On the Individual Mandate [Quote]

"If a mandate was the solution, we could try that to solve homelessness by mandating everybody buy a house."

-Barack H. Obama

A "little-noticed" provision of the health care bill...

The media has a new favorite phrase.

"Tucked inside the huge health reform bill signed into law last week were many surprising and little-noticed provisions that will affect consumers in ways large and small."

"Deep within the massive health-care overhaul legislation, a few little-noticed provisions have quietly reignited one of the bitterest debates in medicine: how to balance the right of doctors, nurses and other workers to refuse to provide services on moral or religious grounds with the right of patients to get care."

"A little-noticed provision of the health legislation has rescued federal support for a controversial form of sex education: teaching youths to remain virgins until marriage."

"A little-noticed provision in the health reform bill will shed significant light on the payments drug and device companies make to doctors and teaching hospitals in California and the rest of the nation."

"A little-noticed provision in the new health care law may not only dramatically increase paperwork for small businesses, but also put them at a disadvantage against their larger competitors."

"In the manager's amendment Senate Leader Harry Reid added to the Senate health care bill, HR 3590, a little noticed provision allowed $7 billion in funding for Community Health Centers buried deep in Section 10503 of the 383-page amendment."

"Effective for plan years beginning after Sept. 23, 2010, health plans that cover dependent children must continue to cover adult kids until they turn age 26. This little-noticed new requirement is a sure way to increase health insurance costs, which is exactly what Obama-care was supposed to prevent."

"The Obama administration is trying to encourage people to buy annuities to ensure that they don't outlive their savings. But a little-noticed provision of the new health care reform law will slap a 3.8% tax on payouts from annuities purchased by high-income earners outside their workplace."

"A little noticed provision added over the weekend to the Senate health bill earmarked $500 million this year for a "cures acceleration program."

"Little-noticed (well, except by me) is the fact that Congress has repealed the anti-trust exemption for health insurance and that the reform plan sets up the basics of a federal infrastructure for insurance regulation. The federal government doesn’t just drop by and visit, they move in. Memo to state insurance regulators: the feds are outside, and they have a HUGE moving van.

"[Jeff] Masters, who lives in Fort Lauderdale, is part of a growing number of Americans who are members of faith-based ``health sharing ministries'' where members directly pay for each others' medical bills. Members also pray for each other, and a ``get well'' card from a stranger isn't uncommon. National healthcare reform will force millions of Americans to buy insurance or face fines, but a little-noticed provision excludes people like Masters who belong to such groups."

"As well as these and other major job-killing provisions, two little-noticed tax changes would also affect employment."

The List continues, with links to the stories, here.

For some reason, I'm getting the impression that nobody actually read this huge, two thousand page bill, before passing it into federal law.

Maybe we should take the time to, I dunno... read bills before we pass them?

I though Pelosi was speaking rhetorically when she said "We have to pass the bill so that you can find out what is in it." Turns out she was dead serious.

The Public Option Lives

Remember when Obama and House Democrats said they were dropping the Public Option? Well, they lied.

The truth is the public option is alive and well, residing in Section 1334, pages 97-100, of the new health care law. That section gives the U.S. Office of Personnel Management — which presently manages the federal civil service — new responsibilities: establishing and running two entirely new government health insurance programs to compete directly with private insurance companies in every state with coverage for people outside of government.

Quoting the new law, former OPM director Donald Devine notes that it makes the OPM boss a health care czar, with power to set “‘profit margin premiums and other such terms and conditions of coverage as are in the interest of enrollees in such plans.’ That’s open-ended. You can do anything.” Dan Blair, another former OPM director, calls the new program “nothing but a placeholder for the public option.” Indeed, the OPM head is also given the authority to “appoint as many employees” as needed to run the program, and to spend “such sums as may be necessary” to establish and administer it.

One has to wonder if this bill would have passed if they had been honest about what was in it.

I wonder what we'll find out next.

Moving Forward on Health Care

America has taken the plunge into (near) Universal Health Care. There is no turning back now. We have just passed a system that shares many key ingredients with Switzerland's current system, such as the reliance on private insurers, so it may be possible to glean some insights into where we're heading by looking at the Swiss system.

Switzerland has the least paternalistic health care system in Europe. It is the only country in Europe with a health care system that is based totally on private insurance.

Health insurance was made mandatory only in 1995. Premiums are not risk-related or linked to income, but are set on a per-capita basis with weightings for age of entry into a fund, regional cost differences, and sex. The government subsidizes poor individuals by paying a percentage of their premiums. These subsidies account for approximately one-third of health care funding by the Swiss Confederation.

Switzerland has also introduced a risk-adjustment system. All insurers in the market are required to pay a portion of the premiums or contributions they collect into a central fund. The relative financial risk of each insurer is then calculated, and insurers with a larger proportion of less healthy, high-risk members receive an amount from the fund that compensates for the higher financial risks involved in insuring their members. This type of risk-adjustment prevents a situation in which all low-risk people would flock to insurance companies that can keep their premiums low because of their minimal risks, while other insurers who have the majority of high-risk members would have to ask exorbitant premiums.

Switzerland solves the high-risk problem by spreading the costs among insurance companies. It reminds me of how NFL franchises share their profits, how large market teams like the Cowboys will in a sense subsidize the lower performing teams like the Jaguars or the Bills.

The law recently passed by Congress will subsidize insurers who take on high-risk subscribers. However, this will not begin until 2014; until then, high-risk people will be able to get on the Medicare expansion or by taxpayer funded high-risk pools, many of which are already administered by state governments.

Among European nations, Switzerland currently spends the largest portion of its GDP on health care, about 11% of their GDP. In comparison, America spends about 16% of its GDP on health care, whereas Sweden spends about 9%. The country with one of the most advanced and efficient health care systems is Japan, who spends about 8% of their GDP on health care.

Other countries pay much less than we do for much more egalitarian health systems. However, all is not perfect sunshine and rainbows on the other side of the Atlantic. The downsides of waste, inefficiency, lowered quality standards, and lack of vibrant research into new treatments definitely exist in countries with highly managed health care schemes.

An examination of several European countries discovered the limitations of universal coverage.

Some Lessons

For Members of Congress and state legislators, there are some valuable lessons from the European experience that should be less surprising.

If you insist on government management of the health care system, do not expect freedom from waste, inefficiency, or inequity in the delivery of care (look at France).

If you want to promise citizens a national or state program of universal insurance coverage, don't expect that you will be able to deliver universal access to high-quality health care. You won't and you can't (look at Britain).

If you want to fix prices for medical services, prescription drugs, or other medical devices, don't expect demand for these goods and services to be met or investment in research and development to continue apace. It won't (look anywhere).

If you insist, with a straight face, that in a government-run health care system, all of your fellow citizens will be treated equally -- regardless of their class, station in life, or disease condition -- you are not merely enthusiastic or well intentioned. You are lying.

America is home to the majority of medical innovations over the last half-centry, in part due to the profit motive that exists in our health care system. Our system can be prohibitively expensive for some of our unluckier citizens, and I can understand the movement to help them out. However, such an endeavor must be taken on very carefully, as Medicare was our first attempt into subsidizing care for the poor, and while it worked temporarily, it is now on the verge of failure.

We must strive to avoid mistakes of the past and learn from others, while forging our own path that retains our critical research and development streams.

Our current system is broken, but not entirely. I only hope the government does not break the good parts while trying to fix the bad.

[Heritage]

13 State Attorneys General Sue Over Health Law

Attorneys general from 13 states have filed suit on behalf of their states against the latest federal health legislation:

The lawsuit claims the bill violates the 10th Amendment, which says the federal government has no authority beyond the powers granted to it under the Constitution, by forcing the states to carry out its provisions but not reimbursing them for the costs.

It also says the states can't afford the new law. Using Florida as an example, the lawsuit says the overhaul will add almost 1.3 million people to the state's Medicaid rolls and cost the state an additional $150 million in 2014, growing to $1 billion a year by 2019.

"We simply cannot afford to do the things in this bill that we're mandated to do," McCollum said at a press conference after filing the suit. He said the Medicaid expansion in Florida will cost $1.6 billion.

"That's not possible or practical to do in our state," he said.

They have a great case, and this expansion of federal power should be scaled back. The ball is in the Supreme Court's hands now, we'll soon see where their priorities lie.

CNN Poll: 59% Oppose the Health Care Legislation

In case you were wondering, CNN polled Americans over the weekend to gauge their approval of the health care bill.

20. As you may know, the U.S. House of Representatives and the U.S. Senate are trying to pass final legislation that would make major changes in the country’s health care system. Based on what you have read or heard about that legislation, do you generally favor it or generally oppose it?

Mar 19-21
2010
Favor 39%
Oppose 59%
No opinion 2%

21. (IF OPPOSE) Do you oppose that legislation because you think its approach toward health care is too liberal, or because you think it is not liberal enough?

Mar 19-21
2010
Favor (from Question 20) 39%
Oppose, too liberal 43%
Oppose, not liberal enough 13%
No opinion 5%

What we have is a government that increasingly ignores the wishes of its people to pass corporatist "reform" legislation, because it's easier than passing real reform.

Health Care Bill Passes, 219-212

It's here. The worst health care reform possible. Enjoy it, suckers.

A comment from a fellow concerned citizen:

The plan to solve health care is to force everyone under penalty of law to buy health insurance? Really? Then why not solve homelessness by passing a law forcing everyone, under penalty of law, to buy a house? Why not solve poverty by passing a law forcing everyone, under penalty of law, to make $100,000 a year?

Well at least we can stop talking about this now.

Rage Against the Morons

I found this in my travels:

To President Obama and all 535 voting members of the Legislature,
It is now official you are ALL corrupt morons:

1. The U.S. Post Service was established in 1775. You have had 234 years to get it right and it is becoming more unsustainable by the day.

2. Social Security was established in 1935. You have had 74 years to get it right and it is bankrupt.

3. Fannie Mae was established in 1938. You have had 71 years to get it right. It is bankrupt and now has an unlimited line of credit from the Fed.

4. The War on Poverty started in 1964. You have had 45 years to get it right; $1 trillion of our money is confiscated each year and transferred to "the poor" and they only want more.

5. Medicare and Medicaid were established in 1965. You have had 44 years to get it right and they are bankrupt.

6. Freddie Mac was established in 1970. You have had 39 years to get it right. It is bankrupt and now has an unlimited credit line from the Fed.

7. The Department of Energy was created in 1977 to lessen our dependence on foreign oil. It has ballooned to 16,000 employees with a budget of $24 billion a year and we import more oil than ever before. You had 32 years to get it right and it is an abysmal failure.

You have FAILED in every "government service" you have shoved down our throats while overspending our tax dollars AND YOU WANT AMERICANS TO BELIEVE YOU CAN BE TRUSTED WITH A GOVERNMENT-RUN HEALTH CARE SYSTEM??

This about sums up my feelings toward our beloved federal government. Depending on how the vote goes Sunday, we may soon have yet another bureaucracy to waste billions of our tax dollars.

WTF is this Health Care Reform, anyways?

On the eve of the historic House vote on health care reform, we reflect back on the substance of the bill, as well as the problems, as much of this has been lost in the heated debate. The bill as it stands now does many things:

• prohibiting health insurers from refusing coverage based on patients' medical histories[5][6]
• prohibiting health insurers from charging different rates based on patients' medical histories or gender[5][6]
• repeal of insurance companies' exemption from anti-trust laws[6][7]
• establishing minimum standards for qualified health benefit plans[5]
• requiring most employers to provide coverage for their workers or pay a surtax on the worker's wages up to 8%[5][8]
• restrictions on abortion coverage in any insurance plans for which federal funds are used[6][8]
• an expansion of Medicaid to include more low-income Americans by increasing Medicaid eligibility limits to 150% of the Federal Poverty Level and by covering adults without dependents as long as either or any segment doesn't fall under the narrow exceptions outlined by various clauses throughout the proposal.[9][10]
• a subsidy to low- and middle-income Americans to help buy insurance[8]
• a central health insurance exchange where the public can compare policies and rates[8]
• requiring most Americans to carry or obtain qualifying health insurance coverage or possibly face a surtax for non-compliance.[5][12]
• a 5.4% surtax on individuals whose adjusted gross income exceeds $500,000 ($1 million for married couples filing joint returns)[5]
• a 2.5% excise tax on medical devices[5]

Basically it will establish minimum standards for "qualified health benefit plans," which we will all be required to buy, or our employer will be required to buy for us, on new "exchanges" which are mechanisms will theoretically allow people to more easily compare and shop for insurance plans. It also expands Medicaid, and provides subsidies for other low income people to buy insurance on exchanges. To pay for this bill, there are several new taxes and non-compliance penalties, as well as scheduled cuts to Medicare.



There are parts of the bill I agree with, but many more that I am completely opposed to. I have several critiques of this bill, but I will limit myself to my top four.

1. We can't afford it. First of all, the largest expenses don't begin until 2014, so this "$1 trillion over the next decade" price tag is misleading. A more honest price tag would start in 2014, and would be substantially higher, estimated at $2.5 trillion. And that's assuming we DO cut Medicare, which Congress is supposed to have done already on several occasions, but has not.

Also, the tax on "Cadillac" insurance plans does not kick in until 2018, and there is a strong possibility that Congress will avoid this unpopular measure when the time comes.

2. It will hurt small business. Businesses with 50 employees or more will be required to cover all of their employees or face stiff penalties. This will put many people out of work as businesses will be unable to afford the assuredly more expensive health insurance, and those who keep their jobs will likely face stagnant or reduced wages in order to pay for health care.

3. It encourages the employer-based insurance system. This system separates citizens from making health care decisions, and is a large part of why our system today is so terrible. Most people with health insurance do not pick their own plans, but rather take what is offered to them at work. The problem here is two-fold: first, since employees don't pick their insurer, employers are likely to pick the cheapest/easiest plan they can, not necessarily the best plan. Since employers may not face the consequences of picking a crappy plan, the money savings can outweigh any potential downsides of choosing a bad provider. Problem two: when you lose your job, you lose your insurance. I do not know how portability is addressed in this bill, so they may have fixed it, but I couldn't find it.

4. It is unconstitutional. Requiring every American to purchase insurance is plainly unconstitutional. Nowhere in the constitution is the federal government given this power, or anything like it. It's job is to regulate commerce, not require it. Idaho and Virginia's Attorneys General will sue over this issue if the health bill passes.

This bill has been watered down so much that little, in the end, will change. Health costs will continue to rise faster than the economy, and there will still be 20 million uninsured in America. I know we can do better.

The Price We Pay For Medicare

A new public option idea is brewing, wherein people can buy into Medicare.

Representative Alan Grayson last week introduced a bill which would allow any U.S. citizen the option of buying a health insurance policy from medicare at cost.

Some facts about this proposal:

-It would not cost taxpayers anything. Those opting in would be paying for their own coverage, in addition to the taxes they pay currently.
-It is totally optional. People who like their private insurance are under no obligation to participate.
-It would actually decrease the cost of Medicare by expanding the risk pool to younger, generally healthier people.

-It has no government pork, earmarks, or kickbacks whatsoever. It is a simple, four page bill that anyone can read and understand.

While this idea has some merit, as in the government does not subsidize the cost of the health insurance. However, Medicare itself is in desperate need of an overhaul.

The annual price we pay for Medicare doubles every 4 years. Hardly a success story, and hardly a model we want to expand to everyone in America. Medicare's effects also expand far beyond it as well. Many doctors break even or lose money on Medicare patients, and they must make up this difference by overcharging the uninsured and private insurers. Private insurers then pass this extra cost on to employers. Employers then pass this extra cost on to employees.

In America, roughly 60% of people are covered by employer based health insurance. On top of that, Medicare covers another 15%. That leaves 25% of Americans in the "free" market, including the 15% of Americans who are uninsured. That leaves 10% of people who actually buy unsubsidized insurance on the "free" market. This segment of the population is too small to greatly influence the market, and they bear the full costs of their insurance. This also means that 60% of Americans, those covered through their employer, are thrice removed from the costs of their health care: once by insurers, twice by employers, then three times by the tax exemption.

As you can see in my diagram, institutions like Medicare and private insurers deal most directly with doctors and hospitals, setting coverage and prices. However, these institutions do not have to bear the full cost of these prices, as they are subsidized by tax dollars. Private insurers are further insulated from the market in that they mainly deal with employers, not individual policy holders. As such, a bad decision by a private insurer is not felt by their customer, the employer, but rather by the employee. This is a system ripe for abuse and inflation.

Overall, costs are shifted to the people with the least amount of decision making power, i.e. taxpayers, employees, and individual policy holders. Taxpayers and employees have almost no say in their health insurance choices, and because individual policy holders are such a small group, they are at the mercy of the larger market.

So now you see why it is a misnomer to classify our health insurance system as a "free market," since only 10% of Americans participate in anything that could even come close to being called a free market, as they are the only group who even knows how much their insurance really costs. The rest of the market is the result of a series of subsidies that create a system wherein people with money decide how much to pay other people with money, and the rest of us have to cough up the cash to fund these decisions.

Now, obviously Medicare is not the only problem. The other major problem is the tax exemption employers get when they offer insurance. This encourages the arcane practice of employer based health insurance, which through it's separation from supplier and consumer allows more inflation in this most critical of markets. But Medicare is still part of the problem, and should be reformed before any expansion of government health insurance.

For more information, I highly recommend This American Life's show on how our health care system came to be.

Fix Medicare First

As the health care battle rages on, we take time to look back at the last major federal health care plan, the $600 billion-a-year elephant in the room: Medicare. Why should we look at Medicare you ask? Because Medicare, you may be intersted to know, was broken before it even started, as is clear in this interview with Joe Califano, the major decision maker of LBJ's 1965 Medicare initiative:

Mr. CALIFANO: By late '67, the budget data was just stunning. I mean 1968, we knew that system should be changed. We asked Congress for authority to change it.

JOFFE-WALT: But you just created it.

Mr. CALIFANO: I know it. But we saw what was happening with costs so fast. So fast.

KESTENBAUM: But they couldn't change it. Doctors now like the system. They were getting paid for work they'd previously done for free. And that was that. This system, with all its problems, stayed in place for almost 30 years. Meanwhile, medicine got more expensive.

The fee-for-service model that Medicare cemented into practice drove costs up so fast that within 2 years even President Johnson exclaimed that they needed to rework the payment system. They never did.

There have been some band-aid solutions proposed here and there, but despite its fundamental flaws, most of the original Medicare model is still in place. It is still causing medical costs to skyrocket, and the cost of Medicare itself doubles every four years.

So to all you would-be health care reformers, before you go mucking with the rest of the system, how about you fix Medicare first.

Hypocrisy that Boggles the Mind

While Democrats contemplate using reconciliation, the so-called 'nuclear option,' to pass health care reform, we reflect on what they were saying about this maneuver during the Bush presidency.

[via exposno1]

Obama Knows Best

Americans have rejected the Democrats' health care bill.

The support/opposition split on the health care bill, according to various pollsters:

Rasmussen: 41/56
Newsweek: 40/49
Public Policy Polling: 39/50
Pew: 38/50
Quinnipiac: 35/54
Ipsos/McClatchy: 37/51
NBC/WSJ: 31/46
CNN: 38/58

Not surprisingly, most people support some provisions of health reform, but they seem to want a more piecemeal approach to fixing the system.

Just look at the latest survey from CNN and Opinion Research. When asked if they support "preventing health insurance companies from dropping coverage for people who become seriously ill," 62 percent say yes. When asked whether they support "requiring all large and midsized businesses to provide health insurance for their employees," 72 percent say yes. And when asked if they support "preventing health insurance companies from denying coverage to people with pre-existing conditions," 58 percent say yes.

On the other hand, asked what Congress should do on health care -- pass the current bill, start work on an entirely new bill, or stop working on the issue altogether -- a huge majority opposes the Democratic proposal now on the table. Just 25 percent of those surveyed want to see the bill passed. Forty-eight percent want Congress to start over, and 25 percent want lawmakers to stop working on health care altogether. Put those last two together, and an overwhelming majority of 73 percent do not want Congress to pass the current bill.

Obama ignores the Republican call to pare down the bill, even though this decision pits him against a huge majority of Americans. As is typical with the nanny staters, they believe they know what citizens want better than the citizens themselves.

[via Instapundit]

Health Summit LIVE

CATO is live streaming/blogging Obama's health summit now!

Fareed Zakaria: Budget fixes are simple -- and unthinkable

Fareed makes some reasonable points:

If he were to cut spending at this point, the economy would quite likely go into a second recession, a double-dip, and then frankly everything collapses. If you don't have growth, you have no prospect of getting out of this budgetary situation. ... But he must in a year begin really to address the serious issues that make up the budget crisis that we have.

The most significant one is health care costs. ... Obama's health care plan, while it has some cost control measures, is mostly about expansion and adding to the costs. ... There has to be a much, much more serious focus on costs.

The second is a number of sacred cows in the federal budget which are very large but which frankly make no sense. We have a $250 billion a year hole in the federal budget because employers are given a tax deduction for health care plans. This is actually bad for health care, because it is one of the factors that contributes to these out of control costs, because it's an invitation to have inflation in the system.

Fareed has a solid plan for bringing down the deficit, but he is disingenuous about the macro economic effects of doing so. He understands and says that cutting spending would hurt the economy in the short term, but in the next breath he proposes tax increases, which would have almost the same net effect.

Not that I disagree with his proposal, because a little short term pain is going to be necessary. But he should be honest about it, or the pundits and partisans will tear it apart for raising taxes.

[via Raven]

We Want These Guys Running Health Care?

Veterans still waiting for GI Bill payments

WASHINGTON - Universities and colleges are still waiting for tuition payments for thousands of Iraq and Afghanistan veterans who attended school last fall under the new GI Bill, leaving the veterans panicked that they'll be unable to return to class in January.

Veterans Affairs Department officials promise to get them back into the classroom. The VA says the number of veterans with claims unprocessed is now fewer than 5,000 — down from tens of thousands — and the goal is to have them all processed by the end of the year.

"We continue to work on a daily basis with schools to make sure that no student is denied attending class as a result of delayed tuition payments," Katie Roberts, a VA spokeswoman, said Tuesday. "It's a top priority for VA to make sure that students can focus on their studies rather than their bank accounts."

And that's just a small part of the VA. Wait till the government is running the entire health care system.

[via evil muppet]

Senate Health Care Bill Will Bankrupt the US

This bill is a disaster of epic proportions, and will quickly bankrupt the United States.

Our current annual deficit is $1.4 trillion. The latest Health Bill is estimated to cost $871 billion over ten years. However, this hides the true cost as many of the bill's measures do not go into effect until 2014. If one calculates the ten year costs from 2014-2023, the bill's price tag jumps dramatically to $2.5 trillion.

Liberals would like you to believe that the bill will actually reduce the deficit. This relies on nearly half a trillion in Medicare cuts, which even honest liberals will tell you will never happen. Medicare is already underfunded, paying about 80% of what a private insurer will pay, and any further cuts to Medicare will certainly put thousands of doctors out of business.

And what about the ever spiraling cost of health care and insurance premiums? The CBO estimates that individual insurance plans will increase 10-13% over what they would be if we simply did nothing. The bill attempts to cover up these costs with subsidies for around half of those subscribers, which avoids the root problem altogether, and the other half of the individual market will just be stuck with massive, unsubsidized increases.

Prices for health care itself will also skyrocket. Massachusetts has already implemented similar reforms and has seen its health care costs increase much faster than the national average. I don't know if the CBO is even accounting for this form of accelerated inflation, but we will all be paying for it soon.

If you need more proof that costs will rise faster, you need look no further than Econ 101: Supply and Demand. With 31 million new people gaining or being forced to buy insurance, the demand for health care will drastically increase. The supply, however, will not. Any freshman economics major can tell you that when demand increases faster than supply, price goes up.

The brilliant lawmakers in Washington have decided to pay for some of this reform with new taxes in the middle of the worst recession in decades. I do not need to explain how billions in new taxes will hurt our economy, especially those at the bottom. Luckily, we won't have to pay for all of it as much of it will be paid for by borrowing.

China is already asking questions about the solvency of our reform plans, as they will be the ones paying for it. Not only will this bill bankrupt us, it will put us further under China's thumb.

Some of those dollars will not even go to reform. Billions in spending were written in for no other reason than political bribery. Ben Nelson's home state, Nebraska, will get $45 million. For Louisiana, another $100-300 million. For Florida, $5 billion. These votes have been bought and paid for, by which I mean bought by Democratic power players and paid for by you and me, bi-partisanship be damned.

Not only will this health bill bankrupt our nation, it will also trample our rights. Many states are challenging the constitutionality of an insurance mandate, and they are making a strong case.

It's probably why a majority of Americans do not want this reform.

Merry Christmas, America, you're about to get the worst health care reform in history.

The Buck Stops Here

I'm done beating around the bush. The reason health care is so expensive is because of our government subsidized employer based insurance. This is the root of the problem and must be attacked if we wish to see any real change.

Some history first: during WWII, wages across America were frozen, forcing businesses to get creative in luring the best talent. Many opted to offer health care insurance in lieu of a higher salary, and people for the most part liked it. Soon, a great number of people were insured through their job, and the government, seeing the people cared for, cemented the system into our society with a tax exemption on insurance premiums for those who got insurance through their job.

This system worked for a while, and many Americans were able to get health care when they needed it. However, the problems of such a system soon became apparent.

Due to a lack of incentive to find a less expensive doctor (hey, insurance is paying the bill so who cares?), price inflation in the health sector exploded. Now, costs are prohibitive to anyone who doesn't have insurance. So uninsured should just buy insurance, right?

Strangely, the government tax exemption applies only to insurance through an employer, not individual policies. So those people who don't get insurance through work are at an immediate disadvantage.

Further, the employer based system has segmented the market and created small, disconnected risk pools that exclude individual policy holders. This means individual policy holders, in addition to paying taxes on their premiums, must also pay a higher premium from the beginning.

The problem only goes deeper from there. Our current insurance model is severely disjointed; insurers may only compete in one state, and in many cases, this has created state monopolies. In NC, for instance, Blue Cross/Blue Shield owns 73% of the health insurance market. Insurers like BC/BS can use their monopoly position to squeeze hospitals for lower prices. Hospitals then pass this cost to the smaller insurers, hurting their ability to compete. Hospitals also pass the cost to the uninsured, making already expensive care even more unaffordable.

Liberals will often tell you that to bring costs down we must give people preventative care, that we can stave off expensive procedures with preventative measures. While partly true, this only treats a symptom of a very sick system where costs are still out of control

Don't get me wrong, preventative care is important, but the best preventative care anyone can do is to get exercise and not smoke. If we allow the market to work (and it does work, just look at the rapid decrease in prices of procedures not covered by insurance), then going to the doctor and getting medicine when you're sick will be cheap for everyone, or better yet, you can get a checkup before you get sick.

We cannot continue this game of "pass the buck" forever. Middle class Americans pass the buck to insurance companies who pass it to health care providers who pass it to small insurers, or to uninsured Americans. And now Americans, via the government, are trying to pass it to wealthier Americans through higher taxes. But we all know what happens when you try to pass the buck to the rich and powerful: they pass it right back to you and me.

So how about we stop thinking about ways to bandaid our horribly broken system and instead reform it from the beginning, where it all started: employer based insurance.

After that, we need only allow nation wide competition, you know, what we have for virtually every other business, and it seems to be working.

Not to Belabor the Point...

But this Senate Health bill is just godawful.

CBO found that premiums in the individual market will rise by 10% to 13% more than if Congress did nothing. Family policies under the status quo are projected to cost $13,100 on average, but under ObamaCare will jump to $15,200.

...

So the bill will increase costs but it will then disguise those costs by transferring them to taxpayers from individuals. Higher costs can be conjured away because they're suddenly on the government balance sheet. The Reid bill's $371.9 billion in new health taxes are also apparently not a new cost because they can be passed along to consumers, or perhaps will be hidden in lost wages.

...

Moreover, CBO is almost certainly underestimating the cost increases. Based on its county-by-county actuarial data, the insurer WellPoint has calculated that Mr. Baucus's bill would cause some premiums to triple in the individual market. The Blue Cross Blue Shield Association came to similar conclusions.

One reason is community rating, which forces insurers to charge nearly uniform rates regardless of customer health status or habits

...

In a 2008 paper in the peer-reviewed Forum for Health Economics and Policy, [economists] found that state community rating laws raise premiums in the individual market by 20.9% to 33.1% for families and 10.2% to 17.1% for singles. In New Jersey, which also requires insurers to accept all comers (so-called guaranteed issue), premiums increased by as much as 227%.

If only we could come up with a real plan that actually reduces costs!

According to CBO, the relatively modest House GOP bill would actually reduce premiums by 5% to 8% in the individual market in 2016, and by 7% to 10% for small businesses. The GOP reforms would also do so without imposing huge new taxes.

Not To Mince Words

But a government takeover of health care will make health care worse. A recent survey of cardiologists and cardiovascular ultrasound technicians found that if Medicare payments are cut to pay for the Health Care Bill, 87 percent may stop accepting Medicare patients, reduce staff or shut down their practices completely.

The survey showed that for the echocardiography service providers affected most directly by the PFS payment cuts, the actions currently being considered most often are:

• 64% would delay the purchase of echo equipment;
• 56% would lay off sonographers or other staff;
• 53% would reduce staff salaries;
• 47% might reduce staff benefits, such as 401K programs or healthcare;
• 23% would refrain from accepting Medicare patients for any services;
• 19% are considering closing a satellite office(s) or have already closed a satellite office(s); 60% of these are located in rural areas.

For those echocardiography service providers who will be indirectly affected by the payment cuts (those who receive payment through the Hospital Outpatient Payment System), the survey showed anticipated outcomes would include:

• Increased workload (74%)
• Longer wait times for patients (67%)
• Lengthened turnaround time for reports (44%)
• Increased overtime for staff or the need to hire additional cardiac sonographers (43%)

Echocardiography is but one of the countless components of our health care system that will be negatively impacted by the current health care legislation up for debate.