Free Markets, Free People

Health Care


Orszag: Advocates Of Delay Just Trying To Kill Health Care Reform

We now have the White House Budget Director weighing in on health care reform legislation:

ORSZAG: We have to remember: there are some who are advocating delay simply because they don’t have anything to put on the table. The typical Washington bureaucratic game of — ‘if you don’t have a better alternative, just delay in the hope that that kills something’ is partly what’s playing out here.

Of course what Peter Orszag seems not to understand is that most of those trying to delay (and eventually kill) the legislative monstrosity called “health care reform” are quite happy with putting nothing on the table as they don’t buy into the manufactured crisis being whipped up by the administration.

Nothing of earth shaking consequence is going to happen in the health care world if this bill isn’t passed before August.  In fact, most likely that statement is true of next August and the following one as well.

What you really hear Orszag subtly acknowledging is the longer this goes on, the more people are going to become aware of what is in the bill and object to the cost and intrusion. This isn’t about “better alternatives” or their lack thereof. This is about the administration’s fear that delay means defeat because of what’s in the bill. Hence the attempt to rush something through before it can be read and understood and certainly before members of Congress have to go home and face their angry and concerned constituents.

~McQ


Obama: “This is a limited time offer! Act now!”

Almost all adults figure out early in life how to deal with pushy salesmen. But there’s a small supply of gullible fools that keep alive the classic sales scam: “You must act now to get this deal!”

Any reasonably savvy adult knows how to deal with such a tactic. You pull back and don’t allow the salesman to bully you into doing something prematurely. The urgency he’s injecting into the situation is purely artificial, and it’s to his benefit for it to be there, not yours.

Obama’s continues to show contempt for the American people by using this tactic. It was slightly plausible for passing the bloated, pork-laden stimulus bill, though many of us saw through it. It’s been a common theme for the cap-and-trade legislation, with presumed incipient global warming as the urgency creator. Again, the excuse is slightly plausible but is far from established if you look at the other side of the debate.

But now he’s ready to drop even the facade of plausibility. Witness his attempted sale of the healthcare bill:

“This is what the debate in Congress is all about: whether we’ll keep talking and tinkering and letting this problem fester as more families and businesses go under and more Americans lose their coverage,” Obama said Saturday in his weekly radio and Internet address. “Or whether we’ll seize this opportunity — one we might not have again for generations [emphasis mine] — and finally pass health insurance reform this year, in 2009.”

Translation: Act now! You may never be offered this deal again! You’ll be sorry if you don’t act right away!

This is nonsense on toast. If his health insurance reform is such a good idea, why won’t it continue to be a good idea after more discussion on it? Why can’t it pass next year after Congress has actually had a chance to read the thousand page bill? Why the rush?

Because this salesman senses that he’s just about to lose his potential customers. His approval figures are dropping, Congressional members are being barraged with email and being visited by protesters, and the decrepitude, insolvency, and dysfunctionality of the healthcare systems already put in place by the government become more obvious every month.

Obama is probably right. If his more-or-less socialist healthcare reform doesn’t pass this year, it will probably be shelved for at least ten years. But that’s not because it’s a once-in-a-lifetime special deal. It’s because it’s a bad idea. And the very fact that he tries to sell it the way he does should tip off all but the most gullible to realize it.


Quote of the Day

It goes to Steve Chapman in his discussion of the government’s health care reform proposals and what they promise:

But efficiency is to government programs what barbecue sauce is to an ice-cream sundae: not a typical component.

Chapman also discusses the illusion of “competition” the reformers are pushing while outlining what real competition in the insurance field might actually look like (and, unsurprisingly it requires less, not more, government).

Make sure you RTWT.


CBO Says Federal Budget On Unsustainable Path (Is Anyone Surprised?)

I‘m not sure how often everyone has to be told, but here’s the warning again, just as Democrats attempt to pile another trillion plus dollars in federal health care spending (and debt). From the CBO Director’s blog:

Under current law, the federal budget is on an unsustainable path, because federal debt will continue to grow much faster than the economy over the long run. Although great uncertainty surrounds long-term fiscal projections, rising costs for health care and the aging of the population will cause federal spending to increase rapidly under any plausible scenario for current law. Unless revenues increase just as rapidly, the rise in spending will produce growing budget deficits. Large budget deficits would reduce national saving, leading to more borrowing from abroad and less domestic investment, which in turn would depress economic growth in the United States. Over time, accumulating debt would cause substantial harm to the economy.

I’m not sure how it can be said any more clearly and more succinctly.

The choices, as laid out in the paragraph above are fairly simple – cut federal spending dramatically or raise taxes (revenues) dramatically to meet the spending or your going to do “substantial harm to the economy”. Of course we also know that raising taxes dramatically would have the same effect. That leaves one option and, as is clear with the health care reform proposals, that’s nowhere near the table, is it?

Yet that’s the formula:

Keeping deficits and debt from reaching these levels would require increasing revenues significantly as a share of GDP, decreasing projected spending sharply, or some combination of the two.

CBO offers the following graph to illustrate the point of letting the status quo remain in place. Note that the second line coming off the actual/projected line – that’s the “extended baseline scenario” where absolutely nothing is changed and the budget, as projected, is executed. Disregard the first line for the moment.

slide2

What is important is to understand this:

The current recession and policy responses have little effect on long-term projections of noninterest spending and revenues. But CBO estimates that in fiscal years 2009 and 2010, the federal government will record its largest budget deficits as a share of GDP since shortly after World War II. As a result of those deficits, federal debt held by the public will soar from 41 percent of GDP at the end of fiscal year 2008 to 60 percent at the end of fiscal year 2010. This higher debt results in permanently higher spending to pay interest on that debt. Federal interest payments already amount to more than 1 percent of GDP; unless current law changes, that share would rise to 2.5 percent by 2020.

Now you’ve heard that, in various forms for years. But what does that mean to you personally – how does one put that in terms that mean anything to a taxpayer?

Well Jim Glass at scrivner.net has done that for us:

The national debt incurs interest that is paid with taxes. The interest rate on US debt is projected be about 6% annually in the long run, according to the Social Security Administration’s actuaries and other such governmental budget projectors. Six percent of one trillion dollars is $60 billion.

There are 80 million payers of income tax in the US. (If that seems low for a population of 300 million remember that 47% of all “tax units”, 70 million potential taxpayers, pay no income tax or receive refundable tax credits from the government.)

Now $60 billion divided by 80 million taxpayers equals $750 per taxpayer — so each trillion dollars of the national debt costs the average taxpayer $750 per year, every year that the debt is carried, forever.

So for every trillion in debt the federal government puts us, we owe $750 per tax payer in interest alone.

Jim extends his example to what the chart above depicts:

As of the end of last year the government’s outstanding explicit and implicit debt was $64 trillion. Add another year’s interest on that, plus this year’s $1.8 trillion deficit, and we will be well over $66 trillion at the end of this year. Which creates an explicit and implict annual interest liability to just carry the debt of more than $49,000 per taxpayer.

Yet we have Joe Biden claiming we have to spend money to avoid bankruptcy – and there are people out there who believe him.  As Jim points out:

As of today most of that is implicit (for unfunded Medicare liabilities, etc.) but every year from now on (as more seniors retire and start collecting Medicare, etc) more of the debt will shift from being implicit to explicit, requiring cash tax collections to pay for it.

And the same entity which has put the country in this shape running a health care system, now wants the rest of it with the stated goal of cutting costs.

If you’re gullible enough, given the facts above, to fall for that, I have to question your critical thinking abilities. In fact, you might want to consider the chart above again and pay attention to the top line coming off the actual/projected line – that’s likely what our debt will look like if you hand over health care to the federal government.

It is very close to fish or cut bait time for the people of the US – we have got to realize, very quickly, that in fact,  we are on the verge of bankruptcy and what that buffoon Biden says is just abject, unthinking nonsense.

Either cut government spending – drastically – or go under. Those are your choices.

~McQ


Quote of the Day

If we didn’t have Joe Biden, we’d have to invent him.  Here’s Joe talking about the Obama administration’s health care plan:

“Now, people when I say that look at me and say, ‘What are you talking about, Joe? You’re telling me we have to go spend money to keep from going bankrupt?’” Biden said. “The answer is yes, that’s what I’m telling you.”

In light of the CBO’s latest testimony on the Democratic health care proposals, this does indeed become a bit of the “we had to destroy the village to save the village” type rationale, doesn’t it?

~McQ


CBO: Busting The Health Care Savings Lie

Does anyone know who Dr. Doug Elmendorf is? He’s the director of the Congressional Budget Office. And today, in testimony before the Senate Budget Committee he answered a few questions from Sen. Kent Conrad (D-ND) about the supposed great savings the country would reap under the planned Democrat “health care reform” bills under consideration by Congress.

Here it is uncut, unfiltered and unedited [emphasis mine]:

Conrad: Dr. Elmendorf, I am going to really put you on the spot because we are in the middle of this health care debate, but it is critically important that we get this right. Everyone has said, virtually everyone, that bending the cost curve over time is critically important and one of the key goals of this entire effort. From what you have seen from the products of the committees that have reported, do you see a successful effort being mounted to bend the long-term cost curve?

Elmendorf: No, Mr. Chairman. In the legislation that has been reported we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount. And on the contrary, the legislation significantly expands the federal responsibility for health care costs.

Conrad: So the cost curve in your judgement is being bent, but it is being bent the wrong way. Is that correct?

Elmendorf: The way I would put it is that the curve is being raised, so there is a justifiable focus on growth rates because of course it is the compounding of growth rates faster than the economy that leads to these unsustainable paths. But it is very hard to look out over a very long term and say very accurate things about growth rates. So most health experts that we talk with focus particularly on what is happening over the next 10 or 20 years, still a pretty long time period for projections, but focus on the next 10 or 20 years and look at whether efforts are being made that are bringing costs down or pushing costs up over that period.

As we wrote in our letter to you and Senator Gregg, the creation of a new subsidy for health insurance, which is a critical part of expanding health insurance coverage in our judgement, would by itself increase the federal responsibility for health care that raises federal spending on health care. It raises the amount of activity that is growing at this unsustainable rate and to offset that there has to be very substantial reductions in other parts of the federal commitment to health care, either on the tax revenue side through changes in the tax exclusion or on the spending side through reforms in Medicare and Medicaid. Certainly reforms of that sort are included in some of the packages, and we are still analyzing the reforms in the House package. Legislation was only released as you know two days ago. But changes we have looked at so far do not represent the fundamental change on the order of magnitude that would be necessary to offset the direct increase in federal health costs from the insurance coverage proposals.

Conrad: And what about the Finance Committee package, as it stands?

Elmendorf: I can’t speak to that Mr. Chairman. We have been working with the Finance Committee and the staff for a number of months on proposals that they have been addressing. But our consultations with them have been confidential because they have not yet released the legislation, and I don’t want to speak publicly about that.

Conrad: All right. In terms of those things that are public from other plans, what are the things that are missing that in your judgement prevent a bending of the cost curve in the right way?

Elmendorf: Bending the cost curve is difficult. As we said in our letter to you, there is a widespread consensus, and you quoted some of this, that a significant share of health spending is not contributing to health. But rooting out that spending without taking away spending that is beneficial to health is not straightforward.

Again, the way I think experts would put it – the money is out there, but it is not going to walk in the government’s door by itself. And devising the legislative strategies and the regulatory changes that would generate these changes is not straight forward. But the directions that have widespread support among health analysts include changing the preferential tax treatment of health insurance. We have a subsidy for larger health insurance policies in our tax code, and that like other subsidies encourages more of that activity. Reducing that subsidy would reduce that. And on the other side, changing the way that Medicare pays providers in an effort to encourage a focus on cost effectiveness in health care and not encourage, as a fee for service system tends to, for the delivery of additional services because bills for that will be paid.

So here is the opinion of the director of the organization that both sides like to quote and use as a definitive source saying that what has been legislatively put on the table will not – not – bend the “cost curve” down, but, will instead bend it upward. It does not – not – in fact accomplish the goal of “cost savings” in terms of health care spending.  Anyone with the brain of a glow worm who had taken a look at the proposals and the promises knew it was a large load of pony pellets.   Those on the side of “belief and faith” (and hopeychangitude) chose to believe in the politician’s promises and have faith in their truth.

Unfortunately for them, Dr. Elmendorf apparently deals in facts and figures.

The last part of the questioning is equally important.  Elmendorf discusses the funding mechanism (along with the eternal promise of corralling “waste, fraud and abuse”). Some savings will come from eliminating waste, fraud and abuse (all of which are rampant in both Medicare and Medicaid and politicians have vowed to end for decades), but not enough to fund the rest.

So they’re left with few options besides a general tax increase. Those options, per Elmendorf include taxing health care benefits and reducing the cost of Medicare by changing how providers are paid (i.e. cutting payments and prohibiting procedures Medicare doesn’t feel are necessary to treatment – the very accusation the government health care proponents constantly level at private insurance).  The first isn’t very palatable politically (and they’d have to exempt unions which would be very unpopular politically) and the second would most likely find a back lash among seniors.  So the fall back position is “tax the rich” – an unstable revenue stream (once the rich figure out how to dodge it).

Anyway, the Democrat’s “cost savings” narrative is again busted. Not only will the proposed legislation not save money, it will cost us a bundle. As I said yesterday, I believe, when I posted the chart with the curve of proposed health care spending under the Democrat bills, the curve isn’t going to go down.

Today the CBO validated that point.

~McQ


Rationing Health Care

Peter Singer has popped up again and he engages in telling us a simple truth about health care – no matter what system you have, health care will be rationed.  Well, for those of us who understand supply and demand we’ve always known health care would be rationed.  When you have 800,000 doctors in a country of 300 million, it isn’t really that difficult to figure out.

However, that’s really not Singer’s point.  If you read through his multiple page piece, you’ll find that he is of the opinion that government bureaucrats would be much better at rationing than would private bureaucrats.  And he attempts to make his point by selectively offering facts that will back his position.

But this amazing paragraph pretty much represents where he believes we must go with our health care reform (and indications are our politicians implicitly agree given the goals they’ve set for “reform”):

Of course, it’s one thing to accept that there’s a limit to how much we should spend to save a human life, and another to set that limit. The dollar value that bureaucrats place on a generic human life is intended to reflect social values, as revealed in our behavior. It is the answer to the question “How much are you willing to pay to save your life?” — except that, of course, if you asked that question of people who were facing death, they would be prepared to pay almost anything to save their lives. So instead, economists note how much people are prepared to pay to reduce the risk that they will die. How much will people pay for air bags in a car, for instance? Once you know how much they will pay for a specified reduction in risk, you multiply the amount that people are willing to pay by how much the risk has been reduced, and then you know, or so the theory goes, what value people place on their lives. Suppose that there is a 1 in 100,000 chance that an air bag in my car will save my life, and that I would pay $50 — but no more than that — for an air bag. Then it looks as if I value my life at $50 x 100,000, or $5 million.

Frankly, this paragraph should make your skin crawl. Because what Singer is doing here is presuming we all accept that others, those nameless bureaucrats he’s so fond of if they happen to be from the government, now have the job (and duty) to decide what your life is worth. Not you. Not your family.

No, what Singer proposes is reducing your life to an arbitrary worth beyond which “they” are not willing to pay to save it. Whether you are or not is apparently not a factor in such calculations.

Singer goes on:

Nevertheless this approach to setting a value on a human life is at least closer to what we really believe — and to what we should believe — than dramatic pronouncements about the infinite value of every human life, or the suggestion that we cannot distinguish between the value of a single human life and the value of a million human lives, or even of the rest of the world. Though such feel-good claims may have some symbolic value in particular circumstances, to take them seriously and apply them — for instance, by leaving it to chance whether we save one life or a billion — would be deeply unethical.

“Deeply unethical” for whom? Certainly not the person with the desire and means to do what they feel is necessary to extend their life or the life of a loved one. They, of course, would value human life above the arbitrary level which Singer and “economists” calculate.

But Singer’s premise here is they shouldn’t have that right. Because other’s don’t have the same opportunity. It would be “deeply unethical” for some to be able to “buy” what others can’t afford. So instead, the ethical thing to do is have everyone held to the economically calculated standard, whether they have the means and desire to do otherwise or not.

Of course we can argue this philosophically for decades, but the point remains that rationing is a feature of any health care system. What isn’t a feature of every health care system is choice. What Singer is actually proposing is taking the choice that now exists in our health care system away and putting everyone under the arbitrary rationing guidelines calculated by government.

He says as much in his next paragraph:

Governments implicitly place a dollar value on a human life when they decide how much is to be spent on health care programs and how much on other public goods that are not directed toward saving lives. The task of health care bureaucrats is then to get the best value for the resources they have been allocated. It is the familiar comparative exercise of getting the most bang for your buck.

The best bang for “your” buck? It’s no longer “your” buck at that point. It is the government’s buck and you have no choice in how it will be spent or “saved”. You will, however, be on the receiving end of any decision.

And where that leads (and where Singer was going with all of this to begin with) is found here:

As a first take, we might say that the good achieved by health care is the number of lives saved. But that is too crude. The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities. We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved. If a teenager can be expected to live another 70 years, saving her life counts as a gain of 70 life-years, whereas if a person of 85 can be expected to live another 5 years, then saving the 85-year-old will count as a gain of only 5 life-years. That suggests that saving one teenager is equivalent to saving 14 85-year-olds.

Pretty darn predictable, no? This is the logical end of Singer’s rationing policy. Utilitarian calculation based on arbitrary worth. And the inevitable decision to ration in such a way as to deny the elderly because they just aren’t “worth” it anymore.

And that, per Singer, would be very ethical.

Trust me, those collectivist premises are what will drive government run health care’s rationing. Given the goals (more coverage, less cost) they must. Choice will eventually be driven out of the system and, as they must, bureaucrats will decide how long you will be allowed to live.

Count on it.

~McQ


Health Care Warning Bells

Just a few of the gems beginning to come out of the Democratic health care reform proposals.

Keith Hennessey wonders if the Democrats really want to tax the uninsured because as the bill is structured a) not everyone will have insurance and b) not everyone will be able to afford it meaning c) they pay a tax. He gives 2 examples:

* Bob is a single 50-year old non-smoking small business employee who makes $50K per year before taxes and does not have health insurance.
* Bob cannot afford a $1,600 bare bones health insurance policy, much less a $3K — $5K policy.
* Bob would get no subsidies under this bill, and his employer would face no penalty for not providing him with health insurance.
* Bob would end up without health insurance and would have to pay $1,150 more in taxes.

Now, what you can expect is not that Democrats would stick with the provisions of the bill, but instead they’d find some way to fold Bob into the program further raising the cost.

Same with Freddy and Kelsey:

* Freddy and Kelsey are a 40-year old couple with two kids. They own and run a small tourist shop in Orlando, Florida.
* They are the only employees, and earn a combined $90K per year.
* They cannot afford even an inexpensive health insurance plan, and so the House bill would make them pay $2,050 in higher taxes.

So given those figures (and be sure to read the whole post by Hennessey) and the estimate of 8 million falling into this category, obviously the bill will cost more than projected.

Second point.

When we first saw the paragraph Tuesday, just after the 1,018-page document was released, we thought we surely must be misreading it. So we sought help from the House Ways and Means Committee.

It turns out we were right: The provision would indeed outlaw individual private coverage. Under the Orwellian header of “Protecting The Choice To Keep Current Coverage,” the “Limitation On New Enrollment” section of the bill clearly states:

“Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day” of the year the legislation becomes law.

So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won’t be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.

While assuring everyone that the same choices we now have would still in the system, this was discovered a mere 16 pages into the 1,000 page monstrosity. I’m sure there are other gems to be had in there as well. But the obvious point here is this puts people who make the choice, for instance, to go into business for themselves, in a situation where they are unable to buy health insurance from a private carrier, whether they want too or not. Of course, that will go a long way toward killing any private market in that niche of the insurance industry. And where will these people eventually end up? On a subsidized public plan, of course.

If that’s not bad enough, there’s the planned expansion of Medicaid. What the federal government plans to do is expand insurance coverage under Medicaid by 11 to 20 million people depending on which percentage above the poverty rate the final bill has. But states pay a large portion of Medicaid expenses. The House version calls on the fed to pick up all the expenses while promising to enact big savings in the program. The Senate version has the fed paying the full freight for 5 years. The latter is more likely to be the version that would pass simply because they can hold the “cost” numbers down a bit by doing so.

But not so in the states where the mandated expansion of Medicaid will end up having to be funded by each state’s taxpayers.

Keep these in mind as you hear cost figures bandied about by the blowhards on the Hill. They give used car salesmen a bad name.

~McQ


Democrats Unveil Their “Affordable” Health Care Plan

And yes, that’s right, just because Democrats put “affordable” in the title doesn’t mean it is anything close to being affordable (unless another trillion in spending is something you find affordable). In fact, you can almost count on the opposite being true.

Another vitally important point to keep in mind is that trillion we’re batting around like we’re talking about spending ten bucks, is a government estimate. Anyone remember the government estimate about the cost of Medicare and how that turned out?

The Democrats are claiming the CBO “scored” this bill and it came up under the “affordable” column.  But the RNC says the CBO didn’t actually score the language in the bill:

In the second paragraph of CBO’s letter, it says, “”It is important to note, however, that those estimates are based on specifications provided by the tri-committee group rather than an analysis of the language released today.” So they scored what Democrats asked them to score. Not the actual bill.

Yes, in this infernal rush to get a bill out, we obviously couldn’t be patient enough to have the CBO score what the bill actually said vs. what the committees declared the bill would say. And we all know how honest our Congress is about such things, don’t we? Last but not least, the politics of the thing. Here’s a graph to show you how the planned appropriation of your money will take place:

houseDemHC Note carefully when the costs will actually begin to kick in. Yes, when Obama is safely in his second term and hopefully, at least as the Democrats reason, still with a Democrat majority Congress (since both the 2010 and 2012 Congressional elections shouldn’t be effected). Note the slope of the curve after that. Philip Klein, who put the chart together, explains:

It’s important to keep in mind that the most costly aspects of the legislation involve providing subsidies to individuals to purchase health care ($773 billion) and to expand Medicaid ($438 billion), but it takes several years for those provisions to kick in. As you can see from the chart below, that means that the costs start out relatively modest but ramp up over time. In the first three years of the plan the cost of the subsidies and Medicaid expansion is just $8 billion; in the first five years, it’s $202 billion; but in the last five years, it’s $979 billion. Put another way, 17 percent of the spending comes in the first five years, while 83 percent comes in the second five years. What this means is that the American people see $1 trillion over 10 years and they think that means the bill would cost about $100 billion a year — but the reality is more than double that. In the final year of the CBO estimates, 2019, the spending hits $230 billion.

Another important note – at the end of 10 years, that line on the graph isn’t going to drop to zero. It’s going to continue to climb. That’s “affordable?” If so, Democrats have given new meaning to the word.  And all of it to be paid for by taxing the rich.

Yes, in the midst of an economic crisis, the con artists in Washington are at it again.  They’ve co-opted “affordable” to sell their snake oil, ignored the impact of such a bill in a weak economy but carefully weighed the politics of it, and have decided that funding it on the back of “the rich” won’t have any adverse consequences when it comes to the economy and its health.

You can see this train wreck coming from miles and miles away, can’t you?

~McQ

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