Free Markets, Free People

Government

So What Could Cap-and-Trade Eventually Bring?

Well if the UK is any example, “green jackets”, a sort of environmental police force with the power to enter and search (with a blanket “warrant”) any company it so chooses to inspect. Is “Gestapo-like” tactics a stretch?

The boys in green are coming as the Environment Agency sets up a squad to police companies generating excessive CO2 emissions.

The agency is creating a unit of about 50 auditors and inspectors, complete with warrant cards and the power to search company premises to enforce the Carbon Reduction Commitment (CRC), which comes into effect next year.

Decked out in green jackets, the enforcers will be able to demand access to company property, view power meters, call up electricity and gas bills and examine carbon-trading records for an estimated 6,000 British businesses. Ed Mitchell, head of business performance and regulation at the Environment Agency, said the squad would help to bring emissions under control. “Climate change and CO2 are the world’s biggest issues right now. The Carbon Reduction Commitment is one of the ways in which Britain is responding.”

The formation of the green police overcomes a psychological hurdle in the battle against climate change. Ministers have long recognised the need to have new categories of taxes and criminal offences for CO2 emissions, but fear a repetition of the fuel tax protests in 2000 when lorry drivers blockaded refineries.

Criminal offenses for “CO2 emissions” – Orwell saw this coming but clearly he didn’t understand that it would be based in criminalizing a natural byproduct of respiration and trace atmospheric gas, did he?

Again, it’s the precedent this sets which is both upsetting and dangerous. Probable cause? Green Jackets don’t need no probable cause!

Let freedom ring.

~McQ

Questions and Observations #3

For new readers, the title is what the shortened “QandO” means.

  • Whether you love her, hate her or really don’t care, it is hard too argue against the assertion that  Sarah Palin effectively ended any national aspirations she might have had by announcing her pending resignation (assuming there isn’t some extremely compelling private family reason for doing so). The first thing any political opponent is going to say is “she quit on the citizens of Alaska, will she quit on you?”
  • The story about the Washington Post selling access to the Obama administration isn’t just about the WaPo. Seems to me there had to be some a) knowledge of the plan and b) cooperation from the White House for it to have been as far along as it was. After all, the first “salon” was scheduled to be held at the publisher’s home in 2 weeks. Is anyone exploring that angle?
  • How concerned is Saudi Arabia with the probability of Iran acquiring nuclear weapons? Apparently enough to make it known they’ll turn a blind eye to any Israeli incursion which crosses the kingdom in order to strike Iran.
  • Apparently the scales have finally fallen from Colin Powell’s eyes concerning Obama and the direction he’s taking this country. Formerly Powell’s message was that American’s wanted more government and were willing to pay for it. He now says he’s concerned with the number of programs, the legislation associated with them and the cost of the additional government they’ll entail. “We can’t pay for it,” he’s now saying? Better late than never, I suppose, but this just underscores my disaffection with Powell politically.
  • Speaking of Sarah Palin, apparently the federal investigation rumors (FBI looking into irregularities concerning the sports complex in Wasilla, etc.) and pending indictment are false. An FBI spokesman in Alaska has said there is no pending indictment or ongoing investigations of her. Concerning the ongoing rumor he says, “it’s just not true”.
  • The after effects of the recent “election” in Iran continue to eat away at the foundation of the “Islamic Republic”. The Association of Researchers and Teachers of Qum split with Ayotallah Khamenei declaring both the election and the new govenrment “illegitimate”. That is a very public and unprecedented challenge to Khamenei’s power. Additionally Moussavi’s campaign has released a report that outlines the election violations in detail. These are very serious challenges to the regime’s legitimacy.
  • Speaking of Iran, it appears that while the world is ready to ratchet up the pressure on the regime in light of its brutal put down of pro-democracy protesters, the Obama administration is apparently prepared to block any sanctions agreed upon at the G8 summit. I swear I can’t figure that bunch out – support the dictator in Iran and mischaracterize a legal use of constitutional power in Honduras in support of another would-be dictator there.
  • The law of unintended consequences continues to operate unabated. Governments, desperate for revenue, have raised property taxes all across the country. Homeowners, knowing their home values have plummeted, are filing an unprecedented number of appeals. Those appeals are costing the governments huge amounts of money in refunds and attorney’s fees. However, homeowners should note that if they don’t appeal, the government will gladly screw them to the wall with an unjustified tax increase. Makes you feel all warm and fuzzy inside, doesn’t it?

~McQ

Busting Medicare’s “Low Overhead Advantage” Myth

One of the favorite arguments of the government health care crowd is the supposed Medicare low overhead argument – i.e. Medicare is more efficient than private insurance because its overhead is so much lower than private administrative costs.

It goes like this:

But the administration of Medicare is a miracle of low overhead and a model, despite all the fraud and abuse, of what government can do right. Three percent of Medicare’s premiums go for administrative costs. By contrast, 10 to 20 percent of private-insurance premiums go for administrative costs. Roll that figure around on your tongue. When you swallow and digest it, you’ll understand that any hope of significantly reducing health-care costs depends on a public option.

Right now, the Medicare average is 3% and private insurance averages 12%. But Tom Bevan points out, some of that difference is an apples and oranges comparison:

But here’s the catch: because Medicare is devoted to serving a population that is elderly, and therefore in need of greater levels of medical care, it generates significantly higher expenditures than private insurance plans, thus making administrative costs smaller as a percentage of total costs. This creates the appearance that Medicare is a model of administrative efficiency. What Jon Alter sees as a “miracle” is really just a statistical sleight of hand.

Furthermore, Book notes that private insurers have a number of additional expenditures which fall into the category of “administrative costs” (like state health insurance premium taxes of 2-4%, marketing costs, etc) that Medicare does not have, further inflating the apparent differences in cost.

However, when you make an apples to apples comparison, Medicare comes out much worse than private insurance:

But, as you might expect, when you compare administrative costs on a per-person basis, Medicare is dramatically less efficient than private insurance plans. As you can see here, between 2001-2005, Medicare’s administrative costs on a per-person basis were 24.8% higher, on average, than private insurers.

So, contrary to claims of Alter, Krugman, and President Obama, moving tens of millions of Americans into a government run health care option won’t generate any costs savings through lower administrative costs. Just the opposite.

Make sure you click through and check out the real Medicare administrative costs as compared to private industry.

Then there’s waste fraud and abuse. Did you happen to catch that little hand wave at “fraud and abuse” in the first quote touting Medicare’s efficiency? What, pray tell, is one of the primary jobs of an administive system? Would you imagine it to be the elimination of fraud and abuse – or said another way, to ensure that the company pays legitimate claims and avoids fraudulent and unnecessary payments?

How efficient is a system which is awash in both fraud and abuse? And, without profit, what incentive do they have to eliminate it?

John Stossel takes that part of the “Medicare efficiency” myth apart:

But there’s a bigger point – the connection between “low” administrative costs and staggeringly HIGH levels of fraud and waste. As Michael Cannon at the Cato Institute and Regina Herzlinger at Harvard Business School have pointed out, much of the 10 to 20 percent of private insurance administrative costs goes to preventing fraud. Private insurers, you see, care about whether or not they lose money. Medicare, with its unlimited claim on the public purse, does not. It’s only taxpayer money, after all.

The results are predictable, but breathtaking nonetheless: an estimated $68 billion (with a B) in outright Medicare fraud every year (About $3 billion in Miami-Dade county ALONE.) On top of that, according to well-respected Dartmouth researchers, roughly a third of Medicare’s total $400 billion annual spending goes to procedures which were medically unnecessary.

That’s, on average, 68 billion every year. Imagine a private insurance company surviving with loss figures like that. But as Stossel points out, without an incentive to eliminate fraud and abuse, it continues year after year after year, with politicians and Medicare administrators tut-tutting but never really doing anything about it.

That is the reality of Medicare’s efficiency. It is also the probable model any future health care insurance run by the government. Efficiency is an illusion brought about by a statistical sleight of hand and ignoring the systemic waste, fraud and abuse of Medicare.

~McQ

Climate Change Update – Falling Dominoes

For the American taxpayer, under the shadow of the recently passed House cap-and-trade (Waxman-Markey) bill, the news continues to be grim. However for the traitorous “deniers”, aka skeptics, who believe the whole climate change hysteria to be an economy killing farce, things are looking better.

For instance India has announced it will not participate in the Western world’s attempts to kill their own economies:

India said it will reject any new treaty to limit global warming that makes the country reduce greenhouse-gas emissions because that will undermine its energy consumption, transportation and food security.

Cutting back on climate-warming gases is a measure that instead must be taken by industrialized countries, and India is mobilizing developing nations to push that case, Environment Minister Jairam Ramesh told the media today in New Delhi.

“India will not accept any emission-reduction target — period,” Ramesh said. “This is a non-negotiable stand.”

Heh … fairly blunt and straight foward wouldn’t you say? Of course, China took the same stand a couple of weeks ago. I call that good news because it is another country which has decided to put its economy first and this nonsense second. When two countries which are or expected to be very soon the two leading emitters of CO2 say “no”, it makes it rather ridiculous for the rest of the world to say “yes” given the consequences vs. payoff, doesn’t it?

And the US cap-and-trade legislation? Well India sees that as a “no-go” as well:

But last week, the US House of Representatives backed a “border adjustment tax” to equalise carbon emissions charges between domestic production and imports from states that do not cap emissions. The legislation is likely to face tough opposition in the Senate.

Mr Ramesh denounced as “pernicious” US efforts to impose “trade penalties” on countries that do not match its carbon reduction moves.

Meanwhile in the EU:

The European Union risks driving industry out of the region if it continues to push for deeper cuts in carbon dioxide emissions than other economies, according to the chief executive of Eon, one of the world’s biggest renewable energy companies.

Wulf Bernotat, Eon’s chief executive, told the Financial Times that the EU was imposing higher energy costs on its industry than competing regions, and criticised the US for doing “basically nothing” to cut its carbon dioxide emissions.

He added that if there were no international deal to cut emissions agreed at the Copenhagen meeting at the end of the year, the EU would have to rethink its plans to take a lead in fighting the threat of climate change.

“It is a European political issue whether the European Union can continue to lead the policy process if the rest of the world is not joining in,” he said.

“We are adding additional costs to our industries, and if other countries don’t follow, then those industries will move to lower-cost regions.”

Yeah, like India or China … or Mexico. That’s the irony of this nonsense. We have a president and Congress who’ve made a cottage industry of demonizing corporations who “outsource” jobs while they pass legislation that encourages corporations to outsource jobs.

And for those who worship at the feet of Al Gore, another inconvenient truth is to be found in a recently published paper from the Journal of Atmospheric and Solar-Terrestrial Physics:

The Abstract states:

Daily temperature and pressure series from 55 European meteorological stations covering the 20th century are analyzed. The overall temperature mean displays a sharp minimum near 1940 and a step-like jump near 1987. We evaluate the evolution of disturbances of these series using mean squared inter-annual variations and “lifetimes”. The decadal to secular evolutions of solar activity and temperature disturbances display similar signatures over the 20th century. Because of heterogeneity of the climate system response to solar forcing, regional and seasonal approaches are key to successful identification of these signatures. Most of the solar response is governed by the winter months, as best seen near the Atlantic Ocean. Intensities of disturbances vary by factors in excess of 2, underlining a role for the Sun as a significant forcing factor of European atmospheric variations. We speculate about the possible origin of these solar signatures. The last figure of the paper exemplifies its main results.

The paper concludes:

In concluding, we find increasingly strong evidence of a clear solar signature in a number of climatic indicators in Europe, strengthening the earlier conclusions of a study that included stations from the United States (Le Mouël et al., 2008). With the recent downturn of both solar activity and global temperatures, the debated correlations we suggested in Le Mouël et al. (2005), which appeared to stop in the 1980s, actually might extend to the present. The role of the Sun in global and regional climate change should be re-assessed and reasonable physical mechanisms are in sight.

Shorter conclusion?

“It’s the sun, stupid”.

~McQ

Welcome To One-Party Rule (Updated)

It’s now official: only one party has the reins to power in Washington, DC:

The Minnesota Supreme Court on Tuesday unanimously ruled Al Franken the winner of last November’s Senate race, putting the former “Saturday Night Live” star on the brink of becoming a United States senator and Democrats on the cusp of holding a dominant 60-vote supermajority in the Senate.

In a unanimous 5-0 decision, the court upheld a three-judge panel’s April 14 ruling that Franken defeated Republican Norm Coleman in the race by 312 votes out of 2.9 million cast. The 32-page was remarkably decisive, picking apart and rejecting one Coleman legal claim after another.

[…]

If Franken is seated, Democrats would hold a 60-40 majority in the Senate, the largest the party has enjoyed in a generation. Sixty votes are needed to break filibusters, ensuring that if Democrats stay united they would be able to cleave the GOP’s last lever of power in Washington. A Franken “yes” vote on health reform, climate change legislation and Supreme Court nominee Sonia Sotomayor gives Senate Majority Leader Harry Reid (D-Nev.) even more of a margin for error on these major votes.

Democrats were already celebrating the result.

Gov. Tim Pawlenty already stated that he would sign the election certificate for Franken if directed to do so by the Supreme Court, so this is pretty much a done deal. Coleman has not indicated whether he would appeal the decision to the U.S. Supreme Court, and the Minnesota Republican Party doesn’t seem to sanguine about pushing further:

Even Minnestoa Republicans – highly disappointed by the ruling – weren’t ready to call for a federal legal challenge.

The Minnesota Republican Party issued a strongly worded statement, saying the ruling “wrongly disenfranchised thousands of Minnesotans who deserve to have their votes counted.”

But the chairman-elect of the party, Tony Sutton, made no mention of next steps, only saying, “As we move forward, our deeply flawed election system must be dramatically improved to ensure our state’s elections are fair, accurate and reliable.”

Assuming that Coleman doesn’t seek cert., or if he does that no stay of the decision is put into place, then Franken will be seated as early as next week. With a vetofilibuster-proof majority in the Senate, the Democrats won’t need to play parliamentary games like using reconciliation bills, or the like, and instead will simply shove legislation down the throats of the minority. So get ready for cap-and-trade, government health care, huge tax increases, and a host of other government programs that don’t need and can’t pay for.

The only downside for Democrats is that they can’t credibly blame the fiscal and economic woes on Bush anymore as they will have cornered the political market. I say “credibly” because they will continue to do so, and the media mostly won’t call them on it, but such claims will be laughably false. The real question is, how and when will this come back to haunt them?

UPDATE: Coleman concedes.

Waxman-Markey (Cap And Trade) Passes The House

The vote was 219 to 212.

4 votes on the other side and it goes down to defeat.

So, who are these people:

Mary Bono Mack (Calif.), Mike Castle, Mark Steven Kirk (Ill.), Leonard Lance (NJ), Frank LoBiondo (NJ), John McHugh (NY), Dave Reichert (Washington), Chris Smith (NJ)

They’re the Republicans who voted for the bill and assured its passage.

You may want to find some way to thank them for passing one of the largest and most regressive tax increases in US history.

~McQ

Questions and Observations #2

For new readers the title is that for which the shortened “QandO” stands. This is the second in a series of questions and observations.

  • In the “you can’t make this up” department, China will block the sale of Hummer for “environmental concerns”.  I guess that’s their nod to the rest of the world after flatly refusing cut CO2 emissions in the future.
  • Ezra Klein is suddenly for smaller government, specifically the elimination of the Agriculture Committee. Of course the only reason he’d like to see it given the deep 6 is because it has, in Klein’s opinion, badly weakened cap-and-trade by extracting “a truly mind-boggling array of tax breaks, exemptions, and straight subsidies”. I guess Klein would like to temporarily make government smaller to make it larger.
  • Yes, Michael Jackson is dead – but for heaven sake, do we have to devote every minute of the news day to running “Thriller” vid and spreading rumors about the possible cause of his death? Is this what “news” organizations have become?
  • Apparently we’re still stalking the North Korean ship enroute to either Singapore or Burma. For those who are waiting for us to confront it and board it, that’s not going to happen. The “tough” UN resolution only provides for boarding if the North Koreans agree. And, while we can demand that they then go to the nearest port for inspection, the North Koreans can refuse that as well. The plan, it seems, is to convince the refueling port the NoKos pull into to refuse to refuel the ship. Then, when the NoKo ship runs out of fuel, put it under tow and then inspect it. As I understand it – they can then inspect it legitimately. Amazing.
  • Waxman-Markey, aka cap-and-trade, survived an earlier test vote that moved the bill to the floor for a 5pm vote. As I recall the margin was 5 votes. It is a job destroyer in the middle of a recession. The Center for Data Analysis of the Heritage Foundation figures it will cost 50,000 jobs in the transportation equipment sector alone. Their data for other sectors is available here.
  • House liberals have staked out a bit of ground on the health care bill saying they will not vote for it if it doesn’t include a public option – period. That is actually good news as the public option does seem to be in trouble. Any bill showing up without it will most likely not get the 80 members of the Congressional Progressive Caucus to vote for it. Add in the Republicans and the Blue Dogs, and it may be in very serious trouble without just the sticker shock of 1 to 3 trillion dollars of cost.
  • Mark Sanford? He should resign. The affair is between he and his family. He should resign because he was derelict in his duty and he misappropriated government funds to pay for his trip to Argentina.  Kinda like Bill Clinton should have resigned, not for the affair, but for lying under oath to a grand jury and attempting to obstruct justice.

~McQ

“Man-Made Warming” Dubbed “Worst Scientific Scandal In History”

I understand that everywhere else today it is “Michale Jackson is dead” day – I suspect days such as this must be infinitely boring to most news junkies because the news is dominated by a single topic.

Meanwhile Democrats are doing their best to rush cap-and-trade through the House today even while the pseudo-science that supports their effort continues to collapse.  The WSJ has an article today which points out:

Among the many reasons President Barack Obama and the Democratic majority are so intent on quickly jamming a cap-and-trade system through Congress is because the global warming tide is again shifting. It turns out Al Gore and the United Nations (with an assist from the media), did a little too vociferous a job smearing anyone who disagreed with them as “deniers.” The backlash has brought the scientific debate roaring back to life in Australia, Europe, Japan and even, if less reported, the U.S.

Interestingly, as the EPA story below points out, it has actually been suppressed here. But that hasn’t stopped the scientific community elsewhere from continuing to destroy the myth of consensus and replace it with a healthy, and might I add peer reviewed, skepticism real science brings to any theory:

In April, the Polish Academy of Sciences published a document challenging man-made global warming. In the Czech Republic, where President Vaclav Klaus remains a leading skeptic, today only 11% of the population believes humans play a role. In France, President Nicolas Sarkozy wants to tap Claude Allegre to lead the country’s new ministry of industry and innovation. Twenty years ago Mr. Allegre was among the first to trill about man-made global warming, but the geochemist has since recanted. New Zealand last year elected a new government, which immediately suspended the country’s weeks-old cap-and-trade program.

The number of skeptics, far from shrinking, is swelling. Oklahoma Sen. Jim Inhofe now counts more than 700 scientists who disagree with the U.N. — 13 times the number who authored the U.N.’s 2007 climate summary for policymakers. Joanne Simpson, the world’s first woman to receive a Ph.D. in meteorology, expressed relief upon her retirement last year that she was finally free to speak “frankly” of her nonbelief. Dr. Kiminori Itoh, a Japanese environmental physical chemist who contributed to a U.N. climate report, dubs man-made warming “the worst scientific scandal in history.” Norway’s Ivar Giaever, Nobel Prize winner for physics, decries it as the “new religion.” A group of 54 noted physicists, led by Princeton’s Will Happer, is demanding the American Physical Society revise its position that the science is settled. (Both Nature and Science magazines have refused to run the physicists’ open letter.)

It is falling apart in big chunks now – not that anyone on the left here is listening. We’ve got the fingers firmly in the ears in Congress and the EPA. Both made up their minds years ago, having bought into the pseudo-science of Al Gore and are now determined to act on their preconceived notions – science be damned.

Economist John M. Keynes once said, “When the facts change, I change my mind. What do you do, sir?”

The answer for the left is ignore them and pass economy killing legislation as fast as they can.

The collapse of the “consensus” has been driven by reality. The inconvenient truth is that the earth’s temperatures have flat-lined since 2001, despite growing concentrations of C02. Peer-reviewed research has debunked doomsday scenarios about the polar ice caps, hurricanes, malaria, extinctions, rising oceans. A global financial crisis has politicians taking a harder look at the science that would require them to hamstring their economies to rein in carbon.

Meanwhile our blinkered ideologues push cap-and-trade while ignoring the new evidence.

Comforting, isn’t it?

~McQ

So Ideology Now Takes A Back Seat To Science?

That was the promise candidate Barack Obama made.  He claimed that wasn’t the case during the Bush administration and under his leadership, science would be ascendent.  They’d just let the chips fall where they may.

Well, except maybe in the EPA when a key to an ideological agenda item – declaring CO2 a pollutant – didn’t have the science available to support the desired result.  Read the executive summary of this suppressed report.  It outlines why the science doesn’t support the desired agenda item of declaring CO2 a pollutant.  Of course without such a declaration, legislation for pollution standards for autos as well as this abomination of a cap-and-trade bill before the House today are without basis.

Michelle Malkin is all over this and it’s ironic that what occurred sounds exactly like what the left accused the Bush administration of doing:

The EPA now justifies the suppression of the study because economist Carlin (a 35-year veteran of the agency who also holds a B.S. in physics) “is an individual who is not a scientist.” Neither is Al Gore. Nor is environmental czar Carol Browner. Nor is cap-and-trade shepherd Nancy Pelosi. Carlin’s analysis incorporated peer-reviewed studies and, as he informed his colleagues, “significant new research” related to the proposed endangerment finding. According to those who have seen his study, it spotlights EPA’s reliance on out-of-date research, uncritical recycling of United Nations data, and omission of new developments, including a continued decline in global temperatures and a new consensus that future hurricane behavior won’t be different than in the past.

It appears, at least in this case, that science isn’t of interest to the ideologues on the left any more than it was to the ideologues on the right.  That may be an “inconvenient truth”, but there it is.  Again we find what was promised by Obama during the campaign, just like transparency and fiscal responsibility, were “just words”.

~McQ

Parsing Obama on Health Care

While I’m sure the specials last night on the deaths of Farrah Fawcett and Michael Jackson vastly outdrew the ABC’s Obama healthcare special the other night (no I didn’t watch it – I was being disappointed by the Yankees/Braves game), there were some very telling moments apparently. And, being the curious type, I found the transcript and read the whole thing.

Let’s say Mr. Eloquent was less than convincing. But he did shed some light on what he’d like to see the final product look like.

Naturally there were some moments that were instantly reported by the media and other bloggers. For instance when he essentially said that if that he’d use his wealth if necessary to go outside any system that denied his family the healthcare he thought they needed. The obvious point is he concedes that his system will do so – i.e. ration care through denial. Of course that’s one of the big complaints he’s had about private healthcare – rationing through denial.

But there were some other things said which only a careful reading of the transcript reveal. Let’s start with this question:

DR. JOHN CORBOY, NEUROLOGIST & MEDICAL PROFESSOR: Well, I think you still have to provide the appropriate care. And I think we all know that there is a significant amount of care that actually is inappropriate and unnecessary.

And the question then is — for you, Mr. President, is, what can you convince — what can you do to convince the American public that there actually are limits to what we can pay for with our American health care system?

And if there are going to be limits, who is going to design the system and who is going to enforce the rules for a system like that?

This question is loaded with key words and phrases. The first is “appropriate”, as in “appropriate care”. Who gets to decide? If you listen to a glib Obama, he constantly says medical decisions should be left to doctors. But this question isn’t being addressed to that point, is it? If there is an “appropriate care” standard, someone is going to have to define it.

And that is precisely what Corboy asks – “who is going to design the system and who is going to enforce the rules?” In fact, who gets to decide what the rules are?

I think you know the answer, but let’s look at the President’s answer:

OBAMA: Well, you’re asking the right question. And let me say, first of all, this is not an easy problem. If it was easy, it would have been solved a long time ago, because we’ve talking about this for decades, since Harry Truman.

We’ve been talking about how do we provide care that is high-quality, gives people choices, and how can we come up with a uniquely American plan? Because one of the ideological debates that I think has prevented us from making progress is some people say this is socialized medicine, others say we need a completely free market system.

We need to come up with something that is uniquely American. Now what I’ve said is that if we are smart, we should be able to design a system in which people still have choices of doctors and choices of plans that makes sure that the necessary treatment is provided but we don’t have a huge amount of waste in the system. That we are providing adequate coverage for all people, and that we are driving down costs over the long term.

OK, let’s stop for the moment right there. We begin with Obama in stump-speech mode. That’s a time buyer. He’s fumbling for an answer and is filling time. By the third paragraph he’s beginning to formulate an answer. Of course, I had to laugh because a uniquely American solution would be to have government back off and let the market take the ball and run with it. But obviously that’s not his plan. I think what he’s saying here is he hopes for a Euro-socialist plan with an American twist.

Anyway, in the third paragraph we’re again into some key words – this time “necessary” and “adequate”. Again, who will decide what is “necessary” and what form of coverage is “adequate”? Well, trust me, it won’t be you or your doctor, because his priority is what? That’s right – “driving down costs over the long term”. So “necessary” treatment will be considered in the context of “driving down costs”. I’m sure you figure out what that means.

Then there’s the “we should be able to design a system”.  He’s not talking about you or the market here.  He’s talking about government.  He’s a part of the ‘we’ – you’re not.

Last, of course, is the overriding priority – drive costs down. He claims health care is the reason for the current deficit.  So the obvious first priority for this so-called reform is to cut costs.

But let’s add 47 million new insured while driving costs down.  Make sense to you?  And if it does, then you have to admit that lesser cost, if possible, will have to come from some part of the current health care system.  He has his ideas, and we’ll cover that in a different post.

Moving on with the answer:

If we don’t drive down costs, then we’re not going to be able to achieve all of those other things. And I think that on the issue that has already been raised by the two doctors, the issue of evidence-based care, I have great confidence that doctors are going to always want to do the right thing for their patients, if they’ve got good information, and if their payment incentives are not such that it actually costs them money to provide the appropriate care.

Here we find a very critical clue to the plan for your health care – the term “evidence-based care”. This is the new way of saying “we’ll decide for you”. Evidence based medicine claims to use the scientific method to determine optimum treatment decisions. The Centre for Evidence Based Medicine says it is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”

Said another way, a group somewhere doing research decides that certain diseases or conditions should be treated in certain ways.  Those treatments are then applied to individual cases without any caveat for unique situations.  The cost savings comes with uniform procedures and uniform care – no deviations.  In other words, for the most part, decisions on how to treat individual cases will most likely have to conform to EBM guidelines or be considered outside the system. So what Obama said with that simple term is “we’ll decide how you will be treated, not your doctor”.

Of course critics of EBM are many and claim that it has some utility in outlining suggested treatment for populations as a whole, but has limited utility when taken down to the individual situation since each is unique.

And then there’s the inference that medicine to this point hasn’t been based on science. As Abraham Verghese said:

“Evidence Based Medicine” is a term which makes about as much sense as “Sex-based intercourse”–Were we practicing based on zodiac signs before EBM came along?

That brings us to the bit about “doctors always want to do the right thing for their patients”. Yes, of course. But what he says next hints that “the right thing” may be what the technocrats think is right, not necessarily what the doctors might think is right. He says doctors will do that “if they’ve got good information, and if their payment incentives are not such that it actually costs them money to provide the appropriate care.”

Anyone know right now instances when “appropriate care” costs a doctor “money to provide”? Yup, Medicare and Medicaid. It’s the reason so many opt out of treating Medi patients.

How then does he plan on changing their payment incentives so it doesn’t cost them money? Well to do that you either change the reimbursement rate or you change what is “appropriate”, don’t you? EBM promises the latter.

That brings us to the final part of his answer:

And right now, what we have is a situation, because doctors are paid fee-for-service, and there are all sorts of rules governing how they operate, as a consequence often times it is harder for them, more expensive for them, to do what is appropriate.

And we should change those incentive structures.

Now this is simply a load of road apples.

Litigation is part of the problem. Obama refuses to address that as a basic health care cost problem. It drives up costs and it also induces doctors to use unnecessary tests in a CYA gambit. Want to “change incentives?” Here’s a great place to start.

The second problem is chronic underpayment by the government through Medicare and Medicaid – something Obama and Congress want to again reduce by up to 20%. That causes cost shifting to the private side of things. But insurance companies have gotten smart and now refuse, in many cases, to pay more than the Medis. That is an artificial distortion of the market introduced by government arbitrarily deciding what a medical procedure is worth.

And the rules under which doctors operate are no less stringent under the Medis than under any private insurance plan.

That’s one question from the staged ABC “town hall meeting”. There was an amazing amount of info in that one question and answer. Enough information that you should be absolutely shaking in your boots, because what he said is he plans on doing precisely what he has been telling you he wouldn’t do – design a system which will decide how your doctor will treat you. It is all there, and no one has even bothered to take the close look it deserves.

I’ll parse a few more questions from the interview as I have the time, but suffice it to say, if you look hard enough you can figure out exactly where this guy wants to take us.

~McQ