HEALTHPLANUSA . NET
Community For Affordable Health Care
Vol VIII, No 2, July, 2009
Utilizing the $1.8 Trillion Information Technology Industry
To Transform the $2.4 Trillion HealthCare Industry into Affordable HealthCare
In This Issue:
1. Featured Article: Why Government Can't Run a Business
2. In the News: The GOP's Health-Care Alternative
3. International Healthcare: Unsafe Hospitals in the National Health Service
4. Government Healthcare: Medicare 72 is younger than Medicare 65 was in 1965.
5. Lean HealthCare: Detroit and Silicon Valley: What can Healthcare Learn?
6. Misdirection in Healthcare: It turns out the president misjudged the nation’s mood
8. Innovations in Health Care: The Latest Salvo
9. The Health Plan for the USA: Get rid of the excessive paperwork that government requires
HealthPlanUSA is now a separate Newsletter devoted to the rapidly evolving field of health plans being promoted throughout the USA. These are dangerous times. Stay tuned to the current issues, which we bring quarterly and will increase as staffing permits. Why not sign up now at www.healthplanusa.net/newsletter.asp?
Thomas Jefferson, identified by historians as a deist who doubted the existence of a personal god, understood that if certain rights (life, liberty and the pursuit of happiness) do not come from a source beyond the reach of the state, then the state could take those rights away.
By WILLIAM J. BENNETT and JOHN CRIBB
“I have never had a feeling politically that did not spring from the sentiments embodied in the Declaration of Independence.” This statement from Abraham Lincoln in Philadelphia in 1861 was no staff-manufactured line. It was an expression from a man filled with deep emotion at finding himself standing in the hall where a courageous band of rebels pledged their lives, their fortunes, and their sacred honor to a high and dangerous purpose -- American independence. We celebrate them on July Fourth.
Lincoln revered the Declaration and its ideals of liberty and equality. In an 1858 speech in Chicago, he said it was "the father of all moral principle" in the American republic, and its spirit "the electric cord . . . that links the hearts of patriotic and liberty-loving men together." . . .
Yet in Lincoln's time, the Declaration and its spirit was under attack. Proponents of slavery insisted that the Founders did not intend for the God-given right to liberty in the Declaration to apply to all people. The notion that "all men are created equal" was belittled by John C. Calhoun in 1848 as "the most false and dangerous of all political error."
The Declaration had its detractors abroad as well. Across Europe, members of privileged classes sneered at the thought of people ruling themselves. Many a nobleman viewed the Civil War as proof that the American democratic experiment would fail.
British statesman John Bright took them to task: "Privilege thinks it has a great interest in this contest, and every morning, with blatant voice, it . . . curses the American Republic. Privilege has beheld an afflicting spectacle for many years past. It has beheld thirty millions of men, happy and prosperous, without emperor, without king . . . Privilege has shuddered at what might happen to old Europe if this grand experiment should succeed."
Lincoln understood that if the American experiment of self-government were to succeed, the country must be saved on the basis of the Declaration of Independence. It was no accident that in the first sentence of the Gettysburg Address, he quoted the Declaration, reminding Americans that from the beginning the nation had been dedicated to the proposition that all men are created equal.
Lincoln also understood that the struggle over the Declaration was part of an eternal struggle between two principles at the basis of all government. "They are the two principles that have stood face to face from the beginning of time, and will ever continue to struggle," as he put it in one of his famous debates with Stephen A. Douglas. "The one is the common right of humanity and the other the divine right of kings."
The struggle continues today. Terrorists and dictators hate the United States for its founding principles. They prefer to rob people of liberty, subjugate women, and spread their power by the sword. Yet America still has iron men and women who stand up to such tyrants. These iron men are now fighting on battlefields in Afghanistan and Iraq.
The Declaration of Independence is not a legal document in the same sense as the Constitution. No one talks about a law being "undeclarational," or opines about their "declarational rights." Yet it remains the first and in some ways most universal of our great founding documents. As Lincoln said in Philadelphia in February 1861, there is "something in that Declaration giving liberty, not alone to the people of this country, but hope to the world for all future time."
As long as the United States stands fast for the moral principles of July 4, 1776, we will continue to be the bulwark of freedom, the last best hope of earth.
Messrs. Bennett and Cribb are the authors of the "American Patriot's Almanac" (Thomas Nelson, 2008).
Printed in The Wall Street Journal, July 3, 2009, page A11
The Obama administration is bent on becoming a major player in -- if not taking over entirely -- America's health-care, automobile and banking industries. Before that happens, it might be a good idea to look at the government's track record in running economic enterprises. It is terrible.
In 1913, for instance, thinking it was being overcharged by the steel companies for armor plate for warships, the federal government decided to build its own plant. It estimated that a plant with a 10,000-ton annual capacity could produce armor plate for only 70% of what the steel companies charged.
When the plant was finally finished, however -- three years after World War I had ended -- it was millions over budget and able to produce armor plate only at twice what the steel companies charged. It produced one batch and then shut down, never to reopen.
Or take Medicare. Other than the source of its premiums, Medicare is no different, economically, than a regular health-insurance company. But unlike, say, UnitedHealthcare, it is a bureaucracy-beclotted nightmare, riven with waste and fraud. Last year the Government Accountability Office estimated that no less than one-third of all Medicare disbursements for durable medical equipment, such as wheelchairs and hospital beds, were improper or fraudulent. Medicare was so lax in its oversight that it was approving orthopedic shoes for amputees.
These examples are not aberrations; they are typical of how governments run enterprises. There are a number of reasons why this is inherently so. Among them are:
1) Governments are run by politicians, not businessmen. Politicians can only make political decisions, not economic ones. They are, after all, first and foremost in the re-election business. Because of the need to be re-elected, politicians are always likely to have a short-term bias. What looks good right now is more important to politicians than long-term consequences even when those consequences can be easily foreseen. The gathering disaster of Social Security has been obvious for years, but politics has prevented needed reforms.
And politicians tend to favor parochial interests over sound economic sense. Consider a thought experiment. There is a national widget crisis and Sen. Wiley Snoot is chairman of the Senate Widget Committee. There are two technologies that are possible solutions to the problem, with Technology A widely thought to be the more promising of the two. But the company that has been developing Technology B is headquartered in Sen. Snoot's state and employs 40,000 workers there. Which technology is Sen. Snoot going to use his vast legislative influence to push?
2) Politicians need headlines. And this means they have a deep need to do something ("Sen. Snoot Moves on Widget Crisis!"), even when doing nothing would be the better option. Markets will always deal efficiently with gluts and shortages, but letting the market work doesn't produce favorable headlines and, indeed, often produces the opposite ("Sen. Snoot Fails to Move on Widget Crisis!").
3) Governments use other people's money. Corporations play with their own money. They are wealth-creating machines in which various people (investors, managers and labor) come together under a defined set of rules in hopes of creating more wealth collectively than they can create separately. . .
4) Government does not tolerate competition. The Obama administration is talking about creating a "public option" that would compete in the health-insurance marketplace with profit-seeking companies. But has a government entity ever competed successfully on a level playing field with private companies? I don't know of one.
5) Government enterprises are almost always monopolies and thus do not face competition at all. But competition is exactly what makes capitalism so successful an economic system. The lack of it has always doomed socialist economies. . .
Cost cutting is alien to the culture of all bureaucracies. Indeed, when cost cutting is inescapable, bureaucracies often make cuts that will produce maximum public inconvenience, generating political pressure to reverse the cuts.
6) Successful corporations are run by benevolent despots. The CEO of a corporation has the power to manage effectively. He decides company policy, organizes the corporate structure, and allocates resources pretty much as he thinks best. The board of directors ordinarily does nothing more than ratify his moves (or, of course, fire him). This allows a company to act quickly when needed. . .
7) Government is regulated by government. When "postalization" of the nation's phone system appeared imminent in 1917, Theodore Vail, the president of AT&T, admitted that his company was, effectively, a monopoly. But he noted that "all monopolies should be regulated. Government ownership would be an unregulated monopoly."
It is government's job to make and enforce the rules that allow a civilized society to flourish. But it has a dismal record of regulating itself. Imagine, for instance, if a corporation, seeking to make its bottom line look better, transferred employee contributions from the company pension fund to its own accounts, replaced the money with general obligation corporate bonds, and called the money it expropriated income. We all know what would happen: The company accountants would refuse to certify the books and management would likely -- and rightly -- end up in jail.
But that is exactly what the federal government (which, unlike corporations, decides how to keep its own books) does with Social Security. In the late 1990s, the government was running what it -- and a largely unquestioning Washington press corps -- called budget "surpluses." But the national debt still increased in every single one of those years because the government was borrowing money to create the "surpluses."
Capitalism isn't perfect. Indeed, to paraphrase Winston Churchill's famous description of democracy, it's the worst economic system except for all the others. But the inescapable fact is that only the profit motive and competition keep enterprises lean, efficient, innovative and customer-oriented.
Mr. Gordon is the author of "An Empire of Wealth: The Epic History of American Economic Power" (HarperCollins, 2004).
Printed in The Wall Street Journal, May 20, 2009, page A13 http://online.wsj.com/article/SB124277530070436823.html#mod=todays_us_opinion
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Republican congressional leaders are finally offering a clear alternative to the health-reform plans being developed by the White House and Democrats in Congress. The goals and the rhetoric of both sides are remarkably similar: cover the uninsured, allow people to keep the coverage they have, provide more choices of affordable health insurance, and rein in health costs. But their policy prescriptions are remarkably different.
Democrats are uniting around proposals to vastly expand federal regulation of health insurance, require everyone to have coverage, and compel employers to provide federally prescribed insurance or pay a new tax. A new Medicare-like insurance plan is still being debated, but even if it doesn't make the cut, Congress could regulate its way to a government-dominated market. . .
The nexus of their plan is redirecting the $300 billion annual tax subsidy for employment-based health insurance to individuals in the form of refundable, advanceable tax credits. Families would get $5,700 a year and individuals $2,300 to buy insurance and invest in Health Savings Accounts.
Low-income Americans would get a supplemental debit card of up to $5,000 to help them purchase insurance and pay out-of-pocket costs. They would have an incentive to spend wisely since up to one-fourth of any unspent money in the accounts could be rolled over to the next year. The combination of the refundable tax credit and debit card gives lower-income Americans a way out of the Medicaid ghetto so they can have the dignity of private insurance.
The great majority of Americans with job-based health insurance would see little more than a bookkeeping change with the Patients' Choice plan. But implicit in the policy is the acknowledgment that our system of tying health insurance to the workplace is not working for upwards of 45 million uninsured Americans.
That's a pivotal point in the fight over reform: Will the next health-reform bill lock in a system of job-based health insurance or allow more individual choice and portability to fit a 21st century work force?
Democrats are fretting over how to pay for their plans, which early estimates peg at $1.5 trillion or more over 10 years. Economists at a recent Senate Finance Committee roundtable unanimously supported limiting the virtually invisible $300 billion tax subsidy that workers receive when they get health insurance through their employers. Even Senate Finance Chairman Max Baucus (D., Mont.) said he feels like Willie Sutton: Congress must look at redirecting at least some of this huge subsidy because "that's where the money is."
This is the same proposal John McCain was criticized for during the 2008 presidential campaign. Television ads by the Obama campaign pounded him for "taxing your health insurance." . . .
While many Americans are fed up with private insurance, opinion polls consistently show a majority think government-controlled health care would be worse. There are problems in the private insurance market, and the Republican plan takes steps that can help. . .
Who will control the system? Doctors and patients, or politicians and regulators? That's the crux of this year's health-care debate. The Republican proposal makes the choice clear.
Ms. Turner is president of the Galen Institute. Mr. Antos is a scholar at the American Enterprise Institute.
Printed in The Wall Street Journal, May 20, 2009 page A17.
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MPs condemn obsession with performance targets
Up to 10% of admissions to hospital may suffer harm
Patient safety has been put at risk through "disastrously unsafe care" in a handful of NHS trusts, and insufficient progress is being made in improving services, a critical parliamentary study warns today.
As many as one in 10 patients who enter hospital may suffer harm, the Commons health select committee reports, while annual payouts for NHS medical negligence have climbed to more than £630m.
Health service managers have become obsessed by government-imposed performance targets, the MPs note, resulting in major lapses where "safety was pushed aside … by other priorities – particularly waiting time targets, the need to achieve financial balance and the achievement of foundation status".
This "undoubtedly … has been a contributory factor in making services unsafe", the Patient Safety report maintains. The three "notorious" examples it cites are Mid Staffordshire NHS trust, Maidstone and Tunbridge Wells NHS trust in Kent, and Stoke Mandeville hospital.
Ninety people died as a result of two Clostridium difficile outbreaks at Maidstone and Tunbridge Wells during 2006 and 2007. A further 33 patients died of C difficile acquired within Stoke Mandeville hospital in 2003 and 2005. The outbreaks grew, it later emerged, when patients were moved from accident and emergency into ordinary wards – spreading the infection – in order to meet a four-hour A&E target.
At Mid Staffordshire, between 400 and 1,200 extra deaths occurred over a three-year period owing to frontline services being reduced to cut back on the trust's debt levels — a precondition to it achieving foundation trust status. . .
"Not only did Monitor fail to detect unsafe care, it effectively allowed the trust to compromise patient safety in premature pursuit of foundation status," says the committee.
The "significant under-reporting" of incidents was due in part to "the persistent failure to eliminate the blame culture". Staff, the MPs say, should be encouraged to report concerns or incidents without fear. They propose a complaints system such as the one in New Zealand, where staff are encouraged to raise concerns, and the creation of a body similar to the Department of Transport's Air Accident Investigation Branch to improve checks.
Patients who have suffered are currently forced to endure "lengthy and distressing litigation to obtain justice and compensation", the report says, while NHS organisations are "encouraged to be defensive", and spend large sums on legal costs.
The committee says it is "appalling" that the Department of Health has not implemented the NHS redress scheme, which aims to resolve complaints quickly and consistently without the need for court action, despite the necessary legislation being passed three years ago.
The figure that 10% of patients may be harmed by the NHS derives from a study by Richard Thomson, professor of epidemiology and public health at the University of Newcastle.
guardian.co.uk © Guardian News and Media Limited 2009
Government medicine does not give access to safe healthcare; it only gives access to a hazardous waiting list.
In America, everyone has access to high quality immediate
HealthCare at all times.
No one can be refused by any hospital.
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What Do We Really Know About the Uninsured? - by William Snyder
We should find out before Obama turns our health care upside-down.
Written By: William Snyder, Published In: The Wall Street Journal, 11/21/2008
. . . when Barack Obama becomes president, he will almost certainly move quickly toward some form of government-provided -- and possibly government mandated -- health insurance. A principal reason for this is the oft-cited figure of 46 million uninsured Americans.
But what does this number mean? And do we really need to remake our entire health-care system to protect the uninsured? Most people have an incomplete understanding of the uninsured population, which can lead to bad policy choices.
Many Americans believe that the uninsured are too poor to purchase coverage and that government programs aren't available to them. But a study published in Health Affairs in November 2006 estimated that 25% of the uninsured were in fact eligible for public coverage, and another 20% probably could afford coverage on their own. If we apply those percentages to today's uninsured population, roughly 25 million people would need assistance in order to get health insurance.
That's a major concern. But the notion that there are 46 million Americans who can't get the health care they need for lack of money or public assistance is a myth.
The other two common misperceptions are that the uninsured don't get health care, and that when they do they're "free riders," i.e., they don't pay for the care they get.
A study published by the California HealthCare Foundation (CHCF) in April 2000 found that, of the uninsured California residents whose household income was at least twice the poverty level, 50% (about 1.3 million) had received care in the last year for which they were charged, and another 8% had received care for which they weren't charged. The study also found that 89% of these people were either somewhat or very satisfied with the care they received, and that only 15% went to the emergency room versus a doctor's office or clinic when they got sick.
Another recent study, published in Health Affairs in August, had similar findings, and estimated that uninsured Americans will receive $86 billion worth of health care in 2008.
These two studies also provide evidence that disputes the free-rider myth. The CHCF study found that of the 1.3 million uninsured who received care for which they were charged, 80% had paid for it, and almost half of the remaining 20% were paying in installments. The study published in Health Affairs estimated that the uninsured would pay for $30 billion of their health-care costs this year -- more than one-third -- out of pocket.
For the millions of the uninsured, then, who are getting and paying for satisfactory care on their own, foregoing needed care and sticking the public with huge ER bills is a myth.
Most of the proposals under discussion today involve a significant expansion of government programs, a legal requirement for everyone to carry insurance, or a combination of the two. But if millions of people have found ways to access and pay for satisfactory health care without involving an insurance company, is forcing them to buy traditional insurance an effective solution?
Perhaps we should look for ways to encourage the millions of people who are currently eligible for existing government programs to enroll before we expand programs to include people that may not need assistance.
Providing and funding care for those who have truly fallen through the cracks should be an urgent priority. But given the demands on state and federal budgets today, it's more important than ever to tailor solutions so limited resources can provide the most relief possible.
. . . President Obama and Congress should do all they can to separate myth from fact before tackling America's health-care problems.
Mr. Snyder is a policy adviser to the Heartland Institute.
[America’s physicians are very concerned and provide care to the poor, the disabled, the veterans, and the elderly. They are providing care to these groups on a daily basis. All the poor in America are covered by the Medicaid programs. Sometimes Medicaid patients obtain more surgery, have a better drug formulary, and see their doctors more frequently than many of the wealthy. All the senior citizens are covered by Medicare from age 65 until death. All Americans of any age who are disabled continuously for a two-year period are also covered by Medicare. They also received Social Security Disability or Social Security Assistance from birth until death. All retired or disabled veterans received VA health care providing a third layer in the health care net. As the graph below shows in visual fashion, America has one of the finest and most complete health care nets found anywhere, with no cracks for anyone to fall through. The 47 million uninsured is a myth, as Mr. Snyder has shown above and as it has been shown innumerable times in the past four decades. Those who still use this myth in any argument can no longer hide that they didn’t know the facts. They simply have another agenda, which has nothing to do with health care, its quality, or providing for more complete coverage.]
Where are the cracks in America’s Health Care net?
Government is not the solution to our problems, government is the problem.
- Ronald Regan
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5. Lean HealthCare: Detroit and Silicon Valley: What can Healthcare Learn?
Andrew S. Grove, former CEO of Intel Corp, has an analysis of what Detroit can learn from Silicon Valley in The Wall Street Journal.
Our government has made heavy investments in the U.S. automobile industry. How should it use its influence? . . .
History shows that most companies do not deal well with transformation. One reason has to do with senior managers. They usually "don't get it." They have a difficult time accepting that the future will be vastly different from the present because they rose to power in the old business environment. They excelled in the old environment and didn't acquire skills necessary to operate in the new.
It is also hard for managers to distinguish between an erosion in a company's competitive position and a change in the fundamental nature of an industry. Knowing the difference is one of the most difficult things to do, even though it is among the most important.
The transformation of an entire industry does not happen very often. It only occurs when a number of factors align, such as a change in consumer demand, a shift of parts of the major supply chain from one country to another, and the emergence of key technological changes.
This is what happened in the computer industry in the 1980s and '90s. Previously, each company produced its own mainframe computers using proprietary hardware and software. The company's sales force then sold these complex and expensive products.
The PC changed this. In a period of just a few years, the industry was pulled apart and reassembled. The entire industry began to rely on common hardware elements (microprocessors) and packaged software; selling was handed off to third parties. In business we call this moving from a "vertical" structure (where a company handles its own development, manufacturing and distribution) to a "horizontal" structure (where some companies specialize in building components while others integrate them and handle distribution tasks).
The result was that the computer industry became more dynamic as old participants (such as Burroughs and Digital Equipment) faded away and new types of companies (such as Compaq and Dell) emerged. . .
Imagine if in the middle of the computer transformation the Reagan administration worried about the upheaval and tried to rescue this vital industry by making huge investments in leading mainframe companies. The purpose of such investments would have been to protect the viability of these companies. The effect, however, would have been to put the brakes on transformation and all but ensure that the U.S. would lose its leadership role. . .
Electric cars have become viable and will likely only become more capable in the future. Components critical to their performance -- batteries and electronic control systems -- are on a rapidly rising technology curve. These technologies are new and therefore capable of improving quickly with incremental investments. By contrast, technologies that have been around a long time, such as the internal combustion engine and the fuel and drive systems built around it, have enjoyed the benefits of decades of development and have limited potential for further improvement.
The result is that there are several factors aligning to bring about a change in the structure of the automobile industry. Electric cars may match the needs of our time better and become more desirable than cars relying on the internal combustion engine. The car industry today is as vertical as the computer industry was before the PC. However, the simplicity of the electric car combined with the standardization of certain components may cause the automobile industry to shift to a horizontal structure. The Internet is already emerging as a key marketing medium for automobiles and is easily adaptable to a horizontal structure.
If such a shift occurs, the success of a producer will depend on how well it takes advantage of the new structure -- whether it can use the mass-producibility and falling cost of batteries and other components better than its competitors.
The U.S. government is investing in the automobile industry with the intention of preventing jobs from being lost. This may improve GM's ability to operate within today's structure. But there is no comparably large investment being made to develop the capabilities that could serve the company in a new era of electric cars.
China appears to be making a different bet. It's not clear precisely how the Chinese government influences industrial strategy. But China is putting a great deal of effort into developing and manufacturing batteries. Essentially, it is betting that it can take the lead in creating the foundation technology of what will likely be the new structure of the auto industry.
Which is the better investment strategy? It is too early to say. In the short term, the U.S. strategy will likely save jobs. The long term is much more problematic. We do not yet know when and if the automobile industry will shift into a horizontal structure. The stakes, however, are very high. The strategic bets being placed by each country may determine which one will end up as the world's leader in automotive technology and manufacturing.
Mr. Grove is the former CEO of Intel Corp.
[Can the same analogy be applied to Healthcare? We are an intensely vertical industry with the highest cost center continuing to be the hospital. Much of health care is becoming outpatient medicine with a large number of procedures and surgeries done on an outpatient basis. Even spinal surgery patients are being discharge the same day and thus this type of surgery can be done in a surgicenter. Horizontal or efficient health care is being prevented by laws of Congress, which prevent this diversification. It has been well shown that if outpatient facilities, including medical groups, could purchase sophisticated diagnostic equipment, costs would plummet. The cost of an MRI keeps increasing. However, the equipment could be made cheaper if the market became larger than just hospitals and their affiliated groups. Some radiologists have estimated a 75 percent drop in cost within five years for the purchase of a small MRI machine adequate for an office of neurosurgeons or orthopedists due to vast reductions in costs of such operations. Congress has prevented this on the assumption that it would simply be a money-making tool for surgeons. However, two neurosurgical or two orthopedic groups competing with each other for patients would drive the costs below what any lawmaker could conceive.
[With government medicine, such as ObamaCare, the mainframe computers (hospitals) would continue to be sacrosanct and personal computers (private offices) would continue to be cost inefficient, thus preventing market-based healthcare.]
Andy Grove has given us an excellent reason to be cautious about any further government involvement in health care—government control may prevent the very efficiencies that they think they can effect.
The Future of Health Care Has to Be Lean, Efficient and Personal.
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This is big, what’s happening. President Obama appears to have misstepped on a major initiative and defining issue. He has misjudged the nation’s mood, which itself is news: He rose from nothing to everything with the help of his fine-tuned antennae. Resistance to the Democratic health-care plans is in the air, showing up more now on YouTube than in the polls, but it will be in the polls soon enough. The president, in short, may be facing a real loss. This will be interesting in a number of ways and for a number of reasons, among them that we’ve never seen him publicly defeated before, because he hasn’t been. So we may be entering new territory, with new struggles shaped by new dynamics.
His news conference the other night was bad. He was filibustery and spinny and gave long and largely unfollowable answers that seemed aimed at limiting the number of questions asked and running out the clock. You don’t do that when you’re fully confident. Far more seriously, he didn’t seem to be telling the truth. We need to create a new national health-care program in order to cut down on government spending? Who would believe that? Would anybody?
The common wisdom the past week has been that whatever challenges health care faces, the president will at least get something because he has a Democratic House and Senate and they’re not going to let their guy die. He’ll get this or that, maybe not a new nationalized system but some things, and he’ll be able to declare some degree of victory.
And this makes sense. But after the news conference, I found myself wondering if he’d get anything.
I think the plan is being slowed and may well be stopped not by ideology, or even by philosophy in a strict sense, but by simple American common sense. I suspect voters, the past few weeks, have been giving themselves an internal Q-and-A that goes something like this:
Will whatever health care bill is produced by Congress increase the deficit? “Of course.” Will it mean tax increases? “Of course.” Will it mean new fees or fines? “Probably.” Can I afford it right now? “No, I’m already getting clobbered.” Will it make the marketplace freer and better? “Probably not.” Is our health-care system in crisis? “Yeah, it has been for years.” Is it the most pressing crisis right now? “No, the economy is.” Will a health-care bill improve the economy? “I doubt it.”
The White House misread the national mood. The problem isn’t that they didn’t “bend the curve,” or didn’t sell it right. The problem is that the national mood has changed since the president was elected. Back then the mood was “change is for the good.” But that altered as the full implications of the financial crash seeped in. The crash gave everyone a diminished sense of their own margin for error. It gave them a diminished sense of their country’s margin for error. Americans are not in a chance-taking mood. They’re not in a spending mood, not after the unprecedented spending of the past year, from the end of the Bush era through the first six months of Obama. Here the Congressional Budget Office report that a health-care bill would not save money but would instead cost more than a trillion dollars in the next decade was decisive. People say bureaucrats never do anything. The bureaucrats of CBO might have killed health care.
The final bill, with all its complexities, will probably be huge, a thousand pages or so. Americans don’t fear the devil’s in the details, they fear hell is. Do they want the same people running health care who gave us the Department of Motor Vehicles, the post office and the invasion of Iraq?
Let me throw forward three other things that I suspect lessen, or will lessen, support for full health-care reform, two of them not quantifiable.
The first has to do with the doctors throughout the country who give patients a break, who quietly underbill someone they know is in trouble, or don’t charge for their services. Also the emergency rooms that provide excellent service for the uninsured in medical crisis. People don’t talk about this much because they’re afraid if they do they’ll lose it, that some government genius will come along and make it illegal for a doctor not to charge or a hospital to fudge around, with mercy, in its billing. People are afraid of losing the parts of the system that sometimes work—the unquantifiable parts, the human parts.
Second, and this is big, some of the bills being worked on in Congress will allow for or mandate taxpayer funding of abortion. Speaking only and narrowly in political terms, this is so ignorant as to be astounding. A good portion of the support for national health care comes from a sort of European Christian Democrat spirit of community, of “We are all in this together.” This spirit potentially unites Democrats, leftists, some Republicans and GOP populists, the politically unaffiliated and those of whatever view with low incomes. But putting abortion in the mix takes the Christian out of Christian Democrat. It breaks and jangles the coalition, telling those who believe abortion is evil that they not only have to accept its legality but now have to pay for it in a brand new plan, for which they’ll be more highly taxed. This is taking a knife to your own supporters.
The third point is largely unspoken but I suspect gives some people real pause. We are living in a time in which educated people who are at the top of American life feel they have the right to make very public criticisms of . . . let’s call it the private, pleasurable but health-related choices of others. They shame smokers and the overweight. Drinking will be next. Mr. Obama’s own choice for surgeon general has come under criticism as too heavy.
Only a generation ago such criticisms would have been considered rude and unacceptable. But they are part of the ugly, chafing price of having the government in something: Suddenly it can make big and very personal demands on you. Those who live in a way that isn’t sufficiently healthy “cost us money” and “drive up premiums.” Mr. Obama himself said something like it in his press conference, when he spoke of a person who might not buy health insurance. If he gets hit by a bus, “the rest of us have to pay for it.”
Under a national health-care plan we might be hearing that a lot. You don’t exercise, you smoke, you drink, you eat too much, and “the rest of us have to pay for it.”
It is a new opportunity for new class professionals (an old phrase that should make a comeback) to shame others, which appears to be one of their hobbies. (It may even be one of their addictions. Let’s stage an intervention.) Every time I hear Kathleen Sebelius talk about “transitioning” from “treating disease” to “preventing disease,” I start thinking of how they’ll use this as an excuse to judge, shame and intrude.
So this might be an unarticulated public fear: When everyone pays for the same health-care system, the overseers will feel more and more a right to tell you how to live, which simple joys are allowed and which are not.
Americans in the most personal, daily ways feel they are less free than they used to be. And they are right, they are less free.
Who wants more of that?
Well-Meaning Regulations Worsen Quality of Care.
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On April 29, the U.S. will have survived the first hundred days of President Barack Obama. Of course, unemployment is up and the stock market is down, but the president's optimism is still unbounded. Mr. Obama's staff is encouraging writers to find parallels to FDR and his first hundred days as president 75 years ago during the Great Depression. Let's take the challenge: Here are three points of similarity between the two presidencies.
First, President Obama, like FDR, has used the economic emergency to pass massive spending bills. For example, Obama warned of dire consequences if Congress failed to pass his 1,100 page emergency "stimulus bill" of $787 billion. Congressmen had no time to reflect on the bill, or even read it. They passed a bill that would spend $25,000 per second every second of the year 2009--without serious debate. In doing that, President Obama was taking a page from FDR's emergency banking bill, which the House passed, sight unseen, after only thirty-eight minutes of debate. As Congressman Robert Luce of Massachusetts responded, "judgment must be waived . . . argument must be silenced, we should take matters without criticism lest we may do harm by delay." The atmosphere in the House in 2009 was almost identical.
Second, President Obama, like FDR, has already begun centralizing power in the executive branch. For example, Obama is already trying to move the Census Bureau into the executive department, from the Commerce Department, to control the counting of the U. S. population for the 2010 census -- which will help to determine congressional representation and federal funding. In FDR's first hundred days, he moved to control the currency -- the banking bill gave him control over the movement of gold, and the Thomas Amendment to the Agricultural Adjustment Act allowed the president to issue greenbacks or tinker with gold and silver, as he saw fit, to promote inflation.
Third, President Obama is following FDR by vilifying businessmen. On TV, we see Mr. Obama pointing his finger at bankers, cajoling executives at credit card companies, and regularly denouncing "Wall Street greed." In doing so, Obama has followed FDR's script. In his first day in office, Roosevelt set the tone for his relentless attacks on businessmen: "rulers of the exchange of mankind's goods have failed through their own stubbornness and their own incompetence. . . The money changers have fled from their high seats in the temple of our civilization."
What is disturbing about these parallels to FDR's first hundred days is to contemplate the next 2,500 days of that bygone era. Where did the cries of emergency, the centralization of power, and the vilification of business take the nation? The answer is class warfare, a deeply divided country, and 18 percent unemployment. The Great Depression of the 1930s lingered -- and lingered, and lingered. It could do nothing else. Massive federal spending merely transferred money from the wallets of average Americans to the hands of federal bureaucrats. As taxes rose to a top marginal rate of 79 percent under FDR (Obama has already promised to raise the current marginal rate on top incomes), entrepreneurs had no incentive to take what capital they had left and start new businesses, or expand existing ones. Uncle Sam wanted almost four out of five of their last earned dollars for taxes. Class warfare, and the redistribution of income, had knocked the creativity out of a generation of entrepreneurs -- some of whom in the 1920s had either invented or expanded the production of radios, talking movies, air-conditioners, zippers, scotch tape, and even sliced bread.
In running for re-election in 1936, FDR said, "They [businessmen] are unanimous in their hate for me -- and I welcome their hatred." He had found, as his speechwriter Ray Moley pointed out, that "every time they [businessmen] made an attack on him… he gained votes and that the result of carrying on his sort of warfare was to bring the people to his support." In other words, FDR had discovered a striking paradox: Attacking businessmen, and raising their taxes, prevented the Great Depression from ending, but it won votes from Americans who came to believe that businessmen were their enemies and FDR was their "fireside chat" friend.
As in the case of FDR, President Obama will soon approach a fork in the road -- does he cut tax rates on income and capital gains, and give incentives to entrepreneurs to invest, or does he continue to vilify businessmen and risk another Great Depression?
Burton Folsom, Jr. is professor of history at Hillsdale College and author of New Deal or Raw Deal? (Simon & Schuster, 2008).
What is Congress Really Saying?
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8. Innovations in Health Care: The Latest Salvo
ObamaCare: No More Kumbaya Among Health Care Reformers by 06.09.09
When the Clinton administration tried to overhaul the health care system in 1993, the bill was written behind closed doors. Interest groups and political opponents gathered outside and stewed with suspicion.
President Obama has smartly avoided that strategy. In March, the White House held a health summit and invited almost all of Washington. With liberal stalwarts such as Sen. Ted Kennedy sitting in the same room as some of the same industry lobbyists who helped tank Hillary-care, the meeting was hailed as a bipartisan triumph.
But the last week has shown that love-ins don't last forever. Now the different groups writing bills and weighing in have begun to clash in ways that portend bigger fights to come. "People are still being gentle," says Robert Laszewski, an influential Beltway health policy consultant. "But the fissures are going to be deep."
The first shot may have been fired last week when President Obama sent a two-page letter to Sens. Kennedy and Baucus, who chair rival committees that are each preparing their own health bills. The letter was ostensibly to get the two to work together by outlining shared principles. While Obama had previously stayed at sky level in the policy debates--refusing to endorse many specific details--that changed last week.
In the letter, he endorsed three controversial tenets that he hoped a final bill will contain. First, he finally came out in favor of a "public plan," where individuals and businesses can buy insurance from a government-run exchange that will pool everyone together and charge low rates.
The second idea Obama endorsed is the "individual mandate," in which, much like car insurance, Americans would be forced to buy health insurance or pay a penalty. This would avoid the problem of only sick people wanting insurance and thus driving up the price. Mandates are controversial among small businesses, who often can't afford to cover their workers, and of course small-government fans.
Finally--and this is more of an inside Washington issue--Obama endorsed ripping Medicare coverage decisions away from Congress. That would mean that lobbies representing different medical specialties, drug companies, device makers, hospitals, home health nurses and other providers would cease to have influence over their own payment rates as they do now. . .
The Public Plan
Especially since the president weighed in last week, Democrats are united in supporting a public plan of some kind. The idea is that Americans should have access to the same kind of plan offered to federal employees, in which you pick from a list of options underneath a government umbrella.
The health insurance industry does not want to compete against the government (or a government-selected private plan), because it would lose market power. A government plan would push down costs significantly and possibly cap industry profits. HMOs would have trouble competing. The Lewin Group, a research organization, predicts that two-thirds of Americans would quickly be transferred into it because of the lower rates.
Doctors and hospitals, which already get paid less by government programs like Medicaid and Medicare than they do by private insurance, do not want a bigger public payer in the market either. That's why the American Medical Association this week came out strongly against it. Similarly, drug and device makers do not want a government-run formulary to guide treatment decisions and eventually, negotiate down prices. Still, most observers agree that the HMO industry has the most to lose if legislation is signed creating a public plan. "It's not just the game changer. They'll lose everything," says Laszewski.
Which Treatments Are Effective?
Related to the idea of a public plan, the administration along with Democrats in the Senate are pushing the notion of "comparative effectiveness research." The stimulus package passed in February included $1 billion in funding to see which competing treatments for medical conditions are most effective. If that research could guide spending by a public plan, the ideas goes, costs would fall dramatically.
Several recent studies, on stents and on cancer drugs, support the notion that some of the most expensive therapies are at best marginally effective. (See "Are Cancer Drugs Worth the Money?") Not surprisingly, the industry lobbies are wary of this kind of research, claiming it will stifle innovation and prevent physicians from experimenting with novel treatments. . .
Financing the Bill
Today, Sen. Kent Conrad, a fiscally conservative Democrat from North Dakota, in an interview with Kaiser Health News, said he would not support a health bill unless it can be paid for. A quaint notion, but yet that could be a big problem. The ideas that are circulating now are estimated to cost from $1 trillion to $2 trillion over 10 years. In the president's budget, $635 billion is provided and the funding comes from sources that some view as dubious. (Assumed cost reductions in Medicare plus assumed efficiencies from computerizing hospitals and doctors offices.) . . .
The president has said that there will be no new widespread taxes to pay for his plans--which he calls "budget neutral." That raises the question of whether a bill will be either unfunded or perhaps not happen at all.
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9. The Health Plan for the USA: Get rid of the excessive paperwork that government requires.
Paperwork adds $9 billion to California annual health spending, study says By Bobby Caina Calvan
Paperwork is driving up health care costs by as much as $9 billion annually in California, according to a public interest group that suggests physicians and insurers spend way too much time on processing insurance claims.
In California, physicians typically spend about 45 minutes a day on insurance paperwork, according to a report released Thursday by the California Public Interest Research Group.
"If we can do it more cheaply, it's a win-win for everybody," said Michael Russo, a health care advocate and staff attorney with CalPIRG. "When costs are skyrocketing, it's best to go for the low-hanging fruit. This is an area where we spend a lot of money."
In all, CalPIRG estimates that $9 billion is spent by insurers and medical practices in California to process insurance claims.
"It's just ridiculous," said Dr. David Kosh, a family physician in Sacramento. He said his billing staff spends most of its day on the phone with insurers.
"If I had to do it, I would never be able to see my patients," Kosh said.
CalPIRG suggests creating a nonprofit health information network similar to those in Utah and New England, which use standardized procedures to reduce time-consuming paperwork.
A study published in May by the journal Health Affairs tallied the national cost of the system: between $23 billion and $31 billion a year. The typical physician spends the equivalent of three weeks a year handling insurance claims.
Legislative efforts to streamline the administrative process for filing insurance claims in California have stalled. Some federal lawmakers are pushing for national standards as part of the proposed overhaul of the country's health care system.
With the sophisticated electronic debit cards we have, insurance must enter the digital age and pay the patient’s claims same as a bank draft. It can be done. Stay tuned to this section for more details. Editor.
Current Issues Being Studied
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Medicine and Liberty - Network of Liberty Oriented Doctors, www.MedLib.ch/, Alphonse Crespo, MD, Executive
Director and Founder
Medicine & Liberty (MedLib) is an independent physician network founded in 2007, dedicated to the study and advocacy of liberty, ethics & market in medical services.
- We support professional autonomy for doctors and liberty of choice for patients
- We uphold the Hippocratic covenant that forbids action harmful to the patient
- We defend responsible medical practice and access to therapeutic innovation free from
- We work towards a deeper understanding of the role and importance of liberty & market in
MedLib is part of a wide movement of ideas that defends
- the self-ownership principle & the property rights of individuals on the products of their
physical and intellectual work
- free markets, free enterprise and strict limits to the role of the State
· Americans for Tax Reform, www.atr.org/, Grover Norquist, President, keeps us apprised of the Cost of Government Day® Report, Calendar Year 2009. Cost of Government Day (COGD) is the date of the calendar year on which the average American worker has earned enough gross income to pay off his or her share of spending and regulatory burdens imposed by government on the federal, state and local levels. Cost of Government Day for 2009 was August 12th, a full 26 days longer than last year and the latest date this day has ever fallen since 1977. With August 12th as the COGD, working people must toil on average 224 days out of the year just to meet all the costs imposed by government. In other words, the cost of government consumes 61.34 percent of national income. If we were to put health care into the public trough, the additional 18 percent would allow the government to control 70 percent or nearly three-fourths of our productivity and destroy our health care in the process. We would have almost no discretionary income.
· National Taxpayer's Union, www.ntu.org/main/, Duane Parde, President, keeps us apprised of all the taxation challenges our elected officials are trying to foist on us throughout the United States. To find the organization in your state that's trying to keep sanity in our taxation system, click on your state at www.ntu.org/main/groups.php. House Democrats use words such as "choice" in stump speeches on behalf of their recently introduced health care legislation, but according to an analysis by the National Taxpayers Union Foundation (NTUF), the actual text of the bill tells a different story. NTUF determined that the words "choice," "options," and "freedom" appear just 85 times in the mammoth 1,018-page legislation, while three restrictive words -- "require," "limit," and "must" (and variations) -- were nine times more prevalent.
· FIRM: Freedom and Individual Rights in Medicine, www.westandfirm.org, Lin Zinser, JD, Founder, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance.
· Ayn Rand, a Philosophy for Living on Earth, www.aynrand.org/site/PageServer, is a veritable storehouse of common sense economics to help us live on earth. To review the current series of Op-Ed articles, some of which you and I may disagree on, go to www.aynrand.org/site/PageServer?pagename=media_opeds.
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"Ask yourself the easy questions and you'll have a hard life, ask yourself the hard questions and you'll have an easier life!" - Peter Thomson: U.K. strategist on business and personal growth
“The unreal is more powerful than the real, because nothing is as perfect as you can imagine it. Because its only intangible ideas, concepts, beliefs, fantasies that last. Stone crumbles. Wood rots. People, well, they die. But things as fragile as a thought, a dream, a legend, they can go on and on.” - Chuck Palahniuk quotes (American freelance Journalist, Satirist and Novelist. b.1961)
Some Relevant Postings
This Month in History – July is Freedom Month and Enslavement Month
July 1 marks the beginning of the month in which so many nations, including our own, gained their freedom.
Canada became a self-governing dominion of Great Britain on this day in 1867.
France celebrates the anniversary of its first revolution on July 14.
Such other nations as Algeria, Argentina, Columbia, Belgium, Peru, Liberia and Venezuela gained self- government and freedom during this month.
Our theme this month is freedom—freedom from several points of view: first, how do we keep it and second, what do we do with it. Third, we have to decide how strongly we are committed to it.
Today, we have a memorable reminder of the sad fact that freedom means different things to different people. Today is the anniversary of the beginning of the Battle of Gettysburg in 1863, a battle memorable both for the bravery and dedication of those who fought it and for its role as a turning point in the Civil War. The Battle of Gettysburg, as Abraham Lincoln said a few months later, must be remembered so that from its honored dead “we take increased devotion to that cause for which they gave the last full measure of Devotion.” In the largest sense, that case was, again as Lincoln said, “that government of the people, by the people, for the people shall not perish from the earth.”
Medicare went into effect in the United States on this date in 1966. Many well-to-do seniors paid for their private health insurance for some years and finally succumb to become enslaved to the government for their most personal privacy. In 1970, my father finally gave up paying his Blue Cross/Blue Shield and White Cross policies premiums and sadly just had Medicare. He felt sad for the country that his parents came to seeking freedom from the Father of government social insurance, German Chancellor Otto von Bismarck. As with any entitlement, there is never an objective appraisal of what alternatives would have kept our nation from enslaving themselves, our children and our grandchildren. Charles Ponzi, Bernard Ebbers, Enron, Lou Pearlman, Ivan Boesky, Michael Millikin, Dr. Bill McGuire, Bernard Madoff, ($65 billion), PG & E, and others were mere pikers compared to the grandiose Ponzi schemes that Roosevelt, Johnson pulled off in 1933 and 1966. It took Reagan and 50 years to reverse the process of living on our children and grandchildren’s future. Will it take another 50 years to survive the current administration’s Ponzi Scheme of $ trillions that will outdo Roosevelt & Johnson combined and also enslave us? Or will we fade into the history of human misery being subject to the devastations of government by Kings, Emperors, Dictators, Czars, and other Ruthless Rulers. We could fade into slavery by not even firing a shot or giving serious resistance. What a tragedy from becoming so comfortable with our freedom that we failed to understand the daily risks. Will we then become so comfortable with enslavement like the people of Russia when Communism was overthrown? Some actually wished for the return of the dictator and be told when and where to buy their daily bread, even if it was only once a week. Starvation was more comfortable and secure to them than freedom.
The 7th Annual World Health Care Congress
Advancing solutions for business and health care CEOs to
implement new models for health care affordability, coverage and quality
The 7th Annual World Health Care Congress will be held April 12-14, 2010
Toll Free: 800-767-9499
Download a brochure: http://www.worldcongress.com/request_brochure.cfm?confCode=HR09000
The Annual World Health Care Congress, a market of ideas, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 3rd annual conference was held April 17-19, 2006, in Washington, D.C. One of the regular attendees told me that the first Congress was approximately 90 percent pro-government medicine. The third year it was about half, indicating open forums such as these are critically important. The 4th Annual World Health Congress was held April 22-24, 2007, in Washington, D.C. That year many of the world leaders in healthcare concluded that top down reforming of health care, whether by government or insurance carrier, is not and will not work. We have to get the physicians out of the trenches because reform will require physician involvement. The 5th Annual World Health Care Congress was held April 21-23, 2008, in Washington, D.C. Physicians were present on almost all the platforms and panels. However, it was the industry leaders that gave the most innovated mechanisms to bring health care spending under control. The 6th Annual World Health Care Congress was held April 14-16, 2009, in Washington, D.C. The solution to our health care problems is emerging at this ambitious Congress. The 5th Annual World Health Care Congress – Europe 2009, met in Brussels, May 23-15, 2009. The 7th Annual World Health Care Congress will be held April 12-14, 2010 in Washington D.C. For more information, visit www.worldcongress.com. The future is occurring NOW. You must become involved.