Examiner Editorial: Government-run health care could be the ultimate SNAFU | WashingtonExaminer.com

But Obamacare is only in the start-up phase. The VA department has been directly providing health care to millions of veterans for decades and evidence is growing that relying on the system can literally be a fatal decision. The Washington Examiner's Mark Flatten reported May 12 that a Texas VA clinic implemented a cost-cutting measure in 2010 that required a patient to undergo three positive bloody stool screens before the government would approve a colonoscopy. Dr. Paul Krugman, who protested the policy while serving in the VA facility, told Flatten that "by the time that you do the colonoscopies on these patients, you went from a stage 1 to a stage 4 [colorectal cancer], which is basically inoperable."

http://washingtonexaminer.com/examiner-editorial-government-run-health-care-could-be-the-ultimate-snafu/article/2548880

A federal bureaucracy that is wasteful and ineffective - truly situation normal.

Who's Helping Whom?

For decades, a series of studies have raised red flags. Surgery patients, cancer victims, and transplant recipients who were enrolled in the program were all found to fare worse—not merely than privately-insured patients with presumably easier lives, but worse than equally poor people who lacked any insurance at all. This literature was capped off by the landmark “Oregon study,” a brand-new analysis that marshals gold-standard methodology to compare Medicaid recipients with uninsured people.

The scholars found mixed results. Medicaid does lower psychological stress and increase financial stability, results we would expect from any transfer program. But the program actually increases unnecessary trips to the emergency room. And remarkably, Medicaid coverage has no measurable impact whatsoever on clinical health.

http://thefederalist.com/2014/02/12/the-party-of-science-has-absolutely-no-clue-what-its-talking-about/

Health emergency: On eve of Obamacare, Britain's NHS needs political therapy | WashingtonExaminer.com

http://washingtonexaminer.com/health-emergency-on-eve-of-obamacare-britains-nhs-needs-political-therapy/article/2536520
"The individual is essentially a suplicant."

Read on and have a look at one person's example of the dark underbelly of getting health care you don't pay for at the point of sale.

Can't Be True

Think government programs are safe from such concerns? Think again. The Government Accountability Office estimates that, in 2011, Medicare and Medicaid made a whopping $50.7 billion in fraudulent payments. That same year, the combined annual profits of the nation's 10 largest insurance companies were $13.7 billion. In other words, the government lost almost four times as much as private insurers made.
http://www.weeklystandard.com/articles/mandate-madness_740066.html?page=2

OK - end medicare and give the elder 1/3 of americans $51,000/year and the responsibility to pay for their own healthcare. 3, 2, 1, go!

Liberty Rears Her Head - For A Roar?

http://reason.com/archives/2012/06/11/obamacare-on-trial
Here's hoping that it will be a roar.

Best Government Is Least Government

Given the statistics in this presentation, how did these government approved interventions come to pass:

Don't eat salt, don't eat fat, take statins to lower cholesterol, install stents to protect from heart disease, eat grains, and take blood pressure meds to lower blood pressure.  

Single Payer - By Hook or By Crook

In reality, as government assumes a greater share of health-care costs, pressure to cut payments to providers will be enormous. Reduced government reimbursements to providers will cause massive cost-shifting to those remaining in the private health-insurance market. More employees will lose coverage. Before long, we will have what the left has long sought—a single payer health-care system modeled after Medicaid.
In recent testimony before the Senate Appropriations Committee, Health and Human Services Secretary Kathleen Sebelius told me that America's health insurance system is in a "death spiral." She failed to acknowledge that implementation of ObamaCare will be the cause of that death spiral, and American taxpayers will be left to pick up the tab.
http://online.wsj.com/article/SB10001424052702304724404577289363234579868.html?mod=WSJ_Opinion_LEADTop

I'm not totally sure they meant for it to happen this way - are they that smart?- but could there be any question that this was the intent when the administration took office?

Notes on Heath Care Econ and the Mandate

In reality, the mandate has almost nothing to do with cost-shifting. The targeted population—the young, healthy and not poor who choose to forgo coverage—has a minimal role in the $43 billion of uncompensated health-care costs. In 2008, for example (the latest figures available), the Department of Health and Human Service's Medical Expenditure Panel Survey showed that the uncompensated care of the mandate's targeted population was no more than $12.8 billion—a tiny one-half of 1% of the nation's $2.4 trillion in overall health-care costs. The insurance mandate cannot reasonably be justified on the ground that it remedies costs imposed on the system by the voluntarily uninsured.
The government's other defense is that the health-care market does not exhibit textbook competition. No market does. The economic features relied upon by the government—externalities, imperfect information, geographically distinct markets, etc.—are characteristic of many markets.
The presence of externalities and other market imperfections does not justify a departure from the normal rules of the constitutional road. Health care is typically consumed locally, and health-insurance markets themselves primarily operate within the states. The administration's attempt to fashion a singular, universal solution is not necessary to deal with the variegated issues arising in these markets. States have taken the lead in past reform efforts. They should be an integral part of improving the functioning of health-care and health-insurance markets.
http://online.wsj.com/article/SB10001424052702304459804577285991632128670.html?mod=opinion_newsreel

If what is driving health care costs and insurance disfuction is government, then you can bet that Obamacare will worsen the problems, not ameliorate them.  The fact that man cannot engineer a functional "health care system", which exceeds that which  might evolve over time without coercoion, has become so obvious to me, I forget that others still it may be done.

Starting points - remove the tax incentives associated with employer "provided" health care plans which are more pre-paid service plans than insurance.  Remove restrictions on cross-state-border plans.  Remove "mandates" which require providers to cover this, that or the other, according to the influence of rent seeking constituencies; instead, let folks buy what they need, which for most, is catastrophic coverage. 

Every federal and state intervention creates negative unintended consequences, which justify further interventions, etc, a classic reinforcing loop of government regulation, perverted incentives, and ineffective, inefficient, care. 

Obamacare and Cost Control - Will The Two Ever Meet?

In reality, cost control is simple.  Everyone knows how to do it: Austerity and incentives.  Government needs to spend less, and stop using regulation to discourage frugality.  Alas, these realistic solutions are extremely unpopular.  Gruber is too technocratic to go full populist and say, "We should spend as much as it takes to give the best possible health care to every American."  But in the end, that's the philosophy behind Obamacare: Do whatever it takes to cover everyone, and hope the American public one day sees the wisdom of austerity and incentives.
http://econlog.econlib.org/archives/2012/01/sins_of_omissio.html

Quite simply, it would be hard to get a better summary of what is wrong with health care and why all the talking heads you generally hear have no idea what they are saying.

One Step Over the Line ...

It's highly unusual in a presidential debate for two Republican candidates -- the two leading in current national polls -- to heap praise on a liberal Democratic senator.
But in the Fox News debate in Sioux City, Iowa, Thursday night, both Newt Gingrich and Mitt Romney had very good words to say for Oregon's Democratic Sen. Ron Wyden.

The subject was the Medicare reform plan put forward in a Wall Street Journal opinion article that morning by Wyden and House Budget Committee Chairman Paul Ryan.
"Today is a big day for the country," Romney said. It was "an enormous achievement" for Ryan and Wyden, people on opposite sides of the aisle, to come together.
http://www.realclearpolitics.com/articles/2011/12/19/a_democrat_reaches_across_the_aisle_on_medicare_112443.html

Very Clear on Post-Obamacare Options

A complete health care safety net assuring essential health care for all can be achieved with no individual mandate and no employer mandate, for just a fraction of the cost of Obamacare, actually sharply reducing government in the process. That starts with the provision already in federal law, stemming from the Kennedy-Kassebaum legislation of the 1990s, providing for guaranteed renewability. That means if you already have health insurance, you cannot be terminated because you become sick. That is what the insurance insures against after all, so such termination would actually be fraud, as state law across the country recognized before Kennedy-Kassebaum. Under this regulation, insurers also cannot discriminatorily raise rates for those who become sick while insured. This law ensures that if you have health insurance, you will be able to keep it as long as you continue to pay the premiums.

The second component of a health care safety net would involve block granting Medicaid back to the states, just as was done with the enormously successful reform of the old AFDC program in 1996. Each state would then transform their Medicaid programs into a premium support system which would provide the assistance necessary to purchase essential health insurance for those who are too poor to pay for it otherwise. Each state would decide how much assistance is necessary at each income level in their state to assure the poor could afford such essential coverage.

This would greatly benefit the poor because Medicaid today is structurally an institution serving to deny the poor essential health care just when they are the sickest and most in need of such care. That is because Medicaid does not pay the doctors and hospitals enough to assure such care. But with the above reform, the poor would enjoy the same health care as the middle class because they would have the same private insurance as the middle class, paying market rates for care.

The third component of the safety net is a high risk pool in each state for the uninsured who never get coverage and then become too sick with costly illnesses like cancer or heart disease to buy it. That is like calling an insurance company for fire insurance after your house is already on fire. The uninsured in this case would be able to get coverage as a last resort from the high risk pool, paying what they can based on their income. Taxes would subsidize the pool to keep it afloat. Because only 1-2 percent ever become actually uninsurable like this, this is the least expensive option for assuring an essential safety net.

http://spectator.org/archives/2011/11/23/the-bell-tolls-for-obamacare

My Letter to Ms. Harrop

...in response to this disheartening (pretense of) analysis: 

Ms Harrop,

Your conclusion represents a false choice between a supposed component of the current free market circumstance and a health care system more than 46% controlled by government.

"The only serious cost-cutting alternative to the free-market jungle is letting government put more order into American health care. Take your pick."

I realize your article is space limited but it left out such huge elements of the current cost drivers of the US health care system that it can't be taken seriously as analysis of the current reality.  I suggest to you Herzlinger's work, or Porter's, as bringing analysis that implicates government interventions which distort the value chain in US health care.  "Prices" for health care have become arbitrary, and are unregulated by market forces which we count on in every non-government enterprise to reward value and punish waste.  There is simply no reason to believe that any government enterprise - the military, transportation infrastructure, and our multiple systems of "welfare" - will ever be efficient or responsive to customer needs.  The experiment has been conducted, and it failed.  From Vallejo, CA (http://www.realclearpolitics.com/2011/10/11/california_ground_zero_for_budget_crises_265168.html), to Medicare's massive unfunded entitlement, the proof is there for those who have eyes to see it. 

As for the theoretical success of the Euro systems, Canada's cost issues are long standing and serious, and a Canadian dog has access to better medical equipment than a human does.  The dubious successes of single payer/socialized systems result from rationing of care, and that is reflected in the health statistics.  Saying that those in the US spend twice as much on health care completely misses the point - we can!  We have the money to spend because we have more liberty.  The rich always pay more new technology, and in that case the US spending on health reflects the same pattern. 

In short, the current system, although ostensibly 54% "market based", is riddled with well intentioned government interventions which have predictably negative unintended consequences.

You don't trust the government to spend enough via vouchers to support those in need, but the current system can't spend enough to do that either.  At least the voucher approach, and other concepts discussed by the aforementioned authors, can be paid for.  They also have the essential benefit of restoring some market based forces to the pricing system which would allow markets to reward value and punish waste. 

It is a stretch to say that your faith in government's coercive monopoly outcomes is less of a matter of religious faith than those who trust cooperative engagement between citizens, aka liberty.  The political calculus on display every single day in DC makes it clear for any who will pay attention that the system serves many interests, but not those about whom you say you are concerned. 

Even were one to make the enormous leap required to think that government has unfulfilled potential to help transform the circumstance of the poor in this nation, isn't it clear by now that theoretical potential will not be achieved? Sincerely, Paul Eich

Brooks' Assumptionland

We’ll probably need a mixture of these approaches to figure out what works. Instead, Republicans decry the technocratic rationing model as “death panels.” Democrats have gone into demagogic overdrive calling premium support ideas “privatization” or “the end of Medicare.”
Let’s be clear about the effect of this mendacity: We’re locking in the nation’s wealth into the Medicare program and closing off any possibility that we might do something significant to reinvigorate the missing fifth. Next time you see a politician demagoguing Medicare, ask this: Should we be using our resources in the manner of a nation in decline or one still committed to stoking the energy of its people and continuing its rise?
http://www.nytimes.com/2011/05/10/opinion/10brooks.html?_r=2
"Figure out what works?"  Fifty years of failed government health care isn't long enough to figure out it won't work?  Of course the politicians are mendacious - that's what they are good at.  What a comic approach.  This man is glad politicians are gaining control of the payment and distribution of health care, but surprised that their primary tool of their trade is to avoid truth, thus being able to say they are everything to everyone.

Mr. Brooks' closing paragraph is noteworthy.  I agree that locking the nation's wealth into a failing Medicare system is an absurdity - if the original idea was "we must do something to ensure that people can still get care while they are old and we can at least pay for some of that via the coercive power of the state", the truth now is we could be spending every penny the government has to throw at the problem and we still won't be able to pay for all the care that could be bought.  And yes, the death panels are an inevitability - once we've given the government the power to tax us to pay for our health care, we have also ceded control over how much we get to spend when in decline, and how heroic the efforts will be to save us.  When it comes down to keeping the dying alive or healing the young, the bureaucrats will choose the later.  It's only logical.  It's also soulless and anyone who fights this bureaucratization of health care is fully justified.

Lastly, look at the assumptions in this absurd statement:
"Should we be using our resources in the manner of a nation in decline or one still committed to stoking the energy of its people and continuing its rise?"
Restated:  Should we continue to allow the political class to seize the results of our life energy and spend it on their re-election and political legacy, or should we respect property rights thereby allowing the citizenry to benefit from their own ingenuity and labor, and from the undeniable boost in wealth and productivity that results from cooperative trade amongst free men?  This author has a serious case of the fatal conceit.

The Five Percent Solution

About 5 percent of the population is responsible for almost half of all health care spending in the United States and for rising premium rates, according to a new report from the National Institute for Health Care Management Foundation.

U.S. health care spending has sharply increased over the past few years. Between 2005 and 2009, national health care spending rose by 23 percent from $2 billion to $2.5 billion, according to the NIHCM Foundation, a nonprofit, nonpartisan organization focused on health care. A foundation report that reviewed the 2008 Medical Expenditure Panel Survey found health care spending was concentrated among a small group of high-cost patients.

The report stated about half of the U.S. population accounted for only 3.1 percent of all expenditures. But 10 percent of the population hogged 63.6 percent of all health spending, the survey found.  The top 5  percent of the population accounted for 47.5 percent of all spending, and the top 1 percent accounted for 20.2 percent.

http://www.nationaljournal.com/healthcare/report-5-percent-of-people-account-for-half-of-u-s-health-care-spending-20110627?mrefid=mostViewed

Unfortunately, the article did not cover what might be done to reduce the cost of care for these 'expensive few'.  We know these folks must be the older part of the population, because about 25% of all spending is spent in the last year of life.  We also know, due to a later quote that half this highly treated population is diabetic or pre-diabetic, that many of these folks have eaten themselves sick - but like smokers, it is hard to discern whether they are more or less costly over their 'life cycle' because they have more illnesses, but live shorter lives.

Any way you slice it, pun intended, the public provision of health care is going to boil down to managing the shortages, and it will satisfy very few but still cost bundles of cash.   "What will the demand for health care if the cost at the point of sale is zero?"

God In The Details?

They just need to take a hard look at this, and I'm sure they'll nail down all those nasty details, and catch all of the unintended consequences, and have this Obamacare thing running like a top.  What could go wrong ...
Back in March 2010, then-House Speaker Nancy Pelosi, D-Calif,, uttered the now-famous words, "We have to pass the bill so that you can find out what is in it, away from the fog of the controversy." Pelosi was talking about the health care law, and it appears she was right about the fact that it was full of unknowns.
It turns out that, due to a glitch in the law, roughly three million middle-income Americans could wind up on Medicaid - which was designed to assist the country's poorest citizens.
"It's gonna cost about $450 billion over 10 years," Senator John Barrasso. R-Wyo., who is also a surgeon, warns. Barrasso says it's yet another burden for average Americans. "Who's gonna pay for that - the taxpayers, people who are paying their bills every day," he says.


Read more: http://politics.blogs.foxnews.com/2011/06/22/pelosi-prediction-backfires-glitches-arise-health-law#ixzz1Q8ZMnKFz

Unintended Consequences? What Could Go Wrong?

The theory for ACOs, as they're known, is that hospitals, primary-care doctors and specialists will work more efficiently in teams, like at the Mayo Clinic and other top U.S. hospitals. ACOs are meant to fix health care's too-many-cooks predicament. The average senior on Medicare sees two physicians and five specialists, 13 on average for those with chronic illnesses. Most likely, those doctors aren't coordinating patient care.
This fragmentation is largely an artifact of Medicare's price control regime: The classic case study is Duke University Hospital, which cut the costs of treating congestive heart failure by 40% but then dumped the integration program because it lost money under Medicare's fee schedule.
http://online.wsj.com/article/SB10001424052702304520804576343410729769144.html?mod=WSJ_Opinion_LEADTop#printMode

The smartest person in the world couldn't figure this out.  But that won't stop those who think they are the smartest, most progressive, most compassionate, from trying, due to the fatal conceit and the instinct to tyranny.  Next historical reference - the goose that lays the golden egg is slowing being murdered by these absurd interventions by the State into the affairs of would be, should be, free folk.

Incompetence or Truly Sinister?

Even as yet another federal court ponders the constitutionality of Obamacare, the bad news about its impact just keeps on coming.
This week a report by the respected McKinsey & Co. found that at least 30 percent of employers are likely to stop offering their workers health insurance as a routine benefit once the federal law kicks in.
As many as half of those 1,300 companies surveyed said they would “definitely” or “probably” drop such coverage even with a government imposed penalty of as much as $2,000 per worker for companies with more than 50 employees.

http://www.bostonherald.com/news/opinion/editorials/view.bg?articleid=1344386&format=text

Unintended consequences are the name of the game as regards federal legislation - and generally they unintended consequences are bad, horrible or worse.

In this case, it does beg the question - did they not foresee these kinds of systemic hits, or did they?  And plunge ahead anyway, knowing that if they wrecked the current Frankenstein monster of high priced care driven by government incentives gone afoul, they would have a defacto single payer system as all that was left? 

It'll take a miracle for this to end well.

Truth In Advertising - For Politicians

After reading the following, it strikes me that we need an additional truth in advertising law that punishes politicians for doing things they say they won't or for not doing things they say they will.  If the indepently elected "Truth in Govt Advertising" agency finds that legislation is used contrary to the way it was "sold", the agency gets to stick a figurative finger in the respective politicians' eyes.  Because right now, it's imminently clear they'll do anything they want to do and there's little or nothing we can do to stop how they spend our money.

The administration is now loosening the requirements (you just need a note from a doctor or nurse saying you've been sick in the last year) and lowering premiums.  But this doesn't mean that they're finally covering more "uninsurables"; it just means they've decided to use the money allocated for those people to cover someone else.  They're changing the "high-risk pools" to something that looks a lot more like simply subsidizing insurance.  But the goal wasn't to spend the $5 billion that HHS got in its budget; the goal was to provide insurance for people who want to buy insurance, but can't find a company willing to write it.  

Since we don't seem to be able to find many of those people, HHS is using the money to cover anyone who lacks insurance and can get a doctor to attest that they've been sick in the last year.  They will eventually no doubt claim that the high-risk pools were a success, relaxing the conditions until they can say they've covered 200,000 or so people.  But the mystery will not have gone away.  Where are the unsinsurables?  And why didn't they want to buy insurance?

http://www.theatlantic.com/business/archive/2011/06/why-hasnt-anyone-signed-up-for-the-high-risk-health-insurance-pools/239833/

"If Mitt Can Make This Fly He's Some Kind of Genius"

If Mitt can make this fly, he’s some kind of genius. The problems with Romneycare are well known: Mitt argued that Massachusetts needed to reform its health-care system because the uninsured were placing huge strains on the state’s emergency rooms and the rest of the population had to pick up the tab for the free-riders, and that was driving up Massachusetts health costs. So, as a famous can-do technocrat, he looked at the problem and came up with a can-do technocratic solution. Three years later, everyone was insured, but emergency-room use was higher than ever, and 70 percent of those newly insured were all but entirely subsidized by the state, and Massachusetts residents were paying 30 percent more for their health care than the U.S. average, and Boston had the longest wait time in the nation to see a new doctor. Last year, I gave a speech to the American Society for Cataract and Refractive Surgery at its annual conference in Boston, and got a cheap laugh by telling the assembled ophthalmologists that just by flying in to the convention center they’d dramatically improved the city’s doctor/patient ratio.
http://www.nationalreview.com/articles/267220/romney-s-fix-mark-steyn


Do you suppose it will hurt the poor any when this house of cards comes crashing down?  Nah, probably not ...

What If We Tried Cooperation?

The former Governor outlined a national approach like the one he ran on in 2008. Its core virtue is that it would equalize the tax treatment of health insurance, ending the destructive federal bias for employer-provided insurance over the individual market and encouraging a consumer market for competitive insurance and more efficient medicine. Health economists across the political spectrum have recognized this distortion for decades.
http://online.wsj.com/article/SB10001424052748703864204576319312743766234.html

This would be a powerful step forward, unfortunately, even those generally in favor of liberty don't realize how powerful and empowering it would be.  Cancel the absurd tax treatment of employer provided health care and remove health care coverage mandates, and you could significantly reduce the cost of health care without using ANY coercive government force.