http://blog.spn.org description http://blog.spn.org/id.4907/detail.asp Today, the Wisconsin Policy Research Institute released a report by Mike Nichols and Christian Schneider that delves into the origin of public financing for campaigns in Wisconsin. While the intent of using taxpayer dollars to run campaigns was noble - supporters thought it would lead to more competitive elections and reduced special interest influence - the actual effect has been just the opposite. In fact, often times politicians (77% of those that take the grant are Democrats) turn right around and funnel the public money to campaign purposes that are outside the intent of the law: (State Representative Spencer) Black, for example, received $4,155 from the public fund on Sept. 30, 1996. This is the same year he gave a total of $4,775 in cash or in-kind contributions to other politicians or committees, including $1,200 to the Dane County Conservation Alliance-a special interest committee registered with the state. On Sept. 30, 2004, state Rep. Mark Pocan accepted $5,574 from the public fund. According to his campaign reports, on that very same day he made a $1,000 contribution to the Unity Fund-the Democratic Party of Wisconsin campaign account that was used, at least in part that year, to support Democratic candidates at the national level. Hintz received his most recent public funding, about $6,000, on Sept. 27, 2008. In the month that followed, he gave $1,000 to the Democratic Party of Wisconsin. There's more: In September of 2002, Bob Jauch accepted 11,932 from the WECF. In November, he made a $5,000 contribution to the State Senate Democratic Committee. He won with 62.1% of the vote. In September of 2006, Jauch accepted a $2,425 contribution from WECF. In November of 2006, he made a $1,000 contribution to the SSDC, and won with 62.3% of the vote. On September 25, 2002, Russ Decker accepted a WECF grant of $11,932. During the same election, Decker spent $6,300 for a poll - for a race he won with 68% of the vote. In December, Decker transferred $1,000 to the SSDC. In September of 2006, Joe Parisi accepted $5,263 from the WECF. In the same election cycle, he donated $1,000 to the Democratic Party of WI, en route to winning with 75.6% of the vote. Furthermore, public financing hasn't done anything to improve the "competitiveness" of state campaigns. Of the 47 winners that took the grant, 38 (81%) were incumbents. Of the 9 winners that were not incumbents, 6 of them beat incumbents (Hines, Freese, Skindrud, Loeffelholz, Weber, and Kreibich) and 3 ran in open seats. The average vote for the 47 winners who accepted a WECF grant: 63.4% The average vote for the 126 losers who accepted a WECF grant: 39.3% Of the 126 losing candidates, only 11 (8.7%) came within 5% of the winner. Only 24 (19%) came within 10% of the winner. More from the article: Politics in Wisconsin is, at the very least, not a game for outsiders. Spencer Black hasn't received less than 87% of a vote since 1992 and now has more than $146,000 in his campaign account. In 2002, Republican Steve Nass accepted $7,013 in public funding and went on to beat Leroy Watson 87% to 13%. In 2006, the Whitewater-area representative took $5,963 and beat a self-described "naturist," Scott Woods, 66% to 34%. If the fund helps anyone, it seems, it is incumbents, the legislators who have the power to make the laws and amend them. Or get rid of them, but don't. One byproduct of heavy favorites receiving the taxpayer funded grant is that they often use the grant to build their campaign accounts to levels that make them unbeatable. More on Spencer Black: Spencer Black, the longtime Democratic representative from Madison, has repeatedly tak Thu, 19 Nov 2009 11:33:00 Christian Schneider http://blog.spn.org/id.4906/detail.asp I have often wondered why we don't hear more about the Swiss health care system -- especially by folks on the left. After all, just about every study of the topic finds the Swiss system to be the most egalitarian in the whole world.During the debate over Hillary Care, the White House flirted with Germany and France. Michael Moore bounced from Canada to France to England and even Cuba in his movie, SiCKO. A recent documentary praising national health insurance focused on Taiwan. The Physicians for a National Health Program has been perpetually fixated on Canada (the only "single payer" system in the world, other than North Korea). The Commonwealth Fund is continually judging European systems superior to our own. But no one on the left ever mentions Switzerland.Continue reading at the John Goodman Health Blog Mon, 19 Oct 2009 12:22:00 John Goodman http://blog.spn.org/id.4905/detail.asp Here we are at the eleventh hour, about to enact Obama/Baucus/Kennedy/Waxman Care and no one other than the insurance industry executives seems to be aware of how genuinely foolish this reform is likely to be.At the top of my list of foolish things is the idea that no one should ever have to pay the real cost of his own health insurance. The most popular alternative is having everyone pay the same premium although, as previously reported at this site, community-rated premiums are not even good for sick people.Continue Reading at the John Goodman Health Blog Wed, 14 Oct 2009 17:01:00 John Goodman http://blog.spn.org/id.4904/detail.asp National Public Radio says that to understand a government health plan just substitute government airline for government health plan. A government airline would be just like a private airline exceptit would take you to Healthyville more efficiently because it wouldn't offer the pillow, the drink, or the movie.Really?No, not really. For the real story, watch the Independence Institute's new one minute video on what it will be like if a government plan manages to get off the ground.On YouTube, at http://www.youtube.com/watch?v=fKXuDPFz_9g Tue, 13 Oct 2009 10:43:00 Linda Gorman http://blog.spn.org/id.4903/detail.asp According to Politico, the White House is trotting out some new arguments lately, including pushing a report from the Treasury Department that tries to make clear that lack of insurance can happen to anyone, not just those with low incomes. For example, the report found that:Continue Reading at the John Goodman Health Blog Mon, 12 Oct 2009 12:26:00 John Goodman http://blog.spn.org/id.4902/detail.asp It's such a simple idea. Yet powerful. Compelling. Alluring. Irresistible.And it's scaring the bejeebies out of the health reform crowd on Capitol Hill.Here it is: Before Congress votes on a final health reform bill, the full text goes up on the Internet for everyone in the nation to read, along with the Congressional Budget Office (CBO) score -- giving the expected price tag and the expected impact on seniors, small business, employer-based coverage, etc.Continue Reading at the John Goodman Health Blog Wed, 7 Oct 2009 11:34:00 John Goodman http://blog.spn.org/id.4901/detail.asp The trademark of the Administration’s approach to health reform is to point to problems and then propose solutions that do not solve them. For example, in response to the problems of cost, quality and access, Obama Care almost certainly will result in higher spending, lower quality and less access (at least for poor people). The individual mandate fits this pattern.The case for government action is what economists call the "free rider" problem. Left to their own devices, some people will avoid buying health insurance and avoid self-insuring and consume all their income instead. Then if they develop expensive-to-treat conditions, they will throw themselves at the mercy of society as a whole. Since most of us are not indifferent to the suffering of others, we chip in and pay for the treatments. But this rewards the free riders (allowing them to be effectively insured without paying their fair share) and encourages others to become just like them. Now, if you think this is a problem — and even if you think it is a serious problem — the type of mandate being proposed on Capitol Hill does not come even close to solving it.Continue reading at the John Goodman Health Blog Mon, 5 Oct 2009 12:51:00 John Goodman http://blog.spn.org/id.4900/detail.asp At long last, the federal government has its new stimulus-tracking website up and running. Interested taxpayers and journalists can now start digging to find out where some of the billions of dollars that have been printed up in Washington under Obama’s stimulus plan are going. The website is recovery.gov and can be found here. Particularly interesting to me was the area of the site that tracked spending of stimulus money in New Mexico. You are encouraged to go in and look at specific grants, loans, and contracts in your area. A few that I noticed in Albuquerque included a $480,000 loan to O’Neill’s Pub on Central. A Cold Stone Creamery ice cream shop got another $800,000 loan. As I told Santa Fe New Mexican reporter Kate Nash, the website, while useful, raises more questions than answers. Hopefully average citizens will take a closer look at some of the businesses receiving this money and find out for themselves whether the federal government should really be involved in all of this. Fri, 2 Oct 2009 12:11:00 Paul Gessing http://blog.spn.org/id.4897/detail.asp A colleague at the Commonwealth Foundation sent me an article in which Mitt Romney again declares Massachusetts health care reform a success, claiming the increase in taxpayer spending was "only" $700 million (assuming a decrease in spending this year). He figured this would provoke me to respond, given we have written on RomneyCare, highlighted evidence of its shortcomings, discussed health care reform in Massachusetts and other states at an event last month, and produced a video on the lessons we should learn from these failures. Of course, I was already prepared, having planned to comment on Grace Marie's Turner blog post which spotlights three major problems with Massachusetts' health care reform. Namely, that health care premiums are skyrocketing, that the state is experience a shortfall in medical providers, and the there will be "crowd-out" as employers drop coverage. There is also the Rasmussen poll where 37% of MA residents think the reforms were a "failure" vs. 26% who think it a success. But I also stumbled across a 2008 survey from Harvard's School of Public Health, which shows residents are much more favorable to the reforms. But there are even more lessons from that study. While 69% said they "support" the law (vs. 22% "opposed"), respondents were more negative when asked about whether it has helped: People who do not have health insurance - Helping: 45%; Hurting: 33% Not much impact: 14%People who do have health insurance - Helping: 26%; Hurting: 18% Not much impact: 48%Small Businesses - Helping: 13%; Hurting: 56%; Not much impact: 19%Large Corporations - Helping: 19%; Hurting: 11%; Not much impact: 56%Young Adults - Helping: 32%; Hurting: 29%; Not much impact: 28%Poor People - Helping: 44%; Hurting: 31%; Not much impact: 14%The Middle Class - Helping: 27%; Hurting: 26%; Not much impact: 40%Doctors and Hospitals - Helping: 40%; Hurting: 16%; Not much impact: 26%The State Budget - Helping: 14%; Hurting: 39%; Not much impact: 26%You Personally - Helping: 14%; Hurting: 18%; Not much impact: 67%Massachusetts Economy - Helping: 22%; Hurting: 35%; Not much impact: 31%Quality of Health Care in Massachusetts - Helping: 29%; Hurting: 21%; Not much impact: 42%Cost of Health Care in Massachusetts - Helping: 20%; Hurting: 39%; Not much impact: 30% Given the prevalence of respondents saying the new Massachusetts health care law is hurting or not having much impact, it is difficult to justify why 69% support it. The lesson is this: Fri, 25 Sep 2009 16:17:00 Nathan Benefield http://blog.spn.org/id.4896/detail.asp Congressional leaders and the White House are pushing forward with their aggressive agenda to remake our health sector as though they are oblivious to the fear and outrage outside the Beltway and the pleas of the American people to put on the brakes.Only one in five Americans say their health insurance coverage and the quality of the care they receive will improve if a bill passes Congress this year. But the Senate Finance Committee nonetheless presses on, slogging its way through more than 500 amendments to the chairman's 220-page "summary" of legislation -- ("Read the bill! What bill?") No number of amendments can turn this dinosaur into a race horse. They need to start over.The hubris is breathtaking in the decisions legislators are willing to make to order people's lives, intrude into their heath care decisions, and spend voters' and taxpayers' money for generations to come.Why don't they stop? The best explanation I've heard is that the leadership is convinced that the reason ClintonCare led to such a huge defeat in the 1994 elections was that Congress failed to get a bill passed. If they would have just tried harder, the thinking goes, voters would not have retaliated against Democrats at the ballot box and instead would have thanked them for passing health reform.Can they possibly be this out of touch? Inside the Beltway, anything is possible Fri, 25 Sep 2009 15:56:00 Grace-Marie Turner http://blog.spn.org/id.4895/detail.asp I agree with the single-payer crowd (but just this once)A few days ago, I read the following headline for an opinion piece in the ABQ Journal "Bill Needs States’ Flexibility." The article, surprisingly enough, was not written by some free market advocate, but some folks from the Health Security for New Mexicans Campaign. While the group’s mission statement does not explicitly state it, the group’s goal is to promote government-run health care in New Mexico.Thus, the point of the op-ed was to encourage Congress and President Obama to include language in any health care legislation that "gives states the flexibility to develop their own approaches to solving the problems of growing numbers of uninsured and rising health care costs." Now, there is no doubt that these folks want a government option and we at the Rio Grande Foundation want less government intervention in the health care marketplace, we can agree that federalism is superior to a top-down "reform" undertaken in Washington.It would be great if all states had the freedom to opt in and out of various government programs and, more importantly, if each state had to foot the bill for those programs. After all, a program is hardly optional if the federal government is offering a 3 for 1 match for states to expand those programs (as is offered for Medicaid in New Mexico). Also, I hope that the federal government will respect the wishes of states (Arizona voters will be voting on just such a ballot measure in 2010) to opt out of any government-run health care system. Fri, 25 Sep 2009 13:33:00 Paul Gessing http://blog.spn.org/id.4891/detail.asp Let's count the number of parties in favor of a top-down, politically driven approach to health care. We've got big government fans generally, big unions, big insurance companies (willing to drop opposition to "guaranteed issue" if government requires everyone to buy their products), big pharmaceutical companies (hoping to both increase sales and make a deal to avoid drastic price controls), and also, "big disease."For example, the American Cancer Society (ACS) has something called the Cancer Action Network. It favors a severe limit on using risk factors to determine premiums (young adults and healthy people, be prepared for your premiums to go up). It also asserts that health care is a right (see Brian Schwartz, however, on why health care is not a right), a proposition that, if acted into law, would have some unfortunate consequences.The job of the ACS isn't to preserve the principles of freedom or limited government or fiscal sanity or even improve health care in its totality. Instead, it's to attack one form (or forms) of ailment, and neglect everything else."Stop cancer" is certainly a worthy goal, but before you support the ACS, you ought to consider the effects their vision for health reform would have. I suspect that other disease groups endorse reforms that ultimately empower government even more, thus leading to rationing, out-of-control costs, and restrictions on personal liberties in the name of fighting disease. Fri, 25 Sep 2009 08:09:00 John LaPlante http://blog.spn.org/id.4888/detail.asp Humana and other health insurance providers have been told to the effect that they are not to distribute information to their patients if this information is in opposition to ObamaCare. This action by the Centers for Medicare & Medicaid Services (CMS) appears to be an open and apparent violation of the First Amendment to the Constitution of the United States. It was not long ago that President Obama assured us that he wanted his "Government Option" health care plan to add more competition to the current health insurance carriers. Many of us maintained that private enterprises, including health care insurance providers, cannot compete against a government that does not have to make a profit, writes the laws and rules, and can print all the money it wants. Now it appears that "gag orders," or worse, will be used to quiet those who dare to oppose ObamaCare. The federal government resorted to bullying tactics when it ordered an investigation of Humana -- one of the country's biggest private insurers -- for its decision to send customers a letter alerting them about pending health reform legislation, a leading Republican charged. U.S. health officials launched the probe after the Louisville-based company mailed a letter to patients enrolled in its Medicare Advantage plans -- private options that replace standard Medicare -- warning that President Obama's health overhaul could eliminate important benefits of the program. Humana said in its letter that if Medicare Advantage funding gets cut, "millions of seniors and disabled individuals ... could lose many of the important benefits and services that make Medicare Advantage health plans so valuable." In a few short months ObamaCare has gone from a socialized health care plan, to a government takeover of our health care, to thuggish control of the opposition. Thu, 24 Sep 2009 10:24:00 Donald R. May http://blog.spn.org/id.4884/detail.asp An ounce of prevention is worth a pound of cure. It’s an idea so simple and powerful that policymakers at both the State and federal levels of government are touting preventative care as one of the powerful solutions to our skyrocketing health care costs. The Minnesota Department of Health’s website touts $47 million in grants awarded last month to county and tribal governments that are aimed at improving Minnesotans’ health and well-being. The grants are to be used by local units of government to encourage such healthy activities as walking, quitting smoking, and eating better. "The Statewide Health Improvement Program will improve the health of Minnesotans and also help contain the spiraling costs of health care" according to Governor Pawlenty. Would that it were so. Almost all the available evidence suggests that in the aggregate preventative medicine increases the cost of health care, often with little health benefit to its intended beneficiaries. The Congressional Budget Office tells us that "Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall." This is true for multiple reasons. First of all, a great deal of cost-effective preventative medicine already takes place. Routine mammograms, prostate cancer checkups, blood tests, and so forth are already done. Routine screening for common diseases have been incorporated into medicine because it already makes sense. Screening for less common diseases, even if they are wildly expensive to treat, will fail a basic cost/benefit test. Secondly, truly preventative medicine usually has less to do with care and more to do with behavior modification, which is wildly difficult to accomplish, and usually equally unpopular (smoking bans being a possible exception). It is easy enough for policymakers to give grants to local governments to get people to walk more or eat better, but translating those grants into miles walked and pounds shed is another matter entirely. Evidence seems to suggest that we are doing a remarkably bad job of it, as obesity education has become even more pervasive than obesity itself. Third, extending lifespan—even healthy lifespan—is not a sure path to lower health care costs. Living longer is undoubtedly an unadulterated good, but not necessarily a cheaper one. It is usually the case that the longer ones lives the more health care one is likely to consume. So even successful wellness and prevention programs are likely to increase health care costs over time. Wed, 23 Sep 2009 16:50:00 David Strom http://blog.spn.org/id.4883/detail.asp If past cycles are any indicator, we are about due for another round of studies showing that being uninsured kills. Headlines will abound, commentators will wring their hands, and anyone who opposes ObamaCare will be portrayed as an insensitive killer.The good news is that the majority of the supposed deaths due to a lack of health insurance are statistical artifacts. Unlike deaths from government health care, which has been extensively documented to cause harm to the seriously ill, the elderly, and the newborn, the deaths due to a lack of health insurance are usually conjured out of data sets using a variety of statistical tricks.Here’s a simple checklist for cutting the number of deaths down to size:1. Does the study interview people only once and then assume that they remain uninsured? If so, it will likely overstate the fraction of people who die because they don’t have health insurance. Relatively few people remain uninsured for more than a year. 2. Does the study track how people died? If not, it probably overstates the number of deaths due to a lack of insurance. Younger people are more likely to be uninsured. Younger people are also more likely to die from homicide, something that health insurance has nothing to do with. If homicides or accidents contribute to the higher mortality in the uninsured group, it is not reasonable to claim that their higher mortality is due to a lack of health insurance. 3. Does the study control for different the differences in social and economic status between the insured and the uninsured groups? All work to date suggests that people who are uninsured differ from the privately insured in ways that are likely to independently increase mortality even in people with coverage. For example, the uninsured are more likely to be high school dropouts, more likely to smoke, less likely to have ever worked, and less likely to be married. All of these characteristics are associated with higher mortality whether or not someone has health insurance. So, does having health insurance reduce mortality or not? Current estimates suggest that if it does, the effect is small, likely smaller than the deaths from the lower incomes created by the higher taxes needed to ensure everyone in American using the Massachusetts-like plans in the ObamaCare bills. June and Dave O’Neill, in a paper on the uninsured written for the Employment Policies Institute, conclude that "lack of health insurance is not likely to be the major factor causing higher mortality rates among the uninsured." Doyle, in a comparison of survival for Wisconsin motor vehicle accident victims who were uninsured or covered by a private plan found that the uninsured were more likely to ride a motorcycle and crash in the middle of the night. Controlling for that, he found that their mortality rate was 1.5 percent higher, except in hospitals with a religious affiliation. Wed, 23 Sep 2009 12:57:00 Linda Gorman http://blog.spn.org/id.4882/detail.asp What's been working at keeping insurance premiums under control? Nothing that's being discussed in Washington these days. StateHouseCall contributor Merrill Matthews, along with Ray Ramthum, laid out some numbers in an op-ed published by Investors' Business Daily.High-deductible health plans are where it's at:For Cigna, costs in CDHPs in their first year went down 4%; those in Cigna's traditional plans went up by 9%.Aetna saw a decline of 10% for CDHPs vs. an 8% increase in traditional plans.Uniprise experienced a 15% drop in CDHPs vs. a 7% rise in traditional plans.And WellPoint compared its group insurance accounts in 2008 and found HMO and PPO rates went up 7% to 10% from the previous years, while CDHPs went down. You can read the whole article here. Tue, 22 Sep 2009 15:51:00 John LaPlante http://blog.spn.org/id.4880/detail.asp The site Health Care Horse Race reports that there are 564 amendments to the Senate Finance bill. Read here for an assessment of the good, the bad, and the ugly. Or at least the bad and the ugly. I haven't seen anything good yet. Tue, 22 Sep 2009 10:57:00 John LaPlante http://blog.spn.org/id.4875/detail.asp There’s more than one way to skin a cat. President Obama has caved in to Republican pressure and declared that any health care reform that made its way to his desk should have provisions that ensure that the new program does not steer resources to illegal aliens. That was the point of contention that inspired Rep. Joe Wilson’s outburst during Obama's speech, and Obama caved on the issue in a Friday night news dump when it became clear that covering illegal immigrants was too hot a political potato to keep a hold of. Now, though, in a speech to the Congressional Hispanic Caucus, President Obama appears to be backtracking a bit. While maintaining that illegal immigrants should not get benefits in the new health care reform package, the President told the Hispanic Caucus that "If anything, this debate underscores the necessity of passing comprehensive immigration reform and resolving the issue of 12 million undocumented people living and working in this country once and for all." Hmm. That’s a neat trick. Instead of covering illegals as the plan implicitly did until recently, the President seems to be suggesting that the best way to deal with the problem of uninsured illegal immigrants is to make them legal and make them eligible for coverage. I don't think that’s what most people thought Obama meant when he promised that our tax dollars wouldn't be spent on providing insurance to the millions of illegal immigrants in this country. Tue, 22 Sep 2009 10:55:00 David Strom http://blog.spn.org/id.4879/detail.asp In an earlier post I noted how the course of the health care policy debate was being steered by the quirky personalities and interests of just a few Senators. Further evidence of how the fate of the entire nation is being determined by parochial interests has emerged in a new story that appeared in the New York Times today. As is always the case when legislation wends its way through Congress it begins to pick up barnacles in the form of earmarks and similar measures designed to pick up votes from recalcitrant members. Sen. Harry Reid, Majority Leader and one of the first critics of the Baucus Bill, has managed to get a measure inserted that would single out hospitals in his home state of Nevada for enhanced reimbursements from the Federal government. Sen. Debbie Stabenow (D-Mich.) and Sen. Blanche Lincoln (D-Ark.) are signed on as well, and for a simple reason: facilities in their states are similarly singled out in what is called a legislative "rifle shot," a legislative measure that appears to establish a general policy, but the terms of which ensure application to only a few intended beneficiaries. Congress is now rapidly moving beyond the policy debate regarding health care reform and getting down to brass tacks: each legislator is simply asking what THEY can get out of the legislation for themselves and their constituents. For those of us who have long been skeptical about Obama's health care reform push this is depressing evidence that we were right about the dangers. In the eyes of most legislators the central question has never been what was good for the country, but rather what will be good for them and theirs. It is incumbent upon us to work assiduously to make them wonder just how politically dangerous going down this path could be. Tue, 22 Sep 2009 10:50:00 David Strom http://blog.spn.org/id.4878/detail.asp In order to save the state money, Idaho's governor, Butch Otter, ordered part-time state employees to contribute more towards health insurance premiums. This action puts the state more in line with private business practices. One group was left out of this plan, though, as Wayne Hoffman of the Idaho Freedom Foundation notes:Idahoans pay around $780,000 a year to insure members of the House and Senate (a small portion of that amount is for the staff of both chambers). State lawmakers, who are the most visible of the cast of part-timers, will still receive the same lucrative health insurance package that full time government employees enjoy. So while part-time workers are paying $166-$302 a month for insurance, lawmakers benefit from a low monthly premium fancied by fulltimers -- $30 per individual. Taxpayers bear the rest of the cost of each insurance policy. To a public weary of government and skeptical of politicians, it smacks of bureaucratic snobbery. Correcting this inequity would strike a blow for fairness and save the state's taxpayers some money in the process. Tue, 22 Sep 2009 09:36:00 Marc Kilmer http://blog.spn.org/id.4870/detail.asp A new government-run plan could sharply increase private insurance premiums if the plan were aggressively implemented to include large numbers of those who currently have private health insurance, write Allen Dobson et al. of the health care consulting firm Dobson Davanzo and Associates LLC. Because public programs often pay less than costs, many hospitals are not otherwise able to cover their costs, modernize, and stay current with emerging technology. To remedy this condition, hospitals may attempt to shift costs to the privately insured to offset other payers' payment shortfalls relative to costs. Tue, 22 Sep 2009 09:23:00 Grace-Marie Turner http://blog.spn.org/id.4877/detail.asp Perhaps the most odious part of any health reform is the requirement that you buy health insurance.Anthony Gregory, a research analyst at the Independent Institute, says there are several reasons why a mandate may be unconstitutional. There is of course the Tenth Amendment, which we've discussed on this site before. But there's also the right to privacy, the Fourth Amendment (secure in your papers and house), the Fifth Amendment (self-incrimination), and the Thirteenth Amendment (involuntary servitude).Some of these arguments sound similar to claims that the Federal income tax is unconstitutional. Good luck making that case before the judge.Of course our legal and political system once held that some men were chattel, so if we're lucky, the Constitution will get the credit it deserves. Some day. Tue, 22 Sep 2009 08:08:00 John LaPlante http://blog.spn.org/id.4876/detail.asp The Baucus bill calls the fine for not complying with its individual mandate to buy health insurance an "excise tax." President Obama must have gone to school with Colorado Democrats. This weekend, President Obama told George Staphanopoulos that the Baucus excise tax is really not a tax because to say you "have to take a responsibility to get health insurance is absolutely not a tax increase." [link]This year the Colorado legislature, which is controlled by Democrats, decided that a measure which makes hospitals send a fixed percentage of billed patient charges to state government was not a tax either, and Colorado's Democrat governor, Bill Ritter, signed the bill.The Colorado Constitution forbids tax increases without a vote of the population. The state needed money, a tax increase would have gone down in flames, so elected officials simply renamed a tax a "fee."In Colorado, it appears that paying the state extra when you need hospital care absolutely isn't a tax increase either. As Colorado Democrats and President Obama have discovered, life is much easier for elected officials who don't worry about the plain meaning of words or, apparently, the Constitutions and statutes that contain them. Mon, 21 Sep 2009 15:51:00 Linda Gorman http://blog.spn.org/id.4874/detail.asp CBO scoring will probably determine fate of health care reform One of the major insights of political science is that process matters at least as much as substance in how policy decisions are made. We can see a great example of that fact in how the health care policy debate is taking place in Washington DC. Everybody knows that the Congressional Budget Office is the official scorekeeper of the fiscal impact of various bills and proposals as they wend their way through Congress. The fate of such proposals is often determined by the fiscal impact projected by the CBO. At several points in the current debate CBO projections have been used as a very effective cudgel to beat up proposals when their fiscal impact was shown to exceed $1 trillion. Why $1 trillion is a magic number of affordability is a mystery to me, but that has become the benchmark against which all proposals seem to be measured. Of course every scoring system can be gamed, and the CBO's is no different. The latest health care proposals have incorporated an evilly brilliant way of doing so by putting into place so-called "automatic" spending cuts that are supposed to kick in if certain spending levels are exceeded. The result of this chicanery is obvious: Congress can promise all manner of wonders for what is deemed a reasonable cost, all the while keeping the budget line lower by promising that costs will be kept in check through automatic spending cuts that are extremely unlikely to ever be implemented. In essence they are promising everyone a Lexus, are budgeting for a Chevy, and promising that if the Lexus costs more than what they now project it will they will simply provide the Lexus for the cost of a Chevy. The CBO is pretty much forced to go along lest they base their projections on the assumption that lawmakers are liars. That may be a fair assumption in reality, but not one that an arm of Congress can tenably maintain. How likely are the automatic spending cuts to be implemented? About as likely as Congress allowing the Alternative Minimum Tax to apply to the millions of middle class taxpayers who are exempted every year. It would be political suicide, so it won't happen. In short, the very same CBO scoring system that has doomed earlier reform proposals over the past year is now about to be gamed effectively to make its passage more likely. Mon, 21 Sep 2009 13:52:00 David Strom http://blog.spn.org/id.4873/detail.asp In an ongoing debate in the Los Angeles Times with Larry McNeely, Michael F. Cannon makes a point that ought to be heard more often: "Democrats in Congress are taxing workers to pay off insurance companies. Democratic Sen. Max Baucus (D-Mont.) just proposed $774 billion in subsidies for private insurers. (Somehow, that's supposed to be more moderate than House Democrats' $773 billion in subsidies.)" It's all part of the same game plan: Buy off all the major industry groups (PhRMA--drug companies; AHIP--insurance companies; and the major doctors' and hospital associations). Mon, 21 Sep 2009 13:12:00 John LaPlante http://blog.spn.org/id.4872/detail.asp The Home School Legal Defense Association has offered several criticisms of H.R. 3200. As a group, home-schooling families are small in number, but they are used to being politically active. Add a few more groups to the mix and you have some powerful opposition to a government takeover of health care, whether through a "public option" or merely increased regulation. Mon, 21 Sep 2009 12:54:00 John LaPlante http://blog.spn.org/id.4869/detail.asp Senate Finance Committee Chairman Max Baucus spent much of the summer dancing with the Congressional Budget Office (CBO) to figure out how to squeeze his health reform bill into its scoring framework and get a positive outcome. Surprise, surprise, he succeeded! The CBO said on Wednesday that the Baucus bill will lead to a "net reduction in the federal budget deficit of $49 billion" over the next 10 years and that 94% of Americans will have health insurance. But then we get into those devilish details. . . The revenues and savings are fictitious and only will come about if you take the American people for chumps. For example, the bill requires individuals to buy health insurance and fines them up to $3,800 a year for a family if they don't comply. The CBO assumes that people will continue to pay the fine year after year, estimating $20 billion in penalties over six years. (The mandate doesn't trigger until 2013. And here's an odd coincidence: That's just after the next presidential election.) And they assume that employers will get increasingly stupid, paying more and more in "free-rider penalties" every year, adding up to $27 billion in fines by 2019. And here's the biggest revenue raiser: The CBO assumes that people will not change their behavior but will continue to buy Cadillac health insurance and that the government will collect $215 billion from excise taxes on the expensive policies by 2019. I thought this USA Today story pretty much summed up the onerous individual mandate, employer fines, and new taxes. And don't get me started on whether or not they really, truly, will be able to wring more than $500 billion in savings and "efficiencies" out of Medicare, Medicaid, and other federal programs. Mon, 21 Sep 2009 06:20:00 Grace-Marie Turner http://blog.spn.org/id.4864/detail.asp The solutions to all of our health care problems are really quite simple. We must get the Federal government out of the way of our health care decisions. Most politicians and bureaucrats have little vested interest in the patient and care little to nothing for the future comfort and happiness of the patient, the integrity of family structures, or even our national security. Most politicians simply have the goal of acquiring as much money and power as possible and as fast as possible. Health care needs to be returned to the basic economic principles that govern the sale of the other necessities of life, including food, water, clothing, transportation, and housing. Free markets work and bureaucracy and socialism do not. Personal responsibility is essential to saving health care and to an ownership society. Medical savings accounts and portable health insurance policies that can be taken from job to job are major reform steps on the road to an ownership society and a health care system that works for all of us. As most people do not understand economics and fear change, any reasonable solutions will be difficult to implement. Foundational to the current health care discussions are five simple solutions: We must block any additional incursion of our Federal government into the control and funding of our health care. We must return health care decisions to the people and their physicians.The ownership of one’s own health care funds and health care insurance are essential steps in our return to a free and economically successful society.Health care for the poor needs to be put in the hands of communities and States. Local people can best provide for the needs of their neighbors who are in need.Tort reform is essential, as greedy trial lawyers greatly increase health care costs. It is time to get our government out of our lives. It is time to return Washington to leaders who are wise, honest, and courageous. Our elected officials must find the courage to return health care, retirement, education, welfare,and other personal and local decisions to the people, communities, and the States. The people can best make their own decisions. Thomas Jefferson gave us this simple assurance that still endures, "Whenever the people are well-informed, they can be trusted with their own government; whenever things get so far wrong as to attract their notice, they may be relied upon to set them to rights." The politicians have created our greatest problems. The politicians have not provided us with workable and beneficial solutions. The politicians simply need to get out of the way and let We the People get back to work. The people and the free markets will quickly restore our country and its prosperity. The politicians who do not get out of the way simply need to be fired as soon as possible. Mon, 21 Sep 2009 05:51:00 Donald R. May http://blog.spn.org/id.4861/detail.asp It is impossible to separate government policies from politics, and that is especially true when it comes to hot button issues such as the health care debate now going on in Congress. In fact, that is one of the best reasons for insisting that policy debates begin with a commitment to free market principles: not because the free market always provides universally satisfactory results, but because government-imposed solutions are always based upon the arbitrary exercise of power exercised by whoever happens to have their hands on the levers at any moment. A couple of cases in point: 1) Over the past few weeks the course of the policy debate in Washington has been plotted by a Senator from Montana seeking to entice a few other Senators from Iowa and Maine. As much as the public has been focused on the storm and strife at the town hall meetings taking place around the country, the fate of the "reform" was being decided in large measure by the negotiations of a "gang of six" Senators. In the end Baucus was unable to secure any Republican support even from the likes of Olympia Snowe, but the bill that was just revealed was largely the product of negotiations between a few members of the Senate Finance committee. Is this how our fates should be determined, by the idiosyncrasies of a few senior members of the Senate? 2) Once the Baucus plan was revealed, it was instantly panned by both Democrats and Republicans. And why? As often as not it was parochial reasons, not policy reasons that drove the dissent. Harry Reid, the Senate Majority Leader is in trouble in his home state and as details came out about the bill it became clear that a number of provisions weren't favorable to his state. So what was Reid’s response? He wants the plan changed to be more favorable to Nevada. And why is this likely to happen? Because he is the Senate Majority Leader. Isn't it comforting to know that health care policy for the entire country will be shaped to ensure that Nevada does better than most states? (No offense Nevada) One of the principles that "policy" experts ignore at the peril is the simple fact that policy and politics are inseparable. In public policy matters there is no immaculate conception. That doesn't mean that we shouldn't engage in public policy studies, of course. But it should give us a sense of humility when it comes to assertions about how easily we can tweak reality to provide better outcomes if we can only gain the ears of those in power. Fri, 18 Sep 2009 12:15:00 David Strom http://blog.spn.org/id.4858/detail.asp It is always great to have a sitting president visit Minnesota — regardless of party affiliation. While President Obama briefly mentioned Mayo Clinic in his speech in Minneapolis last week, it would have been far more instructive for him, and the nation, had he gone to Rochester to see the cutting-edge treatments developed there. Despite President Obama's rhetorical reference to Mayo as an example of what is right, his "new plan" includes proposals that are antithetical to what makes Mayo work for so many people. Better listening might lead to better policy — policy that relies more on what Mayo has learned about bringing teamwork to bear on the best interests of the individual, and less on the heavy hand of the federal bureaucracy. The president could have gone to Medtronic - a global leader with a reputation for innovation such as the integrated insulin pump/glucose monitoring device that improves outcomes and the lives of those with diabetes. Or, he could have met with the folks at Medtronic to listen to them talk about how his tax proposals will impact their ability to create and retain jobs in Minnesota, or in the United States, for that matter. Of course, he could have taken time to visit the University of Minnesota - consistently ranked as one of the top hospitals for health outcomes and for efforts related to childhood cancers and autism therapies. But he didn't. He came to Minnesota to give a partisan speech to generate support for his dea of "reform." Unfortunately, when you spend so much time telling people why you're right you can never really hear people trying to tell you that you might be wrong. Minnesotans already know that our state is a proven incubator for cost-cutting ideas and cutting-edge healthcare technologies. All of us, regardless of party affiliation, must be concerned that these innovations may be at risk if we get this "reform" wrong. We should also all agree that reining in health care costs is a must — the fiscal foundation of our country is at risk. Health-care spending accounts for approximately one-sixth of our national economy, and because of that, getting it right is critical. Unfortunately, President Obama came to Minnesota to tell us what we must change in order to conform to a narrow Washington view of how our health care system should work. He came to Minnesota to tell us that he was going to take some of our ideas, combine them with some of their ideas - put them through the Washington, D.C., spin cycle - and hope that something good comes out he can call reform. Further nationalizing health care should concern all of us. The Medicare program is an example of how federal management of health care is in need of fundamental reform and is actually short-changing states like Minnesota. Reforming Medicare to erase the outrageous inequities is something on which Republicans and Democrats in Minnesota agree — a great opportunity for common ground. The president also has talked about how eliminating "waste, fraud, and abuse" in Medicare must be undertaken. I completely agree, and I suspect any tax-paying Minnesotan would, too. But it underscores the problem with the current state of Washington thinking: If we know there is massive waste, fraud and abuse in the billions of dollars we currently spend on health care in this country, should we not address that before creating another huge government bureaucracy that will generate even greater waste, fraud and abuse? The president can regain the trust of the people and actually pass meaningful reform if he's candid about what's working in health care, what's broken and what the solutions require. But if he relies solely on lofty words that gloss over the serious flaws in bringing even more government control to health care, he won't receive the citizens&#39 Fri, 18 Sep 2009 09:01:00 Laura Brod