Voice For Liberty

Tag: Barack Obama

  • Health care reform threatens anesthesiology, patients

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

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

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

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

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

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

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

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

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

  • President Obama’s health care speech

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    The source of payment for this plan is savings.

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

    Analysis

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

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

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

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

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

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

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

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

  • Articles of Interest

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

    Budgeting outside the box

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

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

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

    Maybe this is why college is expensive

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

    ‘Montoy’ threat again hangs over education-funding discussions

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

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

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

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

    The Whole Foods Alternative to ObamaCare

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

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

  • Astroturf, Obama style

    At the recent New Hampshire town hall meeting, President Obama took a softball question from a young girl. It seemed innocent enough. Almost natural.

    The Boston Global article Question by a Malden girl becomes the target of conservative critics contains this: “The critics point to campaign donations and other partisan links of the girl’s mother, Kathleen Manning Hall, who was an early Obama supporter and donated money to his campaign. But a White House spokesman insisted that audience members are selected randomly.”

    The girl’s mother denies that her daughter was a plant by the White House.

    Astroturf? (Meaning fake political activity, organized from somewhere above, passed off as the genuine action and concern of real, genuine people.)

    The Left takes great glee in portraying actions by those on the political right and by libertarians as astroturf. Doing this allows them to ignore the substance of the criticisms. Instead, they can focus on the personal characteristics of the critics and sidestep the issues.

  • The real right to medical care versus socialized medicine

    In 1994, George Reisman wrote a pamphlet explaining the problems with America’s health care system. He criticized the Clinton plan for reform, and offered an alternative based on freedom and markets rather than government interventionism. It is a brilliant work, and still relevant today: “I wrote this essay to help defeat the Clinton plan for socialized medicine. In all essentials it’s as valid today as it was then. It’s a demonstration that government intervention inspired by the philosophy of collectivism is the cause of America’s medical crisis and that a free market in medical care is the solution for the crisis. I urge everyone who wants to help defeat the essentially similar Obama scheme to read it.”

    You can read the pamphlet by clicking on The real right to medical care versus socialized medicine. It’s lengthy, at about 22,000 words. It takes a while to read. Part of what accounts for its length is Reisman’s explanation of every point he makes, which is very helpful.

    Reisman calls for more than simply defeating the Clinton plan, as we who oppose the Obama plan should be doing too. He calls for reform — radical reform — of America’s health care, and presents a plan.

    By way of introduction, Reisman writes

    … while the philosophy of Marx and Engels is dying, the philosophy of Locke and Jefferson, and Adam Smith, that is, the philosophy of individual freedom and capitalism underlying the American Revolution — the philosophy which, ironically enough, was the original meaning of the word liberalism — has been reborn. It has been reborn first and foremost at the hands of Ayn Rand in political philosophy and of Ludwig von Mises in economic theory, both of whom have enormously strengthened it. This philosophy of individual freedom, of the inviolability of individual rights, of the benevolent functioning of an economic system based on private ownership of the means of production and the profit motive — of capitalism — calls for a radically new political agenda. It calls for a political agenda that progressively rolls back the interference of the state and progressively enlarges the freedom of the individual. This is now what political philosophy and economic theory at their highest levels of development recognize to be the essential means of solving social and economic problems. Movement in this direction — in the direction of individual freedom from government interference — is henceforth to be regarded as the standard of what is to be considered progress in the realm of political action.

    It is on the basis of this newly resurgent, radically different political philosophy and economic theory — this philosophy and theory of individual rights and capitalism — that I explain the causes of the present crisis in medical care, criticize the Clinton plan, and present the appropriate solution and how to achieve it.

    The fundamental problem is this: “… the perverted notion of the need-based right to medical care — that is, an alleged right to medical care that entails a claim on other people’s wealth or labor, which must be met with or without their consent — is what underlies both the collectivization of medical costs and the concomitant loss of the individual’s personal financial responsibility. In this way, it is a perverted notion of the right to medical care that is fundamentally responsible for the rising cost of medical care.”

    Reisman goes on to explain, in detail, how the present system of purchasing health care leads to a variety of problems, such as “the potential for a limitless rise in the price of medical services” and “irrational medical malpractice awards and the practice of defensive medicine.” Most people seem to agree that these problems are present. He also explains how the present system is “perverting technological progress into a source of higher costs rather than lower costs,” how it is responsible for high drug prices, and how hospitals waste money buying costly equipment that is not needed.

    He also explains “bureaucratic interference with medicine and the rise in administrative costs,” characteristics of private health insurance companies that those who support government takeover rail against.

    Reisman then criticizes the details of the Clinton plan. These apply equally to the Obama plan.

    Then, Reisman proposes his solution. It’s not more government, which is what Obama offers. It’s less government and restoration of individual rights:

    The actual solution to the problem of runaway medical costs lies in the precise opposite of the direction chosen by the Clinton plan. It is not the final destruction of the individual’s rational right to medical care, which is what the Clinton plan would achieve, but the restoration and full implementation of that right — that is, the removal of all government interference that stands between buyers and sellers of medical care or in any way causes medical care to be more expensive than it otherwise would be.

    The best way to accomplish reform, Reisman writes, is: “The simplest, most obvious method of achieving a free market in medical care would be at one stroke to abolish all government intervention that violates a free market in medical care.”

    Recognizing that this is not likely to happen, Reisman proposes some steps to take.

    The first is a change in the tax laws that would have the effect of “[having] employees realize that they were responsible for the cost of their own medical care, even if the employer continued to pay insurance premiums on their behalf. This is because the individual employee would know that he could have his share of the money his employer paid on his behalf, in his own pocket if he wished.” In other words, dissolve many peoples’ notion that their health care is free (or very low cost) just because they get it as part of their job.

    Next, end the idea that Medicare is a free resource: “… unless they can demonstrate a lack of means, individuals covered by Medicare be required to pay a substantial deductible before their coverage under the program begins and then to make a continuing copayment of a significant percentage of all costs beyond some maximum limit. ”

    To increase the supply of health care, “it is certainly reasonable to ask that medical licensing laws be liberalized — nothing so extreme, mind you, as their outright abolition, but merely their significant liberalization.”

    To control hospital costs, a radical reduction in the regulation hospitals face is required.

  • Paygo rule meaningless, harmful

    In a letter printed in yesterday’s Wichita Eagle, Doug Ittner of Wichita promotes the benefit of a rule known as “paygo.” The purpose of this rule is to force budget discipline on Congress. As the Washington Post’s David Broder wrote in that newspaper in June: “[Paygo’s] key provision requires that any new tax cut or entitlement increase be paid for by an offsetting reduction in other programs or a tax increase. If, for example, you want to guarantee child care for every working mother or provide her with a payroll tax cut, you would have to find savings or revenue elsewhere of equal size.”

    It sounds like Congress has suddenly been overtaken by reason, doesn’t it?

    If only it were so.

    The reality is that the paygo rule is so feckless as to be meaningless. In fact, the rule causes great harm. By sounding tough, the existence of the rule leaves apparently naive citizens like Mr. Ittner to conclude that things are under control in Washington. But things are far from under control, and this illusion of control is quite harmful.

    A good article to read to understand how paygo works is the Wall Street Journal article The ‘Paygo’ Coverup from June. Here are some of the points it makes.

    • When Democrats took over Congress in 2006, Speaker Nancy Pelosi imposed paygo rules. What happened? “By 2008, Speaker Pelosi had let those rules lapse no fewer than 12 times, to make way for $400 billion in deficit spending.”
    • President Obama campaigned on paygo, and the deficit has exploded by an unprecedented amount since he took office.
    • “Paygo only applies to new or expanded entitlement programs, not to existing programs such as Medicare.” Existing entitlements consume the lion’s share of federal spending, so paygo doesn’t apply to much of the problem.
    • Paygo doesn’t apply to discretionary spending.
    • Congress classifies spending to circumvent paygo. “… the 2010 budget resolution included a $2 billion increase for low-income heating assistance as an entitlement change that should be subject to paygo. But Congressional Democrats simply classified it as discretionary spending, thereby avoiding the need for $2 billion in cuts elsewhere.
    • “The other goal of this new paygo campaign is to make it easier to raise taxes in 2011, and impossible to cut taxes for years after that.”

    Even the liberal David Broder, in his Washington Post piece, recognizes that the current law is “full of loopholes,” as the title of his article indicates.

    We’d be better off without this meaningless rule, so full of loopholes, that lets politicians promote the illusion of controlling the federal budget.

  • European health care rationing boards: coming to America?

    Following up on a letter in the Wichita Eagle written by Brad Beachy of Wichita: He’s making the case that nationalized health care of the type found in Europe is both cheaper and better than what we have in America.

    Cheaper, yes. Better? Let’s take a look.

    Beachy, in his letter, states: “European countries such as England spend about 8 percent of their gross domestic product on health care while covering every single resident.”

    The eight percent of GDP figure is commonly cited, and that’s about half what the United States spends. So how does England do it?

    Last week I reported on the National Institute for Health and Clinical Excellence, or NICE. The Wall Street Journal reports that this is the board in England founded about 10 years ago as “a body that would ensure that the government-run National Health System used ‘best practices’ in medicine.” (We hear phrases like this from Obama. As if the government would know what are “best practices.”)

    But something different happened: “What NICE has become in practice is a rationing board. As health costs have exploded in Britain as in most developed countries, NICE has become the heavy that reduces spending by limiting the treatments that 61 million citizens are allowed to receive through the NHS.”

    The Journal article details a few examples of care that is denied in England, but most Americans get.

    There are real consequences: “The Concord study published in 2008 showed that cancer survival rates in Britain are among the worst in Europe. Five-year survival rates among U.S. cancer patients are also significantly higher than in Europe: 84% vs. 73% for breast cancer, 92% vs. 57% for prostate cancer. While there is more than one reason for this difference, surely one is medical innovation and the greater U.S. willingness to reimburse for it.”

    One of the reasons used by those in favor of national health care is that sometimes insurance companies won’t cover treatments people feel they should receive. A government rationing board — we will have one in America if Obama’s plans proceed — is likely to be much more harsh.

  • Obama-style health care: the effects in England

    In the debate of what to do about health care, advocates — such as President Obama — cite countries that spend much less than the United States. An example is the United kingdom.

    The president believes that if we can control costs through better medical practice and efficiency gains, we too can have more health care provided at less cost.

    The Wall Street Journal article Of NICE and Men tells us how Great Britain is able to control its costs. It’s through the National Institute for Health and Clinical Excellence, or NICE.

    Originally it was established to “ensure that the government-run National Health System used ‘best practices’ in medicine.” This sounds like a good program, doesn’t it?

    But as the Journal article details, it hasn’t quite worked out that way. The article concludes: “But it [NICE] has by now established the principle that the only way to control health-care costs is for this panel of medical high priests to dictate limits on certain kinds of care to certain classes of patients.”e

  • In Obama administration, transparency and science take backseat to politics

    President Barack Obama has promised to make transparency the standard for his administration. He also pledged to base decisions such as our nation’s energy policy on science.

    As reported on this site, the Competitive Enterprise Institute uncovered a series of email messages within the Environmental Protection Agency (EPA) that raise questions as to how seriously these goals are followed.

    What happened is that an EPA analyst prepared a report that challenged the orthodoxy of global warming. His report was suppressed — until CEI uncovered the emails.

    The Wall Street Journal’s Kimberly A. Strassel explains all this very well in her article The EPA Silences a Climate Skeptic.