There has been a lot of talk in Washington about cutting wasteful health-care spending, but it is troubling that such talk has not created a sense of urgency for national tort reform. It is especially frustrating because states have already shown that curbing junk lawsuits can cut costs, create jobs, and increase the quality of care available to patients.
I know this because that is exactly what happened in Missouri when, as governor, I helped to enact comprehensive reforms.
I took office in January 2005 at a time when runaway lawsuits were driving up the cost of doing business in my state and forcing doctors and other business owners to close their doors. The U.S. Chamber of Commerce Institute for Legal Reform keeps a list of states ranked according to their legal environment. At the time, Missouri ranked among the 10 worst.
"Venue-shopping," a tactic that involves shifting a case to a friendly court regardless of where the injury occurred, was common. Defendants could be made to pay 100% of a judgment even if they were only 1% responsible for the injury. And caps on damages had been rendered meaningless by state court decisions.
This legal environment raised the cost of health care for everyone and imposed stiff costs on businesses. It also forced doctors to close their doors. For example, the eastern half of Jackson County, one of Missouri's largest, lost its only neurosurgeons in 2003 due to high malpractice insurance costs. Many other parts of the state suffered from a lack of doctors able to deliver babies. One obstetrician who delivered more than 200 babies annually was forced to quit after his annual insurance premiums skyrocketed 82% in just one year. Making matters worse, few new doctors wanted to move to Missouri. One Kansas City area doctor sent letters to more than 400 physicians finishing their residencies and did not receive a single response back.
To counteract these problems we required that cases be heard in the county where the alleged injury occurred, and we changed the law so that defendants could only be forced to pay a full judgment if their fault exceeded 50%.
We put a $350,000 cap on noneconomic damages and created rules to prevent baseless cases from getting off of the ground. Previously, personal injury lawyers could file cases if they got a written affidavit from any qualified health-care provider claiming that there was negligence. We tightened that by requiring that the affidavit come from an active professional practicing substantially the same specialty as the defendant.
We also took another common-sense step. Doctors often express empathy to a suffering patient regardless of fault. Saying you are "sorry" for someone's plight is a testament of good character, and should not be used against you in court. But tort lawyers were claiming that such statements were an admission of guilt. We stopped that abuse.
Tort reform works. Missouri's medical malpractice claims are now at a 30-year low. Average payouts are about $50,000 below the 2005 average. Malpractice insurers are also turning a profit for the fifth year in a row—allowing other insurers to compete for business in Missouri. This will drive down costs, which will save government programs money as well as improve the system for patients. It will also leave doctors with more resources to invest in better care.
Since 2005, Missouri has moved up to 31st on the Chamber of Commerce Institute for Legal Reform's list.
Because we passed tort reform, cut taxes and controlled state spending, Missouri's economy is now in better shape than it would have been. During the four years I was in office, about 70,000 net new jobs were created in my state.
Texas has seen similar success from its 2003 tort reforms. The number of doctors applying for a license in that state has increased by 57% and doctors' insurance rates have declined by an average of 27%. There are now more doctors in Texas providing care in previously underserved areas.
There is no reason that the success that Missouri, Texas and other states have experienced cannot be replicated nationally. States are demonstrating that tort reform lowers costs, expands access, and creates jobs. The time to get behind national tort reform is now.
Mr. Blunt, a Republican, is a former governor of Missouri.
Wednesday, September 23, 2009
There's No Free Health Care, Obamacare will raise costs--and everybody knows it
Give President Obama credit for persistence. And stubbornness. And lack of imagination. He declared again last week that his health care plan "will slow the growth of health care costs for our families and our businesses and our government." And this historic achievement will be accompanied by a dazzling array of new medical benefits that everyone will receive--guaranteed by law. Okay, you've heard this before. But that's the president's story, and he's sticking to it.
The question is, why? Does he think we're stupid? His argument has failed to persuade a sizeable majority of the American people precisely because they're not stupid. They understand the laws of addition and subtraction. When you offer more--much, much more in this case--of a good, it's going to cost more. Somebody has to pay for it. Yet Obama says we'll all be paying less, and that includes businesses and government.
If he could actually pull off this feat, he would indeed be the One we've been waiting for. But he can't. This is apparent whenever Obama explains where the "savings" will come from. They're from eliminating "hundreds of billions of dollars" in waste, fraud, and abuse (WFA) in the health care system. Surely, he knows better. Everyone in Washington recognizes these savings are imaginary. They're offered with a wink. They never happen. President Reagan promised to slash WFA in the 1980s. The result: zilch. Where Reagan failed, Obama is not likely to succeed.
Obama may be unaware, but there are three programs--in Maine, Massachusetts, and Tennessee--currently testing his idea of get-more-pay-less. The evidence is already in: Expanded health care coverage costs more, an awful lot more. There are no known exceptions.
The question is, why? Does he think we're stupid? His argument has failed to persuade a sizeable majority of the American people precisely because they're not stupid. They understand the laws of addition and subtraction. When you offer more--much, much more in this case--of a good, it's going to cost more. Somebody has to pay for it. Yet Obama says we'll all be paying less, and that includes businesses and government.
If he could actually pull off this feat, he would indeed be the One we've been waiting for. But he can't. This is apparent whenever Obama explains where the "savings" will come from. They're from eliminating "hundreds of billions of dollars" in waste, fraud, and abuse (WFA) in the health care system. Surely, he knows better. Everyone in Washington recognizes these savings are imaginary. They're offered with a wink. They never happen. President Reagan promised to slash WFA in the 1980s. The result: zilch. Where Reagan failed, Obama is not likely to succeed.
Obama may be unaware, but there are three programs--in Maine, Massachusetts, and Tennessee--currently testing his idea of get-more-pay-less. The evidence is already in: Expanded health care coverage costs more, an awful lot more. There are no known exceptions.
Thursday, September 17, 2009
Wednesday, September 16, 2009
The High Cost of Health Care
As Democrats and Obamabots try to remake the health care system in the face of bitter opposition (45% of doctors say they will quit their practices or retire early), the federal public option for the elderly is preparing to cut benefits. This should be part of the debate, but of course it is not.
Supporters of the health care revision tell us that its $1 trillion price tag won’t add a dime to the national deficits. But the reality is any program that expands Washington’s reach into health care will cost far more than the rosy projections we’re hearing. History shows that the bureaucracy always spends far more on programs than the Beltway experts say it will.
One program that has spun wildly out of control is Medicare, enshrined as an entitlement in 1965 over the opposition of many in Congress because they could see what was coming. Actuaries projected its cost for 1990 as $10 billion. Yet actual outlays were $107 billion. Now the program is spending more than it is taking in through the payroll tax that is supposed to fund it, leaving Washington with only two options: ration Medicare or raise taxes.
Don’t make the mistake of thinking that brilliant minds in Washington will figure out a way to avoid rationing before it becomes necessary. Those heads are busy looking for places to slash right now. Medicare, for instance, is considering cutting $1.4 billion in benefits beginning on January 1st, 2010. If the new schedule is adopted, the reductions will be in fees paid to cardiologists and oncologists.
At the same time that fees for heart and cancer physicians will be trimmed by 10%, fees paid to family doctors, who can do for little heart and cancer patients, will be boosted by 8% and reimbursements paid to nurses will rise 7%. The Administration believes that moving the fees toward primary care will be a boost for preventive care which recent studies have been shown to provide no significant savings.
There are two points to take away from this mostly ignored news. One, any scheme passed by Congress and signed into law will cost taxpayers dearly. Two, the government will have to ration care because it cannot possibly pay for a nation of 305 million going on a billion demanding free medical care.
If rationing is adopted, it will have a direct effect on patients, particularly those who are suffering from two of the most serious illnesses. Heart and cancer specialists, who will be expected to accept Medicare reimbursements that are less than some procedures cost, are already reporting that they will either close their practices or limit care. Some will simply stop treating Medicare patients. Welcome to the new brave world of rationed medicine!
Anyone who believes Washington can improve health care by increasing its involvement is not thinking clearly. Its solutions tend to create bigger problems. Yes, a government takeover may improve care for a small segment of the population. But it will be far worst for everyone else. – adapted from an IBD editorial.
In looking for cost savings the government has overlooked the most obvious source for such savings: illegal aliens, legal immigrants, and their progeny who account for a disproportionate share of the uninsured and who use emergency rooms are their primary providers. What if we started demanding that emergency room patients produce evidence of citizenship as soon as possible after their condition is stabilized or sooner if a relative is available to provide that evidence? What if we required the hospitals and emergency rooms to place an automatic call to ICE by pushing a button with a pre-recorded message like, “We are treating a patient who has been unable to produce evidence of citizenship. Please arrange for immediate pick up and deportation as soon as the medical problem is under control.” What if the hospitals and emergency rooms also required the patient to identify the employer of the family breadwinner so he could be billed for any unreimbursed costs? What if they also had a mechanism for billing the countries of origin for all costs of treatment, hospitalization, detention, and repatriation? There is a good possibility of billions of saving to be had with these administrative arrangements. Obviously, Obama is not interested in savings from this quarter or he would be saying, “Why didn’t I think of that?”
Supporters of the health care revision tell us that its $1 trillion price tag won’t add a dime to the national deficits. But the reality is any program that expands Washington’s reach into health care will cost far more than the rosy projections we’re hearing. History shows that the bureaucracy always spends far more on programs than the Beltway experts say it will.
One program that has spun wildly out of control is Medicare, enshrined as an entitlement in 1965 over the opposition of many in Congress because they could see what was coming. Actuaries projected its cost for 1990 as $10 billion. Yet actual outlays were $107 billion. Now the program is spending more than it is taking in through the payroll tax that is supposed to fund it, leaving Washington with only two options: ration Medicare or raise taxes.
Don’t make the mistake of thinking that brilliant minds in Washington will figure out a way to avoid rationing before it becomes necessary. Those heads are busy looking for places to slash right now. Medicare, for instance, is considering cutting $1.4 billion in benefits beginning on January 1st, 2010. If the new schedule is adopted, the reductions will be in fees paid to cardiologists and oncologists.
At the same time that fees for heart and cancer physicians will be trimmed by 10%, fees paid to family doctors, who can do for little heart and cancer patients, will be boosted by 8% and reimbursements paid to nurses will rise 7%. The Administration believes that moving the fees toward primary care will be a boost for preventive care which recent studies have been shown to provide no significant savings.
There are two points to take away from this mostly ignored news. One, any scheme passed by Congress and signed into law will cost taxpayers dearly. Two, the government will have to ration care because it cannot possibly pay for a nation of 305 million going on a billion demanding free medical care.
If rationing is adopted, it will have a direct effect on patients, particularly those who are suffering from two of the most serious illnesses. Heart and cancer specialists, who will be expected to accept Medicare reimbursements that are less than some procedures cost, are already reporting that they will either close their practices or limit care. Some will simply stop treating Medicare patients. Welcome to the new brave world of rationed medicine!
Anyone who believes Washington can improve health care by increasing its involvement is not thinking clearly. Its solutions tend to create bigger problems. Yes, a government takeover may improve care for a small segment of the population. But it will be far worst for everyone else. – adapted from an IBD editorial.
In looking for cost savings the government has overlooked the most obvious source for such savings: illegal aliens, legal immigrants, and their progeny who account for a disproportionate share of the uninsured and who use emergency rooms are their primary providers. What if we started demanding that emergency room patients produce evidence of citizenship as soon as possible after their condition is stabilized or sooner if a relative is available to provide that evidence? What if we required the hospitals and emergency rooms to place an automatic call to ICE by pushing a button with a pre-recorded message like, “We are treating a patient who has been unable to produce evidence of citizenship. Please arrange for immediate pick up and deportation as soon as the medical problem is under control.” What if the hospitals and emergency rooms also required the patient to identify the employer of the family breadwinner so he could be billed for any unreimbursed costs? What if they also had a mechanism for billing the countries of origin for all costs of treatment, hospitalization, detention, and repatriation? There is a good possibility of billions of saving to be had with these administrative arrangements. Obviously, Obama is not interested in savings from this quarter or he would be saying, “Why didn’t I think of that?”
Legal Immigrants, Illegal Aliens, and Their Progeny Increase Healthcare Costs
Like virtually every issue that faces the nation, our healthcare problem is greatly exacerbated by mass immigration—both legal and illegal.
A total of 43 percent of non-citizens lack health insurance, compared to just 12.7 percent of native-born Americans. These uninsured immigrants impose huge strains on our healthcare system that helped create the crisis we currently face.
Plenty of analysts and commentators have exposed how illegal aliens will receive healthcare under ObamaCare. They point out that while the House version of the plan, H.R. 3200, claims to prohibit illegal aliens from receiving benefits, the Democrats repeatedly blocked amendments that would screen for the illegals. It is estimated that 6.6 million illegal aliens will be eligible for public healthcare if the bill passes. Those who support this healthcare bill are essentially supporting a bill that, together with all of our country’s other obligations, will bankrupt the federal government and debase our currency.
This is an outrage for hardworking Americans, but I’d like to focus on two other important but largely ignored aspects of our immigration crisis that will cost taxpayers billions of dollars if Obama’s healthcare boondoggle is passed.
The first is birthright citizenship. The 14th Amendment of the Constitution states, “All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside.”
The Amendment was passed for the sole purpose of granting freed slaves and their children citizenship. Senator Jacob Merritt Howard of Michigan who introduced the Amendment stated that it “will not, of course, include persons born in the United States who are foreigners, aliens, who belong to the families of ambassadors or foreign ministers accredited to the Government of the United States.”
But the obvious intent, as well as the “subject to jurisdiction thereof” clause, is ignored by federal policy that gives children of illegal aliens born in the United States automatic citizenship.
What does this have to do with the healthcare debate? Under H.R. 3200, only one family member needs to be eligible for government healthcare. After that, the whole family can get free healthcare. The Congressional Research Service acknowledged,
There could be instances where some family members would meet the definition of an eligible individual for purposes of the credit, while other family members would not… H.R. 3200 does not expressly address how such a situation would be treated. Therefore, it appears that the Health Choices Commissioner would be responsible for determining how the credits would be administered in the case of mixed-status families.
This means that if a family of illegal aliens has one child after they arrive, their “anchor baby,” a U.S. citizen, could make the entire family eligible for tax-funded healthcare. This would likely incite public opposition, but it’s easy to imagine where Obama’s handpicked “health czar” would come down on the issue. Just look at the interpretation of the 14th amendment that allows instant citizenship to the offspring of illegal aliens. Look at the gross failures of past and present Administrations to secure our borders and pursue vigorous and continuous internal enforcement using E-verify.
Another problem that makes the healthcare bill problematic is our policy of legal immigration. America annually accepts approximately one million legal immigrants in addition to the flood of illegal aliens. Most of these immigrants come through the process of chain migration, whereby legal immigrants and U.S. citizens sponsor family members. The process has spirals out of control until everyone’s cousin is eligible, regardless of professional skills or what they can contribute to this country. Chain immigrations and anchor babies do not bode well for our country’s future but there is little attention given to these matters and their adverse effects on the national interest.
All immigrants, both legal and illegal, as well as their US-born children comprises up to one third of all the uninsured in America. Compared to the native born population, they are twice as likely to be uninsured, and twice as likely to be on Medicaid. That is costing us a bundle already.
In an attempt to partially alleviate the burden chain migration places on social services, the 1996 Welfare Reform Act made some requirements that the sponsors of immigrants be financially responsible for the immigrants. Indeed most welfare programs have some limitations on non-citizens. But under H.R. 3200, new immigrants who are supposed to be supported by a sponsor can get tax-funded healthcare. They can even sponsor more immigrants!
Former Hudson Institute economist Ed Rubenstein estimates that legal immigrants and their children will be responsible for 78 percent of all increased healthcare costs by 2050, totaling 1.2 trillion dollars. Why is the Administration and Congress ignoring this obvious source of healthcare savings as it struggles to justify healthcare reform?
Unlike illegal aliens, anchor babies and legal immigrants did not break any laws. We should not demonize them, but we should not ignore the huge fiscal burden they impose on our already stretched economy.
Fixing our broken healthcare system is not easy, but making some basic changes to our immigration policy is. Securing our borders, enforcing our laws, ending birthright citizenship and chain migration, and reducing our levels of legal immigration; would do much more to lower healthcare costs than any government program.
Before America embarks on healthcare reform, we should either fix these problems in our immigration system, or at least put adequate safeguards to prevent immigrants from receiving even more free benefits at the expense of the US taxpayer.
A total of 43 percent of non-citizens lack health insurance, compared to just 12.7 percent of native-born Americans. These uninsured immigrants impose huge strains on our healthcare system that helped create the crisis we currently face.
Plenty of analysts and commentators have exposed how illegal aliens will receive healthcare under ObamaCare. They point out that while the House version of the plan, H.R. 3200, claims to prohibit illegal aliens from receiving benefits, the Democrats repeatedly blocked amendments that would screen for the illegals. It is estimated that 6.6 million illegal aliens will be eligible for public healthcare if the bill passes. Those who support this healthcare bill are essentially supporting a bill that, together with all of our country’s other obligations, will bankrupt the federal government and debase our currency.
This is an outrage for hardworking Americans, but I’d like to focus on two other important but largely ignored aspects of our immigration crisis that will cost taxpayers billions of dollars if Obama’s healthcare boondoggle is passed.
The first is birthright citizenship. The 14th Amendment of the Constitution states, “All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside.”
The Amendment was passed for the sole purpose of granting freed slaves and their children citizenship. Senator Jacob Merritt Howard of Michigan who introduced the Amendment stated that it “will not, of course, include persons born in the United States who are foreigners, aliens, who belong to the families of ambassadors or foreign ministers accredited to the Government of the United States.”
But the obvious intent, as well as the “subject to jurisdiction thereof” clause, is ignored by federal policy that gives children of illegal aliens born in the United States automatic citizenship.
What does this have to do with the healthcare debate? Under H.R. 3200, only one family member needs to be eligible for government healthcare. After that, the whole family can get free healthcare. The Congressional Research Service acknowledged,
There could be instances where some family members would meet the definition of an eligible individual for purposes of the credit, while other family members would not… H.R. 3200 does not expressly address how such a situation would be treated. Therefore, it appears that the Health Choices Commissioner would be responsible for determining how the credits would be administered in the case of mixed-status families.
This means that if a family of illegal aliens has one child after they arrive, their “anchor baby,” a U.S. citizen, could make the entire family eligible for tax-funded healthcare. This would likely incite public opposition, but it’s easy to imagine where Obama’s handpicked “health czar” would come down on the issue. Just look at the interpretation of the 14th amendment that allows instant citizenship to the offspring of illegal aliens. Look at the gross failures of past and present Administrations to secure our borders and pursue vigorous and continuous internal enforcement using E-verify.
Another problem that makes the healthcare bill problematic is our policy of legal immigration. America annually accepts approximately one million legal immigrants in addition to the flood of illegal aliens. Most of these immigrants come through the process of chain migration, whereby legal immigrants and U.S. citizens sponsor family members. The process has spirals out of control until everyone’s cousin is eligible, regardless of professional skills or what they can contribute to this country. Chain immigrations and anchor babies do not bode well for our country’s future but there is little attention given to these matters and their adverse effects on the national interest.
All immigrants, both legal and illegal, as well as their US-born children comprises up to one third of all the uninsured in America. Compared to the native born population, they are twice as likely to be uninsured, and twice as likely to be on Medicaid. That is costing us a bundle already.
In an attempt to partially alleviate the burden chain migration places on social services, the 1996 Welfare Reform Act made some requirements that the sponsors of immigrants be financially responsible for the immigrants. Indeed most welfare programs have some limitations on non-citizens. But under H.R. 3200, new immigrants who are supposed to be supported by a sponsor can get tax-funded healthcare. They can even sponsor more immigrants!
Former Hudson Institute economist Ed Rubenstein estimates that legal immigrants and their children will be responsible for 78 percent of all increased healthcare costs by 2050, totaling 1.2 trillion dollars. Why is the Administration and Congress ignoring this obvious source of healthcare savings as it struggles to justify healthcare reform?
Unlike illegal aliens, anchor babies and legal immigrants did not break any laws. We should not demonize them, but we should not ignore the huge fiscal burden they impose on our already stretched economy.
Fixing our broken healthcare system is not easy, but making some basic changes to our immigration policy is. Securing our borders, enforcing our laws, ending birthright citizenship and chain migration, and reducing our levels of legal immigration; would do much more to lower healthcare costs than any government program.
Before America embarks on healthcare reform, we should either fix these problems in our immigration system, or at least put adequate safeguards to prevent immigrants from receiving even more free benefits at the expense of the US taxpayer.
Monday, September 14, 2009
Aide: Obama doesn't think tea partiers are racist
WASHINGTON (CNN) – A day after tens of thousands of conservatives gathered in Washington to protest the policies of the Obama administration, a top White House aide said that President Obama doesn’t think the protests and the growing conservative movement against Obama are motivated by racism.
“I don’t think the president believes that people are upset because of the color of his skin,” White House Press Secretary Robert Gibbs said Sunday on CNN’s State of the Union.
Pointing to the upcoming first anniversary of the collapse of investment banking giant Lehman Brothers, Gibbs said he thought the anger directed at the administration stems from the federal government’s unprecedented intervention in the private sector during the financial crisis that began last fall.
“We’ve had to do some extraordinary things, both this administration [and] the previous administration, to rescue the financial system, to ensure that our domestic auto industry didn’t go out of business, and to stimulate the economy,” Gibbs said.
“This rhetoric often gets way too hot,” Gibbs added, “I think what we have to all do is take a step back, take a deep breath and remember who we’re here to represent: millions of Americans that have health insurance but are watching their premiums double.”
“I don’t think the president believes that people are upset because of the color of his skin,” White House Press Secretary Robert Gibbs said Sunday on CNN’s State of the Union.
Pointing to the upcoming first anniversary of the collapse of investment banking giant Lehman Brothers, Gibbs said he thought the anger directed at the administration stems from the federal government’s unprecedented intervention in the private sector during the financial crisis that began last fall.
“We’ve had to do some extraordinary things, both this administration [and] the previous administration, to rescue the financial system, to ensure that our domestic auto industry didn’t go out of business, and to stimulate the economy,” Gibbs said.
“This rhetoric often gets way too hot,” Gibbs added, “I think what we have to all do is take a step back, take a deep breath and remember who we’re here to represent: millions of Americans that have health insurance but are watching their premiums double.”
Friday, September 11, 2009
More Obama Lies or Hyperbole?
Fact checking President Barack Obama’s health care speech from last night, the Associated Press reports: “The president’s speech to Congress contained a variety of oversimplifications and omissions in laying out what he wants to do about health insurance.” That is an understatement. We counted no less than 10 spurious claims made by the President, including:
1. OBAMA: “There are now more than thirty million American citizens who cannot get coverage.”
THE FACTS: On August 8th, President Obama said: “Reform is obviously essential for the 46 million Americans who don’t have health insurance.” So did 16 million uninsured people just disappear in the span of two months? Not quite. The problem is that the 46 million number was always highly misleading and the new 30 million number isn’t much better. According to an analysis based on the 2007 Census data there were 45.7 million uninsured people in the U.S. in 2007. But 9.3 million of those were non-citizens. Another 6.4 million actually are enrolled in Medicaid but mistakenly tell the Census they have no health insurance. Another 4.3 million are eligible for Medicaid or SCHIP but have not signed up. Another 10 million have no insurance, but also make more than 3X the poverty level. That means only 15.6 million U.S. citizens with incomes below 300% of poverty and that are nor already eligible for taxpayer-subsidized health insurance, are uninsured.
2. OBAMA: “First, if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.”
THE FACTS: First, the statement is just false. According to the America’s Health Insurance Plans (AHIP) 4.5 million Americans are covered by Health Savings Accounts. H.R. 3200 gives the Secretary of Health and Human Services the authority to make such plans illegal. In both the House Energy and Commerce Committee mark up and the House Ways and Means Committee mark up, Republicans offered amendments that would have guaranteed Americans’ right to keep their Health Saving’s account. All of these amendments were defeated by Democrats on their respective committees. These 4.5 million Americans will lose their insurance under Obamacare
Second, Americans should never forget that Obama is a lawyer. Here is how Obama used to issue the same promise: “Under the reform we’re proposing, if you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan.” See the difference? Obama used to promise that under his plan “you can keep your doctor.” But now Americans are only promised that nothing in the plan “requires you to change what you have.” This is a night and day difference. Obama is correct that nothing in H.R. 3200 requires people to change their insurance. But H.R. 3200 does allow all businesses to shift their employees into the public plan over time. Under a strong public plan 88.1 million people would be shifted from their employer-sponsored coverage to the federal plan.
3. OBAMA: “And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care … That makes sense, it saves money, and it saves lives.”
THE FACTS: Preventative care does not save money. So says the Congressional Budget Office and so says the New England Journal of Medicine.
4. OBAMA: “That’s why under my plan, individuals will be required to carry basic health insurance – just as most states require you to carry auto insurance.”
THE FACTS: No states require all adults, let alone all citizens, to carry auto insurance. Only those who choose to exercise their privilege to drive are required to purchase auto insurance. Even with that requirement, many still don’t. According to the Congressional Budget Office (CBO), a federal individual mandate for health insurance would be unique and unprecedented because it would “impose a duty on individuals as members of society” and would “require people to purchase a specific service that would be heavily regulated” by the government. According to President Barack Obama HHS nominee Dr. Sherry Glied: “Developing a system to promptly identify and penalize scofflaws will take effort and ingenuity, particularly in our diverse and mobile country. It may require a degree of intrusiveness and bureaucracy that some will find unpalatable.”
5. OBAMA: “There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false – the reforms I’m proposing would not apply to those who are here illegally.”
THE FACTS: H.R. 3200 does not explicitly pay for health benefits for illegal immigrants. It never has, and no one has ever said that it did. The issue is enforcement and the provisions in H.R. 3200 are completely inadequate to ensure that illegal immigrants do not illegally obtain health care through the bill. In the House Ways and Means mark up of H.R. 3200, Rep. Dean Heller (R-NV) introduced an amendment that would use two citizenship status verification systems, the Income and Eligibility Verification System (IEVS) and Systematic Alien Verification for Entitlements (SAVE) programs, to establish an individual’s eligibility to obtain the bill’s proposed affordability credits or enroll in the public insurance option. Both programs are currently used to determine citizenship status and eligibility for other public assistance programs. The Heller amendment failed on a straight party-line vote.
6. OBAMA: “And one more misunderstanding I want to clear up – under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place.”
THE FACTS: In all four mark-ups of health care legislation (three in the House and one in the Senate), Conservatives have offered amendments that would have specifically prohibited federal funds from being used to cover abortion. None of them passed. Instead, the House Energy and Commerce Committee passed an amendment by Rep. Lois Capps (D-CA) that actually requires at least one insurance plan to cover abortion in every geographical region and requires the newly-created public plan to cover all abortion services. Furthermore, President Obama told Planned Parenthood on July17, 2007: “We’re going to set up a public plan that all persons and all women can access if they don’t have health insurance. It will be a plan that will provide all essential services, including reproductive services.” Candidate Obama either was not telling the truth to Planned Parenthood then or President Obama is not telling the truth to the American people now.
7. OBAMA: “They argue that these private companies can’t fairly compete with the government. And they’d be right if taxpayers were subsidizing this public insurance option. But they won’t be. I have insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects.”
THE FACTS: Obama refutes his own argument in the same paragraph: “It would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities.” No public university is self-sufficient. None of them rely solely on student tuition. All of them require taxpayer subsidies every year.
8. OBAMA: “I will not sign a plan that adds one dime to our deficits – either now or in the future. Period. And to prove that I’m serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don’t materialize.”
THE FACTS: According to the Congressional Budget Office, not only does H.R. 3200 increase the deficit by $239 billion in just the first ten years, but CBO director Doug Elmendorf told Congress that the bills crafted by House leaders and the Senate health committee “significantly expands the federal responsibility for health care costs.” And according to the Peter G. Peterson Foundation, H.R. 3200 would run a $1,010 billion deficit in the second decade.
9. OBAMA: “Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan.”
THE FACTS: The Congressional Budget Office (CBO) estimates that Title VI of the House bill dealing with Medicare program integrity will save just $1.3 billion over ten years. That is roughly how much Medicare spends in a single day. CBO estimates ZERO savings from Subtitle F in the House bill that deals with Medicaid program integrity.
10. OBAMA: “This reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money – an idea which has the support of Democratic and Republican experts. And according to these same experts, this modest change could help hold down the cost of health care for all of us in the long-run.”
THE FACTS: These “fees” are nothing more than taxes hidden behind a thin veil of “fairness” rhetoric. They would actually fall on ordinary Americans, not insurance executives or stockholders. When you buy something that is subject to a sales tax who pays the tax – you or the vendor? Just look at the line “sales tax” on your bill. And if you tax insurance companies the cost is passed through in the same way.
1. OBAMA: “There are now more than thirty million American citizens who cannot get coverage.”
THE FACTS: On August 8th, President Obama said: “Reform is obviously essential for the 46 million Americans who don’t have health insurance.” So did 16 million uninsured people just disappear in the span of two months? Not quite. The problem is that the 46 million number was always highly misleading and the new 30 million number isn’t much better. According to an analysis based on the 2007 Census data there were 45.7 million uninsured people in the U.S. in 2007. But 9.3 million of those were non-citizens. Another 6.4 million actually are enrolled in Medicaid but mistakenly tell the Census they have no health insurance. Another 4.3 million are eligible for Medicaid or SCHIP but have not signed up. Another 10 million have no insurance, but also make more than 3X the poverty level. That means only 15.6 million U.S. citizens with incomes below 300% of poverty and that are nor already eligible for taxpayer-subsidized health insurance, are uninsured.
2. OBAMA: “First, if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.”
THE FACTS: First, the statement is just false. According to the America’s Health Insurance Plans (AHIP) 4.5 million Americans are covered by Health Savings Accounts. H.R. 3200 gives the Secretary of Health and Human Services the authority to make such plans illegal. In both the House Energy and Commerce Committee mark up and the House Ways and Means Committee mark up, Republicans offered amendments that would have guaranteed Americans’ right to keep their Health Saving’s account. All of these amendments were defeated by Democrats on their respective committees. These 4.5 million Americans will lose their insurance under Obamacare
Second, Americans should never forget that Obama is a lawyer. Here is how Obama used to issue the same promise: “Under the reform we’re proposing, if you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan.” See the difference? Obama used to promise that under his plan “you can keep your doctor.” But now Americans are only promised that nothing in the plan “requires you to change what you have.” This is a night and day difference. Obama is correct that nothing in H.R. 3200 requires people to change their insurance. But H.R. 3200 does allow all businesses to shift their employees into the public plan over time. Under a strong public plan 88.1 million people would be shifted from their employer-sponsored coverage to the federal plan.
3. OBAMA: “And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care … That makes sense, it saves money, and it saves lives.”
THE FACTS: Preventative care does not save money. So says the Congressional Budget Office and so says the New England Journal of Medicine.
4. OBAMA: “That’s why under my plan, individuals will be required to carry basic health insurance – just as most states require you to carry auto insurance.”
THE FACTS: No states require all adults, let alone all citizens, to carry auto insurance. Only those who choose to exercise their privilege to drive are required to purchase auto insurance. Even with that requirement, many still don’t. According to the Congressional Budget Office (CBO), a federal individual mandate for health insurance would be unique and unprecedented because it would “impose a duty on individuals as members of society” and would “require people to purchase a specific service that would be heavily regulated” by the government. According to President Barack Obama HHS nominee Dr. Sherry Glied: “Developing a system to promptly identify and penalize scofflaws will take effort and ingenuity, particularly in our diverse and mobile country. It may require a degree of intrusiveness and bureaucracy that some will find unpalatable.”
5. OBAMA: “There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false – the reforms I’m proposing would not apply to those who are here illegally.”
THE FACTS: H.R. 3200 does not explicitly pay for health benefits for illegal immigrants. It never has, and no one has ever said that it did. The issue is enforcement and the provisions in H.R. 3200 are completely inadequate to ensure that illegal immigrants do not illegally obtain health care through the bill. In the House Ways and Means mark up of H.R. 3200, Rep. Dean Heller (R-NV) introduced an amendment that would use two citizenship status verification systems, the Income and Eligibility Verification System (IEVS) and Systematic Alien Verification for Entitlements (SAVE) programs, to establish an individual’s eligibility to obtain the bill’s proposed affordability credits or enroll in the public insurance option. Both programs are currently used to determine citizenship status and eligibility for other public assistance programs. The Heller amendment failed on a straight party-line vote.
6. OBAMA: “And one more misunderstanding I want to clear up – under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place.”
THE FACTS: In all four mark-ups of health care legislation (three in the House and one in the Senate), Conservatives have offered amendments that would have specifically prohibited federal funds from being used to cover abortion. None of them passed. Instead, the House Energy and Commerce Committee passed an amendment by Rep. Lois Capps (D-CA) that actually requires at least one insurance plan to cover abortion in every geographical region and requires the newly-created public plan to cover all abortion services. Furthermore, President Obama told Planned Parenthood on July17, 2007: “We’re going to set up a public plan that all persons and all women can access if they don’t have health insurance. It will be a plan that will provide all essential services, including reproductive services.” Candidate Obama either was not telling the truth to Planned Parenthood then or President Obama is not telling the truth to the American people now.
7. OBAMA: “They argue that these private companies can’t fairly compete with the government. And they’d be right if taxpayers were subsidizing this public insurance option. But they won’t be. I have insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects.”
THE FACTS: Obama refutes his own argument in the same paragraph: “It would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities.” No public university is self-sufficient. None of them rely solely on student tuition. All of them require taxpayer subsidies every year.
8. OBAMA: “I will not sign a plan that adds one dime to our deficits – either now or in the future. Period. And to prove that I’m serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don’t materialize.”
THE FACTS: According to the Congressional Budget Office, not only does H.R. 3200 increase the deficit by $239 billion in just the first ten years, but CBO director Doug Elmendorf told Congress that the bills crafted by House leaders and the Senate health committee “significantly expands the federal responsibility for health care costs.” And according to the Peter G. Peterson Foundation, H.R. 3200 would run a $1,010 billion deficit in the second decade.
9. OBAMA: “Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan.”
THE FACTS: The Congressional Budget Office (CBO) estimates that Title VI of the House bill dealing with Medicare program integrity will save just $1.3 billion over ten years. That is roughly how much Medicare spends in a single day. CBO estimates ZERO savings from Subtitle F in the House bill that deals with Medicaid program integrity.
10. OBAMA: “This reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money – an idea which has the support of Democratic and Republican experts. And according to these same experts, this modest change could help hold down the cost of health care for all of us in the long-run.”
THE FACTS: These “fees” are nothing more than taxes hidden behind a thin veil of “fairness” rhetoric. They would actually fall on ordinary Americans, not insurance executives or stockholders. When you buy something that is subject to a sales tax who pays the tax – you or the vendor? Just look at the line “sales tax” on your bill. And if you tax insurance companies the cost is passed through in the same way.
Wednesday, September 9, 2009
Americans wanted Obama to change Washington. Obama wants to use Washington to change America.
GROVER NORQUIST: We Don't Need Another Post Office
Last fall Barack Obama campaigned promising change. Many Americans wanted change. They wanted to change Washington. But Obama meant something very different. He wanted to use Washington to change America. Having the government take over hospitals, doctors, health insurance and life and death decisions is not what most Americans thought they were voting for.
President Obama began his presidency with very high approval ratings. But as Americans watched him take over the banks with bailouts, and take over the car companies with bailouts and spend almost a trillion dollars for a “stimulus” spending package of expensive earmarks and sign a budget with another trillion in new spending—with some nine trillion dollars now to be added to the national debt—the idea of having government take over health care began to look less and less wise.
When Obama said “reform” he clearly meant “take over.” Reform the auto companies. Reform the banking system. Obama would use our tax dollars so he could buy and control whole industries.
When Americans began questioning what Obama and Harry Reid and Nancy Pelosi were doing they found themselves insulted by the politicians who didn’t like the rabble asking pesky questions. Barack Obama doesn’t like his inferiors asking questions like—will the Democrat Congressmen who vote for a “public option” on health care actually live with that public option—or is the public option just for little people?
President Obama was brutally honest when he said the government run “public option” would be like the Post Office. We have, Obama pointed out, a government run post office and privately run UPS and FedEx. Therefore you have choice. Sort of. The federal government taxes UPS and FedEx. The government-run post office does not pay federal or state corporate income taxes or local property taxes. FedEx and UPS do. And it is against the law for you to try and send a first class letter through anyone other than the post office. Well if the government option can tax its competitors and can pass laws to create a monopoly—how is this real choice?
Obama also has a problem because many Americans have friends or relatives with some experience with government run health care in Canada or Britain where the government rations care by making citizens wait to see a doctor, take a test or use a CAT scan or MRI. In Britain, one waits an average of 70 days for cataract surgery, 68 days for bypass surgery, 99 days for hernia repair (ouch), 113 days for tonsillectomy. Median wait times in Canada from general practitioner to seeing a specialist is 9.4 weeks for gynecology. It is on average another 7 weeks between seeing the specialist and getting treatment.
Would the U.S. government ration health care if they ran the health care system? Well, president Obama has already given us the answer. The post office, his model for a public health care system, is losing money (Interesting question how a monopoly loses money). What is the post office response to losing money? Becoming more efficient? No. They will ration post office care by closing on Saturdays. Years ago they rationed by ending twice daily delivery of the mail. Now when you get sick, the government may be closed on Saturdays. Rationing. No fun if you are sick.
Obama promised that health care reform would reduce your insurance costs. And give insurance coverage to 49 million folks with no insurance. Sounded good. Sounded painless. If you were happy with your insurance nothing would change. But now we learn that the government needs one, two or maybe three trillion dollars to give us this new lower-costing health care. If it costs less, what are all the trillions of higher taxes going towards? And now that we read the fine print, we find that there are four general tax hikes in the House of Representatives health care bill. Not just taxes on the rich but on those making less than $250,000 a year, a blatant violation of Obama’s central campaign promise not to raise “any form” of taxes on these families. And new regulations will prevent 30 million American families with flexible spending accounts and health savings accounts from purchasing over the counter medicines. And Medicare will be raided by taking away choices for seniors. You and I are going to pay through the nose for this experiment.
All this pain for what?
For the past eight years Democrats have been voting against and filibustering two important reforms that would help all Americans. First, allowing you to buy your health insurance from any of the 50 states. Right now you are stuck buying insurance from businesses in your state, often with expensive mandates pushed on you by the state legislators and lobbyists for special interests This reform alone, known as the Shadegg bill, would drop the cost of health care an average of 15%. Not bad. Democrats have spent years opposing this fix.
Second, we need to reform tort law—stop the trial lawyer billionaires from suing your doctor and hospital to push up the costs of your health care. Obama, Reid and Pelosi owe the trial lawyer billionaires a great deal. They cannot say no to them. So no reform there. Some suggest that such reforms would save billions in legal fees but also tens of billions in lower costs of so called “defensive” medicine forced by the trial lawyers.
And lastly, Republicans are putting forward legislation that would require all hospitals to post their actual prices for operations on the Internet so we can shop around—like we do with everything else in life. That would generate real price competition that does not exist in today’s highly regulated health care.
Health care is too expensive in America. That is because it is taxed, regulated and sued too much. We need less government in between us and our doctors. Fewer parasitical trial lawyers and more competition free from government created monopolies.
One government run post office is already too many.
Grover Norquist is president of Americans for Tax Reform and author of the book "Leave us Alone – Getting the Government’s Hands Off Our Money, Our Guns, Our Lives."
Last fall Barack Obama campaigned promising change. Many Americans wanted change. They wanted to change Washington. But Obama meant something very different. He wanted to use Washington to change America. Having the government take over hospitals, doctors, health insurance and life and death decisions is not what most Americans thought they were voting for.
President Obama began his presidency with very high approval ratings. But as Americans watched him take over the banks with bailouts, and take over the car companies with bailouts and spend almost a trillion dollars for a “stimulus” spending package of expensive earmarks and sign a budget with another trillion in new spending—with some nine trillion dollars now to be added to the national debt—the idea of having government take over health care began to look less and less wise.
When Obama said “reform” he clearly meant “take over.” Reform the auto companies. Reform the banking system. Obama would use our tax dollars so he could buy and control whole industries.
When Americans began questioning what Obama and Harry Reid and Nancy Pelosi were doing they found themselves insulted by the politicians who didn’t like the rabble asking pesky questions. Barack Obama doesn’t like his inferiors asking questions like—will the Democrat Congressmen who vote for a “public option” on health care actually live with that public option—or is the public option just for little people?
President Obama was brutally honest when he said the government run “public option” would be like the Post Office. We have, Obama pointed out, a government run post office and privately run UPS and FedEx. Therefore you have choice. Sort of. The federal government taxes UPS and FedEx. The government-run post office does not pay federal or state corporate income taxes or local property taxes. FedEx and UPS do. And it is against the law for you to try and send a first class letter through anyone other than the post office. Well if the government option can tax its competitors and can pass laws to create a monopoly—how is this real choice?
Obama also has a problem because many Americans have friends or relatives with some experience with government run health care in Canada or Britain where the government rations care by making citizens wait to see a doctor, take a test or use a CAT scan or MRI. In Britain, one waits an average of 70 days for cataract surgery, 68 days for bypass surgery, 99 days for hernia repair (ouch), 113 days for tonsillectomy. Median wait times in Canada from general practitioner to seeing a specialist is 9.4 weeks for gynecology. It is on average another 7 weeks between seeing the specialist and getting treatment.
Would the U.S. government ration health care if they ran the health care system? Well, president Obama has already given us the answer. The post office, his model for a public health care system, is losing money (Interesting question how a monopoly loses money). What is the post office response to losing money? Becoming more efficient? No. They will ration post office care by closing on Saturdays. Years ago they rationed by ending twice daily delivery of the mail. Now when you get sick, the government may be closed on Saturdays. Rationing. No fun if you are sick.
Obama promised that health care reform would reduce your insurance costs. And give insurance coverage to 49 million folks with no insurance. Sounded good. Sounded painless. If you were happy with your insurance nothing would change. But now we learn that the government needs one, two or maybe three trillion dollars to give us this new lower-costing health care. If it costs less, what are all the trillions of higher taxes going towards? And now that we read the fine print, we find that there are four general tax hikes in the House of Representatives health care bill. Not just taxes on the rich but on those making less than $250,000 a year, a blatant violation of Obama’s central campaign promise not to raise “any form” of taxes on these families. And new regulations will prevent 30 million American families with flexible spending accounts and health savings accounts from purchasing over the counter medicines. And Medicare will be raided by taking away choices for seniors. You and I are going to pay through the nose for this experiment.
All this pain for what?
For the past eight years Democrats have been voting against and filibustering two important reforms that would help all Americans. First, allowing you to buy your health insurance from any of the 50 states. Right now you are stuck buying insurance from businesses in your state, often with expensive mandates pushed on you by the state legislators and lobbyists for special interests This reform alone, known as the Shadegg bill, would drop the cost of health care an average of 15%. Not bad. Democrats have spent years opposing this fix.
Second, we need to reform tort law—stop the trial lawyer billionaires from suing your doctor and hospital to push up the costs of your health care. Obama, Reid and Pelosi owe the trial lawyer billionaires a great deal. They cannot say no to them. So no reform there. Some suggest that such reforms would save billions in legal fees but also tens of billions in lower costs of so called “defensive” medicine forced by the trial lawyers.
And lastly, Republicans are putting forward legislation that would require all hospitals to post their actual prices for operations on the Internet so we can shop around—like we do with everything else in life. That would generate real price competition that does not exist in today’s highly regulated health care.
Health care is too expensive in America. That is because it is taxed, regulated and sued too much. We need less government in between us and our doctors. Fewer parasitical trial lawyers and more competition free from government created monopolies.
One government run post office is already too many.
Grover Norquist is president of Americans for Tax Reform and author of the book "Leave us Alone – Getting the Government’s Hands Off Our Money, Our Guns, Our Lives."
Wednesday, September 2, 2009
Healthcare as a Human Right?
Healthcare as a human right? Yes, but only in a sense. Each person has a ‘right’ to be treated by a doctor. But only if they can pay for the treatment, or have another person is willing to pay on their behalf or if they qualify for Medicaid.
Human rights begin and end with you. Your rights allow you to do something without interference, or to prevent people doing something to you. But your human rights do not extend to other people being forced to make positive acts for your benefit.
While you have a ‘right’ to healthcare, this does not extend to demanding the taxpayer to pay your bills. A man has a ‘right’ to privately own property. But that doesn’t mean he can demand other people to pay his rates. Africans can claim a ‘right’ to clean water, but this does not mean they can demand the water of other people. You have the right to defend yourself from harm. But not to demand other people to defend you. Otherwise your human rights would negatively effect other people, and the whole rights system would fall apart.
Where universal healthcare is provided to all, it is because a government has the money, resources and the incentive to do so. But when a government is already overextended, it should not indulge in more underfunded programs. And when the government provides you a tangiable benefit at the taxpayer’s own expense, then that benefit is a privilege. Not a right.
Human rights begin and end with you. Your rights allow you to do something without interference, or to prevent people doing something to you. But your human rights do not extend to other people being forced to make positive acts for your benefit.
While you have a ‘right’ to healthcare, this does not extend to demanding the taxpayer to pay your bills. A man has a ‘right’ to privately own property. But that doesn’t mean he can demand other people to pay his rates. Africans can claim a ‘right’ to clean water, but this does not mean they can demand the water of other people. You have the right to defend yourself from harm. But not to demand other people to defend you. Otherwise your human rights would negatively effect other people, and the whole rights system would fall apart.
Where universal healthcare is provided to all, it is because a government has the money, resources and the incentive to do so. But when a government is already overextended, it should not indulge in more underfunded programs. And when the government provides you a tangiable benefit at the taxpayer’s own expense, then that benefit is a privilege. Not a right.
Tuesday, September 1, 2009
Study Raises Questions About Cost Savings From Preventive Care
By Lori Montgomery
Washington Post Staff Writer
Tuesday, September 1, 2009
Preventive services for the chronically ill may reduce health-care costs, but they are unlikely to generate the kind of fantastic savings that President Obama and other Democrats have said could help pay for an overhaul of the nation's health system, according to a study being published Tuesday.
Using data from long-standing clinical trials, researchers projected the cost of caring for people with Type 2 diabetes as they progress from diagnosis to various complications and death. Enrolling federally-insured patients in a simple but aggressive program to control the disease would cost the government $1,024 per person per year -- money that largely would be recovered after 25 years through lower spending on dialysis, kidney transplants, amputations and other forms of treatment, the study found.
However, except for the youngest diabetics, the additional services would add to overall health spending, not decrease it, the study shows.
"There's no free lunch here. Prevention will not pay for everything. But it's not as expensive as it looks at first blush," said Michael J. O'Grady, a senior fellow at the National Opinion Research Center at the University of Chicago, and one of four authors whose work is being published on the Web site of Health Affairs, a leading journal of health policy research.
The study comes a week before lawmakers are due back in Washington to continue the debate over Obama's signature domestic initiative, a debate that has come to focus heavily on cost. With budget deficits soaring in the wake of a global recession, Republican critics -- and a growing number of moderate Democrats -- say the nation cannot afford a vast expansion of the health-care system unless it includes measures to reduce federal spending on care over the long term.
In response, Obama, House Speaker Nancy Pelosi (D-Calif.) and House Majority Leader Steny H. Hoyer (D-Md.), among others, have promised that health-care reform will save money, in part by increasing the availability of preventive care. In addition, Pelosi and Sen. Tom Harkin (D-Iowa) have chastised the Congressional Budget Office, the nonpartisan arbiter of the cost of legislation, for failing to include such savings in the estimates of pending reform bills.
The new research offers them added ammunition, arguing that the 10-year horizon typically used by CBO analysts is too brief to capture the savings that eventually result from improved public health. The authors -- who include two University of Chicago medical professors as well as O'Grady and James C. Capretta, who both served for years in various health policy positions in Washington -- suggest that the CBO instead use a 25-year "budget window" to calculate the cost of prevention programs.
"I'm trying to show them that there are other ways to do this, as we face these new challenges from the epidemic of chronic illness," he said. "They're used to thinking like economists. And their friends at Health and Human Services are used to thinking like actuaries. But there's this third way, which is epidemiological, which shows us how a disease progresses over time."
Legislation introduced by House Del. Donna M. Christensen (D-U.S. Virgin Islands) would explicitly permit key lawmakers to ask the CBO to use a longer horizon when estimating the cost of preventive care, a development that concerns some independent budget analysts, who count on the agency for objective analyses. The CBO's official estimates do not take into account savings accrued beyond the 10-year window, in part to prevent lawmakers from counting on savings that may never materialize.
"One of the reasons I worry about rescoring prevention and wellness and pressure on CBO to do it is because [reform advocates] are looking for magic bullets," said Robert Bixby, executive director of the nonprofit Concord Coalition, which urges deficit reduction. "I don't see how they can pay for what they want to do."
But CBO Director Douglas W. Elmendorf said the agency already has the authority to look at costs over a longer term, though not in the context of official estimates. He called the new study, which has been reviewed by CBO staff, "exactly the sort of research that we use in building our cost estimates. And we will consider these findings in future estimates we do in this area."
In its own analysis of preventive care, CBO said earlier this month that the cost of making cancer screening, cholesterol management and other services broadly available is likely to far outweigh any savings ultimately generated. The new study looks at a more narrow population -- people already diagnosed with diabetes -- and projects the cost of providing them with a very specific regimen of frequent checkups and diagnostic tests that has produced predictable results in clinical trials. (Treatment for other forms of disease may vary in their costs.)
For diabetes patients, only about two-thirds of that cost would be recovered in the first decade, when fewer complications materialize, and more than three-quarters would be recovered over 25 years, the study found. Only for the youngest patients, those aged 24 to 30, would spending on preventive care wind up producing a net savings: the study calculates that $21 billion spent on younger patients would cut overall spending on their health care by $6 billion over 25 years.
The study was funded in part by the National Changing Diabetes Program, which is primarily funded by Novo Nordisk, a maker of diabetes medicines.
Washington Post Staff Writer
Tuesday, September 1, 2009
Preventive services for the chronically ill may reduce health-care costs, but they are unlikely to generate the kind of fantastic savings that President Obama and other Democrats have said could help pay for an overhaul of the nation's health system, according to a study being published Tuesday.
Using data from long-standing clinical trials, researchers projected the cost of caring for people with Type 2 diabetes as they progress from diagnosis to various complications and death. Enrolling federally-insured patients in a simple but aggressive program to control the disease would cost the government $1,024 per person per year -- money that largely would be recovered after 25 years through lower spending on dialysis, kidney transplants, amputations and other forms of treatment, the study found.
However, except for the youngest diabetics, the additional services would add to overall health spending, not decrease it, the study shows.
"There's no free lunch here. Prevention will not pay for everything. But it's not as expensive as it looks at first blush," said Michael J. O'Grady, a senior fellow at the National Opinion Research Center at the University of Chicago, and one of four authors whose work is being published on the Web site of Health Affairs, a leading journal of health policy research.
The study comes a week before lawmakers are due back in Washington to continue the debate over Obama's signature domestic initiative, a debate that has come to focus heavily on cost. With budget deficits soaring in the wake of a global recession, Republican critics -- and a growing number of moderate Democrats -- say the nation cannot afford a vast expansion of the health-care system unless it includes measures to reduce federal spending on care over the long term.
In response, Obama, House Speaker Nancy Pelosi (D-Calif.) and House Majority Leader Steny H. Hoyer (D-Md.), among others, have promised that health-care reform will save money, in part by increasing the availability of preventive care. In addition, Pelosi and Sen. Tom Harkin (D-Iowa) have chastised the Congressional Budget Office, the nonpartisan arbiter of the cost of legislation, for failing to include such savings in the estimates of pending reform bills.
The new research offers them added ammunition, arguing that the 10-year horizon typically used by CBO analysts is too brief to capture the savings that eventually result from improved public health. The authors -- who include two University of Chicago medical professors as well as O'Grady and James C. Capretta, who both served for years in various health policy positions in Washington -- suggest that the CBO instead use a 25-year "budget window" to calculate the cost of prevention programs.
"I'm trying to show them that there are other ways to do this, as we face these new challenges from the epidemic of chronic illness," he said. "They're used to thinking like economists. And their friends at Health and Human Services are used to thinking like actuaries. But there's this third way, which is epidemiological, which shows us how a disease progresses over time."
Legislation introduced by House Del. Donna M. Christensen (D-U.S. Virgin Islands) would explicitly permit key lawmakers to ask the CBO to use a longer horizon when estimating the cost of preventive care, a development that concerns some independent budget analysts, who count on the agency for objective analyses. The CBO's official estimates do not take into account savings accrued beyond the 10-year window, in part to prevent lawmakers from counting on savings that may never materialize.
"One of the reasons I worry about rescoring prevention and wellness and pressure on CBO to do it is because [reform advocates] are looking for magic bullets," said Robert Bixby, executive director of the nonprofit Concord Coalition, which urges deficit reduction. "I don't see how they can pay for what they want to do."
But CBO Director Douglas W. Elmendorf said the agency already has the authority to look at costs over a longer term, though not in the context of official estimates. He called the new study, which has been reviewed by CBO staff, "exactly the sort of research that we use in building our cost estimates. And we will consider these findings in future estimates we do in this area."
In its own analysis of preventive care, CBO said earlier this month that the cost of making cancer screening, cholesterol management and other services broadly available is likely to far outweigh any savings ultimately generated. The new study looks at a more narrow population -- people already diagnosed with diabetes -- and projects the cost of providing them with a very specific regimen of frequent checkups and diagnostic tests that has produced predictable results in clinical trials. (Treatment for other forms of disease may vary in their costs.)
For diabetes patients, only about two-thirds of that cost would be recovered in the first decade, when fewer complications materialize, and more than three-quarters would be recovered over 25 years, the study found. Only for the youngest patients, those aged 24 to 30, would spending on preventive care wind up producing a net savings: the study calculates that $21 billion spent on younger patients would cut overall spending on their health care by $6 billion over 25 years.
The study was funded in part by the National Changing Diabetes Program, which is primarily funded by Novo Nordisk, a maker of diabetes medicines.
Montana Court to Rule on Assisted Suicide Case
HELENA, Mont. — Robert Baxter was by all accounts a tough man. Even in the end, last year, as lymphocytic leukemia was killing him, Mr. Baxter, a 76-year-old retired truck driver from Billings, Mont., fought on. But by then he was struggling not for life, but for the right to die with help from his doctor.
Anthony Johnstone, the Montana state solicitor, and Jennifer Anders will defend homicide statutes that prohibit physician-assisted death in a case brought on behalf of Robert Baxter.
“He yearned for death,” his daughter, Roberta King, said in a court affidavit describing her father’s final agonized months.
Now, in death, Mr. Baxter is at the center of a right-to-die debate that could make Montana the first state in the country to declare that medical aid in dying is a protected right under a state constitution.
The state’s highest court on Wednesday will take up Mr. Baxter’s claim that a doctor’s refusal to help him die violated his rights under Montana’s Constitution — and lawyers on both sides say the chances are good that he will prevail.
Washington and Oregon allow physicians to help terminally ill people hasten their deaths, but in those states the laws were approved by voters in statewide referendums, and neither state’s highest court has examined the issue of a constitutional right to die.
In Montana, the question will be decided by the seven-member State Supreme Court. A lower-court judge ruled in Mr. Baxter’s favor last December — on the very day Mr. Baxter died — and the State of Montana appealed the ruling.
The legal foundation for both sides is a free-spirited, libertarian-tinctured State Constitution written in 1972 at the height of a privacy-rights movement that swept through this part of the West in the aftermath of the 1960s. Echoes of a righteous era are reflected in language about keeping government at bay and maintaining individual autonomy and dignity.
“The dignity of the human being is inviolable,” the drafters declared.
Lawyers on both sides say the Montana Supreme Court has a tradition of interpreting the State Constitution with that sentiment in mind, with privacy rights and personal liberty often outweighing other concerns.
Anthony Johnstone, the Montana state solicitor, and Jennifer Anders will defend homicide statutes that prohibit physician-assisted death in a case brought on behalf of Robert Baxter.
“He yearned for death,” his daughter, Roberta King, said in a court affidavit describing her father’s final agonized months.
Now, in death, Mr. Baxter is at the center of a right-to-die debate that could make Montana the first state in the country to declare that medical aid in dying is a protected right under a state constitution.
The state’s highest court on Wednesday will take up Mr. Baxter’s claim that a doctor’s refusal to help him die violated his rights under Montana’s Constitution — and lawyers on both sides say the chances are good that he will prevail.
Washington and Oregon allow physicians to help terminally ill people hasten their deaths, but in those states the laws were approved by voters in statewide referendums, and neither state’s highest court has examined the issue of a constitutional right to die.
In Montana, the question will be decided by the seven-member State Supreme Court. A lower-court judge ruled in Mr. Baxter’s favor last December — on the very day Mr. Baxter died — and the State of Montana appealed the ruling.
The legal foundation for both sides is a free-spirited, libertarian-tinctured State Constitution written in 1972 at the height of a privacy-rights movement that swept through this part of the West in the aftermath of the 1960s. Echoes of a righteous era are reflected in language about keeping government at bay and maintaining individual autonomy and dignity.
“The dignity of the human being is inviolable,” the drafters declared.
Lawyers on both sides say the Montana Supreme Court has a tradition of interpreting the State Constitution with that sentiment in mind, with privacy rights and personal liberty often outweighing other concerns.
Massachusetts Cuts Back Immigrants’ Health Care
BOSTON — State-subsidized health insurance for 31,000 legal immigrants here will no longer cover dental, hospice or skilled-nursing care under a scaled-back plan that Gov. Deval Patrick announced Monday. Gov. Deval Patrick said 31,000 legal immigrants would no longer be covered for dental, hospice or skilled-nursing care.
Mr. Patrick said his administration had struggled to find a solution “that preserves the promise of health care reform” after the state legislature cut most of the $130 million it had previously allotted immigrants, to help close a budget deficit. Although their health benefits will be sharply curtailed in some cases, Mr. Patrick portrayed the new program as a victory, saying the services that the affected group tends to use the most will still be covered.
“It’s an extraordinary accomplishment,” he said in a conference call with reporters, “to offer virtually full coverage for the entire population that’s been impacted in the face of really extraordinary budget constraints.”
The new plan, which will cover permanent residents who have had green cards for less than five years, will cost the state $40 million a year. Some of the affected immigrants will be charged higher co-payments and will have to find new doctors, said Leslie A. Kirwan, Mr. Patrick’s finance director.
Still, Mr. Patrick described the new coverage as comprehensive and said it could be a model for less expensive state-subsidized benefits as health care costs continue to rise. Under the 1996 federal law that overhauled the nation’s welfare system, the 31,000 affected immigrants do not qualify for Medicaid or other federal aid. Massachusetts is one of the few states — others are California, New York and Pennsylvania — that provide at least some health coverage for such immigrants.
Because of its three-year-old law requiring universal health coverage, Massachusetts has the country’s lowest percentage of uninsured residents: 2.6 percent, compared with a national average of 15 percent. The law requires that almost every resident have insurance, and to meet that goal, the state subsidizes coverage for those earning up to three times the federal poverty level, or $66,150 for a family of four.
All of the affected immigrants will be covered under the new plan by Dec. 1, Mr. Patrick said; in the meantime they will have to rely on hospitals that provide free emergency care to the poor.
CeltiCare Health Plan of Massachusetts, a subsidiary of the Centene Corporation, based in Missouri, won a yearlong state contract to provide the new coverage.
Eva Millona, executive director of the Massachusetts Immigrant and Refugee Advocacy Coalition, said she was worried about immigrants’ having to find new primary care doctors at a time when the state is suffering from a shortage of such providers. She also said that the new coverage would in some cases require a much higher co-payment — $50 instead of between $1 and $3 — for non-generic prescription drugs, and that enrollment would be capped at the 31,000 current enrollees.
“We see this as a temporary solution,” Ms. Millona said, “and we are still working to get full restoration for this population that deserves the same level of coverage as all other taxpaying residents of the state.”
Mr. Patrick said his administration had struggled to find a solution “that preserves the promise of health care reform” after the state legislature cut most of the $130 million it had previously allotted immigrants, to help close a budget deficit. Although their health benefits will be sharply curtailed in some cases, Mr. Patrick portrayed the new program as a victory, saying the services that the affected group tends to use the most will still be covered.
“It’s an extraordinary accomplishment,” he said in a conference call with reporters, “to offer virtually full coverage for the entire population that’s been impacted in the face of really extraordinary budget constraints.”
The new plan, which will cover permanent residents who have had green cards for less than five years, will cost the state $40 million a year. Some of the affected immigrants will be charged higher co-payments and will have to find new doctors, said Leslie A. Kirwan, Mr. Patrick’s finance director.
Still, Mr. Patrick described the new coverage as comprehensive and said it could be a model for less expensive state-subsidized benefits as health care costs continue to rise. Under the 1996 federal law that overhauled the nation’s welfare system, the 31,000 affected immigrants do not qualify for Medicaid or other federal aid. Massachusetts is one of the few states — others are California, New York and Pennsylvania — that provide at least some health coverage for such immigrants.
Because of its three-year-old law requiring universal health coverage, Massachusetts has the country’s lowest percentage of uninsured residents: 2.6 percent, compared with a national average of 15 percent. The law requires that almost every resident have insurance, and to meet that goal, the state subsidizes coverage for those earning up to three times the federal poverty level, or $66,150 for a family of four.
All of the affected immigrants will be covered under the new plan by Dec. 1, Mr. Patrick said; in the meantime they will have to rely on hospitals that provide free emergency care to the poor.
CeltiCare Health Plan of Massachusetts, a subsidiary of the Centene Corporation, based in Missouri, won a yearlong state contract to provide the new coverage.
Eva Millona, executive director of the Massachusetts Immigrant and Refugee Advocacy Coalition, said she was worried about immigrants’ having to find new primary care doctors at a time when the state is suffering from a shortage of such providers. She also said that the new coverage would in some cases require a much higher co-payment — $50 instead of between $1 and $3 — for non-generic prescription drugs, and that enrollment would be capped at the 31,000 current enrollees.
“We see this as a temporary solution,” Ms. Millona said, “and we are still working to get full restoration for this population that deserves the same level of coverage as all other taxpaying residents of the state.”
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