. The stakes are too high to let ObamaCare stand.

Read the whole thing here.

Dr. Obama's Idea of Change

Posted on March 22, 2010, 10:41am | Shikha Dalmia

Courtesy John Goodman at the National Center for Policy Analysis, here is the change you can look forward to under ObamaCare:

The ObamaCare Summit and the Republican Response

Posted on February 25, 2010, 10:06am | Shikha Dalmia

So what should Republicans do at the ObamaCare summit today? Karl Rove says this morning in the Wall Street Journal that they should not let President Obama get away with his habitual prevarications on the issue. That's good advice. But, ultimately, Republicans will have to do more if they want to be taken seriously on the issue. They will have to be constructive. And even though bipartisanship is over-rated, they can use it to hoist President Obama on his own petard by countering his phony bipartisan summit with one of their own that is genuinely  bipartisan. Obama has already put his Big Government solutions on the table. Their summit should consider five progressive and five conservative ideas that will do the opposite: Move the country in the direction of patient-powered, market based reforms that will control costs and thereby shrink the rolls of the uninsured.

In my latest Forbest column,  A Bipartisan Solution to ObamaCare, I outline these ideas.

How is the Bay State's Experiment with Universal Coverage Working Out?

Posted on January 18, 2010, 6:31pm | Shikha Dalmia

The big story coming out of Massachusetts that has everyone (at least in my household of two) glued to the TV with popcorn and coke in hand is the Brown vs. Coakley Senate race tomorrow. If Republican Brown pulls an upset, snatching victory from the jaws of defeat, all bets are off when it comes to health care "reform." He will deprive Democrats of their crucial 60-vote majority in the Senate, forcing them to resort to all kinds of politically risky shenanigans to push their bills through.

But here is another interesting story concerning Massachusetts. Remember Jon Gruber? He's the highly respected MIT economist who had been shilling for the Obama administration's health care plan without revealing that he had received hundreds of thousands of dollars from the administration in consultancy fee to help craft the very plan he was shilling for. He challenged insurance industry claims that premiums would rise sharply under ObamaCare -- criticizing an industry report, performed by the prestigious research outfit PricewaterhouseCoopers, on grounds that it had failed to take into account: (a) government subsidies for moderate-income Americans that would lower their out-of-pocket premiums and (b) how lower administrative overheads that would result from the creation of a government-run insurance exchange would lower premiums.

Gruber was also a big supporter of Massachusetts' universal coverage program. Well now Gruber's former MIT student and collaborator, Aaron Yelowitz, has just co-authored a study with CATO Institute's Michael Cannon drawing lessons from the Massachusetts' universal coverage experiment for the rest of the country. They find:

• Official estimates overstate the coverage gains under the Massachusetts law by roughly 50 percent. 

• The actual coverage gains may be lower still, because uninsured residents appear to be concealing their lack of insurance rather than admit to breaking the law. 

• Public programs crowded out private insurance among low-income children and adults.   

• Self-reported health improved for some, but fell for others. 

• Young adults appear to be avoiding Massachusetts as a result of the law 

The study also finds that leading estimates understate the cost of the Massachusetts law by at least one third. 

The authors conclude: "Our results hold important lessons for the legislation moving through Congress. As in Massachusetts, there has been no effort to estimate the cost of the private health insurance mandates that legislation would impose on individuals and employers. The costs may therefore be far greater than legislators and voters believe, while the benefits may be smaller than the conventional wisdom about Massachusetts suggests."

What says you, Mr. Gruber?

ObamaCare: First They Came for the Undocumented Aliens!

Posted on January 18, 2010, 5:40pm | Shikha Dalmia

In my latest Forbes column I argue that the progressive left is serious neither about universal coverage nor about civil liberties. If it were, if wouldn't settle for the travesty in the Senate health care bill that would disbar undocumented aliens -- er, illegal immigrants! -- from buying coverage from the proposed exchange with their OWN money. What's the rationale for the ban? Because, otherwise, they will indirectly benefit from taxpayer aid used in creating and running the exchange. But by this logic, I note:

should we, then, post sentries on federal highways to shoo off undocumented workers? Position guards outside pharmacies to bar them from buying FDA-approved drugs? Dispatch marshals to stop electricity generated by public utilities from flowing into undocumented households? What's really driving the exchange ban is not concern for American taxpayers, since allowing people access on their own dime won't necessarily add to the nation's health care bill.

But that's not the worst of it. The worst is that:

At the same time the government tells Americans how they must spend their money, thanks to the individual mandate, it will tell undocumented aliens where they can't spend theirs. Government intrusiveness combined with government discrimination is not a formula for social justice....

...if universal coverage advocates accept the exchange ban, a sizable portion of the uninsured won't just remain unhelped, they'll be seriously harmed by being permanently locked out of the health care market.

The government hasn't claimed the authority to selectively withhold access to public facilities since the Jim Crow era. But at least then it wasn't using it for any high-minded purpose. This ban will institutionalize inequality in the name of greater equality. Is this a deal that progressives really want to cut?

Poor Dr. King. He must be spinning in his grave.

Read the whole thing here.

ObamaCare: The Immortal Revolution

Posted on January 13, 2010, 10:28am | Shikha Dalmia

In my latest Forbes column, I argue that ObamaCare is not the end of our health care battles -- it is the beginning. The bill that's currently in the works will usher even fiercer confrontations--not only on health care but on constitutional matters of governance as well--that will make the current battle look like the political equivalent of a spit-ball fight.

The constitutional battles will arise because netroots activists will try and reinstate the public option or government insurance that is now all but dead.

The biggest impediment to their ambition--as the current health care battle has made clear--isn't going to be evil Republicans or the venal insurance industry, but America's system of checks and balances. In particular, the Senate filibuster ...

But it can't be abolished without a bruising political battle. To the extent that most laws involve an expansion of government power, scrapping it will inevitably empower the government against its citizens. What's more, a president--a minority of one--will be able to override Congress with a stroke of his pen. But even 49 senators won't be able to stop him from ramming his agenda through their chamber.

And the health care battles will arise because what Congress is doing right now amonts to a de facto nationalization of our health care system.

Such systems always and everywhere face a contest between competing interests trying to capture scarce medical dollars. If, say, women with breast cancer shame political authorities into approving expensive cancer-fighting drugs, men launch their own campaign to shift medical dollars to prostate cancer treatment. Patients who lack the political savvy or represent disfavored causes--obesity, smokers, homosexuality--inevitably get relegated to second class medical status. If money poses an unfair obstacle for patients in a market-based system as progressives allege, can they with a straight face claim that the political establishment doesn't pose a far bigger obstacle in a government-run system?

Read the whole thing here.

No "A" on Health Care for Obama

Posted on January 12, 2010, 9:07am | Shikha Dalmia

Obama's health care marks have reached an all-time low, according to a new CBS News poll, something that is helping to drag down his overall approval rating. According to the CBS story:

Just 36 percent of Americans approve of Mr. Obama's handling of health care, according to the poll, conducted from Jan. 6 - 10. Fifty-four percent disapprove. In December of last year, 42 percent of Americans approved of the president's handling of health care, and 47 percent approved in October.

About six in 10 Americans continue to disapprove of how both Democrats and Republicans in Congress are handling health care reform: 57 percent disapprove of how Democrats are handling the issue, while 61 percent disapprove of how Republicans are handling it.

Approval among each party's own supporters is also low. Just 48 percent of Democrats approve of how Democrats in Congress are handling health care, while only 43 percent of Republicans approve of how their party in Congress is handling the issue.

Moreover, there is little consensus that the reforms under consideration represent the right approach. Only about one in five Americans thinks the reforms strike the right balance when it comes to expanding coverage, controlling costs and regulating insurance companies.

The public is divided on whether the reforms go too far or not far enough in providing health coverage to as many Americans as possible, and about four in 10 think the reforms do not do enough to lower costs or regulate insurance companies.

Overall, the survey reflects good sense on the part of the voters. But anyone who seriously believes that the Dems aren't regulating insurance companies enough obviously hasn't braved through the 2,000-page monstrosity. The regulatory boot on these companies' neck is going to be so heavy (they are going to have to: include a lavish set of benefits in their "basic" coverage package at controlled prices; cover pre-existing conditions; give money back to policy holders if their administrative costs exceed 10% of revenues) that as Nancy Pelosi recently remarked, they will beg Congress for a public option instead.

The Left Wakes Up to the Evils of the Individual Mandate -- Finally!

Posted on December 17, 2009, 10:50am | Shikha Dalmia

Ok - am I engaging in the fallacy of post hoc ergo propter hoc or is the left really listening to us finally? I have written column after column pointing out the perversity of the central plank on which ObamaCare is built: the individual mandate. It would force Americans to either buy health coverage or face fines or jail time. Since often the fines would be lower than the cost of coverage, thousands - perhaps millions - of Americans would simply pay them for the privilege of remaining uninsured. Or become criminals. I even coined a term for this health care approach back in 2008 when Hillary first proposed it: TonySopranoCare.

And in my latest Forbes column this Wednesday about the Medicare buy-in provision in the now-dead ReidCare bill, I asked this question of our leftist comrades. (The buy-in provision pretended to give near-seniors more options to purchase health care by opening up Medicare to the 55-64-year-old cohort):

Come 2011, when the individual mandate will kick in--if Democrats succeed--the uninsured working poor in the 55-to-64 age group would have had to fork over a whopping 50% to 70% of their income to buy into Medicare. Sen. Reid planned to help these folks with subsidies ... by 2014. But what were they supposed to live on until then? His good intentions? How could he and his comrades in good conscience believe it is right to force people to buy coverage now--under threat of fines or jail, mind you--while leaving any relief to the vagaries of politics years from now?

If Americans are dying due to lack of insurance, as Ezra Klein, the writer who called Lieberman a mass murderer, believes they are, can Klein imagine how many more would be driven to starvation, ruin and possible death if ReidCare confiscated a big chunk of their wages every year in order to achieve universal coverage? An individual mandate is bad enough. But an individual mandate that doesn't come with help attached--how can they possibly accept that?

Last night, Democratic National Committee Chairman Howard Dean went on MSNBC and urged his fellow Democrats to defeat the Senate health care bill. Why? Listen:

You're going to be forced to buy health insurance from a company that is going to take on average of 27% of your money ... and there is no choice about that. If you don't buy that insurance you are going to get a fine.

Later in the day, the successor organization to Dean's 2004 presidential campaign, Democracy for America noted:

That [the individual mandate] section of the law requires every single American buy health insurance or break the law and face penalties and fines. So, the bill doesn't actually "cover" 30 million more Americans - instead it makes them criminals if they don't buy insurance from the same companies that got us into this mess.

Ok -- so that last part is wrong. It is not the insurance companies per se but government mandates that drove out small companies from the market leaving a few giants to rule the roost that drove us into this mess. That may be too much nuance for DOA, but -- oh! oh! -- listen to Markos Moulitsas, the founder of one of the largest liberal blogs:

My take is that it's unconscionable to force people to buy a product from a private insurer that enjoys sanctioned monopoly status. It'd be like forcing everyone to attend baseball games, but instead of watching the Yankees, they were forced to watch the Kansas City Royals. Or Washington Nationals. It would effectively be a tax - and a huge one - paid directly to a private industry. Without any mechanisms to control costs, this is yet another bailout for yet another reviled industry.

Amen!

Should we start sending all our netroots comrades a free subscription to Reason magazine? But the real question is that will this 11th hour awakening by the left to the dangers of this monster  -- otherwise called health care reform -- that they are creating doom it?

Fingers crossed.

The ReidCare Debacle

Posted on December 16, 2009, 10:59am | Shikha Dalmia

In my latest Forbes column, I note that the left should celebrate the death of ReidCare. Why? Because the Senate Majority Leader's plan would have hurt the near-seniors, the very people it wanted to help. Those below 150% of the poverty level would have qualified for Medicaid. But what about those over?

They won't qualify for Medicaid. The Medicare buy-in, likely their best option, would have cost them around $15,200, according to an analysis by the Congressional Budget Office of a previous proposal. Individuals making over 150% of the poverty level, or $16,500, would have had to pay $7,600.

In other words, come 2011, when the individual mandate will kick in--if Democrats succeed--the uninsured working poor in the 55-to-64 age group would have had to fork over a whopping 50% to 70% of their income to buy into Medicare. Sen. Reid planned to help these folks with subsidies ... by 2014. But what were they supposed to live on until then? His good intentions? How could he and his comrades in good conscience believe it is right to force people to buy coverage now--under threat of fines or jail, mind you--while leaving any relief to the vagaries of politics years from now?

If Americans are dying due to lack of insurance, as Ezra Klein, the writer who called Lieberman a mass murderer, believes they are, can Klein imagine how many more would be driven to starvation, ruin and possible death if ReidCare confiscated a big chunk of their wages every year in order to achieve universal coverage?

What the ReidCare debacle shows is that the left has not a clue about how to promote its agenda in an incremental yet principled way. However, it can look for guidance from the school choice movement.

Many free-market advocates (like me) believe the best way to improve education is to get the government completely out of the business of running schools. But they also understand that they can't simply will away public schools overnight. Hence, they have accepted all kinds of half-way measures, including school vouchers, education credits and charter schools, that give at least some parents a way out of their dysfunctional public schools. Over time, the hope is that these market-based reforms will prove their efficacy over government-based solutions and lead to a fully privatized system.

But here's the thing: If the entire school choice movement were suddenly stopped in its tracks so that not another voucher was handed out or a charter school opened, choice advocates could still live with themselves secure in the knowledge that the partial changes they did make helped many and left no one worse off.

Could ReidCare advocates honestly have said the same? No. What the Medicare buy-in idea reveals is that the left cares little about who it tramples in its health care battle so long as it can keep marching toward socialized medicine. Americans can sense this triumph of ideology over humanity, which is why they are abandoning Democratic reform efforts in droves. If Democrats want to win them back, instead of ramming something through the Senate as they are hoping to do, they ought to pause till they recover their moral compass. Otherwise, they will have a hard time finding their way back to Capitol Hill next November.

Founders Against ObamaCare

Posted on December 11, 2009, 3:38pm | Shikha Dalmia

Many people have been wondering whether Democratic plans to force individuals to buy health insurance can withstand constitutional scrutiny given that in this country we are supposed to have a government of limited and enumerated powers. But the constitution's commerce clause gives Congress the authority to regulate interstate commerce. And Congress has made expansive use of this authority, thanks to a compliant Supreme Court.

In the 1942 Wickard v. Filburn case, the court ruled that Congress had the right to stop an individual farmer from growing wheat for his personal use - not for commercial sale, mind you - because otherwise he would undercut Congress' efforts to raise national wheat prices. The court essentially reaffirmed this far-fetched rationale in the 2005 Gonzalez v. Raich case when it ruled that Uncle Sam had the authority to go after individuals growing marijuana in states that had legalized medical marijuana - even though they had no intention of ever selling the marijuana across state lines.

So the question is if Congress can use the commerce clause to stop you from growing your own produce to maintain optimal produce prices, why can't it make you buy insurance in order to maintain optimal insurance prices? It is hard to see that the commerce clause can place any principled limits on Congress' authority to regulate any activity with a remote bearing on any interstate market.

But health insurance might be an exception. Robert Levy and Michael Cannon of the CATO Institute  note that what the Dems are forgetting is the McCarran-Ferguson Act passed in 1945, which gave states absolute authority to regulate health insurance.

The perverse effect of the law has been to bar individuals from purchasing health insurance across state lines. But now it will also work against Congressional efforts to engineer a federal takeover of health care because the law essentially made insurance markets off-limits to Congressional meddling.

What's more, the tax that Reid wants to use to enforce the mandate might also be unconstitutional. Write Levy and Cannon:

The Senate bill attaches a penalty for not complying with the mandate to the Internal Revenue Code. But the penalty is not based on income, so it's not an income tax. And it's not based on the value of the policy not purchased, so it's not an excise tax. Instead, the tax is a fixed amount based on family size. That means it's levied per person and therefore a "direct tax" under the Constitution, which requires that such taxes be apportioned among the states according to their population, as determined by the census.

But it won't be apportioned among states in this way. States that have more uninsured - as opposed to more people - will effectively end up paying a bigger tax than those that have fewer uninsured.

In short, should Congress in its infinite unwisdom proceed to pass the individual mandate, there might be legal grounds to mount a very serious legal challenge to it.

Whole Levy-Cannon column here.

"The Public Option is Dead. Long Live the Public Option."

Posted on December 10, 2009, 11:25am | Shikha Dalmia

It's funny. But the death of the public option in the new health care "deal" that Sen. Harry Reid has brokered with centrist and leftist Democrats has produced no triumphant chest-thumping among opponents of the public option. Why? Because what they are getting in exchange is arguably far worse.

As Tunku Vardarajan explains in The Daily Beast, Democrats are now trying to get universal coverage by expanding eligibility for Medicare - a program that is already facing unfunded liabilities to the tune of $35 trillion - from 65-year-olds to 55-year-olds. "This incremental Medicare approach would raise government-sponsored health insurance from about 60 percent (Medicare, Medicaid, veterans, and government employees) to 70 percent or more," writes Vardarajan. "So Republicans, libertarians, and others, beware: Much more than the camel's nose in now under the tent."

Actually, the camel might be getting into the tent rump first. But here is the money quote explaining why the public option might indeed have been the lesser of the two evils:

"Once you add the expansion of Medicaid to the expanded scope of Medicare-with Medicaid eligibility thrown open to everyone below at least 150 percent (and maybe 200 percent) of the poverty level-you are emphatically on a flight path to Canada. Broader subsidies, in fact, apply up to four times the level of poverty, which is $96,000 for a family of four in 2016 and supposedly only flow to those without job-based coverage. That sets up a two-tier system where people with employer-sponsored insurance benefit from one subsidy via the tax exclusion and see lower wages, while people outside ESI would see 70 percent or 80 percent of their insurance costs paid for by taxpayers nationwide, far above the benefit from the exclusion."

When this two-tier system becomes unsustainable, what you'll get is the public option and then single-payer or single-payer directly. What Harry Reckless Reid's compromise really proves is that there is no fixing his health care monstrosity. Nothing good can come out of it. If we have any hope of avoiding socialized medicine in this country, Reid's bill has to be defeated wholly, entirely and in toto.

Whole thing here.

P.S. Addendum via Sally Pipes of Pacific Research Institute regarding Medicare's unfunded liabilities that will cheer you right up!

Already, the program is deep in debt. Medicare Part A, which pays for hospital care, is $36.4 trillion in the hole, according to the latest report from the Medicare Trustees. Medicare Part B, which covers doctor visits, has an unfunded liability of $37 trillion. The trustees have also concluded that the funding source for Part A - the Medicare Hospital Trust Fund - will be insolvent by 2017.

Expanding Medicare to an even greater swath of the population would drown the federal budget in even more red ink.

When will ObamaCare go into Cardiac Arrest?

Posted on November 23, 2009, 11:39am | Shikha Dalmia

With the Senate voting Saturday to allow debate on its version of ObamaCare to proceed, the only hope for defeating this monster now is a public outcry that is so huge that even the MedicoCracy in Washington can't ignore it. Hence, it is significant that the latest Rasmussen poll shows support for health care reform dropping rapidly.

The poll shows that now just 38% of voters favor the health care plan proposed by President Obama and congressional Democrats and 56% oppose it. That's the lowest level of support measured for the plan in nearly two dozen tracking polls conducted since June.

Rasmussen notes that half of the survey was conducted before the Senate voted late Saturday to begin debate. Support for the plan was slightly lower in the half of the survey conducted after the Senate vote.

Prior to this, support for the plan had never fallen below 41%. Last week, it was at 47%, and two weeks ago, it was 45% of voters.

What's more, the poll shows that the more details Americans get, the more they dislike this devil. They aren't buying any of claims of the advocates. "Only 16% now believe passage of the plan will lead to lower health care costs. Nearly four times as many (60%) believe the plan will increase health care costs. Most (54%) also believe passage of the plan will hurt the quality of care," Rasmussen notes.

But what is the tipping point when Democratic legislators might rethink their designs of shoving ObamaCare down the throat of an unwilling public? The creepy but shrewd political strategist of the Clinton yore, Dick Morris, prognosticates:

Democrats will march in lockstep to approve a bill that lags in the public opinion polls by something like the current margin of fifteen points. With roughly 40% approving of the plan and 55% against it, Democrats will likely heed the pleas of their leaders and lend their assent.

But if the current slide in ratings continues and health care's support slips into the mid or low thirties, all bets are off. Even this Congress will not pass a program that meets with a 2:1 disapproval among the voters. They will try to buy off the opposition with compromises, but, failing that, they will just vote no.

So if Morris is right, should the polls drop another four to six points, ObamaCare might go into cardiac arrest.

Perhaps. I'm crossing my fingers but not holding my breath.

Reading the ObamaCare Tea Leaves

Posted on November 22, 2009, 10:57am | Shikha Dalmia

Last night's Senate vote to move forward with the debate on the universal health "don't-care" bill left me deeply pessimistic that this monstrosity could be stopped now. The margin of resistance - mere four senators -- appears too thin for a filibuster. All Comrade Harry Reid has to do, it seemed to me, is continue to smother them in taxpayer-funded goods till they succumb. After all, Sen. Mary L. Landrieu of Louisiana's resistance has already earned her $100 million in extra Medicaid reimbursement for her state. And though she continued to pledge resistance if this or that wasn't changed in the final bill, she was singing a decidedly more conciliatory tune on the Senate floor last night. She recounted the many things she liked about the bill and others that "needed improvement." Nothing was a deal-breaker for her anymore.

Everybody has a price, and if there are only three or four Senators who need to be bought, what does Harry Reid care how much he has to raid taxpayers' pocket to buy them off - especially since defeat will leave the president politically castrated for the rest of his term?

But the Politico this morning has an analysis that has caused me to think that maybe -- just maybe -- it's not over yet.

There are plenty of credible pockets of resistance inside and outside of Capitol Hill that might well derail the bill, Politico's analysis shows.

One: Public option politics.

Politico notes: "Right now, there is no public option plan that could garner 60 votes. A public plan "trigger" if private insurers fall short could come close - saying, losing Sanders but picking up Olympia Snowe (R-Maine) - but there's no guarantee it would fly in the House."

Two: Pro-life and pro-choice activists.

Politico notes: "Anti-abortion activists insisting that health reform cannot expand federal funding for abortions...Reid can't afford a single defection - and already, Sen. Ben Nelson (D-Neb.), who opposes abortion rights, says weak language could be enough to oppose final passage.....

House Speaker Nancy Pelosi could lose at least 10 Democrats if the Senate tried to water down the tough anti-abortion language in her bill."

Three: Various constituencies that will bear the brunt of higher taxes.

Politico notes: "The House and Senate have starkly different visions of how to pay for reform. And the House hates the Senate tax, and the Senate hates the House tax.

Not surprisingly, politics are at play. The House went with a populist soak-the-rich tax on "millionaires" to pay for almost half the near-trillion dollar price-tag in its bill. And bowing to pressure from powerful union backers, Democrats steered clear of any tax on the so-called "Cadillac" plans - high-cost policies that many unions have negotiated for their workers over the years........Reid relies heavily on taxing the Cadillac plans - but won't touch a millionaires tax, which was never debated in the Senate."

Taxing Cadillac plans will lose unions and taxing millionaires will alienate all the rich, limousine liberals who voted for Obama.

Four: A senior revolt.

The Senate bill would cut close to half a trillion in Medicare. "So here we are telling the American people that we're going to fix health care in America and the way we're going to pay for the massive government takeover of health care is through cuts in Medicare?" says Sen. John McCain (R-Ariz.). Republicans are going to pound this and this will put Democrats between a rock and hard place. To keep AARP support - without which this bill will be in deep trouble - Democrats will have to roll back these cuts. And when they do, the bill will no longer be deficit-neutral putting President Obama in a bind because he would be breaking a promise not to sign any bill that raises the deficit by a "single dime" and jeopardizing even more the re-election chances of at least four or five Blue Dogs.

Five: Big Pharma.

Politico notes: "But there's another danger to Democrats lurking in the bill - dissent toward the White House deal with the drug-makers. Many Democrats feel PhRMA got off easy by only having to kick in $80 billion in cuts toward health reform. Some liberal Democrats want to change the deal's terms and force the industry to sell drugs to the federal government at a discount.

PhRMA insists that would bump up the seniors' Medicare prescription drug premiums by 20 percent. If the Senate includes the rebates, industry officials privately say that they'll consider running ads slamming senators for voting to increase seniors' drug costs.

'PhRMA would have to let people know the truth,' said a senior pharmaceutical lobbyist. 'I don't know why they would want to increase premiums.'"

My best guess? I think Democrats will ultimately get something through. All the internal contradictions will certainly make the bill creak mightily as it moves forward, but they won't cause it to collapse. The only hope is very massive outside resistance that even the MedicoCracy-- otherwise called Democratic leadership -- in Washington can't ignore.

How Republicans can Kill ObamaCare

Posted on November 18, 2009, 1:21pm | Shikha Dalmia

Republicans are trying to defeat ObamaCare by arguing that its public option -- or government-run insurance plan -- will drive private insurance companies out of business, leaving Americans with less - not more - options. But the fudmental problem with ObamaCare, I note in my latest Forbes column, is not the public option, but its tyrannical designs to force all Americans to purchase coverage through an insurance mandate. Build public support against this, and the whole Rube Goldberg-like edifice that is ObamaCare will come tumbling down.

A mandate will fundamentally alter the relationship between Americans and their government. Instead of the government being accountable to them, they will become accountable to their government. No less than the Congressional Budget Office--a non-partisan government agency--once admitted as much. "A mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action," it noted. "The government has never required people to buy any good or service as a condition of lawful residence in the United States."

If the government can force Americans to buy coverage on the threat of fines or even imprisonment--an option that Nancy Pelosi has pointedly refused to rule out--every other government diktat becomes small potatoes by contrast. In fact, it becomes necessary. If uninsured Americans must buy coverage, why shouldn't other Americans be taxed to subsidize them? Why shouldn't the insurance industry be required to sell them coverage? Why shouldn't government set insurance prices to ensure affordability? Why shouldn't doctors and hospitals be asked to charge only "reasonable" rates--or offer only government-sanctioned treatments? Nothing about ObamaCare fundamentally changes so long as the individual mandate remains intact.

Therefore, instead of wonkishly droning about the public option, Republicans should counter Democrats' grand appeals for "universal coverage for all" with equally grand appeals for "medical freedom for all." They should stand together on the Capitol steps and issue the health care equivalent of Reagan's Berlin Wall ultimatum: "Mr. President: Tear up this mandate."

Whole column here.

Universal Coverage: A Big Feast for Big Pharma

Posted on November 12, 2009, 9:34pm | Shikha Dalmia

Every special interest group knows that in Washington, "you are either at the table or on the menu." Big Pharma seems to have taken this motto to heart as Obama & Co. proceed to make mince meat out of the American health care system. And it is coming out a big winner.

Remember the $80 billion that President Obama said he had extracted from the drug industry over the next 10 years in order to fund his universal coverage plans? Well, The New Republic reports that it might have all been a giant sham. Far from eating into the profits of Big Pharma, health care reform is likely to prove a big boon to it.

As evidence, compare the March and the October profit forecast of IMS Health, a respected global research and consulting firm.

Back in March, according to TNR, IMS had projected no growth at all for the drug industry between 2008 and 2013. But in October, it projected average annual growth of 3.5%.

What changed? A major factor, according to IMS, was the emerging details of health care reform.

Health reform, as currently envisioned, wouldn't merely bring coverage to the uninsured. It would also fill in the "donut hole" in Medicare Part D--the gap in coverage that leaves beneficiaries with serious health problems paying for hundred if not thousands of dollars in out-of-pocket prescription costs.

In addition, because it will take several years to close the donut hole, reform relies on voluntary discounts from the pharmaceutical industry to make drugs more affordable in the intervening years. But those discounts would apply only to name-brand drugs, not generics.

Put it all together, and you have more demand for name-brand drugs. As a result, IMS believes, pharmaceutical companies would be able to raise their prices--enough to boost revenue significantly: "If this bill is implemented," the report concludes on page 138, "an increase in prices on new drugs can be expected."

Big Pharma has launched a major counter-offensive to the IMS report. It argues that:

"Projecting annual prescription drug sales is notoriously tricky, evident by the fact that IMS Health has released three different forecasts for 2009. Most troubling, the IMS report is based on incomplete information because it does not take into account discounts and rebates which can significantly lower the cost of drugs to payers.
 
"In some ways, it's like trying to project annual U.S. auto sales by adding up sticker prices.  That's not reality.  How many people actually pay full price for a car? Similarly, drug manufacturers often offer steep discounts and rebates through private negotiations. Medicare Part D is a good example. The Medicare Trustees, who unlike IMS have access to rebate data, report that rebates in the Medicare prescription drug program reach 20%-30% for many brand-name drugs and have increased over the past several years.
 
"The IMS forecast is incomplete in other ways, too. For one thing, it does not include key elements of health care reform legislation now pending before Congress, including a large increase of 8 percentage points in the base formula for the rebates that brand manufacturers pay in Medicaid. Nor does the report take into account the fact that Medicaid eligibility could be expanded to tens of millions of Americans who then would have access to lower-priced medicines.
 
"Most curious, however, is the notion that pharmaceutical sales will increase dramatically during the forecast period when major coverage expansions won't even kick in until 2013 or 2014, depending on what's in the final bill......"

It is entirely possible that Big Pharma is getting the short end of the bone in this dog fight. But it is also the case that it has spent $150 million in TV and radio ads to promote universal health care. Is it remotely possible that it is doing so purely out of the goodness of its heart even though it will lose money?

Call me difficult, but that's a line I find hard to swallow ....

That's a Lie, Mr. President

Posted on September 11, 2009, 10:28am | Shikha Dalmia

Obama said during his Wednesday night primte-time speechathon that those who accuse him of engineering a big government takeover of health care are lying. But it is President Obama who is lying. As I point out in a Forbes column:

In the plan he laid out Wednesday night, the government will control every aspect of the medical transaction. It will tell patients when, what and how much coverage they must buy; it will tell sellers when, what and how much coverage they must sell.

How so? He'll mandate "everyone do their part" by buying coverage. He didn't say how, a question he posed repeatedly to Hillary.

But his buddy Sen. Max Baucus, D-Mont., has some rather well-developed ideas on that score. Baucus has proposed a bill that would force the uninsured to pay fines on a sliding scale of income, with those making 300% of the poverty level having to cough up as much as $3,800 a year. In short, Americans would have to pay Uncle Sam for the privilege of remaining uninsured. If there were truth-in-labeling laws for Congress, it would be required to call this bill TonySopranoCare.

And he'll:

ban insurance companies from denying coverage to those with pre-existing conditions--tantamount to forcing fire insurance companies to write coverage on a burning building. He would also prohibit insurers from putting any limits on the coverage they offer and cap what they can require patients to pay out-of-pocket.

If this is not a government takeover of health care, then Tony Soprano is just a decent, hard-working businessman.

Read the whole thing here.

BaucusCare = TaxoCare

Posted on September 9, 2009, 5:01pm | Shikha Dalmia

Montana Senator Max Baucus has already given his prognosis for the so-called public option - or government-run health care plan - ahead of the president's prime-time health care speech tonight: Dead on Arrival. But he is planning to proceed on his alternative plan, regardless of whether it has bipartisan support or not. "Irrespective of whether there are any Republicans, I will move forward," Mr. Baucus said after meeting Wednesday with Democrats on his committee. He has vowed to "mark up" his bill by Sept. 21.

So what is Baucus' plan? And will it be more government-light (or less government-heavy) than the public option would? Don't bet your grandma's life support on it.

According to a Wall Street Journal story this morning, under the plan, Americans will be mandated to buy health insurance on the threat of fines. People who earn between 100% and 300% of poverty level (or $22,000 and $66,000 a year) would face fines ranging from $750 to $1,500 a year. Those with incomes 300% could pay anywhere from $950 to $3,800. In other words, if your cash flow is tight and you are trying to decide whether to fix that leaky roof or purchase health coverage, the government will make you do the latter - or pay up for the privilege of remaining uninsured. As I have noted before, there is a name for this kind of coverage: TonySopranoCare.

Baucus also wants to replace the government insurance option - to keep private insurers honest, you know - with non-profit insurance cooperatives run collectively by patients and providers or something like that. But the rub is that the government will have to spend tens of billions of dollars to seed these cooperatives. Some of that money will come from the fines on individuals. And the rest? According to the Journal story:

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.

Karen Ignagni, chief executive of America's Health Insurance Plans, an industry lobbying group, said the new fees would make it more difficult for health insurers to contain rising costs. "Our members are talking about that being at odds with the goal of cost containment," she said.

In short, insurance companies will be forced to finance their own competition. By that logic, should Baucus be forced to contribute to the campaign of his Republican opponent in the next elections?

And this is what passes for a "moderate" bill in Washington these days!

Post Script: I have two nagging fears about the President's address: One: that I'll fall asleep before he's done, and I have to write about this tomorrow. Two: that he'll actually call for tort reform - such as capping liability awards -- that the Republicans have made their holy grail. If he does, he will claim to have made a huge bipartisan gesture and demand that Republicans accept the mega government takeover of 17% of the economy that the Democrats are demanding. Then patients will be really screwed: They'll face higher health insurance costs and/or taxes as insurers pass on the new "fees" to them. And they'll have less recourse when their doctors screw up.

The French Patient

Posted on August 29, 2009, 12:28am | Shikha Dalmia

Sometime back I pointed out that the idea that America has a free market in health care was a myth. And now Guy Sorman, a French citizen, points out in the latest issue of the City Journal that the idea that the France's universal health care system is free is also a myth. In fact, it is expensive. Very expensive -- contrary to what Sara Paretsky claimed in the New York Times recently.  Paresky recounts in her article, "Le Treatment," the story of how she took her husband, suffering from chest pains during their vacation in France, to a local hospital, where he was treated without delay. A cardiologist correctly diagnosed the problem, pneumonia, and administered the necessary medication. The hospital charged no money up front, though the doctor apologetically said that he would have to bill the couple, as they were not citizens. Six months later, an invoice arrived for $220. Paretsky expresses one minor reservation about what she sees as a nearly perfect health-care system: the hospital staff's behavior was more bureaucratic than cheerful. She concludes, however, that this is a small price to pay for excellent health care at an unbeatable price: "I might put up with a lot of ugly bureaucrats for that."

But Sorman, in his rebuttal entitled, "Paying for Le Treatment," says that Paretsky's adventure is a "parable based on a false assumption: that health care can be public, reliable, and free." 

"It may indeed seem free, or close to free, for an American tourist receiving treatment in an emergency; as a French taxpayer, however, I paid a heavy price for Paretsky's husband's treatment. And you, my American reader, did too," he notes.

How so? Sorman explains:

"France's costly national health insurance is mostly financed by taxes on labor. A Frenchman making a monthly salary of 3,000 euros will pay approximately 350 of them (deducted by his employer) for health insurance. Then the employer will add approximately 1,200 euros, making the total monthly cost to the employer of this individual's services not 3,000 euros but 4,200. High labor costs in France affect not only consumer prices but also unemployment rates, since employers are reluctant to pay so much for low-skill workers. Economists agree that unemployment rates and the cost of national health insurance are directly related everywhere, which partly explains why even in periods of economic growth, the average French unemployment rate hovers around 10 percent.

High as they are, taxes on wages are not enough to cover the constant deficits that national health insurance runs. France imposes an additional levy to try to close the insurance deficit-the CSG (contribution sociale généralisée)-which applies to all income, including dividends, and which Parliament increases every year. Altogether, 25 percent of French national income goes toward what's called Social Security, which includes health care and basic retirement pensions for all.

French national health insurance is also subsidized by American patients. This is because France decides which drugs to use and at what prices; American pharmaceutical companies must either accept the dictated prices or lose an enormous market. The companies therefore sell their medicines at higher prices in the U.S. in order to cover their expenses and turn a profit; the surplus is then sold cheaply to the French, who take the same pills as Americans but at half the price or less.

In the end, who paid for Paretsky's husband's nearly free ride in a French hospital? French workers and taxpayers; American patients; and the young, unqualified, and out-of-work French unable to find jobs because of the unemployment that national health insurance engenders. There is no such thing, anywhere, as a perfect health-insurance system. It's always a trade-off among competing goods, and the choices to be made are ultimately political ones. Americans commenting on health-care reform should try to make the costs and consequences of these choices transparent, rather than resorting to misleading morality plays.

As P J O' Rourke noted: "If you think health care is expensive now, wait till it is free." Grab your wallets, dear American taxpayers!

Breaking the AMA Monopoly

Posted on August 26, 2009, 6:07pm | Shikha Dalmia

Milton Friedman warned back in 1961 that the American Medical Association was a government-sanctioned guild or trade cartel that would raise health care costs and diminish quality. Today, most economists agree with him. That's because the costs of AMA's aggressive tacticts to keep physician wages up by, among other things, imposing onerous licensure rules, capping the number of new doctors, and harassing nurses, midwives etc. who can treat certain routine conditions more cheaply than doctors have become painfully obvious:

According to a 2007 study by McKinsey&Company, physician compensation bumps up health care spending in America by $58 billion annually, on average, because U.S. doctors make twice as much as their OECD peers. And even the poorest in specializations like radiology and surgery routinely rake in around $400,000 annually.

Doctors--and many Republicans--constantly carp about the costs of "defensive medicine" because it forces providers to perform unnecessary procedures and tests to insulate them from potential lawsuits. But excessive physician salaries contribute nearly three times more to wasteful health care spending than the $20 billion or so that defensive medicine does. "While the U.S. malpractice system is extraordinary," the study notes, "it is only a small contributor to the higher cost of health care in the United States." Meanwhile, other studies have found that doctors' salaries contribute more to soaring medical costs than the $40 billion or so that the uninsured cost in uncompensated care--the president's bete noir.....

But still the Obama Administration and Democrats continues to "pal around" with the organization while reviling town-hall protesters as "evil-mongers" and "unAmerican." If they were serious about bringing health care costs under control, instead of demonizing opponents, they would be looking for ways to break AMA's choke-hold on the medical labor market.

Whole column here.

Will ObamaCare Cure a Stupidity Epidemic in Rhode Island?

Posted on August 22, 2009, 10:26pm | Shikha Dalmia

The New York Times last week ran an op-ed entitled, Plain English is the Best Policy, by John Aloysius Cogan Jr., the executive counsel for the Rhode Island Office of the Health Insurance Commissioner, drawing attention to a serious problem with our health care system:

"Every week my office hears from Rhode Islanders who don't understand their insurance coverage and can't get their claims paid," wrote Mr. Cogan. "A cancer patient named Kevin, for example, couldn't figure out why his insurance company had denied his claim for chemotherapy charges. His policy seemed to cover the treatment, but its incomprehensible mishmash of cross-referenced definitions, schedules, exclusions and riders made it hard to tell. When my office pressed company officials to explain the denial, we were told that they were still sorting through the policy; they believed Kevin's claim was not covered, but they needed more time to figure it out. Even the insurance company had trouble understanding its own contract."

"It is hard to believe," Mr. Cogan lamented, "that very many of the 200 million Americans who have private health insurance understand their own coverage."

Here's where I have some news for Mr. Cogan: The 200 million Americans he is referring to don't understand their own coverage because they don't buy their own coverage. Their employers do. Hence, they don't read their coverage, don't know what's in it, and don't really care - till they fall sick and need to use it. One way to fix the problem would be to change the federal tax code so that instead of employers getting a tax deduction for buying individuals insurance, individuals get a tax deduction for buying their own insurance. That'll give them an incentive to read and understand what's in their policies before they sign up. Which, in turn, will give insurance companies an incentive to write these policies in "plan english," just as they do auto, home, life and a myriad other policies that they market to individuals instead of corporate bureaucrats.

But what is Mr. Cogan's solution? He notes that his office's analysis of policies in Rhode Island found that most are written at a college to graduate-school reading level. But the average Rhode Islander reads at an eighth-grade level. So - presto - starting next year, Mr. Cogan boasts, "we have decided to require that all policies in our state be written at that (8^th grade) level."

First of all, it seems to me -- and I could be wrong -- that if an average Rhode Islander reads at the 8th grade level, then his main problem is not lack of well-written insuance policies. It is lack of good schools. 

But what I am wondering is how will Rhode Island enforce this mandate? Will it have 8^th graders read the insurance policies and take a comprehension exam? But then how will it know that the 8^th grader reading the insurance policy actually reads at the 8^th grade level? Perhaps it will have to mandate SAT exams for all 8^th graders? But how will it know that the SAT exam is really measuring what 8^th graders ought to be reading at the 8^th grade level? Maybe it will have to mandate that the test makers making the exam take an exam first showing that they know what 8^th graders should be reading at 8^th grade level.

You catch my drift.....

But here's a thought: If Rhode Island can require insurance policies to be understandable to 8^th graders, can't we require the same of any health care legislation that Congress passes? I don't know what such a law would look like. But I know that it damn well wouldn't be 1,000-plus pages long. And that would be an improvement right there.

Obama's Heavenly Care

Posted on August 22, 2009, 12:45am | Shikha Dalmia

Even as President Obama is pushing America toward CanadaCare - Canadians are flocking to America for health care. The Detroit Free Press reported this morning that many Detroit hospitals are forging lucrative arrangements with the Ontario government to provide services - including cardiac, imaging tests, and bariatric -- to Canadians that their government is unable to provide in a timely way.

"The agreements show how a country with a national care system...copes with demand for care with U.S. partnerships, rather than building new facilities," the Freep cheerfully tells us.

Consider the case of Dany Mercado, a leukemia patient from Kitchener, Ontario. He is cancer-free after getting a bone marrow transplant at the Barbara Ann Karmanos Cancer Institute in Detroit.

Told by Canadian doctors in 2007 he couldn't have the procedure there, Mercado's family and doctor appealed to Ontario health officials, who agreed to let him have the transplant in Detroit in January 2008. The Ontario government paid $200,000 for the procedure. (How is that for saving money?)

Mercado is from around Windsor. But Pat Somers, vice president of operations at Windsor's Hotel-Dieu Grace Hospital, said government "ministries are quite aware of" waits for care in other cities as well. But worry not, they have everything under control! "That's why we are investing in a wait list strategy," Somers assured the Freep reporters. They have very good ways, for example, to determine "how to prioritize cases for people who need hip and knee replacements, cataract surgery and treatment for cancer."

The wait-listed folks make a bee-line for Detroit hospitals, which is certainly great for these hospitals given that they have been losing patients as the city's residents move out.

"In the last few years, we've seen more and more Canadian patients,"  Dr. J. Edson Pontes, senior vice president of international medicine at the DMC, said. "About 300 of the DMC's 400 international patients last year came from Canada," Pontes estimated.

Here is my question: Canadians suffering under nationalized health care come to America for care. Where will Americans suffering under ObamaCare go?

Open the Pearly Gates, please!

Whole story here.

It's How the Co-Ops Get Started That Matters

Posted on August 19, 2009, 6:18pm | Anthony Randazzo

NYTimes blogger Timothy Egan wrote up a post yesterday about the value of co-ops in general and suggesting that all the negative rhetoric towards them should be quelled a bit. He's right in the sense that attacks on co-ops in the form of senseless "death panel" critiques don't really help the opposition argument gain supporters (though it probably does increase the resolve of many who are already opposed). But he seems to be ignoring a key point that I don't really see getting discussed in the value of co-ops: sure, a consumer owned competitor to the current companies may be a somewhat viable model, but the point is not necessarily about whether it would work as much as it is about the source of funding for the co-op.

It is significant that, to start a non-profit health insurance co-op, the government would be kicking in $3 to $6 billion in starter cash. It may not be the HHS running like they might a public option, but it is dishonest to argue the government wouldn't be involved at all. Egan mentions this, but only to say it is "a mere week in the life of bank bailouts." Frankly, appealing to a program that shouldn't have been started in the first place isn't very convincing.

In addition, appealing to the bailouts brings up an important point—look at all of the problems we've dealt with the past year with the government meddling in the businesses of banks. The government just doesn't have the right incentives and has too much political baggage weighing down its decisions to effectively manage the banks. The same would happen with a supposedly privately owned and managed co-op. And lets not just ignore the problem of Fannie and Freddie as government-sponsored enterprises running themselves on the (accurate) assumption that the government would cover any major losses if it came down to crunch time. We want to create more quasi-government organizations?

My colleague Ron Bailey over at Reason magazine has a great piece on co-ops published yesterday as well that is worth reading for anyone confused about co-ops vs. a public option and what the pit falls are. Ultimately, the co-op might be better than a public option in the spectrum of bad ideas, but the fact is that the government should be focused on creating incentives for there to be more price competition in the provision of health care to bring down prices rather than try to get coverage for the unnecessarily high prices from taxpayer supported government organizations that compete with the private sector.

Canada's Health Care System Has Been Diagnosed Terminally Ill

Posted on August 17, 2009, 12:56pm | Anthony Randazzo

Canada's health care system has been diagnosed terminally ill. In coming president of the Canadian Medical Association Dr. Anne Doig says her country's health care system is in desperate need of treatment. According to a story from The Canadian Press:

Dr. Anne Doig says patients are getting less than optimal care and she adds that physicians from across the country - who will gather in Saskatoon on Sunday for their annual meeting - recognize that changes must be made.
"We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize," Doing said in an interview with The Canadian Press.
"We know that there must be change," she said. "We're all running flat out, we're all just trying to stay ahead of the immediate day-to-day demands."

Paul Krugman points out that we're not exactly pursing this exact same system, but the principals are the same. And we should avoid the same traps. Just a thought. 

Read the whole story here.

Obama's Axis of Evil on Health Care

Posted on August 16, 2009, 11:02pm | Shikha Dalmia

Oye Vey.

President Obama just doesn't get it. He has an op-ed in the New York Times this morning excoriating insurance companies for our allegedly crappy health care system, whose primary problem, btw, is no longer the large number of uninsured - but the crummy benefits those with the misfortune of having coverage get. That'll of course be news to the vast majority of patients who have repeatedly told pollsters that they are really quite satisfied -- thank-you, very much -- with their insurance plans. They are no doubts victims of false consciousness that the public option will have a way to cure!

There are too many internal contradictions in Obama's op-ed to get into here. But let me mention one very briefly: The administration has been claiming - and Rachel Maddow was regurgitating on Meet the Press just this morning -- that the public option, which is designed along the lines of Medicare, will keep insurance companies honest by forcing them to compete with the superior administrative efficiencies that Medicare offers. (Michael Cannon of the Cato Institute has debunked this laughable claim by pointing out that Medicare has bought these so-called "superior efficiencies" by, among other things, ignoring fraud). But the president's op-ed claims that he will pay for coverage for the millions of uninsured by "cutting hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid." So which is it? Is Medicare so efficient that it should serve as a model for the rest of the industry or so inefficient that making it more efficient can fund health coverage for all?

But I digress.

The most striking thing about the president's op-ed is the startling similarity between his approach to health care and Bush's approach to foreign policy. Bush was always on the prowl for "evil-doers" abroad. And Obama, it seems, is on the prowl for "evil-doers" at home.  First, he targeted evil Republicans who were blocking his reform. That didn't work, because, as it turns out, Republicans are not the main impediment to his government power-grab; Blue Dog Democrats are. Second, he went after Big Pharma. But Big Pharma buckled down and cut a deal with him. And now - in a calculated attempt to rile up middle-class anxieties about their insurance coverage eg its lack of portability - he is going after those Big Bad Insurance Companies. Talk about the axis-of-evil!

But this won't work any better than his previous efforts at demonization. No matter how much Dems dismiss folks at townhalls as stooges of the insurance companies, they are expressing a real fear out there that Obama's government-heavy prescriptions won't solve their real health care problems; they will make them worse by taking away the options they already have. Going after their insurance carriers only heightens that fear - not allays it.

Obama seems to be finally backing off on the public option. That's good. Robert Gibbs said on CBS's "Face the Nation" that the president "will be satisfied" if the private insurance market has "choice and competition." That would be really good - but only if Obama means what he is saying and starts examining government policies that have stymied more intense competition in the health insurance industry. These include all the laws that prohibit insurers from selling policies across state lines and the failure of Uncle Sam to give individuals buying coverage the same tax treatment that companies get.

But if he simply pushes more regulations and mandates such as "guaranteed issue" and "community rating" (the first forces insurance companies to sell coverage to everyone regardless of risk and the second tells what prices they can charge), he will drive many insurers out of business, producing more market concentration and less choice.

But the first thing he needs to do is drop his preoccupation with the enemy. It didn't serve Bush well. It is not serving him well. And it certainly won't serve the country well.