Dedicated to the continuing healthcare debate

Side Effects: Doctor Participation May Vary

2010-04-26T16:14:00.000-07:00

In recent years, the United States has faced a growing shortage of physicians. Under Obamacare, it will only get worse. Industry experts predict a 40,000 shortfall in doctors over the next decade

There are two factors at play here. First, the existing supply of primary care physicians will not be able to keep up with the increased demand posed by millions of newly-covered patients. Second, and even more alarming, many physicians feel compelled to voluntarily leave the profession when the bill starts to affect their practices.

Call it a double-edged sword on physician supply. It creates demand for more physicians as it encourages doctors to leave the profession entirely. Under Obamacare, physician workload is expected to increase, even as federal health programs cut reimbursement rates for the docs. “Work more for less” is not a slogan calculated to attract more workers to the field or improve the quality of care.

According to a recent study conducted by Medicus Firm, a physician consulting group, over 29 percent of 1,200 doctors surveyed said that they would leave the medical profession or retire early if Obamacare were enacted. Nearly two-thirds (63 percent) said they would not recommend their profession in the wake of the new law.

Medicus Managing Director Kevin Perpetua remarked:

The overwhelming prediction from physicians is that health reform, if implemented inappropriately, could create a detrimental combination of circumstances, and result in an environment in which it is not possible for most physicians to continue practicing medicine…Health-care reform and increasing government control of medicine may be the final straw that causes the physician workforce to break down.

A physician shortage will undermine the bill’s entire premise of extending and improving coverage to all Americans. Shortages hinder patient access to care and can reduce the quality of care given by overextended physicians.

The new health care law extends health coverage to millions… on paper. But given the law’s disincentives for physicians, patients may find it harder and harder to find doctor. And those who do may find longer waiting times and much less time with the doctor in the examining room.

For more information on health reforms that won’t create such problems, click here.

Rick Sherwood currently is a member of the Young Leaders Program at the Heritage Foundation. For more information on interning at Heritage, please visit: http://www.heritage.org/About/Internships-Young-Leaders/The-Heritage-Foundation-Internship-Program

Source: Heritage/ PERMALINK

ObamaCare’s Biggest Opponent Is Not The GOP, It Is The Medical Profession

2010-04-26T16:05:00.000-07:00

July 26, 2009 | By: doctor horton

Filed Under: Other

Why are Speaker Pelosi and President Obama having difficulty with the health care reform bill even though the Democrats have a supermajority? It is because they are politicians and are viewed as untrustworthy my most Americans. These politicians’ biggest opponent is not the GOP, it is the medical profession. In order to gain the support of the American people they must publicly challenge the integrity of 4 of the 5 most trusted professions.

Gallop performs an Annual Honesty and Ethics poll that rates different professions. Each year there is little change. Physicians are usually in the top 3 or 4 and politicians are near the bottom. The most recent Gallop poll was conducted in 11/08 and reported results that were consistent with this claim. The question was asked: Please tell me how you would rate the honesty and ethical standards of people in these different fields — very high, high, average, low, or very low? This particular poll looked at 21 professions among them were nurses, pharmacists, teachers, medical doctors, congressmen, lobbyists, and journalists. The results were typical of years past and showed physicians were near among the most trusted and politicians were near the bottom of the list. At the very bottom were lobbyists.

Nurses were at the top with 84% of Americans giving their honesty and ethical standards as very high. 70% of Americans rated pharmacists very high and 64% rated physicians very high while only 6% rated them very low. Looking further down the list shows journalists received 25% very high and 31% very low, and only 12% of Americans rate congressmen very high while 46% rate their ethical standards and honesty very low. At the bottom of the list were lobbyists with scores of 5% very high and 64% very low.

The Gallop report broke down the results even further into three categories of professions for honesty and ethics: top-rated, neutral, and least well-rated.

Nurses have no peer in the Gallup rankings today, but they are followed by pharmacists, high-school teachers, and medical doctors, all with close to two-thirds of Americans rating them highly. Just over half of Americans consider the honesty and ethics of clergy members and the police high or very high.

While fewer than half of Americans consider funeral directors or accountants to be highly ethical, these professions are much more likely to be viewed positively than negatively.

…Indeed, several professions suffer from a heavily negative tilt in their image ratings. The worst of these are lobbyists, telemarketers, and car salesmen, all of which are considered to have low or very low honesty and ethics by a majority of Americans.

Although several other professions — congressmen, stockbrokers, advertising practitioners, business executives, lawyers, and labor union leaders — are not as negatively viewed as the bottom three, the ratings for them skew negative by more than a 2-to-1 ratio.

Politicians have attempted to make the claim that the “the doctors are behind us” by pointing to the support of the AMA. However, they are now finding that the majority of doctors are not falling in line. Doctors aren’t against this plan for their own selfish reasons. No, we actually care for our patients and are bound to an oath. Physicians, who are trusted with their patient’s lives and families, have a special connection with the American people that President Obama covets….a trusted relationship.

I think that the next effective communicative effort to stop this destructive health care “reform” proposed by Obama must be a campaign of physicians, nurses, and pharmacists speaking the truth to the American people in the various forms of media. The president has called us out and now it is time to give an answer.

Source: Matters of Truth/Gallup

White House Health Care Rhetoric About to Meet Reality

2010-04-26T15:52:00.000-07:00

At the signing of the Senate health bill today, President Barack Obama said: “In a few moments, when I sign this bill, all of the overheated rhetoric over reform will finally confront the reality of reform.” Let’s review some of the “overheated rhetoric” that is about to get tested by reality.

Over the past months, the President and Congress have promised: that premiums would drop by $2500 per family; that if you like what you’ve got, you can keep it; that it would bend the cost curve down; that it would decrease the federal deficit. The fact of the matter is, none of these things will become reality once the bill is implemented—these claims are nothing but the rhetoric attached to an unpopular piece of legislation in the hopes of creating support that has yet to materialize.

The truth about the bill is already becoming evident as effected parties become vocal with their concerns. Some highlights just from today’s headlines include:

State Medicaid Programs Worry About Cost of Expansion: The bill will increase coverage among the uninsured largely through the expansion of Medicaid, a low quality, poorly structured government health care program which is paid for jointly by the federal and state governments. Though the bill will cover the cost of the benefits expansion, it will not cover the added administrative costs, which Heritage analyst Ed Haislmaier has highlighted. According to an article on Bloomberg.com, “States faced with unprecedented declines in tax collections are cutting benefits and payments to hospitals and doctors in Medicaid, the health program for the poor paid jointly by state and U.S. governments. The costs to hire staff and plan for the average 25 percent increase in Medicaid rolls may swamp budgets.”

Haislmaier projects the added administrative cost to the states would total $9.6 billion between 2014, when the provision is implemented, and 2019. This extra burden comes at a time when states are trying to tighten their budgets to account for decreasing revenues. Research by former Heritage analyst Dennis Smith and Ed Haislmaier shows that, as the fiscal burden of the Medicaid expansion grows, it would be in states’ interests to drop the program entirely: “The savings to state budgets are so enormous that failure to leave Medicaid might be viewed as irresponsible on the part of elected state officials. The federal government, however, would be left holding a trillion-dollar-plus tab.”

Businesses that Offer Already Offer Insurance Face Growth-Stifling Expenses: Caterpillar Inc. recently addressed a letter to House leadership claiming that the health care legislation passed Sunday would result in over $100 million in new costs for the company in the first year of implementation alone, due to the increase in Medicare taxes and mandated benefits. Said the letter, “We can ill-afford cost increases that place us at a disadvantage versus our global competitors.” Effects of the bill’s provisions will include job loss, wage reductions, and reduced hours, as testified by more than 130 economists in a letter to President Obama and members of Congress.

In recent research, Heritage analysts Karen Campbell and Guinevere Nell further demonstrate that the economic impact of taxing investments to pay for the bill will be disastrous. In recent months, Americans have made it adamantly clear that their top priority is jobs and the economy—instead, Congress has delivered a health bill that will harm both and burden the ability of American companies to compete globally.

And this is just the tip of the iceberg. The negative unintended consequences of the Senate bill will be quick to surface now that the bill has been signed into law. Americans must remain aware of the direction in which this legislation will lead our nation such that the requisite change will be swift and sure.

Source: Heritage Foundation / PERMALINK

Why the great and growing backlash

2010-01-20T10:40:00.000-08:00

January 20, 2010

Why the Great and Growing Backlash?
What Scott Brown’s election portends for the Obama agenda.
by Victor Davis Hanson
National Review Online

Dream up a gargantuan backlash against Barack Obama’s left-wing gospel, and you still could not invent the notion of a relatively unknown, conservative Scott Brown knocking off an Obama-endorsed, liberal, female attorney in liberal Massachusetts — in a race to fill the seat once held by Ted Kennedy.

If a liberal senatorial candidate can be defeated in Massachusetts, eleven months after the Obama hope-and-change blitzkrieg, it is hard to believe that any liberal seat is necessarily safe anywhere.

So the real story is not a populist backlash, but a growing populist backlash, whose ultimate nature and magnitude are as yet unknown. What’s going on?

Buying Jobs?

Voters are sick and tired of a terrible year of big spending and big deficits — especially the sight of Obama and his congressional allies almost daily talking breezily about spending what we do not have.

Voters went for the hope-and-change Obama in part because he promised fiscal sobriety after the Bush $500 billion deficit. Instead, in utterly cynical fashion, Obama trumped that red ink four times over. In the process, he developed a terrible habit of promising favored constituencies a hundred billion here, a hundred billion there as if it were all paper money — rather than real borrowed currency that will have to be confiscated in the future from the beleaguered taxpayer. It only makes it worse that the more the administration borrowed, printed, and spent, the higher unemployment rose and the lower economic activity plummeted.

Most have had enough of pie-in-the-sky talk of massive new healthcare entitlements, cap-and-trade taxes and regulation, more stimulus, and more takeovers of private enterprise. The country is broke and the people want to pay off, not incur more, crushing debt. What got us into the mess was too much borrowing, skyrocketing debt, and reckless spending — not too many balanced budgets and too much lean government.

Prophets Can’t Mislead?

No politician quite gets a pass for deception and prevarication. Obama in his narcissism thought his sonorous rhetoric made him exempt from a “read my lips” or “I didn’t have sex with that woman” moment. It didn’t.

People heard his serial promises about airing the healthcare debate on C-SPAN, his new-transparency/no-lobbyist vows, and his monotonous boasts to close down Guantanamo within a year. All that is now “inoperative.” The problem was not just that Obama made promises that he broke, but that he made them so frequently and so vehemently — and so cavalierly broke them. That brazen campaign deception is problematic for a politician, but proves fatal for a self-appointed messiah.

A Cessation of Corruption

We went from a Republican “culture of corruption” to a liberal cesspool of corruption. Sen. Chris Dodd lectures Wall Street while he gets sweetheart loans and vacation-home deals. Few could make up a story that the nation’s top tax lawmaker, House Ways and Means Chairman Charles Rangel, is a tax dodger, and the nation’s top tax enforcer, Secretary of the Treasury Timothy Geithner, is an even more egregious tax dodger. When the Democratic Senate leadership started buying healthcare votes at $300 million a clip, our Congress became little more than the praetorian guard, auctioning off its support to any wannabe late Roman emperor. The idea of a muckraking Obama nominating Tom Daschle as his Health Secretary — the liberal populist who skips out of thousands of dollars in taxes on his free corporate limousine service — was the stuff of satire.

Bush Really, Really, Really Did Do It

No one likes a serial whiner. It has been a year now — and Obama still blames George W. Bush ad nauseam. He did it in Massachusetts again — and on the eve of the election, no less. Blaming the past for the mistakes of the present gets old quickly. And when one adds in the constant What’s the Matter With Kansas? brand of condescension about naïve yokels not knowing what’s good for them, it gets even worse.

Yet Obama still pontificates that angry deluded voters will “suddenly” come to appreciate how he rammed healthcare down their otherwise ignorant throats: “The American people will suddenly learn that this bill does things they like and doesn’t do things that people have been trying to say it does. . . . The worst fears will prove groundless. And the American people’s hope for a fair shake from their insurance companies — for quality, affordable healthcare they need — will finally be realized.”

Good luck with that, O philosopher king!

Wall Street Populists

Elite liberals are not good class warriors. Factor in multi-millionaire Nancy Pelosi’s government mega-jet or Barack Obama’s various overseas junkets or the big Wall Street money that went into Obama’s near billion-dollar campaign coffers, and it is hard to take seriously Obama’s constant war against “them.” The voters have figured out that their president likes the elite plutocracy and the lower middle classes, but not so much the wannabe rich who aspire to cross his hated $250,000 income threshold — at which point suddenly they become unpatriotic, unwilling to pay their fair shares, and reluctant to spread the wealth around.

It is not particularly smart to constantly demonize the entrepreneurial classes, promise to raise income, payroll, healthcare, and inheritance taxes on them, and expand government regulations — and then wonder why they are not creating more jobs.

Elmer Gantry

Devotees turn on false prophets with a special vengeance. Obama is beginning to grate. His flip-the-switch-on, evangelical cadences at rallies sound more like a Harvard nerd doing blues imitations than Martin Luther King Jr. Purple-state presidents don’t appoint Van Joneses and Anita Dunns, or turn the NEA into a quid pro quo Ministry of Approved Culture. A healer doesn’t start in on the “rich,” “Wall Street,” the “big” oil companies, drug companies, insurance companies, or “fat-cat bankers” — especially when he has done his best to shake them all down for campaign money, hire as many of them as he can in his own administration, and arrange cut-rate loans, insider deals, bailouts, and guarantees for all of them.

Obama’s populism is beginning to sound more like a bought boxer who belatedly has second thoughts about throwing the fight he previously contracted. In short, Obama’s ideological presidency hinged on his post-racial, post-national mesmerizing presence that reassured reluctant Democrats to vote against their local constituencies.

If cap-and-trade or healthcare reform polled below 50 percent, a worried congressional supporter could always call in Him to charm bolting voters. But now? We have in a blink gone from Obama as the bankable 10 percent edge, to Obama as a non-factor, to Obama as a real liability. In short, why vote for an agenda as unpopular as its albatross author?

Liked by All, Respected by None

Obama thought the antidote to “smoke ’em out,” “dead or alive,” and “bring ’em on” braggadocio was bowing to the Saudis, promulgating new and undiscovered great moments in Islamic history, and reaching out to Ahmadinejad as he rounded up and beat down reformers in the streets of Tehran.

It’s one thing to accuse Bush of shredding the Constitution, quite another to adopt his anti-terrorism protocols like tribunals, renditions, Predators, intercepts, and wiretaps. Somehow Obama offended his base by such duplicity, and then his opposition by his tokenism of trashing Bush, promising the architect of 9/11 a show trial a few blocks from the former World Trade Center, and using touchy-feely euphemisms to suggest we are not in a war against terrorism emanating from the radical Islamic world.

Ahmadinejad, Assad, Chávez, the Castro Brothers, Putin, and others for the first six months liked us as much as they had little respect for our sycophancy; now they openly show contempt. We accept that obsequiousness cannot earn respect, but it apparently cannot earn affection either.

The best thing that could happen to Barack Obama is more Democratic losses in hodgepodge elections that might yank away our young transfixed Narcissus from his mesmerizing reflecting pool.

Almost immediately after Obama showed his ideological cards last spring, I suggested in the first weeks of his presidency that the bait-and-switch president would soon face a Carter/Clinton moment in which he could either press on with his polarizing ideology, damage his party for a generation, and eventually end up churlish and sneering at the electorate, who did not appreciate his exalted morality and genius — or triangulate and follow the Dick Morris/Bill Clinton model of talking and acting sort of centrist.

Who knows after Obama’s Scott Brown moment? We now may hear once again the old “no more Red State/Blue State” tropes, the stale campaign promises of presidential vetoes, claims of financial sobriety, the return of a “war on terror,” and smaller government

We’re either down to all that — or Obama’s more principled road to perdition.

a LEGAL OPINION ABOUT HEALTHCARE

2009-09-17T09:27:00.000-07:00

Seeing but not Believing Obama’s Faulty Health Care Plan
By Mandi D. Campbell, J.D. Legal Director,
Liberty Center for Law & Policy

Many of us have been watching President Obama’s speeches on health care, and have found his comments appalling and at times, humorous. Some of his most entertaining stand-up was captured in Grand Junction, Colorado, on August 15. (See the full text of his speech at: http://latimesblogs.latimes.com/washington/2009/08/barack-obama-colorado-healthcare-text.html). But Obama has regurgitated his talking points at Town Hall Meetings across the country. In the early 1990s, Clinton tried the same scare tactics, screaming that people would die and the economy would fail if health care wasn’t reformed. Well, his plan was voted down, and miraculously we all survived!
Obama says things like: “People have been working on this for months now.” Seriously? A few months? The idea that this is supposed to comfort me is laughable! This health care plan is the introduction of a system that will radically change health care for everyone by changing availability, affordability, and quality. It wouldn’t bother me if Congress spent a few years ensuring that they got this one right. Socialized health care has only created more problems in the UK and Canada (who are warning us against it) and this type of radical change can’t be undone overnight.
When countries that have government-run health care are warning us against it, we should probably listen. I grew up with an older brother. He didn’t get into too much trouble, but from time to time he would come up with some mischievous adventure that would potentially result in some form of punishment by our parents. Knowing the possible outcomes, I would wait to see my parents’ reaction to his acts, before following suit. If he got a spanking, I wasn’t willing to do what he did, no matter how great the adventure sounded, because I’d learned from his mistake. We have a great opportunity to learn from the mistakes of others, and we should heed their warnings. (The following video is a warning from a man who is both a citizen and politician in the U.K: http://www.casttv.com/video/h958dn/glenn-beck-daniel-hannan-mep-warns-america-about-obamacare-fox-news-video .)
Just to clarify, I know that Obama said that “nobody is talking about government takeover of health care. There’s a difference between what we’re proposing, which has some government involvement, versus this idea that somehow government is going to take over everything….” I also know that he said, “… the notion that somehow just by having a public option you have the entire marketplace destroyed is just not borne out by the facts. And in fact, right now you’ve got a lot of private companies who do very well competing against the government. UPS and FedEx are doing a lot better than the post office.” The fact is, those short statements are impregnated with lies and deception.
First, the idea that Obama is not interested in government takeover of health care is false. In 2007 and 2008 he was recorded stating that he’s a proponent of a “single-payer universal healthcare plan.” (See http://www.youtube.com/watch?v=fpAyan1fXCE ; http://www.youtube.com/watch?v=p-bY92mcOdk.) Sometimes it is difficult to know a politician’s true motives in initiating legislation. Then, other times, they’ve made it very clear. Obama has made his wishes and intent very clear, he wants a “single-payer” system, and even I know the government is taking over when it institutes a single-payer system.
Second, even Obama states many factors that give the government an upper-hand when competing with private insurers. He said, “It is true that there are certain costs associated with a private business that a government would not have to worry about.... It’s not just, by the way, property taxes; it’s also things like just the cost of capital. In terms of the cost of borrowing, a public option – insurance companies have to have a lot of money on hand and it’s conceivable that a private entity that’s having to pay a certain interest rate for their money would be really undermined if the government is able to get money much cheaper implicitly because Uncle Sam backs this operation.” These factors will enable the government to charge less for its insurance which will push good care and private insurers out of the market. That being considered, the government will still have to pay doctors and hospitals, their operating costs may simply be lower.
Finally, I’m glad Obama brought up the United States Postal Service because in 2004, the Supreme Court of the United States determined that because the United States Postal Service is a part of the federal government, according to federal antitrust laws, it could not be sued. United States Postal Serv. V. Flamingo Indust. (USA) Ltd., 540 U.S. 736 (2004). Additionally, as a military dependent, I’ve heard a number of stories about families who’ve wanted to sue their military doctors, but because the doctors work for the federal government, by law, they could not do so. I typed in “military doctors cannot be sued” in my search engine and a number of shocking articles about the quality of government-provided-care appeared. This should also serve as a warning to us because just as you can’t sue the post office or military doctors, if the federal government runs your insurance program, you will have no legal recourse if you are refused coverage of a drug, treatment, or procedure that should have been covered by your plan. To me, that’s a scary thought.
Whether this health care plan becomes a “co-op,” “public option,” or “single-payer system,” my big question, which nobody has provided an answer for, is: How are we going to pay for this system? My parents always told me that money didn’t grow on trees and I’m pretty sure that, not even the government has a secret garden where it can harvest money. It comes from you and me, from our pockets, from our paychecks. Obama said, “…we will do all of this without adding to our deficit over the next decade…,” but he also said, “It is absolutely true that in order for us to provide help to those who have no insurance at all, that’s going to cost some money. It’s going to cost some money. We can’t do it for free.” On this one point, he was very
clear-this health care plan will cost you and me money. The question that remains is: How will we pay into the system?
Obama has said the “[p]ublic option can only work if they have to collect premiums just like a private insurer…” But, who pays the premiums for those who currently cannot afford insurance? I have a sneaking suspicion that I’m going to get to pay for mine through my premium and I’ll get taxed to pay for John Doe’s too.
Are you screaming, “Stop the presses?” Are you thinking, “No, Obama said he wouldn’t raise taxes to pay for this?” Well, even if that holds true (which is impossible), he also said he would cap the itemized deductions for upper middle class families at “28 percent.” I’m no economist, but I’m pretty sure that if you take away the option to subtract (or itemize deductions) you are in essence, adding (or raising) taxes. Is that really fair? I’m not in that class of persons Obama is planning on taking deductions away from, but I still think that a person who is benevolent should not be penalized for their benevolence. The more one gives, the more he should be able to deduct (in proportion to the gift, obviously).
Thus, premiums, which I currently pay for my insurance, and higher taxes, I mean lower deductions, will, according to Obama, fix the health care problem without increasing our deficit, even though Obama said: “The biggest driver of our deficit and debt is health care?” Now, that makes me curious. Does he really think that “driver” will diminish when the government takes the responsibility for paying for the health care of more Americans?
The UK cannot make government-run health care work; this is obvious based on a number of articles that state hospitals in the UK sacrifice the health of patients in order to meet government-imposed time targets. http://www.telegraph.co.uk/health/healthnews/5008442/NHS-targets-may-have-led-to-1200-deaths-in-Mid-Staffordshire.html Canada can’t make their system work, many people who need specialized care come to America to receive it. And, even Obama acknowledges our government’s inability to effectively manage Medicare. He made a number of references to Medicare, such as, “The deficit will continue to grow because most of it is Medicare and Medicaid. Medicare will go into the red in less than a decade,” and “Medicare in about eight to nine years goes into the red. Somebody mentioned it’s going broke – yes, it is going broke.” So, what he’s telling us is, our government cannot manage providing health care for part of our population, and to fix that, we’re going to give the government the responsibility of providing health care to everyone? Call us crazy, but most Americans would agree that the government should get Medicare under control before adding to its financial problems.
Even considering the financial strain this plan will impose on families across the nation, my biggest fear is that this health care plan will not only take our money, but it will also take our lives. Obama said, “We had a provision in the House bill that would give the option – the option – of somebody getting counseling on end-of-life care or hospice care, and have it reimbursed by Medicare; the option – voluntary – so you’d have more information about how to deal with these situations.” This is an odd interpretation, because the version of the Bill that I read states that those covered by Medicare are to have an “advance care planning consultation” every “5 years” or “more frequently” if the patient has a significant change in his health condition. One of the topics the physician is required to cover are “end-of life services.” The Bill specifically states but does not limit the counsel to hospice care. Therefore, in Oregon and Washington where euthanasia is an end-of-life service, it is likely that physicians would be required to inform their
patients about euthanasia. And, sadly, the Amendment for a conscience clause was rejected. So, even those physicians who are morally troubled by the idea of encouraging and assisting their patients with suicidal attempts would be required to comply with the counseling requirements.
Ironically, the National Health System in the UK uses similar language (“end-of-life plan”) to our government’s proposal (“end-of-life care”), when discussing care for their older people. For one older woman in the UK, the end-of-life plan meant a death sentence. After being admitted to the hospital, she was deprived water and nourishment because, according to the hospital, she was dying (and it’s a waste of money to feed someone who is dying). However, when her family members visited her, in spite of threats of reporting the family members to social services, they provided the elderly woman with food and water. The family was later able to get her released from the hospital. On the date the article sharing her experience with national health care was written, the woman celebrated her birthday: http://www.lifesitenews.com/ldn/2008/jul/08070205.html. It is amazing what a little bit of food and water can do for the human body. The potential that the government could attribute a higher value to preserving food than preserving life is shocking.
I know it’s difficult to believe, especially when organizations like AARP support the health care plan. I was confused about that too. I didn’t know much about AARP, except that my grandfather was a member; so, I looked at their web site’s vision, “a society in which everyone ages with dignity and purpose….” The vision sounds great, until you find out that the euthanasia laws that were passed in Oregon and Washington were introduced as a “Death with Dignity Act[s].” With AARP fervently supporting Obama’s health care plan, I’m not convinced that the similarity in the language of AARP’s vision and Washington and Oregon’s euthanasia legislation are a coincidence.
Ignoring taxpayers, the elderly and their families, people who believe in the free market system, and people who tend to believe their British and Canadian friends who warn against government-run health care, Obama said: “The only category of folks who might not like this plan are employers who can afford to provide health insurance to their employees but aren’t doing so…” Well, setting aside the fact that there are a number of Americans, democrat and republican and conservative and liberal, who don’t like this health care plan, small business owners around the country must be asking, who is Obama to say what an employer can afford? Perhaps the employer is using its resources to employ more people (in a market where much of the population is seeking employment), perhaps paying a higher salary in order to allow employees to choose their own insurance plan, or perhaps in the business owner’s professional opinion, he truly does not believe he can afford it. Why can’t we trust these small business owners to do their best by their employees, and trust the employees to object or find other employment if the business owner neglects to do so? Why must the government get involved?
Oh, yes, for the “…46 million people [who] don’t have health insurance...,” or is it the “47 million Americans” that Obama referred to as not having insurance on July 22, 2009? I guess it doesn’t really matter. Both numbers are inflammatory! Of those 47 million people, according to the census, more than 21% are not Americans, over 19% have a household income of over $75,000 a year, and over 17% of the individuals without insurance earn over $50,000 a year. Is it really fair for you to pay for the insurance of others who are either not citizens or who have the means of providing their own insurance?
Obama tried to pull at our heart’s strings too by saying, “…the work of generations past reminds us of our duty to generations yet to come,” and approving the health care plan is “a core ethical and moral obligation.” First, he’s exorbitantly increased the debt that my posterity will be accountable for, and now he wants to talk about our duty to future generations? Better late than never, I guess. But, this health care plan will not benefit our children and grandchildren, it will deprive them the care they want and need. Second, Obama is not the indicator on my moral compass. And, third, the fact that he is trying to scare and guilt people into joining the dark side that devalues a free market economy and the lives of people (as evidenced by the “end-of-life care” provisions and the House’s refusal to adopt an Amendment that would prevent abortion funding through this health care plan) is utterly ridiculous.
The American people should expect more from their representatives, and their representatives should be able to deliver them a plan with more safeguards and less government control. Representatives like Barney Frank should be more willing to answer their constituents’ questions, rather than nastily responding (to one citizen who, according to The Weekly Standard, was “a Lyndon LaRouche Democrat”), “trying to have a conversation with you would be like trying to argue with a dining room table, I have no interest in doing it.” But, then again, I guess I too would dodge questions about the health care plan, especially when the system proposed will not benefit the people of this country. The quality of care will go down, the availability of licensed physicians will go down, and the cost for the average American will likely go up because according to Obama’s plan, you not only have to pay your own premium, but you will also be paying for the premiums of others. If there’s one thing I learned in economics class, it’s that “there’s no such thing as a free lunch,” somebody will have to pay for it!

The health care dilemma - Parts I, II, III Problematic issues to health care in review

2009-09-07T06:30:00.000-07:00

Thanks to American Daughter for posting these articles.

The Health Care Dilemma: Part I

By Harris Sherline | Thursday, July 23rd, 2009 at 12:30 am

Leading the effort to sell his health care plan to the nation, President Obama has been appearing almost non-stop in almost any venue that will have him. There is growing opposition to his proposal, as the details come to light. But he presses on, convinced of his own infallible judgment, that he knows what’s best for the entire nation of 300 million plus people and that only his ideas can possibly solve the problem.

Economist Walter E. Williams noted, “I doubt whether there are many Americans who think Congress has either the right or competency to choose where they live, what clothes they wear or what cars they drive. Yet many Americans stand ready to allow Congress to decide what doctors they can use and what treatments they receive. We forget that once we have government-sponsored health care, it can be used to justify almost any restraint on liberty.”

And, columnist David Harsanyi commented, “The president claims that we must pass a government-run health insurance program — possibly the most wide-ranging and intricate government undertaking in decades — yesterday or a ‘ticking time bomb’ will explode. If all this terrifying talk sounds familiar, it might be because the president applies the same fear-infused vocabulary to nearly all his hard-to-defend policy positions. You’ll remember the stimulus plan had to be passed without a second’s delay or we would see 8.7 percent unemployment. We’re almost at 10.”

If the government is so efficient and capable of running large organizations, how is it that the post office and the railroads have never been able to operate at break even, let alone make a profit? So, why would a gigantic health care system that accounts for an estimated 18 percent of the nation’s total economic output be able to do any better?

Medicare is held up as an example of a government run health care system that covers a major portion of the population (about 13 percent), yet operates efficiently, with only about three percent administrative overhead, while providing almost unlimited care to seniors at a reasonable cost. Unfortunately, the reality is not quite as advertised.

For one thing, Medicare loses money. It is one of the nation’s biggest unfunded liabilities. So, the program may be efficient, but it loses money. The Peter G. Peterson Foundation notes: “… between Medicare’s three programs (hospital insurance, outpatient, and prescription drug), current and future promised Medicare benefits amounted to $36.3 trillion.”

Another little-known fact about Medicare is that the program is able to control costs only because it can dictate the prices it pays for services. In other words, the system employs price controls to keep costs down. However, it’s a well documented historical fact, dating as far back as the early Romans (Diocetianus, 244-301 A.D.), that price controls don’t work. For example, hospital fees for both inpatient and outpatient services are determined by the government, in its sole discretion.

Furthermore, prices are set according to a system established by Medicare, which then pays only 80 percent of the fees that it determines are or should be the proper charges. Still, Medicare loses money.

Another representation of the Obama administration and others who are pushing for national health coverage is that there are 47 million Americans who do not have any health insurance, which provides the basis for their haste to adopt a plan. Once again, however, at best this is simply inaccurate, at worst, it’s a gross misrepresentation. FactCheck.org offers the following information:

“Twenty-six percent of the uninsured are eligible for some form of public coverage but do not make use of it…this is sometimes, but not always a matter of choice.”

“Twenty percent of the uninsured have family incomes of greater than $75,000 per year, according to the Census Bureau.”

“Forty percent of the uninsured are young…many young people lack insurance because it’s not available to them, and people who turn down available insurance tend to be in worse health, not better…”

Star Parker has written, “Pulling immigrants out of the equation, we’re left with an uninsured population that can’t afford insurance that is about a third the size of the widely quoted 47 million. It’s a population that is generally poor, young, uneducated, and not working…We’re already set up to deal with these folks. Either through Medicaid or covering their emergency room visits.”

As usual, statistics are being misused or misrepresented to support a position that is not necessarily valid. In this case, the need for a government run health care program for everyone.

Read more of Harris Sherline’s commentaries on his blog at “www.opinionfest.com”

The Health Care Dilemma: Part II

By Harris Sherline | Monday, July 27th, 2009 at 12:30 am

How to pay for a national health care plan is one of the big obstacles the Obama administration must hurdle in order to reach its goal of providing health insurance coverage for every American. The question is whether it can be done at all without literally breaking the bank - especially following on the heels of the approximately $10 trillion in expenditures over the next few years that have already been approved by Congress and signed into law.

So, how do Obama and Congress plan to get this done?

First, they talk almost incessantly about between $1 trillion and $2 trillion in cost savings that can be achieved in the current health care system. He problem is that there is no way to measure it. Not really. It’s just talk.

A number of other ideas are also being floated to pay for universal health care coverage, and the ultimate choice will probably include some combination of the following:

Taxing the “rich”: This source couldn’t possibly cover all the proposed costs of a national health care plan. A graphic illustration can be seen in the fact that if you tax away the profits of the entire Fortune 500 list of companies, it would only bring in around $100 billion. In 2008, the number was $99 billion. This assumes that these businesses would continue to operate if everything they earned is confiscated by the government, in addition to the income taxes they already pay. As for the individual “rich” taxpayers, the result would be much the same. The combined net worth of the Forbes 400 richest Americans is about $1.2 trillion. If the government took everything they have to fund universal health care, it would only be a one-time fix, leaving nothing to tax in the future.

Taxing health care benefits that employees currently receive tax-free from their employers: No doubt this can be accomplished, but not without reducing the incentive employers have to provide health care coverage for their employees. The idea also includes tinkering around the edges of income tax deductions on individual tax returns, such as reducing the deductibility of various expenses. This can certainly generate more taxes, but hardly enough to pay for universal health care on an ongoing basis.

Cutting costs in the current health care system by improving technology, reducing unnecessary or duplicative procedures also really can’t be measured with any degree of confidence. There are simply too many moving parts, all interacting in different ways at different times and continuously changing at the same time.

Reducing payments to doctors and hospitals for Medicare and Medicaid patients: Contrary to the public perception, doctors are already being underpaid by both Medicare and Medicaid, with the result that many physicians are no longer willing to accept patients whose care is paid for by these programs. Furthermore, the government is notoriously “slow pay,” especially the state Medicaid programs. For instance, in California, MediCal is so slow and underpays for services so severely that many doctors refuse to accept their patients. An actual situation I encountered while I was running a hospital illustrate the point: a general surgeon was paid ten cents for a $50 fee that he charged for an emergency room consultation. On another occasion, a neurologist received only 17 cents for an ER consult. Such cases were not all that unusual. So, you can cut payments, but unless you are willing to conscript doctors, you can’t force them to treat patients whose bills are paid by the government.

Lowering the cost of health care insurance by creating a program that will compete with private sector insurance plans seems like a good idea on paper. But the reality is that a government funded health insurance program has unlimited financing available, which means that any losses they might experience will be funded regardless of whether the plan is profitable or not. The private sector can’t compete with this and will eventually be forced out of business, leaving the government plan as the only remaining option. It’s unfair competition, but it won’t be viewed that way by most politicos. There are laws designed to prevent this sort of predatory behavior by private citizens and businesses, but it’s generally OK when the government does it.

It never ceases to amaze me how often people in government seem to think that they are smart enough to structure programs that can control and regulate human behavior without imposing autocratic control over people. It has been repeatedly tried throughout history, and it always fails – eventually. The evidence is abundantly clear in the universal health care plans of other countries that have already adopted such programs.

Read more of Harris Sherline’s commentaries on his blog at “www.opinionfest.com”

The Health Care Dilemma: Part III

By Harris Sherline | Thursday, July 30th, 2009 at 12:30 am

How about universal health care plans in general? How well do they work? Do they deliver as promised, or can they? The two most often mentioned systems are those in England and Canada, although there are others as well: Germany, Japan, Sweden, Finland and Russia, for example. There are also a couple of well-known programs in the U.S., notably in Massachusetts and Oregon, that can be studied to see how effective or efficient government run health care actually is.

So, before jumping off the edge ourselves, doesn’t it make sense that we should evaluate how well some of these other plans are working? Looking at just three, Canada, Oregon and Massachusetts, provides some insight into the track record of government health-care programs:

Assessing Canada’s health care program, Dick Morris noted the following statistics:

A 16% higher cancer death rate in Canada
An eight week wait for radiation therapy for cancer patients.
42% of Canadians die of colon cancer vs. 31% in the U.S.
Cutbacks in diagnostic testing.
The best methods for chemo therapy are not available.
No way out of the system; you can’t even pay for services yourself.

David Gratzer, a Canadian physician, writes in the Wall Street Journal (June 9, 2009):

…Canadians wait for practically any procedure or diagnostic test or specialist consultation in the public system…Canada’s provincial governments themselves rely on American medicine. Between 2006 and 2008, Ontario sent more than 160 patients to New York and Michigan for emergency neurosurgery…Only half of ER patients are treated in a timely manner by national and international standards, according to a government study. The physician shortage is so severe that some towns hold lotteries, with the winners gaining access to the local doc.

How about Oregon, which established a government-run plan in 1993? IBD Editorials.com noted the following (June 9, 2009), among other observations:

…the state’s Health Services Commission (like the title?) has compiled a list of 680 treatments, only 503 of which will be paid for by the Oregon Health Plan…Got condition No. 504…Treatment for lichen planus, a skin rash, is an out-of-pocket expense…So is therapy for a cracked rib (No. 512), nasal polyps (No. 524), a broken big toe (No. 527) and liver cancer (No. 575).” Oregon residents must pay for treatment of all these conditions themselves, along with many other health problems.

A great many lifesaving procedures that ranked high in 2002 have been relegated to much lower positions in 2009, while procedures only tangentially related to life and death have climbed to the top…Treatment for type I diabetes…was ranked second in 2002 but demoted to 10th in 2009, even though not providing treatment is a death sentence.

So, if Oregon didn’t get it quite right, how about Massachusetts, which adopted its own state mandated health care plan in 2006?

Michael Tanner, a senior fellow with the Cato Institute, wrote a briefing paper in June 2009, “Massachusetts Miracle or Massachusetts Miserable: What the Failure of the Massachusetts Models Tells Us about Health Care Reform,” in which he observed:

Although the state has reduced the number of residents without health insurance, 20,000 people remain uninsured…Health care costs continue to rise much faster than the national average…New regulations and bureaucracy are limiting consumer choice and adding to health care costs…Program costs have skyrocketed. Despite tax increases, the programs faces huge deficits – with its attendant rationing…A shortage of providers, combined with increasing demand, is increasing waiting times to see a physician.

In the final analysis, national or universal health care systems, whatever they are called, are invariably forced to resort to rationing of services, by limiting care on the basis of cost, age, the severity of disease or injury, or various other criteria. It’s unavoidable and will happen in the U.S. if the Obama administration manages to get Congress to pass a health care bill.

Whatever the result, the simplest way to evaluate Obama’s health care plan is to ask your Congressperson and Senator if they will be required to participate in the same program as their constituents. If not, why not? And, if not, why should you?

Read more of Harris Sherline’s commentaries on his blog at “www.opinionfest.com”

A medical opinion and review concerning the health care bill in the House of Representative

2009-09-03T07:07:00.000-07:00

THE OBAMA HEALTH CARE PLAN – IN ONE WORD

By David H. Janda M.D.

As a physician who has authored books on Preventative Health Care and Health Care Cost Containment, I was recently given the opportunity to be the keynote speaker at a Congressional Dinner at The Capitol Building in Washington D.C… The presentation, entitled Health Care Reform; The Power & Profit of Prevention was well received.

In preparation for the presentation, I read the latest version of “reform” as authored by The Obama Administration and supported by Speaker Pelosi and Senator Reid. It is important to realize that The Obama Health Care Plan is comprised of two parts…..that’s right, not one but two parts.

The first part of The Obama Health Care Plan was buried in The Stimulus Bill which was signed into law by the President in February (see READ the STIMULUS). It is the second part of The Health Care Plan which is now being debated in Congress. Below is the link to the over 1000 page document….. Bill Text, Adobe PDF format.

Let me summarize just a few salient points of the two part Obama Health Care Plan. Warning……. They need to put the same warning on The Obama Health Care Plan as they do a pack of cigarettes…..Consuming this product WILL be hazardous to your health.

The underlying method of cutting costs throughout the plan is based on rationing and denying care, NOT PREVENTING health care need. The plan’s method is the most inhumane and unethical approach in cutting costs. The rationing of care is implemented through a Council, equivalent to the National Health Care Board in the British Health Care System. The name given to this panel is The Federal Coordinating Council For Comparative Effectiveness Research (”Federal Council”). (Section 9201 H.R. 1 Version of the Stimulus Bill.)

President Obama has already appointed the fifteen member Federal Council. According to the Stimulus Bill, p. 152, all members of the Council must be “senior federal officers or employees.” Thus, medical treatment will be dispensed by a group of bureaucrats from their ivory towers, not by the hands-on practitioners in the presence of the patients. The council was funded with $1.1 BILLION from The Stimulus Bill. (Source.)

“Comparative Effectiveness Research” is based on the formula of the approval or rejection of treatment for patients based upon the cost per treatment divided by the number of years the patient will benefit from the treatment.

According to former New York Lieutenant Governor and Health Policy Analyst Dr. Betsy McCaughey, the Federal Council will set a cost effectiveness standard for treatment. (Stimulus Bill p. 464) Translation…..if you are over 65 or have been recently diagnosed as having an advanced form of cardiac disease or aggressive cancer, dream on if you think you will get treated…..pick out your box. Oh, you say…this could never happen. Sorry….this is the same model they use in Britain.

The plan also empowers the Federal Council to create another level of bureaucracy, The Center for Comparative Effectiveness Research. (Health Care Bill, Section 1181, p. 502). The effect of this extra level of bureaucracy is to slow the development of new medications and technologies in order to reduce costs. How special is that!

The plan also outlines that doctors and hospitals will be overseen and reviewed by The National Coordinator of Health Information Technology. This “Coordinator” will be responsible for monitoring treatments to make sure doctors and hospitals are strictly following what the government deems appropriate and cost effective, and to “guide medical decisions at the time and place of care.” (Stimulus Bill, p. 116; see also pp. 442, 446).

The Stimulus Bill goes on to say that hospitals and doctors that are NOT “meaningful users” of the new systems will face penalties. The Secretary of Health and Human Services will be empowered to impose “more stringent measures of meaningful use over time.” (Stimulus Bill pp. 366, 478, 511, 518, 540, 541.) According to those in Congress, penalties could include large six figure financial fines and possible imprisonment. According to the Obama Plan, if your doctor saves your life but breaks government protocol, you might have to go to the prison to see your doctor for follow-up appointments. I believe this is the same model Stalin used in the former Soviet Union.

Section 102 of the Health Care Plan has the Orwellian title: “Protecting the Choice to Keep Current Coverage.” What this section really mandates is that it is ILLEGAL for you to keep your private insurance if your status changes, e.g., if you lose or change your job, become a senior citizen, graduate from college and land your first job. Yes, illegal. When President Obama was asked about this portion of his plan recently, his response was, “I am not familiar with that part of the plan.”

Obama hosted a conference call with bloggers urging them to pressure Congress to pass his health plan as soon as possible.

During the call, a blogger from Maine said he kept running into an Investors Business Daily article that claimed Section 102 of the House health legislation would outlaw private insurance. He asked: “Is this true? Will people be able to keep their insurance and will insurers be able to write new policies even though H.R. 3200 is passed?” President Obama replied: “You know, I have to say that I am not familiar with the provision you are talking about.”

Then there is Section 1233 of the Health Care Bill, devoted to “Advanced Care Planning.” After each American turns 65 years of age they have to go to a mandated counseling program that is designed to end life sooner. This session is to occur every 5 years unless the person has developed a chronic illness then it must be done every year. The topics in this government run session will include how to decline hydration, nutrition and how to initiate hospice care. It is no wonder the Obama Administration does NOT like my emphasis on Prevention. Under the Health Care Plan for cost containment, Prevention is the “enemy,” since people would live longer.

I rest my case….The Health Care Plan authored by Obama / Pelosi / Reid is hazardous to the health of every American.

In the question/answer session following my Capitol Hill presentation, a Congressman asked: “I am doing a number of network interviews next week on the Obama Health Care Plan. If I am asked what is the one word to describe the plan, what should I answer?”

The answer is simple, honest, direct, analytical, and sad, but truthful. The word is FASCIST.

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Dr. Janda is an orthopedic surgeon and a world-recognized expert on prevention, healthcare cost containment, and health care reform. His website is NOINJURY.com and is a medical site, not a political site. He recently appeared on Ophra.

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Midknight Review additional notes: As used in this article, the word "Fascist" is not about Germany, Hitler or the killing of millions of people including 7 million Jews. In short, the word does not describe a politial/nationalistic machine. Rather, it describes an economic system in which the government "runs" or manages [via legislation and more] privately owned businesses. Socialism is government owned and managed business situations. . . . . mid. rev. editor

Public option and "co-op" are very nearly the same thing.

2009-09-02T03:05:00.000-07:00

Co-ops: A ‘Public Option’ By Another Name

Posted by Michael D. Tanner

Politico reports that the so-called “public option” provision could be dropped from the highly controversial health care bill currently being debated throughout the country:

President Barack Obama and his top aides are signaling that they’re prepared to drop a government insurance option from a final health-reform deal if that’s what’s needed to strike a compromise on Obama’s top legislative priority…. Obama and his aides continue to emphasize having some competitor to private insurers, perhaps nonprofit insurance cooperatives, but they are using stronger language to downplay the importance that it be a government plan.

As I have said before, establishing health insurance co-operatives is a poor alternative to the public option plan. Opponents of a government takeover of the health care system should not be fooled.

Government-run health care is government-run health care no matter what you call it.

The health care “co-op” approach now embraced by the Obama administration will still give the federal government control over one-sixth of the U.S. economy, with a government-appointed board, taxpayer funding, and with bureaucrats setting premiums, benefits, and operating rules.

Plus, it won’t be a true co-op, like rural electrical co-ops or your local health-food store — owned and controlled by its workers and the people who use its services. Under the government plan, the members wouldn’t choose its officers — the president would.

The real issue has never been the “public option” on its own. The issue is whether the government will take over the U.S. health care system, controlling many of our most important, personal, and private decisions. Even without a public option, the bills in Congress would make Americans pay higher taxes and higher premiums, while government bureaucrats determine what insurance benefits they must have and, ultimately, what care they can receive.

Obamacare was a bad idea with an explicit “public option.” It is still a bad idea without one.

Michael D. Tanner • August 17, 2009 @ 10:33 am

Tennessee Experiment's High Cost Fuels Health-Care Debate

2009-08-18T10:53:00.000-07:00

By AVERY JOHNSON

In 1994, Tennessee launched an ambitious public insurance program to cover its uninsured. The plan, TennCare, fulfilled that mission but nearly bankrupted the state in the process.

As originally envisioned, the Tennessee plan expanded Medicaid, the government health-care program for the poor, to cover people who couldn't afford insurance or who had been denied coverage by an insurance company.

With an initial budget of $2.6 billion, TennCare quickly extended coverage to an additional 500,000 people by making access to its plans easy and affordable. But the program became so expensive that Tennessee was forced to scale it back in 2005.

Now, as Congress debates a national health-care overhaul, state experiments like Tennessee's are informing the discussion.

Unlike Massachusetts's more recent universal coverage law, the TennCare plan is most often cited by opponents. They say TennCare's runaway costs show that the public health-insurance proposal by House Democrats could bankrupt the federal government.

In a letter to Congress last month, Rep. Marsha Blackburn (R., Tenn.) compared the public plan envisioned in the House bill to TennCare, warning that TennCare became so costly at its peak that it ate up one-third of Tennessee's budget.

"The promise of TennCare has gone unrealized," she wrote. "Many of the concerns we have expressed about the proposal before us today are the stark realities of a system that went terribly wrong in Tennessee."

The Obama administration says TennCare is different from the proposed public plan because its administration of the Tennessee program is contracted out to private companies. A federal public plan would more likely be run by the government, although the White House on Sunday signaled that it wouldn't insist on having a public option.

Another difference, the administration says, is that a public option would increase competition in the health-insurance market by offering an alternative to private insurers; TennCare was the primary option for Tennessee's uninsured.

What the Tennessee experiment did share with health-care-overhaul supporters was its ambition to cover the uninsured. To qualify, patients only had to show a denial letter from an insurance plan. TennCare charged $2.74 a month in premiums for people earning just above the poverty level. Its rolls quickly swelled to 1.4 million people, leaving only 6% of Tennessee's population without health insurance. It never achieved complete universal coverage in part because of an income cap.

"The lesson is you can quite quickly cut the number of uninsured," said Alan Weil, executive director of the National Academy for State Health Policy. "Tennessee is not a well-off state and they just kind of did it."

TennCare had its failings. The plan, for example, paid health providers less than private insurance plans, prompting some physicians and hospitals to increase charges to private insurers. Some of this resulted in so-called cost shifting, with insurance companies passing on the costs through higher premiums. Opponents of a public option warn the same thing will happen nationally, to the detriment of people who already have health insurance.

Rep. Blackburn says TennCare shows that a public plan would undermine the current employer-based health-care system, citing data from University of California at San Diego that showed 45% of people claiming TennCare's benefits had left employer-provided insurance. Darin Gordon, TennCare's current director, says the switching was more limited than critics allege.

Another Tennessee congressman, Republican Phil Roe, says that as a physician who worked under the program, he saw TennCare's shortcomings up close. He says TennCare reduced access to care: physicians refused to see TennCare patients because of the program's lower reimbursement rates.

"As soon as I heard about this public option, I thought, 'I know how this works,"' said Dr. Roe. He said he has been repeating his cautionary tale about TennCare to colleagues "until I'm hoarse."

TennCare aimed to pay for much of its expanded coverage with cost savings -- mostly by reducing unnecessary care.

In its first five years, TennCare had the lowest per capita cost of any Medicaid program in the country, saving between $245 million and $2 billion by cutting down on emergency-room visits by uninsured patients, for example, according to the Tennessee Justice Center, a public-interest law firm for the poor. It has championed the program and sued the state over cutting people from its rolls.

"TennCare covered the majority of people and did it with the money that was saved by squeezing waste out of health-care infrastructure," said Michele Johnson, managing attorney at the Center.

However, the program's costs quickly escalated. After rising at a roughly $300 million annual rate in its early years, TennCare's budget swelled from $5.4 billion in 2000 to $8.5 billion in 2004. During that period, the state re-assumed much of the risk of managing the program from private insurers who complained they were losing money administering it.

In 2005, with the state's solvency in jeopardy, Gov. Bredesen reduced TennCare's rolls by about 170,000 by booting some people who weren't eligible for Medicaid. He also created a separate limited insurance option called CoverTN that covers only up to $25,000 in annual medical costs.

Emily Tell of Nashville is among those who got bumped off TennCare's rolls. Uninsured after she lost a job in customer service at an insurance agency, she went on TennCare in 2001. She said the program paid an expensive medical bill from a car wreck that resulted in two foot surgeries.

When she got a letter in the mail several years ago telling her she no longer qualified for the program, she says she didn't know what to do. She eventually enrolled in CoverTN, which covers most of her medications for high blood pressure, cholesterol and attention deficit. But she gripes about its $125-a-month premium and regular co-payments.

"That's expensive for a single person," she said. "I know they are trying to save money, but we should have access to health care."

Write to Avery Johnson at avery.johnson@WSJ.com

Ten reasons why America’s health care system is in better condition than you might suppose.

2009-08-14T15:26:00.000-07:00

Here’s a Second Opinion

By Scott W. Atlas

Ten reasons why America’s health care system is in better condition than you might suppose. By Scott W. Atlas

Medical care in the United States is derided as miserable compared to health care systems in the rest of the developed world. Economists, government officials, insurers, and academics beat the drum for a far larger government role in health care. Much of the public assumes that their arguments are sound because the calls for change are so ubiquitous and the topic so complex. Before we turn to government as the solution, however, we should consider some unheralded facts about America’s health care system.

1. Americans have better survival rates than Europeans for common cancers. Breast cancer mortality is 52 percent higher in Germany than in the United States and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the United Kingdom and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.

2. Americans have lower cancer mortality rates than Canadians. Breast cancer mortality in Canada is 9 percent higher than in the United States, prostate cancer is 184 percent higher, and colon cancer among men is about 10 percent higher.

3. Americans have better access to treatment for chronic diseases than patients in other developed countries. Some 56 percent of Americans who could benefit from statin drugs, which reduce cholesterol and protect against heart disease, are taking them. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons, and 17 percent of Italians receive them.

4. Americans have better access to preventive cancer screening than Canadians. Take the proportion of the appropriate-age population groups who have received recommended tests for breast, cervical, prostate, and colon cancer:

Nine out of ten middle-aged American women (89 percent) have had a mammogram, compared to fewer than three-fourths of Canadians (72 percent).

Nearly all American women (96 percent) have had a Pap smear, compared to fewer than 90 percent of Canadians.

More than half of American men (54 percent) have had a prostatespecific antigen (PSA) test, compared to fewer than one in six Canadians (16 percent).

Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with fewer than one in twenty Canadians (5 percent).

5. Lower-income Americans are in better health than comparable Canadians. Twice as many American seniors with below-median incomes self-report “excellent” health (11.7 percent) compared to Canadian seniors (5.8 percent). Conversely, white, young Canadian adults with below-median incomes are 20 percent more likely than lower-income Americans to describe their health as “fair or poor.”

6. Americans spend less time waiting for care than patients in Canada and the United Kingdom. Canadian and British patients wait about twice as long—sometimes more than a year—to see a specialist, have elective surgery such as hip replacements, or get radiation treatment for cancer. All told, 827,429 people are waiting for some type of procedure in Canada. In Britain, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.

7. People in countries with more government control of health care are highly dissatisfied and believe reform is needed. More than 70 percent of German, Canadian, Australian, New Zealand, and British adults say their health system needs either “fundamental change” or “complete rebuilding.”

8. Americans are more satisfied with the care they receive than Canadians. When asked about their own health care instead of the “health care system,” more than half of Americans (51.3 percent) are very satisfied with their health care services, compared with only 41.5 percent of Canadians; a lower proportion of Americans are dissatisfied (6.8 percent) than Canadians (8.5 percent).

9. Americans have better access to important new technologies such as medical imaging than do patients in Canada or Britain. An overwhelming majority of leading American physicians identify computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade—even as economists and policy makers unfamiliar with actual medical practice decry these techniques as wasteful. The United States has thirty-four CT scanners per million Americans, compared to twelve in Canada and eight in Britain. The United States has almost twenty-seven MRI machines per million people compared to about six per million in Canada and Britain.

10. Americans are responsible for the vast majority of all health care innovations. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other developed country. Since the mid- 1970s, the Nobel Prize in medicine or physiology has gone to U.S. residents more often than recipients from all other countries combined. In only five of the past thirty-four years did a scientist living in the United States not win or share in the prize. Most important recent medical innovations were developed in the United States.

Despite serious challenges, such as escalating costs and care for the uninsured, the U.S. health care system compares favorably to those in other developed countries.

This essay appeared on the website of the National Center for Policy Analysis on March 24, 2009. An earlier version was published in the Washington Times.

Available from the Hoover Press is Power to the Patient: Selected Health Care Issues and Policy Solutions, edited by Scott W. Atlas. To order, call 800.935.2882 or visit www.hooverpress.org.

Scott W. Atlas is a senior fellow at the Hoover Institution and a professor of radiology and chief of neuroradiology at Stanford University Medical School.

Why the elderly are right to worry when the government rations medical care.

2009-08-14T09:23:00.000-07:00

Elderly Americans are turning out in droves to fight ObamaCare, and President Obama is arguing back that they have nothing to worry about. Allow us to referee. While claims about euthanasia and "death panels" are over the top, senior fears have exposed a fundamental truth about what Mr. Obama is proposing: Namely, once health care is nationalized, or mostly nationalized, rationing care is inevitable, and those who have lived the longest will find their care the most restricted.

Far from being a scare tactic, this is a logical conclusion based on experience and common-sense. Once health care is a "free good" that government pays for, demand will soar and government costs will soar too. When the public finally reaches its taxing limit, something will have to give on the care and spending side. In a word, care will be rationed by politics.

Mr. Obama's reply is that private insurance companies already ration, by deciding which treatments are covered and which aren't. However, there's an ocean of difference between coverage decisions made under millions of voluntary private contracts and rationing via government. An Atlantic Ocean, in fact. Virtually every European government with "universal" health care restricts access in one way or another to control costs, and it isn't pretty.

The British system is most restrictive, using a black-box actuarial formula known as "quality-adjusted life years," or QALYs, that determines who can receive what care. If a treatment isn't deemed to be cost-effective for specific populations, particularly the elderly, the National Health Service simply doesn't pay for it. Even France—which has a mix of public and private medicine—has fixed reimbursement rates since the 1970s and strictly controls the use of specialists and the introduction of new medical technologies such as CT scans and MRIs.

Yes, the U.S. "rations" by ability to pay (though in the end no one is denied actual care). This is true of every good or service in a free economy and a world of finite resources but infinite wants. Yet no one would say we "ration" houses or gasoline because those goods are allocated by prices. The problem is that governments ration through brute force—either explicitly restricting the use of medicine or lowering payments below market rates. Both methods lead to waiting lines, lower quality, or less innovation—and usually all three.

A lot of talk has centered on what Sarah Palin inelegantly called "death panels." Of course rationing to save the federal fisc will be subtler than a bureaucratic decision to "pull the plug on grandma," as Mr. Obama put it. But Mrs. Palin has also exposed a basic truth. A substantial portion of Medicare spending is incurred in the last six months of life.

From the point of view of politicians with a limited budget, is it worth spending a lot on, say, a patient with late-stage cancer where the odds of remission are long? Or should they spend to improve quality, not length, of life? Or pay for a hip or knee replacement for seniors, when palliative care might cost less? And who decides?

In Britain, the NHS decides, and under its QALYs metric it generally won't pay more than $22,000 for treatments to extend a life six months. "Money for the NHS isn't limitless," as one NHS official recently put it in response to American criticism, "so we need to make sure the money we have goes on things which offer more than the care we'll have to forgo to pay for them."

Before he got defensive, Mr. Obama was open about this political calculation. He often invokes the experience of his own grandmother, musing whether it was wise for her to receive a hip replacement after a terminal cancer diagnosis. In an April interview with the New York Times, he wondered whether this represented a "sustainable model" for society. He seems to believe these medical issues are all justifiably political questions that government or some panel of philosopher kings can and should decide. No wonder so many seniors rebel at such judgments that they know they could do little to influence, much less change.

Mr. Obama has also said many times that the growth of Medicare spending must be restrained, and his budget director Peter Orszag has made it nearly his life's cause. We agree, but then why does Mr. Obama want to add to our fiscal burdens a new Medicare-like program for everyone under 65 too? Medicare already rations care, refusing, for example, to pay for virtual colonsocopies and has payment policies or directives to curtail the use of certain cancer drugs, diagnostic tools, asthma medications and many others. Seniors routinely buy supplemental insurance (Medigap) to patch Medicare's holes—and Medicare is still growing by 11% this year.

The political and fiscal pressure to further ration Medicare would increase exponentially if government is paying for most everyone's care. The better way to slow the growth of Medicare is to give seniors more control over their own health care and the incentives to spend wisely, by offering competitive insurance plans. But this would mean less control for government, not more.

It's striking that even the AARP—which is run by liberals who favor national health care—has been backing away from support for Mr. Obama's version. The AARP leadership's Democratic sympathies will probably prevail in the end, perhaps after some price-control sweeteners are added for prescription drugs. But AARP is out of touch with its own members, who have figured out that their own health and lives are at stake in this debate over ObamaCare. They know that when medical discretion clashes with limited government budgets, medicine loses.

Obama's Senior Moment (WSJ article)

Palin Defends Her Concerns Regarding The 'Death Panels.'

2009-08-13T22:11:00.000-07:00

Yesterday President Obama responded to my statement that Democratic health care proposals would lead to rationed care; that the sick, the elderly, and the disabled would suffer the most under such rationing; and that under such a system these “unproductive” members of society could face the prospect of government bureaucrats determining whether they deserve health care.

The President made light of these concerns. He said:

“Let me just be specific about some things that I’ve been hearing lately that we just need to dispose of here. The rumor that’s been circulating a lot lately is this idea that somehow the House of Representatives voted for death panels that will basically pull the plug on grandma because we’ve decided that we don’t, it’s too expensive to let her live anymore....It turns out that I guess this arose out of a provision in one of the House bills that allowed Medicare to reimburse people for consultations about end-of-life care, setting up living wills, the availability of hospice, etc. So the intention of the members of Congress was to give people more information so that they could handle issues of end-of-life care when they’re ready on their own terms. It wasn’t forcing anybody to do anything.” [1]

The provision that President Obama refers to is Section 1233 of HR 3200, entitled “Advance Care Planning Consultation.” [2] With all due respect, it’s misleading for the President to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. The issue is the context in which that information is provided and the coercive effect these consultations will have in that context.

Section 1233 authorizes advanced care planning consultations for senior citizens on Medicare every five years, and more often “if there is a significant change in the health condition of the individual ... or upon admission to a skilled nursing facility, a long-term care facility... or a hospice program." [3] During those consultations, practitioners must explain “the continuum of end-of-life services and supports available, including palliative care and hospice,” and the government benefits available to pay for such services. [4]

Now put this in context. These consultations are authorized whenever a Medicare recipient’s health changes significantly or when they enter a nursing home, and they are part of a bill whose stated purpose is “to reduce the growth in health care spending.” [5] Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care? As Charles Lane notes in the Washington Post, Section 1233 “addresses compassionate goals in disconcerting proximity to fiscal ones.... If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health-care costs?” [6]

As Lane also points out:

Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. Indeed, that’s an incentive to insist.

Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic. [7]

Even columnist Eugene Robinson, a self-described “true believer” who “will almost certainly support” “whatever reform package finally emerges”, agrees that “If the government says it has to control health-care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending.” [8]

So are these usually friendly pundits wrong? Is this all just a “rumor” to be “disposed of”, as President Obama says? Not according to Democratic New York State Senator Ruben Diaz, Chairman of the New York State Senate Aging Committee, who writes:

Section 1233 of House Resolution 3200 puts our senior citizens on a slippery slope and may diminish respect for the inherent dignity of each of their lives.... It is egregious to consider that any senior citizen ... should be placed in a situation where he or she would feel pressured to save the government money by dying a little sooner than he or she otherwise would, be required to be counseled about the supposed benefits of killing oneself, or be encouraged to sign any end of life directives that they would not otherwise sign. [9]

Of course, it’s not just this one provision that presents a problem. My original comments concerned statements made by Dr. Ezekiel Emanuel, a health policy adviser to President Obama and the brother of the President’s chief of staff. Dr. Emanuel has written that some medical services should not be guaranteed to those “who are irreversibly prevented from being or becoming participating citizens....An obvious example is not guaranteeing health services to patients with dementia.” [10] Dr. Emanuel has also advocated basing medical decisions on a system which “produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.” [11]

President Obama can try to gloss over the effects of government authorized end-of-life consultations, but the views of one of his top health care advisors are clear enough. It’s all just more evidence that the Democratic legislative proposals will lead to health care rationing, and more evidence that the top-down plans of government bureaucrats will never result in real health care reform.

[1] See http://blogs.abcnews.com/politicalpunch/2009/08/president-obama-addresses-sarah-palin-death-panels-wild-representations.html.
[2] See http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf
[3] See HR 3200 sec. 1233 (hhh)(1); Sec. 1233 (hhh)(3)(B)(1), above.
[4] See HR 3200 sec. 1233 (hhh)(1)(E), above.
[5] See http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf
[6] See http://www.washingtonpost.com/wp-dyn/content/article/2009/08/07/AR2009080703043.html].
[7] Id.
[8] See http://www.washingtonpost.com/wp-dyn/content/article/2009/08/10/AR2009081002455.html].
[9] See http://www.nysenate.gov/press-release/letter-congressman-henry-waxman-re-section-1233-hr-3200.
[10] See http://www.ncpa.org/pdfs/Where_Civic_Republicanism_and_Deliberative_Democracy_Meet.pdf
[11] See http://www.scribd.com/doc/18280675/Principles-for-Allocation-of-Scarce-Medical-Interventions.

H.R. 3200: America's Affordable Health Choices Act of 2009

2009-08-07T22:17:00.001-07:00

Full text of H.R. 3200 - the House version (which is the only full text "out there.") Two choices that are not in a PDF (this is a huge bill, of course, and the PDF would be a time comsumming download.)
A. U.S, Gov Track This takes less than 20 seconds to download and seems to be a more comprehensive file (we are not certain on this but we have found references in this that could not be found at Thomas. The problem may be ours, however. Thomas is an instant download.)
B. The Library of Congress - Thomas This is an immediate download

Pertinent Articles In Our Review of This Bill:

1.A Brief Over-View Of The More Controversial Regulations of the H.R. 3200 46 pts briefly discussed. This is only a beginning point in our discussion.

2. Section 102: Independent Non-Government Structured Health Care Will Become Extinct

3. H.R. 3200 - 114 Concerns From Obama Administration’s Health Care Plan A Faith Based Law Firm

4. Is there a co-pay with forced abortion? - Something To Think About.

5. Some (Much?) Of The HealthCare Bill Was Funded Back In Feburary In The Stimulus Bill. Does H.R. 3200 introduce end of life rationing? This article is about that very issue.

A Brief Over-View Of The More Controversial Regulations of the H.R. 3200

2009-08-07T22:10:00.003-07:00

• Page 22: Mandates audits of all employers that self-insure!
• Page 29: Admission: your health care will be rationed!
• Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)
• Page 42: The "Health Choices Commissioner" will decide health benefits for you. You will have no choice. None.
• Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services.
• Page 58: Every person will be issued a National ID Healthcard.
• Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer.
• Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (read: SEIU, UAW and ACORN)
• Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange.
• Page 84: All private healthcare plans must participate in the Healthcare Exchange (i.e., total government control of private plans)
• Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens
• Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan.
• Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter.
• Page 124: No company can sue the government for price-fixing. No "judicial review" is permitted against the government monopoly. Put simply, private insurers will be crushed.
• Page 127: The AMA sold doctors out: the government will set wages.
• Page 145: An employer MUST auto-enroll employees into the government-run public plan. No alternatives.
• Page 126: Employers MUST pay healthcare bills for part-time employees AND their families.
• Page 149: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll
• Page 150: Any employer with a payroll of $250K-400K or more, who does not offer the public option, pays a 2 to 6% tax on payroll
• Page 167: Any individual who doesnt' have acceptable healthcare (according to the government) will be taxed 2.5% of income.
• Page 170: Any NON-RESIDENT alien is exempt from individual taxes (Americans will pay for them).
• Page 195: Officers and employees of Government Healthcare Bureaucracy will have access to ALL American financial and personal records.
• Page 203: "The tax imposed under this section shall not be treated as tax." Yes, it really says that.
• Page 239: Bill will reduce physician services for Medicaid. Seniors and the poor most affected."
• Page 241: Doctors: no matter what speciality you have, you'll all be paid the same (thanks, AMA!)
• Page 253: Government sets value of doctors' time, their professional judgment, etc.
• Page 265: Government mandates and controls productivity for private healthcare industries.
• Page 268: Government regulates rental and purchase of power-driven wheelchairs.
• Page 272: Cancer patients: welcome to the wonderful world of rationing!
• Page 280: Hospitals will be penalized for what the government deems preventable re-admissions.
• Page 298: Doctors: if you treat a patient during an initial admission that results in a readmission, you will be penalized by the government.
• Page 317: Doctors: you are now prohibited for owning and investing in healthcare companies!
• Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval.
• Page 321: Hospital expansion hinges on "community" input: in other words, yet another payoff for ACORN.
• Page 335: Government mandates establishment of outcome-based measures: i.e., rationing. • Page 341: Government has authority to disqualify Medicare Advantage Plans, HMOs, etc.
• Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals.
• Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by phone).
• Page 425: More bureaucracy: Advance Care Planning Consult: Senior Citizens, assisted suicide, euthanasia?
• Page 425: Government will instruct and consult regarding living wills, durable powers of attorney, etc. Mandatory. Appears to lock in estate taxes ahead of time.
• Page 425: Goverment provides approved list of end-of-life resources, guiding you in death.
• Page 427: Government mandates program that orders end-of-life treatment; government dictates how your life ends.
• Page 429: Advance Care Planning Consult will be used to dictate treatment as patient's health deteriorates. This can include an ORDER for end-of-life plans. An ORDER from the GOVERNMENT.
• Page 430: Government will decide what level of treatments you may have at end-of-life. • Page 469: Community-based Home Medical Services: more payoffs for ACORN.
• Page 472: Payments to Community-based organizations: more payoffs for ACORN.
• Page 489: Government will cover marriage and family therapy. Government intervenes in your marriage.
• Page 494: Government will cover mental health services: defining, creating and rationing those services.
Note: apparently, this list came from Fark - not the Fresno based New Republic

H.R. 3200 - 114 Concerns From Obama Administration’s Health Care Plan A Faith Based Law Firm

2009-08-07T22:09:00.002-07:00

Obama Administration’s Health Care Plan
HR 3200 currently under consideration in the House of Representatives

Reviewed, revised and adapted on July 29, 2009, by Liberty Counsel from the original authored by Peter Fleckenstein and posted on FreeRepublic.com and his blog, http://blog.flecksoflife.com.

Sec. 113, Pg. 21-22 of the Health Care (HC) Bill MANDATES a government audit of the books of ALL EMPLOYERS that self-insure in order to “ensure that the law does not provide incentives for small and mid-size employers to self-insure”!
Sec. 122, Pg. 29, Lines 4-16 - YOUR HEALTH CARE WILL BE RATIONED!
Sec. 123, Pg. 30 - THERE WILL BE A GOVERNMENT COMMITTEE deciding what treatments and benefits you get.
Sec. 142, Pg. 42 - The Health Choices Commissioner will choose your benefits for you. You have no choice!
Sec. 152, Pg. 50-51 - HC will be provided to ALL NON-US citizens.
Sec. 163, Pg. 58-59 beginning at line 5 - Government will have real-time access to individual’s finances & a National ID health care card will be issued!
Sec. 163, Pg. 59, Lines 21-24 - Government will have direct access to your bank accounts for electronic funds transfer.
Sec. 164, Pg. 65 is a payoff subsidized plan for retirees and their families in unions & community organizations (ACORN).
Sec. 201, Pg. 72, Lines 8-14 - Government is creating an HC Exchange to bring private plans under government control.
Sec. 203, Pg. 84 - Government mandates ALL benefit packages for private Health Care plans in the exchange.
Sec. 203, Pg. 85, Line 7 - Specifications of benefit levels for plans means that the government will define your HC plan and has the ability to ration your health care!
Sec. 205, Pg. 95, Lines 8-18 - The government will use groups (i.e., ACORN & AmeriCorps) to “inform and educate” (sign up) individuals for government plan.
Sec. 205, Pg. 102, Lines 12-18 - Medicaid-eligible individuals will be automatically enrolled in Medicaid. No freedom to choose.
Sec. 223, Pg. 124, Lines 24-25 - No company can sue the government for price-fixing. No “administrative of judicial review” against a government monopoly.
Sec. 225, Pg. 127, Lines 1-16 - Doctors – the government will tell YOU what you can make. “The Secretary shall provide for the annual participation of physicians under the public health insurance option, for which payment may be made for services furnished during the year.”
Sec. 312, Pg. 145, Lines 15-17 - Employers MUST auto-enroll employees into public option plan.
Sec. 313, Pg. 149, Lines 16-23 - ANY employer with payroll $400,000 and above who does not provide public option pays 8% tax on all payroll.
Sec. 313, Pg. 150, Lines 9-13 - Businesses with payroll between $251,000 and $400,000 who do not provide public option pay 2-6% tax on all payroll.
Sec. 401.59B, Pg. 167, Lines 18-23 - ANY individual who does not have acceptable care, according to government, will be taxed 2.5% of income.
Sec. 59B, Pg. 170, Line 1 - Any NONRESIDENT alien is exempt from individual taxes. (Americans will pay for their health care.)
Sec. 431, Pg. 195, Lines 1-3 - Officers and employees of HC Administration (government) will have access to ALL Americans’ financial and personal records.
Sec. 441, Pg. 203, Lines 14-15 - “The tax imposed under this section shall not be treated as tax.” Yes, it says that.
Sec. 1121, Pg. 239, Lines 14-24 - The government will limit and reduce physician services for Medicaid. Seniors, low income and poor are the ones affected.
Sec. 1121, Pg. 241, Lines 6-8 - Doctors, it does not matter what specialty you have; you’ll all be paid the same. “Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service.”
Sec. 1122, Pg. 253, Lines 10-23 - The government “validates work relative value units” (sets value of doctor’s time), professional judgment, methods etc. (defining the value of humans).
Sec. 1131, Pg. 265 - Government mandates and controls productivity for private HC industries. “Incorporating Productivity Improvements into Market Basket Updates that Do Not Already Incorporate Such Improvements.”
Sec. 1141, Pg. 268 - The government regulates rental and purchase of power-driven wheelchairs.
Sec. 1145, Pg. 272 - Treatment of certain cancer hospitals: Cancer patients and their treatment are open to rationing!
Sec. 1151, Pg. 280 - The government will penalize hospitals for what government deems preventable readmissions (incentives for hospital to not treat and release).
Sec. 1151, Pg. 298, Lines 9-11 - Doctors, treat a patient during initial admission that results in a readmission and the government will penalize you for that action.
Sec. 1156, Pg. 317, Lines 13-20 - “PROHIBITION on physician ownership or Investment.” Government tells doctors what/how much they can own.
Sec. 1156, Pg. 317-318, Lines 21-25, 1-3 - “PROHIBITION on Expansion of Facility Capacity.” The government will mandate that hospitals cannot expand (“number of operating rooms or beds”).
Sec. 1156, Pg. 321, Lines 2-13 - Hospitals have opportunity to apply for exception BUT community input required.
Sec. 1162, Pg. 335-339, Lines 16-25 - The government mandates establishment of outcome-based measures. Rationing.
Sec. 1162, Pg. 341, Lines 3-9 - The government has authority to disqualify Medicare Advantage Plans (Part B), HMOs, etc. This will force people into a government plan. “The Secretary may determine not to identify a Medicare Advantage plan if the Secretary has identified deficiencies in the plan’s compliance with rules for such plans under this part.”
Sec. 1177, Pg. 354 - Government will RESTRICT enrollment of special needs people! “Extension of Authority of Special Needs Plans to Restrict Enrollment.”
Sec. 1191, Pg. 379 - Government creates more bureaucracy – “Telehealth Advisory Committee.” HC by phone or the Internet – dial 1 for your health care advice?
Sec. 1233, Pg. 425, Lines 4-12 - Government mandates Advance (Death) Care Planning consultation. Think Senior Citizens and end of life. END-OF-LIFE COUNSELING. SOME IN THE ADMINISTRATION HAVE ALREADY DISCUSSED RATIONING HEALTH CARE FOR THE ELDERLY.
Sec. 1233, Pg. 425, Lines 17-19 - Government WILL instruct and consult regarding living wills and durable powers of attorney. Mandatory end-of-life planning!
Sec. 1233, Pg. 425-426, Lines 22-25, 1-3 - Government provides approved list of end-of-life resources, guiding you in death.
Sec. 1233, Pg. 427, Lines 15-24 - Government mandates program for orders for life-sustaining treatment (i.e. end of life). The government has a say in how your life ends.
Sec. 1233, Pg. 429, Lines 1-9 - An “advanced care planning consult” will be used as patient’s health deteriorates.
Sec. 1233, Pg. 429, Lines 10-12 - “Advanced Care Consultation” may include an ORDER for end-of-life plans - from the government.
Sec. 1233, Pg. 429, Lines 13-25 - The government will specify which Doctors (professional authority under state law includes Nurse Practitioners or Physician’s Assistants) can write an end-of-life order.
Sec. 1233, Pg. 430, Lines 11-15 - The government will decide what level of treatment you will have at end of life, according to preset methods (not individually decided).
Sec. 1302, Pg. 468, Lines 16-21 - “Community-Based Home Medical Services means a nonprofit community-based or state-based organization.”
Sec. 1302, Pg. 472, Lines 14-17 - PAYMENT TO COMMUNITY-BASED ORGANIZATION: One monthly payment to a community-based organization. Like ACORN?
Sec. 1308, Pg. 489 - The government will cover Marriage and Family therapy. This will involve government control of your marriage.
Sec. 1308, Pg. 494-498 - The government will cover Mental Health Services including defining, creating and rationing those services.
Sec. 1401, Pg. 502 - Center for Comparative Effectiveness Research Established. Big Brother is watching how your treatment works.
Sec. 1401, Pg. 503, Lines 13-19 - The government will build registries and data networks from YOUR electronic medical records. “The Center may secure directly from any department or agency of the United States information necessary to enable it to carry out this section.”
Sec. 1401, Pg. 503, Lines 21-25 - The government may secure data directly from any department or agency of the US, including your data.
Sec. 1401, Pg. 503, Lines 21-25 - The “Center” will collect data both “published and unpublished” (that means public & your private information).
Sec. 1401, Pg. 506, Lines 19-21 - An “Appointed Clinical Perspective Advisory Panel” will advise The Center and recommend policies that would allow for public access of data.
Sec. 1401, Pg. 518, Lines 21-25 - The Commission will have input from HC consumer representatives.
Sec. 1411, Pg. 524, Lines 18-22 - Establishes the “Comparative Effectiveness Research Trust Fund.” More taxes for ALL.
Sec. 1441, Pg. 621, Lines 20-25 - The government will define “NEW Quality” measures in HC. Since when does government know about quality?
Sec. 1442, Pg. 622, Lines 2-9 - To pay for the Quality Standards, government will transfer money from “qualified entities” (government Trust Funds) to other government Trust Funds. More Taxes.
Sec. 1442, Pg. 624, Lines 19-23 - Qualified Entities: “The Secretary shall ensure that the entity is a public, nonprofit or academic institution with technical expertise in the area of health quality measurement.”
Sec. 1442, Pg. 623, Lines 5-10 - “Quality” measures shall be designed to assess outcomes and functional status of patients.
Sec. 1442, Pg. 623, Lines 15-17 - “Quality” measures shall be designed to profile you, including race, age, gender, place of residence, etc.
Sec. 1443, Pg. 628 - The government will give “Multi-Stake Holders” pre-rulemaking input into selection of “quality” measures.
Sec. 1443, Pg. 630-31, Lines 9-24, 1-9 - Those Multi-Stake Holder groups include unions and groups like ACORN deciding what constitutes quality.
Sec. 1444, Pg. 632, Lines 14-25 - The government may implement any “Quality measure” of HC services that bureaucrats see fit.
Sec. 1444, Pg. 632-333, Lines 14-25, 1-9 - The Secretary may issue nonendorsed “Quality Measures” for physician and dialysis services.
Sec. 1251 (beginning), Pg. 634 to 652 - “Physician Payments Sunshine Provision” – government wants to shine sunlight on Doctors but not government. “Reports on financial relationships between manufacturers and distributors . . . and between physicians and other health care entities.”
Sec. 1501 (beginning), Pg. 659-670 - Doctors in Residency – government will tell you where your residency will be, thus where you’ll live.
Sec. 1503 (beginning), Pg. 675-685 - Government will regulate hospitals in EVERY aspect of residency programs, including teaching hospitals.
Sec. 1601 (beginning), Pg. 685-699 - Increased funding to fight waste, fraud, and abuse. (Like the government with an $18 million website?)
Sec. 1619, Pg. 700-703 - If your part of HC plan isn’t in the government’s HC Exchange but you qualify for federal aid, you don’t have to pay.
Sec. 1128G, Pg. 704-708 - If the Secretary determines there is a “significant risk of fraudulent activity,” on HC provider or supplier, the government can do a background check.
Sec. 1632, Pg. 710, Lines 8-14 - The Secretary has broad powers to deny HC providers and suppliers admittance into HC Exchange. Your doctor could be thrown out of business.
Sec. 1637, Pg. 718-719 - ANY Doctor who orders durable medical equipment or home medical services is REQUIRED to be enrolled in, or eligible for, Medicare.
Sec. 1639, Pg. 721 - Government MANDATES that Doctors must have face-to-face with patient to certify patient for home health services.
Sec. 1639, Pg. 723-24, Lines 23-25, 1-5 - The same government certifications will apply to Medicaid and CHIP (Children’s health plan: Your kids).
Sec. 1640, Pg. 723, Lines 16-22 - The government reserves right to apply face-to-face certification for patient to ANY other HC service.
Sec. 1651, Pg. 734, Lines 16-25 - Proposes, for law enforcement sake, that the Secretary of HHS will give Attorney General access to ALL medical data.
Sec. 1701 (beginning), Pg. 739-756 - The government sets guidelines for subsidizing the uninsured (and you have to pay for them).
Sec. 1704, Pg. 756-761 - The government will shift burden of payments to Disproportionate Share Hospitals (DSH) to states (your taxes).
Sec. 1711, Pg. 764 - The government will require preventative services - including vaccinations (no choice).
Sec. 1713, Pg. 768 - Government-determined Nurse Home Visitation Services (Hello union paybacks).
Sec. 1713, Pg. 768, Lines 3-5 - Nurse Home Visit Services – Service #1: “Improving maternal or child health and pregnancy outcomes or increasing birth intervals between pregnancies.” Compulsory ABORTIONS?
Sec. 1713, Pg. 768, Lines 11-14 - Nurse Home Visit Services include determinations of economic self-sufficiency, employment advancement and school-readiness.
Sec. 1714, Pg. 769 - Federal government mandates eligibility for State Family Planning Services. Abortion and government control intertwined.
Sec. 1733, Pg. 788-798 - Government will set and mandate drug prices, therefore controlling which drugs are brought to market. (Goodbye innovation and private research.)
Sec. 1744, Pg. 796-799 - Establishes PAYMENTS for graduate medical education. The government will now control your doctor’s education.
Sec.1751, Pg. 800 - The government will decide which Health Care conditions will be paid. Say “RATION!”
Sec. 1759, Pg. 809 - Billing Agents, clearinghouses, or other alternate payees are required to register. The government takes over private payment systems too.
Sec. 1801, Pg. 819-823 - The Government will identify individuals “likely to be ineligible” for subsidies. Will access all personal financial information.
Sec. 1802, Pg. 823-828 - Government sets up Comparative Effectiveness Research Trust Fund. Another bottomless tax pit.
Sec. 4375, Pg. 828-832, Lines 12-16 - Government will impose a fee on ALL private health insurance plans, including self-insured, to pay for Trust Fund!
Sec. 4377, Pg. 835, Lines 11-13 - Fees imposed by government for Trust Fund shall be treated as if they were taxes.
Sec. 440, Pg. 837-839 - The government will design and implement Home Visitation Program for families with young kids and families that are expecting children.
Sec. 1904, Pg. 843-844 - This Home Visitation Program includes the government coming into your house and teaching/telling you how to parent!
Sec. 2002, Pg. 858 - The government will establish a Public Health Fund at a cost of $88,800,000,000 (That’s Billions).
Sec. 2201, Pg. 864 - The government will MANDATE the establishment of a National Health Service Corps.
o Sec. 2201 - “Fulfillment of Obligated Service Requirement”
o Sec. 2201, Pg. 864-875 - The NHS Corps is a program where Doctors perform mandatory HC for 2 years for partial loan repayment.
Sec. 2212, Pg. 875-891 - The government takes over the education of Medical students and Doctors through education and loans.
Sec. 340L, Pg. 897 - The government will establish a Public Health Workforce Corps to ensure an adequate supply of public health professionals.
Sec. 340L, Pg. 897 - The Public Health Workforce Corps shall consist of civilian employees of the United States as Secretary deems necessary.
Sec. 340L, Pg. 897 - The Public Health Workforce Corps shall consist of officers of Regular and Reserve Corps of Service.
Sec. 340M, Pg. 899 - The Public Health Workforce Corps includes veterinarians. Will animals have heath care too?
Sec. 2233, Pg. 909 - The government will develop, build and run Public Health Training Centers.
Sec. 2241, Pg. 912-913 - Government starts a HC affirmative action program under the guise of diversity scholarships.
Sec. 2251, Pg. 915 - Government MANDATES cultural and linguistic competency training for HC professionals.
Sec. 3111, Pg. 931 - The government will establish a Preventative and Wellness Trust fund, with initial cost of $30,800,000,000 (Billions more).
Sec. 3121, Pg. 934, Lines 21-22 - Government will identify specific goals and objectives for prevention and wellness activities. More control of your life.
Sec. 3121, Pg. 935, Lines 1-2 - The government will develop “Healthy People & National Public Health Performance Standards.” They will tell us what to eat?
Sec. 3131, Pg. 942, Lines 22-25 - “Task Force on Community Preventive Services.” More government? Under the Offices of Surgeon General, Public Health Services, Minority Health and Women’s Health.
Sec. 3141, Pg. 949-979 - BIG GOVERNMENT core public health infrastructure includes workforce capacity, lab systems, health information systems, etc.
Sec. 2511, Pg. 992 - Government will establish school-based “health” clinics. Your children will be indoctrinated and your grandchildren may be aborted!
Sec. 399Z-1, Pg. 993 - School-Based Health Clinics will be integrated into the school environment. More government brainwashing in school.
Sec. 2521, Pg. 1000 - The government will establish a National Medical Device Registry. Will you be tracked?

Is there a co-pay with forced abortion? - Something To Think About.

2009-08-07T22:09:00.001-07:00

Matt Barber

The president has more "czars" running around than Mother Russia. It's mondo bizarro. Kind of fitting, though; must be a communist thing.

Still, as the debate over Obama's multi-trillion dollar pet experiment in socialized healthcare reaches terminal velocity, one of his newest czars underscores – in permanent marker – the true depth of BHO's deep-seated radicalism. His choice of Harvard professor and self-styled "neo-Malthusian" John Holdren as "science czar" provides the latest and perhaps most troubling example of just how bad America really muffed it last November. It could give us a sneak-peak into the not-so-distant future should this Obamacare-health scare become reality. In the name of population control, Holdren has advocated both forced abortion and compulsory sterilization through government-administered tainting of the water supply.

In a book he co-authored, entitled Ecoscience: Population, Resources, Environment, Holdren calls for a "Planetary Regime" to enforce mandatory abortions and limit the use of natural resources. He writes: "There exists ample authority under which population growth could be regulated. It has been concluded that compulsory population-control laws, even including laws requiring compulsory abortion, could be sustained under the existing Constitution if the population crisis became sufficiently severe to endanger the society."

Holdren further suggests that since "[a]dding a sterilant to drinking water or staple foods is a suggestion that seems to horrify people more than most proposals for involuntary fertility control," such an approach would have to "meet some rather stiff requirements; ...be uniformly effective; ...free of dangerous or unpleasant side effects;" and pass both PETA and AARP muster by having "no effect on members of the opposite sex, children, old people, pets, or livestock."

Czar Holdren further postulates that "a comprehensive Planetary Regime could control the development, administration, conservation, and distribution of all natural resources, renewable or nonrenewable. The Planetary Regime might be given responsibility for determining the optimum population for the world and for each region and for arbitrating various countries' shares within their regional limits."

He concludes that "sterilizing women after their second or third child" may be more practical than sterilizing men, and proposes a "long-term sterilizing capsule that could be implanted under the skin" at puberty and then "might be removable, with official permission, for a limited number of births." "Why should the law not be able to prevent a person from having more than two children?" he asks, suggesting "that compulsory population-control laws, even including laws requiring compulsory abortion, could be sustained under the existing Constitution. [N]either the Declaration of Independence nor the Constitution mentions a right to reproduce," observes the learned professor. OK, so, by any reasonable standard this guy's an off-the-rails, helmet-for-his-own-safety, bona fide barking Moonbat.

He makes Ward Churchill look like William F. Buckley. He's piggy Napoleon from Orwell's Animal Farm personified. But that's not what's so unsettling. There are plenty of nuts in the world. In fact, Harvard alone accounts for a significant percentage of them.

What's utterly horrifying is that our president – the leader of the free world – would even think, if only for a moment, "Hey, I just gotta have that Planetary Regime guy in my administration!"

That says a lot more about him than it does Herr Holdren. Indeed "birds of a feather flock together," and these perching political pigeons look down upon our unique American freedoms only to see a newly washed windshield. Obama's über-extremism continues to astound. The mainstream media can't cover it up much longer, and they're finally starting to get that.

As the left pushes this monolithic socialized healthcare scheme (imagine going to the DMV for your emergency appendectomy), the American people are slowly beginning to grasp the radical nature of the minds and philosophies behind it. I'm not saying that forced abortion and compulsory sterilization are an express part of Obamacare...yet.

But once again, look who's baking. They've already mixed the batter, we've licked the spoon and it tastes like...well, see for yourself: First, it provides a federal bailout for Planned Parenthood and the rest of the multi-billion-dollar abortion industry through taxpayer-funded abortion on demand; ostensibly to include reanimation of the horrific and currently banned practice of partial-birth abortion. The bill requires – as Democratic Sen. Barbara Mikulski admitted – "any service deemed medically necessary or medically appropriate." This means that – with a loaded IRS to your head – you, me and every other taxpayer gets to be a moral codefendant in abortion homicide. Isn't "having the right to choose" wonderful?

Secondly, and as Obama has fundamentally admitted, it will, undeniably, necessitate Animal Farm-style healthcare rationing for the elderly and infirm. Don't forget: "Some animals are more equal than others."

Or as Obama put it,

Grandma may have to forgo "additional tests or additional drugs that the evidence shows is not necessarily going to improve care....Maybe you're better off not having the surgery, but taking the painkiller."

(Got that? Sorry, Granny, you're 66 years old – no kidney transplant for you. Here's some morphine, now go lie down and die.) But if all that's not enough, the Senate Health, Education, Labor and Pension Committee's official summary of the bill additionally authorizes a CDC-funded "Community Preventive Services Task Force...to improve immunization coverage of children, adolescents, and adults...through the use of evidence-based interventions," up to and including, "home visits." Mom, Dad – decided against a potentially deadly Gardasil injection for your fourth-grade tween?

Well, get ready for that needle-ready knock at your door from the government vaccination "task force." It's time for your "evidence-based intervention." I wonder: Do jackboots go well with scrubs?

So let's recap: We have taxpayer-funded abortion, healthcare rationing for the elderly and infirm, and vaccination interventions in your living room. I fit all that into one sentence. Obamacare is nearly 1,100 pages long, and even the president hasn't read it. I see no evidence anyone has. But half the fun is in finding out what other gems it holds. Forced abortion? Compulsory sterilization? Well, maybe not yet, but is it really that much of a stretch? We already know it's on Holdren's Christmas list. Suppose Obama's feeling jolly?

Matt Barber (jmattbarber@comcast.net) is director of cultural affairs with Liberty Counsel and associate dean with Liberty University School of Law. This column is printed with permission

Some (Much?) Of The HealthCare Bill Was Funded Back In Feburary In The Stimulus Bill.

2009-08-07T22:08:00.001-07:00

Midknight Review prefatory note: Obama and gang have been plotting the Health Care bill since before his election. The fact that it has already been partially funded tells you that he intended to pass the bill without debate and without partisan help. What is especially troublesome is the fact that "pre" bill funding was for one of the most controversial aspects of the bill - the Federal Coordinating Council for Comparative Effectiveness Research. You will know a little about this with the reading of the article. As it turns out, Sarah Palin could not be more correct in her criticism of this bill (the article is not about Palin, however.)
Emmett Tyrrell
The American Spectator Publisher
The New York Sun Contributing Editor
Committee on the Present Danger
Council on Foreign Relations
Federalist Society
Hudson Institute adjunct scholar
Jefferson Awards Board of Selectors
National Conservative Campaign Fund National Advisory Board

by Emmett Tyrrell
If you have any sense that you may be getting sick in the years ahead, I suggest you get sick immediately. If you will need of surgery or any medical procedure, do it now! If not immediately, be certain that you hand yourself over to the health care professionals before Oct. 15. That is the date on which President Obama hopes to sign his health care bill once it has gone through the congressional baloney grinder.
At the heart of Mr. Obama's plan is his stated goal to cut medical costs. That might sound good to you, but it means cutting services, nurses, technicians, medical tests and, most prominently, the use of expensive technology. The president's top medical advisers are quite frank about this.
Dr. Ezekiel J. Emanuel, brother of White House Chief of Staff Rahm Emanuel and a health-policy adviser in the Office of Management and Budget, has chided Americans for the expense of their "being enamored with technology." Dr. David Blumenthal, another key Obama adviser, charges medical innovations as being responsible for fully two-thirds of the annual increase in health care spending. Their solution is to limit expensive innovations. A 2008 Congressional Budget Office report agrees with their cost analysis but concludes happily that such innovations "permit the treatment of previously untreatable conditions." As I shall show, there are more humane ways to cut health care costs.
Also at the heart of Mr. Obama's plan is the restriction of services for older people, people 65 and older who, by virtue of modern medicine, may actually be 10 and 15 years younger in terms of good health than they would have been a generation ago. Alas, they still have higher health risks and costs than younger people. Thus, they are going to bear the brunt of the Obama administration's cost cuts, for 27 percent to 30 percent of Medicaid spending is spent for caring for people at the end of their lives.
With the government taking over more of the nation's health care costs under the Obama regime, it has already been decided that government monies are more economically spent on younger people than on older people. If a 65-year-old needs a hip replacement, the government will better spend that money on a younger person whose hip will last longer. Or perhaps the government will decide the money is better spent on preventive medicine for younger people.
In the federal stimulus legislation that the president signed Feb. 17, we find funding for a Federal Coordinating Council for Comparative Effectiveness Research. "Comparative effectiveness research" is a term used by economists in health care for making health comparisons based often on age and for limiting care based on a patient's age. In Great Britain, comparative-effectiveness research is actually used to deny patients treatment for age-related diseases such as heart disease and muscular degeneration.
When the federal stimulus bill was going through Congress, there were warnings regarding the consequences of comparative effectiveness research. Rep. Charles Boustany Jr., Louisiana Republican and a heart surgeon, warned it would lead to "denying seniors and the disabled lifesaving care."
Yet the policy remained in the bill along with requirements for doctors' offices and hospitals to maintain data banks on patients while creating a national network to monitor patients' care.
The good side of that is that a central database can send out the latest information on treatments, although doctors who keep up with their medical journals already know about these treatments. The dark side is that it will allow the federal government to control how our doctors treat us. The bill speaks of "appropriate" and "cost-effective" care and provides penalties against doctors beginning in 2014. Now there is an Orwellian twist to the Obama promise of "hope" and "change."
As Betsy McCaughey has written in a groundbreaking analysis of the Obama health care proposals, draconian cost-control measures are not the answer to health care reform, and they are based on erroneous data. Healthcare spending increases over the past five years have been about half what they were in the recent period before that. Average family spending on food, energy and health care have remained the same for decades. Moreover, contrary to myth, there are not 47 million uninsured Americans but actually about 22 million. Rather than pass a health care reform that will mercilessly limit health care to older citizens - and to chronically ill citizens - while still increasing federal expenditures by at least a trillion dollars, she suggests a modest reform, to wit, debit cards for the uninsured and the needy.
In a recent installment of Spectator.org, Ms. McCaughey wrote, "Providing sliding scale assistance, based on household income, to families to purchase coverage would cost $20 billion to $25 billion a year." That is one reform that will deal with our present problems. There are others, which I shall take up in later columns. What we do not need is George Orwell's Big Brother overseeing the rationing of health care to senior citizens, particularly senior citizens with years of life ahead of them.
R. Emmett Tyrrell Jr. is the founder and editor-in-chief of the American Spectator, a contributing editor of the New York Sun, and an adjunct scholar at the Hudson Institute.

Congressional Budget Office H.R. 3200 expence analysis

2009-05-28T23:58:00.004-07:00

Preliminary Analysis of the House Democrats’ Health Reform Proposal
Yesterday CBO released a preliminary analysis, conducted with the staff of the Joint Committee on Taxation (JCT), of H.R. 3200, the America’s Affordable Health Choices Act of 2009, as introduced by several House committees on July 14. Earlier this week, CBO released a preliminary report on the health insurance coverage provisions of the bill; this latest report added analysis of the other provisions.
According to CBO’s and JCT’s assessment, enacting H.R. 3200 would result in a net increase in the federal budget deficit of $239 billion over the 2010-2019 period. That estimate reflects a projected 10-year cost of the bill’s insurance coverage provisions of $1,042 billion, partly offset by net spending changes that CBO estimates would save $219 billion over the same period, and by revenue provisions that JCT estimates would increase federal revenues by about $583 billion over those 10 years.
By the end of the 10-year period, in 2019, the coverage provisions would add $202 billion to the federal deficit, CBO and JCT estimate. That increase would be partially offset by net cost savings of $50 billion and additional revenues of $86 billion, resulting in a net increase in the deficit of an estimated $65 billion.
The figures released yesterday do not represent a complete cost estimate for the legislation. In particular, the estimated impact of the provisions related to health insurance coverage is based on specifications provided by the committee staff, rather than on a detailed analysis of the legislative language. (The estimates for other spending provisions reflect the specific legislative language. JCT has separately published its estimates of the effects of revenue provisions contained in H.R. 3200.) In addition, the figures do not include certain costs that the government would incur to administer the proposed changes and the impact of the bill’s provisions on other federal programs, and they do not reflect any modifications or amendments made after the bill was introduced. Nevertheless, this analysis reflects the major net budgetary effects of H.R. 3200.

The Health Care Bill: What HR 3200 - Evaluated by John David Lewis, PhD

2009-05-28T23:58:00.003-07:00

John David Lewis
Bio notes: John David Lewis, Ph.D.
Visiting Associate ProfessorPhilosophy,
Politics and Economics Program
Duke UniversityAugust 6, 2009

What does the bill, HR 3200, short-titled ‘‘America’s Affordable Health Choices Act of 2009,” actually say about major health care issues? I here pose a few questions in no particular order, citing relevant passages and offering a brief evaluation after each set of passages.

This bill is 1017 pages long. It is knee-deep in legalese and references to other federal regulations and laws. I have only touched pieces of the bill here.

For instance, I have not considered the establishment of

(1) “Health Choices Commissio0ner” (Section 141);

(2) a “Health Insurance Exchange,” (Section 201), basically a government run insurance scheme to coordinate all insurance activity;

(3) a Public Health Insurance Option (Section 221); and similar provisions.This is the evaluation of someone who is neither a physician nor a legal professional.

I am citizen, concerned about this bill’s effects on my freedom as an American. I would rather have used my time in other ways—but this is too important to ignore.We may answer one question up front: How will the government will pay for all this? Higher taxes, more borrowing, printing money, cutting payments, or rationing services—there are no other options.

We will all pay for this, enrolled in the government “option” or not.(All bold type within the text of the bill is added for emphasis.)1.

1. WILL THE PLAN RATION MEDICAL CARE?

This is what the bill says, pages 284-288, SEC. 1151. REDUCING POTENTIALLY PREVENTABLE HOSPITAL READMISSIONS:‘(ii) EXCLUSION OF CERTAIN READMISSIONS.

—For purposes of clause (i), with respect to a hospital, excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the Secretary) of discharges for such applicable condition for the applicable period and such hospital.and, under “Definitions”:‘‘

(A) APPLICABLE CONDITION.—The term ‘applicable condition’ means, subject to subparagraph (B), a condition or procedure selected by the Secretary . . .and:‘‘

(E) READMISSION.—The term ‘readmission’ means, in the case of an individual who is discharged from an applicable hospital, the admission of the individual to the same or another applicable hospital within a time period specified by the Secretary from the date of such discharge.and:

‘‘(6) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of— . . .‘‘(C) the measures of readmissions . . .

EVALUATION OF THE PASSAGES:1. This section amends the Social Security Act2. The government has the power to determine what constitutes an “applicable [medical] condition.”3. The government has the power to determine who is allowed readmission into a hospital.4. This determination will be made by statistics: when enough people have been discharged for the same condition, an individual may be readmitted.5. This is government rationing, pure, simple, and straight up.6. There can be no judicial review of decisions made here. The Secretary is above the courts.7. The plan also allows the government to prohibit hospitals from expanding without federal permission: page 317-318.2.

Will the plan punish Americans who try to opt out?

What the bill says, pages 167-168, section 401, TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE:‘‘(a) TAX IMPOSED.

—In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of—(1) the taxpayer’s modified adjusted gross income for the taxable year, over(2) the amount of gross income specified in section 6012(a)

(1) with respect to the taxpayer. . . .”EVALUATION OF THE PASSAGE:1. This section amends the Internal Revenue Code.

2. Anyone caught without acceptable coverage and not in the government plan will pay a special tax.3.

The IRS will be a major enforcement mechanism for the plan.

3. what constitutes “acceptable” coverage?Here is what the bill says, pages 26-30, SEC. 122, ESSENTIAL BENEFITS PACKAGE DEFINED:(a) IN GENERAL.

—In this division, the term ‘‘essential benefits package’’ means health benefits coverage, consistent with standards adopted under section 124 to ensure the provision of quality health care and financial security . . .(b) MINIMUM SERVICES TO BE COVERED.

—The items and services described in this subsection are the following:

(1) Hospitalization.

(2) Outpatient hospital and outpatient clinic services . . .

(3) Professional services of physicians and other health professionals.

(4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care . . .

(5) Prescription drugs.

(6) Rehabilitative and habilitative services.

(7) Mental health and substance use disorder services.

(8) Preventive services . . .

(9) Maternity care.

(10) Well baby and well child care . . .(c) REQUIREMENTS RELATING TO COST-SHARING AND MINIMUM ACTUARIAL VALUE . . .(3) MINIMUM ACTUARIAL VALUE.—(A) IN GENERAL

.—The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).

EVALUATION OF THE PASSAGES:

1. The bill defines “acceptable coverage” and leaves no room for choice in this regard.

2. By setting a minimum 70% actuarial value of benefits, the bill makes health plans in which individuals pay for routine services, but carry insurance only for catastrophic events, (such as Health Savings Accounts) illegal.4. Will the PLAN destroy private health insurance?Here is what it requires, for businesses with payrolls greater than $400,000 per year. (The bill uses “contribution” to refer to mandatory payments to the government plan.) Pages 149-150, SEC. 313, EMPLOYER CONTRIBUTIONS IN LIEU OF COVERAGE(a) IN GENERAL.

—A contribution is made in accordance with this section with respect to an employee if such contribution is equal to an amount equal to 8 percent of the average wages paid by the employer during the period of enrollment (determined by taking into account all employees of the employer and in such manner as the Commissioner provides, including rules providing for the appropriate aggregation of related employers). Any such contribution—(1) shall be paid to the Health Choices Commissioner for deposit into the Health Insurance Exchange Trust Fund, and(2) shall not be applied against the premium of the employee under the Exchange-participating health benefits plan in which the employee is enrolled.(The bill then includes a sliding scale of payments for business with less than $400,000 in annual payroll.)The Bill also reserves, for the government, the power to determine an acceptable benefits plan:

page 24, SEC. 115. ENSURING ADEQUACY OF PROVIDER NETWORKS.5 (a) IN GENERAL.

—A qualified health benefits plan that uses a provider network for items and services shall meet such standards respecting provider networks as the Commissioner may establish to assure the adequacy of such networks in ensuring enrollee access to such items and services and transparency in the cost-sharing differentials between in-network coverage and out-of-network coverage.

EVALUATION OF THE PASSAGES:1. The bill does not prohibit a person from buying private insurance.2. Small businesses—with say 8-10 employees—will either have to provide insurance to federal standards, or pay an 8% payroll tax. Business costs for health care are higher than this, especially considering administrative costs. Any competitive business that tries to stay with a private plan will face a payroll disadvantage against competitors who go with the government “option.”3. The pressure for business owners to terminate the private plans will be enormous.4. With employers ending plans, millions of Americans will lose their private coverage, and fewer companies will offer it.5. The Commissioner (meaning, always, the bureaucrats) will determine whether a particular network of physicians, hospitals and insurance is acceptable.6. With private insurance starved, many people enrolled in the government “option” will have no place else to go.5. Does the plan TAX successful Americans more THAN OTHERS?

Here is what the bill says, pages 197-198, SEC. 441. SURCHARGE ON HIGH INCOME INDIVIDUALS‘‘SEC. 59C. SURCHARGE ON HIGH INCOME INDIVIDUALS.‘‘

(a) GENERAL RULE.—In the case of a taxpayer other than a corporation, there is hereby imposed (in addition to any other tax imposed by this subtitle) a tax equal to—‘‘

(1) 1 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $350,000 but does not exceed $500,000,‘‘

(2) 1.5 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $500,000 but does not exceed $1,000,000, and‘‘

(3) 5.4 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $1,000,000.

EVALUATION OF THE PASSAGE:1. This bill amends the Internal Revenue Code.2. Tax surcharges are levied on those with the highest incomes.3. The plan manipulates the tax code to redistribute their wealth.4. Successful business owners will bear the highest cost of this plan.6. 6. Does THE PLAN ALLOW THE GOVERNMENT TO set FEES FOR SERVICES?

What it says, page 124, Sec. 223, PAYMENT RATES FOR ITEMS AND SERVICES:(d) CONSTRUCTION.—Nothing in this subtitle shall be construed as limiting the Secretary’s authority to correct for payments that are excessive or deficient, taking into account the provisions of section 221(a) and the amounts paid for similar health care providers and services under other Exchange-participating health benefits plans.(e) CONSTRUCTION.—Nothing in this subtitle shall be construed as affecting the authority of the Secretary to establish payment rates, including payments to provide for the more efficient delivery of services, such as the initiatives provided for under section 224.EVALUATION OF THE PASSAGES:The government’s authority to set payments is basically unlimited.The official will decide what constitutes “excessive,” “deficient,” and “efficient” payments and services.7. Will THE PLAN increase the power of government officials to SCRUTINIZE our private affairs?What it says, pages 195-196, SEC. 431. DISCLOSURES TO CARRY OUT HEALTH INSURANCE EXCHANGE SUBSIDIES.‘‘(A) IN GENERAL.—The Secretary, upon written request from the Health Choices Commissioner or the head of a State-based health insurance exchange approved for operation under section 208 of the America’s Affordable Health Choices Act of 2009, shall disclose to officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, return information of any taxpayer whose income is relevant in determining any affordability credit described in subtitle C of title II of the America’s Affordable Health Choices Act of 2009. Such return information shall be limited to—‘‘(i) taxpayer identity information with respect to such taxpayer,‘‘(ii) the filing status of such taxpayer,‘‘(iii) the modified adjusted gross income of such taxpayer (as defined in section 59B(e)(5)),‘‘(iv) the number of dependents of the taxpayer,‘‘(v) such other information as is prescribed by the Secretary by regulation as might indicate whether the taxpayer is eligible for such affordability credits (and the amount thereof), and‘‘(vi) the taxable year with respect to which the preceding information relates or, if applicable, the fact that such information is not available.

And, page 145, section 312, EMPLOYER RESPONSIBILITY TO CONTRIBUTE TOWARDS EMPLOYEE AND DEPENDENT COVERAGE:(3) PROVISION OF INFORMATION.

—The employer provides the Health Choices Commissioner, the Secretary of Labor, the Secretary of Health and Human Services, and the Secretary of the Treasury, as applicable, with such information as the Commissioner may require to ascertain compliance with the requirements of this section.

EVALUATION OF THE PASSAGE:1. This section amends the Internal Revenue Code2. The bill opens up income tax return information to federal officials.3. Any stated “limits” to such information are circumvented by item (v), which allows federal officials to decide what information is needed.4. Employers are required to report whatever information the government says it needs to enforce the plan.8.

8. Does the plan automatically enroll Americans in the GOVERNMENT plan?

What it says, page 102, Section 205, Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plan:(3) AUTOMATIC ENROLLMENT OF MEDICAID ELIGIBLE INDIVIDUALS INTO MEDICAID.

—The Commissioner shall provide for a process under which an individual who is described in section 202(d)(3) and has not elected to enroll in an Exchange-participating health benefits plan is automatically enrolled under Medicaid.

And, page 145, section 312:(4) AUTOENROLLMENT OF EMPLOYEES.—The employer provides for autoenrollment of the employee in accordance with subsection (c).EVALUATION OF THE PASSAGES:1. Do nothing and you are in.2. Employers are responsible for automatically enrolling people who still work.9. 9.

Does THE PLAN exempt federal OFFICIALS from COURT REVIEW?

What it says, page 124, Section 223, PAYMENT RATES FOR ITEMS AND SERVICES:(f) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 224.

And, page 256, SEC. 1123. PAYMENTS FOR EFFICIENT AREAS.‘‘(C) LIMITATION ON REVIEW.—There shall be no administrative or judicial review under section 1869, 1878, or otherwise, respecting—‘‘(i) the identification of a county or other area under subparagraph (A); or‘‘(ii) the assignment of a postal ZIP Code to a county or other area under subparagraph (B).

EVALUATION OF THE PASSAGES:1. Sec. 1123 amends the Social Security Act, to allow the Secretary to identify areas of the country that underutilize the government’s plan “based on per capita spending.”2. Parts of the plan are set above the review of the courts.

2009-05-01T20:26:00.001-07:00

return pathway to the main-page of midknight review

2009-04-29T08:00:00.006-07:00

return pathway to the main-page of midknight review

Timely Comments From The '08 GOP Platform On Global Warming

2009-04-29T01:09:00.000-07:00

Below are those statements taken from the '08 Republican Platform.

Environmental Protection
By increasing our American energy supply and decreasing the long term demand for oil, we will be well positioned to address the challenge of climate change and continue our longstanding responsibility for stewardship over the environment. [MidKnight Review believes an end to our dependency on oil is unavoidable. The increase of oil supply via offshore drilling must be pursued but within the context of the development of alternative fuel supplies. A free and private economy can and will provide solutions if given direction, incentive and the freedom to develop and produce alternatives to our present emphasis on oil consumption.]

Addressing Climate Change Responsibly
The same human economic activity that has brought freedom and opportunity to billions has also increased the amount of carbon in the atmosphere. While the scope and long-term consequences of this are the subject of ongoing scientific research, common sense dictates that the United States should take measured and reasonable steps today to reduce any impact on the environment. Those steps, if consistent with our global competitiveness will also be good for our national security, our energy independence, and our economy [MidKnight Review has elimidated this from the statement: "Any policies should be global in nature, based on sound science and technology, and should not harm the economy." We believe that "any policies" dealing with climate/enviornmental issues should have cooporative global aspect, the "nature" of environmental legislation should concern itself, primarily, with the health, welfare and economic concerns of the United States.]

The Solution: Technology and the Market
As part of a global climate change strategy, Republicans support technology-driven, market-based solutions that will decrease emissions, reduce excess greenhouse gasses in the atmosphere, increase energy efficiency, mitigate the impact of climate change where it occurs, and maximize any ancillary benefits climate change might offer for the economy.
To reduce emissions in the short run, we will rely upon the power of new technologies, as discussed above, especially zero-emission energy sources such as nuclear and other alternate power sources. But innovation must not be hamstrung by Washington bickering, regulatory briar patches, or obstructionist lawsuits. Empowering Washington will only lead to unintended consequences and unimagined economic and environmental pain; instead, we must unleash the power of scientific know-how and competitive markets.

International Cooperation
Because the issue of climate change is global, it must become a truly global concern as well. All developed and developing economies, particularly India and China, can make significant contributions in dealing with the matter. It would be unrealistic and counterproductive to expect the U.S. to carry burdens which are more appropriately shared by all.

Doing No Harm
Republicans caution against the doomsday climate change scenarios peddled by the aficionados of centralized command-and-control government. We can – and should– address the risk of climate change based on sound science without succumbing to the no-growth radicalism that treats climate questions as dogma rather than as situations to be managed responsibly.

A robust economy will be essential to dealing with the risk of climate change, and we will insist on reasonable policies that do not force Americans to sacrifice their way of life or trim their hopes and dreams for their children. This perspective serves not only the people of the United States but also the world’s poorest peoples, who would suffer terribly if climate change is severe – just as they would if the world economy itself were to be crippled. We must not allow either outcome.

Continuing Our Stewardship over the Environment
Our national progress toward cleaner air and water has been a major accomplishment of the American people. By balancing environmental goals with economic growth and job creation, our diverse economy has made possible the investment needed to safeguard natural resources, protect endangered species, and create healthier living conditions. State and local initiatives to clean up contaminated sites – brownfields – have exceeded efforts directed by Washington. That progress can continue if grounded in sound science, long-term planning, and a multi-use approach to resources.

Government at all levels should protect private property rights by cooperating with landowners’ efforts and providing incentives to protect fragile environments, endangered species, and maintain the natural beauty of America. Republican leadership has led to the rejuvenation and renewal of our National Park system. Future expansion of that system, as well as designation of National Wilderness areas or Historic Districts, should be undertaken only with the active participation and consent of relevant state and local governments and private property owners.

D.C Vouchers And Obama's Disgrace

2009-04-23T11:34:00.000-07:00

Our title - Will's words.
By George Will
. . . . . . . . . . . . . . . . . . . . . . . . . . The president's $100 million edict actually suggests an insufficiency in the river of federal assistance flowing out of Washington to the deserving poor, as that category is currently understood: incompetent car companies, reckless insurance companies, mismanaged banks, profligate state governments, etc. But political satirists, too, deserve a bailout from a federal government that has turned their material into public policy.
The president has set an example for his Cabinet. He has ladled a trillion or so dollars ("or so" is today's shorthand for "give or take a few hundreds of billions") hither and yon, but while ladling he has, or thinks he has, saved about $15 million by killing, or trying to kill, a tiny program that this year is enabling about 1,715 District of Columbia children (90 percent black, 9 percent Hispanic) to escape from the District's failing public schools and enroll in private schools.

The District's mayor and school superintendent support the program. But the president has vowed to kill programs that "don't work." He has looked high and low and -- lo and behold -- has found one. By uncanny coincidence, it is detested by the teachers unions that gave approximately four times $15 million to Democratic candidates and liberal causes last year.

Not content with seeing the program set to die after the 2009-10 school year, Secretary of Education Arne Duncan (former head of Chicago's school system, which never enrolled an Obama child) gratuitously dashed even the limited hopes of another 200 children and their parents. Duncan, who has sensibly chosen to live with his wife and two children in Virginia rather than the District, rescinded the scholarships already awarded to those children for the final year of the program, beginning in September. He was, you understand, thinking only of the children and their parents: He would spare them the turmoil of being forced by, well, Duncan and other Democrats to return to terrible public schools after a tantalizing one-year taste of something better. Call that compassionate liberalism.

After Congress debated the program, the Department of Education released -- on a Friday afternoon, a news cemetery -- a congressionally mandated study showing that, measured by student improvement and parental satisfaction, the District's program works. The department could not suppress the Heritage Foundation's report that 38 percent of members of Congress sent or are sending their children to private schools. The Senate voted 58-39 to kill the program. Heritage reports that if the senators who have exercised their ability to choose private schools had voted to continue the program that allows less-privileged parents to make that choice for their children, the program would have been preserved.

As the president and his party's legislators are forcing minority children back into public schools, the doors of which would never be darkened by the president's or legislators' children, remember this: We have seen a version of this shabby act before. One reason conservatism came to power in the 1980s was that in the 1970s liberals advertised their hypocrisy by supporting forced busing of other people's children to schools the liberals' children did not attend.

This issue will be back. In a few months, the appropriation bill for the District will come to the floor of the House of Representatives, at which point there will be a furious fight for the children's interests. Then we will learn whether the president and his congressional allies are capable of embarrassment. On the evidence so far, they are not.
We have edited this article: for the full version, so to : Here

Comments to georgewill@washpost.com or midknightmail1@aol.com (MidKnight Review)

American Spectator - Obamanomics and Fact

2009-04-17T19:17:00.000-07:00

Special Report
The Tea Party Revolution
By Peter Ferrara on 4.15.09 @ 6:08AM

Congratulations to the hundreds of spontaneous grassroots organizers who have successfully organized the over 300 tea party events that will take place today across the country. Such events have already been widespread, and highly successful, with sudden big crowds: 2,000 in St. Louis, 3,000 in Cincinnati, 6,000 in Orlando, as recently reported by Peter Roff in a Fox News blog.

Because these events are highly decentralized, with no significant institutional organization or funding behind them, they represent a genuine outpouring of grassroots opinion with enormous political importance. For every person out in the streets today, there are undoubtedly many more who didn't make it who share the same opinions. The bigger the demonstrations today, the bigger the rest of the iceberg under water. Moreover, this movement represents genuine grassroots organization, as names and contact information are collected, and this will be valuable for future political activity.

These people are both against and for something. They are against the left-wing extremism of the current political leadership in Washington, from Barack Obama to Nancy Pelosi, to Barney Frank, to Henry Waxman, and on and on. No wonder Newsweek (soon going out of business) thinks we are a nation of socialists now, as it admitted in a recent cover story.
But even more, the tea party revelers are for a sophisticated vision of economic freedom. They recognize that the more resources the government takes out of the private sector, through taxes, borrowing and spending, the less freedom that average working people have left for the pursuit of happiness. Taxes as a percent of GDP, government spending as a percent of GDP, should be taken as reverse indicators of economic freedom. The higher they are, the less economic freedom people have. The lower they are, the more economic freedom we have. In other words, the more the government takes your money to spend on what it wants, the less freedom you have to choose to spend, or to save and invest, your own money as you want. And visa versa.

Let us review the already gruesome results of the Obama economic policy to see what has the people out in the streets. Obama's budget for this year increases federal spending by an extremist 34% over the budget adopted for last year, to a total of $4 trillion, the highest ever! Since World War II, going back over 60 years now, federal spending as a percent of GDP has been stable, hovering around 20%. But federal spending for this year under the Obama budget and economic policies will soar to a shocking 28.5%of GDP, an increase in the size of the federal government in Obama's first year of 42% compared to the postwar average relative to GDP.
Over the longer run, because of exploding federal entitlements, federal spending will soar to 40% to 50% of GDP, depending on how much permanent damage Obama does. With state and local spending, the total will climb towards 60%, and we will no longer be a free country.

The Congressional Budget Office projects Obama's budget deficit for this year at a shocking $1.845 trillion, the highest ever. That would be more than seven times Reagan's largest deficit of $221 billion, which caused so much howling among liberals and Democrats. This Obama budget deficit will total an astounding 13.1% of GDP, more than one-eighth of the entire U.S. economy, for the federal deficit alone!

Obama says that this is George Bush's budget deficit. But it wasn't George Bush who led adoption of a $1 trillion stimulus package in February, followed by a $410 billion supplemental spending bill the next week, with a $275 billion housing bailout plan proposed the following week, $634 billion as a down payment on a new national health insurance entitlement adopted in the budget, and another $1 trillion bank bailout plan recently announced as well. (Note: The entire economy produces just $14 trillion a year, so $1 trillion is real money.)

Obama said in his national press conference on March 24, "We're doing everything we can to reduce that deficit." But do his actions recounted above look like he is "doing everything we can to reduce that deficit"?

The deficit for the last budget adopted when Congress was controlled by Republican majorities, for fiscal 2007, was $162 billion, or 1.2% of GDP. CBO projects that by 2019 under Obama's budget, the deficit will still be well over $1 trillion.

Finally, under Obama's budget the national debt will double over the next five years, and triple over the next ten, to $17.3 trillion. The national debt as a percent of GDP will soar from 40% to a peacetime record of 82.4%, almost as large as the entire economy, and twice as high as when Reagan left office. If the economy does not recover permanently next year, as even the CBO assumes (not going to happen long term), Obama could even top the World War II record of national debt at 113% of GDP, spending mostly on welfare and entitlements, rather than on fighting the Nazis and Imperial Japan.

Does this sound like we're "moving from an era of borrow-and-spend to one where we save and invest," as Obama also said in his press conference last month?

Is this unfair to Obama, who needed to restore economic growth to a collapsing economy he inherited? After all, as Obama recently laughed, "What do you think a stimulus is?"
Well, ask yourself, will we restore growth through increased welfare, runaway federal spending, and record deficits and debt? Or does growth come from reducing tax rates, unnecessary regulatory burdens, and government spending, and maintaining a strong dollar? That's what Reagan did, and the result was a 25-year economic boom that spread across the entire planet, with "70 million people a year [worldwide]…joining the middle class," as Steve Forbes recently observed. What Obama is doing is the opposite of this proven formula, in every detail.
Oh, the economy will "recover" later this year, because it is still a powerful, capitalist economy that tends towards growth. But Obama's economic policies are taking America back on a long, slow, nostalgia tour to the glorious economy of Jimmy Carter, complete with gas and energy shortages, soaring inflation and interest rates, and persistent unemployment. Over the longer run, that road leads back to the liberal left glory days of the 1930s.

And I haven't even begun to talk about Obama's tax increases. By the end of next year, the top income tax rate will have risen by 20%, the top capital gains tax rate by 33%, and the tax on dividends by 33% as well, with the top death tax rate restored to 45%. Obama ran for President promising a tax cut for 95% of Americans, which turned out to be a miserable $400 per worker income tax credit, less than $8 a week, with no incentive effects to promote the economy. That will be more than offset by the $645 billion cap and trade tax Obama has proposed to combat non-existent global warming, which will be paid by everybody through higher prices for gas, electricity, home heating oil, coal, and everything produced with energy. Obviously, these sharp tax increases will trash the economy in the future, not promote growth. Higher energy costs in particular will chase remaining American manufacturing overseas.

All of this is why America will be in the streets today demanding a U-turn from Obama's road to oblivion, returning to Reagan's highway to prosperity, which Bush mistakenly exited.
But over the longer run, the tea party revelers are looking for an expanded vista of economic freedom, with less government control, lower taxes, reduced spending and debt, fewer unnecessary regulatory burdens, and sound money free from inflation. How can America achieve that?

Let me offer a few ideas. I am not claiming these as the agenda of today's tea parties. I am offering them as the best of the ideas that have been developed over recent decades, and the most promising for long-term freedom and prosperity, in the hope that many of those demonstrating today will support them in the future.

Newt Gingrich, who is speaking at the tea party in Atlanta today, has offered a 12-point economic recovery plan based on the principles of President Reagan's 1981 recovery plan. Gingrich proposes to reduce the 25% income tax rate paid by middle-income earners to 15%, which would effectively establish a flat tax of 15% for close to 90% of Americans. He would also reduce the federal corporate tax rate of 35%, the second highest in the industrialized world, to the 12.5% rate adopted 20 years ago in Ireland, which boosted that traditionally poor country to the second highest income in the EU. Our own Treasury Department says Ireland's 12.5% rate generates more corporate tax revenue as a percent of GDP than our 35% rate.

Gingrich also proposes to abolish the capital gains tax and the death tax, which both involve double taxation of savings and capital. He would also open up production of domestic U.S. energy across the board, ensuring plentiful, low cost energy supplies for the American economy. These policies would produce another generation-long economic boom.

Rep. Paul Ryan (R-WI) has offered a tax reform plan with just two rates, 10% applying to the first $100,000 in income each year, and 25% applying to all income above that. Generous personal exemptions would eliminate income taxes for a family of four on the first $40,000 earned each year.

For the payroll tax, Ryan has developed and introduced legislation that would allow workers the freedom to choose to save and invest half their Social Security taxes in their own personal accounts. To the extent each worker exercised this option, benefits from the account would replace future promised Social Security benefits on a proportional basis. Because over the long run market investment returns are so much higher than what Social Security can even promise, let alone pay, working people can gain enormously from this option. But Ryan's bill wisely retains the Social Security safety net, guaranteeing that each worker would still receive at least what they would have been paid in Social Security benefits under current law. So workers can gain, but they can't lose. Experience shows, however, that few if any workers would fall into that safety net over the long run.

Such personal savings, investment, and insurance accounts should be expanded over the long run to empower workers with the freedom to substitute the accounts for the entire payroll tax, with the accounts providing all of the benefits now financed by the payroll tax. This would produce an enormous reduction in the size of the federal government.

Another good idea is the national sales tax proposal. But the 23% sales tax rate is too high. The sales tax should substitute only for the income tax, not the payroll tax as well. Better to phase out the payroll tax under the personal account proposal above. The sales tax reform also does not need to be completely revenue neutral. It would work better providing a net tax cut. This may allow a sales tax rate of only 14%, particularly considering the boost to economic growth such reform would produce.

Another major reform would involve sending the hundreds of federal welfare programs back to the states based on the model of the highly successful 1996 reform of the old AFDC program. That reform replaced AFDC with a block grant of finite federal funds to each state for their own new, redesigned, welfare program based on work. The result surprised even the advocates of the idea, reducing the number of dependents on the old program by close to 60% nationwide. This same reform should now be extended to Medicaid, Food Stamps, housing subsidies, and the hundreds of other means-tested, federal welfare programs. This would also result in an enormous reduction in the size of the federal government.

The most important Obama initiative to stop now is health-care reform. Adding another huge entitlement program, ultimately the biggest of all, to our nation's debts will hasten the explosion of big government and the ultimate bankruptcy of our country. Obama's proposal inevitably involves the same government health-care rationing as in every other country that has adopted such a government-run health care system. That is because once such a system is adopted, there is no other way to control health costs.

Such government health-care rationing means a reduction in the standard of living for average Americans, as they suffer less timely and less effective health care. A huge reduction in America's standard of living would result as well from Obama's cap and trade global warming plan, as America must then suffer with less energy costing much more. That means smaller, weaker cars, less driving and other transportation, less consumption of energy-intensive meat and dairy products, colder homes, workplaces and stores in winter, hotter homes, workplaces and stores in summer, and less of everything that uses electricity.

A safety net assuring essential health-care services can be created without a government takeover of the entire health-care system. Broader use of reforms that extend patient power and choice, such as health savings accounts and interstate sales of health insurance, would best control costs.

These reforms and ideas would create a bright future for America of freedom and prosperity. Achieving them requires active, widespread, grassroots support. That is the hope that today's tea parties across America raise.

Peter Ferrara is director of budget and entitlement policy at the Institute for Policy Innovation and general counsel for the American Civil Rights Union. He formerly served in President Reagan's White House Office of Policy Development, and as Associate Deputy Attorney General of the United States under the first President Bush. He is a graduate of Harvard College and Harvard Law School.